Poor Counties Research Articles

Demand for Litigation in the Absence of Traditions of Rule of Law: An Example of Ottoman and Habsburg Legacies in Romania

The paper investigates the impact of historical legacies of the Habsburg and Ottoman Empires on demand for litigation in contemporary Romania, reflected in the number of appeals in criminal cases. It finds that nowadays a key difference between these two historical zones is that in the Habsburg counties demand for litigation increases if the income goes up; in the Ottoman counties, however, the demand remains constant. Furthermore, the demand for litigation in poor counties is smaller in Habsburg than in Ottoman districts. We provide several explanations to this phenomenon and compare it to the anecdotal evidence of culture of judicial appeals in other countries.

ABSTRACT

About 20% of children in the United States have been reported to live in rural communities, with child poverty rates higher and geographic isolation from resources greater than in urban communities. There have been surprisingly few studies of children living in rural communities, especially poor rural communities. The Family Life Project helped fill this gap by using an epidemiological design to recruit and study a representative sample of every baby born to a mother who resided in one of six poor rural counties over a 1-year period, oversampling for poverty and African American. 1,292 children were followed from birth to 36 months of age. This monograph described these children and used a cumulative risk model to examine the relation between social risk and children's executive functioning, language development, and behavioral competence at 36 months. Using both the Family Process Model of development and the Family Investment Model of development, observed parenting was examined over time in relation to child functioning at 36 months. Different aspects of observed parenting were examined as mediators/moderators of risk in predicting child outcomes. Results suggested that cumulative risk was important in predicting all three major domains of child outcomes and that positive and negative parenting and maternal language complexity were mediators of these relations. Maternal positive parenting was found to be a buffer for the most risky families in predicting behavioral competence. In a final model using both family process and investment measures, there was evidence of mediation but with little evidence of the specificity of parenting for particular outcomes. Discussion focused on the importance of cumulative risk and parenting in understanding child competence in rural poverty and the implications for possible intervention strategies that might be effective in maximizing the early development of these children.

Rural Neighborhood Context, Child Care Quality, and Relationship to Early Language Development

Research Findings: Prior research with older urban children indicates that a disadvantaged neighborhood context is associated with poorer early development, including poorer verbal ability, reading recognition, and achievement scores among children. Neighborhood disadvantage in rural communities and at younger age levels may also be related to development; however, this relationship has received little examination. In this study we utilized data from the Family Life Project, a representative sample of babies born to mothers in poor rural counties in North Carolina and Pennsylvania, to address questions related to the relationship between neighborhood context (disadvantage and safety) and children's early language development. We examined the mediation of this relationship by child care quality. We also examined geographic isolation and collective socialization as moderators of the relationship between neighborhood context and child care quality. Results indicated that although neighborhood disadvantage did not predict children's development or child care quality, neighborhood safety predicted children's receptive language, with child care quality a partial mediator of this relationship. Collective socialization but not geographic isolation moderated the relationship between neighborhood safety and child care quality. Practice or Policy: Implications for policy, practice, and future research are discussed, including improving community safety through community policing, neighborhood watch, and social networks and increasing access to quality child care.

Diversity in Medical Toxicology: Why This Is Important

Medical toxicology is an avant-garde specialty. The care provided by medical toxicologists knows no boundary and encompasses all aspects of the practice of medicine. Medical toxicologists have responded to world disasters, testified before federal regulators regarding medication safety, performed research on novel antidotes, and even alerted authorities to the presence of serial poisoning. Yet in 2013, there is a toxicologic health disparity in the USA. In 2002, the Institute of Medicine released a report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. This report stated that “Evidence of racial and ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services” [1]. The racial and ethnic health and health-care disparity is evident in our field. Environmental injustice is a term that describes the disproportionately heavy exposure of vulnerable populations to toxic chemicals, contaminated water, unsafe workplaces, and other environmental hazards [2]. The concept of environmental injustice was developed in the 1980s when studies found that waste sites in the Southeastern United States were located in poor counties inhabited, in large part, by African-Americans and Native Americans [2]. Similar waste site distributions were found elsewhere in the USA [2, 3]. Waste sites are not the only sources of environmental injustice, and disproportionate exposure to intoxicants has consequences. African-American children consistently are documented to have higher rates of lead poisoning than white children [4–6]. Air pollution has been linked to increased cancer risk in certain African-American communities [7]. Migrant farm workers have been exposed to work conditions leading to pesticide toxicity in the fields and, in some cases, exposing their families in the home [8]. These are just a few examples of the many that illustrate the toxicologic health disparity. Underserved populations, specifically racial and ethnic minorities, suffer disparities in the treatment of cardiovascular diseases, HIV, cancer, and diabetes, among other medical maladies [1, 9]. The same applies to toxicologic maladies as well. A consistent recommendation to combat racial and ethnic disparities in health care is to increase the proportion of underrepresented US racial and ethnic minorities among health professionals [1]. Within the fold of racial and ethnic minorities, there is the concept of physicians who are underrepresented in medicine. The Association of American Medical Colleges defines underrepresented in medicine as physicians whose numbers in medicine are disproportionally lower than in the US population [10]. This group has historically included African-Americans, Native Americans, Mexican Americans, and mainland Puerto Ricans; however, underrepresented in medicine is not limited to these groups. Racial and ethnic minority physicians are more likely to serve minority and underserved populations and can help health systems improve cultural competence and reduce linguistic barriers [9, 11]. Racial and ethnic minority patients report higher satisfaction when care is provided by minority health-care professionals [9, 11]. Diversity of faculty and staff in medical education and training has a positive impact on the education of all students [12, 13]. Racial and ethnic diversity among investigators would broaden the research agenda and increase the likelihood of conducting research within minority communities [12, 13]. When examining the data regarding diversity in medicine, there is no specific mention of the practice of medical toxicology. While these data apply to our specialty, it is conceivable that the young age of our specialty has precluded specific research by medical toxicologists in this direction. The 2010 US Census Bureau data show that 13 % of the US population was identified as African-American or Black and 16 % were Hispanic [14]. A 2010 report from the AAMC shows that 5 % of emergency physicians, the specialty in which most medical toxicologists are trained primarily, are African-American and 5.3 % are Hispanic [15]. There are no racial and ethnic data available for medical toxicology as a specialty or within our specialty society, the American College of Medical Toxicology. The strides medical toxicology has made in a short span of time—ACGME recognition for fellowship programs and board certification within the American Board of Medical Specialties, an active and engaged professional society—show that our field is comprised of energetic and innovative physicians. Within our field, however, increased attention should be given to the concepts of diversity in medicine and toxicologic health disparities and efforts should be made to address their consequences. We should actively recruit physicians of diverse backgrounds into our specialty. We should invite to our meetings and form collaborations with physicians and researchers of various specialties who are working to address issues related to environmental injustice and health disparities. As we are the leaders in all other aspects of medical toxicology, we should become leaders addressing the toxicologic health disparity in all of its facets.

Ethnic differences on nutritional status of children under 3 years old in poor counties of the western China

To explore the ethnic differences on nutritional status of children under three years old, in the western areas of China and to identify the affecting factors. 14 072 children under the age of three years and their mothers were recruited, using the proportion population sampling method in 45 counties in the western areas of China. Height and weight were used as the measurement on nutrition of children. Height and weight of children with Han, Uyghur, Tibetan and Zhuang ethnicities were all lower than the WHO standards and with differences on height and weight among them. There were also ethnic differences on the status of malnutrition. Prevalence rates of stunting were 14.7%, 20.3%, 26.9% and 26.5% for Han, Uyghur, Tibetan and Zhuang ethnicities, respectively. Prevalence rates of underweight were 6.1%, 10.7%, 6.8% and 15.5% among the Han, Uyghur, Tibetan and Zhuang ethnicities, respectively. The prevalence rates of wasting were 4.2%, 5.3%, 2.9%, 8.9%, and of under nutrition were 19.2%, 25.5%, 30.3% and 36.5% for the Han, the Uyghur, the Tibetan and the Zhuang ethnicities, respectively. When factors as family size, years of schooling of parents, family numbers, sex, age (months), mother's height and weight, ways of feeding and sources of family income etc. were adjusted, children with Uyghur, Tibetan, Zhuang and other ethnicities were still presented more malnutrition than the children with Han ethnicity. There were differences on malnutrition status of children under the age of three years among the studies on different ethnicities. Undernutrition was less than nutritional status, seen in children of the Han nationality than other minority ethnicities. Ethnicity seemed to be related to differences in the nutritional status of children in western China while children of the Han nationality would be better than other minorities on nutritional status if they were in same living conditional.

Development of Radiology in Nepal: Gearing Up for Mountainous Challenges

INTRODUCTION Nepal is a poor county with a population of 30 million. Its annual per capita income is about $540. More than 25% of the population lives below the poverty line, earning less than $1 per day [1,2]. More than 90% of the poor population lives in rural areas and the rest in urban areas. Only 41.4% of rural households have access to nearby health institutions within a short walking distance [3]. The government has declared primary health care to be a fundamental right of every citizen of Nepal, but the infrastructure of the nation’s health care system is still poor, with inadequate utilization and delivery of facilities. Annual per capita health expenditures are about $29. Total expenditures on health care account for 5.5% of the government’s budget. The curative sector is funded by 49% of the health budget [4,5]. Radiology in Nepal, including the diagnostic and radiotherapy sectors, is funded inadequately compared with other curative sectors. Therefore, radiologic service is poor, with limited resources, which are located in limited private and government hospitals in the capital and major cities. Major differences exist between urban and rural areas in access to radiologic and other health care facilities [6-8]. Private-sector investment, which amounts to about 25%, is beginning to improve service quality by increasing the availability of advanced facilities [5]. However, inequity still exists because these expensive medical facilities are affordable only to wealthy people. The poor citizens of Nepal remain

Declining Use of Brachytherapy for the Treatment of Prostate Cancer

Previous patterns of care analyzes had demonstrated increasing utilization of brachytherapy (BT) relative to external beam radiation (EBRT) during the 1990s. With the advent of increasingly sophisticated EBRT techniques associated with higher reimbursements, this may no longer be the case. Our aim was to analyze recent trends in the utilization of these two radiation treatment modalities using a large, population-based US database. Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized adenocarcinoma of the prostate between 2004 and 2009 who were treated with radiation as local therapy. We evaluated the utilization of BT, EBRT, and combination BT + EBRT by year of diagnosis. For the purposes of this analysis, BT included both LDR and HDR therapy. Logistic regression analysis (with Wald Chi-Square test to determine significance) was used to determine if there was variation in the rate of decline of BT utilization by patient /tumor characteristics. Moreover, we performed a multivariable logistic regression analysis to determine predictors of BT (with or without EBRT) as treatment choice. The number of patients identified was 75,434. Median age for the entire cohort was 68 years old. In total, 27% were treated with BT, 57% were treated with EBRT, and 14% were treated with combination BT + EBRT (2% were treated with unknown radiation). When analyzing all patients, EBRT use increased from 56% in 2004 to 62% in 2009 whereas BT use correspondingly decreased from 30% in 2004 to 26% in 2009. Moreover, combination BT + EBRT use also decreased from 14% in 2004 to 12% in 2009. We found significant variation in the decline of BT utilization by patient race (greater decline for Whites), SEER registry, median county income (greater decline amongst patients from poorer counties), and NCCN risk categorization (greater decline amongst patients with low-risk disease) (p < 0.001 for all interactions). There was, however, no significant variation in the decline of BT utilization by patient age (p = 0.763) or marital status (p = 0.193). In total, decreasing utilization of BT was noted in 13 of the available 18 SEER registries. Multivariable analysis found that younger age, White race, being un-married, higher median county income, and lower NCCN risk category were independent predictors of BT as treatment choice (all p < 0.001). Additionally, there was significant variation in the utilization of BT by SEER registry (p < 0.001). After accounting for all significant patient and tumor characteristics, multivariable analysis confirmed that year of diagnosis was an independent predictor of BT as treatment choice, with patients diagnosed in 2009 least likely do undergo BT (p < 0.001). This patterns of care analysis reveals decreasing utilization of BT relative to EBRT in patients with localized prostate cancer. Although the potential causes of this trend are unclear (probably multifactorial although likely due, at least in part, to the higher reimbursements associated with EBRT), the decreasing utilization of prostate BT relative to EBRT will undoubtedly have significant implications in terms of national health care expenditure.

The contribution of bamboo to household income and rural livelihoods in a poor and mountainous county in Guangxi, China

Despite becoming one of China's fastest expanding and most valuable forest land uses, bamboo's role in livelihoods and rural development is poorly understood. Detailed quantitative data from 240 households were used to study the contribution of bamboo to household income and rural livelihoods in 12 remote and mountainous villages in southern China. Bamboo was a ubiquitous and highly utilised resource for a wide range of subsistence purposes in all households. Bamboo income was predominantly derived from dried bamboo shoots cultivated in small-scale household plots, and was the single most valuable source of cash. The average bamboo income share was 13.3%, ranging from 0 to 50% between villages. High income households had the highest absolute bamboo income, but low income households had the highest dependence on bamboo income. It is suggested that bamboo is an excellent pro poor resource, especially in remote, mountainous areas with limited off-farm income opportunities.

Impact of Host Genetics on Susceptibility and Resistance to Mycobacterium avium Subspecies Paratuberculosis Infection in Domestic Ruminants

Johne's disease or Paratuberculosis has emerged as major infectious disease of animals in general and domestic livestock in particular on global basis. There have been major initiatives in developed countries for the control of this incurable malady of animals and human beings alike (inflammatory bowel disease or Crohn's disease). Disease has not received similar attention due to inherent complexities of disease, diagnosis and control, in resource poor counties around the world. However, the rich genetic diverstiy of the otherwise low productive animal population offers opportunity for the control of Johne's disease and improve per animal productivity. Present review aims to gather and compile information available on genetics or resistance to Johne's disease and its future exploitation by resource poor countries rich in animal diversity. This review will also help to create awareness and share knowledge and experience on prevalence and opportunities for control of Johne's disease in the livestock population to boost per animal productivity among developing and poor countries of the world. Breeding of animals for disease resistance provides good, safe, effective and cheaper way of controlling Johne's disease in animals, with especial reference to domestic livestock of developing and poor countries. Study will help to establish better understanding of the correlation between host cell factors and resistance to MAP infection which may have ultimately help in the control of Johne's disease in future.

Predicting success incorporating conservation subdivisions into land use planning

Conservation subdivisions have emerged as a development option for communities wishing to conserve important ecological features and maintain rural character without decreasing housing density. Yet, these alternatives to conventional subdivisions rarely are used. We used logistic regression models to identify variables that predict county level success at adopting an ordinance and having a conservation subdivision built. Important predictors for adopting ordinances were median income, percent urban population, and a negative interaction between the two variables; important predictors for successfully completing a conservation subdivision were the adoption of an ordinance allowing conservation subdivisions and percent of residents with at least a four year college degree. Urban counties and the rural counties with higher median income were most successful adopting ordinances. Urban counties with higher education levels and an ordinance in place were most likely to have a conservation subdivision built within them. In poor rural counties, implementation may be more difficult because of limited resources to develop ordinances; these counties could collaborate with land trusts, other planning departments, or a regional council of governments to help lessen the financial burden associated with rewriting ordinances and implementing new land use practices.

Regional Income Convergence in Sweden, 1911-2003: A Time Series Analysis

The issue of income convergence is important for policy makers’ regional strategies aimed at redistributing funds to poorer regions in a country. We investigate the growth and convergence characteristics of 24 Swedish counties during the period 1911–2003. Using time series techniques, we find that shocks to relative county per capita incomes are temporary, and that initially poor (rich) counties tend to experience higher (lower) growth rates than the nation as whole. Our findings are consistent with the neoclassical model's prediction of conditional convergence, and imply that market forces rather than interregional government redistribution are the main drivers behind our results.

Biochar Utilization in Poyang Lake Eco-Economic Zone: Chances and Difficulties

The Poyang Lake Eco-Economics Zone includes 38 counties where 25 relatively poor counties are close to the lake. The country has been helping those rural areas and enhancing farmers’ living standard for many years, however, due to the historical, geographical, climatic reasons, farmers’ living standards do not have significant improvement so far. In addition to government subsidy, another way to enhance farmers’ income is to encourage of bioenergy production in a form of biochar/pyrolysis. Biochar/pyrolysis is a feasible method to produce clean and renewable energy along with substantial environmental and economic benefits such as increase in farmer’s revenue. However, there are also difficulties in its application due to transportation, feedstock collection, and storage. However, there need further investigation to quantify the gains and losses of pyrolysis/biochar technology.

Improving reproductive health in rural China through participatory planning

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.

Abstract A18: Spatial analyses reveal increased incidence of large cell lung carcinoma in specific regions of Maine that differ in men and women

Abstract Lung cancer is a major cause of death among cancers in the U.S. Environmental exposures to tobacco or radon are considered the two highest risks for lung cancer. Maine is one of the top 15 states with the highest rates of lung cancer in the U.S., with smoking rates that vary from 20–30% across counties. We recently reported on spatial variations in radon exposure. In this study, we investigated if there were spatial regions of excessive lung cancer by gender in Maine, and if these might overlay the high radon exposure regions. Age-adjusted lung cancer incidence rates in Maine were compared to those of the US overall, using NCI SEER and CDC databases. Data for all lung cancer cases in Maine reported during 1995–2006 were obtained from the Maine Cancer Registry. Population data used Base U.S. Census 2000 data. Lung cancer incidence was adjusted for age and population density. We assessed the spatial distribution of lung cancer by subtype, using spatial scan statistic, assuming a discrete Poisson distribution. We did not adjust for race as Maine is 95% white. We also examined spatial variations by pathology sub-types classified as adenocarcinoma, small cell carcinoma, large cell carcinoma. Within Maine, Washington County, which also has the highest smoking rate, reported the highest lung cancer incidence rates [men: 131.7 (110.5,156.2); women: 73 (58.5, 90.5), compared to Maine overall (men: 97.2 (93.9,100.5); women: 66.6 (64.2, 69.1) or the US (men: 84.3 (84.1, 84.5); women: 55.8 (55.6, 55.9)]. Maine is a rural, mostly nonagrarian state, with significant health disparities due to poverty, access to healthcare and geographic isolation. In considering other disadvantaged populations, lung cancer incidence rates for Maine men and women were higher than those reported for U.S. blacks, Hispanics and American Indians. Our results showed small “hotspots” for lung cancer overall with RR greater than 1 for females (RR 1.8, p 0.03) in eastern Washington County, and for males (RR 1.7, p 0.03) in northern Washington County and in the Pittsfield Region, Somerset County. No significant differences were detected in spatial distribution for adenocarcinoma or small cell carcinoma. The most striking geospatial regions with RR greater than 1 were detected for large cell lung cancer in Washington County, one of the poorest counties in the U.S. Women exhibited very high rates (RR 5.3, p 0.002) along the southern coastal region of Washington County while men exhibited very high rates (RR 3.7, p 0.04) within a smaller region in northern coastal Washington county where we have mapped use of pesticide sprays. Published literature linking large cell carcinoma with smoking is ambivalent. Washington County and the Pittsfield Region have air and water radon exposures below 4 pCi. There are no heavy industry or highways that could implicate particulate matter. In conclusion, we found statistically significant spatial regions (p&amp;lt;05; RR greater than 1) of high large cell lung carcinoma incidence in coastal regions of Washington County, but “hotspots” for men and women differed geographically. Environmental risk factors commonly correlated with lung cancer did not appear to explain the distribution of large cell lung cancer cases. More research is needed to explain the high incidence of large cell lung cancer in a nonagrarian, mostly white population with cancer and health disparities.

Land of Disenchantment: Latina/o Identities and Transformations in Northern New Mexico (review)

Reviewed by: Land of Disenchantment: Latina/o Identities and Transformations in Northern New Mexico Silvia Spitta Keywords Michael L. Trujillo, Silvia Spitta, Land of Disenchantment, New York socialites, foreign artists, intellectuals, Española, drugs, tricultural harmony, folk life, Marco Cholo, poverty, violence, drug abuse, migration, genizaro, trickster, jokes Trujillo, Michael L. Land of Disenchantment: Latina/o Identities and Transformations in Northern New Mexico. Albuquerque: U of New Mexico P, 2009. 265 pp. Michael L. Trujillo's engaging study Land of Disenchantment is an extended meditation on and important debunking of the notion of New Mexico as an enchanted space. The view of an exotic New Mexico was created in large measure by New York socialites and foreign artists and intellectuals who settled there from the 1920s on. This migration would only increase exponentially between the world wars. The artworks this group produced, the important collections of Hispanic and pueblo Indian folk arts they amassed, and the museums they founded, all led to the establishment of New Mexico as a magical place. This idea, underpinned by visions of tricultural harmony, has spread to the entire US, and New Mexico is now seen (and increasingly marketed) as a place that does not correspond to the space and time of the greater US. The result is that New Mexico's exoticism is so often confused with Mexico's alleged exoticism that the state's license plate has to clarify: "New Mexico, USA: Land of Enchantment." Trujillo grapples with an ethnographic tradition that—inadvertently, perhaps—reproduces the idea of New Mexico as an enchanted space when it focuses on village and folk life. This privileging of the idyllic, magical aspects of the state stands in stark contrast to the dearth of anthropological studies of Española and other poorer cities in the Greater Española Valley. It is reflected in the marketing of Taos and Santa Fe as tourist destinations while poor areas are marginalized from this circuit, thereby reinforcing cycles of poverty. Trujillo's focus on Española and his alternative ethnography is informed not only by the stories he grew up hearing at home in centralWashington state of what life had been like in New Mexico for his parents and parts of his extended family, but also by several years spent in New Mexico working variously as a reporter for the newspaper The Rio Grande Sun; a detox attendant and facilitator of drug rehabilitation groups in Española; and at the University of New Mexico in a drug treatment study. These experiences with what largely constitutes the negative, disenchanted [End Page 162] underside of New Mexico overlooked by promoters of its enchantment inform the main chapters in the book, making it very readable (and fun to read). Indeed, this ethnography's focus on what Trujillo theorizes as the "negative" is perhaps best embodied by jokes told in the area that go like this: "Who discovered Española?" And people reply, "Marco Cholo." But the negative is also most visible in the shocking statistics that show Rio Arriba County, which is the focus of his study, to be one of the "poorest counties in New Mexico," and what is perhaps even more troubling, that the entire state of New Mexico "maintains some of the worst poverty rates in the United States" (11). As Trujillo explains, jokes bracket his ethnography, introducing and ending it, because jokes ensue precisely in those spaces where, as Mary Douglas pointed out, deep disparities rub up against one another. Indeed, the poverty and crime rates of the state serve as a form of disenchantment of the enchanted. Trujillos's Española, therefore, "is a place where discourses of tradition and the most painful aspects of modernity seem to intermingle, boil, and saturate the landscape" (3). The chapters that conform this image of a disenchanted New Mexico focus on the terrible poverty, violence, and drug abuse that permeate the area. The first chapter traces the history that would lead to the dismemberment of the foot of a prominent statue to Oñate (conqueror of New Mexico in the 16th century). The second is on the celebration of Holy Friday in Chimayó when a terrible murder that shakes the region is...

Prevalence and Predictive Value of Hypoalbuminemia in Appalachians With Chronic Kidney Disease

Background : Chronic kidney disease (CKD) has reached epidemic proportions worldwide and in the United States, racial minorities reach end stage renal disease (ESRD) at a disproportionate rate. A rural state in the heart of Appalachia, West Virginia leads the nation in rates of incident ESRD, despite its predominantly Caucasian population. Characteristics of this racially homogeneous CKD population are herein examined for their impact on progression to ESRD or death. Methods : Retrospective analysis of demographic and clinical information for 4258 patients seen between 2001 and 2010. Associations between risk factors and outcomes were assessed for significance using Cox Proportional Hazards models. Results : Patients with CKD were largely Caucasian (94.3%), 39% diabetic, with a mean age of 60.1 ± 16.7; 39% presented with serum albumin levels &lt;= 3.5 g/dl. Patients with higher albumin levels had better survival and less progression to dialysis than those with lower levels (P &lt; 0.0001). Hypoalbuminemia, hypocalcemia, hyperparathyroidism and anemia independently correlated with reduced survival and more rapid progression to ESRD (P &lt; 0.0001). Compared to those from more affluent counties, patients from poorer counties had lower albumin levels (3.36 ± 0.014 vs 3.68 ± 0.079 gm/dl; P &lt; 0.04) and higher rates of progression to dialysis or death (P &lt; 0.016). Conclusions : In this predominantly Caucasian population of central Appalachia, hypoalbuminemia and residence in a county of low socioeconomic status independently predicted overall survival and progression to dialysis, suggesting that poverty and culture, irrespective of race, warrant further study for their impact on outcomes in patients with CKD. doi:10.4021/wjnu3e

Sexual Divisions of Labor in Export-Oriented Manufacturing Sectors: The Reconstruction of Gender and the Urbanization of Production in the Global South

The feminization of labor in parallel with the feminization of poverty in poor countries is a controversial topic in the field of development, especially with regards to foreign-owned export-oriented manufacturing sectors (FEMS). This paper offers a critique of the dominant argument that the introduction or expansion of a poor county’s FEMS will positively affect the status of women, thereby stimulating sustainable human development. I argue that intersecting oppressions (i.e. female, poor, immigrant, rural, dark skinned) are exploited and exaggerated in order to achieve economic interests. International development groups such as the World Bank have labeled FEMS in poor countries as opportunities for women to increase their independent earning power and socioeconomic status. This is based on the logic that gender equality—a factor believed to stimulate development—is only achieved through access to the formal labor sector and independent capital earnings. However, this neglects the underlying fact that for FEMS to be economically sustainable, gender inequality, as well as global economic inequality, must remain unchanged. In addition to this critique, this paper attempts to answer the following questions: What are the different ways in which poor women in the Global South are impacted by the influx of export-oriented manufacturing industries? How is gender constructed and utilized within these industries’ managerial policies? What are the ensuing effects of this on the labor force?

Anaemia among Students of Rural China’s Elementary Schools: Prevalence and Correlates in Ningxia and Qinghai’s Poor Counties

Although the past few decades have seen rising incomes and increased government attention to rural development, many children in rural China still lack regular access to micronutrient-rich diets. Insufficient diets and poor knowledge of nutrition among the poor result in nutritional problems, including iron-deficiency anaemia, which adversely affect attention and learning of students in school. Little research has been conducted in China documenting the prevalence of nutritional problems among vulnerable populations, such as school-age children, in rural areas. The absence of programmes to combat anaemia among students might be interpreted as a sign that the Government does not recognize its severity. The goals of this paper were to measure the prevalence of anaemia among school-age children in poor regions of Qinghai and Ningxia, to identify individual-, household- and school-based factors that correlate with anaemia in this region, and to report on the correlation between the anaemic status and the physical, psychological and cognitive outcomes. The results of a cross-sectional survey are reported here. The survey involved over 4,000 fourth and fifth grade students from 76 randomly-selected elementary schools in 10 poor counties in rural Qinghai province and Ningxia Hui Autonomous Region, located in the northwest region of China. Data were collected using a structured questionnaire and standardized tests. Trained professional nurses administered haemoglobin (Hb) tests (using Hemocue finger prick kits) and measured heights and weights of children. The baseline data showed that the overall anaemia rate was 24.9%, using the World Health Organization's blood Hb cut-offs of 120 g/L for children aged 12 years and older and 115 g/L for children aged 11 years and under. Children who lived and ate at school had higher rates of anaemia, as did children whose parents worked in farms or were away from home. Children with parents who had lower levels of education were more likely to be anaemic. The anaemic status correlated with the adverse physical, cognitive and psychological outcomes among the students. Such findings are consistent with findings of other recent studies in poor, northwest areas of China and led to conclude that anaemia remains a serious health problem among children in parts of China.

Efeitos redistributivos e determinantes de recebimento do ICMS Ecológico pelos municípios mineiros DOI: 10.5007/2175-8085.2010v13n1p95

Esse artigo teve como objetivo analisar a mudanca na distribuicao do ICMS aos municipios mineiros pela introducao do criterio ecologico. Procurouse tambem avaliar os determinantes da probabilidade de os municipios pertencerem a categoria de receptores do ICMS Ecologico. Os resultados obtidos mostram que este recurso como mecanismo de distribuicao beneficia mais intensamente os municipios menores, mas seu impacto e pequeno pelo reduzido valor de seu percentual (1%). Alem disso, o impacto do ICMS Ecologico para esses municipios vem perdendo forca nos ultimos anos com o aumento do numero de municipios recebedores, o que e preocupante em termos do incentivo a novos municipios que queiram se adequar as normas de recebimento deste recurso.

School Dropouts and Conditional Cash Transfers: Evidence from a Randomized Controlled Trial in Rural China's Junior High Schools

Recent anecdotal reports suggest that dropout rates may be higher and actually increasing over time in poor rural areas. There are many reasons not to be surprised that there is a dropout problem, given the fact that China has a high level of poverty among the rural population, a highly competitive education system and rapidly increasing wages for unskilled workers. The overall goal of this study is to examine if there is a dropout problem in rural China and to explore the effectiveness that a Conditional Cash Transfer (CCT) program could have on dropouts (and mechanism by which the CCT might affect drop outs). To meet this objective, we conducted a randomized controlled trial (RCT) of a CCT using a sample of 300 junior high school students in a nationally-designated poor county in Northwest China. Using our data, we found that the annual dropout rate in the study county was high, about 7.0%. We find, however, that a CCT program reduces drop outs by 60%; the dropout rate is 13.3% in the control group and 5.3 % in the treatment group. The program is most effective in the case of girls, younger students and the poorest performing students.