scholarly journals Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gillian Gorham ◽  
Kirsten Howard ◽  
Joan Cunningham ◽  
Federica Barzi ◽  
Paul Lawton ◽  
...  
Keyword(s):  
Health Service ◽  
Urban Areas ◽  
Dialysis Treatment ◽  
Remote Areas ◽  
Urban Models ◽  
Urban Rural ◽  
The Mean ◽  
Cost Studies ◽  
Cost Differences ◽  
Health Service Costs

Abstract Background Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations. Objective To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) associated with different dialysis models in urban, rural and remote locations. Methods Using cost weights attributed to diagnostic codes in the NT Department of Health’s hospital admission data set (2008–2014), we calculated the mean (SD) total annual health service costs by dialysis model for 995 dialysis patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between different explanatory variables to estimate ‘best casemix’/‘worst casemix’ cost scenarios. Results The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and $43 440 (SD $5 048) and lowest for remote at $19 584 (SD $4 394). When combined with the observed maintenance dialysis costs, expenditure was the highest for urban models at $148 510 (SD $19 774). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person from a remote area, was $5 648 more and increased further for those from remote and very remote areas to $10 785 and $15 118 respectively. Conclusions This study demonstrates that dialysis treatment in urban areas for relocated people has health and cost implications that maybe greater than the cost of remote service delivery. The study emphasises the importance of considering all health service costs and cost consequences of service delivery models. Key points for decision makers Relocation for dialysis treatment has serious health and economic consequences. Relocated people have low dialysis attendance and high hospital costs in urban areas. While remote dialysis service models are more expensive than urban models, the comparative cost differences are significantly reduced when all health service costs are included. The delivery of equitable and accessible dialysis service models requires a holistic approach that incorporates the needs of the patient; hence dialysis cost studies must consider the full range of cost impacts beyond the dialysis treatments alone.

scholarly journals Country-level determinants of the severity of the first global wave of the COVID-19 pandemic: an ecological study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042034
Author(s):  
Tiberiu A Pana ◽  
Sohinee Bhattacharya ◽  
David T Gamble ◽  
Zahra Pasdar ◽  
Weronika A Szlachetka ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Vaccination Coverage ◽  
Urban Areas ◽  
Ecological Study ◽  
Environmental Parameters ◽  
The Philippines ◽  
International Travel ◽  
Bcg Vaccination ◽  
Country Level ◽  
The Mean

ObjectiveWe aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic.DesignEcological study of publicly available data. Countries reporting >25 COVID-19 related deaths until 8 June 2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, population >65 years, average body mass index and smoking prevalence); economic parameters (gross domestic product per capita); environmental parameters (pollution levels and mean temperature (January–May); comorbidities (prevalence of diabetes, hypertension and cancer); health system parameters (WHO Health Index and hospital beds per 10 000 population); international arrivals; the stringency index, as a measure of country-level response to COVID-19; BCG vaccination coverage; UV radiation exposure; and testing capacity. Multivariable linear regression was used to analyse the data.Primary outcomeCountry-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase.ParticipantsThirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the UK and the USA.ResultsOf all country-level determinants included in the multivariable model, total number of international arrivals (beta 0.033 (95% CI 0.012 to 0.054)) and BCG vaccination coverage (−0.018 (95% CI −0.034 to –0.002)), were significantly associated with the natural logarithm of the mean death rate.ConclusionsInternational travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID-19 outbreaks and prevent related deaths.

Urban–Rural Dichotomy in Planning: Review of Legal Framework in Four States of India

2021 ◽  
pp. 001955612110016
Author(s):  
Anurima Mukherjee Basu ◽  
Rutool Sharma
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Planning Process ◽  
Legal Framework ◽  
Quantum Jump ◽  
Class 1 ◽  
Urban Settlements ◽  
Urban Rural ◽  
Territorial Approach ◽  
Sizeable Number

Current urbanisation trends in India show a quantum jump in number of ‘census towns’, which are not statutorily declared as urban areas, but have acquired all characteristics of urban settlements. Sizeable number of such census towns are not located near any Class 1 city. Lack of proper and timely planning has led to unplanned growth of these settlements. This article is based on a review of planning legislations, institutional framework and planning process of four states in India. The present article analyses the scope and limitations of the planning process adopted in the rapidly urbanising rural areas of these states. The findings reveal that states are still following a conventional approach to planning that treats ‘urban’ and ‘rural’ as separate categories and highlights the need for adopting an integrated territorial approach to planning of settlements.

scholarly journals Salt intake and blood pressure in Iranian children and adolescents: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad Hassan Emamian ◽  
Hossein Ebrahimi ◽  
Hassan Hashemi ◽  
Akbar Fotouhi
Keyword(s):  
Blood Pressure ◽  
Rural Areas ◽  
Urban Areas ◽  
Salt Intake ◽  
Daily Intake ◽  
Population Based ◽  
World Health ◽  
Second Phase ◽  
Salt Consumption ◽  
The Mean

Abstract Background Previous studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure. Methods A random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.’s formula. Results Among 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5–9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4–11.2)] was higher than urban areas [9.4 (95% CI 9.3–9.6)], in people with hypertension [10.8 (95% CI 10.3–11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3–9.6)], and in boys [9.8 (95% CI 9.7–10.0)] was more than girls [9.3 (95% CI 9.1–9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure. Conclusion Daily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.

scholarly journals Urban–rural disparity in cancer incidence in China, 2008–2012: a cross-sectional analysis of data from 36 cancer registers

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042762
Author(s):  
Shuai Yuan ◽  
Shao-Hua Xie
Keyword(s):  
Cancer Incidence ◽  
Rural Areas ◽  
Urban Areas ◽  
Incidence Rates ◽  
Cancer Type ◽  
Anatomic Site ◽  
Cross Sectional ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Urban Rural

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.

scholarly journals A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaili Yang ◽  
Liyan Xu ◽  
Qi Fan ◽  
Yuwei Gu ◽  
Bo Zhang ◽  
...  
Keyword(s):  
Clinical Data ◽  
Rural Areas ◽  
Visual Function ◽  
Urban Areas ◽  
Demographic Data ◽  
Corneal Thickness ◽  
Positive Family History ◽  
Education Level ◽  
Central China ◽  
The Mean

AbstractChina is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.

RURAL–URBAN MIGRATION AND CHILD SURVIVAL IN URBAN BANGLADESH: ARE THE URBAN MIGRANTS AND POOR DISADVANTAGED?

2008 ◽  
Vol 40 (1) ◽  
pp. 83-96 ◽  
Author(s):  
M. MAZHARUL ISLAM ◽  
KAZI MD ABUL KALAM AZAD
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Urban Poor ◽  
Child Survival ◽  
Childhood Mortality ◽  
Policy Implications ◽  
Urban Migration ◽  
Under Five ◽  
Urban Migrants ◽  
Urban Rural

SummaryThis paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children’s survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999–2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban–rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural–urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant–native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural–urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor–non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant’s children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban–rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.

scholarly journals Seasonal variation and spatial distribution of carbonaceous aerosols in Taiwan

2010 ◽  
Vol 10 (19) ◽  
pp. 9563-9578 ◽  
Author(s):  
C. C.-K. Chou ◽  
C. T. Lee ◽  
M. T. Cheng ◽  
C. S. Yuan ◽  
S. J. Chen ◽  
...  
Keyword(s):  
Spatial Distribution ◽  
Rural Areas ◽  
Urban Areas ◽  
Air Pollutants ◽  
Chemical Properties ◽  
Anthropogenic Sources ◽  
Carbonaceous Aerosols ◽  
Urban Rural ◽  
Southern Taiwan ◽  
Northern Taiwan

Abstract. To investigate the physico-chemical properties of aerosols in Taiwan, an observation network was initiated in 2003. In this work, the measurements of the mass concentration and carbonaceous composition of PM10 and PM2.5 are presented. Analysis on the data collected in the first 5-years, from 2003 to 2007, showed that there was a very strong contrast in the aerosol concentration and composition between the rural and the urban/suburban stations. The five-year means of EC at the respective stations ranged from 0.9±0.04 to 4.2±0.1 μgC m−3. In rural areas, EC accounted for 2–3% of PM10 and 3–5% of PM2.5 mass loadings, comparing to 4–6% of PM10 and 4–8% of PM2.5 in the urban areas. It was found that the spatial distribution of EC was consistent with CO and NOx across the network stations, suggesting that the levels of EC over Taiwan were dominated by local sources. The measured OC was split into POC and SOC counterparts following the EC tracer method. Five-year means of POC ranged from 1.8±0.1 to 9.7±0.2 μgC m−3 among the stations. It was estimated that the POM contributed 5–17% of PM10 and 7–18% of PM2.5 in Taiwan. On the other hand, the five-year means of SOC ranged from 1.5±0.1 to 3.8±.3 μgC m−3. The mass fractions of SOM were estimated to be 9–19% in PM10 and 14–22% in PM2.5. The results showed that the SOC did not exhibit significant urban-rural contrast as did the POC and EC. A significant cross-station correlation between SOC and total oxidant was observed, which means the spatial distribution of SOC in Taiwan was dominated by the oxidant mixing ratio. Besides, correlation was also found between SOC and particulate nitrate, implying that the precursors of SOA were mainly from local anthropogenic sources. In addition to the spatial distribution, the carbonaceous aerosols also exhibited distinct seasonality. In northern Taiwan, the concentrations of all the three carbonaceous components (EC, POC, and SOC) reached their respective minima in the fall season. POC and EC increased drastically in winter and peaked in spring, whereas the SOC was characterized by a bimodal pattern with the maximal concentration in winter and a second mode in summertime. In southern Taiwan, minimal levels of POC and EC occurred consistently in summer and the maxima were observed in winter, whereas the SOC peaked in summer and declined in wintertime. The discrepancies in the seasonality of carbonaceous aerosols between northern and southern Taiwan were most likely caused by the seasonal meteorological settings that dominated the dispersion of air pollutants. Moreover, it was inferred that the Asian pollution outbreaks could have shifted the seasonal maxima of air pollutants from winter to spring in the northern Taiwan, and that the increases in biogenic SOA precursors and the enhancement in SOA yield were responsible for the elevated SOC concentrations in summer.

scholarly journals Urban–Rural Disparities in the Magnitude and Determinants of Stunting among Children under Five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991–2016

2021 ◽  
Vol 18 (10) ◽  
pp. 5184
Author(s):  
Wenjun Zhu ◽  
Si Zhu ◽  
Bruno F. Sunguya ◽  
Jiayan Huang
Keyword(s):  
Urban Areas ◽  
Health Surveys ◽  
Demographic And Health Surveys ◽  
Household Level ◽  
Individual Level ◽  
Child Stunting ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Urban Rural ◽  
The Individual

Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn from 1991–1992, 1996, 1999, 2004–2005, 2009–2010, and 2015–2016 surveys were conducted. Under-5 child stunting prevalence was calculated separately for rural and urban children and its decline trends were examined by chi-square tests. Descriptive analyses were used to present the individual-level, household-level, and societal-level characteristics of children, while multivariable logistic regression analyses were performed to examine determinants of stunting in rural and urban areas, respectively. Additive interaction effects were estimated between residence and other covariates. The results showed that total stunting prevalence was declining in Tanzania, but urban–rural disparity has widened since the decline was slower in the rural area. No interaction effect existed between residence and other determinants, and the urban–rural disparity was mainly caused by the discrepancy of the individual-level and household-level factors between rural and urban households. As various types of determinants exist, multisector nutritional intervention strategies are required to address the child stunting problem. Meanwhile, the intervention should focus on targeting vulnerable children, rather than implementing different policies in rural and urban areas.

Agriculture Biomaterial Industry in Romania

2021 ◽  
Vol 10 (1) ◽  
pp. 32-44
Author(s):  
Irina Bancescu
Keyword(s):  
Rural Development ◽  
Rural Areas ◽  
Urban Areas ◽  
Rural Poverty ◽  
Value Added ◽  
Poverty Rate ◽  
Economic Implications ◽  
Income Gap ◽  
Rural Income ◽  
Urban Rural

Rural areas in Romania are underdeveloped, with the main economic activity being agriculture. Urban-rural income gap and poverty levels are indicative of an underdeveloped rural area. Urban-rural absolute income gap for average monthly income increased from 352 RON in 2007 to 663 RON in 2017. Moreover, the work poverty rate is higher in rural areas than in urban areas. Economic rural development can be achieved by improvements of the labour market and introduction of new value-added products. Agricultural and non-agricultural activities are dependent on each other for a successful rural development leading to poverty alleviation. An industry that combines the two types of economic activities is agriculture biomaterial industry. In this paper, the authos investigates the factors influencing rural poverty and analyses the current stage of the bioplastics market in Romania and its economic implications. Bioplastics industry can reduce urban-rural income gaps and poverty in rural areas.

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