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PubMed2006

A nationwide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties.

OBJECTIVES: Despite their increasing numbers, little is known about the health of American Indians/Alaska Natives living in urban areas. We examined the health status of American Indian/Alaska Native populations served by 34 federally funded urban Indian health organizations. METHODS: We analyzed US census data and vital statistics data for the period 1990 to 2000. RESULTS: Disparities were revealed in socioeconomic, maternal and child health, and mortality indicators between American Indians/Alaska Natives and the general populations in urban Indian health organization service areas and nationwide. American Indians/Alaska Natives were approximately twice as likely as these general populations to be poor, to be unemployed, and to not have a college degree. Similar differences were observed in births among mothers who received late or no prenatal care or consumed alcohol and in mortality attributed to sudden infant death syndrome, chronic liver disease, and alcohol consumption. CONCLUSIONS: We found health disparities between American Indians/Alaska Natives and the general populations living in selected urban areas and nationwide. Such disparities can be addressed through improvements in health care access, high-quality data collection, and policy initiatives designed to provide sufficient resources and a more unified vision of the health of urban American Indians/Alaska Natives.

Adolescent↗
PubMed1995

Health services access and use among older adults in North Carolina: urban vs rural residents.

OBJECTIVES: This study compared health service use and satisfaction with health care among older adults living in urban vs rural counties in North Carolina. METHODS: A stratified random sample of 4162 residents of one urban and four rural counties of North Carolina was surveyed to determine urban/rural variation in inpatient and outpatient health service use, continuity of care and satisfaction with care, and barriers (transportation, cost) to care. RESULTS: Inpatient and outpatient service use did not vary by residence in controlled analyses. Continuity of care was more frequent in rural counties. Transportation was not perceived as a barrier to health care more frequently in rural than in urban counties, but cost was a greater barrier to care among rural elderly people. CONCLUSIONS: In this sample, older persons living in rural counties within reasonable driving distance of urban counties with major medical centers used health services as frequently and were as satisfied with their health care as persons in urban counties. Cost of care, however, was a significant and persistent barrier among rural elderly people, despite Medicare coverage.

Age Factors↗
PubMed2000

Community, service, and policy strategies to improve health care access in the changing urban environment.

Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.

Aged↗
PubMed2000

Urban issues in health promotion strategies.

The powerful influence of behavioral choices on health status is well established. The implications and challenges for urban populations are formidable. Understanding urban environments will better prepare health promotion professionals to deal effectively with the forces affecting health-related behaviors. In thinking about urban health promotion in the United States, researchers often distinguish between 2 frameworks; one contending with urbanization, which affects most of us, and another contending with inner-city environments, where many of the deepest needs are. Urbanization confers both benefits and liabilities, but the single greatest challenge for health promotion may lie in reestablishing positive social connections. In contrast, 2 key features of the inner-city environment may be the negative ecological forces within neighborhoods and the lack of control over one's fate. Too often, prescriptions for the inner city stereotype its problems and ignore its strengths. For the inner city, important foundation stones for the future include ways to build on these strengths through positive connections and increased community control through coalition building.

Health Promotion↗
PubMed2005

[Urban violence: a challenge for pediatricians].

OBJECTIVES: To present the main aspects of an approach to urban violence among children and adolescents and to point out the social and educational role of pediatricians. SOURCES OF DATA: A literature review based on MEDLINE, LILACS and SciELO was carried out for the years 1993 to 2005, using the following keywords: urban violence, children and adolescents. In addition to the review, policies and institutional reports on violence were also analyzed. SUMMARY OF THE FINDINGS: The causal relationship of violence is presented in a range of different ways, from personal points of view to broader structural aspects. The literature suggests that urban violence results from varied actions, and also from specific risk behaviors. It is a worrying and complex phenomenon that results in high levels of morbidity and mortality, affecting children and adolescents. Special attention was given to homicide and to the psychological results of violent acts. Firearms are the most lethal instruments among adolescents and young males when compared to all other causes of death. CONCLUSIONS: Urban violence is one of the main social problems in Brazil. Violence prevention requires intersectoral and multiprofessional actions with the participation of the government and of the organized civil society. Children, and above all adolescents, are the groups that are most widely exposed to the consequences of urban violence. Pediatricians can have an important role in the process of prevention, diagnosis and treatment. Through their wide-ranging abilities, pediatricians are well-positioned to help victims and their families to establish a healthy and dynamic relationship with their environment and with themselves.

Adolescent↗
PubMed1993

The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa.

OBJECTIVE: To determine the prevalence of NIDDM and associated risk factors in urban Africans in Cape Town, South Africa. RESEARCH DESIGN AND METHODS: With a three-stage, proportional, stratified, random cluster method, we sampled 1000 Africans, > 30 yr of age, living in African residential areas in Cape Town. We assessed glucose tolerance with a 75-g oral glucose tolerance test, according to World Health Organization criteria, and obtained anthropometric and demographic data. RESULTS: The response rate was 79%. The prevalence of NIDDM was 8.0% (confidence interval 5.8-10.3%), age-adjusted to world population figures and that of impaired glucose tolerance, 7.0% (confidence interval 4.9-9.1%). Multivariate analysis indicated that increased age (odds ratio 4.18), upper-segment fat distribution (odds ratio 2.94), proportion of life spent in an urban area (odds ratio 2.32), and obesity (odds ratio 2.31) were significant independent risk factors for NIDDM. In contrast, sex, family history, alcohol intake, and physical activity were not independent risk factors. Only increased age (odds ratio 4.06) was a significant risk factor for impaired glucose tolerance. CONCLUSIONS: The prevalence of NIDDM in urban Africans in Cape Town, South Africa, is moderately high, and considerably higher than previous reports from Africa. The association of NIDDM with urbanization has important implications in view of the large-scale urbanization occurring in southern Africa.

Adult↗
PubMed2006

Different spatial distribution of Aedes aegypti and Aedes albopictus along an urban-rural gradient and the relating environmental factors examined in three villages in northern Thailand.

A larval survey of dengue vectors was conducted from July to November 1966 and from May to November 1997 in Chiangmai Province, Thailand. Three villages in urban, transition, and rural areas were selected for the survey to clarify the spatial distribution of Ae. aegypti and Ae. albopictus along an urban-rural ecological gradient. The average number of Ae. aegypti larvae in larvitraps was higher in the urban area than in the rural area, as we expected, whereas the opposite was found for Ae. albopictus, rural area > urban area. A house survey of larvae-inhabiting containers showed significant differences in the number and composition of these containers among the study areas. Significant differences were also found in the average distance between houses, average tree height, and average percentage of vegetation cover for each house. The seasonal pattern of rainfall recorded in each study area did not show great differences among the study areas. The response of Ae. aegypti and Ae. albopictus to the urban-rural gradient is discussed in relation to the possibility of applying geographic information system techniques to plan the control strategy and surveillance of dengue vectors.

Aedes↗
PubMed1982

Polymorphic acetylation of sulphamethazine in rural bedouin and urban-dwellers in Saudi Arabia.

1. The polymorphic acetylation of sulphamethazine (sulphadimidine, sulphamezathine) has been investigated in a population of 109 Saudi male arabs of rural bedouin origin and in 126 Saudi female arabs from urban cosmopolitan areas of Jeddah. 2. Rural males excreted 5-79% of the administered dose (1 X 5 g/m2 body surface area) in the 0-12 h urine and the urban females excreted 5-97%. 3. The frequency distribution of the ratio acetyl sulphamethazine/sulphamethazine was bimodal in rural, urban and the combined populations with a clear antimode at 70% acetylation of the recovered dose. 4. The incidence of slow acetylators was 67 X 9, 59 X 5 and 63 X 4% in the rural, urban and combined populations. The incidence of the As allele in Saudi arabs was thus 0 X 80+/-0 X 03 S.E.M., which is similar to that found in the neighbouring countries, of Egypt and Sudan. Since no significant difference in As frequency was apparent between the rural (pure) and urban (cosmopolitan) arabs, it is concluded that immigrants to Saudi Arabia from other muslim countries have not affected the gene frequencies with respect to acetylation. 5. Methodology of assessing acetylation phenotype is discussed. It would appear that urine analysis alone gives satisfactory discrimination between phenotypes.

Acetylation↗
PubMed1996

High-consulting children indicate illness-prone families. A study of 38 rural and 38 urban Swedish children's health and use of medical care.

OBJECTIVE: To study health problems and use of medical care in a group of rural and urban children. To relate a number of socio-demographic factors to the children's consultation frequency. To compare high- and low-consulting children with respect to socio-economic status of the family and use of medical care and sicklisting pattern of their parents. DESIGN: Health check-up at school start. Investigation of the children's medical records from birth to the age of seven, and of their parents' use of primary medical care during the same period. SETTING: Lammhult, a rural community with 3000 inhabitants, and Teleborg, an urban district with 9000 inhabitants, situated in Växjö town, southern Sweden. SUBJECTS: 38 rural and 38 urban preschool children, as well as their parents. MAIN OUTCOME MEASURES: Medical visits encountered and antibiotic courses prescribed during the first seven years of life. RESULTS: Parents having manual occupations and mother being a smoker were factors of importance for the children's use of health and medical care (i.e. gave a high number of medical visits). The 14 high consulters had recurring respiratory tract infections and allergic/asthmatic complaints. Their parents were also high users of primary medical care and they were more often sick-listed than parents of low-consulting children. Rural and urban children made the same number of medical visits and received the same number of antibiotic courses during their first seven years of life. CONCLUSION: With respect to the children's use of health and medical care, we found only minor differences between rural and urban children, whereas socio-economic characteristics of the families were of importance. Moreover, high-consulting children had parents who were high users of primary medical care and who were often sick-listed.

Anti-Bacterial Agents↗
PubMedDate not supplied

A contextual model of adolescent alcohol use across the rural-urban continuum.

In the research presented here, we develop and test with respondents from a broad range of contexts a multilevel social control model of adolescent substance use, integrating macro- and microsociological and criminological perspectives. Specifically, this research examines the individual-level social control processes or mechanisms thought to lead to alcohol use embedded in school contexts in different community settings along the rural-urban continuum. In this way we determine 1) the main effects of individual- and contextual school-level variables and 2) the conditioning or moderating influences of school climate on individual alcohol use and on individual-level processes leading to alcohol use. Furthermore, given that our sample contains students from a broad range of settings along the rural-urban continuum, our findings address the appropriateness of conceptualizing rural and urban drug use and their respective etiologies as dichotomous. In this respect our findings suggest that heterogeneity in drug use exists within rural school settings as well as within urban school settings, and that examining rural drug use as separate from urban drug use is not justified.

Adolescent↗
PubMed2001

Blood pressure, serum cholesterol concentration and their related factors in urban and rural elderly of Ho Chi Minh City.

In Vietnam, information about blood pressure, serum lipids and their factors is limited. To obtain some of this information, a cross sectional nutrition survey was carried out in an urban and rural area of Ho Chi Minh City with 217 participants aged 60-69 y (148 females and 69 males). Anthropometry and blood pressure were measured. For three consecutive weekdays, 24 h dietary recalls were performed. Single 24 h urine was collected for sodium and potassium analysis. A fasting blood sample was taken and biochemical parameters were measured. Results indicate a high percentage of hypertension in urban (female: 35.5%, male: 43.8%) and rural areas (female: 22.2%, male: 35.1%). Blood pressure was correlated with body mass index (BMI) and 24 h urinary sodium-to-potassium (Na/K) ratio. A high prevalence of serum total cholesterol (TC) above 220 mg/dL (female: 55.3%, male: 31.3%) and overweight (female: 34.2%, male: 25.0%) were observed in urban residents. By contrast, 5.6% and 24.3% of rural females and males respectively had TC below 150 mg/dL and both genders had the same prevalence of underweight (32.4%). TC was positively correlated with body weight, BMI, dietary protein and dietary lipids. Overweight might be a major risk factor for hypertension in our urban elderly. A high Na/K intake ratio might be a risk factor for hypertension in both areas. The high prevalence of elevated TC in the urban area might to be related to the high lipid intake, and the high prevalence of low TC in the rural area might to be related to the low lipid intake.

Aged↗
PubMed2003

Macronutrient intake and nutritional status of primary school-aged girls in rural and urban areas of South Vietnam.

The dietary habits and nutritional status of Vietnamese primary school girls were investigated using a cross-sectional survey. We interviewed 348 girls aged 7 to 9 yr old, randomly selected from three rural (n=193) and two urban (n=155) primary schools. The nutritional status of the children was evaluated by anthropometric and biochemical data. Dietary data were calculated based on the results of a 24-h recall interview carried out for three consecutive days. The dietary macronutrient pattern of the rural group showed a deficiency of energy, fat, animal protein, and fiber content. On the other hand, high animal protein ratio, deficiency of fiber consumption, low polyunsaturated fatty acid, and high saturated fatty acid proportions were typically found in the urban group. A high number of rural children skipped lunches, resulting in low energy consumption: however, frequently skipped breakfast in the urban group did not influence total energy consumption because of extra meals taken. The mean height of rural children was 5.8 cm less than that of their urban counterparts. In addition, 11.4% of wasted rural children needed emergency intervention with energy supplementation. Moreover, a high proportion of children with a high atherogenic index (AI) (41.5%) and low HDL cholesterol (40.9%) were found in the rural group. In contrast, a tendency toward obesity, high cholesterol, LDL cholesterol, and high AI was observed in a proportion of the urban children (5.2%, 15.5%, 12.3%, and 29.0%, respectively).

Body Height↗
PubMed2006

Urban stress and health in developing countries: development and validation of a neighborhood stress index for India.

Stress caused by chronic difficulties encountered by people residing in poor urban neighborhoods is associated with health problems and disease in developed countries, but the relationship between neighborhood stress and health in developing nations, such as India, has not been assessed. In this study, the authors administered the City Stress Inventory, a self-report measure assessing stress experienced as a function of environmental conditions unique to living in large cities that was validated in the United States, to 163 high school students in New Delhi, India. Components of urban stress in India, with some modifications, appear to be similar to components of urban stress reported by adolescents in the United States. Urban stress was predictive of high blood pressure as reported by the adolescents 'parents. In addition, urban stress also predicted health habits, such as chewing tobacco and alcohol use, and psychosocial characteristics, such as hostility. Adolescents' reports of parental stress concerning money and social pressures were also associated with city stress. The current study indicates that the City Stress Inventory is valid in an Indian sample and is predictive of health problems.

Adolescent↗
PubMed2004

[Mortality rates in rural and urban areas of Brittany].

Relative differences in environment, behaviour, social composition as well as access to health care tend to suggest that levels of health may vary between urban and rural areas. The aim of this study was to identify rural-urban variations in mortality risks in the region of Brittany for the period from 1988 to 1992. The definition of urban and rural areas used adhered to that of the zoning of urban areas established by the INSEE (the National Statistical Office). The amalgamation of all causes of standardised mortality ratios (SMR) show only a moderately increased risk in the rural areas compared with the overall regional level (+4% in men, +5-7% in women). The analysis of cause specific SMRs display higher rural mortality for cardiovascular diseases and external causes of death, road traffic accidents in particular (+24% in men). Among all specific causes investigated, only lung cancer mortality risk appears to be higher in urban areas.

Adolescent↗
PubMed2000

Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study.

Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.

Adaptation, Psychological↗
PubMed2006

Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes.

OBJECTIVE: To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences. DESIGN: Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry. SETTING: All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service. PARTICIPANTS: 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003. RESULTS: Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew. CONCLUSIONS: Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.

Aged↗
PubMed1999

[Diarrhea in urban agricultural workers in Nouakchott in Mauritania].

Nearly 200 million people in the developing world are dependent or urban gardening for food and income. This practice has been accelerated by the droughts of recent decades which have forced more and more migrants into urban areas. Numerous potential health hazards have been attributed to urban gardening but the exact risks in Sahelian areas remain unclear. The purpose of this cross-sectional study was to evaluate the incidence of diarrhea at the Tel Zatar gardening site in urban Nouakchott, Mauritania. In addition, a case-control study was carried out to identify risk factors for diarrhea in function of gardeners' activity and living conditions. Statistical analysis was performed using univariate and logistical regression methods. The annual incidence of diarrhea ranged from 6.9 (IC95 p. 100 = 5.0-8.8) to 8.5 (IC95 p. 100 = 6.2-10.8) episodes per gardener and year. Multivariate analysis identified four significant risk factors. Two of these factors were unrelated to gardening, i.e., not having spent more than USD 3.50 the previous day (odds ratio (OR = 2.8, IC95 p. 100 = 1.01-7.81) and poor food hygiene (cooking outside (OR = 4.69, IC95 p. 100 = 1.06-20.83). The other two factors were regular consumption of raw vegetables (OR = 25.5, IC95 p. 100 = 2.0-32.0) and use of untreated well water (OR = 3.85, IC95 p. 100 = 1.08-14.29). Unprotected well water was the cause of 59.2 p. 100 of diarrheal episodes reported by gardeners at Tel Zatar. The results of this study confirm that vegetable production in urban gardens such as Tel Zatar is associated with health risks. Public health measures should address not only the garden sites but also domestic hygiene.

Adult↗
PubMed1999

[Health as premise for urban planning].

Concerns for health have been a foundation for planning in towns the cities in Norway from the 19th century up to the present. Doctors previously took active part in discussions of urban planning. Planners developed new concepts for urban design and town planning. Sun, air, low density and separation of functions were important tools to achieve a healthy city. Modern planning has led to dispersed cities requiring a great deal of transport. A more dense built-up urban area is necessary to achieve sustainable development. Higher population density and a mix of functions should be encouraged in order to reduce the need for transport. This strategy is contrary to the development of urban planning over the last 150 years. Health professionals must participate in the discussion on urban form and planning in order to avoid new health problems higher density and a mix of functions in our cities may cause.

Cities↗