Antibiotic resistance through the lens of One Health: A study from an urban and a rural area in Sri Lanka.

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

219: Factors In Recruiting and Retaining Emergency Physicians to Rural Emergency Departments

Aims: To assess the concentration of toxic heavy metals [Cadmium, Copper, Lead and Nickle] in dairy milk and animal feed of urban and rural areas and correlate them. Study Design: It was a cross-sectional comparative study. Place and Duration of Study: The study was conducted on the dairy milk and animal feed in milk farms of Peshawar. The samples were collected during June – July of 2010. Methodology: The study area was divided into two zones: urban area which was located in the centre of the city and rural area comprising of peri urban villages. Fifty milk samples were collected, 30 from urban and 20 from rural areas. Feed samples were also collected. Milk and feed samples were prepared by wet digestion method using HNO3 and H2O2 as described by Association of Official Analytical Chemists (AOAC) of North America, 1990. This was followed by analysis on Atomic Absorption Spectrometer. Results: The results showed that the mean concentration of toxic heavy metals under study namely Cadmium, Copper, Lead and Nickle were greater in dairy milk than the maximum residue limits (MRLs) of these elements as given by Joint Expert Committee on Food and Agriculture and World Health Organization. In comparison of urban and rural areas it was found that higher concentration of Cadmium, Copper, and Nickle was found Original Research Article British Biotechnology Journal, 4(8): 883-893, 2014 884 in dairy milk samples from urban areas than rural areas but there was no significant difference in Lead concentration of the two areas. Their concentration in urban and rural samples were respectively Cadmium 0.69 and 0.037 with P-value <0.001, Copper 1.40 and 0.09 with P-value 0.001, Nickel 0.806 and 0.024 with P-value <0.001, Lead 2.243 and 2.082 with P -value 0.026. However in this study all these elements were within the permissible limits in animal feed except for copper in cotton khal which was 83.3mg kg against the MRL of 10 mg kg given by National Research Council, NRC, 2005. Also there was no significant difference in the concentration of these elements in feed of urban and rural areas. Correlation study between the concentration of these elements in milk and feed showed positive pearson’s correlation coefficient between the two particularly for copper (0.451) in sugarcane khal and (0.341) in wheat grain, Nickle (0.342) in maize, and (0.30) in wheat bran and cotton khal. Conclusion: The concentrations of toxic metals were higher than the maximum residue limits in milk but were within their normal limits in animal feed suggesting that milk is being contaminated by various other sources but not farm feed. Comparison between urban and rural areas showed higher concentration in urban milk samples as compared to rural except for lead probably because urban farms are located in polluted areas in the centre of the city. However no significant difference was found in animal feed of urban and rural areas because it is supplied from common source.

To analyze the incidence and mortality trends of female breast cancer in urban and rural areas of Beijing from 2004 to 2008. The incidence and mortality data of female breast cancer from 2004 to 2008 were sorted from Beijing Cancer Registry Database, including 15 527 new diagnosed cases and 3219 deceased cases in total, covering population 29 351 258 person years; among which 11 065 new cases and 2378 deceased cases were from urban areas, covering 17 877 128 person years and 4462 new diagnosed cases and 841 deceased cases were from rural areas, covering 11 474 130 person years. The incidence cases aged 25 and above were divided into 13 age groups by 5 years. The cases under 49 years (≤ 49) and over 49 years (> 49) were separately defined as premenopausal group and postmenopausal group. Incidence and mortality rates in each year, age-specific incidence and mortality rates in urban and rural areas in Beijing were calculated. The annual standard incidence and mortality rates were adjusted by world population constitution; and the incidence rates ratio in different years related to the place of residence, urban or rural were calculated. JoinPoint software was applied to analyze the incidence trend and calculated the annual percentage of changing (APC). The age of female breast cancer patients in urban Beijing in 2004 was (55.83 ± 13.01), while it changed to (56.10 ± 12.80) in 2008, increasing by 0.27 years old. The proportion of the patients who were under 49 years declined from 38.32% (732/1910) in 2004 to 34.02% (894/2628) in 2008. While the average age of the patients in rural areas have improved 0.21 year old, from (52.15 ± 11.33) years old in 2004 to (52.36 ± 11.59) years old in 2008; and the proportion of the patients under 49 years also declined from 45.44% (314/691) in 2004 to 43.40% (454/1046) in 2008. From 2004 to 2008, the incidence and mortality rate of female breast cancer in urban areas of Beijing separately rose from 55.43/100 000 (1910/3 445 812) and 10.65/100 000 (367/3 445 812) to 70.70/100 000 (2628/3 717 436) and 15.01/100 000 (558/3 717 436). And in rural areas, those rates separately rose from 30.60/100 000 (691/2 257 953) and 5.54/100 000 (125/2 257 953) in 2004 to 44.78/100 000 (1046/2 336 040) and 7.49/100 000 (175/2 336 040) in 2008. After adjusting by world population constitution, the difference showed no statistical significance in mortality trend of female breast cancer in rural areas of Beijing (P > 0.05). In year 2004, the female breast cancer incidence rate ratio of urban to rural areas in Beijing fluctuated between 1.34 and 4.47, with the average ratio value at 1.81. In year 2008, the ratio value fluctuated between 1.15 and 2.37, with the average ratio value at 1.57. During 2004 and 2008, the peak age group of the female breast cancer incidence in urban areas was in 60 - 64 years old group, with the rate of 126.92/100 000 (998/786 300) whereas the mortality rate was increasing within aging. In rural areas the peak age groups of the incidence and mortality were separately in 50 - 54 and 80 - 84 years old groups, with the rate of 80.63/100 000 (793/983 516) and 29.17/100 000 (40/137 132) respectively. The incidence and mortality of breast cancer in urban areas in Beijing, as well as the incidence of breast cancer in rural areas in Beijing showed increasing trend annually. The gap in breast cancer incidence between rural and urban areas in Beijing was narrowing, while the incidence rate among different aging groups and the peak mortality rate showed significant difference between urban and rural areas in Beijing.

The rural-urban gap in sociodemographic, lifestyle, and disease-related characteristics among COPD patients is prevalent. These differences may influence the prevalence of mild cognitive impairment (MCI). This study aimed to compare the prevalence and determinants of MCI between rural and urban areas among COPD patients. The cross-sectional study sample comprised 372 COPD patients from China. We evaluated the cognitive function and lung function, collected sociodemographic, lifestyle, and disease-related information, to compare the prevalence of MCI in rural and urban areas. Using multivariate regression analysis to examine the effects of variables to MCI. The prevalence of MCI in rural areas was higher than that in urban areas (65.4% vs 47.9%, P=0.001). The prevalence in farm laborers was almost twice as high as that of non-farm laborers in urban areas (82.6% vs 43.1%), but no significant difference in rural areas (P=0.066). However, the data were lower in subjects who insisted on long-term home oxygen therapy (39.7%, CI:27.8-51.6, P<0.001), and who with higher monthly household income (49.6%, CI:40.2-58.9) in rural areas, but no significant difference in urban areas (P=0.985 and 0.502). Multivariate logistic regression analysis indicated that participants aged 71 years and above, former smokers were at a high risk of MCI in both urban and rural areas. However, participants who slept for 6-8 hours a day, shopping frequently, or exercised for more than 2 hours a day had a lower risk of MCI in urban areas. But rural participants who insisted on long-term home oxygen therapy had a lower probability of developing MCI. This study revealed that there were significant differences in MCI among COPD patients in rural and urban areas, especially in exercise, sleeping, shopping, and long-term home oxygen therapy. Medical staff should give health guidance according to the actual situation of patients with COPD.

The presence of heavy metals in indoor dust is a world-wide concern owing to its negative impact on humans. In this study, we collected indoor dust samples from urban and rural residential areas during the heating season in Taiyuan City. We then identified the concentrations of 11 heavy metals (Cd, Co, Cr, Pb, Mn, Ni, Cu, Zn, V, As, and Hg) using inductively coupled plasma-mass spectrometry. Based on the concentrations, we categorized the pollution levels of indoor dust using the geo-accumulation index and the pollution load index. We further identified the sources of heavy metals using the enrichment factor and principal component analysis. Finally, we evaluated the potential ecological risks of heavy metals via the potential ecological index. The results illustrated that ① with the exception of Co, Mn, and V, the mean concentrations of Cd, Cr, Cu, Ni, Pb, As, Zn, and Hg in indoor dust were higher than the soil background values of Shanxi Province. There was a significant difference (P<0.05) in the concentrations of Co, Cr, Cu, Mn, Ni, and Hg between the urban and rural areas. ② Overall, the pollution degree of heavy metals in indoor dust was identified as moderate in the urban area of Taiyuan City, but slight in the rural area. The indoor dust sample in the urban area was not contaminated by Co, Mn, and V. However, it was slightly polluted by As, Ni, and Hg. In addition, it was close to moderately polluted by Cd, Cr, Cu, Pb, and Zn. In the rural area, the pollution degrees of all the metals, except for Hg and V, in indoor dust were lower than those in the urban area. ③ The As, Cd, Cu, Pb, Zn, and Hg in indoor dust for both urban and rural areas might have mainly originated from anthropogenic sources. The pollution sources were mainly transportation and industry in the urban area and coal combustion and indoor smoking in the rural area. The Co, Cr, Mn, Ni, and V in indoor dust in Taiyuan City might have mainly originated from natural sources. ④ The ecological risk of heavy metal pollution in indoor dust for both the urban and rural areas of Taiyuan City was relatively high, with integrated ecological risk indexes of 359.43 and 471.02 in the urban and rural areas, respectively. In addition, Cd and Hg were the largest contributors.

The one of most common tendencies in world now days is urbanization, as a result of which the economic structure of territories changes - both human and financial resources are moved, and human lifestyles and the perception of life become more diversified. One of the main goals set by the European Union (EU) is to balance the development of urban and rural areas by promoting their mutual functional linkages and partnerships based on concept that urban and rural areas are mutually interconnected and depend on each other. To evaluate rural and urban areas the administrative division approach will be used - the territory in Latvia is subdivided into 118 municipalities - both urban and rural. The values of social indicators in 2009 are better in rural municipalities, but higher values of economic indicators are observed for the urban municipalities, indicating the impact of the large urban areas. Over past six years all socio-economic indicators have improved both in urban and rural areas, but there are still significant differences between them.The significance of interaction between urban and rural areas is emphasised in planning documents of all levels in Latvia. The directions of development that have to be perfected are: mobility possibilities for residents, promoting the flows of labour and knowledge both to urban and rural areas, increasing the flow of capital to rural areas to diversify their economy, and supplying quality and unique tourism services in rural areas.

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Burn injuries among children under five remain a significant public health concern globally, particularly in low- and middle-income countries like Tanzania. Despite various national efforts, the burden and associated factors of burns, particularly in relation to rural-urban differences, have not been well-documented in the Dodoma Region. The study aimed to compare the prevalence of burn wounds and associated factors among children under five years old between rural and urban areas in Dodoma Region. An analytical cross-sectional study was conducted from May to June 2025, involving 299 children under five years from both rural and urban areas in the Dodoma Region. Data were collected through structured questionnaires and analyzed using SPSS version 27 with descriptive and inferential statistics. Overall, the prevalence of burn wounds for children under five was 78 (26%) for both urban and rural areas. By categorizing, 31 (39.7%) of burn wound cases were from urban areas, and 47 (60.3%) cases were from rural areas. In rural areas, good caregiver supervision was associated with the majority of children under five ending up with no burn wound (χ2 = 4.16, P = 0.04). The household hazards in urban areas were associated with burn wounds among children under-five (χ2 = 17.69, P < 0.001). In rural areas, the under-five children without risk behaviours were associated with most of under five children ending up with no burn wound (χ2 = 4.31, P = 0.038). Moreover, several participants' sociodemographic characteristics were associated with the prevalence of burn wounds. This study found that burn injuries among under-five children in the Dodoma region are more prevalent in rural areas than in urban areas. In comparing predictors of burn wounds in rural and urban areas, a major contributing factor to burn wounds in rural areas is poor caregiver supervision, while the predictor of burn wounds in urban areas is household hazards.

Objective To analyze the satisfaction and the demands for the community healthcare of elderly patients with chronic diseases in the rural area. Methods A total of 428 elderly patients were investigated, and 64 urban elderly patients and 122 elderly patients from towns were included as the control group. Results The overall elderly patients′ satisfaction in rural area was 40.4%, which was significantly lower than that of 62.5% in the urban area (Z=-3.278, P 0.05). There were significant differences in the advancement of medical equipment, medical environment, the healthcare team′s attitude and technology level, and the healthcare education level between the rural and urban area were statistical significant (Z=-4.743, -8.587, -4.945, -3.685, -3.624, -2.766, -2.399, respectively; P<0.05). Except for disease consult, there were significant differences in the above aspects between the rural and county area (Z=-4.377, -7.868, -3.120, -2.647, -3.077, -3.886, respectively; P<0.05). For the rural area, 102 patients (23.8%) acquired medical knowledge by newspapers and books and 11 patients (2.6%) acquired medical knowledge by internet. Those number of patients in the urban area were 40 cases (62.5%) and 10 cases (15.6%). There were significant differences between the rural and urban area (χ2=40.545, 20.137, respectively; P<0.05). Those number of patients in the county area were 67 cases (54.9%) and 18 cases (14.8%). There were significant differences between the rural and county area(χ2=43.101, 28.217, respectively; P<0.05). Conclusions The satisfaction for the community healthcare of elderly patients in rural area is low, so it should be further improved. Key words: Elderly patients; Chronic diseases; Community; Satisfaction; Rural area

BackgroundAging in place is the crucial object of long-term care policy worldwide. Approximately 15.6–19.4 % of people aged 15 or above live with a disability, and 15.3 % of them have moderate or severe disabilities. The allocation of home nursing care services is therefore an important issue. Service providers in Taiwan vary substantially across regions, and between rural and urban areas. There are no appropriate indices for describing the capacity of providers that it is due to the distances from care recipients. This study therefore aimed to describe and compare distance barriers for home nursing care providers using indices of the “profit willing distance” and the “tolerance limited distance”.MethodsThis cross-sectional study was conducted during 2012 and 2013 using geocoding and a geographic information system to identify the distance from the providers’ locations to participants’ homes in urban (Taipei City) and rural (Hualien County) areas in Taiwan. Data were collected in-person by professionals in Taiwanese hospitals using the World Health Organization Disability Assessment Schedule 2.0. The indices were calculated using regression curves, and the first inflection points were determined as the points on the curves where the first and second derivatives equaled 0.ResultsThere were 5627 participants from urban areas and 956 from rural areas. In urban areas, the profit willing distance was 550–600 m, and we were unable to identify them in rural areas. This demonstrates that providers may need to supply services even when there is little profit. The tolerance limited distance were 1600–1650 m in urban areas and 1950–2000 m in rural areas. In rural areas, 33.3 % of those living inside the tolerance limited distance and there was no provider within this distance, but this figure fell to just 13.9 % in urban areas. There were strong disparities between urban and rural areas in home nursing care resource allocation.ConclusionsOur new “profit willing distance” and the “tolerance limited distance” are considered to be clearer and more equitable than other evaluation indices. They have practical application in considering resource distribution issues around the world, and in particular the rural–urban disparities for public resource.

<scp>COVID</scp>‐19 and Food Security in Fiji: The Reinforcement of Subsistence Farming Practices in Rural and Urban Areas

Background: Before the revolution, the gap between rural and urban areas of Iran was enormous and the socio-economic condition in rural areas was substantially different from the condition of their urban counterparts. Over the past 35 years, the Islamic Republic of Iran has made a considerable investment in infrastructures to reduce inequalities between rural and urban areas. Therefore, we evaluated the regional status of health infrastructure development between 1976 and 2011 in rural and urban areas. Methods: We selected piped water, electricity, piped gas, bathrooms, and health houses as the investigated variables. We used the national population and housing data in Iran obtained in 1976, 1986, 1996, 2006, and 2011, as well as the health house census data. We constructed variables for consistent geographic areas in STATA software. The share of the variables was calculated at the county level and the mean and standard deviation was calculated at the provincial level. Results: The gap between rural and urban areas and between different regions of the country was great in access to piped water and electricity in 1976 before the Islamic revolution. In addition, the speed of health houses construction was very slow and households of urban and rural areas did not have piped gas, at all. Between the 1986 and 1996 census, infrastructure variables, except piped gas, experienced a good improvement, especially in rural areas. After the war, the ascending trend continued with a higher speed so that the gap between rural and urban areas decreased sharply. Conclusions: Although involved in a war with Iraq between 1980 and 1988, Iran had a great development in infrastructure variables. In that period, simultaneously several voluntary organizations began their activities in the rural areas; therefore, the sharp progress could be a result of these activities. Although the gap between rural and urban areas has decreased over time, inequity between provinces still is high and this issue calls for more attention.

Physical activity (PA) and sedentary behavior (SB) have been affected by the COVID-19 pandemic and its restrictive environments, such as social distancing and lockdown measures. However, regional differences in the changes in domain-specific PA and SB in response to the COVID-19 pandemic are not clearly understood. This study aimed to examine regional differences in domain-specific PA and SB, as well as sleeping time in response to the COVID-19 pandemic in Japan. A web-based cross-sectional nationwide survey and an accelerometer-based longitudinal observation were conducted. In the web-based survey, we recruited 150 Japanese men and 150 Japanese women for each of the following age groups: 20s, 30s, 40s, 50s, 60s, and 70s (n=1800). A total of 1627 adults provided valid responses to web-based surveillance from June to July 2020. Participants were recruited from urban (Greater Tokyo Area, n=1028), urban-rural (regional core cities, n=459), or rural (regional small and medium cities, n=140) areas. They answered sociodemographic and health-related questions and retrospectively registered the PA data of their average day before and during the COVID-19 pandemic in a web-based PA record system. In the accelerometer-based observation, PA and step count data were obtained using a triaxial accelerometer on people living in urban (n=370) and rural (n=308) areas. Before the COVID-19 pandemic, there were no significant differences between these 3 regions in the time spent sleeping, staying at home, working or studying, and exercising (P>.05). By contrast, people living in urban areas had a longer duration of SB and transportation and a shorter duration of moderate-to-vigorous PA and lying or napping time compared with people living in rural areas (P>.05). During the COVID-19 pandemic, a significant decrease was observed in transportation time in urban (-7.2 min/day, P<.001) and urban-rural (-2.0 min/day, P=.009) areas but not in rural (-0.4 min/day, P=.52) areas. The moderate-to-vigorous PA was decreased in urban (-31.3 min/day, P<.001) and urban-rural (-30.0 min/day, P<.001) areas but not in rural areas (-17.3 min/day, P=.08). A significant increase was observed in time spent sleeping in urban (+22.4 min/day, P<.001) and urban-rural (+24.2 min/day, P<.001) but not in rural areas (+3.9 min/day, P=.74). Lying or napping was increased in urban (+14.9 min/day, P<.001) but not in rural areas (-6.9 min/day, P=.68). PA and step count obtained using an accelerometer significantly decreased in urban (P<.05) but not in rural areas (P>.05). The effect of the COVID-19 pandemic on PA and SB was significantly dependent on living area, even in a single country. The effects of PA and SB were greater in the Greater Tokyo Area and regional core cities but were not observed in regional small and medium cities in Japan.

Introduction: Malnutrition among toddlers can be correlated to family characteristics, access to food and the socio-economic background of the family in rural and urban areas. These situations influence the children’s nutrition status. Objectives: To identify the prevalence of malnutrition and the related factors among toddlers in rural and urban areas based on family characteristics in Aceh Province, Indonesia. Method: A cross-sectional study was performed among 600 households with toddlers in rural and urban areas. A self-administered questionnaire was used to measure family characteristics. The toddlers’ height and weight were measured to identify their nutritional status. Data were analysed using Chi-square. Results: The prevalence of malnutrition among toddlers was higher in urban areas than in rural areas with underweight (59.7% vs. 40.3%), stunting (51.0% vs. 49.0%), and wasting (52.3% vs. 47.7%). There were no differences between underweight and stunting problems in urban and rural areas (p> 0.05). However, there were differences between wasting in urban and rural areas, related to mothers’ education (p= 0.031) and mothers’ occupation (p= 0.014) Conclusions: Mothers’ education and the mothers’ job status were significantly different regarding their effect on the child’s wasted status in rural and urban areas (p Sri Lanka Journal of Child Health, 2020; 49(3): 263-268