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PubMed2002

The use of GIS for monitoring and predicting urban growth in east and west St Paul, Winnipeg, Manitoba, Canada.

Most urban growth in Canada occurs in the urban-rural fringe. The increasing dispersal of the Canadian urban population is due to centrifugal forces pulling urbanites past the suburbs into the surrounding exurban communities. Most Canadian urban centres are located on prime agricultural land. Exurban sprawl devours an inordinate amount of the better agricultural land. The growth around the city of Winnipeg is a case in point. Within Winnipeg's urban field are the rural municipalities of East and West St Paul. The objective of this study is to investigate the impact of urban growth on the agricultural land of these RMs as well as the rate of urban growth in both Municipalities based on database analysis using aerial photographs taken in 1960 and 1989 and Geographic Information System (GIS). East St Paul was found to have a higher rate of urbanization (from 10.14% to 43.75%) between 1960 and 1989 than West St Paul (from 7.36% to 23.57%). The growth prediction using Markov probability chain analysis showed that East St Paul will henceforth experience a reduced rate of increase than West St Paul. The rate of urbanization for both RMs is found to be comparable with areas surrounding other major cities such as Toronto. The largest increases in urban land use categories occurred in and around the existing exurban settlements. It was found that most urbanization take place on the most fertile soil.

Cities↗

PubMed1997

Urban birth and residence as risk factors for psychoses: an analysis of 1880 data.

It is known that social drift to cities increases the urban prevalence for severe mental illnesses. Recent studies in England and Sweden have reported that being born in, or raised in, an urban area is also a risk factor for later developing schizophrenia. The present study utilized 1880 census data, the most complete enumeration of severely mentally ill individuals ever done in the United States, to examine the association of urban residence and severe mental illnesses. Individuals identified as having one of seven forms of 'insanity' (n = 91959) were allocated to their county of origin (n = 2661) in the census. Rates of 'insane' persons per 1000 population were calculated for each county. The counties were then divided by degree of urbanization based on the largest cities and the percentage of population living in towns of 4000 or more. The point prevalence of 'insanity' in the United States as a whole in 1880 was 1.8 per 1000. There was a significant association between 'insanity' by county and degree of urbanization, with odds ratios of 1.66 for urban, 1.46 for semi-urban, and 1.44 for semi-rural, and 1.37 for rural, using completely rural counties as a baseline. Most completely rural counties with high rates included mining camps, lumbering camps, or fishing villages, and not farming areas. In addition to urban drift, urban birth and residence appear to be risk factors for developing severe mental illnesses. Psychological and biological explanations have both been proposed. However, recent studies reporting winter birth and urban birth or residence as synergistic risk factors favor the latter.

Cluster Analysis↗

PubMed2000

[Tuberculosis control of urban areas in Japan].

The rates of tuberculosis remain high in urban areas. The declining speed of tuberculosis incidence rate in urban areas has been slower than other areas. Efforts and resources to tuberculosis control must be concentrated on urban locations to eradicate tuberculosis in Japan. 1. Tuberculosis control in a public health center of urban area: Teru OGURA and Chiyo INOGUCHI (Toshima City, Ikebukuro Public Health Center, Tokyo Metropolitan) A wide range of TB control measures is implemented by public health centers, such as a patient registration, home-visit guidance, contact examination in urban areas. Directors of every health center have the direct responsibility for tuberculosis control measures in their jurisdiction. Ikebukuro is urban areas where there are many offices, shopping and amusement facilities. Urban people is often on the move looking for job, so public health centers are often not easy to carry out contact examinations as planned. In recent years, homelessness has been recognized as a growing urban social problem. Their incidence of tuberculosis is high. Special TB control program must be carried out in urban areas. 2. Tuberculosis Control in Tokyo Metropolitan: Kazumasa MATSUKI (Department of Infectious Diseases and Tuberculosis, Bureau of Public Health, Tokyo Metropolitan) There has been a steady decline in the TB wards. The beds for TB patients are running short and even smear positive TB cases cannot be put in a hospital without waiting several days. Staffs of an urban emergency department must protect tuberculosis infection by environmental controls of emergency room. Tokyo Metropolitan government supports the engineering improvements of emergency room to hospitals. Directly observed therapy for tuberculosis patients at a district has been implemented to complete their therapy. On DOT, a trained health worker observes the patient take anti-TB medication. 3. Usefulness of Molecular Epidemiologic approach on Tuberculosis Control: Atsushi HASE (Osaka City Institute Laboratory of Health and Environment) DNA fingerprinting establishes the genetic relatedness of Mycobacterium tuberculosis isolates and has become a powerful tool in tuberculosis epidemiology. To use DNA fingerprinting to assess the efficacy of current tuberculosis infection-control practices. Combining conventional epidemiologic techniques with DNA fingerprinting of M. tuberculosis can improve the understanding of how tuberculosis is transmitted. Patients were assigned to clusters based on mycobacterial isolates with identical DNA fingerprints. Clusters were assumed to have arisen from recent transmission. We analyzed M. tuberculosis isolates from patients reported to the tuberculosis registry by RFLP techniques. These results were interpreted along with demographic data. Patients infected with the same strains were identified according to their RFLP patterns, and patients with identical patterns were grouped in clusters. RFLP patterns of high incidence districts have more variations than other areas. This suggests that the source of tuberculosis infection are quite diverse and complicated. Tuberculosis patients may accumulate to high incidence districts from other places after infection. 4. Structure of High Incidence of Tuberculosis and Control Plan in Osaka City: Yoichi TATSUMI (Bureau of Infection Control, Osaka City Office) The case notification rate in Osaka City is the highest in Japan. That of all TB cases and smear positive TB cases was 1573 and 216 per 100,000 population in 1997 at Airin District in Osaka City. The main reason for this highest incidence rate is that there are many homeless people and it is a mobile population. Most of residents are daily laborers. They come from all over Japan and stay there, mainly in rented rooms, to look for jobs. Thousands of homeless people also live in tents on streets or in parks. We are making to new strategic plan to intensify tuberculosis control measures throughout the city. Osaka city government h

Ill-Housed Persons↗

PubMed2001

Urban expansion and the loss of prime agricultural lands in Puerto Rico.

In many countries where the economy has shifted from mainly agricultural to industrial, abandoned agricultural lands are lost to urbanization. For more than 4 centuries the Puerto Rican economy depended almost entirely on agriculture, but sociopolitical changes early in the 20th century resulted in a shift to industry. This shift in the economy, and an increase in population, has resulted in an increase in urban areas. This study describes the rate and distribution of urban growth on the island of Puerto Rico from 1977 to 1994 and the resulting influence on potential agricultural lands. Urban extent and growth were determined by interpreting aerial photographs and satellite imagery. The 1994 urban coverage was combined with a soil coverage based on agricultural potential to determine the distribution of urban areas relative to potential farmlands. Analyses showed that in 1977, 11.3% of Puerto Rico was classified as urban. After 17 years, urban areas had increased by 27.4% and urban growth on soils suitable for agriculture had increased by 41.6%. This represents a loss of 6% of potential agricultural lands. If this pattern of encroachment by urban growth into potential farmlands continues, Puerto Rico's potential for food production in the future could be greatly limited.

Agriculture↗

PubMed2005

Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study.

OBJECTIVE: To estimate the burden of rheumatic disorders in adults (age >/= 15 yrs) in Bangladeshi rural and urban communities. METHODS: The survey was carried out in a rural community, an urban slum, and an affluent urban community with samples of 2635, 1317, and 1259 adults, respectively. Through door-to-door surveys, trained interviewers identified subjects with musculoskeletal pain. A socio-culturally adapted and validated Bengali version of the COPCORD (Community Oriented Program for Control of Rheumatic Disorders) questionnaire was used. Trained internists and rheumatologists examined the positive respondents using an English COPCORD examination sheet to identify respondents with definite rheumatic disorders and to reach a diagnosis. RESULTS: The overall point prevalence of musculoskeleletal pain was 26.3%. The point prevalence estimates of musculoskeletal pain in rural, urban slum, and affluent urban communities were 26.2% (women 31.3%, men 21.1%), 24.9% (women 27.5%, men 22.6%), and 27.9% (women 35.5%, men 18.6%), respectively. Most commonly affected sites were low back, knees, hips, and shoulders in all 3 communities. The point prevalence of definite rheumatic disorders was 24.0%. The commonest rheumatic disorders were osteoarthritis of the knees, nonspecific low back pain, lumbar spondylosis, fibromyalgia, and soft tissue rheumatism. Their prevalence estimates were 7.5%, 6.6%, 5.0%, 4.4%, and 2.7%, respectively, in the rural, 9.2%, 9.9%, 2.0%, 3.2%, and 2.5%, respectively, in the urban slum, and 10.6%, 9.2%, 2.3%, 3.3%, and 3.3% in the urban affluent community. The point prevalence of functional disability was 25.5%, 23.3%, and 24.8%, respectively, in the rural, urban slum, and urban affluent communities. Among the positive respondents, 22%, 52%, and 22% reported loss of work for durations of 49.3 +/- 47.5, 50.90 +/- 103.3, and 29.25 +/- 56.5 days, respectively, within the previous year. CONCLUSION: Rheumatic disorders are common causes of morbidity, disability, and work loss in rural and urban communities of Bangladesh. Women are affected more frequently than men. Mechanical disorders are more common than inflammatory arthropathies.

Adult↗

PubMedDate not supplied

Age variation in blood pressure: effect of sex and urbanization in a genetically homogeneous caste population of Andhra Pradesh.

Age variation in blood pressure and prevalence of hypertension were studied in relation to sex and urbanization in a caste population of southern Andhra Pradesh living in rural, semi-urban, and urban locales. There is an increase in mean blood pressure from rural to semi-urban areas, and a slight but insignificant decline in urban men. Sex differences in mean blood pressure are significant only in the urban and semi-urban environments. However, the increase in blood pressure with age is sharper in women than in men, and age effects are more perceptible in the urban setting compared to the other two environments. Similarly, age influences SBP more strongly than DBP. The prevalence of hypertension is greater in urban than in rural areas, at older ages (> or = 45 years), and in men compared to women. Results of multiple logistic regression suggest that urban residence and alcohol consumption are associated with increased risk of hypertension in men. Higher risk for hypertension in women is more significantly associated with older age (> or = 45) and obesity (BMI > 25). The results indicate that blood pressure and hypertension are more strongly correlated with the indices of modernization and associated lifestyle patterns in men than in women.

Adult↗

PubMed2006

Land-cover changes in an urban lake watershed in a mega-city, Central China.

Urbanization can exert a profound influence on land covers and landscape characteristics. In this study, we characterize the impact of urbanization on land cover and lacustrine landscape and their consequences in a large urban lake watershed, Donghu Lake watershed (the largest urban lake in China), Central China, by using Landsat TM satellite images of three periods of 1987, 1993 and 1999 and ground-based information. We grouped the land covers into six categories: water body, vegetable land, forested land, shrub-grass land, open area and urban land, and calculated patch-related landscape indices to analyze the effects of urbanization on landscape features. We overlaid the land cover maps of the three periods to track the land cover change processes. The results indicated that urban land continuously expanded from 9.1% of the total watershed area in 1987, to 19.4% in 1993, and to 29.6% in 1999. The vegetable land increased from 7.0% in 1987, 11.9% in 1993, to 13.9% in 1999 to sustain the demands of vegetable for increased urban population. Concurrently, continuous reduction of other land cover types occurred between 1987 and 1999: water body decreased from 30.4% to 23.8%, and forested land from 33.6% to 24.3%. We found that the expansion of urban land has at least in part caused a decrease in relatively wild habitats, such as urban forest and lake water area. These alterations had resulted in significant negative environmental consequences, including decline of lakes, deterioration of water and air quality, and loss of biodiversity.

Agriculture↗

PubMed2005

Caregivers's knowledge, attitude and practice on childhood malaria and treatment in urban and rural communities in Enugu, south-east Nigeria.

OBJECTIVE: To ascertain caregivers's knowledge, attitude and practice regarding malaria and treatment of children in rural and urban communities in Enugu, Nigeria. STUDY DESIGN: This was a cross-sectional study, and caregivers were selected by convenience sampling. METHOD: In total, 224 and 184 respondents were interviewed in paediatric outpatient clinics in rural and urban areas, respectively, using structured questionnaires. RESULTS: Most respondents in rural and urban areas has heard of malaria (99% urban, 74% rural; P < or = 0.05). Both groups were unaware of the particular susceptibility of children and pregnant women to the disease, and respondents preferred to use self-medication (urban 79%, rural 20%). The rural and urban caregivers were quite familiar with and used antimalarial drugs such as chloroquine (urban 23%, rural 15%) and sulphadoxine-pyrimethamine (urban 50%, rural 6%), although in inappropriate dosages. They were also aware of preventive measures against malaria such as insecticide-treated nets (urban 32%, rural 56%), but there was low usage in both communities (7 and 2%, respectively). CONCLUSIONS: Both rural and urban communities were aware of malaria as a disease, but practices were grossly inadequate. The provision of affordable healthcare facilities and the use of health education to change knowledge, attitude and practice will help meet the target goals of the 'Roll Back Malaria' campaign in the area.

Caregivers↗

PubMed2000

Nutrient intake of adult women in Jilin Province, China, with special reference to urban-rural differences in nutrition in the Chinese continent.

OBJECTIVES: The objectives of this study were to investigate possible urban-rural differences in food intakes in Jilin province and in continental China as a whole, and to examine possible implications for nutritional status of urban and rural populations. DESIGN: Cross-sectional study. SETTING: Communities. SUBJECTS: In total, 499 adult women in six urban sites and four rural sites, 10 sites in total, including two sites in Jilin province. METHODS: A pair of surveys were conducted in September, 1999, in the provincial capital of Changchun and a farming village in Dehui county, both in Jilin province, in northeast China. Each of 50 adult women per survey site provided a 24 h duplicate food sample and a blood sample, and had an interview on health history including anthropometry and blood pressure measurement. Nutrient intakes were estimated from the food duplicates, using national food composition tables. Results from the two sites were supplemented with data from eight sites where surveys had been conducted following the same protocol, and the pooled material were subjected to analyses for possible urban-rural differences. RESULTS: The Jilin participants consumed daily, on average, about 1600 kcal energy, 44 g protein, and 60 g lipid with a lipid energy ratio (i.e. the ratio of lipid over total nutrients in terms of energy) of 33%. When nutrient intakes were compared between the urban (i.e. Changchun) and rural (Dehui) groups, urban women consumed more energy, protein (especially animal protein) and lipid than rural women. Similar examination of data from six urban and four rural sites, including the present two, showed that adult women in urban areas eat more animal protein and animal fat than their counterparts in villages, and suggested that the observation on urban rural difference in Jilin province can be extrapolated to a nationwide scale. CONCLUSIONS: Urban rural differences in nutrient intakes still persist in 1999 not only in Jilin but in other provinces, typically in the terms of intakes of animal-based foods.

Adult↗

PubMed2002

Physical activity and its relationship with obesity, hypertension and diabetes in urban and rural Cameroon.

OBJECTIVES: To evaluate and compare physical activity patterns of urban and rural dwellers in Cameroon, and study their relationship with obesity, diabetes and hypertension. METHODS: We studied 2465 subjects aged >or=15 y, recruited on the basis of a random sampling of households, of whom 1183 were urban dwellers from Yaoundé, the capital city of Cameroon and 1282 rural subjects from Bafut, a village of western Cameroon. They all had an interviewer-administered questionnaire for the assessment of their physical activity and anthropometric measurements, blood pressure and fasting blood glucose determination. The procedure was satisfactorily completed in 2325 (94.3%) subjects. Prevalences were age-adjusted and subjects compared according to their region, sex and age group. RESULTS: Obesity was diagnosed in 17.1 and 3.0% urban and rural women, respectively (P<0.001), and in 5.4 vs 1.2% urban and rural men, respectively (P<0.001). The prevalence of hypertension was significantly higher in urban vs rural dwellers (11.4 vs 6.6% and 17.6 vs 9.1% in women and men, respectively; P<0.001). Diabetes was more prevalent in urban compared to rural women (P<0.05), but not men. Urban subjects were characterized by lower physical activity (P<0.001), light occupation, high prevalence of multiple occupations, and reduced walking and cycling time compared to rural subjects. Univariate analysis showed significant associations between both physical inactivity and obesity and high blood pressure. The relationship of physical inactivity with hypertension and obesity were independent in both urban and rural men, but not in women. Body mass index, blood pressure and glycaemia were higher in the first compared with the fourth quartiles of energy expenditure. CONCLUSION: Obesity, diabetes and hypertension prevalence is higher in urban compared to rural dwellers in the populations studied. Physical activity is significantly lower and differs in pattern in urban subjects compared to rural. Physical inactivity is associated with these diseases, although not always significant in women.

Adult↗

PubMed1996

Effect of economic reforms on child growth in urban and rural areas of China.

BACKGROUND: Beginning in 1978, China implemented economic reforms to transform the economy to a free-market system. We compared the effect of the reforms on the growth of children in urban and rural areas. METHODS: Using data from five large cross-sectional surveys conducted between 1975 and 1992, we examined the trends in height for age of children two to five years of age in urban and rural areas. Mean height for age was expressed as the height in centimeters adjusted to a reference value of 99.1 cm for a 42-month-old boy. RESULTS: Height increased before and during the economic reforms. In 1975, the average height of children in periurban rural areas was about 3.5 cm less than that of children in urban areas. Between 1975 and 1985, the average height of children in periurban rural areas increased by 2.0 cm, as compared with 1.3 cm in urban children. Between 1987 and 1992, the average height of both urban and rural children increased, but the net increase for rural children was only one fifth that for urban children (0.5 vs. 2.5 cm). In a 1990 survey of seven provinces, the rural mean height was 92.5 cm, as compared with the urban mean of 96.9 cm and the reference value of 99.1 cm; 38 percent of rural children had moderate stunting of growth and 15 percent had severe stunting, as compared with 10 percent and 3 percent of urban children, respectively. Differences in height between rural and urban children were greater in provinces in which the average height of children was lower. CONCLUSIONS: Despite an overall improvement in child growth during the economic reforms in China, the improvement has not been equitable, as judged by increased differences in height between rural and urban children and increased disparities within rural area.

Adolescent↗

PubMed1997

Epidemiologic study of trace elements and magnesium on risk of coronary artery disease in rural and urban Indian populations.

OBJECTIVE: To determine the association of trace elements and magnesium with risk of coronary artery disease (CAD) in rural and urban populations of India. DESIGN AND SETTING: Cross-sectional surveys on the randomly selected municipal streets in Moradabad city and one village in Moradabad tahsil in North India. SUBJECTS AND METHODS: There were 162 rural (86 men and 96 women) and 152 urban (80 men and 72 women) subjects between 26 to 65 years of age. Evaluations were obtained by physician- and dietitian-administered, validated questionnaires, physical examination, electrocardiogram and blood examination. RESULTS: The prevalence of CAD and coronary risk factors was 2.5 times higher in the urban population compared to rural subjects (8.6 vs. 3.0%). In rural subjects, dietary intakes and plasma levels of vitamins and minerals were comparable with those of urban subjects except for higher dietary intake of magnesium in rural subjects and higher plasma vitamin A level in urban subjects. In both rural and urban subjects, low serum zinc (80 +/- 82 vs. 110 +/- 11.0 micrograms/dl, p < 0.05) and magnesium levels (1.60 +/- 0.36 vs. 1.71 +/- 0.41 mEQ/L, p < 0.05) and lower zinc/copper ratio (0.58 +/- 0.08 vs. 1.11 +/- 0.25 p < 0.50) were inversely associated with CAD. Serum levels of copper and iron were significantly higher and plasma levels of antioxidant vitamins A, E and C and beta-carotene were significantly lower in patients with CAD compared to the rest of the subjects. In both rural (7.1 +/- 1.2 mg/day) and urban subjects (8.6 +/- 1.6 mg/day), zinc consumption was half of the recommended dietary allowances. Higher prevalence of CAD in urban compared to rural subjects was attributed to higher dietary fat intake and higher prevalence of risk factors in urban subjects. CONCLUSIONS: The findings suggest that lower serum levels of zinc and magnesium and lower zinc copper ratio were inversely associated with CAD. It is possible that urban populations with higher risk of CAD may benefit by decreasing dietary fat intake and by increasing their intake of foods rich in zinc and magnesium.

Adult↗

PubMed1997

Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India.

OBJECTIVE: This study was conducted to determine and compare the prevalence of coronary artery disease and coronary risk factors in both a rural and an urban population of Moradabad in north India. DESIGN AND SETTING: A cross-sectional survey of two randomly selected villages from the Moradabad district and 20 randomly selected streets in the city of Moradabad. SUBJECTS AND METHODS: The 3575 subjects were between 25 and 64 years old; 1769 (894 men and 875 women) lived in the countryside and 1806 (904 men and 902 women) lived in the city. The survey methods were questionnaires, physical examination and electrocardiography. RESULTS: The overall prevalence of coronary artery disease, based on a clinical diagnosis and an electrocardiogram, was 9.0% in the urban and 3.3% in the rural population. The prevalences were significantly (P < 0.001) higher in the men compared with the women in both urban (11.0 vs 6.9%) and rural (3.9 vs 2.6%) populations, respectively. The prevalence of symptomatic coronary artery disease (known coronary disease and Rose questionnaire-positive angina) was 2.3% in the men (n = 19) and 1.5% in the women (n = 13) in the rural subjects, and 8.5% in the men (n = 77) and 3.4% in the women (n = 31) in the urban population. When diagnosed on the basis of electrocardiographic changes alone, the prevalences were 1.5% (n = 26) in the rural population and 3.0% (n = 55) in the urban. Coronary risk factors were two- or three-fold more common among urban subjects compared to the rural population in both sexes. Central obesity was four times more common in the urban population compared to the rural in both sexes. Sedentary lifestyle and alcohol intake were significantly (P < 0.01) higher in the urban population compared to the rural subjects. There was a significant association between coronary disease and age, hypercholesterolaemia, hypertension and central obesity in both sexes. Smoking was a significant risk factor of coronary disease in men. CONCLUSIONS: Coronary artery disease and coronary risk factors were two or three times higher among the urban compared with the rural subjects, which may be due to greater sedentary behaviour and alcohol intake among urbans. It is possible that some Indian populations can benefit by reducing serum cholesterol, blood pressure and central obesity and increasing physical activity.

Adult↗

PubMed2004

Cancer and cancer risk in South Australia: what evidence for a rural-urban health differential?

OBJECTIVE: To determine the extent of evidence for a rural-urban health differential in cancer and cancer risk in South Australia. DESIGN: Secondary analysis and synthesis of data available between 1977 and 2000 from the publications of the South Australian Cancer Registry and reports of population health surveys carried out by the South Australian Department of Human Services. RESULTS: The mean annual age-standardised incidence of all forms of cancer combined was about 4% lower for rural residents (265.2 per 100,000 cf. 274.9 per 100,000). Of 31 types of cancer listed, the incidence of three was significantly higher among rural residents, the incidence of eight was significantly higher among urban residents and for 20 types there was no significant difference. Five year case survival for all cancers combined was 52% in both urban and rural residents. Significant survival differences were identified for only 10 cancers and survival for each was higher among urban residents. Melanomas were diagnosed in situ more often in the country, but invasive cases tended to be thicker. There was no rural-urban difference in early detection rates for breast cancer or bladder cancer. There were no substantial reported differences in major risk factors and early detection experiences apart from higher rates of smoking in the country. CONCLUSIONS: There is little evidence for substantial or systematic differences in risk factors for, and incidence and early detection of cancers between urban and rural South Australia. However, the apparent consistently poorer survival among rural residents warrants further study. WHAT THIS PAPER ADDS: It is widely reported that the health status of rural Australians is worse than that of their urban counterparts. There is an apparent increasing gradient in mortality from urban to remote areas of Australia. However, this apparent gradient is not evident for all diseases. This paper seeks to answer the question: is there any difference in the cancer disease experience (incidence, survival and early detection) and cancer risk factors between residents of rural and urban South Australia. Cancer registry data indicate that overall, the incidence of cancer is similar in rural and urban South Australia. The findings on survival differentials are of concern. While overall survival rates are very similar in country and city, and this is encouraging, analysis of individual types of cancer raises some concerns. The registry reports that significant differences in survival were only measured for 10 cancers and for all of these rural residents experienced higher mortality rates.

Adolescent↗

PubMed2005

Motivations and perceived influences on rural and urban general practitioners when prescribing conventional non-steroidal anti-inflammatory drugs or COX-2 inhibitors.

BACKGROUND AND OBJECTIVE: Prescribers in rural and remote locations perceive that there are different influences on their prescribing compared with those experienced by urban prescribers. The aim of this study was to compare the motivations and perceived influences on general practitioners (GPs) when prescribing COX-2 inhibitors rather than conventional non-steroidal anti-inflammatory drugs (NSAIDs) between rural and urban-based GPs in Queensland, Australia. METHODS: A questionnaire was administered to two geographically distinct groups of GPs, one urban (n=67) and one rural (n=67), investigating the reasons that the GP would prescribe a COX-2 inhibitor rather than a conventional NSAID or vice versa and also focusing on patients requesting a prescription for a COX-2 inhibitor. RESULTS AND DISCUSSION: A 51% response rate (n=68) was achieved. The difference between the rural and the urban GPs was that the urban GPs were more likely to perceive that they were influenced to prescribe COX-2 inhibitors by their patients' knowledge of these new (at the time) drugs. GPs in both the rural and urban areas perceived the COX-2 selective inhibitors to be safer than conventional NSAIDs, and that there was little difference in terms of efficacy between the two drug classes. However, GPs from both of the study areas stated that conventional NSAIDs were preferred over COX-2 selective inhibitors, primarily due to their expense, if their patients were not at risk for developing a GI bleed. CONCLUSION: The motivations and perceived influences to prescribe a COX-2 inhibitor in rural and in urban areas of Queensland, Australia were very similar. Almost all surveyed GPs in rural and urban areas had patients request a prescription, or enquire about the COX-2 inhibitors. Urban GPs were more likely to feel pressured to prescribe a COX-2 inhibitor than their rural counterparts, agreeing with other research which found that patient pressure to prescribe appears to be greater in urban general practice.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1998

Urban-rural variations in health in The Netherlands: does selective migration play a part?

STUDY OBJECTIVE: Urban-rural health differences are observed in many countries, even when socioeconomic and demographic characteristics are controlled for. People living in urban areas are often found to be less healthy. One of the possible causes for these differences is selective migration with respect to health or health risk factors. This hypothesis is hardly ever empirically tested. This paper tries to assess the existence of selective urban-rural migration. DESIGN: Health indicators and health risk factors were measured in a 1991 population sample. Moves were registered between 1991 and 1995. Using logistic regression analyses, comparisons were made between, firstly, urban to rural movers and rural to urban movers and secondly, between movers and stayers. SETTING: Region surrounding the city of Eindhoven in south eastern part of the Netherlands. SUBJECTS: Data were used of 15,895 respondents aged 20-74 in 1991. By 1995 613 subjects had moved from urban to rural and 191 subjects from rural to urban. MAIN RESULTS: Bivariate nor multivariate analyses show hardly and differences between movers into urban and movers into rural areas. Bivariate analyses on movers and stayers show that movers are healthier than stayers. However, when socioeconomic and demographic variables are controlled for, movers appear to be less healthy, with the exception of the younger age groups. CONCLUSIONS: Areas that attract many migrants from and lose few migrants to other degrees of urbanicity will in the long run obtain healthier populations, because of demographic and socioeconomic characteristics. However, if these characteristics are accounted for, the opposite is true, with the exception of younger age groups. In extreme cases this may cause spurious findings in cross sectional research into the relation between urbanicity and health. Absolute numbers of migrants need to be very high, however, to make this noticeable at the aggregate level.

Adult↗

PubMed1998

Prevalence and risk factors of HIV-1 and HIV-2 infection in urban and rural areas in Tamil Nadu, India.

We aim to study the factors associated with the prevalence of HIV-1 and HIV-2 infection in the urban and rural areas of Tamil Nadu, India. The population of Tamil Nadu is approximately 60 million. Between April 94 and March 95, 992 samples from 5 representative urban centres and 1071 samples from 5 representative rural centres were collected and studied. A questionnaire was administered privately and it preceded collection of each sample. Samples were screened using ELISA and antibodies to HIV-1 and HIV-2 were confirmed using Western blot. The study was anonymous and unlinked. The prevalence of HIV infection in urban and rural areas was 7.2% (95% CI=6.1 to 8.31%); HIV-1 antibodies were found in 7.4% (95% CI=5.8 to 9.2%) of urban and 7.0% (95% CI=5.6 to 8.7%) of rural population; HIV-2 antibodies were found in 0.8% of urban and 0.3% of rural population. Heterosexual transmission, more so among those with multiple partner sex, was the main mode; higher prevalence of HIV infection among divorced/single individuals both in urban (21.1%) and rural (26.1%) was found. HIV infection among housewives stood at 4.1% (urban) and 3.8% (rural). The strength of association between STDs and HIV was observed to be greater in rural subjects (OR=8.89; 95% CI=5.11 to 15.57) than in urban subjects (OR=1.9; 95% CI=1.14 to 3.18). The prevalence of condom use was found to be less than 2% in the study subjects. HIV-2 is not as widely prevalent in Tamil Nadu as HIV-1. In our study the most common risk factors for HIV infection that emerged were (a) having multiple sexual partners, and (b) history of STDs or Venereal Disease Research Laboratory (VDRL) reactivity. Mobility of individuals between urban and rural areas has furthered the dissemination of HIV infection. Low condom usage among study subjects questions the effectiveness of the existing AIDS awareness and education programme. The study indicates the importance of placing equal emphasis on HIV prevention in rural India. HIV infection among housewives in urban and rural areas is indicative of gender inequalities and the importance of empowering women to prevent infection from spouse.

Adult↗

PubMed2002

Increasing rural-urban gradients in US suicide mortality, 1970-1997.

OBJECTIVES: This study examined rural-urban gradients in US suicide mortality and the extent to which such gradients varied across time, sex, and age. METHODS: Using a 10-category rural-urban continuum measure and 1970-1997 county mortality data, we estimated rural-urban differentials in suicide mortality over time by multiple regression and Poisson regression models. RESULTS: Significant rural-urban gradients in age-adjusted male suicide mortality were found in each time period, indicating rising suicide rates with increasing levels of rurality. The gradient increased consistently, suggesting widening rural-urban differentials in male suicides over time. When controlled for geographic variation in divorce rate and ethnic composition, rural men, in each age cohort, had about twice the suicide rate of their most urban counterparts. Observed rural-urban differentials for women diminished over time. In 1995 to 1997, the adjusted suicide rates for young and working-age women were 85% and 22% higher, respectively, in rural than in the most urban areas. CONCLUSIONS: The slope of the relationship between rural-urban continuum and suicide mortality varied substantially by time, sex, and age. Widening rural-urban disparities in suicide may reflect differential changes over time in key social integration indicators.

Adolescent↗