北京城乡良性前列腺增生发病的差异

中国农村前列腺增生（ＢＰＨ）发病低于城市，对北京４０岁以上男性乡村４１３人、城镇４１９人的饮食结构和国际前列腺症状评分（Ｉ－ＰＳＳ）、生活质量评分（Ｌ）、最大尿流率（Ｑｍａｘ）、前列腺体积（Ｖ）、剩余尿（Ｒ）等进行比较，发现城市居民ＢＰＨ发病率高，摄取动物蛋白亦高。动物蛋白摄入量可能对ＢＰＨ发生有影响。     

Comparison of the prevalence of reversible airways obstruction in rural and urban Zimbabwean children

The prevalence of reversible airways obstruction has been assessed in children in three areas in Zimbabwe--northern Harare (high socioeconomic class urban children), southern Harare (low socio-economic class urban children), and Wedza Communal Land (rural children from peasant families). Peak expiratory flow (PEF) was measured before and after six minutes' free running in 2055 Zimbabwean primary school children aged 7-9 years. Height and weight were measured and nutritional state expressed as a percentage of the 50th centile for age (Tanner-Whitehouse standards). Reversible airways obstruction was deemed to be present when peak expiratory flow was below the 2.5th centile for height before exercise and rose by more than 15% after inhalation of salbutamol and when it fell by 15% or more after exercise and rose again after salbutamol. The prevalence of reversible airways obstruction was 5.8% (95% confidence interval 4.1-7.5%) in northern Harare (n = 726); 3.1% (1.8-4.5%) in southern Harare (n = 642), and 0.1% (0.0-0.4%) in Wedza (n = 687). In northern Harare, the only study area in which white children were found, the prevalence of reversible airways obstruction was similar in white (5.3%, 10/188) and black (5.9%, 32/538) children. Indicators of nutritional state also showed no significant differences between white and black children in northern Harare but were lower in southern Harare and lower still in Wedza. Urban living and higher material standards of living appear to be associated with a higher prevalence of reversible airways obstruction in children in Zimbabwe.     

The prevalence of hypertension in the Indian population of Roodepoort (Transvaal)

In a house-to-house study of 318 Roodepoort Indians the prevalence of hypertension was 19% by 1962 World Health Organization criteria and 12% by 1978 WHO criteria. This change in criteria may lead to misinterpretation of trends in the prevalence of hypertension. The mean systolic and diastolic pressures rose with age. Sixty-three per cent of subjects found to be hypertensive were already on therapy and 26% of the hypertensives were undiagnosed until this survey. The proportion of undiagnosed cases has important health implications.     

Exercise induced bronchospasm in Ghana: differences in prevalence between urban and rural schoolchildren

BACKGROUND: As more developing countries adopt a westernised style of living, an increase in the prevalence of asthma can be expected to occur in these areas. A study was undertaken to establish the normal response to exercise in Ghanaian children and to use these normal values to determine the prevalence of exercise induced bronchospasm (EIB) in urban rich (UR), urban poor (UP), and rural (R) school children. Skin test reactivity to common inhalant allergens in UR, UP, and R children with and without EIB was also investigated. METHODS: Two hundred children aged 9-16 years without a previous history of respiratory symptoms were randomly selected and underwent free running exercise testing. A normal response to exercise was defined as the group mean change in peak expiratory flow rate (PEFR) +/- 2 standard deviations. This value was used to identify the prevalence of EIB in UR, UP, and R schoolchildren. A total of 1095 children from three different schools underwent exercise testing (220 UP, 599 UR, 276 R), after which 916 children underwent skin prick testing to six common inhalant allergens (D farinae, D pteronyssinus, cat, dog, Aspergillus flavus and Candida albicans). RESULTS: From the results of exercise testing in asymptomatic children the normal range was defined as a fall in PEFR of < 12.5% after exercise. Thirty four children were classified as having EIB on the basis of the above definition, giving an overall prevalence of 3.1%. The prevalence of EIB was significantly higher in UR children (4.7%) than in both UP (2.2%; p < 0.05) and R children (1.4%; p < 0.01). However, the prevalence rates in the UP and R children were similar. The prevalence of atopy in the whole population was 4.4%. Of the children with EIB, 10% were skin test positive to at least one of the allergens tested. The prevalence of atopy was significantly higher in UR children (6.55%, 95% confidence interval (CI) 4.5% to 9.2%) than in UP (2.9%, 95% CI 0.9% to 6.7%) and R children (1.5%, 95% CI 0.4% to 3.7%), respectively (p < 0.005). CONCLUSIONS: The prevalence of EIB and atopy is higher in urban rich than in urban poor or rural children suggesting that, in addition to genetic predisposition, social and environmental factors such as wealth, life style, and housing are important determinants of these phenotypes.


     

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations.

OBJECTIVE: To establish the relationship between HIV infection and cervical dysplasia in young women in rural South Africa. METHODS: This cross-sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu- Natal. Standardised questionnaires were used to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap smears were done using standard methods. Pap smear data were linked to HIV serostatus. RESULTS: Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 - 55 years), and 80% were younger than 30 years. The HIV prevalence rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9 - 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intraepithelial lesions), and 1.3% HGSIL (high-grade squamous intraepithe lial lesions). The association between HIV seropositivity and abnormal Pap results was statistically significant (p < 0.05). CONCLUSION: There is a need for more data on cervical changes in HIV co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and where access to antiretroviral treatment remains limited.     

Hip fractures in northern Sweden 1973-1984. A comparison of rural and urban populations

The hip-fracture incidence in persons aged 50 years and older in the two northernmost counties of Sweden was studied during three periods between 1973 and 1984. The mean age rose from 75 to 78 years, and the annual number of fractures increased from 511 to 754. Half of this increase could be attributed to demographic aging. For persons 80 years and older, the fracture incidence in 1983/84 was higher (P less than 0.01) than the fracture incidence in 1973/74. The women/men ratio was approximately 2:1 during the survey, while the ratio cervical/trochanteric fracture type changed from 1.7:1 to 1.8:1. The crude fracture incidence rate rose from 4.4 to 5.8 fractures per 1,000 women 50 years and older; the corresponding figures for men were 2.3 and 3.4. Comparison of a rural mountain population with an urban population revealed a lower age-adjusted hip-fracture incidence rate in the rural area during the final part of the study (P less than 0.001). In the rural population, there was no change in age-specific incidence during the survey, while in the urban area the age-specific incidence in person 75 years and older was higher in 1983/84 compared with 1973/74.     

A comparison of endocrine reactions to different types of acute stressors in rural and urban black populations

Moving from a rural setting to an urban environment is a stressful experience. This situation will most likely result in changes in lifestyle and health. Changes in endocrine reactivity may contribute to the development of western-type diseases in urban communities. In this study it was found that individuals in the process of urbanization exhibit significantly higher endocrine reactivity than rural communities during acutely stressful situations.     

Incidence of hip fracture in western Sweden 1974-1982. Comparison of rural and urban populations

Several epidemiological studies in northern Europe have shown that fractures in the elderly exceed the expected increase in the aging populations. We have compared the incidence of hip fracture in the rural county of Skaraborg and the city of G?teborg in Sweden. After adjustment for age changes in the population, the incidence of hip fracture in Skaraborg County was lower than in G?teborg during the period 1974-1984. The non-age-related increase in the incidence of fractures found in the city was not confirmed in the rural area.     

Lactose maldigestion--age-specific prevalence in black and Indian children

A study was performed to determine the prevalence and age of onset of primary lactose maldigestion in healthy black and Indian children, and to determine whether this was of clinical significance. More black (22 of 44-50%) than Indian children (10 of 45-22.2%) had lactose maldigestion (P less than 0.02), the development of which was age-related and occurred earlier in blacks than in Indians; 6 of 19 black children less than 5 years old (31.6%) were lactose maldigesters, compared with 8 of 10 (80%) over 10 years old, while only 1 of 16 Indian children aged under 8 years (6.3%) were maldigesters, compared with 5 of 13 (38.5%) aged over 10 years. Most children had a very low intake of milk and lactose maldigestion was of no clinical significance to them.     

High prevalence of hypertension among an ethnic group in Sudan: implications for prevention

Objective Hypertension is an emerging non-communicable disease in developing countries. Due to its silent nature and serious complications, active screening is essential in order to prevent complications. For instance, premature mortality from cardiovascular diseases could be prevented by the effective control of hypertension. The aim of this study was to determine the prevalence of undiagnosed hypertension among Nuba ethnic group living in Atbara city, north Sudan and to identify the associated risk factors. Subject and methods All consenting 500 adults from Nuba tribe who live in El Wihda District, Atbara were included. Blood pressure (BP) and body mass index were measured. Standard interviewing procedures were used to record medical history, socio-demographic data, and lifestyle characteristics. Results Among the 500 participants, females were 364 (72.8%) and males were 136 (27.2%). The overall prevalence of undiagnosed hypertension was 49.4% (30.8% stage 1 hypertension and 18.6% stage 2 hypertension). In addition, 41% of the population was having prehypertension. The significant risk factors for high BP were: male sex, age above 45 years, overweight, illiteracy, and alcohol consumption. Conclusion Undiagnosed high BP is very common among Nuba ethnic group; therefore, active screening and early management are recommended to prevent complications.     

Nutritional parameters in urban and rural Zulus

Anthropometric, biochemical and haematological nutritional parameters were measured in 103 (65 men, 38 women) Durban Zulu adults (urban) and 109 (41 men, 68 women) Tugela Ferry Zulu adults (rural). Men conformed to an ideal weight for height whereas women were 18% overweight in Tugela Ferry and 30% so in Durban. Mean arm muscle circumference in men was between the 10th and 20th centiles. Other nutritional parameters were similar to those accepted internationally as normal. In particular the serum albumin level was normal in both urban and rural Zulus. There was little change in the parameters with age except that hand grip as measured by dynamometry fell with age (P less than 0,05). Serum albumin levels fell with age in women (P less than 0,01) but not in men. Nine mothers of babies suffering from kwashiorkor showed normal nutritional profiles.     

High prevalence of vitamin D deficiency in north Indian adults is exacerbated in those with chronic kidney disease

Aim:   Vitamin D is being increasingly recognized as an important player in disease. Hypovitaminosis D is widespread in chronic kidney disease (CKD) populations around the world. The vitamin D status of Indian CKD patients is not known.
Methods:   Levels of 25(OH) vitamin D and parathyroid hormone (PTH) were measured in adult north Indian male patients with newly diagnosed stage IV–V CKD and matched control subjects drawn from the same population. A total of 100 (34 stage IV and 66 stage V) patients with CKD and 72 controls were studied.
Results:   Only 4% control and 1% of CKD subjects had normal (>30 ng/mL) vitamin D levels. Approximately 68% of control and 77% of the CKD population had vitamin D deficiency (<15 ng/ml) whereas the remaining 38% control and 22% CKD patients had insufficient (15–30 ng/mL) vitamin D levels. Levels were lower in CKD subjects compared to their family members, and the CKD patients were significantly more likely to have severe vitamin D deficiency (<5 ng/mL). A strong negative correlation was noted between vitamin D and PTH. No significant correlation was found between vitamin D levels and body mass index, bodyfat percentage, serum albumin or calcium levels.
Conclusion:   Vitamin D deficiency is highly prevalent in north Indians, and this is more pronounced in CKD subjects. There is a significant inverse correlation between the vitamin D and PTH levels. The clinical significance of this deficiency and the potential benefits to be derived from vitamin D supplementation in this population merits further studies.     

Comparisons of the prevalence and correlation factors of chronic kidney disease between the old urban and rural residents in MinHang district of Shanghai

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population. Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai, respectively. Based on the over-60-year old people health examination program, 6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated. The prevalence of CKD in urban and rural areas was compared, and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis. Results (1) The survey objectives with an average age of (69.57±7.04) years, including 4345 cases of the city residents and 1806 cases of rural residents, were enrolled. The age structures of urban and rural showed differences, population over 80 years old account for 13.1% of the rural total, significantly higher than 7.4% in the urban population (P＜0.001). (2) The prevalence rates of diabetes, hyperuricemia, hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents, which were 26.4% vs 13.7%, 9.9% vs 2.3%, 53.7% vs 37.4%, 51.4% vs 15.6% (all P＜0.01). The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas, which were 32.9% vs 44.2%, 84.6% vs 62.8% (all P＜0.01). Compared with those in rural areas, the treatment rates of hypertension and high blood lipids in urban residents were increased (all P＜0.01). (3) The prevalence of CKD was 23.4%. Female CKD prevalence was higher than male, respectively 26.3% and 18.5% (P＜0.01). In urban CKD prevalence was 22.2%, lower than 25.2% in rural. The prevalence rate of hematuria in urban areas was lower than in rural areas, but the prevalence rate of decline in renal function was higher (all P＜0.05). With the increase of age, the prevalence rate of CKD was increased (P＜0.01). (4) Age (OR=1.072), smoking history (OR=1.543), previous history of kidney disease (OR=1.351), diabetes (OR=1.373), hyperuricemia (OR=2.498), obesity (OR=1.364), history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population, while the higher education (OR=0.676, OR=0.604) and drinking (OR=0.585) had negative correlation (all P＜0.05). Age (OR=1.032), female (OR=1.860) had positive correlation with CKD in rural elderly population (all P＜0.05). Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district. The prevalence of CKD is higher in urban areas than in rural. Age is a common factor for CKD in urban and rural. Previous smoking, history of kidney disease, diabetes, hyperuricemia, obesity, history of interventional therapy, education and drinking have correlation with urban CKD patients. Female has correlation with rural CKD population.     

中老年人前列腺体积增长的城乡差异

为了解国人中年以后前列腺的生长情况及其可能的影响因素，对北京、河北、湖北等地四个社区的城乡居民前列腺体积进行了经腹Ｂ超测量。结果表明城区居民的前列腺体积明显大于相应年龄段的农村居民，城区居民的前列腺增长速率比农村居民高二倍。生活环境和饮食习惯的不同可能为其原因之一。     

Respiratory symptoms of rural Fijian and Indian children in Fiji.

BACKGROUND--Significant ethnic differences exist in the respiratory morbidity of children in the Fiji Islands. Indian children have higher national hospital admission rates for asthma whereas Fijian children have higher admission rates for pneumonia. In Suva City the prevalence of wheeze is similar in Fijian and Indian children, productive cough is more common in Fijians, and bronchial hyperresponsiveness is more common in Indians. This study was undertaken to see whether ethnic differences in national hospital admission rates are reflected in the prevalence of respiratory symptoms in rural children. METHODS--A respiratory symptoms questionnaire in three languages with known repeatability was returned by 487 (98.2%) of 496 class 4 primary school children with a mean age of 9.3 years living in Nausori District, an agrarian region with a climate similar to Suva City. RESULTS--The prevalence of one or more episodes of wheezing in the last 12 months was similar in Fijians (19.8%) and Indians (19.4%). However, 8.9% of Indian children had experienced four or more episodes of wheeze in the last 12 months compared with only 2.9% of Fijian children. Productive cough on most mornings occurred more frequently in Fijians (35.8%) than Indians (23.9%), but this difference was not significant after controlling for the presence of a smoker in the home. CONCLUSIONS--This study provides the first evidence that frequent wheeze (four or more episodes in the last 12 months) is more prevalent in Indian than Fijian children. The higher prevalence of productive cough in Fijian children may be related to exposure to smoking in the home.     

Differences and similarities between rural and urban operations

BACKGROUND: The importance of rural operations is magnified by super-specialization, uneven geographic distribution, and special educational needs. Definition of practice patterns and quality measures are needed. METHODS: A statewide network of 60 operative specialists studied costs, quality, and outcomes in 17,319 patients undergoing 46 different specialty operations between 1998 and 2003, comparing 9,544 rural to 7,775 urban patients. These data are augmented by additional data from 5,339 operative patients in 2004. RESULTS: Both high volume rural and urban surgeons achieved fewer deaths than less frequent practitioners of colon or rectal resections (2/309 vs 5/167). Urban surgeons had sicker patients undergoing more extensive procedures, and used fewer consultations, but had more complications and reoperations. Laparoscopic cholecystectomy had similar outcomes with 5 deaths among 1,788 patients. Urban surgeons converted to an open procedure more frequently, whereas rural surgeons used hepatobiliary iminodiacetic acid (HIDA) scans as indication for cholecystectomy more often (P < .01). Indications for upper and lower endoscopy varied, but abnormalities were noted in 64%; only 11 of 6,938 patients undergoing endoscopy were admitted for complications, 5 required operations, 3 due to totally obstructing cancers. Hysterectomy, urologic procedures, and tympanostomy had admission/readmission rates as low as 1/400. Documented patient preoperative education occurred in 94% of both groups. Overall, performance measures were addressed more consistently by rural surgeons (P < .001). CONCLUSIONS: Operative practice reaches high standards in both settings; indications for operations vary, and rural practice is broader than urban practice. Rural surgeons exceed their urban colleagues on some quality process measures.