Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia

Aim: To audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. 

Methods: A robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80% of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1% male, 37.9% female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. 

Results/conclusions: Urban and rural groups had similar prevalences of severe visual impairment/blindness (7.0% urban, 5.2% rural) and cataract (7.3% urban, 7.1% rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1% and 5.0%, respectively (OR 2.9, p <. 0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.

Use of eye care services among diabetic patients in urban and rural China.

OBJECTIVE: To assess the use of eye care and its predictors among diabetic patients in China. DESIGN: Cross-sectional, clinic-based study. PARTICIPANTS: Diabetic patients 18 years of age or older were recruited consecutively from an urban tertiary and community hospitals and from a rural clinic in Guangdong, China. METHODS: Information obtained by questionnaire and chart review included: demographic and socioeconomic status, knowledge about diabetic retinopathy (DR), and ocular and medical history. MAIN OUTCOME MEASURES: Self-reported or chart history of an eye examination ever or within the preceding 12 months. RESULTS: The participation rate among 889 eligible subjects was 92.7%. Among 824 participants (mean age, 62.6+/-12.9 years; 58.8% female), 550 (66.7%) had not been examined in the last year as recommended by the American Academy of Ophthalmology, and 356 (43.2%) had never been examined. For the rural hospital, these figures were 81.1% and 68.7%, respectively. In regression analyses, factors associated with having an eye examination in the last year were: attendance at urban hospitals (odds ratio [OR], 3.46 [P<0.001] and 1.76 [P = 0.021] for the tertiary and community hospitals, respectively, compared with the rural clinic), higher DR knowledge score (OR, 1.24; P = 0.001), greater concern about vision loss (OR, 1.22; P = 0.007), and recommendation of regular eye examinations by the provider (OR, 2.36; P = 0.011). Predictors of ever having an eye examination were similar. Monthly income and health insurance status were not predictive of being examined. CONCLUSIONS: These results suggest that the low proportion of diabetic receiving recommended annual eye examinations in China may be improved through patient and physician education. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Evaluating the social effects of the EU URBAN Community Initiative Programme

This article explores alternative interpretations of the meaning and method of urban policy evaluation within the European Union (EU) Structural Funds. Using the EU URBAN Community Initiative Programme 1994-1999 it draws a distinction between 'instrumental' techniques that are primarily concerned with performance and efficiency measures and 'interpretative' approaches that stress the need to explore power relationships in the development and delivery of spending programmes. Empirically, it reflects on the interpretation of EU guidance and the MEANS (Means for Evaluating Actions of a Structural Nature) Collection to evaluate the Derry/Londonderry (UK) URBAN Sub-programme 1994-1999. The analysis concludes by emphasizing the need to ensure that urban policy evaluation is consistent with the broader social turn in the scope and content of regeneration programmes.

Cut down by some cowardly miscreants’: Plant maiming, or the Malicious Cutting of Plants as an Act of Protest in Eighteenth and Nineteenth Century Rural England

Since the publication of Hobsbawm and Rudé's Captain Swing our understanding of the role(s) of covert protests in Hanoverian rural England has advanced considerably. Whilst we now know much about the dramatic practices of incendiarism and animal maiming and the voices of resistance in seemingly straightforward acquisitive acts, one major gap remains. Despite the fact that almost thirty years have passed since E. P. Thompson brought to our attention that under the notorious ‘Black Act’ the malicious cutting of trees was a capital offence, no subsequent research has been published. This paper seeks to address this major lacuna by systematically analysing the practices and patterns of malicious attacks on plants (‘plant maiming’) in the context of late eighteenth- and early nineteenth-century southern England. It is shown that not only did plant maiming take many different forms, attacking every conceivable type of flora, but also that it was universally understood and practised. In some communities plant maiming was the protestors' weapon of choice. As a social practice it therefore embodied wider community beliefs regarding the defence of plebeian livelihoods and identities.

Housing Rural Communities: Connecting Rural Dwellings to Rural Development in Ireland

This paper explores the interaction between rural development policy and spatial planning policies for rural housing within the context of the island of Ireland. It draws on research commissioned by the Northern Ireland Housing Executive for a high level review of its rural housing policy. The paper highlights issues of wider relevance comprising a strained relationship between rural communities and rural planning, and argues for the adoption of cultural, environmental and community values within the rural planning policy arena.

Growth Coalitions and Rural Development Police in the EU and the US

A recent issue of EuroChoices (7:1) was devoted to a discussion of comparative US-EU rural development policies. This article discusses the concept of growth coalitions, well developed in urban literature but less so in rural literature. Some light is shed on the different positions of rural and environmental issues in EU and US policies. The agricultural lobby is the dominant actor in agricultural growth coalitions because it perceives land in terms of its exchange value. Environmental and rural development actors perceive land in terms of its use value and its contributions to quality of life: they form a rural development coalition, seeing the need to balance growth with quality of life, but they have less political power than the agricultural growth coalition. In the European context, rural and environmental agendas are linked to a multi-functional agricultural agenda allowing common ground between these two coalitions and greater visibility in the policy arena. In the US, rural interests and environmental groups are more often in opposition to agriculture. This reduces their political visibility and clout. The challenge is how to link the power of the agricultural growth coalitions with rural development coalitions to achieve a broader balance of concerns and a more effective rural development policy.

The diverse geographies of rural gentrification in Scotland

Gentrification has for too long been investigated as an urban phenomenon. Only relatively recently has it been viewed as an avenue for fruitful rural research. This paper focuses on the repopulation of rural Scotland. Using survey and interview data it examines evidence of gentrification among in-migration flows and seeks to explore both the social transformation of rural areas and the social displacement of rural residents.

The findings point towards important geographical variations. Not all in-migration represents gentrification, and where it does gives rise to very differing impacts. Clear spatial divisions in the local housing market are identified, and evidence is obtained to support a number of differing theoretical debates. Issues of social displacement and population replacement are explored, with the paper tentatively suggesting an important link between urban and rural gentrification processes. Finally, temporal and geographical phases of gentrification are identified. Collectively these findings have direct relevance to how we define gentrification.

Cities Ready for Energy Crises - Building Urban energy Resilience

Various sources indicate that threats to modern cities lie in the availability of essential streams, among which energy. Most cities are strongly reliant on fossil fuels; not one case of a fully self-sufficient city is known. Engineering resilience is the rate at which a system returns to a single steady or cyclic state following a perturbation. Certain resilience, for the duration of a crisis, would improve the urban capability to survive such a period without drastic measures.
The capability of cities to prepare for and respond to energy crises in the near future is supported by greater or temporary self-sufficiency. The objective of the underlying research is a model for a city – including its surrounding rural area – that can sustain energy crises. Therefore, accurate monitoring of the current urban metabolism is needed for the use of energy. This can be used to pinpoint problem areas. Furthermore, a sustainable energy system is needed, in which the cycle is better closed. This will require a three-stepped approach of energy savings, energy exchange and sustainable energy generation. Essential is the capacity to store energy surpluses for periods of shortage (crises).
The paper discusses the need for resilient cities and the approach to make cities resilient to energy crises.

Resistance or Resilience? Tracking the Pathway of Recent Arrivals to a ‘New’ Rural Destination

Recent patterns of migration indicate that international migrants are not confined to urban gateways. Instead many migrants have settled in new destination areas located in rural and small town areas. While this might appear to be a positive phenomenon for rural areas struggling with decline and stagnation, the reality is that many of these areas are ill-equipped to manage the rate and pace of change that has been witnessed in recent years. Migration to established, typically urban areas has been the subject of extensive research. However, little is known about the way in which migrants navigate their way through social structures as they settle into destinations with little experience of immigration. Using empirical research, this article considers the way in which migrants navigate their way through social structures to establish life in a so-called ‘new’ migration destination. It analyses the way in which government and civil society respond to their needs of recent arrivals, showing how both NGO’s and the statutory sector play an important role in this process. It considers the ramifications for these different sectors and the implications for so-called ‘new’ destinations as they become more established or ‘mature’ areas of immigration.

Rural Migration, Agrarian Change and Institutional Dynamics: Perspectives from the Majority World

Overall, this special issue provides insights into the mutually constitutive ways in which rapid economic development associated with industrialisation drives institutional change, migration and mobility, and, finally, altered relationships between – and conceptions of – rural and urban. The following papers pose important conceptual, normative as well as practical, policy-relevant questions relating to the human consequences of these processes and point to the applications of population research – a central objective of this journal.

Contemporary and 'messy' rural in-migration processes: Comparing counterurban and lateral rural migration.

This paper questions the ongoing dominant coverage given to counterurbanisation in the rural population literature. It is argued that this provides only a partial account of the true diversity of contemporary migration processes operating in rural areas and has the potential to fuse together different in-migration processes. Specifically, lateral rural migration has been under-researched to date. Using empirical data from a survey of 260 migrant households to 3 UK case study areas (in Scotland, Wales, and Northern Ireland), the significance of lateral rural migration is revealed and compared with counterurban migration and migrants. The last change of address shows that 59% relocated from an urban area (participating in a counterurban flow) whilst 41% moved from another rural location (lateral rural flow). The boundary between migration processes can, however, be blurred: Some moves are an example of both counterurbanisation and lateral rural flows. Incorporating lifetime migration histories data demonstrates the contemporary complexity and messiness of rural in-migration processes. For example, 26% of these migrant households only ever undertook a lateral rural move during their lifetime. For others, the direction of migration has changed numerous times and intertwined with each move are aspects of life course, return, and inter-regional migration. Comparing the survey characteristics and motivations of counterurban and lateral rural migrants, alongside interview material, highlights important similarities and differences. The paper concludes by calling on rural population geographers to more fully engage with the complexity, totality, and indeed messiness of contemporary rural in-migration processes.

Hardware Software Interface: a Strategy for the implementation of Urban Agriculture

This paper describes how urban agriculture differs from conventional agriculture not only in the way it engages with the technologies of growing, but also in the choice of crop and the way these are brought to market. The authors propose a new model for understanding these new relationships, which is analogous to a systems view of information technology, namely Hardware-Software- Interface.
The first component of the system is hardware. This is the technological component of the agricultural system. Technology is often thought of as equipment, but its linguistic roots are in ‘technis’ which means ‘know how’. Urban agriculture has to engage new technologies, ones that deal with the scale of operation and its context which is different than rural agriculture. Often the scale is very small, and soils are polluted. There this technology in agriculture could be technical such as aquaponic systems, or could be soil-based agriculture such as allotments, window-boxes, or permaculture. The choice of method does not necessarily determine the crop produced or its efficiency. This is linked to the biotic that is added to the hardware, which is seen as the ‘software’.
The software of the system are the ecological parts of the system. These produce the crop which may or may not be determined by the technology used. For example, a hydroponic system could produce a range of crops, or even fish or edible flowers. Software choice can be driven by ideological preferences such as permaculture, where companion planting is used to reduce disease and pests, or by economic factors such as the local market at a particular time of the year. The monetary value of the ‘software’ is determined by the market. Obviously small, locally produced crops are unlikely to compete against intensive products produced globally, however the value locally might be measured in different ways, and might be sold on a different market. This leads to the final part of the analogy - interface.
The interface is the link between the system and the consumer. In traditional agriculture, there is a tenuous link between the producer of asparagus in Peru and the consumer in Europe. In fact very little of the money spent by the consumer ever reaches the grower. Most of the money is spent on refrigeration, transport and profit for agents and supermarket chains. Local or hyper-local agriculture needs to bypass or circumvent these systems, and be connected more directly to the consumer. This is the interface. In hyper-localised systems effectiveness is often more important than efficiency, and direct links between producer and consumer create new economies.