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The author discusses urbanization in the People's Republic of China and problems in data analysis "due to the lack of standardized and well-defined terms for the urban settlements and urban population on the mainland. This paper clarifies the relationship between geographic units and demographic data, identifies the major types of urban population and their characteristics, explains the reasons for the differing levels of urbanization revealed in various data sources, and presents a comprehensive data series on mainland China's urbanization that best approximates reality." (SUMMARY IN ENG)
Comparison of the parameters of obesity between two populations, urban from Warsaw and agricultural-industrial from Tarnobrzeg province revealed that skinfolds thickness, Quetelet index and body fat index, and per cent of overweight were statistically significantly higher in men from urban population. In the group of women these parameters were also statistically higher in Warsaw population with the exception of triceps skinfold and Quetelet index--differences of no statistical significance. There were also differences in the set of variables which correlate with the parameters of obesity between these two tested populations.
OBJECTIVE: The epidemiology of peripheral vascular disease has rarely been studied in non-European populations. The purpose of this study was to determine the prevalence and risk factors of peripheral vascular disease (PVD) among South Indians. RESEARCH DESIGN AND METHODS: The Chennai Urban Population Study is an epidemiological study involving 2 residential areas in Chennai in South India. Of the 1,399 eligible subjects (> or =20 years of age), 1,262 (90.2%) participated in the study. All of the study subjects underwent an oral glucose tolerance test and were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes. Peripheral Doppler studies were performed on 50% of the study subjects, and PVD was defined as an ankle-brachial index (ABI) <0.9. RESULTS: The prevalence rates of PVD were 2.7, 2.9, and 6.3% in individuals with NGT, IGT, and diabetes, respectively The overall prevalence rate was 3.2%. Known diabetic subjects had a higher prevalence of PVD (7.8%) compared with newly diagnosed diabetic subjects (3.5%). PVD was uncommon until middle-age and then the prevalence rate increased dramatically. Univariate regression analysis showed age >50 years (odds ratio [OR] 6.3, 95% CI 2.1-20.6, P<0.001) and hypertension (OR 2.7, 0.9-7.3, P = 0.08) to be associated with PVD, whereas smoking and serum lipid levels showed no association. Multivariate regression analysis identified age as the most significant risk factor for PVD. Of the 90 subjects who had coronary artery disease (CAD), only 6 had PVD, and the positive predictive value of the ABI for CAD was only 30%. CONCLUSIONS: The prevalence of PVD in this urban South Indian population is considerably lower than that reported in European and U.S. studies and is in marked contrast to the high prevalence rate of CAD reported in this population.
BACKGROUND: Socioeconomic differences have been shown to be linked with the prevalence of coronary artery disease (CAD) and its risk factors such as dyslipidaemia based on urban-rural comparisons. However, very little data are available on the prevalence of dyslipidaemia within an urban environment. The aim of this study was to assess the pattern of dyslipidaemia in two different socioeconomic groups within an urban South Indian population. METHODS: The Chennai Urban Population Study is an epidemiological study involving two residential areas in Chennai, South India representing different socioeconomic strata. Of the 1399 eligible subjects (age > or = 20 years), 1262 (90.2%) participated in the study (Tirumangalam: middle income group, 479 subjects, response rate 91.4%; and T. Nagar: low income group, 783 subjects, response rate 89.4%). A detailed questionnaire on the socioeconomic and clinical background of the subjects was collected. Biochemical investigations included lipid profile and oral glucose tolerance tests. The classification of lipid abnormalities was done according to the National Cholesterol Education Programme-Adult Treatment Panel III [NCEP (ATP III)] guidelines. RESULTS: The Tirumangalam group (mean monthly income of Rs 8075) represents the middle income group, while the T. Nagar group (mean monthly income of Rs 1399) represents the low income group. The prevalence rates of lipid abnormalities were higher among the middle income group compared to the low income group. The prevalence of high risk cholesterol levels in men was 10.6% (middle income group) v. 2.7% (low income group; p<0.001) and among women 19.1 v. 4.7% (p<0.001). Similarly, the prevalence of high risk triglyceride levels in men was 15.7% v. 9.3% (p=0.02) and among women 10.3% v. 7.5% (p<0.05); high risk low density lipoprotein (LDL) levels among men was 7.8% v. 3.0% (p=0.01), and among women 11.2% v. 4.5% (p<0.001). High density lipoprotein (HDL) cholesterol levels were lower in the low income group but the total cholesterol/HDL cholesterol ratio was higher among men in the middle income group (p<0.001) but not among women. Logistic regression analysis revealed that socioeconomic status had a strong association with hypercholesterolaemia and high LDL levels, even after adjusting for age and body mass index. CONCLUSION: Socioeconomic factors influence the pattern of dyslipidaemia in this urban South Indian population, with dyslipidaemia being more common and severe in the middle income group.
BACKGROUND & OBJECTIVES: Although earlier studies had shown socio-economic factors to be strongly associated with the insulin resistance syndrome (IRS) and its components, there is still a paucity of data on Indians who have increased insulin resistance. In this study, we assessed the prevalence of IRS in two socio-economic groups in an urban south Indian population. METHODS: The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennal in south India. Of the 1262 eligible subjects (age > or = 20 yr) who participated in the study, 1070 (76.5%) subjects who had a complete set of data were recruited for this study. Insulin resistance was calculated using the homeostasis assessment (HOMA) model. Insulin resistance syndrome was defined as the presence of insulin resistance in combination with at least 2 of the following conditions: hyperglycaemia, hypertension, dyslipidemia or central body obesity. RESULTS: The overall prevalence of IRS was 11.2 per cent (95% confidence interval: 9.4-13.3). The prevalence of the IRS in the middle-income group (18.7%) was significantly higher compared to the low income group (6.5%; P < 0.001). Multiple logistic regression analysis revealed age (P < 0.001), body mass index (P < 0.05) and socio-economic status (P = 0.014) to be associated with IRS. INTERPRETATION & CONCLUSION: The overall prevalence rate of IRS was 11.2 per cent. Age and higher socio-economic status were the risk factors for insulin resistance in this selected urban south Indian study population.
OBJECTIVE: Hypertension is a major public health problem in developing countries. There is however very little population based data particularly in South India. The aim of this study is to determine the prevalence of hypertension and its associated risk factors in an urban South Indian population at Chennai. METHODS: The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in South India. Of the total of 1399 eligible subjects (age > or = 20 years), 1262 (90.2%) participated in the study. All the study subjects underwent a glucose tolerance test (GTT) and were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or diabetes mellitus (DM). Subjects were classified as hypertensive using the criteria, systolic blood pressure (SBP) > or = 140 mm Hg, and/or diastolic blood pressure (DBP) > or = 90 mm Hg and/or treatment with anti-hypertensive drugs. Twelve-lead resting electrocardiography (ECG) was performed in 1175 individuals and peripheral Doppler studies were done in 50% of the individuals (n=631). RESULTS: The overall crude prevalence of hypertension (HTN) in this population is 21.1% (n=266) while the age standardized prevalence is 17.0%. Body mass index (BMI) and waist-hip ratio (WHR) were significantly higher (p < 0.001) in the HTN group compared to the non-hypertensive individuals. The prevalence of diabetes (p < 0.001), obesity (p < 0.001), CAD (p = 0.001) and PVD (p = 0.0055) was higher among the hypertensive compared to normotensive group. Multiple logistic regression analysis revealed HTN to be significantly associated with age (p < 0.001), body mass index (p < 0.001) and glucose intolerance (p = 0.005). CONCLUSION: The prevalence of hypertension appears to be high in this urban South Indian population and this calls for urgent steps for its prevention and control.
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AIMS: To determine the prognosis, total mortality and cardiac morbidity, of patients with left ventricular systolic dysfunction and heart failure (HF) in a general population sample. METHODS AND RESULTS: A total of 764 subjects, 432 females and 332 males, median age (range) 66 years (50-89), participated in this cross sectional survey. The study population was recruited from randomly selected general practitioners and stratified to include a minimum of 150 persons in each age decade stratum. Each participant filled in a heart failure questionnaire and ECG, blood tests and echocardiography were performed. Median (range) follow-up was 1145 (51-1197) days. Subjects with LVEF < or = 0.40 had a significantly higher all-cause mortality (27.8% vs. 5.6%, P<0.0001), admission rate for HF (25.0% vs. 1.9%, P<0.0001) and for other cardiac causes (25.0% vs. 6.3%, P<0.0001) than in subjects with LVEF>0.40. The age and gender adjusted 2-year relative risk of death was 4.6 (95% C.I.=1.6-13.2). No significant difference in mortality was found between subjects with or without heart failure symptoms. CONCLUSION: Significantly higher mortality as well as cardiac morbidity was found in subjects with symptomatic and asymptomatic LV systolic dysfunction compared to those with normal systolic function. These conditions were among the strongest predictors of all-cause mortality and cardiac morbidity.
This Illinois study shows that rural patients who were postmenopausal and node negative were more likely than urban patients to have a modified radical mastectomy (P=.03) and less likely to have had an oncology consultation (P=.01). Postmenopausal rural patients with positive nodes were more likely than comparable CCOP patients to receive radiation therapy (P=.0001), regardless of surgical choice, and were less likely to get hormone therapy than urban patients with an estrogen receptor-positive tumor (P=.007). After adjustment for confounders, rural patients were less likely than those in either comparison group to have limited surgery (odds ratio [OR] = 2.8, 95% confidence interval [CI] 1.4, 5.6 for urban patients, and OR = 2.9, 95% CI 1.5, 5.7 for CCOP patients) and more likely than CCOP patients to undergo radiation (OR = 0.2, 95% CI 0.1, 0.4). These data can be used to assess the impact that dissemination of state-of-the-art treatment strategies has on breast cancer mortality.
The frequency of sensitization to environmental antigens changes in different regions. As such, the pattern of sensitivity to common allergens was studied at multiple sites across central Pennsylvania, an area composed of small cities and rural communities, to determine uniqueness of allergies in populations from this area in contrast to allergies as determined by skin testing in large urban centers. The study reported was undertaken to determine allergen variation from an urban population compared with a rural population of a Northeastern state so that environmental avoidance and immunotherapy can be more precisely prescribed. Patient charts were retrospectively reviewed to determine sensitivity to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cockroach, Penicillium, Aspergillus spp, dog, cat, timothy grass, ragweed, oak, and Alternaria tenuis at five sites in Pennsylvania. All of these sites were classified as "small city" or "rural" for the study. One hundred patient records were examined at each site for the results of allergy testing by the prick puncture, radioallergosorbent test (RAST), or intradermal methods. These small-city and rural data were pooled and compared with that of the National Cooperative Inner-City Asthma Study (NCI-CAS), which included 1286 patients from urban environments. The prevalence of allergy to both species of dust mites, dog, timothy grass, and ragweed was significantly greater in the pooled rural group than in the NCICAS inner-city patients (P < .05). In contrast, sensitivity to cockroach antigens and Alternaria was significantly greater in the NCICAS urban population than in the pooled rural group (P < .05). No statistically significant difference was found between the NCICAS and the pooled rural patients in reference to Penicillium, cat, and oak (P > .05).
The involvement of urban living environments in IgE-increase (atopy) and ECP-increase (enhanced eosinophil activity), the inter-relationship of IgE-increase and ECP-increase, and their involvement in developing airway allergic symptoms were studied on a population of adult nonsmoking women, in order to elucidate the latent factors aggravating airway allergic symptoms in an urban population. In our earlier study on child asthma in 1994, we examined the relationship between living environments and mite proliferation in asthma and non-asthma groups and the involvement of mite proliferation in developing atopy in the non-asthma group. The asthma group consisted of 190 children under 12 years old who had been recently diagnosed as having bronchial asthma and under the care of Osaka Prefectural Habikino Hospital. The non-asthma group consisted of 78 children under 12 years old who had been under care at Osaka Prefectural Hospital but had no present history of allergic symptom. The adult woman group consisted of 423 non-smoking women who had been diagnosed as having no allergic disease by the medical examination done at Yao City, Osaka, each March from 1995 to 1997. Individual living environments such as housing and heating styles were surveyed by questionnaire. Also, the amount of mite allergen (Dp: Dermatophagoides pteronyssinus, Df: Dermatophagoides farinae) in room and bedding dust (only in the case of children) and the concentration of continine in urine were examined as objective indicators for the load of environmental allergen and the indoor air pollution by tobacco smoke, respectively. Atopy was diagnosed according to whether Dp-specific immunoglobulin E (Dp-IgE) was present/absent (positive/negative), and ECP-increase was defined as serum ECP concentration over 10 ng/ml. The results were as follows: 1. An environment of higher humidity (dampness) causing a room to become moldy appeared to enhance mite proliferation, while heating only with an electric heater or kotatsu appeared to suppress it. 2. Living environments were involved in the development of atopy in children and adult women through the effects on mite proliferation. In the case of children, heating with oil or gas heater appeared to have a positive effect while reinforced concrete housing a negative effect, probably by effects on the immune system. However, in the case of adult women, such modification was not observed. 3. Passive smoking in adult women was related to ECP-increase. 4. IgE-increase and ECP-increase appeared to be involved in each other. 5. Among airway allergic symptoms such as cough, sputum and wheeze, atopy was involved in wheeze, and ECP-increase in cough.
In an urban population with widespread birth control practice the distribution of the number of pregnancies, births and abortions was studied in a cohort of women of completed fertility. The mean number of pregnancies per woman was 4.03 +/- 0.08 (sigma = = 2.98); the mean number of births - 1.12 +/- 0.02 (sigma = 0.77). 7.4% of women which had completed their reproductive performance had no pregnancies and 19.5% - no births. The Crow's Index of the Opportunity for Selection and its components connected with differential fertility and differential mortality were estimated. In the population under study two components of selection - selection at the prenatal stages and selection associated with infertility - are shown to be still significant. Such type of selection is exemplified by investigation of couples suffering from repeated spontaneous abortions.
AIM: To assess the prevalence of active and inactive uveitis unrelated to previous surgery or trauma in an urban population in southern India. METHODS: As part of the Andhra Pradesh Eye Disease Study, 2522 subjects (85.4% of those eligible), a sample representative of the population of Hyderabad city in southern India, underwent interview and detailed dilated eye examination. Presence of sequelae of uveitis without current active inflammation was defined as inactive uveitis. RESULTS: Unequivocal evidence of active or inactive uveitis unrelated to previous surgery or trauma was present in 21 subjects, an age-sex adjusted prevalence of 0.73% (95% confidence interval (CI) 0.44-1.14%). Active uveitis was present in eight subjects, an age-sex adjusted prevalence of 0.37% (95% CI 0. 19-0.70), of which 0.06% was anterior, 0.25% intermediate, and 0.06% posterior. The 0.36% (95% CI 0.17-0.68%) prevalence of inactive uveitis included macular chorioretinitis scars (0.26%), anterior (0. 07%) and previous vasculitis involving the whole eye (0.03%). The prevalence of visual impairment due to uveitis of less than 6/18 in at least one eye was 0.27%, less than 6/60 in at least one eye was 0. 16%, and less than 6/60 in both eyes was 0.03%. CONCLUSION: These population based cross sectional data give an estimate of the prevalence of various types of uveitis in this urban population in India. Active or past uveitis that might need treatment at some stage was present in one of every 140 people in this population.
As Americans live longer, they will require more health and social services to address the onset of acute and chronic conditions. The persistent changes in health care delivery and the increasingly diverse older adult population in urban settings, coupled with the high expectation for families to be responsible for home care needs, challenge social workers, who work alongside physicians, nurses, and other health care professionals, to provide services effectively. Because social workers are becoming more essential, social work education must increase the numbers of social workers with the knowledge and skills necessary for practice in the current U.S. health, mental health, and social service systems, particularly in caring for the aging populations in urban settings. A New York Academy of Medicine study identified the need for increased synergy between the two components of graduate social work education: the field experience and classroom instruction. One educational model, the Practicum Partnership Program, which is designed to better integrate field and classroom, is being tested at six sites. Early results from over 300 graduates are encouraging, with evidence that students' knowledge and skills regarding aging adults have increased, their satisfaction with the experience was very high, and those who were trained reflect the diversity of the population of older adults. The early success of this program suggests that innovative educational models that expose graduate social work students to diverse populations across the continuum of care are possible. Such models will be essential for the nation to be successful in producing a social work labor force qualified to meet the challenge of an aging urban population.