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PubMed2004

Urban-rural shifts in intentional firearm death: different causes, same results.

OBJECTIVES: We analyzed urban-rural differences in intentional firearm death. METHODS: We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban-rural variable. RESULTS: The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide. CONCLUSIONS: Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.

Homicide↗
PubMed2004

Differences in health-related quality of life in rural and urban veterans.

OBJECTIVES: We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts. METHODS: We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence. RESULTS: Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural-urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors. CONCLUSIONS: When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.

Chi-Square Distribution↗
PubMed2006

Impacts of urbanization on West Nose Creek: a Canadian experience.

The lower reaches of West Nose Creek have been subject to urbanization since the 1970s, leading to channel widening and excessive erosion. This paper discusses what would likely happen if urbanization were allowed to continue in the same manner. Comparisons are presented of the channel width and depth for both the upstream rural and downstream urbanizing reaches. Estimates of the evolution of the creek were generated by linking the dominant discharge to the entire shape and volume of the hydrograph that the creek is subjected to rather than solely considering peak discharges. otential remedial measures and stormwater management philosophies are discussed in relationship to instream flow needs (IFNs) initiatives. IFNs are generally developed by relating the amount of suitable aquatic habitat to the quantity of flow. The emphasis has so far been on IFNs for large river systems. Unfortunately, none of the IFN approaches cover streams that are subject to significant urbanization. In urbanized streams the issue is not as much the impacts due to withdrawals but due to significantly increased runoff rates and volumes generated within the urban areas. Examples are provided how fisheries habitat is impacted by the changed hydrologic regime and changed stream morphology.

Alberta↗
PubMed2003

Geographical variation in nutrient intake between urban and rural areas of Jiangsu province, China and development of a semi-quantitative food frequency questionnaire for middle-aged inhabitants.

The intake of food and nutrients differs between urban and rural areas in China. To develop a practical semi-quantitative food frequency questionnaire to cover both the urban and rural areas, we conducted diet surveys and compared food and nutrient intake between the two areas. We recruited 198 urban and 214 rural healthy inhabitants aged 35-55 years, and performed diet surveys, using a 3-day weighed dietary record approach. The intake of 29 nutrients was calculated according to actual consumption of foods, with Standard Food Composition Tables for China and Japan. Then, contribution analysis and multiple regression analysis were employed to select food items covering up to a 90% contribution and a 0.90 R2 of coefficient of determination, respectively. Consumption of energy and carbohydrates was greater in the rural area, but mean protein intake was higher in the urban case. Values for total fat were greater for rural than for urban males, with animal fat as the major contributor. We finally selected 117 and 76 food items for the urban and rural semi-quantitative food frequency questionnaires, respectively, covering 18 and 27 nutrients constituting up to 90% of the nutrient intake. Further validity and reproducibility tests are now needed to assess their appropriateness for usage.

Adult↗
PubMed1988

A comparison of the resource intensity of inpatients in urban and rural nonteaching hospitals.

PL 98-21 mandated a prospective payment system based on diagnosis related groups (DRGs) for all Medicare inpatients. The predetermined payment for each DRG is intended to reflect the resources used to treat patients within the DRG. Eventually, the system will allow for one payment level for each DRG in rural hospitals and a higher payment level for the same DRG in urban hospitals. This represents an equitable approach, provided there is not a predominance of high severity cases in rural hospitals and that higher costs in urban hospitals are reflective of higher priced exogenous factors beyond the control of the hospital. Equitability also requires that DRGs capture the resource intensity of treatment for a given classification of patients, equally for urban and rural patients. This work compares the pediatric population of urban hospitals without a pediatric residency program with that of rural hospitals in terms of major diagnostic category, DRG, disease severity, length of stay, and charges. It also compares the capacity of DRGs to explain the variation in resource consumption in urban and rural hospitals. A sample of 116,721 discharges from 130 urban hospitals and a sample of 54,073 discharges from 97 rural hospitals are used in this work. The results indicate that there is no difference in the patient populations of these two hospital groups. The results also indicate that DRGs explain only 50 percent of the variance in the resource variables, but this obtains equally for both populations.

Child↗
PubMed1981

The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa.

Rural-urban comparisons of diabetes prevalence were made in te Polynesian population of Western Samoa. The prevalence of diabetes in the urban population was almost three times that in the rural (10.1% versus 3.6%). While the urban male and female subjects were significantly more obese than their rural counterparts, the difference in prevalence rate could not be wholly explained on the basis. Diabetes prevalence was still approximately double in urban subjects when we compared the rural and urban populations after removing the differences in obesity and age. The results suggest that, apart from age and obesity, other factors, e.g., differences in diet, physical activity, or stress (or a combination of these), may participate in the rural to urban difference in diabetes prevalence.

Adult↗
PubMedDate not supplied

A comparison of the use of smokeless tobacco in rural and urban teenagers.

This paper compared the use of smokeless tobacco and its effects in rural and urban teenagers. A random sample of 445 subjects from rural Colorado were examined: 82.9 percent of the total sample were Caucasian, and 94.6 percent of those who used smokeless tobacco were Caucasian. This percentage supports the findings of an earlier urban study that the habit is predominantly one of male Caucasians. The average age of the users was 16.7 years, slightly older than in the urban study. Of the rural users, 62.5 percent had lesions of the oral tissues, compared with 48.7 percent lesional incidence in urban users. In both studies, those subjects with lesions had longer daily contact with smokeless tobacco, as well as a longer history of use than those without lesions. These are numerical averages that reflect great individual variations in susceptibility. The average duration of use for rural and urban users with lesions was almost the same; the development of lesions appears to be related to the length of daily exposure, which, on the average, was greater among rural users than urban users. Additionally, more than twice as many degree 3 lesions were found among users in the rural study. The habituating effects of nicotine and the influence of this substance on the future tobacco-usage patterns of youngsters who presently use smokeless tobacco are areas of concern. It is hoped that additional research will further delineate the scope of this current health problem.

Adolescent↗
PubMed1998

Health status of urban and rural elders in Korea.

The main purpose of this study was to describe the differences in health status between urban and rural elders in Korea. The sample consisted of one thousand one hundred non-institutionalized individuals, aged 65 or over, living in three metropolitan cities and two rural provinces. The modified Cornell Medical Index, ADL, IADL, and existing medical diagnosis were used to measure the health status of the elders. Rural elders reported significantly more health problems than urban elders. Differences in ADL and IADL scores were not statistically significant. There was a difference in the types of health problems between the urban and rural elders. While more rural elders reported that they were diagnosed as having neuralgia and arthritis, more urban elders reported that they had diabetes. The results of this study demonstrated that rural elders had significantly more health problems than urban elders even after all the other variables were controlled. However, in Korea, most health care resources available to elders are concentrated in large urban cities. This study suggests that it is important to invest more health care resources in rural areas to meet the needs of all elders in Korea.

Aged↗
PubMed2004

Contribution of household environment factors to urban childhood mortality in Mozambique.

OBJECTIVES: Household environment factors are known to be associated with child mortality in urban and rural areas of many developing countries. In Mozambique, no study to date has addressed this relationship. This study is aimed to access the contribution of household environment factors to urban childhood mortality in Mozambique. DESIGN: Retrospective follow-up study. SETTING: Urban Mozambique. SUBJECTS: One thousand and forty eight children born in urban areas of Monzambique within five years of the 1997 Demographic and Health Survey. METHODS: Cox regression analysis was performed on a sample of 1048 children born in urban areas of Mozambique within five years of the 1997 Demographic and Health Survey. RESULTS: Children of mother's who lived in households with no toilet facility or with well as a source of drinking water had a high risk of dying compared to children who lived in households with flush toilet and piped water. CONCLUSION: Type of toilet facility and source of drinking water play an important role in the risk of childhood mortality in urban areas of Mozambique and the relationship seems to be mediated partly by demographic and socioeconomic factors.

Adolescent↗
PubMed2004

Exposure to feline and canine pathogens in bobcats and gray foxes in urban and rural zones of a national park in California.

Exposure of bobcats (Lynx rufus) and gray foxes (Urocyon cinereoargenteus) to a range of common canine and feline pathogens was assessed in urban and rural zones of Golden Gate National Recreation Area, a National Park in the San Francisco Bay Area, (California, USA) from 1992 to 1995. Testing included serology for canine distemper virus, canine parvovirus (CPV), canine adenovirus, Leptospira interrogans, feline calicivirus (FCV), feline panleukopenia virus, feline herpesvirus, feline enteric coronavirus (FECV), feline immunodeficiency virus, feline leukemia virus, Toxoplasma gondii, and Bartonella henselae. Testing was also performed for Dirofilaria immitis. Significantly more gray foxes were seropositive for CPV in the urban zone than in the rural zone. In addition, radio-tracking of gray foxes in the rural zone indicated that all three of the rural CPV-seropositive foxes had traveled into adjoining small towns, whereas only one of the 11 seronegative animals had done so. Significantly more bobcats were seropositive for FCV in the rural zone than in the urban zone. Individual bobcats with positive FCV antibody titers had patterns of movement that intercepted park inholdings where domestic cats lived. Bobcat samples were seronegative for all five of the other viral feline pathogens, with the exception of a FECV-seropositive bobcat. High seroprevalence was detected for B. henselae and T. gondii in both zones. Variation in the seroprevalence for different pathogens might be related to differences in the exposure of bobcats and foxes to domestic animals: in the urban zone, gray foxes were located in residential areas outside the park, whereas bobcats were not. Although for most of the pathogens examined there was no relationship between urbanization and exposure, our results for CPV in foxes and FCV in bobcats indicated that proximity to urban areas or contact with humans can increase the risk of disease exposure for wild carnivore populations. Combining behavioral information from radio-tracking with data on pathogen exposure or disease incidence can provide valuable insights into the ecology of wildlife disease that might be missed with broad-scale, population-level comparisons alone.

Animal Identification Systems↗
PubMed1994

The impact of rural-urban migration on child survival.

Large rural-urban child mortality differentials in many developing countries suggest that rural families can improve their children's survival chances by leaving the countryside and settling in towns and cities. This study uses data from Demographic and Health Surveys in 17 countries to assess the impact of maternal rural-urban migration on the survival chances of children under age two in the late 1970s and 1980s. Results show that, before migration, children of migrant women had similar or slightly higher mortality risks than children of women who remained in the village. In the two-year period surrounding their mother's migration, their chances of dying increased sharply as a result of accompanying their mothers or being left behind, to levels well above those of rural and urban non-migrant children. Children born after migrants had settled in the urban area, however, gradually experienced much better survival chances than children of rural non-migrants, as well as lower mortality risks than migrants' children born in rural areas before migration. The study concludes that many disadvantaged urban children would probably have been much worse off had their mothers remained in the village, and that millions of children's lives may have been saved in the 1980s as a result of mothers moving to urban areas.

Adolescent↗
PubMed2000

Use of walk-in clinics by rural and urban patients.

OBJECTIVE: To compare use of walk-in clinics by rural and urban family practice patients and to describe patients' perceptions of the quality of care in physicians' offices. DESIGN: Questionnaire completed by patients in family physicians' offices. SETTING: Nine community-based family practices located in rural and urban areas of Alberta. PARTICIPANTS: Patients who had visited their family physicians' offices during April, May, June, or July 1997. Response rate was 89.6% (403 of 450 questionnaires were completed). MAIN OUTCOME MEASURES: Use of walk-in clinics, patients' perceptions of the quality of care in physicians' offices. RESULTS: Overall, 27.5% of patients (22.2% of rural, 35.5% of urban patients) attended walk-in clinics in the 6 months before visiting their family physicians' offices: 43.3% went during weekdays when their family physicians' offices were open. Significantly more rural (91.1%) than urban (60.7%) patients felt they could contact their doctors during evenings and weekends (P.004). Significantly more urban (67.2%) than rural (33.3%) patients did not call their own physicians before going to walk-in clinics (P.002). Patients who attended walk-in clinics were more likely (P.01) than patients who did not to rate their family physicians' office hours poor to good (27.9% vs 15.6%). CONCLUSIONS: Many patients attending the offices of community-based family physicians in both urban and rural areas of Alberta also attend walk-in clinics. Family practice patients attend walk-in clinics primarily because their own physicians' offices are less convenient.

Adolescent↗
PubMed1999

Rural-urban differences in food and nutrient intake of Pakistani children.

BACKGROUND: Global increase in urbanisation accompanied by increase in complexity of nutritional problems is a cause of concern for most nations. OBJECTIVE: The aim of this study was to assess the differences in frequency of food consumption and nutrient intake of urban and rural Pakistani children. SETTING: Forty rural, 59 middle income urban and 81 affluent urban children belonging to the province of Punjab. Children were recruited through schools in Lahore and Rayonpura, Kala-Shah-Kaku (Sheikhupura district). METHOD: Three-day estimated diet records were kept by a total of 180, 10-12 year old school-children. The nutrient intake was calculated by the nutritional analysis package COMP-EAT and analysed on SPSS. The results of the three groups were compared. RESULTS: Consumption of chapati, eggs, yoghurt and some of the traditional vegetarian snacks was very similar in all the three groups. Consumption of lentils, cooked vegetables, paratha (fried Asian bread) and tea decreased and that of milk, meat curry, chicken curry, chocolates, cakes, ice-cream, fruit and raw vegetables increased with urbanization. As compared with the rural children, the urban children had a higher mean daily intake of calories, sugar, protein, total fats, cholesterol, calcium, sodium, potassium, niacin, vitamin B12, folic acid, antioxidant vitamins A, C and E and lower intake of total carbohydrates, fibre and starch. CONCLUSION: It is concluded that although the macro-nutrient consumption pattern of rural children appears to be heart healthy lower consumption of protective micro-nutrients by them may put them at risk. In view of rapid urbanisation and its multidimensional impacts on the health of the populations living in the urban areas of the developing world, these dietary trends provide baseline information for health professionals.

Child↗
PubMedDate not supplied

Disparities in premature coronary heart disease mortality by region and urbanicity among black and white adults ages 35-64, 1985-1995.

OBJECTIVES: Regional and urban-rural disparities in premature coronary heart disease (CHD) mortality were evident in the US as early as 1950. Recent favorable trends at the national level may obscure less favorable outcomes for certain regions and localities. The authors examined trends in premature CHD mortality for 1985-1995 for black and white adults ages 35-64 years for four categories of urbanicity in two regions of the US (South and non-South). METHODS: All counties in the US (excluding Alaskan counties) were grouped by urbanicity and region. Annual age-adjusted CHD mortality rates were calculated for adults ages 35-64 by racial category (African American or white) and gender for each geographic area for the years 1985- 1995. Loglinear regression models were used to estimate average annual percent declines in mortality for each of 28 geo-demographic groups. Data were also collected on selected socioeconomic resources by urbanicity for the non-South (excluding Alaska) and South. RESULTS: For both white and black adults ages 35-64, the highest rates of premature CHD mortality and slowest mortality declines were observed in the rural South. For white men and women, marked disparities in premature CHD mortality across categories of urbanicity were noted in the South but not outside the South. Unexpectedly high rates of premature CHD mortality were observed for African Americans in major metropolitan areas outside the South despite favorable levels of socioeconomic resources. CONCLUSIONS: Disparities in premature CHD mortality by region and urbanicity appear to have widened between 1985 and 1995. Residents of the rural South had the highest rates of premature CHD mortality, and rural communities in the South face significant barriers to effective heart disease prevention and control.

Adult↗
PubMed2000

[Nutrition, urbanization and poverty in subsaharan Africa].

Africa is currently the continent with the highest urbanization rate in the world. This demographic upheaval has sometimes been considered as an opportunity for modernization but as early as the 1980s experts called attention to its potential impact on nutrition. In recent decades, economic problems and structural reforms have had dire effects on urban populations. Today increasing poverty and the effects of globalization have revived concerns about urban nutrition. Retarded growth and emaciation are less common than in urban areas than in rural areas, but disparities between the rich and poor are much greater. However, in some cities, the incidence of emaciation progressed the more during the 1990s, and now equals that in rural areas. In cities the level of obesity in adult women is a sign of nutritional transition but emaciation has also increased. Despite the wide variety of urban conditions, analysis of the underlying factors reveals several constants. For most of these factors, the characteristic feature of the urban environment is a further increase of social inequality.

Adult↗
PubMed2001

Sero-epidemiology of hepatitis E virus (HEV) in urban and rural children of North India.

OBJECTIVE: To estimate the prevalence of anti-HEV IgG and IgM antibodies to ORF3 peptide of Hepatitis E virus genome in an age stratified urban and rural population of children. DESIGN: Cross sectional survey. SETTING: Pediatric out-patient clinics in a tertiary hospital and a rural dispensary. METHODS: Study subjects between 6 months and 10 years with minor, non-hepatic illnesses were recruited for the study from March to December 1996. Baseline demographic details, drinking water source, sewage disposal methods, reasons for attending the hospital, histories of parenteral exposure in the past 12 months and acute hepatitis in the subjects and the family in the previous six months were obtained. Serum anti-HEV IgG antibodies were screened in all subjects, and in those who were positive, anti-HEV IgM antibodies were assayed as an indicator of recent infection. Serum aminotransferase (ALT) was estimated in those who were anti-HEV IgM antibody positive. RESULT: Out of 2160 subjects recruited, 2070 samples could be screened for anti-HEV IgG antibodies. In the urban population (n = 1065) anti-HEV IgG antibodies were detected in 306 subjects (28.7%; 95% CI 26.0-31.6) and of these 131 (42.8%; 95%CI 37.2-48.6) were anti-HEV IgM antibody positive. Amongst 1005 rural children, anti-HEV IgG antibodies were present in 239 (23.8%; 95% CI 21.1-26.4) and IgM antibodies in 113 (47.3%; 95% CI 40.9-53.7) children. The antibodies were present since the first year of age till 10 years of age and, increased with advancing age. Serum transaminases were raised in 7.5% (9/120) and 5.5% (5/88) of subjects with anti-HEV IgM antibodies in urban and rural centers respectively. Overall the seroprevalence of IgG antibodies against HEV were significantly more in urban as compared to that in rural subjects (p = 0.011). However, proportion of children with anti-HEV IgG carrying IgM antibodies was similar in the two study groups (p = 0.298). A model for estimating expected prevalence of anti-HEV IgG antibodies was developed. The observed antibody prevalence in both urban and rural subjects at each age interval after 48 months was less as compared to the expected levels and this gap increased with advancing age categories. It appeared that there was a decay of HEV antibodies with time. CONCLUSIONS: Children are susceptible to HEV infection since early infancy. The probability of exposure to HEV during childhood was higher in urban than rural population. Seropositivity to HEV antibodies increased by over 2 times beyond 4 years of age as compared to younger age. Anti-HEV IgG antibodies appear to wean off with increasing age.

Antibodies, Viral↗
PubMed2001

Parameter optimisation of real-time control strategies for urban wastewater systems.

Real-time control (RTC) of wastewater systems has been a topic of research and application for over two decades. Attempts so far have mainly focused on one of the parts of the urban wastewater system: either the sewer system, or the treatment plant or the river. Approaches to integrate these subsystems and considering them jointly for control purposes have been pursued only recently. Control of the systems aims at pursuing one (or several concomitant) objectives, which are expressed, for example, in terms of overflow volumes, loads, effluent concentrations, receiving water quality or monetary costs, to name just a few. This paper provides a general and formal definition of the problem to define a real time control algorithm for a given urban wastewater system. A general mathematical optimization problem is formulated, which describes the task of finding an (in some sense) optimum control algorithm. Since this optimization problem is, in the general case, highly non-linear with only limited information available about the objective function itself, optimization methods appropriate for this type of problem are identified. Here, the similarity of the problem to find a control algorithm and of the parameter estimation problem common in mathematical modelling becomes apparent. Hence, methods (and problems encountered) in parameter estimation can be transferred to the problem of determining optimum RTC algorithms. This parallelism is outlined in the paper. As an application of the parameterisation and optimization of control strategies, integrated control of an urban wastewater system is discussed. Since the analysis of integrated control as just described poses certain requirements on a simulation engine, a novel modelling tool, called SYNOPSIS, is utilized here. This simulation tool, comprising of modules simulating water quantity and quality processes in all parts of the urban wastewater system, is embedded into a suite of optimization procedures. An integrated RTC algorithm for the urban wastewater system is formulated, the parameters of which are optimized using various global optimization routines. Comparison of their efficiency indicates good performance for the Controlled Random Search and for the genetic algorithms. The findings suggest that integrated control can indeed lead to an increase in performance of the urban wastewater system. These results appear to be encouraging and justify further work. Areas for further development are identified in the final section of the paper.

Algorithms↗
PubMed2000

A rural-urban comparison of patterns of physician assistant practice.

Access to primary care continues to be a concern in rural areas. The deficit of primary care providers in rural environments has the potential to increase the role of physician assistants (PAs) in the system of rural health care delivery. Little is known about the conditions, sites, and patterns of practice of PAs and their distribution in Pennsylvania, the state with the largest rural population. To learn more about these providers in rural and urban settings and their willingness to practice in underserved areas, the author conducted a census of all PAs who hold a Pennsylvania license. Survey results revealed significant rural-urban differences in socioeconomic, demographic, and practice profile parameters. Providers in rural areas are more likely than urban counterparts to practice primary care in a primary care practice setting; see more patients per week; and are the principal provider of care for a higher percentage of their patients. Experience with managed care is greater for urban PAs. A rural PA is more likely than an urban PA to practice in an underserved area. For both rural and urban PAs who practice primary care, significant differences were noted in their willingness to practice in a rural underserved area, compared to PAs who do not practice primary care.

Data Collection↗