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Impact of urbanization on detection rates of eating disorders.

OBJECTIVE: The purpose of this study was to examine the incidence of anorexia nervosa and bulimia nervosa among patients in primary care and to evaluate the impact of urbanization, age and sex differences, and changes over time. METHOD: During 1985-1989, 58 general practitioners, trained in diagnosing eating disorders, registered all of their patients who had diagnoses of anorexia nervosa and/or bulimia nervosa according to strict criteria. The study population (N = 151,781) was 1% of the population of the Netherlands; the distribution of sexes, ages, geographical locations, and degrees of urbanization in the study group was representative of the Dutch population. Main outcome measures were rates of newly detected cases and age-adjusted rate ratios. RESULTS: The crude annual incidence rate of detected cases in primary care per 100,000 person-years was 8.1 for anorexia nervosa and 11.5 for bulimia nervosa. The incidence of bulimia nervosa was lowest in rural areas, intermediate in urbanized areas, and highest in large cities (6.6, 19.9, and 37.9, respectively, per 100,000 females per year); no rural-urban differences for anorexia nervosa were found. Pronounced sex and age differences in incidence rates were observed. Over the 5-year period, there was no time trend in the incidence of anorexia nervosa, but the incidence of bulimia nervosa tended to increase. CONCLUSIONS: The incidence rates of eating disorders--as defined by detection rates in primary care--are higher than previously reported. Urbanization seems to be a risk factor for bulimia nervosa but not for anorexia nervosa.

Adolescent↗

Early cancer detection among rural and urban Californians.

BACKGROUND: Since the stage of cancer detection generally predicts future mortality rates, a key cancer control strategy is to increase the proportion of cancers found in the early stage. This study compared stage of detection for members of rural and urban communities to determine whether disparities were present. METHODS: The California Cancer Registry (CCR), a total population based cancer registry, was used to examine the proportion of early stage presentation for patients with breast, melanoma, and colon cancer from 1988 to 2003. Cancer stage at time of detection for these cancers was compared for rural and urban areas. RESULTS: In patients with breast cancer, there were significantly more patients presenting at early stage in 2003 compared to 1988, but no difference in the percentage of patients presenting with early stage disease between rural and urban dwellers. There were no differences in incidence in early stage cancer incidence between these groups for melanoma patients, as well. In colorectal cancer in 1988, significantly more patients presented with early stage disease in the urban areas (42% vs 34%, p < 0.02). However, over time the rural patients were diagnosed with early stage disease with the same frequency in 2003 as 1988. CONCLUSION: This analysis demonstrates that people in rural and urban areas have their breast, melanoma or colorectal cancers diagnosed at similar stages. Health care administrators may take this information into account in future strategic planning.

Breast Neoplasms↗

Rapid urban malaria appraisal (RUMA) in sub-Saharan Africa.

BACKGROUND: The rapid urban malaria appraisal (RUMA) methodology aims to provide a cost-effective tool to conduct rapid assessments of the malaria situation in urban sub-Saharan Africa and to improve the understanding of urban malaria epidemiology. METHODS: This work was done in Yopougon municipality (Abidjan), Cotonou, Dar es Salaam and Ouagadougou. The study design consists of six components: 1) a literature review, 2) the collection of available health statistics, 3) a risk mapping, 4) school parasitaemia surveys, 5) health facility-based surveys and 6) a brief description of the health care system. These formed the basis of a multi-country evaluation of RUMA's feasibility, consistency and usefulness. RESULTS: A substantial amount of literature (including unpublished theses and statistics) was found at each site, providing a good overview of the malaria situation. School and health facility-based surveys provided an overview of local endemicity and the overall malaria burden in different city areas. This helped to identify important problems for in-depth assessment, especially the extent to which malaria is over-diagnosed in health facilities. Mapping health facilities and breeding sites allowed the visualization of the complex interplay between population characteristics, health services and malaria risk. However, the latter task was very time-consuming and required special expertise. RUMA is inexpensive, costing around 8,500-13,000 USD for a six to ten-week period. CONCLUSION: RUMA was successfully implemented in four urban areas with different endemicity and proved to be a cost-effective first approach to study the features of urban malaria and provide an evidence basis for planning control measures.

Adolescent↗

Child health implications of worldwide urbanization.

The upsurge of urbanization, often poorly planned and uncontrolled, has caused major impacts on human societies for at least two centuries. Urban environments and urbanized lifestyles have strong influences on health and well-being, including on infant and childhood populations in developed and underdeveloped countries, as well as among societies in developmental and environmental transition around the world. Urbanization will inevitably have significant impacts on the health of future generations. Notably, the health consequences of urbanized lifestyles are not confined to residents of cities and large towns but rather are becoming manifest in rapidly changing, previously traditional societies in rural and remote areas because globalization is altering infant feeding practices and the dietary habits and lifestyle patterns of their children. In underdeveloped countries, overcrowding and environmental pollution are huge problems that are exacerbated by undernutrition and infection, particularly respiratory and diarrheal diseases. In developed societies, other problems like injuries; poisonings; violence; drug abuse; exposure to chemical, biological, industrial, and atmospheric pollutants, including pesticides; sexually transmissible diseases; and 'lifestyle' diseases, including obesity and cardiovascular disease risk, are of great current and potential importance.

Breast Feeding↗

Urban sprawl and risk for being overweight or obese.

OBJECTIVES: I examined the association between urban sprawl and the risk for being overweight or obese among US adults. METHODS: A measure of urban sprawl in metropolitan areas was derived from the 2000 US Census; individual-level data were obtained from the Behavioral Risk Factor Surveillance System. I used multilevel analysis to assess the association between urban sprawl and obesity. RESULTS: After I controlled for gender, age, race/ethnicity, income, and education, for each 1-point rise in the urban sprawl index (0-100 scale), the risk for being overweight increased by 0.2% and the risk for being obese increased by 0.5%. CONCLUSIONS: The current obesity epidemic has many causes, but there is an association between urban sprawl and obesity.

Adult↗

Two regional (rural-urban) life tables for India.

"This paper proposes to construct, for India, a two-regional life table, considering two regions viz., rural and urban. Such a table provides information on the probabilities of survivorship and migration, as well as life expectancy by age, region and place of birth and in particular information on: (1) The probability that an individual living in a rural area at age x will be living in an urban area at age y. (2) Life expectancy at birth in a rural area, and the number of years on average this individual may live in an urban area. The aim here is to compare and contrast rural to urban and urban to rural migration probabilities by sex and age for the years 1971, 1981 and 1991, and provide the underlying reasons. Region-specific life expectancy is also compared for these years." (SUMMARY IN ITA AND FRE)

Age Factors↗

[Role of the public health (and environmental) office in urban development--current status and perspectives].

Our central question is how the local public health services can influence urban development and urban renewal policies. The need for a three-way cooperation between departments of urban planning and development, environmental affairs and health is now being widely acknowledged. In practice, however, it has to face manifold and serious problems. We suggest that there are basically three essential "instruments" which could lead to a new and defined role of health departments in urban development: environmental and health audits, local health profiles and "health promotion committees" or similar bodies for closer cooperation at the local level. These three "instruments" are described in terms of the present state of development and dissemination by analysing empirical studies from public health research. The results indicate that the "new role" of local health services in urban planning and development is presently fulfilled only in a few pilot cases. The lack of basic requirements particularly in terms of resources, motivation and qualifications is the main cause for the inability to implement the three "instruments" on a broader level in local health services.

City Planning↗

Variations in avoidable mortality in relation to health care resources and urbanization level.

"Avoidable" mortality may be defined as causes of death whose occurrence is closely related to medical intervention. Areas with particular health care delivery problems can be identified through a geographical comparison of these "avoidable deaths." Mortality data for Valencia from 1982 to 1990 were examined to determine whether or not the availability of medical care resources in the area influenced the occurrence of avoidable deaths. We identified variations in mortality from avoidable causes, grouped according to the differences in levels of urbanization and health care resources, in the 537 municipalities of the Valencian community. (In Spain, the municipality is the lowest administrative division.) Linear regression analysis was performed to predict or estimate this relationship. Only in a small number of avoidable causes did the mortality trend for males differ significantly from 0 (p < 0.005) in relation to different levels of urbanization and health care resources. A direct association between these two variables was observed in males with regards to pneumonia, tuberculosis, chronic rheumatic heart disease, and bacterial infection. In females, a relationship between "avoidable" mortality rates and the differences in urbanization and health care resources was found in cervical cancer, pneumonia, abdominal hernias, and cholecystitis. Mortality from asthma and cardiovascular disease (in both males and females) declined faster in urbanized, high income areas than in rural areas. The results clearly demonstrate the considerable mortality risk associated with living in urban areas. On the contrary, we found very little correlation between health service access and mortality.

Adolescent↗

Rural and urban population changes and the stages of economic development: a unified approach.

The long-term aspects of the process of economic development and urbanization are examined. A model is presented that shows the dynamics of economic development from the earliest to the more advanced stages. "The model is able to explain not only the occurrence of a downturn in the rural population after the initial phase of population growth both in rural and urban areas, but also the delayed occurrence of such a downturn in many present-day developing countries. The author then focuses [on] the later stages of economic development and explains two alternative courses of urbanization, namely, the reversal process and the continual-growth process, as special cases of the general model; which of the courses occurs depends on the value of the elasticity of urban agglomeration-economies."

Demography↗

The effect of agricultural price-support policies on interregional and rural-to-urban migration in Korea: 1976-1980.

The impact of rice price-support policies, designed to increase farmers' income and reduce rural-urban migration in the Republic of Korea, is examined for the period 1976-1980 using a polytomous logistic model. "Our findings revealed that the elasticity of migration with respect to rice yield per origin farm household is positive and is significantly different from zero. The elasticities of migration with respect to rate of urbanization, particularly urban concentration-agglomeration, and population size of the destination are also positive and are significantly different from zero.... Our findings questioned the wisdom of employing rice price price-support programs as a viable policy for reducing interregional and rural-to-urban migration in Korea."

Agriculture↗

The dynamics or urban demographic change in Malaysia: an analysis of the 1991 population census.

"This paper examines how and to what extent the three demographic components of urban change, urban reclassification, natural increase and net migration, operated in Malaysia between 1980 and 1991.... Since there is a spatial dimension to urban demographic changes, another emphasis of the paper is to differentiate the areal patterns of such changes. The analysis is conducted at both the national level and sub-national levels." Data are from the Malaysian Department of Statistics. The author finds that "the important role of natural increase in urban population change is remarkable considering that a rapid fertility transition had been unfolding in Malaysia up to the mid-1970s."

Asia↗

Todaro migration and primacy models: relevance to the urbanization of the Philippines.

"This paper looks into the set of factors that [influence] the urbanization of the Philippines, a fast-growing developing economy in South East Asia. The paper demonstrates that the ¿migration primacy urbanization model' is an appropriate one that is able to explain the urbanization case in the Philippines. The model draws supporting evidence from rank-size distribution analysis of major cities in the Philippines, a detailed examination of historical, geopolitical and economic forces which have evolved in the development of the Philippines as a sovereign state, and the applicability of the Todaro model on rural-urban migration to the Philippines."

Asia↗

Vector-borne disease problems in rapid urbanization: new approaches to vector control.

Owing to population growth, poor levels of hygiene, and increasing urban poverty, the urban environment in many developing countries is rapidly deteriorating. Densely packed housing in shanty towns or slums and inadequate drinking-water supplies, garbage collection services, and surface-water drainage systems combine to create favourable habitats for the proliferation of vectors and reservoirs of communicable diseases. As a consequence, vector-borne diseases such as malaria, lymphatic filariasis and dengue are becoming major public health problems associated with rapid urbanization in many tropical countries. The problems in controlling these diseases and eliminating vectors and pests can be resolved by decision-makers and urban planners by moving away from the concept of "blanket" applications of pesticides towards integrated approaches. Sound environmental management practices and community education and participation form the mainstay of some of the most outstanding successes in this area. On the basis of these examples, it is argued that the municipal authorities need to apply a flexible methodology, which must be based on the possibilities of mobilizing community resources, with minimal reliance on routine pesticidal spraying. In this way, vector control becomes a by-product of human development in the city environment. This is now a true challenge.

Animals↗

Somatic comparisons of South Korean children and youths born and reared in a rural area with the descendants of rural to urban migrants.

During April-May 2000 somatic data were collected on 236 males and 191 females ages 6, 9, 13, and 15 years residing in rural areas around the communities of Ankye, Euisung, and Kunwi in Kyungsang Puk Do province, South Korea, and 237 males and 219 female of the same ages born and reared at Taegu in families of "rural to urban migrants." Comparisons were made between urban and rural groups for measures of body size and form, skinfold thickness, the body mass index (BMI), and estimated arm muscle area (ARM). Age at menarche was obtained from school records for the 13- and 15-year-olds. The data were analyzed in separate 2 (urban-rural) x 4 (age) analyses of variance with an alpha level of P < 0.01. Age differences were significant for all dimensions. There was a significant main effect for urban-rural differences in arm girth, upper limb index, and ARM. Rural males were larger in these variables. Among females, only arm girth was significantly different. Age at menarche was significantly earlier in the urban sample (12.6 years) than in the rural sample (13.0 years). Compared with both recent and earlier data for South Korea, present-day 6-, 9-, 13-, and 15-year-old males and females are taller and heavier at every age, indicating secular gains.

Adolescent↗

Growth of rural and urban children in the valley of Oaxaca, Mexico.

Weight, stature, arm circumference, and the triceps skinfold were measured in 1,410 school children, 6 through 14 years of age, from two urban colonias in the city of Oaxaca de Juarez (n = 479), and from two rural Ladino (n = 467) and two rural Zapotec (n = 464) communities in the Valley of Oaxaca in southern Mexico. Children from rural Ladino communities and urban colonias are significantly taller, heavier, and more muscular than children in rural Zapotec communities. The differences between rural Ladino and urban colonia children favor the former, particularly for weight and stature. These observations thus suggest 1) that children in the rural, indigenous communities in the Valley of Oaxaca are relatively undernourished compared to children in Ladinoized and urban communities, and 2) that rural-to-urban migration does not necessarily result in improved growth status.

Adolescent↗

Growth of rural and urban children in the valley of Oaxaca, Mexico.

Weight, stature, arm circumference, and the triceps skinfold were measured in 1,410 school children, 6 through 14 years of age, from two urban colonies in the city of Oaxaca de Juarez (n = 479), and from two rural Ladino (n = 467) and two rural Zapotec (n = 464) communities in the Valley of Oaxaca in southern Mexico. Children from rural Ladino communities and urban colonies are significantly taller, heavier, and more muscular than children in rural Zapotec communities. The differences between rural Ladino and urban colonia children favor the former, particularly for weight and stature. These observations thus suggest 1) that children in the rural, indigenous communities in the Valley of Oaxaca are relatively undernourished compared to children in Ladinoized and urban communities, and 2) that rural-to-urban migration does not necessarily result in improved growth status.

Adolescent↗

A comparison of waste-reduction practices and new environmental paradigm of rural and urban Chinese citizens.

This paper compares the public attitudes of three southern Chinese cities/towns, namely Guangzhou, Dongguan, and Yuanzhou on waste recycling and avoidance, and the New Environmental Paradigm (NEP). The latter describes the concept of treating the resources and the ecosystems on Earth as things having their own rights rather than being subordinate and subservient to humans. These three places are chosen to represent areas in different stages of urbanization in the Guangdong province. As Hong Kong is also a southern Chinese city, where data of similar nature are available, comparison with Hong Kong is also made. It was found that the support for source separation of household waste in the rural and urban areas in mainland China was greater than that found in Hong Kong. Concerning actual practices on waste separation, about 85% of the respondents in the cities and almost all of the rural household surveyed have the habit of saving up and selling the recyclables. It is estimated that about 11-13% of the household waste was diverted in such a way. This is higher than the estimated 8% household waste recovery rate of Hong Kong. The majority of the respondents in the three surveyed cities have recovered household recyclables in the past but with higher family incomes, it was now less common. On the contrary, the lower income group tended to recover greater portion of their waste for selling to the waste depots. These findings have implications on the future waste management policy formulation in China. Regarding the acceptance of the New Environmental Paradigm, it was found that the rural population scored better than the urban population and they tended to agree more frequently with the NEP. However, the rural population perceives a greater potential for industrial and urban development without dampening environmental quality. It was also found that the NEP scores of the mainland Chinese are higher, in general, than their Hong Kong counterparts as measured in early 1990s. Insufficient public support has often been a concern for source separation programmes in all countries despite the obvious waste management benefits of recycling. This study shows that there is overwhelming support for source separation of waste in Mainland China, whether it is in rural or urban communities, and that most people are already undertaking source separation due to the redemption value of the recyclables. Therefore, for policy-makers, the concern should not be on whether the public knows how to separate the waste but rather on how to motivate them to separate waste for the good of society, and how to maintain an effective market for recyclables.

Adolescent↗

Diabetes mellitus in urban and rural communities in Papua New Guinea. Studies of prevalence and plasma insulin.

Oral glucose tolerance tests (75 g) in 185 urban residents of Port Moresby and 105 ethnically similar rural villagers showed that 15.8% of urban residents had diabetes mellitus (two hour plasma glucose > 11.0 mmol/l and a total of 22% were glucose intolerant (plasma glucose > 9.0 mmol/l), compared with 1.0% and 5.5% in rural people. - Urban men and women were significantly fatter than rural people, but within each population glucose tolerance was not significantly related to weight or to age, although the numbers of old people studied were small. Compared to Australians the Papua New Guinea subjects had a higher fasting plasma insulin (16.5 vs 10.7 microU/ml, p = < 0.05); independent of weight fasting plasma insulin was significantly higher in the rural than urban people studied. After the glucose load, plasma insulin and glucose levels were positively correlated in rural people. In contrast, for the urban group the relation best fitted a quadratic function, with decline in plasma insulin at high levels of glucose. - The prevalence of diabetes in urbanised Melanesians in Papua New Guinea appears similar to other South Pacific countries.

Adolescent↗