Central County Research Articles

Influence of Supervision as a Motivation Factor on Stress Levels of Teachers in Public Primary Schools in Kajiado Central Sub-County, Kenya

Educationists and other stakeholders have recognized teachers’ psychological wellbeing as a key aspect in teacher motivation. It has been used to judge the ability of teachers and thus the main determinant of teachers’ performance and employment. Motivation hence has played an important role in the management of schools, because it may have a positive relationship with the stress levels of the teachers. The purpose of this study was to determine the influence of the teachers’ supervision as a motivation factor on stress levels among public primary school teachers in Kajiado Central Sub-County. The study adopted a descriptive survey research design. The target population comprised of 826 public primary school teachers, and 80 deputy head teachers and 80 head teachers from the 96 public primary schools from Kajiado Central Sub-County. However, 16 of the public primary schools were located in areas with intercommunity clashes and poor road transport and therefore the entire target population was not practically accessible. The accessible population comprised of 697 public primary school teachers, 80 deputy head teachers and 80 head teachers from the 80 public primary schools . Sampling of the public primary schools and teachers was done using stratified random sampling while the sampling for head teachers and the deputy head teachers was done using purposive sampling. The total study sample size was 256 respondents, which comprises of 248 teachers and eight head teachers from eight public primary schools. Data was collected through questionnaires for teachers and interviews scheduled for head teachers. Data was analysed using Statistical Package for Social Sciences (SPSS) version 24. The study found that teachers’ supervision significantly influenced the teachers stress levels in Kajiado Central Sub County. The findings may inform the Teachers Service Commission and the government policy makers on what needs to be changed or enhanced to promote motivational factors and reduce job stress among the primary school teachers. Keywords: Influence of Supervision, Motivation, Stress levels, Kenya DOI: 10.7176/JEP/11-29-11 Publication date: October 31 st 2020

INFLUENCE OF FOOD ADEQUACY ON ENROLMENT IN ECE CENTRES IN TURKANA CENTRAL SUB COUNTY, TURKANA COUNTY, KENYA

Purpose: This study sought to establish the influence of SFP on children enrolment in early childhood education centers in Turkana Central Sub-County, Kenya. Specific objective was to establish the influence of food adequacy on enrolment in ECE centres in Turkana Central Sub County, Turkana County, Kenya.
 Methodology: The study was based on Maslow hierarchy of needs, the program theory and liberal egalitarian theory. The study used a mixed research method. The study adopted the cross-sectional research design. The target population was 250 schools, 78 teachers and head teachers and 5,000 parents in pre-schools in Turkana Central Sub County. The study used purposive sampling to select respondents. The sample size of the study was 150 schools, 60 teachers and head teachers and 357 parents. Primary data was gathered by use of questionnaires and interviews guides. Secondary data consisted of report forms of pre-schoolers. Quantitative information was analyzed using descriptive statistics which was computed using SPSS version 21. Qualitative data was analyzed using content analysis. Multiple regressions were done to analyze the influence of SFPs on children enrolment in ECDE centres in Turkana Central Sub County.
 Findings: The study found that food adequacy significantly and positively relate with children enrolment in ECE centres in Turkana Central Sub County, Turkana County, Kenya. Food adequacy had statistically significant effect of school enrolment in ECD (β = 0.415, P = 0.005). It implies that food adequacy significantly and positively relate with children enrolment in ECE centres in Turkana Central Sub County, Turkana County, Kenya. This implies that increasing food adequacy will lead to increase in children enrolment in ECE centres in Turkana Central Sub County, Turkana County, Kenya.
 Unique contribution to theory, practice and policy: The study therefore recommends the government to increase food supply to ensure adequacy. There is need to continue supply of balanced diet to children because it improves their growth and learning. Some of the children are from very poor families and during school holidays they suffer because of lack of food; the study therefore recommends orphans, poor and disabled to be fed even during holidays.

Tracking Urbanization and Exurbs: Migration Across the Rural-Urban Continuum, 1990-2016.

This paper summarizes annual migration patterns across the rural–urban continuum in the USA between 1990 and 2016. We introduce a modified rural–urban continuum classification, the Rural–Urban Gradient (RUG). The RUG holds metropolitan classification constant, effectively designates exurbs, and distinguishes central city core counties in major metropolitan areas from their suburbs and exurbs. The RUG is used to compare, over time and across regions, net migration, and migration efficiency using annual county-level data from the Internal Revenue Service. Results show how migration patterns correlated with changes in demographics and housing depending on counties’ location along the RUG. We also describe the extent to which rural migration flows converged in counties at metropolitan peripheries and concentrated in the South and West, thus shaping widening disparity across US rural contexts.

Descriptive Epidemiology of Infant Botulism in California: The First 40 Years

To ascertain the descriptive epidemiology of infant botulism, the flaccid paralysis that results when neurotoxigenic Clostridium species produce botulinum toxin (BoNT) in the infant colon, in its first 40years following initial recognition in California in1976. Cases were defined by laboratory identification of BoNT and/or neurotoxigenic Clostridium species in patients' feces. Parents were interviewed using a structured questionnaire. Descriptive epidemiologic characteristics were compared between 1976-1996 and 1997-2016. From 1976-2016, 1345 cases of infant botulism occurred in 45 of 58 California counties (6.5 cases/100000 live-births/year) caused by BoNT types A, B, Ba, Bf, and F; 88% of cases were ≤6months of age and 51% were female. Cases were white (84.2%), Asian (8.9%), other races (3.8%), and African American (2.8%); 29.4% of cases were Hispanic. More than 99% of cases were hospitalized. Case occurrence peaked in summer-fall. Of 8 designated geographic regions, the Central Coast counties had 3 times the statewide incidence in both 20-year time periods. Breast-fed patients (83%) were more than twice as old at onset as formula-fed patients (median, 4.4 vs 1.7months, respectively; P<.001). BoNT/A cases were older at onset than BoNT/B cases (median, 3.8 vs 2.9months, respectively; P<.001). Comprehensive continuous surveillance of infant botulism for 40years in a large, diversely populated state identified fundamental epidemiologic characteristics of this uncommon illness. Unusual features included greater than 99% case hospitalization, absence of male preponderance, and a distinctive age distribution.

Relationship between Locus of Control Orientation and School Adjustment of Orphaned and Vulnerable Pupils in Kisumu Central Sub County, Kenya.

This study investigated the relationship between locus of control orientation and school adjustment of orphaned and vulnerable pupils (OVP) in primary schools in Kisumu Central Sub County, Kenya. It adopted a correlational research design. Purposive and snowball sampling techniques were used to sample 284 participants which included 248 OVP and 36 class teachers. Data was collected using an adapted form of Nowicki-Strickland locus of control scale for children (N-SLOC) and a modified form of teacher rating scale of school adjustment (TRSSA). The instruments were piloted in two schools to determine their validity and reliability. Content validity was ascertained by incorporating results of the pilot study and views of experts in the Department of Educational Psychology of Masinde Muliro University of Science and Technology. On the other hand, split-half technique corrected by Spearman-Brown formula was used to determine reliability of the data collection instruments. N-SLOC yielded a reliability coefficient of .793 while TRSSA, .995. Data was analysed using inferential statistics at .05 level of statistical significance and 95% confidence level. Statistical package for social sciences (SPSS) version 25 aided in the analysis. Results revealed a weak significant positive correlation between locus of control orientation and school adjustment, r = .183, df = 246, p < .05 . Recommendations were made that could help stakeholders respond to OVP in ways that increase their comfortability and ultimate adjustment in the school environment. Key words: Adjustment, locus of control orientation, orphan, school adjustment and vulnerable pupil. DOI : 10.7176/JEP/11-21-16 Publication date :July 31st 2020

Relation between Soil Weed Seedbank and Weed Management Practises and Diversity in Farms in Kisii Central Sub County, Nyanza

This study sought to determine the relation between soil weed seed bank and weed management practices and diversity in farms in Kisii Central Sub County, Western Kenya. Eight administrative sub-locations were randomly selected. Ten farms were selected at equal distance along transect laid across each sub-location. Weed soil seed bank was assessed from soil samples collected from each of the farms; a sub-sample was taken from a composite sample of ten soil cores of 5cm diameter and 15cm deep and placed in germination trays in a greenhouse. Weed diversity in soil weed seedbank was calculated using the Shannon index (H’). Twelve weed species from 12 genera of nine families were recorded. Diversity of the weed species in soil weed seed bank was (H'=1.48). Weed management practises significantly affected weed species soil weed seedbank reserves. Use of inefficient and ineffective hand-weeding techniques resulted in high weed species diversity and abundance.

Heat-Related Deaths - United States, 2004-2018.

Deaths attributable to natural heat exposure, although generally considered preventable (1), represent a continuing public health concern in the United States. During 2004-2018, an average of 702 heat-related deaths occurred in the United States annually. To study patterns in heat-related deaths by age group, sex, race/ethnicity, and level of urbanization, and to explore comorbid conditions associated with deaths resulting from heat exposure, CDC analyzed nationally comprehensive mortality data from the National Vital Statistics System (NVSS).* The rate of heat-related mortality tended to be higher among males, persons aged ≥65 years, non-Hispanic American Indian/Alaska Natives, and persons living in noncore nonmetropolitan and large central metropolitan counties. Natural heat exposure was a contributing cause of deaths attributed to certain chronic medical conditions and other external causes. Preparedness and response initiatives directed toward extreme heat events, currently underway at local, state, and national levels, can contribute to reducing morbidity and mortality associated with natural heat exposure. Successful public health interventions† to mitigate heat-related deaths include conducting outreach to vulnerable communities to increase awareness of heat-related symptoms and provide guidance for staying cool and hydrated, particularly for susceptible groups at risk such as young athletes and persons who are older or socially isolated (2). Improved coordination across various health care sectors could inform local activities to protect health during periods of high heat. For instance, jurisdictions can monitor weather conditions and syndromic surveillance data to guide timing of risk communication and other measures (e.g., developing and implementing heat response plans, facilitating communication and education activities) to prevent heat-related mortality in the United States. CDC also recommends that federal, state, local, and tribal jurisdictions open cooling centers or provide access to public locations with air conditioning for persons in need of a safe, cool, environment during hot weather conditions. In light of the coronavirus disease 2019 (COVID-19) pandemic, CDC updated its guidance on the use of cooling centers to provide best practices (e.g., potential changes to staffing procedures, separate areas for persons with symptoms of COVID-19, and physical distancing) to reduce the risk for introducing and transmitting SARS COV-2, the virus that causes COVID-19, into cooling centers.§.

Changes in the exposure of California’s levee-protected critical infrastructure to flooding hazard in a warming climate

Levee systems are an important part of California’s water infrastructure, engineered to provide resilience against flooding and reduce flood losses. The growth in California is partly associated with costly infrastructure developments that led to population expansion in the levee protected areas. Therefore, potential changes in the flood hazard could have significant socioeconomic consequences over levee protected areas, especially in the face of a changing climate. In this study, we examine the possible impacts of a warming climate on flood hazard over levee protected land in California. We use gridded maximum daily runoff from global circulation models (GCMs) that represent a wide range of variability among the climate projections, and are recommended by the California’s Fourth Climate Change Assessment Report, to investigate possible climate-induced changes. We also quantify the exposure of several critical infrastructure protected by the levee systems (e.g. roads, electric power transmission lines, natural gas pipelines, petroleum pipelines, and railroads) to flooding. Our results provide a detailed picture of change in flood risk for different levees and the potential societal consequences (e.g. exposure of people and critical infrastructure). Levee systems in the northern part of the Central Valley and coastal counties of Southern California are likely to observe the highest increase in flood hazard relative to the past. The most evident change is projected for the northern region of the Central Valley, including Butte, Glenn, Yuba, Sutter, Sacramento, and San Joaquin counties. In the leveed regions of these counties, based on the model simulations of the future, the historical 100-year runoff can potentially increase up to threefold under RCP8.5. We argue that levee operation and maintenance along with emergency preparation plans should take into account the changes in frequencies and intensities of flood hazard in a changing climate to ensure safety of levee systems and their protected infrastructure.

Abstract C111: Biologic and self-reported stress levels among Latina breast cancer survivors: The Nuevo Amanecer Rural Trial

Abstract Among Latinas, breast cancer is the primary cause of cancer-associated mortality. Latinas experience breast cancer health disparities in disease-free survival, health-related quality of life, pain, fatigue, and anxiety, which may be a result of experiences of chronic stress. Chronic stress can impact the hypothalamic pituitary adrenal (HPA) axis, leading to changes in the tumor microenvironment and subsequently facilitate cancer progression. Little is known about the role of stress in cancer health disparities among Latinas. Our aim was to assess the feasibility of biospecimen collection and describe biologic and self-reported levels of stress using baseline data from a randomized controlled trial of a stress-management intervention among Spanish-speaking rural Latina breast cancer survivors (LBCS). We used community-based participatory research (CBPR) methods to recruit women, conduct interviews, and obtain saliva and hair samples. Recruiters were bilingual-bicultural women from local communities working in the community organizations that were research partners. Videos and print materials with graphics were developed in low-literacy Spanish to demonstrate biospecimen collection procedures. Recruiters provided instruction and demonstrations on sample collection and collected self-reported stress and depressive symptoms via in-person interviews in Spanish. Self-reported measures of stress and depressive symptoms consisted of the Perceived Stress Scale (PSS-10) and Personal Health Questionnaire (PHQ-8). Biologic stress was measured using hair (1 sample) and salivary cortisol (3 samples/day for 3 days). Mean hair cortisol concentration (HCC) in pc/mg units was used to assess chronic stress. The cortisol awakening response (CAR) measure assessed the activity of the HPA axis; curves that demonstrate a cortisol peak 30 minutes after awakening and a cortisol dip bedtime were considered normal. We recruited 103 participants from the Central Valley and Imperial County, California. Eighty-six percent provided saliva samples for CAR analysis, and 53% provided hair samples for HCC. Participants' mean age was 56 years (SD=10.6) and mean time since breast cancer diagnosis was 3.2 years (SD=3.2). Participants reported moderate (PSS mean score = 14.5; SD 7.5) stress levels and mild depression (PHQ-8 mean score = 6.3; SD 5.5). Biologic stress measurements demonstrated that 37% of participants had an abnormal CAR at baseline, and elevated HCC (mean HCC = 362.9 pg/mg). Bivariate models showed no relationship between self-reported and biologic markers of stress. Using CBPR methods leads to successful recruitment of Latinas to clinical research involving biospecimen collection. Although self-reported stress and depression were moderate or mild, biologic stress levels were high and abnormal in over 1/3 of participants, suggesting that chronic stress, and its subsequent integration into the biologic stress pathways, may help explain ethnic disparities in cancer outcomes of LBCS. Citation Format: Cathy Samayoa, Jasmine Santoyo-Olsson, Leticia Márquez-Magaña, Anna M. Nápoles. Biologic and self-reported stress levels among Latina breast cancer survivors: The Nuevo Amanecer Rural Trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C111.

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.

AUTOMATIC GRADE PROMOTION POLICY AND ITS INFLUENCE ON PUPILS’ ACADEMIC ACHIEVEMENT AMONG PUBLIC PRIMARY SCHOOLS IN KIRINYAGA CENTRAL SUB-COUNTY, KENYA

There has been a declining trend in performance among pupils in public primary schools at Kenya Certificate of Primary Education (KCSE) examinations since the introduction of automatic grade policy. The cause of this worrying trend is blamed on, among other factors, the implementation of the policy. The purpose of this study was to establish the influence of automatic grade promotion policy on pupils’ academic performance in Kirinyaga Central Sub-County. Specifically, this study sought to establish; the status of adequacy of physical facilities in primary schools arising from the implementation of automatic grade promotion Policy in Kirinyaga Central Sub County, and the impact of physical facilities on performance of Pupils’ academic performance at KCSE among primary schools in Kirinyaga Central Sub-County. This study used descriptive survey research design and adopted a mixed method approach. The population of the study was 32 head teachers, 181 teachers and 2170 pupils; and a sample of 30 head teachers, 118 teachers and 325 pupils. Purposive sampling technique was used to sample head teachers while simple random sampling was used on the teachers and pupils. Questionnaires were used to collect data from teachers and pupils, while sampled head teachers were interviewed. Questionnaires were piloted in a neighboring Sub County using test retest method and reliable reliability index of 0.702 and 0.756 obtained for teachers’ and pupils’ questionnaires respectively. The questionnaires and interview guide were adequately validated and administered. Quantitative data is tabulated while qualitative data was analyzed thematically in line with the research purpose and to answer the research questions. The study established that there are inadequate physical facilities in primary schools in the study area arising from the implementation of the automatic grade promotion. It further found out that the facilities were not adequately maintained and therefore compromised learners’ health and safety, and hampered instruction. The study concludes that school physical facilities influence pupils’ academic achievement. The study recommends that; government and other stakeholders should provide adequate physical facilities in schools alongside complementary resources for effective implementation of automatic grade promotion policy, schools should institute routine schedule of maintaining the available physical facilities. It further recommends a similar study be carried out in other Counties and to engage a larger population and more variables. Article visualizations:

Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients

BackgroundThe evaluation of one's physical health and psychological wellbeing may be subjective. Aspects of functional capacity, including the patients' own estimation of physical health and wellbeing, have been shown to be strong predictors of postoperative outcomes and should be the focus of further research. AimThis study aimed to explore the associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among orthopaedic patients. MethodsThis was a longitudinal study using a quantitative approach. SettingsA central county hospital in northern Sweden. ResultsA high ASA classification rated by anaesthetists was not associated with physical health and psychological wellbeing self-estimated as less than good. A high ASA classification was significantly associated with self-estimated anxiety prior to surgery. Three days and one month post-surgery, the situation was reversed, and the ASA I/II group, to a significantly higher extent, rated that they felt anxiety. ConclusionPreoperative screening systems for orthopaedic patients should not only focus on the medical and objective physical issues but also include the patients’ own estimation of their physical health and psychological wellbeing. It is essential that orthopaedic patients receive relevant information that provides a realistic outlook, as well as an honest and optimistic future view.

Parent and Provider Preferences for Parenting Intervention Delivery in Rural Appalachia: A Qualitative Analysis Guiding Adaptation.

The public health impact of behavioral parent training (BPT) is limited, especially in underserved communities such as rural central Appalachia. To improve access to BPT in this region, we completed the first two steps of the ADAPT-ITT framework for systematic adaptation of evidence-based interventions: (1) assessing community perspectives about BPT delivery, and (2) deciding upon a specific intervention and adaptations needed to increase its acceptability and accessibility in rural central Appalachian counties. Guided by a community advisory board, we conducted key informant interviews with parents (N = 21) and three focus groups with child service providers to elicit stakeholders' perspectives about child behavior problems in their communities; existing resources; and preferences regarding four characteristics of BPT delivery: interventionist, modality, dose, and location. Results of directed content analysis led to the selection of local, trusted community health workers to deliver a brief, tailored BPT with flexibility in modality and location.

Women Will Vote: Winning Suffrage in New York State by Susan Goodier and Karen Pastorello

Reviewed by: Women Will Vote: Winning Suffrage in New York State by Susan Goodier and Karen Pastorello Natalie A. Naylor (bio) Women Will Vote: Winning Suffrage in New York State By Susan Goodier and Karen Pastorello. Ithaca: Three Hills, 2017. 316 pages, 6" x 9". $29.95 cloth. This year, 2020, is the Centennial of the 19th Amendment when women achieved the right to vote in the United States. Three years earlier, women in New York State won suffrage in a referendum in 1917, which was pivotal for the national movement. Susan Goodier and Karen Pastorello in Women Will Vote provide a comprehensive account of the suffrage struggle in New York in the seven decades that they dub "From Ridicule to Referendum" (1). Their useful Timeline begins in 1827 with the abolition of slavery in New York, and four events when women sought political rights in New York prior to the 1848 Seneca Falls convention (xv–xvii). The authors focus much of their attention on five disparate groups who have not received sufficient attention in most accounts: male suffragists, rural, working-class immigrant, African American, and radical women. Each of these groups is the subject of one of their chapters. Moreover, they want to emphasize upstate New York (defined as outside the metropolitan New York City area). In the nineteenth century, suffrage activities and organization were most extensive upstate. The New York State Woman Suffrage Association was organized in Saratoga in 1869 and held 47 yearly conventions to 1917 (Appendix 1 conveniently lists and maps the dates and locations). In the last decades of the century, suffrage activity was concentrated in the central and western counties of the state. Local leaders upstate regarded New York City as a "lost cause" (39). New York City, however, had a majority of the state's population after adding Brooklyn in 1898. Matilda Joslyn Gage, Martha Coffin Wright, Jean Brooks Greenleaf, and Lillie [End Page 150] Devereaux Blake were among the upstate presidents and leaders of the State Association. The Association worked on a variety of suffrage efforts, including petition drives, school suffrage, and legislative lobbying. By 1910, the state organization had 155 affiliated clubs in 26 counties with 555,00 members. The largest club was in Geneva with 400 members. More information might have been included on this organization, though by the early twentieth century, it was "dominated by an elite leadership primarily located in New York City" (50). National leaders from New York, including Elizabeth Cady Stanton, Susan B. Anthony, Alva Vanderbilt Belmont, Harriot Stanton Blatch, and Carrie Chapman Catt, are included throughout the book. Others who played important roles nationally and in New York include Gertrude Foster Brown, Harriet Burton Laidlaw, Inez Milholland, Vira Boar-man Whitehouse, and Harriet May Mills. Except for Mills, who was based in Syracuse, each of these women was based in New York City. Information on rural upstate women is a major contribution. Churches, granges, lyceums, lecture circuits, women's clubs, and the Woman's Christian Temperance Union (WCTU) all were involved in suffrage efforts in a "complex network" of "concurrent activism," which extended to the other groups discussed (3). Rochester, with 40 percent of its population immigrants in 1900, had many women working in the garment industry The analysis of suffrage in Rochester is insightful; both the city and county voted against suffrage in the 1915 referendum. Most of the African American suffrage leaders discussed were from New York City or Brooklyn, including Sarah Garnet, Verina Morton Jones, and Victoria Earle Mathews. Heather Jeffrey did form a Susan B. Anthony Club for Colored Women in Rochester; it, like most of the black organizations, had a broader focus than suffrage, also confronting racism. The attention paid to male suffragists is welcome, focusing on the Men's League for Woman Suffrage, founded in New York City in 1909. (Brooke Kroeger's Suffragents: How Women Used Men to Get the Vote, also published in 2017, provides further detail on men in the movement.) The activities of anti-suffragists are included throughout (Goodier had published No Votes for Women: The New York State Anti-Suffrage Movement in 2013). Most of the radical women were based in New York City...

Measurement of the real urbanization level in China and its international comparison

Purpose The purpose of this paper is to estimate the real urbanization level in China so as to provide a measurement that can be compared with the international level. Design/methodology/approach Taking into consideration 300m residents living in the administrative towns (300m residents here are referred to the population in administrative towns, including those in all counties), the gap between the urbanization rate of China and that of the world average becomes much wider. Findings China, however, implements the administrative system of government at the central, provincial, municipal, county and township levels. By city, it means the jurisdiction at and above the level of county, which includes the municipality directly under the central government, prefecture-level municipal and county. By town, it means the jurisdiction below the level of county (including the Chengguan Town, or capital town, where the county government is located) and exclusive of rural townships. Originality/value China has witnessed rapid development for 40 years since the reform and opening up in 1978. Nowadays, China has already stepped into the period of post-industrialization, with its urbanization rate (UR) of permanent population reaching 58.58 percent. However, on the basis of registered population, the UR is 43.37 percent, which is not only far below the average level of 81.3 percent in high-income countries, but also lower than the average of 65.8 percent in upper middle-income countries which are comparable to China in terms of per capita income. (The classification of state income level is based on the data of national income per capita and division standards in 2016 from the World Bank, in which annual revenue per capita in high-income countries reaches over US$12,736 and that in upper middle-income countries between US$4,126 and US$12,735.)

The impact of lack of disease awareness on the experience of primary varicose veins

Symptoms are often one of the main reasons for patients with chronic diseases to seek medical care. However, the symptoms experienced by patients with primary varicose veins are not serious until late in the course, hence rarely drawing enough attention. A deep understanding of disease awareness and experiences of patients is particularly important in disease management. The aim of this study was to describe the awareness and experience of patients with primary varicose veins. This study used a descriptive design with a qualitative approach. Semistructured interviews were conducted with 12 patients with primary varicose veins at a general central county hospital in China. Colaizzi's 7-step analysis was used to analyze the interview text. Participants reported their lack knowledge of the disease, including etiology, symptoms, and complications. Three themes emerged concerning the experiences: "preoperative emotional responses," "lack of confidence in disease management," and "the need for family and social support." The findings suggested that the health care system in China needed to increase the awareness about the disease and pay more attention to the needs of patients, give better health education, and provide effective social support, so as to improve self-management among patients.

Biodiversity, road transport and urban planning: A Swedish local authority facing the challenge of establishing a logistics hub adjacent to a Natura 2000 site

The aim of the article is to analyse and reflect upon the process and outcome of a potential clash between urban biodiversity and road transport interests in the Swedish city of Örebro, as a case of planning in the face of conflict. Combining an application of multilevel governance theory with negotiation planning and narrative method, it examines the siting of a huge warehouse and “logistics centre” at the edge of a Natura 2000 site on the outskirts of the city. Despite the city’s ambitious environmental goals and sustainability profile, the local authority decided to offer the company a site adjacent to a wetland area intended for preserving and developing biodiversity. After an intervention by the central state County Administrative Board [länsstyrelsen], the local authority had to implement certain security measures, and also reserve an additional, large natural land area to compensate for the threats to the Natura 2000 site. Before the final decision was made, a series of negotiations occurred between the involved actors, mainly the local authority, the multinational Sonepar Group/Elektroskandia and the County Administrative Board, and the case is a fruitful target for a multifaceted analysis illuminating the tension between the goals of preserving urban biodiversity and promoting road transport and urban growth. It also offers an inside view of the negotiation and planning process. The key issue is how the siting of a potentially hazardous, transport intensive national warehouse in a city renowned for its high environmental-protection profile was possible. Considering Sweden’s high-profile regarding sustainability, the selected case also offers food for reflection on the potentials and barriers of implementing ecological modernization more generally. The lessons learned from an examination of the local authority’s attempt to harmonize such diverse policy priorities as urban biodiversity and intensive road transport for economic growth, on a site adjacent to a Natura 2000 wetlands area, may help enable urban planners and scholars to find creative policy solutions, avoid causing damage to biodiversity, and increase ecosystem values in terms of residents’ and other visitors’ experience and understanding of nature. However, at the end of the article we address the question of whether our empirical conclusion is not “too good to be true”, and raise concerns regarding the intricate relationship between sustainability and resilience; the systemic power exerted by the global Sonepar Group/Elektroskandia; and the potentials and limits of public negotiation planning.

Evaluation of Effectiveness of Early Recovery Strategies in Use against Drought in Turkana Central Sub County, Kenya

Evaluation of Effectiveness of Early Recovery Strategies in Use against Drought in Turkana Central Sub County, Kenya

Socio-Cultural Factors Affecting Nutrition Interventions in Care and Treatment of HIV And Aids in Nandi Central Sub County, Nandi County, Kenya

Socio-Cultural Factors Affecting Nutrition Interventions in Care and Treatment of HIV And Aids in Nandi Central Sub County, Nandi County, Kenya

Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties - United States, 2010-2017.

A 2017 report quantified the higher percentage of potentially excess (or preventable) deaths in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas. In that report, CDC compared national, regional, and state estimates of potentially excess deaths among the five leading causes of death in nonmetropolitan and metropolitan counties for 2010 and 2014. This report enhances the geographic detail by using the six levels of the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme for counties and extending estimates of potentially excess deaths by annual percent change (APC) and for additional years (2010-2017). Trends were tested both with linear and quadratic terms. 2010-2017. Mortality data for U.S. residents from the National Vital Statistics System were used to calculate potentially excess deaths from the five leading causes of death among persons aged <80 years. CDC's NCHS urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Potentially excess deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Potentially excess deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and District of Columbia. The number of potentially excess deaths among persons aged <80 years in the United States increased during 2010-2017 for unintentional injuries (APC: 11.2%), decreased for cancer (APC: -9.1%), and remained stable for heart disease (APC: 1.1%), chronic lower respiratory disease (CLRD) (APC: 1.7%), and stroke (APC: 0.3). Across the United States, percentages of potentially excess deaths from the five leading causes were higher in nonmetropolitan counties in all years during 2010-2017. When assessed by the six urban-rural county classifications, percentages of potentially excess deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan) for the study period. Potentially excess deaths from heart disease increased most in micropolitan counties (APC: 2.5%) and decreased most in large fringe metropolitan counties (APC: -1.1%). Potentially excess deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan (APC: -16.1%) and large fringe metropolitan (APC: -15.1%) counties. In all county categories, potentially excess deaths from the five leading causes increased, with the largest increases occurring in large central metropolitan (APC: 18.3%), large fringe metropolitan (APC: 17.1%), and medium metropolitan (APC: 11.1%) counties. Potentially excess deaths from CLRD decreased most in large central metropolitan counties (APC: -5.6%) and increased most in micropolitan (APC: 3.7%) and noncore (APC: 3.6%) counties. In all county categories, potentially excess deaths from stroke exhibited a quadratic trend (i.e., decreased then increased), except in micropolitan counties, where no change occurred. Percentages of potentially excess deaths also differed among and within public health regions and across states by urban-rural county classification during 2010-2017. Nonmetropolitan counties had higher percentages of potentially excess deaths from the five leading causes than metropolitan counties during 2010-2017 nationwide, across public health regions, and in the majority of states. The gap between the most rural and most urban counties for potentially excess deaths increased during 2010-2017 for three causes of death (cancer, heart disease, and CLRD), decreased for unintentional injury, and remained relatively stable for stroke. Urban and suburban counties (large central metropolitan and large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in potentially excess deaths from unintentional injury during 2010-2017, leading to a narrower gap between the already high (approximately 55%) percentage of excess deaths in noncore and micropolitan counties. Routine tracking of potentially excess deaths by urban-rural county classification might help public health departments and decision-makers identify and monitor public health problems and focus interventions to reduce potentially excess deaths in these areas.