Why urban setting matters in shaping tourist attitudes towards interaction with residents: Causation or selection in three urban settings

BackgroundEarly Intervention in Psychosis Services (EIS) for young people in England experiencing first-episode psychosis (FEP) were commissioned in 2002, based on an expected incidence of 15 cases per 100 000 person-years, as reported by schizophrenia epidemiology in highly urban settings. Unconfirmed reports from EIS thereafter have suggested higher than anticipated rates. The aim of this study was to compare the observed with the expected incidence and delineate the clinical epidemiology of FEP using epidemiologically complete data from the CAMEO EIS, over a 6-year period in Cambridgeshire, for a mixed rural–urban population.MethodA population-based study of FEP (ICD-10, F10–39) in people aged 17–35 years referred between 2002 and 2007; the denominator was estimated from mid-year census statistics. Sociodemographic variation was explored by Poisson regression. Crude and directly standardized rates (for age, sex and ethnicity) were compared with pre-EIS rates from two major epidemiological FEP studies conducted in urban English settings.ResultsA total of 285 cases met FEP diagnoses in CAMEO, yielding a crude incidence of 50 per 100 000 person-years [95% confidence interval (CI) 44.5–56.2]. Age- and sex-adjusted rates were raised for people from black ethnic groups compared with the white British [incidence rate ratio (IRR) 2.1, 95% CI 1.1–3.8]. Rates in our EIS were comparable with pre-EIS rates observed in more urban areas after age, sex and ethnicity standardization.ConclusionsOur findings suggest that the incidence observed in EIS is far higher than originally anticipated and is comparable to rates observed in more urban settings prior to the advent of EIS. Sociodemographic variation due to ethnicity and other factors extend beyond urban populations. Our results have implications for psychosis aetiology and service planning.

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On-Scene Intravenous Line Insertion Adversely Impacts Prehospital Time in Rural Vehicular Trauma

The American Surgeon ◽

10.1177/000313480807401109 ◽

2008 ◽

Vol 74 (11) ◽

pp. 1083-1087 ◽

Cited By ~ 2

Author(s):

Richard P. Gonzalez ◽

Glenn R. Cummings ◽

Herbert A. Phelan ◽

Madhuri S. Mulekar ◽

Charles B. Rodning

Keyword(s):

Linked Data ◽

Motor Vehicle ◽

Motor Vehicle Crash ◽

Urban Setting ◽

Rural Setting ◽

Urban Settings ◽

Intravenous Line ◽

Rural And Urban ◽

Rural Settings ◽

Prehospital Time

Fatality rates from rural vehicular trauma are almost double those found in urban settings. Increased emergency medical services (EMS) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced Trauma Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV). The purpose of this study was to assess the association between intravenous line placement and motor vehicle crash (MVC) scene time in rural and urban settings. An imputational methodology using the National Highway Traffic Safety Administration Crash Outcome Data Evaluation System permitted linkage of data from police motor vehicle crash and EMS records. Intergraph GeoMedia software permitted this linked data to be plotted on digital maps for segregation into rural and urban groups. MVCs were defined as rural or urban by location of the accident using the U.S. Bureau of Census Criteria. Linked data were analyzed to assess for EMS time on-scene, on-scene IV insertion, on-scene IV insertion attempts, and patient mortality. Over a 2-year period from January 2001 through December 2002, data were collected from Alabama EMS patient care reports (PCRs) and police crash reports. A total of 45,763 police crash reports were linked to EMS PCRs. Of these linked crash records, 34,341 (75%) and 11,422 (25%) were injured in rural and urban settings, respectively. Six hundred eleven (1.78%) mortalities occurred in rural settings and 103 (0.90%) in urban settings (P < 0.005). There were 6,273 (18.3%) on-scene IV insertions in the rural setting and 1,290 (11.3%) in the urban setting (P < 0.005). Mean EMS time on-scene when single IV insertion attempts occurred was 16.9 minutes in the rural setting and 14.5 minutes in the urban setting (P < 0.0001). When two attempts of on-scene IV insertion were made, mean EMS time on-scene in the rural setting (n = 891 [2.6%]) was 18.4 minutes and 15.7 minutes in the urban setting (n = 142 [1.2%; P < 0.005). Excluding dead on-scene patients, mean EMS time on-scene when mortalities occurred in rural and urban settings was 18.9 minutes and 10.8 minutes, respectively (P < 0.005). On-scene IV insertion occurred with significantly greater frequency in rural than urban settings. This incurs greater EMS time on-scene and prehospital time that may be associated with increased vehicular fatality rates in rural settings.

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Patient Attitudes Toward Spoken Surveys in a Low-Income Urban Surgical Clinic

The American Surgeon ◽

10.1177/0003134820960054 ◽

2020 ◽

pp. 000313482096005

Author(s):

Montgomry L. Burgoon ◽

Parker A. Miller ◽

Bryson Hoover-Hankerson ◽

Nicolle Strand ◽

Howard Ross

Keyword(s):

Health Care ◽

Low Income ◽

College Education ◽

Urban Setting ◽

University Hospital ◽

Low Literacy ◽

Urban Settings ◽

Advantages And Disadvantages ◽

Interview Format ◽

Survey Responses

Diverse groups in urban settings demonstrate poor participation in health care and low levels of literacy. It is possible the method of health information delivery (eg, spoken vs. written) in these settings could impact health care related communication and understanding, though little is known on this topic. The objective of this study was to uncover the advantages and disadvantages of spoken survey administration in a low-income urban setting. The data for this study were collected via spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital (TUH) in North Philadelphia. Survey responses were coded into various groups until categories and relationships among them emerged to produce themes relevant in demonstrating the advantages and disadvantages of spoken survey. 69% (55) of respondents preferred a spoken survey format. Of the 55 patients who preferred the spoken format, 33% (18) possessed some level of college education and 47% (26) had finished high school. Of the 23 patients who primarily spoke Spanish or another language at home, 78% (18) preferred a spoken interview format. Overall, 53% (42) of patients experienced at least 1 instance of poor understanding throughout the survey. Patients were better able to understand questions in a spoken survey compared to written ones that they had completed in the past due to the opportunity for surveyors to explain questions when needed. It is possible that question explanation is necessary in low-income urban settings due to low-literacy levels or improved feelings of survey intimacy and efficiency.

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Long-Term Comparison of Attraction of Flying Insects to Streetlights after the Transition from Traditional Light Sources to Light-Emitting Diodes in Urban and Peri-Urban Settings

Sustainability ◽

10.3390/su11226198 ◽

2019 ◽

Vol 11 (22) ◽

pp. 6198 ◽

Cited By ~ 5

Author(s):

Roy H. A. van Grunsven ◽

Julia Becker ◽

Stephanie Peter ◽

Stefan Heller ◽

Franz Hölker

Keyword(s):

Light Emitting Diodes ◽

Spectral Composition ◽

Mercury Vapor ◽

World Market ◽

Relative Difference ◽

Urban Setting ◽

Light Sources ◽

Urban Settings ◽

Light Emitting ◽

The Impact

Among the different light sources used for street lighting, light-emitting diodes (LEDs) are likely to dominate the world market in the coming years. At the same time, the spectral composition of nocturnal illumination is changing. Europe and many other areas worldwide have implemented bans on energy-inefficient lamps, such as the still very common mercury vapor lamps. However, the impact of artificial light on insects is mostly tested with light-traps or flight-intercept traps that are used for short periods only. By comparing the numbers of insects attracted by street lamps before and after replacing mercury vapor light sources (MV) with light emitting diodes, we assessed the impact in more typical (urban and peri-urban) settings over several years. We found that LED attracted approximately half of the number of insects compared to MV lights. Furthermore, most insect groups are less drawn by LED than by MV, while Hymenoptera are less attracted by MV than by LED. Thus, the composition of the attracted communities differed between the light sources, which may impact ecosystem processes and functions. In green peri-urban settings more insects are attracted than in an urban setting, but the relative difference between the light sources is the same.

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Prevalence and Genetic Characterization of Cryptosporidium Isolates from Common Brushtail Possums (Trichosurus vulpecula) Adapted to Urban Settings

Applied and Environmental Microbiology ◽

10.1128/aem.00809-08 ◽

2008 ◽

Vol 74 (17) ◽

pp. 5549-5555 ◽

Cited By ~ 30

Author(s):

Nichola J. Hill ◽

Elizabeth M. Deane ◽

Michelle L. Power

Keyword(s):

Urban Areas ◽

White Blood Cells ◽

Urban Setting ◽

Urban Habitat ◽

Brushtail Possum ◽

Trichosurus Vulpecula ◽

Sympatric Populations ◽

Cryptosporidium Hominis ◽

Urban Settings ◽

Zoo Animals

ABSTRACT The common brushtail possum (Trichosurus vulpecula) is one of the most abundant native marsupials in urban Australia, having successfully adapted to utilize anthropogenic resources. The habituation of possums to food and shelter available in human settlements has facilitated interaction with people, pets, and zoo animals, increasing the potential for transmission of zoonotic Cryptosporidium pathogens. This study sought to examine the identity and prevalence of Cryptosporidium species occurring in possums adapted to urban settings compared to possums inhabiting remote woodlands far from urban areas and to characterize the health of the host in response to oocyst shedding. Findings indicated that both populations were shedding oocysts of the same genotype (brushtail possum 1 [BTP1]) that were genetically and morphologically distinct from zoonotic species and genotypes and most closely related to Cryptosporidium species from marsupials. The urban population was shedding an additional five Cryptosporidium isolates that were genetically distinct from BTP1 and formed a sister clade with Cryptosporidium parvum and Cryptosporidium hominis. Possums that were shedding oocysts showed no evidence of pathogenic changes, including elevated levels of white blood cells, diminished body condition (body mass divided by skeletal body length), or reduced nutritional state, suggesting a stable host-parasite relationship typical of Cryptosporidium species that are adapted to the host. Overall, Cryptosporidium occurred with a higher prevalence in possums from urban habitat (11.3%) than in possums from woodland habitat (5.6%); however, the host-specific nature of the genotypes may limit spillover infection in the urban setting. This study determined that the coexistence of possums with sympatric populations of humans, pets, and zoo animals in the urban Australian environment is unlikely to present a threat to public health safety.

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Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya

PLoS ONE ◽

10.1371/journal.pone.0257542 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257542

Author(s):

Jackline Oluoch-Aridi ◽

Patience Afulani ◽

Cindy Makanga ◽

Danice Guzman ◽

Laura Miller-Graff

Keyword(s):

Maternity Care ◽

Multilevel Models ◽

First Trimester ◽

Health Facilities ◽

Urban Setting ◽

Clinical Officer ◽

Cross Sectional ◽

Urban Settings ◽

Factors Associated ◽

Nurse Midwife

Introduction Peri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women’s experience of maternity care in peri-urban settings will allow health facility managers and policy makers to improve services in these settings. This study examines factors associated with PCMC in a peri-urban setting in Kenya. Methods and materials We analyzed data from a cross-sectional study with 307 women aged 18–49 years who had delivered a baby within the preceding six weeks. Women were recruited from public (n = 118), private (n = 76), and faith based (n = 113) health facilities. We measured PCMC using the 30-item validated PCMC scale which evaluates women’s experiences of dignified and respectful care, supportive care, and communication and autonomy. Factors associated with PCMC were evaluated using multilevel models, with women nested within facilities. Results The average PCMC score was 58.2 (SD = 13.66) out of 90. Controlling for other factors, literate women had, on average, about 6-point higher PCMC scores than women who were not literate (β = 5.758, p = 0.006). Women whose first antenatal care (ANC) visit was in the second (β = -5.030, p = 0.006) and third trimester (β = -7.288, p = 0.003) had lower PCMC scores than those whose first ANC were in the first trimester. Women who were assisted by an unskilled attendant or an auxiliary nurse/midwife at birth had lower PCMC than those assisted by a nurse, midwife or clinical officer (β = -8.962, p = 0.016). Women who were interviewed by phone (β = -7.535, p = 0.006) had lower PCMC scores than those interviewed in person. Conclusions Factors associated with PCMC include literacy, ANC timing and duration, and delivery provider. There is a need to improve PCMC in these settings as part of broader quality improvement activities to improve maternal and neonatal health.

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Women differentials in fertility: The case of rural and urban educational development in Benue State, Nigeria

Tropical Journal of Education ◽

10.47524/tje.v2i1.9 ◽

2021 ◽

Vol 2 (1/2) ◽

pp. 80-86

Author(s):

Bridget Demekaa ◽

Umbur Demekaa

Keyword(s):

Educational Development ◽

General Purpose ◽

Urban Setting ◽

Girl Child ◽

Urban Settings ◽

Fertility Differential ◽

Rural And Urban ◽

Child Education ◽

Lower Fertility ◽

The Government

This study relates women education to fertility in the Ihugh (rural) and Makurdi (urban) setting in Benue State. The general purpose of the study is to test whether women with substantial schooling do have lower fertility than those without schooling. The study reveals that there is fertility differential for rural and urban settings, and that schooling is an index of the differentials. The study presents its findings and puts forward some recommendations that can help the government to address the issue of women education, especially the girl-child education.

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Trypanosoma cruzi infection in Triatoma infestans and high levels of human–vector contact across a rural-to-urban gradient in the Argentine Chaco

Parasites & Vectors ◽

10.1186/s13071-020-04534-z ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Alejandra Alvedro ◽

María Sol Gaspe ◽

Hannah Milbourn ◽

Natalia Paula Macchiaverna ◽

Mariano Alberto Laiño ◽

...

Keyword(s):

Trypanosoma Cruzi ◽

Rural Areas ◽

Control Strategies ◽

Blood Feeding ◽

Urban Setting ◽

Transmission Risk ◽

Triatoma Infestans ◽

Urban Gradient ◽

Urban Settings ◽

Feeding Sources

Abstract Background Peri-urban and urban settings have recently gained more prominence in studies on vector-borne transmission of Trypanosoma cruzi due to sustained rural-to-urban migrations and reports of urban infestations with triatomines. Prompted by the finding of Triatoma infestans across the rural-to-urban gradient in Avia Terai, an endemic municipality of the Argentine Chaco, we assessed selected components of domestic transmission risk in order to determine its variation across the gradient. Methods A baseline vector survey was conducted between October 2015 and March 2016, following which we used multistage random sampling to select a representative sample of T. infestans at the municipal level. We assessed T. cruzi infection and blood-feeding sources of 561 insects collected from 109 houses using kinetoplast DNA-PCR assays and direct enzyme-linked immunosorbent assays, respectively. We stratified triatomines according to their collection site (domestic or peridomestic), and we further categorized peridomestic sites in ecotopes of low- or high-risk for T. cruzi infection. Results The overall adjusted prevalence of T. cruzi-infected T. infestans was 1.8% (95% confidence interval [CI] 1.3–2.3) and did not differ between peri-urban (1.7%) and rural (2.2%) environments. No infection was detected in bugs captured in the urban setting; rather, infected triatomines were mainly collected in rural and peri-urban domiciles, occurring in 8% of T. infestans-infested houses. The main blood-feeding sources of domestic and peridomestic triatomines across the gradient were humans and chickens, respectively. The proportion of triatomines that had fed on humans did not differ between peri-urban (62.5%) and rural (65.7%) domiciles, peaking in the few domestic triatomines collected in urban houses and decreasing significantly with an increasing proportion of chicken- and dog- or cat-fed bugs. The relative odds ratio (OR) of having a T. cruzi infection was nearly threefold higher in bugs having a blood meal on humans (OR 3.15), dogs (OR 2.80) or cats (OR: 4.02) in a Firth-penalized multiple logistic model. Conclusions Trypanosoma cruzi transmission was likely occurring both in peri-urban and rural houses of Avia Terai. Widespread infestation in a third of urban blocks combined with high levels of human–triatomine contact in the few infested domiciles implies a threat to urban inhabitants. Vector control strategies and surveillance originally conceived for rural areas should be tailored to peri-urban and urban settings in order to achieve sustainable interruption of domestic transmission in the Chaco region.

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Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia

10.21203/rs.2.12764/v1 ◽

2019 ◽

Cited By ~ 1

Author(s):

Sarah Forthal ◽

Abebaw Fekadu ◽

Girmay Medhin ◽

Medhin Selamu ◽

Graham Thornicroft ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Low Income ◽

Rural Areas ◽

Negative Binomial ◽

Mental Illnesses ◽

Urban Setting ◽

Low Income Countries ◽

Urban Settings ◽

Adjusted Risk

Abstract Background Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting. Methods The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders. Results Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (χ2(1)=4.80; p=0.028), the police (χ2(1) =11.97; p=0.001), in keeping a job (χ2(1)=5.43; p=0.020), and in safety (χ2(1)=5.00; p=0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33). Conclusions Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.

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Spatial modelling of sand fly vector’s response to a synthetic sex-aggregation pheromone: impact on the incidence of visceral leishmaniasis in rural and urban settings

10.1101/2020.10.18.20214569 ◽

2020 ◽

Author(s):

Renata Retkute ◽

Erin Dilger ◽

James GC Hamilton ◽

Matt J Keeling ◽

Orin Courtenay

Keyword(s):

Visceral Leishmaniasis ◽

Aggregation Pheromone ◽

Human Infection ◽

Urban Setting ◽

Sand Fly ◽

Mathematical Framework ◽

Urban Settings ◽

Infection Incidence ◽

Host Seeking ◽

Rural And Urban

AbstractBackgroundVisceral leishmaniasis (VL) is a potentially fatal protozoan parasitic disease of humans and dogs. In the Americas, dogs are the reservoir and Lutzomyia longipalpis is the sand fly vector. A synthetic version of the vector’s sex-aggregation pheromone attracts conspecifics to co-located lethal insecticide, reducing reservoir infection and vector abundance. Mathematical models of spatially deployed interventions are lacking, thus best practise using this novel lure-and-kill vector control approach to reduce infection incidence has not been fully explored.MethodsWe developed a predictive mathematical model of vector host-seeking behaviour combined with spatially explicit transmission models to evaluate changes in human and canine spatial infection incidence under variable pheromone implementation scenarios and demographic conditions.ResultsThe risk of human infection increased exponentially with canine incidence, but at different rates between rural and urban settings with spatial clustering of high forces of human infection related to their proximity to canine infected households. A predicted 70% household coverage using a cost-effective amount (50mg) of pheromone, plus insecticide, reduced rural and urban setting infection incidence by approximately 44% and 50% in dogs, and by 64% and 68% in humans, within 1-2 years. Near or complete transmission elimination in dogs and humans was achieved after 10 years intervention using 50mg of pheromone under 70% household coverage in urban settings when newly acquired (immigrant) dogs had no pre-existing infections, but in rural settings required 90% coverage using 500mg. The willingness to pay (WTP) price per 10mg unit of pheromone is likely to be <$3 USD, making it a cost-beneficial intervention compared to current alternative strategies.ConclusionsIntegrated stochastic and spatial models capturing vector host-seeking behaviour, is a useful mathematical framework to evaluate spatially dependent intervention methods, fine-scale transmission dynamics, and to identify best practise.

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