Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey.

OBJECTIVE To estimate chlamydia prevalence among 16-29-year-olds attending general practice clinics in Australia. DESIGN, PARTICIPANTS AND SETTING A cross-sectional survey was conducted from May 2010 to December 2012. Sexually experienced 16-29-year-olds were recruited from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics (consecutive patients were invited to participate). Participants completed a questionnaire and were tested for chlamydia. MAIN OUTCOME MEASURE Chlamydia prevalence. RESULTS Of 4284 participants, 197 tested positive for chlamydia (4.6%; 95% CI, 3.9%-5.3%). Prevalence was similar in men (5.2% [65/1257]; 95% CI, 3.9%-6.4%) and women (4.4% [132/3027]; 95% CI, 3.5%-5.2%) (P = 0.25) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI) - 17.0% in men (8/47; 95% CI, 2.8%-31.2%); 9.5% in women (16/169; 95% CI, 5.1%-13.8%). Nearly three-quarters of cases (73.4% [130/177]) were diagnosed in asymptomatic patients attending for non-sexual health reasons, and 83.8% of all participants (3258/3890) had attended for non-sexual health reasons. Prevalence was slightly higher in participants from rural and regional areas (4.8% [179/3724]; 95% CI, 4.0%-5.6%) than those from metropolitan areas (3.1% [17/548]; 95% CI, 1.5%-4.7%) (P = 0.08). In multivariable analysis, increasing partner numbers in previous 12 months (adjusted odds ratio [AOR] for three or more partners, 5.11 [95% CI, 2.35-11.08]), chlamydia diagnosis in previous 12 months (AOR, 4.35 [95% CI, 1.52-12.41]) and inconsistent condom use with most recent partner (AOR, 2.90 [95% CI, 1.31-6.40]) were significantly associated with chlamydia in men. In women, increasing partner numbers in previous 12 months (AOR for two partners, 2.59 [95% CI, 1.59-4.23]; AOR for three or more partners, 3.58 [95% CI, 2.26-5.68]), chlamydia diagnosis in previous 12 months (AOR, 3.13 [95% CI, 1.62-6.06]) and age (AOR for 25-29-year-olds, 0.23 [95% CI, 0.12-0.44]) were associated with chlamydia. CONCLUSIONS Chlamydia prevalence is similar in young men and women attending general practice. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas.

Water harvesting: guidelines to good practice

These guidelines provide an overview of proven good practice in water harvesting from all over the world. They form a practical reference guide while providing support and specific technical expertise for the integration of water harvesting technologies into the planning and design of projects. Thus existing information and experience is strengthened. On a broader scale, the guidelines’ objective is to facilitate, share and upscale good practice in water harvesting given the state of current knowledge. Targeted end users include local and regional planners / advisors, rural development consultants, rainwater harvesting networks and communitiesof- practice, project managers, extension agents and other implementing staff. Through informing these professionals, the aim is to stimulate discussion and new thinking about improved water management in general, and water harvesting in particular, within rainfed agriculture, particularly in the drylands. The ultimate goal is to contribute to lifting 80 million rural people out of poverty by 2015: water security is a prerequisite to achieve food security for these people.

The door of the tomb is open: Participatory action research to assess the impact of strengthened community capacity on maternal health care in rural Mali

This participatory action-research project addressed the hypothesis that strengthened community and women's capacity for self-development will lead to action to address maternal health problems and the prevention of maternal morbidity and mortality in Mali. Research objectives were: (1) to undertake a comparative cross-sectional study of the association of community capacity with improved maternal health in rural areas of Sanando, Mali, where capacity building interventions have taken place in some villages but not in others. (2) to describe women's maternal health status, access to and use of maternal health services given their residence in program or comparison communities.^ The participatory action research project was an integrated qualitative and quantitative study using participatory rural appraisal exercises, semi-structured group interviews and a cross-sectional survey.^ Factors related to community capacity for self-development were identified: community harmony; an understanding of the benefits of self-development; dynamic leadership; and a structure to implement collective activities.^ A distinct difference between the program and comparison villages was the commitment to train and support traditional birth attendants (TBAs). The TBAs in the program villages work in the context of the wider, integrated self-development program and, 10 years after their initial training, the TBAs continue to practice.^ Many women experience labor and childbirth alone or are attended by an untrained relative in both program and comparison villages. Nevertheless a significant change is apparent, with more women in program villages than in comparison villages being assisted by the TBAs. The delivery practices of the TBAs reveal the positive impact of their training in the "three cleans" (clean hands of the assistant, clean delivery surface and clean cord-cutting). The findings of this study indicate a significant level of unmet need for child spacing methods in all villages.^ The training and support of TBAs in the program villages yielded significant improvements in their delivery practices, and resulting outcomes for women and infants. However, potential exists for further community action. Capacities for self-development have not yet been directed toward an action plan encompassing other Safe Motherhood interventions, including access to family planning services and emergency obstetric care services. ^

Patient self-management of oral anticoagulation with vitamin k antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.

Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years). Median age at the time of training was 54.2 years (range 18.2-85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p<0.001), patients>50 years of age (2.0; 1.6-2.6; p<0.001), and men (1.6; 1.2-2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2-0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.

Urban expansion and its impact on urban agriculture – remote sensing based change analysis of Kizinga and Mzinga Valley – Dar Es Salaam, Tanzania

Urban agriculture is a phenomenon that can be observed world-wide, particularly in cities of devel-oping countries. It is contributing significantly to food security and food safety and has sustained livelihood of the urban and peri-urban low income dwellers in developing countries for many years. Population increase due to rural-urban migration and natural, coupled with formal as well as infor-mal urbanization are competing with urban farming for available space and scarce water resources. A multitemporal multisensoral urban change analysis over the period of 25 years (1982-2007) was performed in order to measure and visualize the urban expansion along the Kizinga and Mzinga valley in the South of Dar es Salaam. Airphotos and VHR satellite data were analyzed by using a combination of a composition of anisotropic textural measures and spectral information. The study revealed that unplanned built-up area is expanding continuously and vegetation covers and agricultural lands decline at a fast rate. The validation showed that the overall classification accuracy varied depending on the database. The extracted built-up areas were used for visual in-terpretation mapping purposes and served as information source for another research project. The maps visualize an urban congestion and expansion of nearly 18% of the total analyzed area that had taken place in the Kizinga valley between 1982 and 2007. The same development can be ob-served in the less developed and more remote Mzinga valley between 1981 and 2002. Both areas underwent fast changes where land prices still tend to go up and an influx of people both from rural and urban areas continuously increase density with the consequence of increasing multiple land use interests.

Epidemiology of allergic gastroenteritis in socio-culture perspective of rural Egypt

Diarrhea is a major public health problem in developing countries among infants and young children. Not all episodes of diarrhea are confirmed as infectious, suggesting alternate mechanisms. One such is immunoglobulin E (IgE) mediated or allergic diarrhea that can be seen in food allergy. In order to determine the relation between allergic gastroenteritis and feeding practice, a cohort of 152 infants were followed from birth to one year age in a rural community of Egypt between October, 1987 to April, 1988 were analyzed. In multivariate analysis of the data, statistically conclusive higher risk had been observed with presence of factors, like consumption of milk pudding (RR = 7.4, CI = 1.5-36.2 and p = 0.01), infant's age 3-6 months (RR = 7.7, CI = 1.3-45.9 and p = 0.02), infants whose mothers were vaccinated antenatally (RR = 3.1, CI = 1.3-7.0 and p = 1.3-7.0, p = 0.0) and wet-nursed infants (RR = 2.7, CI = 1.1-6.5 and p = 0.02). In contrast, infants who were completely breast-fed (RR = 0.13, CI = 0.02-0.6 and p = 0.01), and infants family owning a television set (RR = 0.29, CI = 0.1-0.6 and p = 0.0) were less likely to develop allergic gastroenteritis. The role of IgE on development of persistent diarrhea was also examined in a nested case-control design. Multivariate analysis revealed a significant association between detection of fecal IgE and development of persistent diarrhea compared to acute diarrhea (OR = 3.32, CI = 1.0-10.9 and p = 0.04) and health or non diarrhea (OR = 4.8, CI = 1.07-21.7 and p = 0.03) controls. ^

Study of rural leadership and implications for community participation and development in the health and family planning programs in Bangladesh

The vast majority of Bangladesh are poor and are unable even to provide for the most basic human needs. These are the landless and marginal farmers of Bangladesh. They constitute 70% of the rural population, which in turn constitute about 90% of the country's population.^ Effective development of Bangladesh would largely mean the development of the landless and marginal farmers. Past efforts of development in this section of the population, including that of the government, have not succeeded. One of the development goals of the government of Bangladesh is to improve the quality of life of the rural population through health and population control measures. Overpopulation, malnutrition and diarrhea are the major impediments to socioeconomic development in Bangladesh.^ The current study was designed to identify whether there is effective opinion leadership among the marginal and landless peasants affecting decisions on acceptance or nonacceptance of family planning methods and oral rehydration therapy (ORT) in the selected rural areas of Bangladesh. The study was conducted in eight randomly selected villages with funding from the Ministry of Health and Family Planning, government of Bangladesh. One hundred twenty-five opinion leaders were interviewed after they were identified by 408 rural couples owning land less than 2 acres and wives' age below 50. The study was conducted in two phases; couples' interview preceded that of the leaders.^ Findings of the study reveal that the opinion leaders influencing adoption of health and family planning among the landless and marginal farmers belong to the same class. Theses opinion leaders own land much less than the rich farmers and the formal leaders in the rural areas. Majority of these of opinion leaders are friends, neighbors and relatives, some are other persons who are businessmen and professionals like doctors, while the rest few are the field workers of health and family planning. Source of influence as a factor contribute most in differentiating use and non-use of family planning and ORT among both couples and leaders. The most frequent sources of influence referred by the couples and the leaders are the field workers of health and family planning, followed by the peer opinion leaders (friends, neighbors, relatives) and spouse.^ The opinion leaders do not differ much from the poor couples on land holding, a strong indicator of economic status, they however differ considerably on social factors such as family planning practice, education, and exposure to mass media.^ The study suggests that future development efforts in Bangladesh have to ensure community participation by the landless and marginal farmers and opinion leaders belonging to their class. ^

Identificación de la pobreza rural y algunas estrategias de intervención : Mendoza (Argentina)

En Mendoza, Argentina, más del 60 % de los productores agrícolas tiene predios menores de 10 ha, algunos de ellos con modelos productivos que no alcanzan para la sustentabilidad del grupo familiar. La presente investigación identifica la situación actual de la población estudiada, mediante variables de ingreso familiar, grado de asociativismo, características de la comercialización y algunas prácticas de gestión, para establecer comparaciones entre grupos poblacionales. Se trabajó en una muestra de productores regantes del Río Mendoza. Para los de menos de 10 ha se agregó un cuestionario complementario que indagó sobre niveles de asociación y sus resultados. Se analizó con mayor detalle el sector vitícola y olivícola con nuevas encuestas y entrevistas en profundidad. El 42 % de los productores tiene vid, el 30 % olivos y el 28 % horticultura, fruticultura y floricultura. El mayor nivel de asociación se encuentra entre los viticultores. En los demás sectores, éste es muy bajo o nulo. En la comparación de grupos, los mayores niveles de pobreza están en los productores de menos de 10 ha y baja tecnología. Además, en el sector vitícola, los menores niveles de ingreso se encuentran en aquellos no asociados y en toda la población estudiada la pobreza es mayor en el sector asalariado que en los propietarios de la tierra. Este proyecto identifica la capacitación como una de las acciones para mejorar la situación socioeconómica de los productores.

Ingenieros agrónomos, desarrollo rural y cultura política : reflexiones críticas en torno a la práctica de la (ex)tensión rural

En esta nota breve se analiza, desde una perspectiva crítica, la práctica de la extensión rural realizada por profesionales agrónomos en Mendoza, Argentina. En base a una amplia revisión bibliográfica y análisis documental sobre programas de desarrollo rural, analizamos los condicionamientos socio-culturales de dicha práctica, elementos que inciden sobre la concepción, ejecución y orientación de las estrategias de desarrollo promovidas por estos sujetos y sus instituciones. Así argumentamos que a pesar de los profundos cambios ocurridos en el mundo, particularmente los que afectan al mundo rural, las prácticas de los extensionistas y su concepción, continúan arraigadas a los ya viejos supuestos de la modernización y el progreso indefinido. Asimismo sostenemos que la falta de reflexividad crítica institucional retroalimenta la crisis del desarrollo rural con considerables repercusiones en sus promotores, los extensionistas. Finalmente destacamos que la reflexión sobre la práctica de la extensión rural tiene una relevancia social e institucional central, considerando que un análisis crítico de las limitaciones y posibilidades en este campo puede contribuir a orientar -y superar- los desafíos actuales y futuros.

Migraciones temporarias, ciclos laborales y estrategias de reproducción social : El caso de las unidades domésticas del área rural de Bernardo de Irigoyen (Misiones, Argentina)

Este artículo versa sobre un conjunto de unidades domésticas ubicadas en el área rural de Bernardo de Irigoyen (Misiones), en las que algunos de sus integrantes migran temporalmente al empleo forestal de otras provincias. El objetivo es comprender la práctica migratoria y su peso con relación a los demás mecanismos de reproducción social en las unidades domésticas. La metodología es de tipo cualitativa mediante la realización de entrevistas a trabajadores migrantes y sus parientes. El trabajo concluye que la movilidad espacial es un recurso al cual los trabajadores y sus familias acceden de modo desigual para lograr su reproducción social

Genealogía de una elite rural : Elucidación antropológica de una práctica de poder

En este artículo se interroga la noción de elite en tanto herramienta conceptual para analizar las relaciones de poder tal como éstas se construyen en el mundo agrorural contemporáneo argentino. Con este objetivo estudiamos un grupo específico, los empresarios innovadores inscriptos en el modelo agribusiness, congregados en torno de la Asociación Argentina de Productores en Siembra Directa (AAPRESID). A través del material etnográfico generado en el marco de un trabajo de campo antropológico (2003-2007), se analizará el modo en que movilizan la identidad de elite como factor de legitimación de la posición material y simbólica ocupada en el escenario rural

Extensión rural en Uruguay : Problemas y enfoques vistos por sus extensionistas

Comprender los problemas a los que se enfrenta la extensión rural en Uruguay y las concepciones con que los técnicos de terreno guían sus prácticas constituye un elemento de interés tanto para las políticas públicas de desarrollo rural como para el espacio más amplio del MERCOSUR. Se llevó adelante una investigación cuali-cuantitativa centrada en un cuestionario a 32 extensionistas uruguayos. Las respuestas fueron sometidas a análisis estadísticos y de contenido. Se concluye que existe una visión compleja de la extensión rural que articula lo técnico-productivo y lo social, la cual se asocia con una visión crítica y participativa de la práctica. No obstante, esto no quita la persistencia de una visión difusionista en algunos casos. Se destaca como principal problema las dificultades relacionadas con el manejo de grupos y asociaciones

Migraciones temporarias, ciclos laborales y estrategias de reproducción social : El caso de las unidades domésticas del área rural de Bernardo de Irigoyen (Misiones, Argentina)

Este artículo versa sobre un conjunto de unidades domésticas ubicadas en el área rural de Bernardo de Irigoyen (Misiones), en las que algunos de sus integrantes migran temporalmente al empleo forestal de otras provincias. El objetivo es comprender la práctica migratoria y su peso con relación a los demás mecanismos de reproducción social en las unidades domésticas. La metodología es de tipo cualitativa mediante la realización de entrevistas a trabajadores migrantes y sus parientes. El trabajo concluye que la movilidad espacial es un recurso al cual los trabajadores y sus familias acceden de modo desigual para lograr su reproducción social

Genealogía de una elite rural : Elucidación antropológica de una práctica de poder

En este artículo se interroga la noción de elite en tanto herramienta conceptual para analizar las relaciones de poder tal como éstas se construyen en el mundo agrorural contemporáneo argentino. Con este objetivo estudiamos un grupo específico, los empresarios innovadores inscriptos en el modelo agribusiness, congregados en torno de la Asociación Argentina de Productores en Siembra Directa (AAPRESID). A través del material etnográfico generado en el marco de un trabajo de campo antropológico (2003-2007), se analizará el modo en que movilizan la identidad de elite como factor de legitimación de la posición material y simbólica ocupada en el escenario rural

Extensión rural en Uruguay : Problemas y enfoques vistos por sus extensionistas

Comprender los problemas a los que se enfrenta la extensión rural en Uruguay y las concepciones con que los técnicos de terreno guían sus prácticas constituye un elemento de interés tanto para las políticas públicas de desarrollo rural como para el espacio más amplio del MERCOSUR. Se llevó adelante una investigación cuali-cuantitativa centrada en un cuestionario a 32 extensionistas uruguayos. Las respuestas fueron sometidas a análisis estadísticos y de contenido. Se concluye que existe una visión compleja de la extensión rural que articula lo técnico-productivo y lo social, la cual se asocia con una visión crítica y participativa de la práctica. No obstante, esto no quita la persistencia de una visión difusionista en algunos casos. Se destaca como principal problema las dificultades relacionadas con el manejo de grupos y asociaciones