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PubMed2005

Can urban regeneration programmes assist coping and recovery for people with mental illness? Suggestions from a qualitative case study.

Researchers and policy-makers are increasingly recognizing that urban socio-environmental conditions can affect the development and course of numerous health problems. The aim of this paper is to investigate the impact an urban regeneration programme can have on everyday functioning, coping and recovery for people with a mental illness. We were also interested in discerning which component parts of the regeneration are the most important in positively affecting people with mental illness. These questions were explored through an in-depth qualitative case study of the Gospel Oak neighbourhood in London, which recently underwent an intensive urban regeneration programme. Interviews and focus groups were conducted with residents living with a mental illness (n = 16). Relevant participant observation was also conducted. Participants reported that interventions that improved community safety were by far the most important in affecting everyday coping and functioning. Interventions that improved the quantity and quality of shared community facilities had a positive, but milder effect on mental health. Component parts that appeared to have little effect included environmental landscaping and greater community involvement in decision-making processes. Most participants reported that their mental illness was a consequence of severe insults over the life-span, for example childhood neglect or family breakdown. Thus, the regeneration was seen as something that could assist coping, but not something that could significantly contribute to complete recovery. Our results thus suggest that urban regeneration can have a mild impact on people with mental illness, but this appears to be outweighed by life-span experience of severe individual-level risk factors. That said, some of our findings converge with other studies indicating that community safety and community facilities can play a role in positively affecting mental health. Further ethnographic and epidemiological research is necessary to explore these two factors.

Adaptation, Psychological↗
PubMed2002

The Dar Es Salaam Urban Health Project, Tanzania: a multi-dimensional evaluation.

BACKGROUND: In the 1990s, as a response to rapid urbanization, there were a number of large, urban health initiatives in sub-Saharan Africa. Most tended to be comprehensive as opposed to selective in scope: they aimed at strengthening the health system as a whole, and placed emphasis on delivering improved services at the primary level, with increased community participation. A multi-dimensional approach is required to assess the achievements of such initiatives. METHODS: In 2000 an external evaluation of the Swiss-funded Dar es Salaam Urban Health Project, Tanzania, used 50 key informant interviews, 90 health facility exit interviews, 90 community resident interviews and document analysis to assess achievements over a 10 year period. The study considered achievements in terms of capacity building, improving quality of care, community involvement, inter-sectoral action and sustainability. RESULTS: Although the project achieved improvements in capacity building and in structural and technical quality of care, there were difficulties in generating inter-sectoral action and the concept of participation was limited. However, city-level 'ownership' of the activities was high, and, with the advent of sector-wide allocation of funds (SWAPs) in the health sector in Tanzania, the prospects for sustainability of the achievements made in the project appear to be good. CONCLUSION: Both the multi-dimensional method of the evaluation and the findings can inform future urban health initiatives in sub-Saharan Africa and in other resource-constrained environments. The decentralization that occurred in Dar es Salaam and the general approach of the project provided a platform to test out various elements that are common to health sector reform across developing countries.

Community Health Centers↗
PubMed2006

Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life.

OBJECTIVES: To identify factors associated with the use of selected medical services near the end of life in cognitively impaired residents of rural and urban nursing homes. DESIGN: Retrospective cohort study using Centers for Medicare and Medicaid Services administrative data for 1998 through 2002. SETTING: Minnesota and Texas nursing homes. PARTICIPANTS: Nursing home residents aged 65 and older with severe cognitive impairment who subsequently died during 2000/01. MEASUREMENTS: Minimum Data Set and Medicare Provider Analysis and Review, Hospice, and Denominator files were used to identify subjects and to assess medical service use. U.S. Department of Agriculture metro-nonmetro continuum county codes defined rural (codes 6-9) and urban (codes 0-2) nursing homes. Nursing home residents with hospice or health maintenance organization benefits were excluded. Use of hospital services at the end of life was adjusted for use of corresponding services before the last year of life. Outcome variables were feeding tube use, any hospitalization, more than 10 days of hospitalization, and intensive care unit (ICU) admission. RESULTS: The population included 3,710 subjects (1,886 rural, 1,824 urban). In multivariable logistic regression analyses (all P<.05), feeding tube use was more common in urban nursing home residents, whereas rural nursing home residents were at greater risk for hospitalization. CONCLUSION: Rural residence was also associated with lower risk of more than 10 days of hospitalization and ICU admission. Nonwhite race and stroke were associated with higher use of all services. Rural nursing home residence is associated with lower likelihood of use of the most-intensive medical services at the end of life.

Aged↗
PubMed1997

First-onset schizophrenia in the community: relationship of urbanization with onset, early manifestations and typology.

As part of a World Health Organization collaborative study in 12 centres in developing and developed countries within defined urban and rural catchment areas with populations of 348,786 and 103,865, respectively, a total of 155 and 54 cases of first-onset schizophrenia, respectively, were identified over a 24-month period by a comprehensive and active recruitment of all cases. Approximately 50% of the subjects in both cohorts were in the age range of 15-24 years. There was a preponderance of males in the younger age group and of females in the older age group. The majority of cases had no family history and had shown good adjustment in childhood and adolescence. The onset was much more frequently acute and much less often insidious in our samples and (more so in the rural cohort), compared to the figure for all developed countries' sites. With regard to early manifestations of the disorder, there was a much higher incidence of loss of interest in appearance and cleanliness, being irritable and angry without reason, and loss of appetite, sleep or interest in sex in both of our samples, and of being excited or overactive for days or weeks in our rural cohort than in the developed countries' centres as a whole. On the other hand, claiming impossible things, behaving as if hearing voices and feeling persecuted, harmed or bewitched were much less frequent in our rural cohort than in the urban cohort or the developed countries' centres as a whole. With regard to the clinical diagnosis of schizophrenia, paranoid, hebephrenic/disorganized and residual types were under-represented in our samples (more so in the rural sample), and catatonic type and acute schizophrenic episode were over-represented compared to the developed countries' centres. Moreover, the proportion of subjects of CATEGO class S+ was lower in our samples. With regard to onset, early manifestations and clinical subtypes of schizophrenia, our rural cohort deviated most from developed countries' centres as a whole, with our urban sample falling in between, thus indicating the role of socio-cultural factors in general, and urbanization in particular, in these variables in schizophrenia.

Acute Disease↗
PubMed2005

Malaria and urbanization in sub-Saharan Africa.

There are already 40 cities in Africa with over 1 million inhabitants and the United Nations Environmental Programme estimates that by 2025 over 800 million people will live in urban areas. Recognizing that malaria control can improve the health of the vulnerable and remove a major obstacle to their economic development, the Malaria Knowledge Programme of the Liverpool School of Tropical Medicine and the Systemwide Initiative on Malaria and Agriculture convened a multi-sectoral technical consultation on urban malaria in Pretoria, South Africa from 2nd to 4th December, 2004. The aim of the meeting was to identify strategies for the assessment and control of urban malaria. This commentary reflects the discussions held during the meeting and aims to inform researchers and policy makers of the potential for containing and reversing the emerging problem of urban malaria.

Africa South of the Sahara↗
PubMed2006

Spatial accessibility of primary care pediatric services in an urban environment: association with asthma management and outcome.

BACKGROUND: Disadvantaged urban children with asthma depend heavily on emergency departments (EDs) for episodic care. We hypothesized that among an urban population of children with asthma, higher spatial accessibility to primary care pediatric services would be associated with (1) more scheduled primary care visits for asthma, (2) better longitudinal asthma management, and (3) fewer unscheduled visits for asthma care. METHODS: We enrolled children aged 12 months to 17 years, inclusive, who sought acute asthma care in an urban pediatric ED. Eligibility criteria included a history of unscheduled visits for asthma in the previous year. We collected comprehensive data on each participant's asthma medical management and prior health care utilization. In addition, we calculated each participant's spatial accessibility to primary care pediatric services, reported as a provider-to-population ratio at their place of residence. Patients then were stratified by their spatial accessibility to care and compared with respect to measures of medical management and health care utilization. RESULTS: Among the 411 eligible participants, the spatial accessibility of primary care ranged from 7.4 to 350.2 full-time pediatric providers per 100,000 children <18 years of age, with a mean of 57.7 +/- 40.0. Patients in the middle and highest tertiles of spatial accessibility made significantly more scheduled visits for asthma care than patients in the lowest tertile. There were no differences among tertiles of accessibility with respect to asthma management or with respect to unscheduled visits for asthma care. CONCLUSIONS: Within this highly urban, largely disadvantaged and minority population of children with chronic asthma, patients with higher spatial accessibility to primary care services made significantly more scheduled visits for asthma care.

Adolescent↗
PubMedDate not supplied

Migration, employment and the urban labour market: a study in the Indian Punjab.

"Fears are often expressed that migration to the towns is a cause of surplus labour, increased unemployment, and the general decline in the quality of life in urban areas. In a detailed study of the interaction between migration and the urban labour market in an Indian city, the authors investigate these questions and show how the migrants fare as compared with the urban natives. They find no evidence that migrants are confined to marginal employment or contribute disproportionately to urban underemployment. Policy-makers are cautioned against adopting measures to curb migration, which is part of the process of economic growth and social advance, without first making a detailed assessment of its effects."

Asia↗
PubMed2002

Pattern of adolescent growth among the Brahmin girls--rural-urban variation.

A cross-sectional study of adolescent growth was undertaken among the Brahmin girls residing in rural and urban areas of Sagar districts, Madhya Pradesh to evaluate the urban-rural differences. Six anthropometric measurements, such as weight, stature, sitting height, head circumference, upper arm circumference and chest girth are taken into consideration. Though the urban girls show consistently higher values of weight, stature, sitting height and chest girth than the rural girls, but in case of head circumference and upper arm circumference they show consistently lower values. The maximum increment occurs between the ages 13 and 14 years in all the six measurements in both rural and urban girls.

Adolescent↗
PubMed2003

Is low immunisation coverage in inner urban areas of Australia due to low uptake or poor notification?

INTRODUCTION: The Australian Childhood Immunisation Register (ACIR) consistently reveals pockets of lower immunisation coverage in inner urban areas. We investigated whether low uptake or poor notification of immunisation is the main reason for this difference. METHODS: We estimated under reporting by telephone surveying the parents of 640 children recorded as incompletely immunised on the ACIR at 12 months of age. Immunisation status was based on parental report of written records and/or date of receipt. RESULTS: Of the 97 children living in inner urban areas (defined by postcode and population density), 55 (57%) were shown to be 'definitely immunised'. One hundred and thirty-four (53%) of the 253 children in other urban areas were shown to be 'definitely immunised'. Both these groups were significantly more likely to be 'definitely immunised' than the 104 (36%) of 290 children in areas outside capital cities (p < 0.0001). DISCUSSION: Apparent lower immunisation uptake in inner urban areas of Australia may be attributable to reporting error.

Australia↗
PubMed2003

Determinants of childhood mortality and morbidity in urban slums in India.

The large and continuous increase in India's urban population and the concomitant growth of the population residing in slums has resulted in overstraining of infrastructure and deterioration in public health. The link between urbanization, a degraded environment, inaccessibility to healthcare and a deteriorating quality of life is significant and particularly evident in the sharp inequities in IMR if one looks at urban specific studies. It is hence, germane to address the appalling inequalities in the distribution and access to basic amenities and health services with a focus on enhanced service coverage, improved sanitation and water supplies and mobilization of community action for effectively mitigating the childhood death and disease burden in urban slums.

Cause of Death↗
PubMed1991

The impact of urbanization on the health of black pre-school children in the Umtata district, Transkei, 1990.

The impact of rapid urbanisation on some aspects of child health in Transkei was assessed. The study area comprised clusters from urban, peri-urban and rural areas, giving a sample size of 1,080 children. Information collected included anthropometric measurements (weight and height), immunisation status, family socio-economic status, and practices regarding preventive health. The child's place of birth, maternal education and paternal support were also assessed. In the sample, 20.6% of children were born at home. Diarrhoea prevalence ranged from 18.3% in urban to 24.9% in peri-urban areas; 70.2% of mothers/carers knew about oral rehydration therapy and 56.3% had used it to treat diarrhoea, only 2.5% knew how to prepare the solution properly. Breast-feeding was practised early in life but by 1 year 74.6% of mothers had stopped; 54.9% started supplementary feeds by 1 month of age and by 4 months 89.6% of all children were on supplementary feeds. Of the children, 9.5% were underweight, 25.5% were stunted and 3.8% had acute protein energy malnutrition (wasting). Monthly per capita food expenditure was used to assess socio-economic status and 50% of all children came from homes spending R21,000 per person on food per month. Reasons for poor child health were examined and recommendations are made for promoting child health in the face of rapid urbanisation.

Black or African American↗
PubMedDate not supplied

A study of dental caries in rural and an urban primary school of Zambia.

320 children, 160 from a rural and 160 from an urban primary school were examined for dental caries. The urban children were found to have twice as much caries as their rural counterparts. Their D.M.F./df indices were also much higher. No significant sex difference was noted. The tribal distribution shows that the Tonga are the most susceptible tribe while the Lenje have the least caries. The relationship between caries and brushing habits, as well as consumption of confectionary was established. The commonest teeth affected and their relationship to age was also noted. It was concluded that urbanization has definitely contributed to the higher caries prevalence in the urban school children. Although the situation is not as bad as in the West, if it remains unchecked, 90% of the population may have caries in another 15 years.

Adolescent↗
PubMed1993

Cancer mortality by urbanization and altitude in a limited area in Northeastern Italy.

The geographical patterns of cancer mortality have been studied in Friuli-Venezia Giulia Region (1.2 million inhabitants), the North-eastern part of Italy, with respect to certain characteristics (i.e., rural, mixed, urban) and the altitude of the commune where the deceased subjects lived permanently at the time of death. In males, significantly increased mortality rates in rural versus urban communes (after allowance for altitude) were found for cancer of the oral cavity and pharynx, oesophagus and stomach. Conversely, significantly decreased mortality rates emerged for cancer of the colo-rectum, liver, lung, bladder, kidney and Hodgkin's disease. In females, significantly increased mortality rates in rural as compared to urban communes were observed for stomach cancer while significantly decreased mortality rates emerged for cancer of the colo-rectum, gallbladder, lung, breast, ovary, bladder and brain. With respect to altitude, residence above 200 meters retained a significant association in males, after allowance for the degree of urbanization of the commune of residence, for cancer of the oral cavity and pharynx, stomach and larynx (positive) and cancer of the colorectum and brain (negative). Women in locations above 200 meters seemed significantly at risk for stomach cancer, but protected from cancer of the colo-rectum and kidney. These results may provide a useful summary guide for further aetiological investigations into the risk factors associated with the diseases and give practical indications for local strategies of cancer control.

Adolescent↗
PubMed1993

Health care in China: a rural-urban comparison after the socioeconomic reforms.

This article provides an overview of the current Chinese health care system with particular emphasis on rural-urban differences. China's post-1978 economic reforms, although they improved general living standards, created some unintended consequences, as evidenced by the disintegration of the rural cooperative medical system and the sharp reduction in the number of "barefoot doctors", both of which were essential elements in the improvement of health status in rural China. The increase in the elderly population and their lack of health insurance and pensions will also place enormous pressure on services for their care. These changes have disproportionately affected the rural health care system, leaving the urban system basically intact, and have contributed to the rural-urban disparity in health care. Based on recent data the article compares current rural-urban differences in health care policy, systems, resources, and outcomes, and proposes potential solutions to reduce them.

Cause of Death↗
PubMed1997

Magnesium status and risk of coronary artery disease in rural and urban populations with variable magnesium consumption.

This survey was conducted to determine the association between amount of magnesium intake and prevalence of coronary artery disease (CAD) and coronary risk factors in north India. There were 3575 subjects aged 25-64 years including 1769 rural (894 men, 875 women) and 1806 urban (904 men, 902 women) subjects. The survey methods were questionnaires for 7-day food intake record, physical examination and electrocardiography using World Health Organization criteria. The overall prevalence of CAD was three-fold greater in urban compared to rural subjects (9.0 vs 3.3 per cent, p < 0.001). The prevalence of CAD was significantly higher among subjects consuming lower dietary magnesium. Lower magnesium status was inversely associated with risk of CAD in both rural and urban subjects in both sexes. Among subjects with low magnesium status, there was a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus showing a significant increasing trend with decrease in magnesium status. Multivariate logistic regression analysis after pooling of data from rural and urban subjects and after adjustment of age showed that magnesium intake had an inverse association with prevalence of CAD. Serum magnesium (odds ratio: men 1.14, women 1.05), dietary magnesium (men 1.21, women 1.12), serum cholesterol (men 1.15, women 1.15), blood pressure (1.26 men, women 1.21), diabetes mellitus (men 1.20, women 1.18) in both sexes and smoking in men (1.05) were significant risk factors of CAD. Lower consumption of dietary magnesium and low serum Mg level in north India have a higher prevalence of CAD and of the coronary risk factors hypertension, hypercholesterolemia and diabetes mellitus. It is possible that increased intake of magnesium to about 500 mg/day may be of benefit in the prevention of CAD.

Adult↗
PubMed1998

Consultations at central hospitals: reasons and outcome of referrals from urban clinics in Bulawayo, Zimbabwe.

OBJECTIVE: To quantify the main reasons for referral from urban primary health care clinics to central hospitals and to assess the outcome of such referrals in Bulawayo. DESIGN: Descriptive cross sectional study. SETTING: Mpilo Central Hospital, a quaternary level hospital and referral centre for urban clinics. SUBJECTS: 914 patients referred by urban clinics who attended the hospital in April and May 1995. MAIN OUTCOME MEASURES: Frequency of referrals by referrer, reasons for referral, outcome of referrals, diagnosis of admitted referrals. RESULTS: Of 914 referrals studied, 863 (94%) were made by registered general nurses and 51 (6%) by medical officers. Four hundred and forty four (49%) referrals made by registered general nurses were for doctors to establish the diagnosis, and 341 (37%) were for treatment or operation. The other referrals were for specialists to take over management, for advice on management and referral back to the clinic, and for the hospital to carry out specific tests. Of all referrals, 844 (92%) were consulted by generalist medical officers (GMOs), and only 70 (8%) by specialists. A total of 148 (16%) patients were admitted. Of these, 84 (57%) were females and 47% of admissions were aged 15 years or more. Nine (18%) of 51 referrals made by medical officers were admitted compared to 139 (16%) of 863 by registered general nurses. The rate of admission was not different by referrer (p = 0.7). CONCLUSIONS: The main reasons for referral from urban clinics to central hospitals are for doctors to either establish the diagnosis or provide treatment. There is scope for reducing the number of referrals made primarily for these reasons if a secondary or tertiary level of care institution is availed to Bulawayo and/or if clinic operations are reorganized to make medical officers' advice more accessible to registered general nurses during working hours.

Adolescent↗
PubMed2000

Preventive services for rural and urban African American adults.

BACKGROUND: Studies have shown that African Americans and rural patients receive fewer preventive services than other patients. OBJECTIVE: To compare the use of preventive services by African Americans in urban and rural settings to determine if race and rural residence were additive risks for not obtaining preventive services. METHODS: Three hundred African American patients seeking care in family practices in South Carolina were surveyed about preventive health care. RESULTS: Rural and urban African Americans were equally likely to know about preventive services and be up-to-date on receiving these services. In both practices, those with lower incomes were less likely to be up-to-date. Patients seen in the urban setting were more likely to receive counseling regarding exercise and smoking than those in the rural practice (87% vs 71%, P = .003). CONCLUSIONS: For both urban and rural African American patients with access to primary care physicians, preventive service use is high. The best predictor of poor compliance with preventive service recommendations was low income, suggesting that a lack of access to care is the primary reason why rural and African American populations do not receive adequate preventive health care.

Adult↗
PubMed2001

Urban-rural differences in the quality of care for medicare patients with acute myocardial infarction.

BACKGROUND: There are urban-rural differences in health care utilization in Kansas. This study was conducted to determine if similar differences exist in the quality of inpatient care provided for patients with acute myocardial infarction (AMI). METHODS: All acute care hospitals in the state were stratified into 12 urban, 31 semirural, and 76 rural hospitals according to their location. Data from medical records of 2521 Medicare patients 65 years and older who had survived AMI and were discharged alive from hospitals during an 8-month period in 1994/1995 were abstracted. The measures of the quality of care (quality indicators [QIs]) were the use of aspirin (during hospital stay and at discharge) and the administration of beta-blockers, intravenous (IV) nitroglycerin, heparin, and reperfusion by thrombolytic therapy or primary angioplasty. RESULTS: A significantly higher proportion of ideal candidates for the use of aspirin during hospital stay and at discharge, heparin, and IV nitroglycerin received these medications in urban hospitals, and a lower proportion of similar patients received these medications in rural hospitals compared with the patients in semirural hospitals (P<.001). Similar trends in each of the 6 QIs were observed for less than ideal patients (P<.05). Patient age was associated with a relatively poor quality of care in terms of the 6 QIs. Except for the administration of IV nitroglycerine to less than ideal patients, age adjustments did not change the observed urban-rural differences in the QI measures. CONCLUSION: Relatively poor quality of care for patients with AMI was provided by rural hospitals where greater opportunity for improvement exists.

Adrenergic beta-Antagonists↗