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PubMed1989

The relationship between serum lipid levels and nutrient intake in healthy inhabitants of urban and rural Shanghai.

The serum lipid levels (mean +/- SD) of 3312 healthy urban and rural inhabitants over 40 years of age in Shanghai were studied. The results were: cholesterol 166.7 +/- 30.9 mg/ml, triglyceride 81.1 +/- 42.3 mg/dl, HDL-cholesterol (HDLc) 57.4 +/- 11.6 mg/dl, HDL2c 20.6 +/- 9.8 mg/dl and HDL3c 37.1 +/- 7.8 mg/dl. Dietary surveys were carried out in 512 of these subjects and their average daily nutrient intake was estimated to be: total calories 2,577 Kcal, proteins 656 g (50.7 g of vegetable proteins), fat 69.1 g (P/S ratio 0.70), carbohydrates 423 g, cholesterol 282 mg, dietary fibres 23.5 g, sodium 4993 mg, potassium 2,618 mg and magnesium 575 mg. The serum lipid levels of urban and rural inhabitants were compared. Total cholesterol levels were significantly higher in urban inhabitants of all age groups and of both sexes, while triglyceride levels were significantly higher in urban inhabitants of certain age groups. However, HDLc levels, particularly HDL2c levels were significantly higher in rural inhabitants of most age groups and of both sexes. The above differences were probably the result of differences in dietary patterns and nutrient intake between urban and rural inhabitants.

Adult↗
PubMed1989

[Differences in length and weight growth patterns between urban and rural infants].

Mixed longitudinal data of length and weight growth from 595 rural and 337 urban infants were analysed. Count models were fitted to the means of length and weight in different ages, sexes and feedings separately. The curve fitting to the data was rather satisfactory. Comparison of model parameters between urban and rural infants suggested that rural infants had a higher length level at birth but lower accelerative growth afterwards than urban ones, which was even more obvious in breast-fed infants. The difference in birth weight between them was not significant; and the urban infants had a faster linear growth velocity than rural ones. These results might be caused by the fact that food supplementing in urban infants was significantly earlier and better than in rural ones.

Body Height↗
PubMed1989

Are rural referral centers as costly as urban hospitals?

This article evaluates the claim that rural referral centers (RRCs), identified by HCFA criteria for special treatment under Medicare's prospective payment system, have average costs similar to urban hospitals. Multivariate analysis led us to conclude that RRC Medicare costs were 13 percent higher than those of other rural hospitals in 1984, holding constant Medicare case mix, teaching activity, and relative wages. However, RRCs were 9 percent ($200) less costly per case than urban hospitals. Outliers explained most of the cost difference between RRCs and urban hospitals, while transfers were more important in explaining differences between RRCs and other rural hospitals. Given that bed size alone explained all of the RRC-other rural cost difference, paying RRCs the urban rate results in an indirect way of paying them based on bed size. It also gives them an average excess of payment over Medicare cost well above the national rural and urban average.

Costs and Cost Analysis↗
PubMed1989

Urban unfinished business.

Water and sanitation services and hygiene education are crucial in preventing communicable and other diseases which daily take an enormous toll both in morbidity and mortality around the world. Diarrheal diseases are the most prevalent, affecting hundreds of millions of infants, children, and others. There is a current major demographic trend of migration to and explosive growth of low-income peri-urban settlements in and around large cities in developing nations. These settlements lack adequate and affordable water supplies and often have no sanitary facilities whatsoever. They are perfectly suited for the flourishing of water- and sanitation-related communicable and other diseases, which add considerably to the misery of abject poverty. However, working with members of these communities to provide water and sanitation services can both prevent such diseases and improve economic conditions. International assistance must be facilitative rather than interventionist. Developed nations should greatly increase their financial contribution for the facilities necessary for better water and sanitation. Initially, it is important to create an international urban information center to act as a clearinghouse of information. It would also be helpful to begin a four-decade urban sanitation planning effort along with an "Urban Watch" to promote significant developments in peri-urban settlements.

Developing Countries↗
PubMed1987

Sources of hospital cost variation by urban-rural location.

Under current law, Medicare's Prospective Payment System (PPS) recognizes a 25% differential in standardized average costs per admission between rural and urban areas. Using Medicare Part A and B claims data from four states across the country, this paper employs descriptive and multivariate techniques to explain the underlying sources of cost variation. DRG mix and within-DRG severity differences were found to contribute only 10-15% to the overall urban-rural variation compared to about one third for wage differences. Differences in procedure intensity for basically similar patients explained another 25-50% of the urban-rural difference depending on illness. Evidence was also found for systematic cost and procedure differences between core city versus suburban hospitals. If the urban-rural rate differential were eliminated, the impact on urban hospitals could have major effects on the intensive way in which physicians treat patients. Whether this would have demonstrable outcome effects is unknown, but initial severity differences alone do not justify the observed procedural differences.

Aged↗
PubMedDate not supplied

Health status and medical consumption of the elderly in urban and rural areas in The Netherlands; a secondary analysis of CBS-data.

Data of the life situation survey of the Central Bureau of Statistics (CBS) of 1982 have been analysed. This secondary analysis has been carried out to study differences in health and medical consumption between urban and rural elderly. Two contrasting groups of elderly have been used: urban and rural elderly. It has been found that there are no differences in the prevalence of chronic disorders. More mental complaints have been found among male urban elderly compared to male rural elderly. The same relationship, although not significant, exists for women. For women it has been found that urban elderly feel less healthy than rural elderly. Male urban elderly aged 55-74 year pay more visits to the general practitioner than rural elderly of the same age. The same holds for women aged 75 year and over who also pay more visits to the physician.

Aged↗
PubMed1988

Infant mortality rates in urban areas of South Africa, 1981-1985.

National infant mortality rates (IMRs) for South Africa are at present based on guestimates. There is no reliable national black IMR estimate. A study was undertaken to determine the IMR for 10 large urban areas (where records are available) for 1981-1985 and to use these to estimate a national black IMR. Considerable variability in the IMR was found for blacks both between cities and years. An overall national IMR estimate for blacks of between 94 and 124 deaths per thousand live births was obtained. This is about twice as high as the national figure of 51.9 for coloureds. The coloured non-urban rate was 2.6 times the urban rate of 25.9 while the Asian and white rates were similar in urban and non-urban areas (17.9 and 12.3 respectively).

Black or African American↗
PubMed1984

Malaria in urban and rural areas of southern Ghana: a survey of parasitaemia, antibodies, and antimalarial practices.

A comparative cross-sectional survey was undertaken in two populations, urban and rural, in southern Ghana to assess the impact of urbanization on the prevalence of malaria parasitaemia and antibodies. At the same time, a survey of antimalarial practices was conducted on sample populations in the two communities. The results showed a low parasite rate (1.6%) and correspondingly low titres of malaria antibodies in a significant proportion of the urban community, particularly in children less than 10 years old. This was associated with widespread use in the urban community of antimalarial drugs, particularly chloroquine, as prophylaxis. The parasite rate in the rural community was 22%, and 97% of the sample population over 1 year of age had antibodies against Plasmodium falciparum. These results demonstrate that a substantial proportion of urban children are growing up with little exposure to malaria, even in a region considered endemic for malaria. The implications of these findings are discussed.

Adolescent↗
PubMed1980

Heavy metal concentrations in soils of five United States cities, 1972 urban soils monitoring program.

Lead, mercury, cadmium, and arsenic levels were determined in soil samples from Des Moines, Iowa, Fitchburg, Massachusetts, Lake Charles, Louisiana, and Reading and Pittsburgh, Pennsylvania, as part of the 1972 Urban Soils Monitoring Program. Sampling sites within each Standard Metropolitan Statistical Area (SMSA) were defined as urban or suburban based on their position either within or outside the official city limits, respectively. In addition, each site was classified lawn or waste according to the maintenance it received. Except in Fitchburg, urban soils of each SMSA contained significantly higher mean concentrations of cadmium, lead, and mercury than did suburban soils. Mean urban soil concentrations in each SMSA except Des Moines and Reading, where urban levels were significantly higher. Generally, the metal concentrations in lawn and waste areas did not differ significantly. The results indicate a general contamination of these areas, probably as a result of fallout of airborne metal aerosols from industrial processes and/or fossil-fuel combustion.

Arsenic↗
PubMed1978

Cause of death risk in relation to general mortality in zones with different degrees of urbanization.

This investigation deals with the distribution of mortality of four groups of causes (Diseases of the Circulatory System, of the Respiratory System, of the Digestive System, Injuries and Poisonings) in the coastal (urban area), hill (semi-urban area) and mountain (rural area) zones of the Marche (a region of Central Italy) with the aim of evaluating the risk of death from a specific cause in relation to mortality from all causes. Besides the Age Standardized Mortality Rates (ASDR), both the Relative Standardized Mortality Ratios (RSMR) and the Standardized Proportional Mortality Ratios (SPMR) were utilized.--The results obtained showed that the RSMR and the ASDR had the same trend when the urgan area and the rural area were compared--excluding the diseases of the circulatory system--the risk of death from causes was higher in the urban area. On the contrary, comparing the semi-urban area with the urban area and the rural area, dissonant behaviour between the two parameters was revealed.--The results obtained with the RSMR and with the SPMR were almost always similar.--To determine the significance of the deviation between expected number and observed number of deaths, the procedure for estimating the relation of mortality from specific causes to that from all causes (adaptation of Mantel-Haenszel method) was used. The deviation of the observed from expected number of deaths in the mountain zone, taking the coastal zone as control, was statistically significant or very close to significance for each cause with the exception of injuries and poisonings in females and diseases of the circulatory system in both sexes.

Cardiovascular Diseases↗
PubMed1978

Special problems of zoonoses connected with urban areas.

The following items are discussed: 1) Zoonoses with an urban cycle: a) Salmonellosis; b) Dermatophytozoonoses; c) Toxoplasmosis; d) Larva migrans visceralis; 3) Flea and tick infections; f) Zoonoses of cities located on lakes, rivers and the sea. 2) Animalization of the urban environment. 3) Zoonoses which may be transferred from the rural to the urban environment: a) Rural zoonoses transmitted to urban animals; b) Rural zoonoses transmitted to man in cities. 4) Zoonoses which may be transmitted from the urban to the rural environment.

Animals↗
PubMed1995

Critical issues in urban emergency medical services for children.

In order to be effective those wishing to improve emergency care of children in an urban environment must be aware of barriers as well as resources. Urban children are at high risk for requiring emergency care as a result of both illness and injury. These children face a dangerous environment resulting from the problems of poverty, homelessness, overcrowded living conditions, drug abuse, and a shrinking tax base. They face this nation's highest rates of violent injury (intentional and unintentional), immunization delays, and preventable infectious diseases such as TB and measles. In addition, they have poor access to quality primary health care and suffer the greatest morbidity rates from chronic diseases such as asthma and diabetes. On the other hand, there is great opportunity to ensure that urban children receive quality emergency health care. The urban environment is rich in "centers of pediatric excellence," which often have paid full-time EMS systems in operation, and is the locale in which the majority of pediatric emergency medicine specialists and prehospital advanced life support providers practice. The child advocate must work to ensure that the urban child can benefit from these resources.

Ambulances↗
PubMed1994

Immunization coverage of infants--rural-urban difference in Kerala.

A study on the Immunization Coverage relating to the six vaccine preventable diseases was carried out in an urban, semi urban and rural area in Kerala and the results from the three areas were compared and discussed. The percentage of fully immunized children was similar in all the three areas and it was quite high. Coverage of measles vaccine was high in the Health Unit, Pangappara where health education activities were carried out by the interns. The awareness about vaccine preventable diseases was more in the urban and semiurban areas. The drop out rate for DPT and OPV was also less in urban and semiurban than in the rural areas. More than 50% of the households in urban, semiurban and rural areas were unaware of the diseases prevented by DPT vaccine. Intense Health Education Campaign can definitely improve the immunization coverage further in a state which has already attained total literacy.

Health Surveys↗
PubMed1993

[The relationship between nutrition and prevalence of coronary events and stroke in urban and rural areas of Shijiazhuang].

The prevalence of coronary events was 64.5/100,000 in the urban of shijia zhuang and it was higher than 23.8/100,000 in rural. Contrary to the coronary events, the prevalence of stroke in urban (159.6/100,000) was lower than that in rural (170.2/100,000). The paradox was studied with their relation to nutrition. The SBP and DBP levels, hypertension rate, serum cholesterol, BMI and dietary saturated fatty acid and cholesterol in urban were higher than that in rural. They were risk factors especially to coronary events. The urban inhabitants had high animal protein intake and higher serum amino acids and higher SO4 excreted in daily urine than that of the rural inhabitants. The result suggests that the higher animal protein intake may be preventive factor for stroke in urban inhabitants.

Adult↗
PubMed1993

[A survey of nutrition knowledge-attitudes-practices of Sichuan urban and rural adults].

To provide a basis for designing nutrition education, two nutrition knowledge--attitudes--practices (KAP) surveys of adults aged 18 to 55 were conducted in 1989 in an urban (N = 1004) and a rural (N = 506) area of Sichuan. The results indicated that the nutrition levels in both sites were low, and an awareness of the relationship between nutrition and certain common diseases was lacking. However, both urban and rural adults possessed good attitudes toward nutrition and nutrition education. Large differences existed between urban and rural adults' food patterns, with the rural diet more monotonous than the urban one. The rural women will be a hard-to-reach audience requiring more intensive efforts. The findings suggest that nutrition education efforts for Sichuan urban and rural area adults will require different contents and emphases, different methods of delivery, and language suitable for each group, in order to obtain good results.

Adolescent↗
PubMed1993

Urban-nonurban distribution of HIV infection in childbearing women in the United States.

Women account for an increasing proportion of AIDS cases in the United States, and the number reported from small cities and rural areas is growing. To better describe the geographic characteristics of the human immunodeficiency virus (HIV) epidemic in women, we analyzed data for more than 1.6 million newborn specimens tested for maternal antibody to HIV-1 in 35 states in 1989. To provide comparable geographic units for analysis, seroprevalence rates were calculated for state-designated health districts, which are groups of counties defined for the planning and delivery of health services. Health districts with > or = 75% of the population residing in urban areas as defined by the 1990 census were considered urban. Prevalence of HIV infection ranged from 0 to 12.2 per 1,000, with the highest rates found in urban health districts, primarily those on the East coast; however, high rates were also found in some nonurban districts, particularly in the South. Rates among black women were three to 35 times higher than in white women in nine states, regardless of urbanicity. These findings should be used to focus prevention activities and direct health care planners to urban and rural areas in need of HIV-related services for women.

Adolescent↗
PubMed1995

Diabetes, obesity and hypertension in urban and rural people of bedouin origin in the United Arab Emirates.

In the United Arab Emirates, coronary heart disease has emerged as the leading cause of mortality over a 20-year period of rapid socioeconomic development. CHD risk factors of non-insulin dependent diabetes mellitus (NIDDM), obesity and hypertension were investigated by community based survey among a bedouin-derived Emirati population sample of 322 subjects (> or = 20 years). Diagnosis of diabetes was based on a random capillary blood glucose level > or = 11.1 mmol l-1. Overall diabetes prevalence was 6% (11% in male and 7% in female subjects aged 30-64 years). Urban residence was associated with higher blood glucose levels (P = 0.000), and with higher Body Mass Index (BMI) values (P = 0.002): 27% of all urban residents were obese (BMI > or = 30). The Shamsi were positively associated with higher blood glucose levels compared with other tribal groups (P = 0.000). Female gender was associated with higher BMI values (P = 0.000). Between 19 and 25% of all subjects (male or female; urban or rural residents) have systolic hypertension (> 140 mm Hg). Male gender was associated with raised diastolic BP (P = 0.023). Diabetes was associated with higher mean systolic (P = 0.0274) and diastolic (P = 0.0132) BP levels. Differences in lifestyle between urban and rural residents are becoming blurred with further socioeconomic development and it is expected that the incidence of these CHD risk factors will continue to rise. Further studies are needed to specify changes associated with urbanization. Tribal influence also merits further study given the tradition of consanguinity in the UAE and the genetic basis to NIDDM.

Adult↗
PubMed1996

Reason and protest in the new urban public health movement: an observation on the sociological analysis of political discourse in the 'healthy city'.

The urban environment represents an important social and geographical focus for the international new urban public health movement in general and the World Health Organization's 'Healthy Cities' project in particular. Existing and new policies of relevance to urban health are however infused with notions of cause, effect and ideas of appropriate intervention that reflect highly malleable and more or less conscious expressions of rationality, self-interest and organizational purpose--factors central to sociological analysis of the political discourse and objectives associated with the new urban public health movement. This article begins to develop a research agenda in this respect through consideration of the 'language' of policy and reference to Habermas' idea of 'communicative reason'. It is argued that case-study based research into the discourse of the new urban public health movement has to balance empirical accounts with analysis of the 'policy ontologies' that confront and underpin the mobilizations and has, secondly, to consider the 'communicative capacity and orientation' of such initiatives.

Communication↗