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.

Las mipymes artesanales como un medio de desarrollo para los grupos rurales en México

La actividad artesanal sigue teniendo vigencia a nivel regional en muchos países, no sólo subdesarrollados, sino también del primer mundo, lo que permite a algunos grupos sociales tener una fuente de ingresos única o complementaria. En este trabajo se hace una descripción de este sector, comenzando con conceptos de los términos relacionados con la artesanía, su importancia económica y social dentro de las micro, pequeñas y medianas empresas, los tipos de productos artesanales en el mundo y en México. Se establecen, igualmente, las problemáticas y los retos que habrá de enfrentar, así como las contribuciones posibles desde los ámbitos gubernamental y académico.

Social and material influences on the Kelabit dwelt environment

Relations with the environment are key to the ways in which people pursue their dwelling practices. The complex processes of globalisation challenge the isolation of rural groups, consequently affecting their perception and use of the environment. One such place where this can be seen is the Kelabit Highlands of northern Sarawak (Malaysian Borneo), where the recent arrival of commercial logging has allowed local people to make wider connections via the logging roads. Cultural and historic traditions are reconstituted in the light of new material relations with a dynamic environment, which can be seen reflected in changing customs of housebuilding.

Work and the adolescent in medieval England (AD 900-1550). The osteological evidence

What was it like to be a teenager in medieval England? Despite the fact that medieval society often singled young apprentices and workers out for comment, their study has been largely neglected in medieval archaeology. The skeletal remains of 4940 adolescents (6.6-25 years) from 151 sites in medieval England was compiled from a combination of primary data collection and secondary data from published and unpublished skeletal reports and on-line databases. The aim was to explore whether apprentices could be identified in the archaeological record and if so, at what age they started work and what impact occupation had on their health. The data were divided into urban and rural groups, dating from before and after the Black Death of AD 1348-9, and before the Industrial Revolution. A shift in the demographic pattern of urban and rural adolescents was identified after the Black Death, with a greater number of young females residing in the urban contexts after 14 years. The average age of males increased from 12 years to 14 years after the plague years, contrary to what we might expect from the documentary sources. There were higher rates of spinal and joint disease in the urban adolescents and their injuries were more widespread than their rural counterparts. Domestic service was the potential cause of the greater strain on the knees and backs of the urban females, with interpersonal violence evident in the young urban males. Overall, it was the urban females that carried the burden of respiratory and infectious diseases suggesting they may have been the most vulnerable group. This study has demonstrated the value of adolescent skeletal remains in revealing information about their health and working life, before and after the Black Death.

Antecedentes históricos de la unidad de las corporaciones agropecuarias pampeanas : La formación de la Comisión de Enlace y la disputa por la renta (1966-1973)

El presente trabajo busca aportar a la comprensión de la intervención política de la burguesía agraria pampeana, tomando como observable las acciones y los posicionamientos de las corporaciones rurales en un momento de crisis política. Los estudios sobre el tema han tendido a sobreestimar las diferencias entre productores chicos ("chacareros") y grandes ("oligarquía"), lo que ha eclipsado el estudio de los momentos de confluencia, que tienen por lo menos 40 años de historia en la Argentina. Luego de discutir el enfoque predominante en la bibliografía, abordaremos la conformación, en 1970, de la Comisión de Enlace, en la que confluyeron Federación Agraria, CONINAGRO, Confederaciones Rurales Argentinas y Sociedad Rural. Recurriendo a periódicos de tirada nacional y documentos institucionales de las corporaciones, reconstruiremos los acuerdos en torno a los que se estructuró esta alianza y su intervención concreta.

Antecedentes históricos de la unidad de las corporaciones agropecuarias pampeanas : La formación de la Comisión de Enlace y la disputa por la renta (1966-1973)

El presente trabajo busca aportar a la comprensión de la intervención política de la burguesía agraria pampeana, tomando como observable las acciones y los posicionamientos de las corporaciones rurales en un momento de crisis política. Los estudios sobre el tema han tendido a sobreestimar las diferencias entre productores chicos ("chacareros") y grandes ("oligarquía"), lo que ha eclipsado el estudio de los momentos de confluencia, que tienen por lo menos 40 años de historia en la Argentina. Luego de discutir el enfoque predominante en la bibliografía, abordaremos la conformación, en 1970, de la Comisión de Enlace, en la que confluyeron Federación Agraria, CONINAGRO, Confederaciones Rurales Argentinas y Sociedad Rural. Recurriendo a periódicos de tirada nacional y documentos institucionales de las corporaciones, reconstruiremos los acuerdos en torno a los que se estructuró esta alianza y su intervención concreta.

Antecedentes históricos de la unidad de las corporaciones agropecuarias pampeanas : La formación de la Comisión de Enlace y la disputa por la renta (1966-1973)

El presente trabajo busca aportar a la comprensión de la intervención política de la burguesía agraria pampeana, tomando como observable las acciones y los posicionamientos de las corporaciones rurales en un momento de crisis política. Los estudios sobre el tema han tendido a sobreestimar las diferencias entre productores chicos ("chacareros") y grandes ("oligarquía"), lo que ha eclipsado el estudio de los momentos de confluencia, que tienen por lo menos 40 años de historia en la Argentina. Luego de discutir el enfoque predominante en la bibliografía, abordaremos la conformación, en 1970, de la Comisión de Enlace, en la que confluyeron Federación Agraria, CONINAGRO, Confederaciones Rurales Argentinas y Sociedad Rural. Recurriendo a periódicos de tirada nacional y documentos institucionales de las corporaciones, reconstruiremos los acuerdos en torno a los que se estructuró esta alianza y su intervención concreta.

Extractivism and the de jure and de facto ethno-territorial rights in Latin America: How important are the constitutions? : Extractivismo y derechos étnico-territoriales de jure y de facto en Latinoamérica: ¿Cuán importantes son las constituciones?

A growing number of Latin American rural groups have attained extended ethno-territorial rights, and sizeable territories were safeguarded by progressive constitutions. This trend was the product of extended cycles of protest at local, national and transnational levels; social movements struggle, with broader collective South-South collaboration. Nonetheless, the continent simultaneously experienced a resource extraction boom. Commonly, the extractivism takes place in protected areas and/or indigenous territories. Accordingly, economic interests clash with the safeguarding and recognition of constitutional rights. Through the analysis of selected illustrative cases across Latin America, this study analyses the (de jure) rights on paper versus the (de facto) rights in practice. 

The Kaipara story: a closer look at the benefits of working together, the evolution of a federation of aquaculture self-help groups and a one-stop aqua shop in rural West Bengal

What is special about Kaipara is that most recently, they have founded a federation of Self-Help Groups that work together to develop their own support network and to draw in the support of others. This is a sophisticated ‘home-grown’ support infrastructure that is the subject of this story. (Pdf contains 8 pages).

Understanding barriers to cataract surgery among older persons in rural China through focus groups.

PURPOSE: To utilize focus groups (FGs) to identify barriers to cataract surgery specific to older persons in rural Guangdong, China. METHODS: Three focus groups in separate locations were carried out for persons aged 60 years and above with best-corrected vision <= 6/18 due to cataract, either accepting or refusing surgery. Participants also ranked responses to questions about acceptance of surgery among the elderly. FG transcripts were coded independently by two investigators using qualitative data management software. RESULTS: Twenty participants had a mean age of 72.7 ± 6.1 years, 14 (70.0%) were women and 17 (85.0%) were blind (best-corrected vision <= 6/60) in at least one eye. Cost was ranked by two of three groups as the main barrier to surgery, and all groups listed reducing cost as the best strategy to increase surgical uptake. Many respondents planned to use China's New Cooperative Medical Scheme (NCMS) health insurance to pay for surgery. Participants showed poor understanding of cataract, but ranked educational interventions low as methods of increasing uptake. Though opinions of local service quality were poor, respondents did not see quality as an important barrier to accepting service. Participants frequently depended on family members to pay for surgery. CONCLUSIONS: Contrary to some previous reports, cost may be an important barrier to cataract surgery in rural China, which NCMS may help to alleviate. Educational interventions to increase knowledge about cataract are needed, but may face skepticism among patients. Strategies to promote cataract surgery should target the entire family.

Leader Rural Development Program in Spain: Profile and Functions of Workers in Local Action Groups.

Occupations in the labor market are linked with to a minimum basic training and other capacities. Hired workers should be able to accomplish required functions related to their specific job. Regarding the rural development labor market, local action groups? workers have defined performance areas?projects, strategy, organization and training & market?but specific functions within each of these areas are not as clearly defined. Neither both, basic training and capacities needed to perform each job profile within the local action group are defined. This communication analyses training and other capacities linked to each of the job profiles within the local action group. Functions within each of the performance areas previously defined are also analyzed regarding the job profiles.

Rural primary groups

Mode of access: Internet.

Rural and remote road safety study : final report

• Introduction: Concern and action for rural road safety is relatively new in Australia in comparison to the field of traffic safety as a whole. In 2003, a program of research was begun by the Centre for Accident Research and Road Safety - Queensland (CARRS-Q) and the Rural Health Research Unit (RHRU) at James Cook University to investigate factors contributing to serious rural road crashes in the North Queensland region. This project was funded by the Premier’s Department, Main Roads Department, Queensland Transport, QFleet, Queensland Rail, Queensland Ambulance Service, Department of Natural Resources and Queensland Police Service. Additional funding was provided by NRMA Insurance for a PhD scholarship. In-kind support was provided through the four hospitals used for data collection, namely Cairns Base Hospital, The Townsville Hospital, Mount Isa Hospital and Atherton Hospital.----- The primary aim of the project was to: Identify human factors related to the occurrence of serious traffic incidents in rural and remote areas of Australia, and to the trauma suffered by persons as a result of these incidents, using a sample drawn from a rural and remote area in North Queensland.----- The data and analyses presented in this report are the core findings from two broad studies: a general examination of fatalities and casualties from rural and remote crashes for the period 1 March 2004 until 30 June 2007, and a further linked case-comparison study of hospitalised patients compared with a sample of non-crash-involved drivers.----- • Method: The study was undertaken in rural North Queensland, as defined by the Australian Bureau of Statistics (ABS) statistical divisions of North Queensland, Far North Queensland and North-West Queensland. Urban areas surrounding Townsville, Thuringowa and Cairns were not included. The study methodology was centred on serious crashes, as defined by a resulting hospitalisation for 24 hours or more and/or a fatality. Crashes meeting this criteria within the North Queensland region between 1 March 2004 and 30 June 2007 were identified through hospital records and interviewed where possible. Additional data was sourced from coroner’s reports, the Queensland Transport road crash database, the Queensland Ambulance Service and the study hospitals in the region.----- This report is divided into chapters corresponding to analyses conducted on the collected crash and casualty data.----- Chapter 3 presents an overview of all crashes and casualties identified during the study period. Details are presented in regard to the demographics and road user types of casualties; the locations, times, types, and circumstances of crashes; along with the contributing circumstances of crashes.----- Chapter 4 presents the results of summary statistics for all casualties for which an interview was able to be conducted. Statistics are presented separately for drivers and riders, passengers, pedestrians and cyclists. Details are also presented separately for drivers and riders crashing in off-road and on-road settings. Results from questionnaire data are presented in relation to demographics; the experience of the crash in narrative form; vehicle characteristics and maintenance; trip characteristics (e.g. purpose and length of journey; periods of fatigue and monotony; distractions from driving task); driving history; alcohol and drug use; medical history; driving attitudes, intentions and behaviour; attitudes to enforcement; and experience of road safety advertising.----- Chapter 5 compares the above-listed questionnaire results between on-road crash-involved casualties and interviews conducted in the region with non-crash-involved persons. Direct comparisons as well as age and sex adjusted comparisons are presented.----- Chapter 6 presents information on those casualties who were admitted to one of the study hospitals during the study period. Brief information is given regarding the demographic characteristics of these casualties. Emergency services’ data is used to highlight the characteristics of patient retrieval and transport to and between hospitals. The major injuries resulting from the crashes are presented for each region of the body and analysed by vehicle type, occupant type, seatbelt status, helmet status, alcohol involvement and nature of crash. Estimates are provided of the costs associated with in-hospital treatment and retrieval.----- Chapter 7 describes the characteristics of the fatal casualties and the nature and circumstances of the crashes. Demographics, road user types, licence status, crash type and contributing factors for crashes are presented. Coronial data is provided in regard to contributing circumstances (including alcohol, drugs and medical conditions), cause of death, resulting injuries, and restraint and helmet use.----- Chapter 8 presents the results of a comparison between casualties’ crash descriptions and police-attributed crash circumstances. The relative frequency of contributing circumstances are compared both broadly within the categories of behavioural, environmental, vehicle related, medical and other groupings and specifically for circumstances within these groups.----- Chapter 9 reports on the associated research projects which have been undertaken on specific topics related to rural road safety.----- Finally, Chapter 10 reports on the conclusions and recommendations made from the program of research.---- • Major Recommendations : From the findings of these analyses, a number of major recommendations were made: + Male drivers and riders - Male drivers and riders should continue to be the focus of interventions, given their very high representation among rural and remote road crash fatalities and serious injuries.----- - The group of males aged between 30 and 50 years comprised the largest number of casualties and must also be targeted for change if there is to be a meaningful improvement in rural and remote road safety.----- + Motorcyclists - Single vehicle motorcycle crashes constitute over 80% of serious, on-road rural motorcycle crashes and need particular attention in development of policy and infrastructure.----- - The motorcycle safety consultation process currently being undertaken by Queensland Transport (via the "Motorbike Safety in Queensland - Consultation Paper") is strongly endorsed. As part of this process, particular attention needs to be given to initiatives designed to reduce rural and single vehicle motorcycle crashes.----- - The safety of off-road riders is a serious problem that falls outside the direct responsibility of either Transport or Health departments. Responsibility for this issue needs to be attributed to develop appropriate policy, regulations and countermeasures.----- + Road safety for Indigenous people - Continued resourcing and expansion of The Queensland Aboriginal Peoples and Torres Strait Islander Peoples Driver Licensing Program to meet the needs of remote and Indigenous communities with significantly lower licence ownership levels.----- - Increased attention needs to focus on the contribution of geographic disadvantage (remoteness) factors to remote and Indigenous road trauma.----- + Road environment - Speed is the ‘final common pathway’ in determining the severity of rural and remote crashes and rural speed limits should be reduced to 90km/hr for sealed off-highway roads and 80km/hr for all unsealed roads as recommended in the Austroads review and in line with the current Tasmanian government trial.----- - The Department of Main Roads should monitor rural crash clusters and where appropriate work with local authorities to conduct relevant audits and take mitigating action. - The international experts at the workshop reviewed the data and identified the need to focus particular attention on road design management for dangerous curves. They also indicated the need to maximise the use of audio-tactile linemarking (audible lines) and rumble strips to alert drivers to dangerous conditions and behaviours.----- + Trauma costs - In accordance with Queensland Health priorities, recognition should be given to the substantial financial costs associated with acute management of trauma resulting from serious rural and remote crashes.----- - Efforts should be made to develop a comprehensive, regionally specific costing formula for road trauma that incorporates the pre-hospital, hospital and post-hospital phases of care. This would inform health resource allocation and facilitate the evaluation of interventions.----- - The commitment of funds to the development of preventive strategies to reduce rural and remote crashes should take into account the potential cost savings associated with trauma.----- - A dedicated study of the rehabilitation needs and associated personal and healthcare costs arising from rural and remote road crashes should be undertaken.----- + Emergency services - While the study has demonstrated considerable efficiency in the response and retrieval systems of rural and remote North Queensland, relevant Intelligent Transport Systems technologies (such as vehicle alarm systems) to improve crash notification should be both developed and evaluated.----- + Enforcement - Alcohol and speed enforcement programs should target the period between 2 and 6pm because of the high numbers of crashes in the afternoon period throughout the rural region.----- + Drink driving - Courtesy buses should be advocated and schemes such as the Skipper project promoted as local drink driving countermeasures in line with the very high levels of community support for these measures identified in the hospital study.------ - Programs should be developed to target the high levels of alcohol consumption identified in rural and remote areas and related involvement in crashes.----- - Referrals to drink driving rehabilitation programs should be mandated for recidivist offenders.----- + Data requirements - Rural and remote road crashes should receive the same quality of attention as urban crashes. As such, it is strongly recommended that increased resources be committed to enable dedicated Forensic Crash Units to investigate rural and remote fatal and serious injury crashes.----- - Transport department records of rural and remote crashes should record the crash location using the national ARIA area classifications used by health departments as a means to better identifying rural crashes.----- - Rural and remote crashes tend to be unnoticed except in relatively infrequent rural reviews. They should receive the same level of attention and this could be achieved if fatalities and fatal crashes were coded by the ARIA classification system and included in regular crash reporting.----- - Health, Transport and Police agencies should collect a common, minimal set of data relating to road crashes and injuries, including presentations to small rural and remote health facilities.----- + Media and community education programmes - Interventions seeking to highlight the human contribution to crashes should be prioritised. Driver distraction, alcohol and inappropriate speed for the road conditions are key examples of such behaviours.----- - Promotion of basic safety behaviours such as the use of seatbelts and helmets should be given a renewed focus.----- - Knowledge, attitude and behavioural factors that have been identified for the hospital Brief Intervention Trial should be considered in developing safety campaigns for rural and remote people. For example challenging the myth of the dangerous ‘other’ or ‘non-local’ driver.----- - Special educational initiatives on the issues involved in rural and remote driving should be undertaken. For example the material used by Main Roads, the Australian Defence Force and local initiatives.