Architecture and Urban P

1754-1762. 10 Lohmann T,Kellner K,Verlohren HJ,et al.Titre and combination of ICAand autoantibodies to glutamic acid decarboxylase discriminate two clini-cally distinct types of latent autoimmune diabetes in adults(LADA).Di-abetologia,2001,44:1005-1010.…     

Urban health in India: who is responsible?

Urban health has received relatively less focus compared with rural health in India, especially the health of the urban poor. Rapid urbanization in India has been accompanied by an increase in population in urban slums and shanty towns, which are also very inadequately covered by basic amenities, including health services. The paper presents existing and new evidence that shows that health inequities exist between the poor and the non‐poor in urban areas, even in better‐off states in India. The lack of evidence‐based policies that cut across sectors continues to be a main feature of the urban health scenario. Although the problems of urban health are more complex than those of rural health, the paper argues that it is possible to make a beginning fairly quickly by (i) collecting more evidence of health status and inequities in urban areas and (ii) correcting major inadequacies in infrastructure–both health and non‐health–without waiting for major policy overhauls. Copyright © 2014 John Wiley & Sons, Ltd.     

Parent–Teen Communication about Sex in Urban Thai Families

This study describes sexual communication among Thai parents and their teens and identifies variables related to communication about sex in urban Thai families. Data were derived from 420 families whose teenage children ages 13–14 years were randomly selected using the probability proportional to size technique. Interviews were conducted with 1 parent and 1 teenage child in each family. In-depth interviews were also conducted in 30 parents and teens drawn from the same 420 families. Results showed that parents were most likely to talk with their teens about body changes and dating; however, less discussion about sex-related issues, birth control, and HIV/AIDS occurred. More daughters than sons reported frequent discussions with their parents about sex. Parents who believed their teens had been involved in sexual activity were more likely to talk about HIV/AIDS and the difficulty of teenagers having babies, instead of talking about sexual intercourse or when to start having sex. Multiple regression analysis indicated that gender of the child (female), parental religiosity, and parental perception of teen sexual activity were significant predictors of increased sexual communication in Thai families. The findings suggest a need for approaches designed to facilitate communication skills about sex-related issues among Thai parents.     

Rural–Urban Differences in End-of-Life Care: Implications for Practice

Most older adults with advanced illnesses express the wish to die at home. Home-based care from home health and hospice agencies makes this possible, but there are great geographic variations in utilization. Interviews and focus groups with key constituents in home health and hospice agencies across the 8-county region of Western New York State were used to explore how rural–urban location and agency type (home health or hospice) influence variations in end-of-life care. Emergent themes were: Rural-Urban Differences (geographic challenges, market forces, and programming issues) and End-of-life Care Issues (macrosocial, mezzosocial, and microsocial factors). Implications for social work practice are discussed.     

Pesticide and Pathogen Contamination of Vegetables in Ghana’s Urban Markets

The objective of the study was to determine and compare the current level of exposure of the Ghanaian urban population to hazardous pesticide and fecal coliform contamination through the consumption of fresh vegetables produced in intensive urban and periurban smallholder agriculture with informal wastewater irrigation. A total of 180 vegetable samples (lettuce, cabbage, and spring onion) were randomly collected under normal purchase conditions from 9 major markets and 12 specialized selling points in 3 major Ghanaian cities: Accra, Kumasi and Tamale. The samples were analyzed for pesticide residue on lettuce leaves, total and fecal coliforms, and helminth egg counts on all three vegetables. Chlopyrifos (Dursban) was detected on 78% of the lettuce, lindane (Gamalin 20) on 31%, endosulfan (Thiodan) on 36%, lambda-cyhalothrin (Karate) on 11%, and dichloro-diphenyl-trichloroethane on 33%. Most of the residues recorded exceeded the maximum residue limit for consumption. Vegetables from all 3 cities were fecally contaminated and carried fecal coliform populations with geometric mean values ranging from 4.0 × 10³ to 9.3 × 10⁸ g^–1 wet weight and exceeded recommended standards. Lettuce, cabbage, and spring onion also carried an average of 1.1, 0.4, and 2.7 helminth eggs g^–1, respectively. The eggs were identified as those of Ascaris lumbricoides, Ancylostoma duodenale, Schistosoma heamatobium, and Trichuris trichiura. Because many vegetables are consumed fresh or only slightly cooked, the study shows that intensive vegetable production, common in Ghana and its neighboring countries, threatens public health from the microbiologic and pesticide dimensions. Standard recommendations to address this situation (better legislations, law enforcement, or integrated pest management) often do not match the capabilities of farmers and authorities. The most appropriate entry point for risk decrease that also addresses postharvest contamination is washing vegetables before food preparation at the household or “chop” bar (street restaurant).     

Is Sprawl Associated with a Widening Urban–Suburban Mortality Gap?

This paper examines whether sprawl, featured by low development density, segregated land uses, lack of significant centers, and poor street connectivity, contributes to a widening mortality gap between urban and suburban residents. We employ two mortality datasets, including a national cross-sectional dataset examining the impact of metropolitan-level sprawl on urban–suburban mortality gaps and a longitudinal dataset from Portland examining changes in urban–suburban mortality gaps over time. The national and Portland studies provide the only evidence to date that (1) across metropolitan areas, the size of urban–suburban mortality gaps varies by the extent of sprawl: in sprawling metropolitan areas, urban residents have significant excess mortality risks than suburban residents, while in compact metropolitan areas, urbanicity-related excess mortality becomes insignificant; (2) the Portland metropolitan area not only experienced net decreases in mortality rates but also a narrowing urban–suburban mortality gap since its adoption of smart growth regime in the past decade; and (3) the existence of excess mortality among urban residents in US sprawling metropolitan areas, as well as the net mortality decreases and narrowing urban–suburban mortality gap in the Portland metropolitan area, is not attributable to sociodemographic variations. These findings suggest that health threats imposed by sprawl affect urban residents disproportionately compared to suburban residents and that efforts curbing sprawl may mitigate urban–suburban health disparities.

In an Urban Neighborhood,Who Is Physically Active and Where?

Previous research has shown differences in adult physical activity (PA) levels within urban population, in what types of activities they participated, and where they were active. A sample of 514 urban Philadelphia adult residents was surveyed about level and location of PA. A majority (55.6%) of survey participants reported being vigorously or moderately active or walking enough to meet PA guidelines. A significantly higher proportion of men (vs. women), younger (vs. older) adults and people who were employed (vs. unemployed) met the PA guidelines. Most participants (87.5%) reported walking at least once within the previous week, while 79.3% reported engaging in moderate or vigorous activity. Of the participants who reported being moderately or vigorously active, 64.0% were physically active in indoors only, 22.6% were active in outdoors only, and 13.4% were active in both indoors and outdoors. Significantly fewer black women were active outdoors, compared to all other race/sex combinations (odds ratio = 0.43, p-value < 0.01). In this diverse sample of urban residents, outdoor PA was significantly less frequently reported than indoor PA, particularly for Black women. These findings could help inform urban PA interventions.     

Urban cause-specific socioeconomic mortality differences. Which causes of death contribute most?

BACKGROUND: Cause-specific information on socioeconomic differences in health is necessary for a rational public health policy. At the local level, the Municipal Health Service studies these differences in order to support the authorities in policy making. METHODS: Mortality data of the under 65 age group in The Hague were analysed (1982-1991) at residential area level. RESULTS: Causes of death with a high socioeconomic gradient among males were: homicide, chronic liver disease, 'other' external causes of injury, diabetes, bronchitis, emphysema and asthma, and motor vehicle accidents; and among females: diabetes, ischaemic heart disease, 'other' diseases of the circulatory system, signs, symptoms and ill-defined conditions, malignant neoplasm of cervix, and 'other' diseases. Main contributors to the mortality differences between the highest and lowest socioeconomic quartiles among males were: ischaemic heart disease (17.3%), 'other' diseases of the circulatory system (10.2%), signs, symptoms and ill-defined conditions (9.0%), 'other' external causes of injury (8.6%), and chronic liver disease (7.2%); and among females: ischaemic heart disease (25.5%), 'other' diseases (20.1%), signs, symptoms and ill-defined conditions (18.6%), 'other' diseases of the circulatory system (11.0%), and diabetes (9.1%). Among females the contributions of malignant neoplasms of breast (-16.3%) and colon (-5.5%) and suicide (-4.3%) were negative. CONCLUSIONS: The diseases that are the main contributors to urban socioeconomic mortality differences can be influenced by public health policy.     

Co-designing Urban Living Solutions to Improve Older People’s Mobility and Well-Being

Mobility is a key aspect of active ageing enabling participation and autonomy into later life. Remaining active brings multiple physical but also social benefits leading to higher levels of well-being. With globally increasing levels of urbanisation alongside demographic shifts meaning in many parts of the world this urban population will be older people, the challenge is how cities should evolve to enable so-called active ageing. This paper reports on a co-design study with 117 participants investigating the interaction of existing urban spaces and infrastructure on mobility and well-being for older residents (aged 55?+ years) in three cities. A mixed method approach was trialled to identify locations beneficial to subjective well-being and participant-led solutions to urban mobility challenges. Spatial analysis was used to identify key underlying factors in locations and infrastructure that promoted or compromised mobility and well-being for participants. Co-designed solutions were assessed for acceptability or co-benefits amongst a wider cross-section of urban residents (n?=?233) using online and face-to-face surveys in each conurbation. Our analysis identified three critical intersecting and interacting thematic problems for urban mobility amongst older people: The quality of physical infrastructure; issues around the delivery, governance and quality of urban systems and services; and the attitudes and behaviors of individuals that older people encounter. This identified complexity reinforces the need for policy responses that may not necessarily involve design or retrofit measures, but instead might challenge perceptions and behaviors of use and access to urban space. Our co-design results further highlight that solutions need to move beyond the generic and placeless, instead embedding specific locally relevant solutions in inherently geographical spaces, populations and processes to ensure they relate to the intricacies of place.     

Urban–rural inequalities in suicide mortality: a comparison of urbanicity indicators

Background

Urban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators.

Methods

Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors.

Results

Urban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported.

Conclusions

The strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised.

     

Urban–Rural Differentials in Overweight and Obese Individuals with Diarrhea in Bangladesh

Objective: The study aimed to determine urban and rural differences in overweight and obesity (OO) with diarrhea regarding subjects’ sociodemographic, clinical characteristics, etiology, and antimicrobial susceptibility.

Methods: Relevant information from 2000 to 2011 were extracted from the data archive of the Diarrheal Disease Surveillance System of urban Dhaka (1248, 4.5%) and rural Matlab (615, 3.4%) hospitals of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).

Results: The proportion of OO significantly increased in both urban (3–7%; chi-square for trend p < 0.001) and rural (1–6%; p < 0.001) areas over the study period. In multivariate modeling, monthly income more than US$100 (odds ratio [OR] = 54.44, 95% confidence interval [CI], 25.37–116.82, p < 0.001), high wealth quintile (OR = 18.23, 95% CI, 8.63–38.49, p < 0.001), access to sanitary toilet (OR = 3.07. 95% CI. 1.76–5.26. p < 0.001), boiled drinking water (OR = 2.77, 95% CI, 1.09–7.05, p = 0.032), antimicrobial use before hospitalization (OR = 4.99, 95% CI, 2.85–8.74, p < 0.001), fever (OR = 0.14, 95% CI, 0.37, 0.50, p < 0.001), watery stools (OR = 5.59, 95% CI, 2.11–14.80, p < 0.001), dehydrating diarrhea (OR = 5.17, 95% CI, 2.54–10.52, p < 0.001), intravenous saline infusion after hospitalization (OR = 2.65, 95% CI, 1.28–5.49, p = 0.009), and Salmonella infection (OR = 0.20, 95% CI, 0.50–0.83, p = 0.027) remained significantly associated with urban OO individuals. At least 88% of Shigella isolates were susceptible to ciprofloxacin in both urban and rural areas; for mecillinum it was 90%. Ciprofloxacin had the least detected resistance for Vibrio cholerae (0%) and trimethoprim-sulfamethoxazole (TMP-SMX) showed the greatest resistance (Dhaka 86%; Matlab 98%). Susceptibility for Salmonella showed ampicillin (95%), chloramphenecol (100%), ciprofloxacin (95%), ceftraxone (93%), TMP-SMX (95%) at both sites.

Conclusion: Urban OO with diarrheal illnesses was significantly different from that in rural areas, including antimicrobial susceptibility.     

A Longitudinal Analysis of Rural and Urban Veterans’ Health-Related Quality of Life

Context: Cross-sectional studies have identified rural-urban disparities in veterans’ health-related quality-of-life (HRQOL) scores. Purpose: To determine whether longitudinal analyses confirmed that these disparities in veterans’ HRQOL scores persisted. Methods: We obtained data from the SF-12 portion of the veterans health administration's (VA's) Survey of Healthcare Experiences of Patients (SHEP) collected between 2002 and 2006. During that time, the SHEP was randomly administered to approximately 250,000 veterans annually who had used VA outpatient services. We evaluated 163,709 responses from veterans who had completed 2 or more surveys during the years studied. Respondents were classified into rural-urban groups using ZIP Code-based rural-urban commuting area designations. We estimated linear regression models using generalized estimating equations to determine whether rural and urban veterans’ HRQOL scores were changing at different rates over the time period examined. Findings: After adjustment for sociodemographic differences, we found that urban veterans had substantially better physical HRQOL scores than their rural counterparts and that these differences persisted over the study period. While urban veterans had worse mental HRQOL scores than rural veterans, those differences diminished over the time period studied. Conclusions: Rural-urban disparities in HRQOL scores persist when tracking veterans longitudinally. Reduced access among rural veterans to care may contribute to these disparities. Because rural soldiers are overrepresented in current conflicts, the VA should consider new models of care delivery to improve access to care for rural veterans.