Mortality by socio-occupational categories in urban and rural areas

Mortality data in France are studied by a cross sectional analysis including both population density (urban or rural aggregates) and socio-economic groups. The socio-economic differentials in mortality increase with the size of localities. Specific social class distribution partly explains the excess of mortality in rural areas and the lowest mortality in the parisian agglomeration. On the contrary social class distribution does not affect mortality in small towns. Nevertheless, the expected effect of social class does not explain all the discrepancies in mortality between urban and rural areas. The population density is a parameter that should be taken into account when analyzing mortality.     

Mortality effects of average education: a multilevel study of small neighbourhoods in rural and urban areas in Norway

Background  

The intention was to find out whether there was an association between the socio-economic resources in a small neighbourhood ("basic statistical unit"; BSU) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others. The possibility of a rural-urban difference in the health effect of community resources has not been checked earlier.     

城乡医院医生工作效率的分析

分析不同地区、类别医院工作效率变动效率，为医院改革提供依据。该采用医生日均门诊数和医生床日数在1986－1997年间的变动趋势，进行投入-产出分析。结果显示12年间门诊和住院工作效率指标都有下降，平均下降1／3左右。城市医院效率优于农村、经济发达地区医院效率优于不发达地区。建议进一步分析引起医院效率下降的原因，并提出综合卫生改革的建议。     

Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.     

Deprivation and stillbirth risk in rural and urban areas

The objective of the study was to investigate whether stillbirth risk was higher, and the effect of deprivation on inequality in stillbirth risk more marked, in rural than in urban areas. We carried out a cohort study of all 280 757 singleton births to mothers domiciled in Cumbria, north-west England, 1950-92. After allowing for individual social class and community deprivation, the risk of stillbirth was lower outside urban centres both during 1950-65 (OR = 0.91, 95% CI 0.84, 1.00) and during 1966-92 (OR = 0.82, 95% CI 0.73, 0.92). In earlier years, unsupported mothers in rural areas and mothers living in remote areas were particularly at risk. Urban/rural differences in risk were not explained by individual social class, community deprivation or overcrowding and have persisted over a 40-year time period.     

城市和农村药房托管绩效评估研究

药房托管是目前正在积极试点的医药分开的一种方式。对于药房托管的效果,文章建立的基于层次分析法(AHP)的绩效评估体系模型,从托管企业、医疗机构、病人、社会四个角度综合评估药房托管的绩效,通过计算得出总体的评估结果。该评估体系对加强药房托管的科学管理,使药房托管顺利实施并达到预期目的有着很好的监督管理作用。     

The relationship between toxics release inventory discharges and mortality rates in rural and urban areas of the United States

Background: Potential environmental exposures from chemical manufacturing or industrial sites have not been well studied for rural populations. The current study examines whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program are associated with population mortality rates for both rural and urban populations. Methods: We used the TRI database, Centers for Disease Control and Prevention age‐adjusted mortality data, and additional county‐level covariate data to conduct a national study at (N = 3,142) of the association between amounts of on‐site TRI air and water releases for the years 1988‐2006 and total age‐adjusted mortality rates for the years 1999‐2006, after controlling for the effects of other risk variables. Results: Results of multiple linear regression analyses indicated significantly higher adjusted mortality rates associated with greater water and air releases in both rural and urban counties. The strongest associations between TRI releases and rural mortality rates were found when 8 or more prior years of TRI release data were used to study subsequent mortality. Conclusion: The results support the use of the TRI as a public reporting tool and a research tool, and demonstrate that greater amounts of air and water TRI releases are related to mortality outcomes for both rural and urban populations.     

Organochlorine pesticide exposure in rural and urban areas in Mexico

The objective of this study was to determine the level of organochlorine pesticides in maternal milk of women living in urban and rural areas in central Mexico. High levels of the DDT (1,1,1,-trichloro-2,2-bis (p-chlorophenyl) ethane) and metabolites, p,p'-DDT (1.83, 0.66 and 3.13 mg/kg) and p,p'-DDE (2.49, 4.28 and 13.32 mg/kg), were encountered for Mexico City, Cuemavaca and rural Morelos, respectively. As was expected, the highest levels of exposure to these pesticides were found in the rural areas of the State of Morelos.     

Medicare prospective payment without separate urban and rural rates

The elimination of urban-rural differences in the Medicare prospective payment system (PPS) standard rates implies a need to re-examine all the PPS payment adjustments. Refinements for case mix, outliers, and the wage index can make a significant contribution to avoiding payment disparities in a single-rate system. However, changes in the adjustments for teaching and disproportionate-share (DSH) hospitals are also needed. The typically urban location of these hospitals makes it difficult to balance PPS payments and costs among major groups of urban and rural hospitals without some form of higher payment for all hospitals located in large urban areas.     

城乡社区卫生服务反应性比较

目的：了解和比较城乡社区卫生服务反应性的差距及存在的问题。方法：参照WHO卫生系统反应性评价方法，设计问卷进行现场调查和入户调查。结果：城市、农村社区卫生反应性存在差异，总水平和分布均以城市社区较好，城市和农村的反应性指数分别为8．26和7．16，认为能较好地平等对待不同人群的比例分别为89．1％和74．7％。结论；城乡应改善的反应性条目和问题基本相同，主要有及时关注、保密、选择等条目和对特殊人群得不到平等对待的问题，但农村还包括基础设施和交流等条目。