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PubMed1983

Comparison of mental health services in rural and urban Washington.

Rural mental health has been an area of increased study in recent years because of unique problems in service of rural areas and underrepresentation of professionals in rural areas. This study collected information from mental health centers in the state of Washington via the state management information system. Rural/urban differences were examined. Results showed that (1) rural therapist were more likely to be generalists than urban therapists, (2) psychologists performed more of the direct service work in rural centers than they did in urban centers, (3) rural centers spent less time in direct activities, and more time in support activities, but did not differ from urban centers in indirect activities, and (4) rural and urban centers did not spend different percentages of time in specific direct, indirect, and support activities with the exception of day treatment where urban centers put more of their time than rural centers.

Community Mental Health Services↗
PubMed1992

Plasma lipids and fatty acids in urbanized Bushmen, Hereros and Kavangos of southern Africa (Namibia).

Thirty-nine urbanized ethnic Namibian people comprising 21 Bushmen (semi-urbanized), 7 Hereros and 11 Kavangos were assessed for plasma lipids and fatty acid (FA) composition. Total cholesterol and triacylglycerol concentrations were measured by enzymatic methods, and neutral lipid FA composition by gas-liquid chromatography. The results demonstrated that while total cholesterol concentrations were not significantly different, significant differences in triacylglycerol concentrations (P < 0.05) were seen between Bushmen and Kavangos. By comparing Bushmen with Hereros and Kavangos, significant differences between Bushmen and Kavangos were also observed in plasma triacylglycerol FA compositions, particularly 16:0 (32.73% vs. 25.05%), 16:1n-7 (7.00% vs. 5.06%), 18:2n-6 (9.30% vs. 22.25%) and 20:3n-6 (0.12% vs. 0.48%), while Kavangos had higher 20:4n-6 levels than Hereros (1.44% vs. 2.00%). In plasma cholesteryl esters, Bushmen were significantly different from Kavangos in 16:1n-7 (8.85% vs. 4.93%), 18:1n-9 (32.06% vs. 23.07%) and 20:4n-6 (6.91% vs. 10.00%). Significant differences were also observed between Bushmen and Hereros in 18:0 (1.08% vs. 1.29%) and 18:2n-6 (35.68% vs. 45.50%). The FA of Namibian groups were also compared with South African reference groups comprising urbanized whites and Xhosas and rural Vendas. The differences in blood lipid values can be explained primarily by excessive alcohol consumption. These results suggest that semi-urbanized Bushmen have changed their diets under urbanized conditions which may increase their risk of coronary heart disease.

Alcohol Drinking↗
PubMed2006

A rural-urban comparison of the characteristics of the metabolic syndrome by gender in Korea: the Korean Health and Genome Study (KHGS).

The number of cases of the metabolic syndrome is increasing dramatically in Western countries. However, the evaluation of the metabolic syndrome is limited in Asian countries. Thus, our objectives were: 1) to investigate parameters of the metabolic syndrome defined by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII) in the subjects representing Korean general population and 2) the modification of which factor is most effective in reducing the metabolic syndrome. A total of 10,044 (5024 rural and 5020 urban) Korean men and women in the age range 40-69 yr voluntarily participated in this community-based cross-sectional study (a rural and an urban community was selected). Anthropometric parameters (weight, height, waist and hip circumference and blood pressure), social factors (smoking, alcohol, exercise and education status) as well as biochemical parameters (fasting glucose and insulin, lipids and body composition) were measured. Twenty-six point one per cent of the total subjects were classified as having the metabolic syndrome. Age- and sex-adjusted prevalences were 29.3 and 22.3% in the rural and urban community, respectively (p< 0.01). Abdominal obesity (46.9%) and high blood pressure (45.2%) were major components in the rural community; hypertriglyceridemia (37.6%) and low HDL-cholesterolemia (37.0%) in the urban community. In conclusion, abdominal obesity in the rural community and dyslipidemia in the urban community should be a main subject of intervention, aimed at reducing the prevalence of the metabolic syndrome in Korea. Given the rapid progression of the Korean economy over the past 30 yr, the prevalence of the metabolic syndrome is expected to increase continuously. A strategy to prevent this expected extraordinary event should be conducted at a national level.

Adult↗
PubMed2006

Evidence that the urban environment specifically impacts on the psychotic but not the affective dimension of bipolar disorder.

OBJECTIVES: High rates of psychotic disorders and psychotic symptoms have been found in urban environments but reports for bipolar affective illness have been inconsistent, possibly due to failure to stratify for comorbid psychotic symptoms. It was hypothesised, therefore, that any effect of urbanicity on the bipolar phenotype would be moderated by comorbid psychotic symptoms. METHODS: In a random, representative population cohort of 7049 adults with no history of non-affective psychotic disorder, the cumulative incidence of bipolar and psychotic symptoms and syndromes, assessed with the CIDI, was examined over five levels of population density of place of residence. Similarly, the degree of comorbidity between broadly and narrowly defined bipolar phenotypes on the one hand, and the dichotomous presence of broadly (17.2%) and narrowly defined (3.8%) psychotic symptoms on the other, was examined as a function of population density of place of residence. RESULTS: The rate of bipolar disorder, however defined, was progressively higher in more urbanised areas. However, in models of bipolar phenotypes, a strong interaction between comorbid psychosis and level of urbanicity was apparent, indicating that the greater the degree of psychotic comorbidity, the greater the effect size of the urban environmental factor. For bipolar disorder without psychosis, no effect of urbanicity was apparent. CONCLUSIONS: The results suggest differential environmental causal effects on affective and cognitive dimensions of bipolar psychopathology that are nevertheless strongly comorbid within the same categorically defined disorder, possibly due to the effect of shared genetic risk factors.

Adolescent↗
PubMed2006

Airborne particulate matter and premature deaths in urban Europe: the new WHO guidelines and the challenge ahead as illustrated by Spain.

Twenty first century epidemiological publications on urban air pollution are confirming that inhalation of fine, airborne particulate matter (PM) has serious chronic human health effects and is a major cause of premature death worldwide. Recently updated recommendations by WHO identify three "Interim Targets" for the stepped reduction in PM levels within world cities in the quest to achieve an annual mean Air Quality Guideline (AQG) concentration of 20 mug/m(3) for particles less than 10 microns in size (PM(10)). In this paper we offer a perspective from Spain, a country with the longest record of reporting pollution data from large numbers of urban traffic sites to a central European database (AIRBASE). We can demonstrate that average annual PM concentrations at urban traffic monitoring stations in many European cities continue to be 50-100% above the WHO AQG, a situation exacerbated by high urban PM(2.5/10) ratios which indicate a dominance of finer, more deeply inhalable particles potentially more detrimental to health. Given that WHO has estimated in 2000 there were well over 250,000 premature deaths in Europe attributable to PM inhalation, such continuing high urban pollution levels are placing a huge burden on European medical resources.

Air Pollution↗
PubMed2006

An analogy on assessment of urban air pollution in Turkey over the turn of the millennium (1992-2001).

Rapid industrialization and urbanization in Turkey, especially over the last twenty five years, has provided better living standards to its residents, but it also caused a decrease in environmental quality. In late 1970's, air quality monitoring activities were started in some major cities by individual researchers in Turkey. It was just around the 1990's that a countrywide program on continuous air pollution monitoring in major province centers and selected large towns was launched. The impact of air pollution on people depend on various factors, such as existence and magnitude of coal powered energy generation plants, type of urban heating and their efficiency, and the numbers and specifications of vehicles. In this study, current Turkish urban air quality over the turn of the Millennium (1992-2001) is studied in the light of the country's worst cities in terms of outdoor air quality, the number of upper respiratory diseases, sinusitis, bronchitis, and pneumonia cases in these provinces reported by the state medical treatment facilities in 2001. The population that is under outdoor urban air pollution hazard was computed. A comparative analysis between the provinces that use natural gas and others that use fossil fuels was also completed in order to project monetary gains if the studied provinces will transform their indoor heating and industrial operations to be run by natural gas or other cleaner energy sources. If natural gas use in air polluted urban centers could be realized in the near future, approximately 212 to 350 million US dollars per annum could to be saved just by reducing health related problems caused by outdoor air pollution.

Air Pollution↗
PubMed2006

Monitoring urbanization of Iskenderun, Turkey, and its negative implications.

This study aimed to analyze long-term urban land use (LU) change and its negative implications on the coastal environment of Iskenderun, Turkey. Information on urban LU change for the 144-year period between 1858 and 2002 was extracted from a historic city plan, black-white monoscopic aerial photographs, and Landsat ETM+ imagery. According to the results, areal extent of urban areas has increased approximately 40 times during the past 144 years. The population growth as a result of industrial developments and permanent migration was main driving force to the urbanization. Environmental problems that resulted from rapid development in the region such as air, water and soil pollution were highlighted and some recommendations were made in the light of qualitative and quantitative information on the urbanization and its negative consequences.

Environmental Monitoring↗
PubMed2005

Patient safety-related information technology utilization in urban and rural hospitals.

Ongoing research has linked certain information technology applications to reduction of medical errors and improved patient outcomes. The purpose of this study was to assess both the use of patient safety-related information technologies (PSIT) in urban and rural hospitals, as well as the organizational factors which may be linked to overall PSIT adoption. Florida's 199 acute care hospitals (170 urban; 29 rural) were surveyed regarding their utilization of PSIT. Of the 10 technologies studied, rural hospitals averaged 30% utilization compared to 48% for urban hospitals. Individual PSIT applications such as pharmacy-based systems, clinical decision support systems, and outcomes and quality management tools were all more likely to be present in urban hospitals. Hospital bed size (less than 100 beds), tax status (not-for-profit vs. for-profit), and system-affiliation appeared to be related to overall PSIT utilization. These findings are valuable for those interested in the current status of hospital PSIT and set the stage for further studies relating these applications to clinical outcomes in urban and rural hospitals.

Hospital Bed Capacity↗
PubMed2006

Hospital utilization for injection drug use-related soft tissue infections in urban versus rural counties in California.

Drug related-soft tissue infections (DR-STIs) are a significant source of hospital utilization in inner-city urban areas where injection drug use is common but the magnitude of hospital utilization for DR-STIs outside of inner-city urban areas is not known. We described the magnitude and characteristics of hospital utilization for DR-STIs in urban versus rural counties in California. All discharges from all nonfederal hospitals in California in 2000 with ICD-9 codes for a soft tissue infection and for drug dependence/abuse were abstracted from the California Office of Statewide Health Planning and Development discharge database. There were 4,152 DR-STI discharges in 2000 from hospitals in 49 of California's 58 counties. Residents of 12 large metropolitan counties accounted for 3,598 discharges (87% of total). The majority of DR-STI discharges were from urban safety net hospitals with county indigent programs and Medicaid as the expected payment source and opiate related discharge diagnoses. Hospital utilization for DR-STIs in California is highest in large urban metropolitan counties, although DR-STI discharges are widespread. Increased access to harm reduction services and drug treatment may reduce government health care expenditures by preventing unnecessary hospital utilization for DR-STIs.

Adolescent↗
PubMed2004

Establishing sustainable strategies in urban underground engineering.

Growth of urban areas, the corresponding increased demand for utility services and the possibility of new types of utility systems are overcrowding near surface underground space with urban utilities. Available subsurface space will continue to diminish to the point where utilidors (utility tunnels) may become inevitable. Establishing future sustainable strategies in urban underground engineering consists of the ability to lessen the use of traditional trenching. There is an increasing interest in utility tunnels for urban areas as a sustainable technique to avoid congestion of the subsurface. One of the principal advantages of utility tunnels is the substantially lower environmental impact compared with common trenches. Implementing these underground facilities is retarded most by the initial cost and management procedures. The habitual procedure is to meet problems as they arise in current practice. The moral imperative of sustainable strategies fails to confront the economic and political conflicts of interest. Municipal engineers should act as a key enabler in urban underground sustainable development.

Electricity↗
PubMed1983

Acute myocardial infarction: survey of urban and rural hospital mortality.

Mortality rates for acute myocardial infarction (AMI) in the province of Manitoba were studied by a retrospective, randomized survey of urban and rural hospital records. Urban hospitals had formal coronary care unit (CCU). Selected rural hospitals lacked CCUs but usually possessed portable monitoring and defibrillation equipment. Twenty-seven percent of 852 cases in the study population died. The mortality rate for unequivocal AMI was 14% to 15% to both urban and rural hospitals. Patients with possible AMI had high mortality rates in both facilities (41% to 45%). Subgroup analysis of the definite AMI population failed to reveal statistically significant differences in urban vs rural mortality, although a consistent trend toward superior performance in urban centers was found. The magnitude of the potential of a rural hospital intervention program to reduce the AMI mortality nevertheless appeared to be small.

Aged↗
PubMed1996

Prevalence of otitis media, hearing impairment and cerumen impaction among school children in rural and urban Dar es Salaam, Tanzania.

Eight hundred and two (802) primary school children in rural and urban Dar es Salaam, Tanzania, were examined to determine the prevalence of otitis media, hearing impairment and cerumen impaction by otoscopy and pure tone audiometry. Ear disease was found in 222 (27.7%) of the children. One hundred and twenty six (15.7%) had cerumen impaction, 70 (8.7%) had sensorineural hearing loss and 21 (2.6%) had chronic suppurative otitis media. Cerumen impaction was found in 20.45% of the rural school children and in 14.8% of the urban school children. This difference in prevalence between the two groups was not statistically significant. The prevalence of chronic suppurative otitis media (COM) was 9.44% among the rural school children and 1.3% among the urban school children, the difference being statistically significant (P < 0.001). Sensorineural hearing impairment was found in 14.1% of the rural school children and in 7.7% of the urban children, this also being statistically significant (P < 0.05). The low prevalence of chronic suppurative otitis media among the urban school children is ascribed to better medical services which facilitate early diagnosis and treatment of acute otitis media. This emphasizes the need to improve the health services in the rural areas so that acute otitis media is diagnosed and treated at the primary level of health care. This will in turn prevent hearing impairment due to chronic suppurative otitis media.

Adolescent↗
PubMed1986

Rural tranquility?: urban-rural differences in tranquilliser prescribing.

Literature concerning patterns of psychotropic prescribing and its causes is discussed before focusing on the relationship between geographical location and psychotropic drug prescribing. The association between tranquilliser prescribing and urban-rural location is investigated using data from general practices in two urban and two rural Family Practitioner Committee areas. Our findings indicate that in general, doctors in urban practices were more likely to prescribe tranquillisers than those in rural practices. However, the number of principals in the practices had an effect on tranquilliser prescribing which differed according to the urban-rural designation: in urban practices, tranquilliser prescribing increased with increasing number of principals, but the reverse was true in rural practices. Possible explanations for these findings are discussed and lines of further research suggested.

Drug Utilization↗
PubMedDate not supplied

Alcohol, drugs, and urban violence in a small city trauma center.

Substance abuse and urban trauma go hand in hand. But research focuses on large cities served by major academic medical centers. Do small cities face the same problems? Two hundred thirty-three urban trauma inpatients from a metro area of 250,000 were studied using patient interviews and medical records. As in large cities, one half used alcohol or drugs when attacked. Seventy percent were likely to be young, male, poor African-Americans. Only 3% were gang members, but demographic characteristics failed to explain substance abuse as they have for larger cities. A culture of violence pervades the small city, as it does in large urban ghettos. Two fifths were repeat urban trauma victims. Two fifths witnessed assaults in the past year. One third carried a knife or gun. Fifteen percent used a weapon on another person in the last year. Contextual variables, like being hurt in a bar, were related to drinking and drugs. The best predictor of present substance abuse and urban trauma was medical history of substance abuse. The need for (a) toxicology screens for all trauma victims, (b) referrals to substance abuse programs, (c) targeting at-risk populations for prevention, and (d) eliminating environments fostering violence and substance abuse is supported.

Adult↗
PubMed1995

Different trends in serum cholesterol levels among rural and urban populations aged 40-59 in Japan from 1960 to 1990.

In Japan, coronary heart disease mortality is low and has been declining since 1970, despite recent increases in serum cholesterol levels which have been reported in nationwide surveys. Longitudinal and cross-sectional surveys of serum cholesterol levels in rural and urban populations from 1960 to 1990 were reviewed. In the surveys in the 1960s, serum cholesterol levels in urban populations were higher than those in rural populations. An increase in serum cholesterol levels for men and women was observed in all longitudinal studies among rural populations; mean increases in serum cholesterol levels per year were 0.034 mmol/l (p < 0.001) and 0.033 mmol/l (p < 0.001), respectively. These trends were still observed after combining the data from the longitudinal and cross-sectional studies in both men and women (0.027 and 0.028 mmol/l per year, respectively), while there was no significant increase among urban populations. The results of National Nutrition Surveys are consistent with these findings and show that meat consumption per day per capita increased from 23.9 to 66.2 g in rural populations and 51.2 to 77.6 g in urban populations in the 1966 and 1990 surveys. It is suggested that different trends in coronary heart disease mortality should also be apparent in rural and urban populations over this period.

Adult↗
PubMed1996

Cardiac structure and exercise blood pressure in urban and rural Canadian men of Icelandic descent.

The objective of the study was to determine the relationship between exercise systolic blood pressure (ESBP), during bicycle ergometry, and echocardiographically determined left ventricular structure in rural and urban Canadian men of Icelandic descent. The study was cross-sectional in design. The settings were urban Winnipeg and the rural Interlake District in the province of Manitoba, Canada. Subjects were adult male volunteers from families of wholly Icelandic descent. The subjects were 30 to 60 years of age and had supine blood pressure < 160/95 mm Hg. Anthropomorphic measurements, echocardiography and sphygmomanometry, at rest and during bicycle ergometry, were performed on all subjects. Prevalence of exaggerated ESBP (> or = 200 mm Hg) and left ventricular hypertrophy (LVH) was not significantly different in the two groups. In all but one individual LVH was classified as eccentric hypertrophy. In both urban and rural subjects with exaggerated ESBP, left ventricular mass index (LVMI) was greater than in those subjects without exaggerated ESBP. The LVMI correlated with ESBP at the highest workloads (> or = 150 W). Multivariate analysis of all subjects showed that cardiac index, ESBP, body mass index, and low exercise heart rate were predictive of LVMI. There was no significant difference in prevalence of ESBP or LVH between urban and rural Manitobans of Icelandic descent. However, LVMI levels were lower, and values for ESBP greater, in the rural group compared with the urban group. Within each of the two groups there was a positive association between ESBP and LVMI; hence, the study supports findings of our previous investigation showing evidence of early target organ effects in normotensive men with an exaggerated ESBP.

Adult↗
PubMed2004

Rural and urban traffic fatalities, vehicle miles, and population density.

The purpose of this study was to evaluate the effect of population density on the rates of motor vehicle mortality in rural and urban areas, while controlling for vehicle miles traveled (VMT). Rural and urban data for traffic mortality, VMT, and population were obtained for each state from the Federal Highway Administration for 1998-2000. Linear regression was used to estimate the effect of population density, VMT per capita, southern location, and presence of a trauma system on mortality. Variation in rural mortality rate (per 100,000 population) was proportional to rural VMT per capita, but population density and southern location were also independent predictors, together accounting for 91% of this variation. Variation in urban mortality rates was not affected by population density, but urban rates were also higher in the south. The exposure-based rural mortality rate (deaths per 100 million VMT) was inversely proportional to population density, which along with southern location explained 41% of the variation from state to state. The presence of a state trauma system did not measurably affect mortality. After controlling for VMT and southern location, state population density was a moderately strong predictor of rural but not urban traffic mortality rates.

Accidents, Traffic↗
PubMed2005

Urban-rural differences in motor vehicle crash fatality and hospitalization rates among children and youth.

This population-based study examined motor vehicle crash hospitalization rates and death rates among children and youth in rural and urban areas of the province of Alberta, Canada. Using police report data (1997-2002, inclusive), average annual motor vehicle crash hospitalization and death rates among those 0-19 years of age were calculated for rural and urban regions. Across all age and sex strata examined, both the hospitalization and the fatality rates were significantly higher in rural compared with urban regions. After adjusting for age, sex and calendar year, the relative risk of a motor vehicle crash hospitalization (rural versus urban) was 3.0 (95% CI: 2.8, 3.2). After adjusting for age, sex and calendar year, the relative risk of a motor vehicle crash fatality was 5.4 (95% CI: 4.2, 6.9). Motor vehicle crash injury hospitalization and fatality rates among children and youth in the province of Alberta are considerably higher in rural areas compared with urban areas. There is a need to identify social, demographic and environmental driving hazards associated with the rural environment.

Accidents, Traffic↗