Persons In Urban Areas Research Articles

OUT-OF-POCKET EXPENDITURE ON OUT-PATIENT CARE IN EAG STATES: AN ANALYSIS BASED ON NSSO 75TH ROUND DATA

Regardless of their socio-economic status, everyone has the human right to receive healthcare. Since the Indian government spends so little on health care, healthcare spending has been a major source of concern. However, most of the literature in India on determinants of health spending has focused on hospitalization, and there are relatively fewer separate studies on health-seeking behaviour and expenditure in outpatient departments. The purpose of this study was to determine the patterns of health-care-seeking behaviour and the pattern of expenditure incurred by households during outpatient care in Empowered Action Group (EAG) States. The present study used secondary data from the latest 75th round of National Sample Survey (NSS) conducted from July 2017 to July 2018 on the key indicators of social consumption in India: Health. The finding suggest that the seeking behaviour of ailing persons as outpatients, across EAG states only limited population access to public sources of healthcare (36.8% in rural and 27.3% in urban). Rajasthan (46.7%), Madhya Pradesh (41.5%), Bihar (32.9% rural), and Uttar Pradesh (31.3%) have the highest percentage of outpatient who expressed dissatisfaction with the standard of public health services in rural areas. Among EAG states of urban areas, Uttar Pradesh (42.6%) have the highest percentage of not satisfied with the quality of care by government sources. Among EAG states, Significant inter-state variation was observed, with Rajasthan (Rs. 886) reporting the highest expenditure for outpatient treatment and Chhattisgarh (Rs. 350) reporting the lowest in rural areas. However, Uttar Pradesh (Rs. 1194) reported the highest and Odisha (Rs. 508) reported the lowest expenditure incurred on outpatient care by ailing persons in urban areas. The amount that each state spends on healthcare varies greatly, which causes inter-state differences in the cost of outpatient treatment in EAG states. As a result, the government needs to control the cost of medications and diagnostic tests and ensure that plans for outpatient care include coverage. KEYWORDS: Outpatient care, out-of-pockect expenditure, EAG states,

COVID-19 Among Non-Hispanic American Indian and Alaska Native People Residing in Urban Areas Before and After Vaccine Rollout-Selected States and Counties, United States, January 2020-October 2021.

Objectives. To evaluate COVID-19 disparities among non-Hispanic American Indian/Alaska Native (AI/AN) and non-Hispanic White persons in urban areas. Methods. Using COVID-19 case surveillance data, we calculated cumulative incidence rates and risk ratios (RRs) among non-Hispanic AI/AN and non-Hispanic White persons living in select urban counties in the United States by age and sex during January 22, 2020, to October 19, 2021. We separated cases into prevaccine (January 22, 2020-April 4, 2021) and postvaccine (April 5, 2021-October 19, 2021) periods. Results. Overall in urban areas, the COVID-19 age-adjusted rate among non-Hispanic AI/AN persons (n = 47 431) was 1.66 (95% confidence interval [CI] = 1.36, 2.01) times that of non-Hispanic White persons (n = 2 301 911). The COVID-19 prevaccine age-adjusted rate was higher (8227 per 100 000; 95% CI = 6283, 10 770) than was the postvaccine rate (3703 per 100 000; 95% CI = 3235, 4240) among non-Hispanic AI/AN compared with among non-Hispanic White persons (2819 per 100 000; 95% CI = 2527, 3144; RR = 1.31; 95% CI = 1.17, 1.48). Conclusions. This study highlights disparities in COVID-19 between non-Hispanic AI/AN and non-Hispanic White persons in urban areas. These findings suggest that COVID-19 vaccination and other public health efforts among urban AI/AN communities can reduce COVID-19 disparities in urban AI/AN populations. (Am J Public Health. 2022;112(10):1489-1497. https://doi.org/10.2105/AJPH.2022.306966).

Health Behaviors and Health Literacy: Questing the Role of Weak Social Ties Among Older Persons in Rural and Urban Ghana.

BackgroundOlder persons are one of the most vulnerable groups as regards low health literacy. However, little is known about the extent of limitations and multi-faceted nature of their health literacy, such as its characteristics and social and geographical dimensions. Additionally, most existing studies have predominantly treated health literacy as a risk factor of health and wellbeing of older persons as opposed to an outcome that must be pursued.ObjectivesThis study investigated the moderating role of weak social ties (bridging social capital) in the relationship between health behaviors, such as smoking, alcohol intake, voluntary body check-up and physical exercise, and health literacy among older persons in rural and urban Ghana.MethodsData was drawn from a cross-sectional survey comprising 522 respondents across five administrative regions in Ghana. Ordinary Least Squares regression technique was used to analyse the data.ResultsOlder persons in urban areas had higher health literacy [Mean/Standard deviation (SD) = 9.1/4.1 vs. 10.1/4.2] as well as higher bridging social capital (Mean/SD = 2.0/1.2 vs. 1.6/0.9) than their rural counterparts. Bridging social capital was negatively associated with the health literacy of urban residents (B = −0.997, p < 0.01). We found evidence that smoking (B = −0.787, p < 0.05) and undertaking physical activities (B = 0.812, p < 0.01) were associated with health literacy of older persons in rural areas. Having voluntary body check-ups (B = 0.155, p < 0.01) was associated with health literacy in urban areas. Bridging social capital negatively moderated the association of smoking with health literacy in rural areas (B = −5.032, p < 0.01), but it instead positively modified the relationship between alcohol intake and health literacy in urban areas (B = 0.185, p < 0.05).ConclusionFor policymakers and practitioners aiming to promote older persons' health literacy as a public health asset at individual and community levels, an important starting point to achieving such goals is to understand the fundamental indicators (e.g., health behaviors) and the role that social and geographical factors play in shaping their health literacy.

Do Older People Expect Reciprocity When Providing Care? Evidence From a National Cohort

Background: The debate on whether caregiving is selfless or self-serving is unresolved. From the perspective of caregiving as a moral responsibility, the motivation to provide care is altruistic. The exchange or reciprocity perspective suggests that care is provided with an expectation to be cared for in the future. The context of filial obligation and rapid socio-economic transformation in recent decades in urban and rural China provided a unique opportunity to investigate these two driving forces. Methods: We tested the effects of caregiving experience in older persons on their care expectation from their children using data from the China Longitudinal Aging Social Survey (n=8,308). Using a multiple-indicator multiple-cause model, a special form of structural equation modelling, we examined the effect of caring for one’s older parents, helping adult children with housework, and caring for grandchildren on older persons’ care expectation from their children. Results: Older persons in urban areas had higher expectation for future care from their children if they have helped them with housework or took care of their grandchildren, whereas their experience of taking care of their own parents is related to a lower care expectation from their children. Although a similar pattern was observed in rural areas, only the experience of helping adult children with housework significantly increased care expectation. Discussion: Both altruistic and exchange motivations are involved in caregiving. Caring for older parents was more likely altruistic. Caring for an adult child in both urban and rural areas, and grandparenting in urban areas, were motivated by reciprocity.

An Epidemiological Study of Diabetes Mellitus in Productive Aged Urban Nepalese of Makalbari Area of Gokarneshwor Municipality

Diabetes mellitus is a chronic disease that through its complications can seriously impact the quality of life of an individual. The incidence of diabetes mellitus is starting to rise at a younger age. This study is carried out to determine the prevalence of diagnosed diabetes mellitus in productive aged persons and to study the association of socio-demographic characteristics, body mass index (BMI) and blood pressure among persons with and without diabetes mellitus. A community-based cross-sectional, observational study was conducted in Makalbari area. Systematic random sampling technique was used to select the households. The family members from those households who met the inclusion criteria were interviewed with self-constructed semi-structured questionnaire which included socio-demographic information of respondents. Height, weight and blood pressure were recorded. BMI was interpreted as per WHO guidelines and hypertension was defined as per Joint National Committee (JNC) VII guidelines. Among total 662 participants, 342 (51.7%) were female and 320 (48.3%) were male. About 196 (29.6%) of subjects were between 25 to 34 age group followed by 145(21.9%) of them in 35 to 44 age group. Prevalence of diagnosed diabetes mellitus in productive aged persons in urban area was 3.8%. The prevalence of BMI of ≥25 was 42.4%. Out of total subjects, maximum number of respondents were prehypertensive 406 (61.3%). Mean age of total participants was 37.9±13.59 and BMI was 24.15±3.89.The age of respondents was highly statistically significant among the persons with diabetes (p = 0.000). The number of diabetes mellitus increased with increase in age and BMI of the participants. Prevalence of diabetes mellitus was almost same in both male 13 (52.0%) and female 12 (48.0%). Diabetes mellitus was seen more in subjects who had completed secondary level education 11 (44.0%) and in homemakers and government job holders, 3 (33.3%) each. In conclusion, most of the people in productive age groups were preobese and were in prehypertensive stage which may increase the risk of acquiring diabetes mellitus in future. This necessitates the screening of more persons in productive age group for diabetes mellitus.

Spatial data modeling in disposable income per capita in china using nationwide spatial autoregressive (SAR)

China as a country became the economic center of the world. However, with a population of 1.3 billion, China's per capita income is still at number 80 in the world. In the world, considering the imbalance between town and country with 100 million people still living in poverty. Thus, to address this imbalance, it is necessary to study the condition in depth, because income per capita is often used as a benchmark to measure the prosperity of a country. With greater and equitable income per capita, the country will be judged increasingly affluent. Two factors, mainly industry and tourism, play an important role in the economic progress in China. These are include Per capita Disposable Income Nationwide (yuan), Total Value of Exports of operating units (1,000 USD), Registered Unemployed Person in Urban Area (10000 person), Foreign Exchange Earning from International tourism(in millions USD) and Number of Overseas Visitor Arrivals (million person/time). Thus, it is necessary to investigate the influence of these factors to increase per capita income. Since the economic development of a region usually affect the surrounding area, this study aims to include spatial effects, using Spatial Autoregressive (SAR) Model. The results suggest that the per capita income affected by the Tourism factor is about 58.65% (R-squared).

Epidemiological study of hardiness profile of blind people

Objective: To study the risk factors in psychosocial profile of blind people undergoing vocational training. using a screening test ,Personality based hardiness index and suggest recommendations if any. Study design: Cross sectional study. Participants: Blind people. Study Variables: Sex, socioeconomic status, literacy, psychiatric morbidity. Statistical analysis: Fishers Exact test, χ2 test. Results: Recently introduced technique of Personality based hardiness index was tested for its utility for screening of blind persons to detect possible psychological maladjustments and hardiness. Analysis of results of Personality based hardiness index revealed that 9% subjects were non hardy. Most of the non hardy subjects were males 13% as compared to females 3% belonging to lower socioeconomic class (100%) illiterates 34.3% as compared to literates 2% residing in rural area (12.7%) as compared to person in urban area (0%) The overall results of the above detailed tests brought some salient risk factors that can be strongly associated with psychosocial maladjustments and hardiness in the handicapped persons. These risk factors are Lower socioeconomic class, Rural residence, Illiteracy, Sex These risk factors that emerged out of the statistical analysis of the data can be immensely useful in the planning stages of rehabilitation.

Adherence to HIV Treatment and Care at a Rural Appalachian HIV Clinic

Persons living with HIV (PLWH) in rural areas face different barriers to care and treatment adherence compared to persons in urban areas. Our project identified strategies used by a rural HIV clinic with high rates of viral suppression, as evidenced by data abstraction from medical records from January 2010 through December 2014, including 411 patients ages 18years or older. As HIV viral load is used as a marker for adherence and impacts health outcomes and transmission, it is an important assay. The national goal is for 80% of PLWH to be virologically suppressed by the end of 2020. This clinic exceeded the goal in 2014 with observed rates of 80% to 90% suppression. Eleven national guidelines for HIV care have been adopted by this clinic, along with five additional evidence-based interventions. Nurses played a critical role in all of these methods, and our intent was to report success-related factors.

Contamination Composition of Fe, Mn and Al at 8 Different Profiles of Solid Waste Disposal Areas in Malaysia

Solid waste is a major issue in environmental management as it was generated by almost every single person in the world. In Malaysia, it is estimated 0.8 kg solid waste dumped by one person in rural area and 1.5 kg by person in urban area in a day. Landfill as a final waste disposal point is currently in critical number where it keeps on increasing every year. The most serious issues is landfill may cause air, water and soil pollution as waste disposed at landfill may produce leachate through water runoff at the area. Hence, this research aimed to assess the contamination level of three types of heavy metal which are Iron, Manganese and Aluminum (Fe, Mn, Al) at 8 selected contaminated landfill areas in Selangor, Perak and Melaka. As a result, Fe exhibited highly contamination level ranged from 0.15 mg/L to 0.77 mg/L followed by Mn ranged from 0.06 mg/L to 0.57 mg/L and the lowest is Al ranged from 0.04 mg/L to 0.08 mg/L. Interestingly Perak solid waste disposal area was found to have the highest Fe content (0.77 mg/L), substantially higher than all other areas tested. In contrast Mn was detected highest (0.57 mg/L) in Selangor landfill area. There was positive relationship between type and total content of heavy metals and location of landfill area. Therefore, collaboration and concern from authority and public in managing solid waste may help to reduce the pollution as these types of heavy metal may cause bad impact to the environment and surely human health.

Being old and living alone in urban areas: the meaning of self-care and health on the perception of life situation and identity.

BackgroundLiving alone in urban areas when getting old is an important and necessary field for research as the growth of the urban population worldwide increases, and due to the fact that people live longer. How older people manage their self-care and health, and how this might influence their identity and life situation may be very important to understand when planning for a new, upcoming older generation. The aim of this study was to elucidate the meaning of self-care and health for the perception of life situation and identity among single-living older individuals in urban areas in southern Norway.MethodsA phenomenological–hermeneutic approach inspired by Ricoeur was applied. Nine single-living older persons in urban areas, 70–82 years of age, and identified to be in good health were interviewed. The interviews were audiotaped, transcribed verbatim, and analyzed using a phenomenological–hermeneutic method.ResultsStrength and a time dimension characterized the meaning of self-care and health for the perception of life situation and identity as narrated by the group of single-living older individuals in urban areas in southern Norway. The informants were, as older individuals, caring, autonomous, and robust characters, who had gone through difficult times in life, and in a resilient way moved towards a new future. They valued and were grateful for what they had learned in their lives and could go forward and still experience and explore.ConclusionSelf-care is significant in the perception of life situation and identity among single urban older people in this study, and characterized by strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge the strengths and capabilities of older people to a greater extent.

Use of Community Health Workers for Management of Malaria and Pneumonia in Urban and Rural Areas in Eastern Uganda

Use of community health workers (CHWs) has been implemented the same way in urban and rural areas despite differences in availability of health providers and sociodemographic characteristics. A household survey was conducted in rural and urban areas in eastern Uganda, and all children who were febrile in the previous two weeks were assessed for their symptoms, treatment received at home, and when and where they first went for treatment. Rural children were more likely to use CHWs than urban children. Urban children received outside treatment more promptly, and used herbs at home less. Symptoms and proportion of children being taken out for treatment were similar. Children from the poorest households used CHWs less and private providers more than the middle quintiles. Drug shops and private clinics should be included in the community case management to cater for the poorest in rural areas and persons in urban areas.

(R)Evolution in vehicle acoustics—sound design, warning signals and quiet cities

The increasing electrification of the powertrain offers the unique opportunity for complete new sounds with respect to vehicle interior sound and exterior noises after an era of 125 years of combustion engine. With this expected development noise affected persons in urban areas hope for quiet cities and a better quality of life in general. In particular, the creation and preservation of quiet zones in cities is a special focus in European noise policy exploiting the potential of electric vehicles. However, with the expected engine concepts changes - besides the hopes - several conflicts and problems are seen. These concerns are related to apparent technological problems (infrastructure, costs, range limitations) as well as to noise issues probably leading to an decrease of pedestrian safety. This has caused a general demand for acoustical warning signals for quiet (electric) vehicles to alert blind and visually-impaired persons. Are the concepts recently argued really well-thought-out and sustainable? Recent and potential future sound developments are highlighted from different perspectives. Here, from the constituting frame of reference regarding public opinion, automotive manufacturers' considerations, legislative initiatives and political actions the potential design of electric vehicle sound is discussed.

An Approach to Human Adaptability towards its Built Environment: A Review

This paper deals with the human adaptability to its built environment. The built environment as we know it rarely finds itself adapting to its surrounding context, whether it be on the level of interaction with humans or the climate. Humans and nature both are in a constant state of flux; moving, changing, sensing, and reacting to their context and information they gather and perceive. A barrier is formed between the built environment and humans and nature due to the fact that their inherent characteristics are utterly contrasting. It is commonly estimated that persons in urban areas spend at least 80% of their time indoors. This suggests that the quality of the indoor environment can have a significant impact on comfort, health, and overall sense of well being. The indoor environment of buildings should thus be designed and controlled, as to provide a comfortable and healthy space for occupants. In order to maintain the quality of the indoor environment, we mechanically condition our buildings to achieve constant, uniform and comfortable environments. The maintenance of thermal equilibrium between the human body and its environment is one of the primary requirements. History of thermal comfort and climate design shows a definite relation between them and research is needed to know “What are comfort conditions?” and “How buildings could adapt themselves to these conditions”.

Geographic variation in hospice use prior to death.

To examine national variation in use of the Medicare hospice benefit by older individuals before their death, and to identify individual characteristics and local market factors associated with hospice use. Retrospective analysis of Medicare administrative data. Hospice care. Older Medicare enrollees who died in 1996. Rate of hospice use per 1,000 older Medicare beneficiary deaths. Overall, 155 of every 1,000 older Medicare beneficiaries who die use hospice before death. This rate is significantly higher among younger older persons (P < .001), non-blacks (P < .001), persons living in wealthier areas (P < .001), and persons in urban areas (P < .001). Areas with a higher proportion of non-cancer diagnoses among hospice users have higher rates of hospice use for both cancer and non-cancer reasons than areas with a majority of hospice users having cancer diagnoses (P < .001). Hospice use is higher in areas with fewer hospital beds per capita (P < .001), areas with lower in-hospital death rates (P < .001), and areas with higher HMO enrollment (P < .001). Rates of hospice use are also positively related to average reimbursements for health care (P < .001) and to physicians per capita (P < .001). In the largest metropolitan statistical areas (MSAs), rates of hospice use vary more than 11-fold from a low of 35.15 (Portland, ME) to a high of 397.2 per 1,000 deaths (Ft. Lauderdale, FL). The wide variation in hospice use suggests that there is great potential to increase the number of users of the Medicare hospice benefit.

Women and sanitation: Urban reality experiences of government programmes, NGOs and CBOs

Between 20-40 million persons in urban areas are without access to a toilet. Of these, two thirds are women and children. High on the list of urgent priorities in urban poor communities are toilets, whose absence is known to exacerbate health and nutritional burden of the poor, and increase susceptibility to abuse. Municipal solutions to toilet needs are invariably big community toilet complexes. This paper discusses problems of big toilets versus smaller alternatives, building a case for household toilets and networking poor households/communities to city systems using examples from some best practices in the country. Sanitation needs require a whole city perspective with the objective of reaching all poor in a city, especially the un-reached. No problem of sanitation can however be resolved without people's involvement. UBSP demonstrated a strategy for community organisation that enabled people to dialogue with city governments. Adopting the strategy under PEEP, women's associations are being armed with information to negotiate for their rights. People's participation ensures sustainable and cost effective alternatives based on their life strategies. Some recommendations at the end of the chapter are aimed at addressing the challenge of urban sanitation in an effort at creating a Sanitation Suraksha Chakra, that envelopes the entire city.

Cohort study on association of smoking and air pollution with lung cancer among 210,000 persons in shanghai

Survey on smoking habit and other related factors has been carried out among 110,000 persons in urban area and 100,000 persons in suburb and outer suburb area. The degrees of air pollution among three areas are different and the urban area is the one with the heaviest degree and the outer suburb with the lowest. Study on the relationship between smoking, air pollution and lung cancer has been carried out among the residents with the age of 40 years old and over in the three areas. The subjects were followed up for six years in urban area and five years in suburb and outer suburb. The total number of lung cancer death found in this period was 828. Most of these diagnosis were classified as group of high (I or II) degree. For nonsmokers, there were no significant differences of standardized mortality radio (SMR) of lung cancer among three areas. For male smokers, the highest SMR of lung cancer was seen in urban area, the lowest in outer suburb and these differences reached the significant lever. Cigarette smoking was significantly associated with increased risk of lung cancer by comparing the data between smokers and non-smokers in the three areas. Also, it was showed that the combiend effect of smoking with air pollution probably existed. The age-specific mortality rates for lung cancer among non-smokers in Shanghai urban were much higher than those in West Europe and North America, which indicated that risk factors other than smoking may exist.

The Distribution of Schizophrenics in Nottingham

The distributions of selected schizophrenic populations in Nottingham are analysed. The main hypotheses concerning the aetiology of schizophrenia are discussed. The possibility that several aspects of the social and urban environment explain the areal variations in the incidence of schizophrenia is investigated by means of oblique factor analysis. The results suggest that these 'ecological' factors may form an important link in the causal chain. IN both theoretical and practical terms it can be argued that the distribution of mentally disturbed persons in urban areas should rank as an important field of research in social geography. Investigators from other sciences have preempted the work of geographers with graphic analyses showing the marked concentration of disordered persons in the inner, decaying areas of large cities.1 In England and Wales, such studies are available for Liverpool, Bristol, London, Salford and Sheffield.2 The present author is aware of only three such investigations by geographers, relating to Derby, Luton and Southampton.3 The dearth of theoretical and empirical geographical research in this field can partly be ascribed to the fact that urban geographers have generally restricted their attention to