Comparing the experiences of rural and urban family caregivers of the terminally ill

Introduction: There are many challenges in delivering rural health services; this is particularly true for the delivery of palliative care. Previous work has identified consistent themes around end-of-life care, including caregiver burden in providing care, the importance of informal care networks and barriers imposed by geography. Despite these well-known barriers, few studies have explored the experience of palliative care in rural settings. The purpose of the present study was to compare the experiences of rural family caregivers actively providing end-of-life care to the experiences of their urban counterparts. Methods: Caregivers' perceived health status, the experience of burden in caregiving, assessment of social supports and the pattern of formal care used by the terminally ill were explored using a consistent and standardized measurement approach. A cross-sectional survey study was conducted with 100 informal caregivers (44 rural, 56 urban) actively providing care to a terminally ill patient recruited from a publicly funded community agency located in northeastern Ontario, Canada. The telephone-based survey included questions assessing: (i) caregiver perceived burden (14-item instrument based on the Caregiver's Burden Scale in End-of-Life Care [CBS-EOLC]); (ii) perceived social support (modified version of the Multidimensional Scale of Perceived Social Support [MSPSS] consisting of 12 items); and (iii) functional status of the care recipient (assessed using the Eastern Collaborative Oncology Group performance scale). Results: Rural and urban caregivers were providing care to recipients with similar functional status; the majority of care recipients were either capable of all self-care or experiencing some limitation in self-care. No group differences were observed for caregiver perceived burden: both rural and urban caregivers reported low levels of burden (CBS-EOLC score of 26.5 [SD=8.1] and 25.0 [SD=9.2], respectively; p=0.41). Urban and rural caregivers also reported similarly high levels of social support (mean MSPSS total score of 4.3 [SD=0.7] and 4.1 [SD=0.8], respectively; p=0.40). Although caregivers across both settings reported using a comparable number of services (rural 4.8 [SD=1.9] vs urban 4.5 [SD=1.8]; p=0.39), the types of services used differed. Rural caregivers reported greater use of family physicians (65.1% vs 40.7%; p=0.02), emergency room visits (31.8% vs 13.0%; p=0.02) and pharmacy services (95.3% vs 70.4%; p=0.002), while urban caregivers reported greater use of caregiver respite services (29.6% vs 11.6%; p=0.03). Conclusion: Through the use of standardized tools, this study explored the experiences of rural informal family caregivers providing palliative care in contrast to the experiences of their urban counterparts. The results of the present study suggest that while there are commonalities to the caregiving experience regardless of setting, key differences also exist. Thus, location is a factor to be considered when implementing palliative care programs and services. © K Brazil, S Kaasalainen, A Williams, C Rodriguez, 2013.

Small towns as 'sub-poles' in English rural development: Investigating rural-urban linkages using sub-regional social accounting matrices

This paper uses spatial economic data from four small English towns to measure the strength of economic integration between town and hinterland and to estimate the magnitude of town-hinterland spill-over effects. Following estimation of local integration indicators and inter-locale flows, sub-regional social accounting matrices (SAMs) are developed to estimate the strength of local employment and output multipliers for various economic sectors. The potential value of a town as a 'sub-pole' in local economic development is shown to be dependent on structural differences in the local economy, such as the particular mix of firms within towns. Although the multipliers are generally small, indicating a low level of local linkages, some sectors, particularly financial services and banking, show consistently higher multipliers for both output and employment. (c) 2007 Elsevier Ltd. All rights reserved.

Rural-urban disparities in child nutrition in Bangladesh and Nepal

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

Morphological and fecundity traits of Culex mosquitoes caught in gravid traps in urban and rural Berkshire, UK

Culex pipiens s.l. is one of the primary vectors of West Nile Virus in the USA and Continental Europe. The seasonal abundance and eco-behavioural characteristics of the typical form, Cx. pipiens pipiens, make it a key putative vector in Britain. Surveillance of Culex larvae and adults is essential to detect any changes to spatial and seasonal activity or morphological traits that may increase the risk of disease transmission. Here we report the use of the modified Reiter gravid box trap, which is commonly used in the USA but scarcely used in the UK, to assess its suitability as a tool for British female Culex mosquito surveillance. Trapping was carried out at 110 sites in urban and rural gardens in Berkshire in May, July and September 2013. We tested if reproductively active adult female Culex are more abundant in urban than rural gardens and if wing characteristic traits and egg raft size are influenced by location and seasonal variations. Gravid traps were highly selective for Culex mosquitoes, on average catching significantly more per trap in urban gardens (32.4 ± 6.2) than rural gardens (19.3 ± 4.0) and more in July than in May or September. The majority of females were caught alive in a good condition. Wing lengths were measured as an indicator of size. Females flying in September were significantly smaller than females in May or July. Further non-significant differences in morphology and fecundity between urban and rural populations were found that should be explored further across the seasons.

Global and diffuse solar irradiances in urban and rural areas in southeast Brazil

The seasonal evolution of daily and hourly values of global and diffuse solar radiation at the surface are compared for the cities of Sao Paulo and Botucatu, both located in Southeast Brazil and representative of urban and rural areas, respectively. The comparisons are based on measurements of global and diffuse solar irradiance carried out at the surface during a six year simultaneous period in these two cities. Despite the similar latitude and altitude, the seasonal evolution of daily values indicate that Sao Paulo receives, during clear sky days, 7.8% less global irradiance in August and 5.1% less in June than Botucatu. On the other hand, Sao Paulo receives, during clear sky days, 3.6% more diffuse irradiance in August and 15.6% more in June than Botucatu. The seasonal variation of the diurnal cycle confirms these differences and indicates that they are more pronounced during the afternoon. The regional differences are related to the distance from the Atlantic Ocean, systematic penetration of the sea breeze and daytime evolution of the particulate matter in Sao Paulo. An important mechanism controlling the spatial distribution of solar radiation, on a regional scale, is the sea breeze penetration in Sao Paulo, bringing moisture and maritime aerosol that in turn further increases the solar radiation scattering due to pollution and further reduces the intensity of the direct component of solar radiation at the surface. Surprisingly, under clear sky conditions the atmospheric attenuation of solar radiation in Botucatu during winter - the biomass burning period due to the sugar cane harvest - is equivalent to that at Sao Paulo City, indicating that the contamination during sugar cane harvest in Southeast Brazil has a large impact in the solar radiation field at the surface.

Internal Architecture and Population Size of Acromyrmex subterraneus molestans (Hymenoptera, Formicidae) Nests: Comparison Between a Rural and an Urban Area

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Global and diffuse solar irradiances in urban and rural areas in southeast Brazil

The seasonal evolution of daily and hourly values of global and diffuse solar radiation at the surface are compared for the cities of São Paulo and Botucatu, both located in Southeast Brazil and representative of urban and rural areas, respectively. The comparisons are based on measurements of global and diffuse solar irradiance carried out at the surface during a six year simultaneous period in these two cities. Despite the similar latitude and altitude, the seasonal evolution of daily values indicate that São Paulo receives, during clear sky days, 7.8% less global irradiance in August and 5.1% less in June than Botucatu. on the other hand, São Paulo receives, during clear sky days, 3.6% more diffuse irradiance in August and 15.6% more in June than Botucatu. The seasonal variation of the diurnal cycle confirms these differences and indicates that they are more pronounced during the afternoon. The regional differences are related to the distance from the Atlantic Ocean, systematic penetration of the sea breeze and daytime evolution of the particulate matter in São Paulo. An important mechanism controlling the spatial distribution of solar radiation, on a regional scale, is the sea breeze penetration in São Paulo, bringing moisture and maritime aerosol that in turn further increases the solar radiation scattering due to pollution and further reduces the intensity of the direct component of solar radiation at the surface. Surprisingly, under clear sky conditions the atmospheric attenuation of solar radiation in Botucatu during winter - the biomass burning period due to the sugar cane harvest - is equivalent to that at São Paulo City, indicating that the contamination during sugar cane harvest in Southeast Brazil has a large impact in the solar radiation field at the surface.

Cytogenetic and random amplified polymorphic DNA analysis of Leptodactylus species from rural and urban environments (Anura, Amphibia)

Cytogenetic and random amplified polymorphic DNA analyses carried out in the species Leptodactylus podicipinus, L. ocellatus, L. labyrinthicus, and L. fuscus from rural and urban habitats of the northwest region of São Paulo State, Brazil, showed that the karyotypes (2n = 22), constitutive heterochromatin distribution and nucleolus organizer region (NOR) location did not differ between the populations from the two environments. The in situ hybridization with an rDNA probe confirmed the location of the NORs on chromosome 8 revealing an in tandem duplication of that region in one of the chromosomes of L. fuscus. DAPI showed that part of the C-band-positive heterochromatin is rich in AT, including that in the proximity the NORs in L. podicipinus and L. ocellatus. The molecular analyses showed that the two populations (urban and rural) of L. podicipinus and L. fuscus are similar from a genetic point of view. The urban and rural populations of species L. ocellatus and L. labyrinthicus showed differences in genetic structures, probably due to urbanization which interferes with the dispersion of those frogs. The marked differences observed between the two populations of L. ocellatus can be representing the cryptic condition of the species. Unweighted pair-group method of analysis and genetic distance analysis detected the genetic proximity between L. ocellatus and L. fuscus. The results indicate that there was no reduction in the genetic diversity in the populations from the urban environment; however, the survival of these frogs would not be guaranteed in the case of an increase in human impact especially for populations of L. labyrinthicus and L. ocellatus. ©FUNPEC-RP.

Molar incisor hypomineralisation: Possible aetiological factors in children from urban and rural areas

Aim: To analyse factors potentially associated with molar incisor hypomineralisation (MIH) development. METHODS: A population-based study was carried out with 903 children aged from 6-12 years old, born and residing in rural and urban areas of the town of Botelhos, State of Minas Gerais, Brazil. Their mothers completed a structured medical history questionnaire, from pregnancy to the child's 3rd year of life. Two examiners evaluated children for MIH according to criteria suggested by the European Academy of Paediatric Dentistry. Descriptive analyses of the data and odds ratios (OR) with 95% test-based confidence intervals (CI) were estimated. Chisquare test was used to evaluate the differences between groups. RESULTS: The prevalence of MIH in children from rural area (RA) was significantly higher than those from the urban area (UA) (24.9% versus 17.8%, p= 0.01). In urban children, neither significant associations with MIH nor medical problems were found. In rural children, however, MIH was significantly more common among those whose mothers had experienced medical problems during pregnancy (OR=2.11; 1.01-4.37 CI 95%; p=0.04), who had throat infections (OR=2.93; 1.47-5.87 CI 95%; p=0.01), who had high fever (OR=1.91; 1.07-3.39 CI 95%; p=0.02), and who had used amoxicillin associated with other antibiotics (OR=1.92; 1.02-3.62 CI 95%; p=0.04) during the first 3 years of life. CONCLUSION: This study suggests a link between MIH and health problems during pregnancy, as well as environmental factors.

Hypertension control and related variables among urban and rural adults in Taiwan

Literature on hypertension treatment has demonstrated that a healthy life style is one of the best strategies for hypertension control. In exploring the mechanisms of behavioral change for hypertension control, a comprehensive study based on the Transtheoretical Model was carried out in Taiwan during the summer of 2000 with a sample of 350 hypertensive adults living in Taipei urban and rural areas. ^ The relationships among stages of change, processes of change and demographic factors were analyzed for six health behaviors—low fat food consumption, alcohol use, smoking, physical activity, weight control, and routine blood pressure checkups. In addition, differences were assessed between urban and rural populations in changing their behavior for hypertension control. ^ The results showed that rural populations had more difficulties than urban populations in avoiding smoking and engaging in physical activity, and the processes of change being used by urban populations were significantly greater than rural populations. The study findings support a strong association between processes and stages of change. ^ Individuals who use more processes of change will be more inclined to move from precontemplation stage to maintenance stage. Counterconditioning, which is the substitution of alternatives for the problem behaviors, in this study, significantly helped people to change diet, engage in physical activity, and check blood pressure regularly. For example, counterconditioning is eating more vegetables instead of meat, or engaging in physical activity as a time to relax rather than another task to accomplish. ^ In addition, self-reevaluation was the most important process for helping people to engage in physical activity; and social liberation was the most important process for changing diet behavior. The findings in this study may be applied to improve health behaviors among rural populations with low income and low education; however, at the same time, the obesity problems among urban populations should be prevented to control hypertension in Taiwan. ^

Comparison of rural and urban attitudes to the conservation of Asian elephants in Sri Lanka: empirical evidence

There has been little study of economic and general attitudes towards the conservation of the Asian elephant. This paper reports and analyses results from surveys conducted in Sri Lanka of attitudes of urban dwellers and farmers towards nature conservation in general and the elephant conservation in particular. The analyses are based on urban and a rural sample. Contingent valuation techniques are used as survey instruments. Multivariate logit regression analysis is used to analyse the respondents' attitudes towards conservation of elephants. It is found that, although some variations occurred between the samples, the majority of the respondents (both rural and urban) have positive attitudes towards nature conservation in general. However, marked differences in attitudes toward elephant conservation are evident between these two samples: the majority of urban respondents were in favour of elephant conservation; rural respondents expressed a mixture of positive and negative attitudes. Overall, considerable unrecorded and as yet unutilised economic support for conservation of wild elephants exists in Sri Lanka. (C) 2002 Elsevier Science Ltd. All rights reserved.

Comparative academic performance of medical students in rural and urban clinical settings

OBJECTIVE To determine whether the academic performance of medical students learning in rural settings differs from those learning in urban settings. DESIGN Comparison of results of assessment for 2 full cohorts and 1 part cohort of medical students learning in rural and urban settings in 2002 (209 students), 2003 (226 students) and 2004 (220 students), including results for each specialist rotation in the 3rd year and end-of-year examinations in the 2nd and 4th years. SETTING University of Queensland School of Medicine, Brisbane. Students spent the whole 3rd year (of a 4-year graduate entry programme) conducting 5 specialist 8-week rotations in either the rural clinical division (rural students) or in Brisbane (urban students), all following the same curriculum and taking the same examinations. RESULTS For the 2002 cohort there were no statistically significant differences in academic performance between rural and urban students. For the 2003 cohort the only significant difference was a higher score for rural students in the end of the 4th-year clinical skills examination (65.7 versus 62.3%, P = 0.025). For the 2004 cohort, rural students scored higher in the 3rd-year mental health rotation (79.3 versus 76.2%, P = 0.038) and lower in the medicine rotation (65.5 versus 68.6%, P = 0.037). CONCLUSION Academic performance among students studying in rural and urban settings is comparable.

Food customs of rural and urban Inupiaq elders and their relationships to select nutrition parameters, food insecurity, health, and physical and mental functioning

The Inupiaq Tribe resides north of the Arctic Circle in northwestern Alaska. The people are characterized by their continued dependence on harvested fish, game and plants, known as a subsistence lifestyle (Lee 2000:35-45). Many are suggesting that they leave their historical home and move to urban communities, places believed to be more comfortable as they age. Tribal Elders disagree and have stated, "Elders need to be near the river where they were raised" (Branch 2005:1). The research questions focused on differences that location had on four groups of variables: nutrition parameters, community support, physical functioning and health. A total of 101 Inupiaq Elders ≥ 50 years were surveyed: 52 from two rural villages, and 49 in Anchorage. Location did not influence energy intake or intake of protein; levels of nutrition risk and food insecurity; all had similar rates between the two groups. Both rural and urban Elders reported few limitations of ADLs and IADLs. Self-reported general health scores (SF-12.v2 GH) were also similar by location. Differences were found with rural Elders reporting higher physical functioning summary scores (SF-12.v2 PCS), higher mental health scores (SF-12.v2 MH), higher vitality and less pain even though the rural mean ages were five years older than the urban Elders. Traditional food customs appear to support the overall health and well being of the rural Inupiaq Elders as demonstrated by higher intakes of Native foods, stronger food sharing networks and higher family activity scores than did urban Elders. The rural community appeared to foster continued physical activity. It has been said that when Elders are in the rural setting they are near "people they know" and it is a place "where they can get their Native food" (NRC 2005). These factors appear to be important as Inupiaq Elders age, as rural Inupiaq Elders fared as well or better than Inupiaq Elders in terms of diet, mental and physical health.

Ethnic differences in body composition and anthropometric characteristics in Australian Caucasian and urban Indigenous children

The objective was to compare ethnic differences in anthropometry, including size, proportions and fat distribution, and body composition in a cohort of seventy Caucasian (forty-four boys, twenty-six girls) and seventy-four urban Indigenous (thirty-six boys, thirty-eight girls) children (aged 9–15 years). Anthropometric measures (stature, body mass, eight skinfolds, thirteen girths, six bone lengths and five bone breadths) and body composition assessment using dual-energy X-ray absorptiometry were conducted. Body composition variables including total body fat percentage and percentage abdominal fat were determined and together with anthropometric indices, including BMI (kg/m2), abdominal:height ratio (AHtR) and sum of skinfolds, ethnic differences were compared for each sex. After adjustment for age, Indigenous girls showed significantly (P < 0·05) greater trunk circumferences and proportion of overweight and obesity than their Caucasian counterparts. In addition, Indigenous children had a significantly greater proportion (P < 0·05) of trunk fat. The best model for total and android fat prediction included sum of skinfolds and age in both sexes (>93 % of variation). Ethnicity was only important in girls where abdominal circumference and AHtR were included and Indigenous girls showed significantly (P < 0·05) smaller total/android fat deposition than Caucasian girls at the given abdominal circumference or AHtR values. Differences in anthropometric and fat distribution patterns in Caucasian and Indigenous children may justify the need for more appropriate screening criteria for obesity in Australian children relevant to ethnic origin.