Evaluation of Nutrient Composition in Breast Milk of Breast Feeding Mothers in Urban and Sub-Urban Subjects in Rivers State

The human breast milk is considered to be the perfect food for infants, specifically adapted to their needs. Changes in lifestyle and environment may impact on breast milk composition. This study was aimed at comparing the nutrients composition in breast milk in postpartum women in urban and sub-urban areas in Rivers State. The cross-sectional study was conducted among 59 postpartum subjects between 0 and 10days of child delivery in each group. Sampling was done through a simple random sampling method. Human breast milk was collected by means of a manual breast pump for the analysis of carbohydrate, protein and lipid using ClegAnthrone Method, Kjedahl Method and Soxhelt Extraction Method respectively. The results revealed that carbohydrate level was 6.1±0.5% in urban group and 5.0±0.1% in sub-urban group which was statistically significant (t-value=2.2; p-value=0.04). Protein level was 3.5±0.6% in urban group and 3.9±0.3% in sub-urban group which was statistically non-significant (t-value=0.6; p-value=0.57). Lipid level was 6.1±0.5% and 5.0±0.1% in urban and sub-urban groups respectively which was statistically non- significant (t-value=1.2; p-value=0.27). This study has revealed that differences in settlements (urban and sub-urban) have no impact on breast milk composition except in carbohydrate.

A cross sectional study to assess the prevalence of malocclusion in 08-12 years old school age children of the selected urban & rural community of Bangladesh

Objective: To determine the prevalence of malocclusion in school-age children from a selective area of the urban and rural community of Bangladesh. Methods: A cross-sectional descriptive survey was conducted among 748 children aged 08-12 years old were examined from October 2019 to September 2020 in Sylhet Sardar Upazila, Bangladesh. Angle”s classification was used for recording molar relationship with malocclusion traits. The study participants were examined by disposable dental tools (calibrated probs and mirror) including torchlight. After the collection of all data, it was compiled and analyzed by Statistical Package for the Social Sciences (SPSS) Windows version 23. Chi-square test was used for categorical variables. P values <0.05 were considered as statistically significant. Result: The prevalence of malocclusion in urban school-age children was 237(63.4%) and in rural 213(57.0%).In urban area, the prevalence of malocclusion was 109(58.3%) in boys and 128(68.4%) in girls group. The majority (70.5%) were found Angle’s class I in urban group and 148(69.5%) in rural. One forty three (60.3%) patients were found increased overbite with malocclusion in urban group and 124(58.2%) in rural. Angle’s class-I malocclusion and Increased overbite were the most commonly occurring malocclusion. Conclusion: Prevalence of malocclusion was more in urban school age children when compared with rural. Malocclusion was significantly more in girls than boys in both urban and rural area. Angle’s class-I malocclusion and Increased overbite were the most commonly occurring malocclusion of school age children from a selected urban and rural community of Bangladesh. Update Dent. Coll. j: 2021; 11(2): 10-15

The art of snacking: Innovative food extraction in a synanthropic species is associated with food exposure and food categorization

Extractive foraging is generally studied from the perspective of behavioral flexibility, cognitive ability, innovation and social learning. Despite its potential to elucidate synanthropic adaptation in species exploiting enclosed anthropogenic food, research on extractive foraging under urban conditions is limited. Since a large extent of anthropogenic food is packaged and contains highly processed food, processes of identification/extraction of food by nonhuman species become intriguing themes of research. We studied how processing status of embedded food determined extraction decisions across groups of a species differing in exposure and familiarity to the food. Further, we tested the generalizability of extraction methods. Experimenting with wild bonnet macaques (Macaca radiata), we found exposure- and form (native/shelled/peeled)-specific familiarity to peanuts, state (raw/boiled/roasted)-specific distinction in depeeling, and exposure- and state-specific differences in methods of depeeling. Group with the highest exposure to peanut differed in its propensity to use sophisticated extraction methods, e.g. depeeling by rubbing between palms (bimanual asymmetric action) and rubbing against horizontal substrata (unimanual action). The innovative methods were also extended to roasted peas and chickpeas by the urban group. Our study establishes a causal relationship between familiarity and processing status of food and shows the generalized extension of extraction methods based on food categorization.

The impact of the SARS-CoV-2 pandemic on the mental health of hemodialysis patients in Lebanon

Hemodialysis is a necessary treatment for end-stage kidney disease patients. It imposes undergoing three sessions of dialysis per week in a specialized center. Amid the SARS-CoV-2 pandemic, precautionary measures were mandatory in all dialysis facilities and may have negatively impacted patients’ well-being. This study aimed to uncover the scale of this effect. We performed a cross-sectional study of all patients undergoing chronic hemodialysis in two dialysis units (one urban and another rural). Patients with Alzheimer’s disease were excluded. Patients filled a questionnaire including information on socio-demographics, factors related to the dialysis facility, and the impact of the COVID-19 epidemic on their mental health. A total of 72 patients responded. Their median age was 70 (60.79) years. Of them, 68% were males, 71% were married, and 10% were living alone. Following the pandemic, 35% felt more anxious, with a higher incidence of anxiety in the rural unit (p=0.021). Half of them felt very limited in their relationships, and 29% were isolated from their families. In total, 98% of patients were satisfied with the staff support. The imposed preventive measures were perceived as very strict in 27% of the surveyed patients. The majority of the urban group were bothered for not eating during the session, and they felt significantly more stress than the rural group (p=0.001). The SARS-CoV-2 pandemic increased anxiety among hemodialysis patients from a rural setting. Stress was more prevalent in the urban group and most probably related to limitations in eating during sessions. The majority were satisfied with staff support.

MO759COMPERATIVE STUDY OF THE CARDIOVASCULAR SYSTEM IN PATIENTS WITH CKD ON HEMODIALYSIS IN URBAN AND RURAL POPULATIONS OF UZBEKISTAN

Background and Aims According to recently published WHO data, kidney disease has been the 10th leading cause of death in the world over the past 20 years. The lethality of dialysis patients with cardiovascular pathology is 3 times higher than that of patients without CVD. This is especially pronounced in developing countries. Uzbekistan is a country with a population of 34 million and has an equal urban and rural population. In this regard, it is of interest to comparatively study the structure of CVD in patients with CKD stage 5D of the rural and urban population of Uzbekistan. Method We examined 165 (90 men and 75 women) patients with CKD stage 5 receiving dialysis in urban and rural areas of Uzbekistan. The patients were divided into 2 groups depending on their permanent place of residence and the medical center where they receive hemodialysis. 104 (51 men and 53 women) patients were included in the Urban group and 61 (39 men and 22 women) patients were included in the Rural group. The average age of the urban population was 49.7 ± 1.38 years, the rural population was 45.5 ± 1.83 years. All patients underwent programmed hemodialysis according to the standard scheme for 4 hours 3 times a day (12 hours/week). The average duration of hemodialysis in the Urban group was 37.0 ± 4.77 months (M ± m) and 16.6 ± 2.4 months in the Rural group. The main causes of CKD 5D in both groups were glomerulonephritis (Urban-36.5%, Rural-62%) and type 2 diabetes (Urban-31.7%, Rural-18%). Results CVD comorbidity occurred in 55,8% (n=92) of all 165 examined patients, of which 52 were men and 40 were women. The most common CVDs in all groups were hypertension (51%, n=84), coronary heart disease, presented as angina (28%, n=47), heart failure (14%, n=23) and various types of arrhythmias (5%, n=8). 77% (n=127) of patients had anemia due ESRD. In the group Urban(n=104), 62.5% (n=65) had CVD. The main CVD was Hypertension. It was found in 92% (n=60) of patients with CVD in this group. Less (65%, n=42) were patients with angina. Heart failure was detected in 31% (n=20) of patients. Arrhythmia was diagnosed in only 5% (n=5). A large number of combined CVD have been identified. 69% (n=45) of all patients with CVD had a combined CVDs in different combinations. The most common combination was hypertension + angina (n = 26). It accounted for almost 58% of all combined cases. Only 28% (n=17) of all cases with hypertension had "isolated" hypertension. The main combination with hypertension was hypertension + angina (43%, n=26), 11% (n=11) of patients had hypertension + angina + heart failure, a combination in the form of hypertension + angina + arrhythmia had 3% (n=3) patients. Relatively fewer (n = 27, 44%) CVD were found in the Rural group. The most frequent CVD was also a hypertension. Patients with hypertension made up 89% (n = 24) of all patients with CVD in this group. The second place is occupied by angina, it was found in 18.5% (n=5) cases among patients with CVD. Combined CVS pathologies were less common in the rural group. A total of 8 patients (29.6% of all CVD cases) had several CVDs. Conclusion Сardiovascular diseases in the urban population (62.5%) occur almost one and a half times more often than in the rural population (44%). Combined CVD pathology occupies a leading place in the structure of CVD in patients with CKD 5D, both urban and rural.

Tammany Hall and the Machine Style in Black Politics

“I seen my opportunities and I took ’em,” explained George Washington Plunkitt speaking to the journalist William L. Riordan at the dawn of the twentieth century. For many college students, William Riordan's collection of musings and reminiscences from New York State Senator Plunkitt, delivered at a shoeshine stand on Manhattan's West Side, offers a definitive introduction to the history of urban machine politics. Plunkitt of Tammany Hall: A Series of Very Plain Talks on Very Practical Politics, first published in 1905, has become a ubiquitous text, frequently assigned in political science courses and excerpted in U.S. history source books. Plunkitt's reflections, while entertaining, present a transactional and opportunistic form of political practice. He famously differentiates between honest graft and dishonest graft; insists that showing up at fires to help victims is key to holding your district; declares the Irish to be natural born leaders; and derides reformers as “mornin’ glories.” He rages against the key urban reform project of the era, civil service examinations, as “the curse of the nation,” amounting to “a lot of fool questions about the number of cubic inches of water in the Atlantic and the quality of sand in the Sahara desert.” Civil service exams blocked machine politicians from distributing jobs to loyal followers, which in the case of the New York Democratic machine typically meant recently arrived Irish immigrants. As Plunkitt explains, “The Irishman is grateful. His one thought is to serve the city which gave him a home. He has this thought even before he lands in New York, for his friends here often have a good place in one of the city's departments picked out for him while he is still in the old country.” Plunkitt's characterization of the linkage between migrant arrival and municipal work points to the central role that access to city payrolls played in the economic and political history of the New York Irish. Arguably, the only other urban group that relied as heavily on city jobs for economic mobility has been African Americans.

Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level

Background Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system. Methods The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.” Results Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed. Conclusions The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.

Segregated Schools, “Slow Minds” and “Must Be Done Jobs”: Experiences About Formal Education and Labour Market in a Roma Community in Romania

Based on a long-term ethnographic fieldwork, this study applies the cultural-ecological theory to understand reasons for making and maintaining a segregated school in a Romanian town, and those community forces which track and maintain Roma children there. As findings indicate, creating and sustaining such an institution reflects the flipsides of Romanian national policies, which due to the financing strategies and centralized curricula—involuntarily—block the chances to provide quality education to marginal groups. Tracking and staying of Roma children into such schools is a result of their parents’ ambivalent experiences with formal economic activities and formal education. Experiences with work and schooling shared by this urban group of Roma reveal that parents have clear expectations towards school: transmission of practical knowledge, good treatment and isolation of the school problems from family life, which not always can be fulfilled by the educational units.

Abstract 13706: Differences in the Distribution of Systolic Blood Pressure by Rural and Urban Residence

Introduction: The incidence of stroke is higher in rural areas. Hypertension is the leading risk factor for stroke, but the difference in systolic blood pressure (SBP) for those living in rural and urban areas is unknown. Hypothesis: We hypothesized that rural residence is associated with higher SBP levels, and this difference is modified by race, sex, and United States (US) division. Methods: We analyzed 26,113 participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, recruited between 2003 and 2007. Participants were grouped based on the Rural-Urban Commuting Area (RUCA) scheme into urban, large-rural, and small-isolated rural groups. Resting SBP was measured during the initial home visit. Differences in percentiles of SBP distribution were compared using multivariate models with adjustment for age, race, sex, and US Census Bureau division. Results: Of the participants, 20,976 (80.3%) were classified as urban, 3,020 (11.6%) as large-rural, and 2,137 (8.2%) as small-isolated rural, reflecting the distribution of the population. The large-rural group had a 0.09 mmHg higher mean SBP compared to the urban group (95% CI, 0.33 to 1.52 mmHg, p = 0.0023), but the difference in SBP at the 95th percentile between these groups was 3.23 mmHg (95% CI, 1.43 to 4.73 mmHg, p = 0.0006). A similar difference was present between the small-isolated rural and urban groups at the highest percentiles. No urban-rural interaction was observed by race, sex, or US division. However, large SBP differences were present between US divisions, especially at the highest percentiles. To illustrate, SBP at the 95th percentile was 9.51 mmHg higher in the East North Central division than in the Pacific (95% CI, 6.41 to 12.61 mmHg, p < 0.0001). Conclusions: Residence in a rural area is associated with higher SBP, with larger differences at the highest percentiles of distribution. SBP differences are present between US divisions, independent of urban-rural status.

Clinical Outcomes Among Bullous Pemphigoid Patients—A Comparison of Urban and Rural Populations

Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It can be challenging to manage and is associated with an increased risk of mortality. Access to dermatologic care is essential for patients with BP. However, the influence of geographic residence and distance to specialty care on patient outcomes or treatment regimens is unknown. Objective Assess whether the rural-dwelling or urban-dwelling geographic status of our patients impacts the treatment duration of systemic corticosteroids (CS) in the management of BP. Numerous secondary outcomes were evaluated including the cumulative systemic corticosteroid dose received, steroid-sparing agent utilized, and duration and number of follow-up appointments. Methods Retrospective analysis of patient records from January 2013 to May 2019 seen at the university-associated clinic in Edmonton, Alberta. Patients were stratified based on their rural-dwelling or urban-dwelling status via their Forward Sortation Area. Results There were 59 patients with BP. Of these, 37 completed their systemic corticosteroid course. The time required for 51.0% of the urban group to complete their steroid course was 543 days, and for 51.5% of the rural group it was 507 days. Methotrexate and azathioprine were the most common steroid-sparing agents utilized in both groups. Rural patients were seen in follow-up significantly less often than urban patients. Conclusion Our findings demonstrate that the location of a patient’s geographic residence does not influence the systemic corticosteroid or steroid-sparing agent use at our center. Interestingly, rural patients are able to receive similar treatment to urban patients despite having significantly fewer follow-up appointments.