Information needs of rural health professionals: a review of the literature

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

Multilocus DNA fingerprinting reveals high rate of heritable genetic mutation in herring gulls nesting in an industrialized urban site.

Genotoxins, such as polycyclic aromatic compounds, are ubiquitous in urban and industrial environments. Our understanding of the role that these chemicals play in generating DNA sequence mutations is predominantly derived from laboratory studies with specific genotoxins or extracts of contaminants from environmental media. Most assays are not indicative of the germinal effects of exposure in situ to complex mixtures of common environmental mutagens. Using multilocus DNA fingerprinting, we found the mutation rate in herring gulls inhabiting a heavily industrialized urban harbor (Hamilton Harbour, Ontario) to be more than twice as high as three rural sites: Kent Island, Bay of Fundy; Chantry Island, Lake Huron; and Presqu'ile Provincial Park in Lake Ontario. Overall we found a mutation rate of 0.017 +/- 0.004 per offspring band in Hamilton, 0.006 +/- 0.002 at Kent Island, 0.002 +/- 0.002 from Chantry Island, and 0.004 +/- 0.002 from Presqu'ile Provincial Park. The mutation rate from the rural sites (pooled) was significantly lower than the rate observed in Hamilton Harbour (Fisher's exact test, two-tailed; P = 0.0006). These minisatellite DNA mutations may be important biomarkers for heritable genetic changes resulting from in situ exposure to environmental genotoxins in a free-living vertebrate species.

Como estamos indo? Estudo do deslocamento ativo no Brasil

Introdução: O deslocamento ativo tem estreita relação com problemas de saúde pública da atualidade e sua promoção pode contribuir para melhorias quanto à mobilidade urbana, estado de saúde e proteção do meio ambiente. Entretanto, a maior parte das pesquisas sobre o tema tem sido desenvolvida em países de renda alta. A presente tese busca ampliar a investigação sobre o deslocamento ativo no Brasil. Objetivos: i) Descrever a frequência, a distribuição e a variação temporal de indicadores do deslocamento ativo em populações brasileiras; ii) Avaliar o impacto de mudanças no padrão de transporte da população sobre o deslocamento ativo, o tempo sedentário e desfechos de saúde em populações brasileiras. Métodos: Tese composta por sete manuscritos. O primeiro apresenta revisão sistemática de estudos com informações sobre a prática de deslocamento ativo na América Latina e Caribe; o segundo descreve estimativas representativas da população brasileira sobre a prática de deslocamento ativo para o trabalho; o terceiro e o quarto descrevem a frequência e tendência temporal do deslocamento ativo na Região Metropolitana de São Paulo (ciclistas e escolares); o quinto discute a questão da mobilidade urbana e do direito à cidade em São Paulo; o sexto e o sétimo avaliam o impacto de mudanças no padrão de mobilidade da metrópole paulistana sobre a prática de deslocamento ativo, tempo não-ativo de deslocamento e tempo total de deslocamento, bem como sobre a poluição do ar e saúde da população. Resultados: A prevalência mediana de deslocamento ativo encontrada em diferentes locais do Brasil foi de 12 por cento , variando entre 5,1 por cento em Palmas (Tocantins) a 58,9 por cento em Rio Claro (São Paulo) (Manuscrito 1). Um terço dos homens e das mulheres desloca-se a pé ou de bicicleta de casa para o trabalho no país. Em ambos os sexos, esta proporção diminui com o aumento da renda e da escolaridade e é maior entre os mais jovens, entre os que residem em áreas rurais, e na região Nordeste. Em todas as regiões metropolitanas estudadas, o quinto das pessoas de menor renda apresenta uma maior frequência de deslocamento ativo (Manuscrito 2). Entre os anos de 2007 e 2012, observamos redução no número de ciclistas em São Paulo e diferenças expressivas na proporção de ciclistas entre homens e mulheres (9,7 por mil habitantes versus 1,4 por mil habitantes em 2012) (Manuscrito 3). Também verificamos uma queda na proporção de crianças que se deslocam ativamente para a escola entre os anos de 1997 e 2012 (Manuscrito 4). O cenário epidemiológico do deslocamento ativo no país é resultante da disputa pelo direito à cidade, com repercussões na transição de mobilidade humana e na saúde e qualidade de vida da população, como podemos observar no caso de São Paulo (Manuscrito 5). A construção de uma São Paulo mais inclusiva, com menores distâncias para os deslocamentos cotidianos e maior frequência de caminhada e bicicleta, levaria à substancial redução do tempo total e do tempo sedentário despendidos nos deslocamentos, sem diminuir a duração do deslocamento ativo (Manuscrito 6). Traria também ganhos à saúde da população, sobretudo pelo aumento da prática de atividade física e da redução da poluição do ar (Manuscrito 7). Conclusões: A prática de deslocamento ativo no Brasil apresenta marcadas diferenças segundo região e características sociodemográficas. De um modo geral, esta prática vem diminuindo no país, o que deve contribuir negativamente para a saúde da população. A promoção de cidades mais inclusivas e compactas, com o favorecimento a modos ativos de deslocamento, pode contribuir para reverter esta preocupante tendência.

El problema sanitario de España: saneamiento y medio rural en los primeros decenios del siglo XX

En los primeros decenios del siglo XX, la situación socio-sanitaria de la sociedad española fue descrita como catastrófica, tanto en el ámbito urbano como en el rural. En aquel contexto, el saneamiento del medio aparece como una de las claves del proceso de regeneración que asumió la higiene en su papel de mediadora. A través de las obras de los higienistas G. De Membrillera y Luis Muñoz Antuñano, publicadas en 1921, nos hemos acercado al análisis de la situación sanitaria de la España rural durante este periodo.

Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007

Background: While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). Methods: All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders. Results: Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Conclusions: Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

La expansión del área urbana de Segovia. Transformación paisajística del entorno rural periurbano

En la última década, el área urbana de Segovia ha experimentado un profundo cambio radicado en la urbanización de municipios del entorno rural periurbano. Los crecimientos más significativos se han dado en los núcleos situados en torno al eje de la carretera CL-601 que une Segovia con el Real Sitio de San Ildefonso. La expansión del área urbanizada en este espacio genera cambios en la dinámica territorial que pueden llegar a producir desajustes funcionales que afecten negativamente a los valores patrimoniales y paisajísticos que definen a este territorio.

Urban penalty: nuevas hipótesis y caso español (1860-1920)

El término urban penalty fue en principio utilizado para definir la sobremortalidad urbana durante la revolución industrial. Los antropómetras lo emplearon más tarde para definir un hecho simultáneo: el descenso de la estatura urbana con respecto a la rural. En la primera parte del trabajo proponemos tres nuevas hipótesis sobre ese castigo urbano: a) incorporar las aportaciones de la Teoría Económica sobre fallos de mercado al análisis de la sobremortalidad urbana; b) explicar la urban penalty mediante el modelo que Floud, Fogel, Harris y Chul Hong han elaborado recientemente para Gran Bretaña y c) sugerir respuestas a una pregunta que debe ser avalada o desmentida por investigaciones de ámbito municipal: ¿por qué los políticos españoles de la restauración tardaron décadas en acometer la reforma sanitaria de las ciudades? En la segunda parte del trabajo ofrecemos información que demuestra que España padeció sobremortalidad urbana derivada de fallos de mercado. Los datos de estatura rural y urbana evidencian por el contrario que, salvo excepciones, el país no experimentó urban penalty. El trabajo termina tratando de explicar esta particularidad y sosteniendo que el modelo de Floud, Fogel, Harris y Chul Hong puede aplicarse a esas excepciones.

Política pública en el desarrollo de la juventud rural

La política pública es fundamental para cumplir con el propósito de atender los problemas colectivos a través de la negociación colectiva. En el medio rural se expresa en toda su amplitud, como agenda de formulación, de ejecución y de evaluación ajena a los actores municipales. De esta forma, este artículo tiene como objetivo comprobar los procesos, condiciones y efectos que genera en la población que las recibe, las acepta y se adapta a ellas. Desde el enfoque territorial, se encontró que la política pública y algunos programas dirigidos a los jóvenes, se centran en la juventud urbana; mientras que los jóvenes rurales desconocen las políticas públicas y los programas que son creados o aplicados a ellos. Las instancias de gobierno municipal, registran una falta de atención a los jóvenes, por la escases de estructura administrativa y de recursos económicos, que profundizan la ausencia de coordinación y comunicación entre los tres niveles de gobierno y la sociedad civil; causando que la duplicidad de programas con recursos limitados e insuficientes se sumen a los demás factores que limitan la atención de los jóvenes de la Sierra Norte de Puebla.

South America, 1807 (Image 2 of 7) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Colombia Prima or South America : in which it has been attempted to delineate the extent of our knowledge of that continent, extracted chiefly from the original manuscript maps of ... Pinto, likewise fom those of João Joaquin da Rocha, João da Costa Ferreira ... Francisco Manuel Sobreviela &c. and from the most authentic edited accounts of those countries, digested & constructed by ... Louis Stanislas D'Arcy Delarochette. It was published by William Faden geographer to His Majesty and to His Royal Highness the Prince of Wales in June 4th, 1807. Scale [ca. 1:3,000,000]. This layer is image 2 of 7 total images of the eight sheet map, representing the northern portion of the map.The image inside the map neatline is georeferenced to the surface of the earth and fit to the South America Lambert Conformal Conic projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, territorial boundaries, shoreline features, mines, tribes, and more. Relief shown by hachures. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

South America, 1807 (Image 3 of 7) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Colombia Prima or South America : in which it has been attempted to delineate the extent of our knowledge of that continent, extracted chiefly from the original manuscript maps of ... Pinto, likewise fom those of João Joaquin da Rocha, João da Costa Ferreira ... Francisco Manuel Sobreviela &c. and from the most authentic edited accounts of those countries, digested & constructed by ... Louis Stanislas D'Arcy Delarochette. It was published by William Faden geographer to His Majesty and to His Royal Highness the Prince of Wales in June 4th, 1807. Scale [ca. 1:3,000,000]. This layer is image 3 of 7 total images of the eight sheet map, representing the eastern portion of the map.The image inside the map neatline is georeferenced to the surface of the earth and fit to the South America Lambert Conformal Conic projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, territorial boundaries, shoreline features, mines, tribes, and more. Relief shown by hachures. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

South America, 1807 (Image 4 of 7) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Colombia Prima or South America : in which it has been attempted to delineate the extent of our knowledge of that continent, extracted chiefly from the original manuscript maps of ... Pinto, likewise fom those of João Joaquin da Rocha, João da Costa Ferreira ... Francisco Manuel Sobreviela &c. and from the most authentic edited accounts of those countries, digested & constructed by ... Louis Stanislas D'Arcy Delarochette. It was published by William Faden geographer to His Majesty and to His Royal Highness the Prince of Wales in June 4th, 1807. Scale [ca. 1:3,000,000]. This layer is image 4 of 7 total images of the eight sheet map, representing the northeast portion of the map.The image inside the map neatline is georeferenced to the surface of the earth and fit to the South America Lambert Conformal Conic projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, territorial boundaries, shoreline features, mines, tribes, and more. Relief shown by hachures. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

South America, 1807 (Image 5 of 7) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Colombia Prima or South America : in which it has been attempted to delineate the extent of our knowledge of that continent, extracted chiefly from the original manuscript maps of ... Pinto, likewise fom those of João Joaquin da Rocha, João da Costa Ferreira ... Francisco Manuel Sobreviela &c. and from the most authentic edited accounts of those countries, digested & constructed by ... Louis Stanislas D'Arcy Delarochette. It was published by William Faden geographer to His Majesty and to His Royal Highness the Prince of Wales in June 4th, 1807. Scale [ca. 1:3,000,000]. This layer is image 5 of 7 total images of the eight sheet map, representing the southwest portion of the map.The image inside the map neatline is georeferenced to the surface of the earth and fit to the South America Lambert Conformal Conic projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, territorial boundaries, shoreline features, mines, tribes, and more. Relief shown by hachures. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

South America, 1807 (Image 6 of 7) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Colombia Prima or South America : in which it has been attempted to delineate the extent of our knowledge of that continent, extracted chiefly from the original manuscript maps of ... Pinto, likewise fom those of João Joaquin da Rocha, João da Costa Ferreira ... Francisco Manuel Sobreviela &c. and from the most authentic edited accounts of those countries, digested & constructed by ... Louis Stanislas D'Arcy Delarochette. It was published by William Faden geographer to His Majesty and to His Royal Highness the Prince of Wales in June 4th, 1807. Scale [ca. 1:3,000,000]. This layer is image 6 of 7 total images of the eight sheet map, representing the western portion of the map.The image inside the map neatline is georeferenced to the surface of the earth and fit to the South America Lambert Conformal Conic projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, territorial boundaries, shoreline features, mines, tribes, and more. Relief shown by hachures. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

South America, 1807 (Image 7 of 7) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Colombia Prima or South America : in which it has been attempted to delineate the extent of our knowledge of that continent, extracted chiefly from the original manuscript maps of ... Pinto, likewise fom those of João Joaquin da Rocha, João da Costa Ferreira ... Francisco Manuel Sobreviela &c. and from the most authentic edited accounts of those countries, digested & constructed by ... Louis Stanislas D'Arcy Delarochette. It was published by William Faden geographer to His Majesty and to His Royal Highness the Prince of Wales in June 4th, 1807. Scale [ca. 1:3,000,000]. This layer is image 7 of 7 total images of the eight sheet map, representing the southern portion of the map.The image inside the map neatline is georeferenced to the surface of the earth and fit to the South America Lambert Conformal Conic projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, territorial boundaries, shoreline features, mines, tribes, and more. Relief shown by hachures. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.