scholarly journals Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dantong Zhao ◽  
Zhongliang Zhou ◽  
Chi Shen ◽  
Rashed Nawaz ◽  
Dan Li ◽  
...  
Keyword(s):  
Patient Experience ◽  
Primary Healthcare ◽  
Urban Areas ◽  
Healthcare Services ◽  
Urban Residents ◽  
Exact Matching ◽  
Rural Residents ◽  
Healthcare Resources ◽  
Coarsened Exact Matching ◽  
Rural And Urban

Abstract Background Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. Methods Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. Results The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = − 2.897, 95%CI: − 4.434, − 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = − 3.040, 95%CI: − 4.473, − 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. Conclusions Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.

Population-level effects of diet, lifestyle, and health environment on obesity and non-communicable diseases in India

2019 ◽  
Author(s):  
Kuhu Joshi ◽  
Devesh Roy ◽  
Lora Iannotti ◽  
Aishwarya Nagar ◽  
Avinash Kishore
Keyword(s):  
Urban Areas ◽  
Population Level ◽  
Overweight And Obesity ◽  
Lifestyle Changes ◽  
Exact Matching ◽  
Rapid Urbanization ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Linear Probability ◽  
The Impact

Abstract Background: Obesity is rising in developing countries like India and is associated with an increase in cardiometabolic problems. Rising incomes, rapid urbanization, and mechanization have induced lifestyle changes like consumption of more obesogenic foods and sedentary habits at work and leisure, contributing to a transition from under- to over-nutrition. This study maps the prevalence of adult (15-49 years) overweight and obesity across regions and socioeconomic groups in India, and estimates its association with lifestyle, health environment, dietary patterns, diabetes, and hypertension.Methods: We employ a combination of 3 latest nationally representative datasets with over 700,000 adults. We use a linear probability regression model to identify the correlates of overweight/obesity and their relative magnitudes. We use intra-household regression to identify differences between men and women and coarsened exact matching to causally estimate the impact of obesity on diabetes and hypertension.Results: Overweight/obesity rates have increased across all states, in rural and urban areas, and for all wealth levels. Women are more likely to be overweight/obese than men, even in the same household. Improved health environment (toilets, piped water, clean cooking fuel), urban jobs, television watching, and processed snacks increase the risk of overweight/obesity. Adults who are overweight/obese have a 5.6% higher risk of diabetes and a 9.7% higher risk of hypertension.Conclusions: Our results underscore the need for policy intervention to reduce the burden of obesity and NCD’s in India.

scholarly journals The Influence of Information Services on Public Transport Behavior of Urban and Rural Residents

2019 ◽  
Vol 11 (19) ◽  
pp. 5454
Author(s):  
Xuemei Zhou ◽  
Jiahui Liang ◽  
Xiangfeng Ji ◽  
Caitlin Cottrill
Keyword(s):  
Public Transport ◽  
Rural Areas ◽  
Urban Areas ◽  
Information Service ◽  
Rural Residents ◽  
Rural And Urban Areas ◽  
Transport Behavior ◽  
Urban And Rural Residents ◽  
Rural And Urban ◽  
Urban And Rural Areas

Rural and urban areas are mainly connected by public transport in China. The characteristics of the trips of local residents in rural and urban areas are different; therefore, the demand for public transport information services is different. Based on the revealed data, a structural equation model is applied to examine the critical factors affecting the behavior of urban and rural residents in choosing public transport in the Beidaihe District, Qinhuangdao City, China. The effect of information service factors on public transport behavior of urban and rural residents is obtained. The influence level of public transport information service on public transport behavior of urban and rural residents before and during travel is discussed. This study provides valuable insights to improving public transport services between urban and rural areas of China, which can attract more residents to use public transport and promotes sustainable development between urban and rural areas.

scholarly journals Multi-Mode Two-Step Floating Catchment Area (2SFCA) Method to Measure the Potential Spatial Accessibility of Healthcare Services

2019 ◽  
Vol 8 (5) ◽  
pp. 236 ◽  
Author(s):  
Jianhua Ni ◽  
Ming Liang ◽  
Yan Lin ◽  
Yanlan Wu ◽  
Chen Wang
Keyword(s):  
Travel Behavior ◽  
Urban Areas ◽  
Catchment Area ◽  
Methodological Approach ◽  
Open Data ◽  
Healthcare Services ◽  
Spatial Accessibility ◽  
Urban Residents ◽  
Transportation Modes ◽  
Multi Mode

While great progress in the development of a methodological approach to measure the accessibility of healthcare services has been made, the exclusion of the complex multi-mode travel behavior of urban residents and a rough calculation of travel costs from the origin to the destination limit its potential for making a detailed assessment, especially in urban areas. In this paper, we aim to describe and implement an enhanced method that enables the integration of multiple transportation modes into a two-step floating catchment area (2SFCA) method to estimate accessibility. We used a travel-mode choice survey, based on distance sections, to determine the complex multi-mode travel behavior of urban residents. Taking Nanjing as a study area, we proposed complete door-to-door approaches to determine every aspect of basic transportation modes. Additionally, we processed open data to implement an accurate computing of the origin-destination (OD) time cost. We applied the enhanced method to estimate the accessibility of residents to hospitals and compared it with three single-mode 2SFCA methods. The results showed that the proposed method effectively identified more accessibility details and provided more realistic accessibility values.

scholarly journals A multiethnic association analysis of hyperuricaemia with cardiovascular risk in rural and urban areas in Chinese adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Leilei Liu ◽  
Juan Lei ◽  
Linyuan Zhang ◽  
Nana Ma ◽  
Zixuan Xu ◽  
...  
Keyword(s):  
Older Adults ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ethnic Group ◽  
Rural Women ◽  
Urban Areas ◽  
Rural Residents ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Increased Risk

AbstractComprehensive research on rural–urban disparities in the association of hyperuricaemia (HUA) with cardiovascular disease (CVD) in China, especially among minority groups, is limited. We explored the HUA-CVD relationship between rural and urban areas within ethnic Chinese groups. We included Dong, Miao, and Bouyei adults in Southwest China from the China Multi-Ethnic Cohort Study. Multivariable logistic regression models were used to assess the relationship between HUA and CVD in both residences. We performed stratified analyses by sex and age. The study population included 16,618 people (37.48% Dong, 30.00% Miao, and 32.52% Bouyei) without a reduced estimated glomerular filtration rate. We identified 476 (188 Dong, 119 Miao, and 169 Bouyei) and 175 (62 Dong, 77 Miao, and 36 Bouyei) CVD cases in rural and urban areas. Compared to urban residents, an at least 49% increased CVD risk (adjusted OR 1.49, 95%CI 1.06–2.08 for the Dong ethnic group; 1.55, 1.07–2.25 for the Bouyei ethnic group) and a 1.65-fold elevated coronary heart disease risk (1.65, 1.03–2.64) related to HUA was present in rural residents. Moreover, HUA was positively associated with increased risk of CVD and coronary heart disease in rural women (2.05, 1.26–3.31; 2.11, 1.19–3.75) and rural older adults (1.83, 1.22–2.75; 2.32, 1.39–3.87) among the Bouyei ethnic group, respectively. We found rural elderly individuals with HUA among the Dong ethnic group had a 52% elevated risk of CVD (1.52, 1.05–2.21); furthermore, an at least 79% increased risk of stroke related to HUA was observed in women (2.24, 1.09–4.62) and elderly people (1.79, 1.02–3.13) in rural areas among the Dong ethnic group. But a positive association was not found among the Miao ethnic group. Screening early-onset HUA patients may be helpful for the control and prevention of CVD in rural residents, especially for women and older adults living in a rural community, among the Dong and Bouyei ethnic groups in China.

scholarly journals Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262358
Author(s):  
Farzana Bashar ◽  
Rubana Islam ◽  
Shaan Muberra Khan ◽  
Shahed Hossain ◽  
Adel A. S. Sikder ◽  
...  
Keyword(s):  
Service Delivery ◽  
Primary Healthcare ◽  
Service Provision ◽  
Urban Areas ◽  
Financial Incentives ◽  
Clinical Skills ◽  
Healthcare Services ◽  
Working Environment ◽  
Staff Retention ◽  
Contracting Out

Background “Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting. Methodology In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. Results The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. Conclusions An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

scholarly journals NIGERIAN NURSES AND MIDWIVES UNEMPLOYMENT SURVEY

2020 ◽  
Vol 8 (6) ◽  
pp. 92-101
Author(s):  
EGWUENU RN ◽  
G.I. NSHI RN
Keyword(s):  
Nursing Education ◽  
Rural Community ◽  
Primary Healthcare ◽  
Urban Areas ◽  
Community Setting ◽  
Healthcare Services ◽  
Community Settings ◽  
Health Extension Workers ◽  
Mass Migration ◽  
Nurses And Midwives

Background: The quacking controversy that trailed the Nursing & Midwifery Council of Nigeria’s (N&MCN) release of a “License Community Nurse (LCN)” circular (Ref No. N&MCN/SG/RO/CIR/24/VOL.4/152 dated March 3, 2020) which conveyed the intention of the council to lower the existing standard of nursing education for the LCN programme that will take secondary school leavers at least a credit in English and Biology to be admitted into and two years to complete, and inter alia blamed the crude situation and abysmal performance of the Nigerian Primary Healthcare (PHC) system in the community settings on mass migration of Nurses & Midwives to urban areas and to other countries prompted UGONSA to initiate this survey to empirically determine whether there are indeed a shortage of Nurses & Midwives to fill the manpower need of the Nigerian PHC system in the community settings or not, or whether the shortage is as a result of the deliberate age-long policy of attrition and displacement of Nurses & Midwives from the PHC system in the community settings and their replacement with Community Health Extension Workers (CHEWs) [who do not have nursing education, training, skills or the ethical leaning to be responsible and accountable for nursing & midwifery services] by the National Primary Healthcare Development Agency (NPHCDA). Objective: The main aim of the study was to determine if there is a shortage of nurses that could fill the nursing needs of the PHC system in the community settings. The study also sought to compile the list of unemployed and underemployed Nurses & Midwives and to find out if unemployed Nurses & Midwives are willing to work in the community settings if the opportunity to serve the PHC system in the community setting is offered to them by the NPHCDA. The study further sought to determine the ratio of unemployed Nurses & Midwives in relation to the possible number of graduates that can be licensed by the N&MCN in a session. Methods: Using Google forms an online compilation was carried out from March 7 to April 08, 2020, in a descriptive survey of unemployed Nurses & Midwives that could be reached online within the timeline. Names, Phone numbers, State of Residence, Year of Graduation, Qualification(s), and how long they have remained unemployed after graduation were compiled. In addition, two questions were asked about the objective of the study. Analysis of data was done via Google forms statistical tools.   Results: A total of 3317 unemployed Nurses & Midwives responded to the survey. Among these unemployed Nurses & Midwives – 38% holds RN only, 19% holds both RN & RM, 15.4% holds RM only, while 27.6% holds BNSc plus another qualification. For the year they have remained unemployed after graduation 57.1% have spent 0–2 years, 29.9% have been unemployed for 3–5 years, 7% have been unemployed for 6 – 8 years and 6.1% have been unemployed for more than 8 years. To the question, “Do you think there is a shortage of Nurses and Midwives in Nigeria?” – 47.5% said yes, 43.5% said no whereas 9% were undecided (said maybe). Furthermore, the result showed that while 95% of the unemployed Nurses & Midwives are willing to work in the rural community settings, 1% was not willing to work in the rural community settings and 4% were undecided (.i.e. said maybe) on whether they will work in the rural community settings or not. The result also revealed that the 3317 unemployed Nurses & Midwives captured in the survey represents graduates of 66 Nursing & Midwifery schools per session out of a total of 162 schools that are currently accredited by the N&MCN. This represents 41% of the possible number of graduates that can be turned out of the accredited Nursing & Midwifery Schools (excluding Post-basic schools) in a session. Conclusion: Despite the reported migration of Nurses to urban areas and other countries, at least 41% of Nigerian Nurses & Midwives produced in a session remain unemployed and 95% of them are willing to work in the rural community settings if given the opportunity. These unemployed Nurses & Midwives can bridge the Nursing & Midwifery manpower needs in the Primary Healthcare System should the NPHCDA engage their services with a commensurate or higher payment to what their employed counterparts receive in Federal Government-owned establishments and hospitals. There is no current shortage of Nurses that necessitates the lowering of the existing standard of nursing education. Nurses & Midwives are not responsible for the design, implementation, and delivery of healthcare services at the PHC level and therefore are not culpable for the deplorable condition and abysmal performance of the Nigerian PHC System.

scholarly journals CHANGES IN RURAL POVERTY AFTER POLAND’S ACCESSION TO THE EUROPEAN UNION

2018 ◽  
Vol 50 (4) ◽  
Author(s):  
Barbara Chmielewska ◽  
Józef Stanisław Zegar
Keyword(s):  
European Union ◽  
Social Exclusion ◽  
Rural Areas ◽  
Urban Areas ◽  
Risk Index ◽  
Rural Poverty ◽  
Urban Residents ◽  
The European Union ◽  
Rural And Urban ◽  
The Eu

The purpose of this paper is to assess changes in the risk of poverty in European Union Member States and the extent of poverty in rural areas and farming households after Poland’s accession to the EU. The above aspect was consid- ered against the background of urban residents and other so- cioeconomic groups of households. The study was based on EU-SILC, Eurostat and CSO data. For a comparative assess- ment across EU countries, the poverty and/or social exclusion risk index was used. For a comparative assessment of rural and urban areas, the following basic poverty thresholds (as es- timated by the Central Statistical Office), were used: extreme poverty (subsistence minimum), relative poverty and statutory poverty. Despite the high level of socioeconomic development in the European Union, the risk of poverty or social exclusion is widespread and varies strongly across countries, regions and social groups. In Poland, rural areas are more affected by poverty than urban areas, mainly because rural households have lower incomes than urban households. The risk of pov- erty in the EU has declined. After the accession to the EU, Poland has experienced a decrease in the extent of poverty. This positive change was the combined result of many factors, mainly including an increase in incomes of the farming and rural population. In Poland, income disparities between rural and urban residents and between farm and landless families have decreased. Reducing poverty and social exclusion is one of the most important goals of the EU social policy.

scholarly journals Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: Time to contextualize the interventions? A cross-sectional study

2020 ◽  
Author(s):  
Charlotte Bavuma Munganyinka ◽  
Sanctus Musafiri ◽  
Pierre-Claver Rutayisire ◽  
Loise M Ng’ang’a ◽  
Ruth McQuillan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Rural Women ◽  
Clinical Characteristics ◽  
Urban Residents ◽  
Key Words Diabetes ◽  
Rural Residents ◽  
Family History Of Diabetes ◽  
Running Water ◽  
Rural And Urban ◽  
History Of

Abstract Background: Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in settings such as rural Africa where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural and urban Rwanda. Methods: Across-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents. Results: A total of 472 participants were recruited (mean + SD age 40.2±19.1years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32±18 vs 41±17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66%, 14.9% vs 28.7% and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5% and 30% vs 6%, respectively; p< 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p< 0.001). Conclusions : Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Africa. Generic guidelines for diabetes prevention and management may not be appropriate in different populations. Key words: diabetes; risk factors; malnutrition; rural; Rwanda

scholarly journals Family medicine residents' risk of adverse motor vehicle events: comparison between rural and urban placements.

2013 ◽  
Vol 4 (2) ◽  
pp. e28-e40 ◽  
Author(s):  
Fred Janke ◽  
Bonnie Dobbs ◽  
Rhianne McKay ◽  
Meghan Lindsell ◽  
Oksana Babenko
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Urban Areas ◽  
Motor Vehicle ◽  
Medical Schools ◽  
Cross Sectional Study ◽  
Urban Residents ◽  
Rural Residents ◽  
Cross Sectional ◽  
Family Medicine Residents

Background: Sleep deprivation and fatigue are associated with long and irregular work hours. These work patterns are common to medical residents. Motor vehicle crashes (MVCs) are a leading cause of injury related deaths in Canada, with MVC fatality rates in rural areas up to three times higher than in urban areas. Objectives: To: 1) examine the number of adverse motor vehicle events (AMVEs) in family medicine residents in Canada; 2) assess whether residents with rural placements are at greater risk of experiencing AMVEs than urban residents; and 3) determine if family medicine residency programs across Canada have travel policies in place. Methodology: A prospective, cross-sectional study, using a national survey of second-year family medicine residents. Results: A higher percentage of rural residents reported AMVEs than urban residents. The trend was for rural residents to be involved in more MVCs during residency, while urban residents were more likely to be involved in close calls. The majority of Canadian medical schools do not have resident travel policies in place. Conclusion: AMVEs are common in family medicine residents, with a trend for the number of MVCs to be greater for rural residents. These data support the need for development and incorporation of travel policies by medical schools.

scholarly journals Assessment of intake inadequacy and food sources of zinc of people in China

2007 ◽  
Vol 10 (8) ◽  
pp. 848-854 ◽  
Author(s):  
Guansheng Ma ◽  
Yanping Li ◽  
Ying Jin ◽  
Songming Du ◽  
Frans J Kok ◽  
...  
Keyword(s):  
World Health ◽  
Food Sources ◽  
Molar Ratio ◽  
Urban Residents ◽  
Rural Residents ◽  
Zinc Intake ◽  
Lactating Women ◽  
Urban And Rural Residents ◽  
Rural And Urban ◽  
Health Organization

AbstractObjectivesTo assess the intake inadequacy and food sources of zinc of people in China.Design and subjectsDiets of 68 962 subjects aged 2–101 years (urban 21 103, rural 47 859) in the 2002 China National Nutrition and Health Survey were analysed. Dietary intake was assessed using 24-hour recall for three consecutive days. Zinc intake inadequacy was calculated based on values suggested by the World Health Organization.ResultsThe median zinc intake ranged from 4.9 mg day− 1(urban girls, 2–3 years) to 11.9 mg day− 1(rural males, 19+ years). The zinc density of urban residents (2–3 to 19+ years) was 5.0–5.3 mg day− 1 (1000 kcal)− 1, significantly higher than that of their rural counterparts (4.7–4.8 mg day− 1 (1000 kcal)− 1). Differences in food sources of zinc from cereal grains (27.4–45.1 vs. 51.6–63.2%) and animal foods (28.4–54.8 vs. 16.8–30.6%) were found between urban and rural residents. Zinc from vegetables and fruits (8.2–13.8 vs. 9.7–12.4%) and legumes (1.3–3.3 vs. 2.5–3.4%) was comparable between urban and rural residents. The proportion of zinc intake inadequacy ranged between 2.8% (urban females, 19+ years) and 29.4% (rural lactating women). Rural residents had higher proportions of zinc intake inadequacy than their urban counterparts. Significantly higher proportions of zinc inadequacy were found in the category of phytate/zinc molar ratio >15 for both rural and urban residents.ConclusionsAbout 20% of rural children are at risk of inadequate zinc intake, with phytate as a potential important inhibitor. Moreover, lactating women are also considered a vulnerable group.

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