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PubMed2002

Community medicine in action: an integrated, fourth-year urban continuity preceptorship.

OBJECTIVE: To provide an opportunity for fourth-year students at the University of Wisconsin Medical School in Madison to immerse in urban community medicine during a 34-week program. This experience enhances the integrity of the fourth year as well as merges medicine and public health perspectives in medical education as called for by the Medicine and Public Health Initiative. DESCRIPTION: A limited number of fourth-year Wisconsin medical students have the opportunity to select a one-year, continuity-based preceptorship at the Milwaukee clinical campus with a focus in one of three domains: family medicine, internal medicine, or women's health. Students participate in the following clinical activities: a one-year, integrated preceptorship (one to three half days per week in a primary preceptor's office), medicine subinternship, senior surgery clerkship, selectives (16-20 weeks of clerkships relevant to preceptorship focus area), and one month of out-of-city electives. Complementing this community-based clinical experience is the opportunity to develop an increased appreciation for urban community health issues and resources by participating in a required urban community medicine clerkship and a mentored student scholarly project focusing on an aspect of urban community medicine and population health. All students begin the year in July with a four-week urban community medicine clerkship, which is based on the St. Luke's family practice residency's community medicine rotation and arranged by residency faculty. They conduct a "windshield survey" of a Milwaukee neighborhood, observing health hazards and identifying assets, and then present these observations to others in the clerkship. During this first month, students are introduced to the work of a variety of social service agencies, the Milwaukee City Health Department, and the Aurora Health Care/UW community clinics, which serve the state's most diverse zip codes. They meet with providers and researchers who share their expertise in infectious disease, preventive medicine, perinatal epidemiology, domestic violence, sexual assault, and disease management. Students develop increased understanding of barriers to health and personal resilience by listening to focus groups conducted with homeless men and undocumented Latino women. They participate in a resident and faculty development retreat on enhancing community medicine knowledge and skills. By August, students select an advisor and outline a project designed to expand understanding in the areas of urban population health research, community health education, professional education, or health intervention planning and evaluation. Faculty members at the Center for Urban Population Health work closely with the students throughout the year, which includes two weeks in the spring that are dedicated to intensive work on the projects. DISCUSSION: This fourth-year, urban community-based preceptorship is designed to provide students with an alternative fourth year that integrates skill development in clinical and community medicine, offers a continuity primary care experience, and showcases innovative urban health resources and role models. It is hoped that these students will pursue graduate medical education in Milwaukee, incorporate a population perspective in their practice, and choose to work in neighborhoods that are currently underserved.

Community Medicine↗

PubMed1975

A study of attempted suicides in urban versus rural areas, with a follow-up.

The group of subjects consisted of 44 patients (attempters) who were admitted to hospital for treatment because of attempted suicide during a 3-month period in Norther Savo (in Eastern Finland), another 44 patients (non-attempters) admitted to hospital in the same period for other reasons serving as controls. The number of women was the same in both groups, and so was, in consequence, the number of men. The study compared the attempters with the non-attempters and, in addition, the patients coming from urban areas with those coming from rural areas, the ratio of the urban to the rural patients being the same in both groups. The study was based on personal psychiatric interviews with the patients, which took place in each case both immediately following the patient's admission and precisely 3 months afterwards. The results showed that schizophrenia was significantly more frequent in the rural than in the urban attempter group. By contrast, alcoholism and alcohol abuse were more frequent in the urban than in the rural attempter group. Compared with the urban patients, the rural patients tended to be physically more seriously desordered. Poisoning by drugs was a significantly more frequent means of attempted suicide in the urban than in th rural group. The patients in the latter group, again, had resorted oftener to the so-called "active" methods of attempted suicide. Of the attempters, 25% attempted suicide anew during the 3-month follow-up period, the corresponding figure for the non-attempter group being only 6%. During the follow-up period, a greater number of suicidal attempts was made by the patients in the rural group than by those in the urban group, and, as regards the intent to succeed, the attempts of the former were more serious than those of the latter. The so-called "active" methods were used more often by rural than by urban patients also during the follow-up period. All in all, the self-destructive behaviour exhibited during the follow-up period was graver in the rural than in the urban group.

Adult↗

PubMed1999

Rural and urban physicians: does the content of their Medicare practices differ?

Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the different specialties, diagnosis clusters, patient age and sex, and procedure frequency and type for board-certified rural and urban physicians in 12 ambulatory medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician-gynecologists, the diagnostic scope of practice was specialty-specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician-gynecologists had more visits out of their specialty domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physicians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rural and urban practitioners to care for the elderly is similar, rural general surgeons and obstetrician-gynecologists need training outside their traditional specialty areas to optimally care for their patients.

Aged↗

PubMed2006

Family decision-making for nursing home residents with dementia: rural-urban differences.

CONTEXT: Research has demonstrated substantial differences between end-of-life care in rural and urban settings. As the end of life approaches, rural elders are less likely to be hospitalized, to be placed in an intensive care unit, or to have a feeding tube, compared to their urban counterparts. These differences cannot be fully explained by rural-urban differences in access to medical services. PURPOSE: To describe and understand rural-urban differences in attitudes toward death and in end-of-life decision making. METHODS: Eight focus groups were convened in rural and urban Minnesota nursing homes. The 38 focus group participants were family members of nursing home residents with severe cognitive impairment. FINDINGS: Most rural focus group participants voiced unqualified acceptance of death and placed few conditions on death, beyond their hope that it would be quick and peaceful. Urban respondents presented a wider range of attitudes toward death, from unambiguous acceptance of immediate death to evident discomfort with welcoming death under any circumstances. These rural-urban differences had practical implications. Rural respondents were much less likely to endorse interventions that would impede death, compared to their urban counterparts. CONCLUSIONS: Rural respondents tended to express confidence in natural forces; death was seen as neutral or beneficent. Resistance to the approach of death was more characteristic of urban respondents, some of whom insisted upon aggressive medical care in advanced dementia.

Aged↗

PubMed2003

Incident cerebrovascular disease in rural and urban Alberta.

STUDY OBJECTIVE: This study examines the pattern of incidence and health service utilisation of cerebrovascular disease cases in urban and rural areas within a publicly funded health care system. DESIGN: A population-based study covering a large geographic region, using population-wide administrative health data. Age- and sex-standardised incidence and mortality rates were calculated for rural and urban areas. Final status (discharge or death), place of service and place of residence were reported for all cases across several different subsets of cerebrovascular disease. SETTING: The province of Alberta, located in western Canada. PARTICIPANTS: Incident cases of cerebrovascular disease (stroke and transient ischaemic attack) and 4 different definitions of incident stroke were identified from data on emergency department admissions in the 1999/2000 fiscal year. MAIN RESULTS: The rate of cerebrovascular disease per 10,000 was similar between urban (13.24) and rural (13.82) areas. Rural residents frequently reported their incident episode to urban emergency departments. Although the mortality is similar between urban and rural residents, rural dwellers die more frequently in the emergency department setting than urban dwellers, who die more often as in-patients. CONCLUSIONS: Overall mortality is similar between urban and rural residents. A large proportion of rural residents receive diagnoses and treatment for cerebrovascular disease in urban areas. Location of service and location of death differs between rural and urban cases of cerebrovascular disease.

Adolescent↗

PubMed1994

Flow rate and composition of whole saliva in rural and urban Tanzania with special reference to diet, age, and gender.

The association of flow rate and biochemical and microbiological characteristics of saliva with diet was studied in 83 12-year-old children and in 127 adults (84 in the age group 35-44 years, 43 in the age group 65-74 years) living in rural and urban communities in Tanzania. No significant differences were observed between the salivary flow rates of the rural and urban subjects. The mean salivary flow rates were slightly lower in women than in men and significantly lower in the 12-year-old children than in the two older age groups (p < 0.05). The buffer effect was higher in the rural than the urban population. Further, it was lower in women than in men (p < 0.001). Salivary protein, IgG, and sialic acid concentrations were significantly higher in the rural than in the urban population, whereas amylase activity and IgA concentrations were lower. Microbiological studies showed mutans streptococci in 97% of the rural and in 91% of the urban subjects (n.s.). Lactobacilli grew significantly less often in the rural than urban samples (p < 0.01). Analyses of 24-hour dietary recalls showed that the rural and urban diets differed. The proteins in the rural diet were largely of plant origin, while in the urban diet animal proteins dominated. The rural diet contained also less sucrose but more fibre (mainly from grain) than the urban diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Urban lymphatic filariasis in central Nigeria.

Wuchereria bancrofti and the other mosquito-borne parasites that cause human lymphatic filariasis (LF) infect over 120 million people world-wide. Global efforts are underway to stop transmission of the parasites, using annual, single-dose mass drug administrations (MDA) to all at-risk populations. Although most MDA to date have been in rural settings, they are also recommended in urban areas of transmission. It remains unclear whether there is significant urban transmission in West Africa, however, and the need for urban MDA in this region therefore remains a matter of debate.Clinic-based surveillance, for the clinical manifestations of LF, has now been used to identify areas of urban transmission of W. bancrofti in Jos, the major urban population centre of Plateau state, Nigeria. The eight clinics investigated were all located in slum areas, close to vector breeding sites, and were therefore considered to serve at-risk populations. Over a 1-month period, selected providers in these clinics sought hydrocele, lymphoedema, elephantiasis, or acute adenolymphangitis among the patients seeking treatment. The consenting patients who were suspected clinical cases of LF, and a cohort of patients suspected to be cases of onchocerciasis, were tested for W. bancrofti antigenaemia. All the patients were asked a series of questions in an attempt to determine if those found antigenaemic could only have been infected in an urban area. During the study, 30 suspected clinical cases of LF were detected and 18 of these (including two patients who were found to be antigenaemic) lived in urban areas. Of the 98 patients with exclusively urban exposure who were tested for filarial antigenaemia, six (6.1%) were found antigenaemic. Clinic-based surveillance appears to be a useful tool for determining if there is W. bancrofti transmission in an urban setting.

Adolescent↗

PubMed2003

Urban form, health, and the law's limits.

Urban form, the law, and health are undoubtedly linked. However, nonlegal factors such as 20th-century reliance on the automobile as well as associated governmental actions and private investment choices have greatly influenced urban form, especially urban sprawl. The American system of federalism, with its traditional allocation of land-use legal authority to local governments, and resulting fragmented legal authority over causes and effects of urban sprawl, renders difficult legal efforts to reshape urban form. Legal frameworks and the dynamics and effects of urban sprawl are largely mismatched. Still, existing legal frameworks and modest legal reforms provide means to encourage or at least allow urban forms that are more conducive to health. However, the law will not easily transform urban form and deter urban sprawl.

Automobiles↗

PubMed1997

Effect of socioeconomic risk factors on the difference in prevalence of diabetes between rural and urban populations in Bangladesh.

OBJECTIVE: To compare the prevalence of diabetes between the poor and rich of rural and urban populations in Bangladesh. RESEARCH DESIGN AND METHODS: A total of 1,052 subjects from urban and 1,319 from rural communities (age > or = 20 years) of different socioeconomic classes were investigated. Capillary blood glucose levels, fasting and 2 h after a 75-g glucose drink (2-h blood glucose [BG]), were measured. Height, weight, waist, hips, and blood pressure were also measured. RESULTS: Age-adjusted (30-64 years) prevalence of NIDDM was higher in urban (7.97% with 95% CI 6.17-9.77) than in rural subjects (3.84%, CI 2.61-5.07), whereas impaired glucose tolerance (IGT) prevalence was higher in rural subjects. In either urban or rural areas, the highest prevalence of NIDDM was observed among the rich, and the lowest prevalence was observed among the poor socioeconomic classes. The rural rich had much higher prevalence of IGT than their urban counterpart (16.5 vs. 4.4%, CI 6.8-17.4). Increased age was an important risk factor for IGT and NIDDM in both rural and urban subjects, whereas the risk related to higher BMI and waist-to-hip ratio (WHR) was less significant in rural than urban subjects. Using logistic regression and adjusting for age, sex, and social class, the urban subjects had no excess risk for NIDDM. In contrast, an excess risk for glucose intolerance (2-h BG > or = 7.8 mmol/l) was observed in the rural subjects. CONCLUSIONS: Adjusting for age, sex, and social class, the prevalence of NIDDM among urban subjects did not differ significantly from that among rural subjects. Increased age, higher socioeconomic class, and higher WHR were proven to be independent risk factors for glucose intolerance in either area.

Adult↗

PubMed2002

Cardiovascular reactivity in Black South-African males of different age groups: the influence of urbanization.

OBJECTIVE: Blacks in an urban environment seem to be more vulnerable to excessive increases in blood pressure during daily life events. This greater cardiovascular reactivity during acute stress situations in urban Blacks may lead to the development of hypertension in their later lives. Because Blacks in South Africa are involved in a massive process of urbanization, which may lead to chronic diseases of lifestyle like hypertension and diabetes, this study was undertaken to compare the cardiovascular reactivity patterns of urbanized and rural Black males in the North-West province of South Africa. DESIGN: Two hundred twenty-three Black males of different age groups, Group 1: younger than 25 years of age; Group 2: between 25 and 44 years of age; and Group 3: 45 years of age and older. Participants were randomly selected from rural and urbanized settlements. METHODS: After resting blood pressure was recorded with a Finapres apparatus, and cardiac output, stroke volume, heart rate, and total peripheral vascular resistance had been obtained, an acute laboratory stressor (hand dynamometer exercise) was applied and the above measurements repeated. RESULTS: The SBP, DBP, and MAP increased 28% and 42% in both the rural and the urbanized groups. There was a shift from a central reactivity pattern (increased cardiac output) in the young rural group (< 25 years) to a peripheral reactivity pattern (increased total peripheral resistance) in the > or = 45 years old urbanized males after applying the stressor. CONCLUSIONS: Cardiovascular reactivity differs between Black males from a rural area compared to urbanized Black males. The urbanized males > or = 45 years of age were at a higher risk of developing cardiovascular disease because their total peripheral resistance reactivity increased the most during application of the stressor.

Adolescent↗

PubMed2003

Oral hygiene and periodontal treatment needs of urban school children compared with that of rural school children in Lagos State. Nigeria.

OBJECTIVE: To assess the oral hygiene methods being used by the children in the urban and rural areas studied, the effect on their oral hygiene and the periodontal treatment needs of urban and rural school children. SETTING: An urban and a rural local government area in Lagos State, Southwest Nigeria. DESIGN: Cross-sectional and descriptive. METHOD: 1829 primary school children from primary one to six were selected from thirteen fee-paying and non fee-paying schools using a multistage random sampling. One thousand, and twenty-three (1023) children were examined in the urban area and eight hundred and six (806) children were examined in the rural area. The simplified oral hygiene index of Greene and Vermillion and the Community Periodontal Index of Treatment needs (CPITN) were used to assess the oral hygiene status and Periodontal treatment needs respectively. RESULTS: 205 (20%) of the children in the urban area use the toothbrush and toothpaste only and 84 (10.4%) of those in the rural area use only the toothbrush and toothpaste. 255 (31.6%) of the children in the rural area use only the chewing stick compared with 5 (0.5%) of the children in the urban area. Majority of the children use a combination of methods based on what is available. Children in the urban area had significantly better oral hygiene than those in the rural area but children from low social class in the urban area had significantly poorer oral hygiene than those from the high social clans. Majority of the children from the rural area and the low class urban area needed scaling and polishing. It was concluded that there is a need for improvement in oral hygiene of the children via oral health education. There is a greater need for middle level oral health manpower as the majority required scaling and polishing with oral hygiene instructions.

Adolescent↗

PubMed2004

Integrated urban malaria control: a case study in dar es salaam, Tanzania.

The rapid growth of cities in sub-Saharan Africa, much of it driven by rural-urban migration, is associated with complex transformations of these ecosystems and an intricate set of challenges for malaria control. Urban malaria transmission is substantially less intense and much more focal than in rural and peri-urban settings. However, the danger of epidemics is higher and the presence of substantial non-immune populations places people of all ages at comparable levels of risk. The limited number of breeding sites in urban centers suggests that prevention strategies based on vector control, with emphasis on environmental management, should be a central feature of urban malaria control programs. We focus on malaria in the city of Dar es Salaam, Tanzania. Following a brief review of the 100-year history of malaria control in this urban center, we describe and evaluate a control program that operated from 1988 to 1996 as a consequence of a bilateral agreement between the governments of Tanzania and Japan. We present an innovative urban malaria risk mapping methodology based on high-resolution aerial photography with ground-based validation. This strategy clarifies that remote sensing technology at a level of resolution of one meter is essential if this kind of information is to play a role in guiding the detailed specification of intervention strategies for urban malaria control. The Tanzania-Japan multiple-intervention malaria control program, adaptively implemented over time, is described and evaluated with implications for urban malaria control in sub-Saharan Africa more generally.

Animals↗

PubMed2005

[A landscape ecological approach for urban non-point source pollution control].

Urban non-point source pollution is a new problem appeared with the speeding development of urbanization. The particularity of urban land use and the increase of impervious surface area make urban non-point source pollution differ from agricultural non-point source pollution, and more difficult to control. Best Management Practices (BMPs) are the effective practices commonly applied in controlling urban non-point source pollution, mainly adopting local repairing practices to control the pollutants in surface runoff. Because of the close relationship between urban land use patterns and non-point source pollution, it would be rational to combine the landscape ecological planning with local BMPs to control the urban non-point source pollution, which needs, firstly, analyzing and evaluating the influence of landscape structure on water-bodies, pollution sources and pollutant removal processes to define the relationships between landscape spatial pattern and non-point source pollution and to decide the key polluted fields, and secondly, adjusting inherent landscape structures or/and joining new landscape factors to form new landscape pattern, and combining landscape planning and management through applying BMPs into planning to improve urban landscape heterogeneity and to control urban non-point source pollution.

City Planning↗

PubMed2005

Influence of new town development on the urban heat island-the case of the Bundang area.

Five new towns have been developed around the Seoul metropolitan area since 1996. However, these new towns generate lots of traffic and related problems in the areas including those new towns and Seoul as a result of increases in population and a lack of ecological-self-sufficiency. Currently, construction of another new town is under deliberation, and what should be a major consider is the notion that the new town be located within a wide, green zone. Many studies have revealed that green space can play an important role in improving urban eco-meteorological capability and air quality. In order to analyze the urban heat island which will be created by the new urban development, and to investigate the local thermal environment and its negative effects caused by a change of land use type and urbanization, Landsat TM images were used for extraction of urban surface temperature according to changes of land use over the last 15 years. These data are analyzed together with digital land use and topographic information. As a study result, it was found the urban heat island of the study area from 1985 to 1999 rapidly developed which showed a difference of mean temperature above + 2.0. Before the Bundang new town construction the temperature of the residential area was the same as a forest, but during the new town construction in 1991 analysis revealed the creation of an urban heat island. The temperature of a forest whose size is over 50% of the investigation area was lowest, and thus the presence of a forest is believed to have a direct cooling effect on the urban environment and its surroundings. The mean temperature of the residential and commercial areas in the study was found to be + 4.5 higher than the forest, and therefore this part of land use is believed to be the main factor causing the temperature increase of the urban heat island.

Environment↗

PubMedDate not supplied

A rural-urban comparison of prehospital emergency medical services in Nebraska.

BACKGROUND: Provision of emergency medical services (EMS) in the rural United States presents a unique challenge. While rural and urban EMS outcomes have been compared, differing urban-rural population characteristics and roles for rural ambulance teams can confound such comparisons. METHODS: A year-long study of the prehospital EMS was conducted in rural Richardson County, Nebraska. Data were collected on the age, sex, and race of patients, response time, transport distance, medical problems encountered, and treatment rendered enroute. These data compared with those from an urban Lancaster County comparison group and statistical data from the Nebraska State Health Department. RESULTS: In the rural county, 70 percent of calls involved the elderly, whereas 38 percent of the urban calls and 36 percent of the Nebraska State calls involved the elderly. The rural ambulance service was more likely to provide for routine transfers, to involve patients with fractures and cardiorespiratory and neurologic problems, and twice as likely to result in hospital admission than was the urban ambulance service. The frequency with which advanced life support measures were applied in the rural area was similar to that in the urban area. The rural area response times were equivalent to the urban area response times after the rural area long-distance transfers were excluded. The location of service in the rural area was more likely to be the hospital or nursing home, whereas the urban location was more likely to be a home, on a highway, or in a public setting. CONCLUSIONS: Prehospital EMS in this rural location involved a predominantly elderly population with a large number of routine transfers linking the nursing home and community hospital. Further comparisons of rural and urban EMS outcomes should account for possible differences in type and severity of illness and type and location of service.

Adolescent↗

PubMed1995

Convergence in rural-urban patterns of nuptiality and mortality: a life table update.

"Based on 1979-1981 and 1989-1991 [U.S.] vital registration and 1980 and 1990 census data, we construct increment-decrement life tables for rural and urban males and females. The analysis is centered on 1980 and 1990 and describes urban-rural differences in patterns of mortality and nuptiality by age and sex. Our research updates an earlier study that described urban-rural mortality and marital transition patterns for Tennessee, 1970. The 1980 and 1990 findings parallel the 1970 results. Rural women and men have shorter life expectancies; higher infant mortality rates; younger median ages of entry into first marriage, divorce, and widowhood; a greater proportion of their cohorts ever marrying; lower probabilities of divorce; and higher probabilities of widowhood than urban women and men. However, there was a decline in urban-rural differences from 1970-1990. These changes suggest that urbanization, technological advances in communication and transportation, and the diffusion of urban lifestyles and values may have blurred the urban-rural distinction."

Age Factors↗

PubMed2004

Measuring urbanization pattern and extent for malaria research: a review of remote sensing approaches.

Within the next 30 years, the proportion of urban dwellers will rise from under half to two thirds of the world's population. Such a shift will entail massive public health consequences, and most of this urban transition will occur in low-income regions of the world. Urban populations face very different health risks compared to those in rural areas, particularly in terms of malaria. To target effective and relevant public health interventions, the need for clear, consistent definitions of what determines urban areas and urban communities is paramount. Decision makers are increasingly seeing remote sensing as a cost-effective solution to monitoring urbanization at a range of spatial scales. This review focuses on the progress made within the field of remote sensing on mapping, monitoring, and modeling urban environments and examines existing challenges, drawbacks, and future prospects. We conclude by exploring some of the particular relevance of these issues to malaria and note that they are of more general relevance to all those interested in urban public health.

Africa↗

PubMed1991

Urbanization and health in developing countries.

In developing countries the level of urbanization is expected to increase to 39.5% by the end of this century and to 56.9% by 2025. The number of people living in slums and shanty towns represent about one-third of the people living in cities in developing countries. This article focuses upon these poor urban populations and comments upon their lifestyle and their exposure to hazardous environmental conditions which are associated with particular patterns of morbidity and mortality. The concept of marginality has been used to describe the lifestyle of the urban poor in developing countries. This concept is critically examined and it is argued that any concept of the urban poor in developing countries being socially, economically or politically marginal is a myth. However, it can certainly be claimed that in health terms the urban poor are marginal as demonstrated by some of the studies reviewed in this article. Most studies of the health of the urban poor in developing countries concentrate on the environmental conditions in which they live. The environmental conditions of the urban poor are one of the main hazards of the lifestyle of poor urban residents. However, other aspects of their way of life, or lifestyle, have implications for their health. Issues such as smoking, diet, alcohol and drug abuse, and exposure to occupational hazards, have received much less attention in the literature and there is an urgent need for more research in these areas.

Developing Countries↗