Residents Of Rural Communities Research Articles

Relationship between Resting Pulse Rate and Lipid Metabolic Dysfunctions in Chinese Adults Living in Rural Areas

BackgroundResting pulse rate has been observed to be associated with cardiovascular diseases. However, its association with lipid metabolic dysfunctions remains unclear, especially resting pulse rate as an indicator for identifying the risk of lipid metabolic dysfunctions. The purpose of this study was to examine the association between resting pulse rate and lipid metabolic dysfunctions, and then evaluate the feasibility of resting pulse rate as an indicator for screening the risk of lipid metabolic dysfunctions.MethodsA cross-sectional survey was performed, and 16,926 subjects were included in this study from rural community residents aged 35–78 years. Resting pulse rate and relevant covariates were collected from a standard questionnaire. The fasting blood samples were collected and measured for lipid profile. Predictive performance was analyzed by receiver operating characteristic (ROC) curve.ResultsA significant correlation was observed between resting pulse rate and TC (r = 0.102, P = 0.001), TG (r = 0.182, P = 0.001), and dyslipidemia (r = 0.037, P = 0.008). In the multivariate models, the adjusted odds ratios for hypercholesterolemia (from 1.07 to 1.15), hypertriglyceridemia (1.11 to 1.16), low HDL hypercholesterolemia (1.03 to 1.06), high LDL hypercholesterolemia (0.92 to 1.14), and dyslipidemia (1.04 to 1.07) were positively increased across quartiles of resting pulse rate (P for trend <0.05). The ROC curve indicated that resting pulse rate had low sensitivity (78.95%, 74.18%, 51.54%, 44.39%, and 54.22%), specificity (55.88%, 59.46%, 57.27%, 65.02%, and 60.56%), and the area under ROC curve (0.70, 0.69, 0.54, 0.56, and 0.58) for identifying the risk of hypercholesterolemia, hypertriglyceridemia, low HDL hypercholesterolemia, high LDL hypercholesterolemia, and dyslipidemia, respectively.ConclusionFast resting pulse rate was associated with a moderate increased risk of lipid metabolic dysfunctions in rural adults. However, resting pulse rate as an indicator has limited potential for screening the risk of lipid metabolic dysfunctions.

The Prevalence and Risk Factors of Low Back Pain in Rural Community Residents of Korea

A community-based, cross-sectional study that is part of the prospective Korean Health and Genome Study. To determine the prevalence of low back pain (LBP) among middle-aged and elderly rural community residents in Korea and to examine the relevant risk factors, including activities reflecting the Asian lifestyle, and the relationship between radiographical features of degenerative changes in the lumbar spine and LBP. The prevalence and implication of LBP among the elderly, particularly Asians, are under-represented in previous reports. Data for LBP were collected for 4181 subjects from a rural farming community. The point and cumulative lifetime prevalences of LBP were obtained in addition to measurement of the severity of LBP. Lateral lumbar spine radiographs were obtained according to a standard protocol. The mean age of the study subjects was 56 years and 55% were women. The lifetime prevalence of LBP was 61.3%, with women having a higher prevalence. The point and 6-month prevalences were also higher among women. The lifetime, point, and 6-month prevalences increased with age in both sexes, except for lifetime prevalence in men. The prevalence of LBP of grade 3 or more was significantly higher in women and increased significantly with age, particularly in women. Both lifetime and point of prevalence of LBP were significantly associated with age, female sex, and time spent squatting. After adjusting for age and sex, the presence of disc space narrowing, osteophytes, and advanced Kellgren-Lawrence grade in lumbar radiograph was associated with LBP. The prevalence of LBP is comparable between these Korean community residents and other population groups. Risk factors associated with LBP included advanced age, female sex, squatting, the presence of osteophytes, joint space narrowing, and advanced Kellgren-Lawrence grading on lumbar radiograph.

Utilisation of public eye care services by the rural community residents in the Capricorn district, Limpopo Province, South Africa

BackgroundVisual impairment and blindness are major health problems worldwide, especially in the rural and remote areas of developing countries. Utilisation of eye care services is essential to reduce the burden of visual impairment and blindness, and it is therefore important that it is monitored.ObjectivesThe objectives of this study were to determine the level of utilisation of public eye care services and factors that might have influenced their usage in rural communities, Capricorn district, Limpopo Province, South Africa.MethodA population-based cross-sectional study design was used. Participants were residents in selected rural villages located within approximately 5 km of six Government hospitals. Following ethical approval and receipt of informed consent, a questionnaire with closed and open-ended questions was used to collect information on the utilisation of eye care services and factors that might influence utilisation. Descriptive statistics and Pearson's Chi-square test were used to analyse and compare the data.ResultsMany (62.7%) of the respondents had used the government eye care services in the past. Over fifty-nine per cent (59.3%) of them were satisfied with the services. Factors reported to influence utilisation (such as monthly income, knowledge of available services and the need for regular eye tests) were positively associated with utilisation of eye care services in this study (p < 0.05).ConclusionUtilisation of eye care services was relatively good, but varied significantly between sites. An awareness campaign by government and non-governmental organisations about eye care services may increase utilisation amongst rural communities.

279 Got Wheels? Adolescent Exposure to All-Terrain Vehicles and Their Driving Practices

Study Objectives: All-terrain vehicle (ATV)-related injuries have almost tripled in the past decade and residents in rural communities and large suburban acreages suffer the brunt of this problem. More children die each year in the United States from ATVs than from bicycle crashes. However, the degree of adolescent exposure to ATVs is currently unknown. The objective of this study was to determine young adolescent exposure to ATVs and their operating practices, and measure their knowledge of several key ATV safety issues.

Leveraging Community-Academic Partnerships to Improve Healthy Food Access in an Urban, Kansas City, Kansas, Community

Leveraging Community-Academic Partnerships to Improve Healthy Food Access in an Urban, Kansas City, Kansas, Community Natabhona Marianne Mabachi, PhD and Kim S. Kimminau, PhD What Is the Purpose of this Study? • To partner with grass roots organizations in a low-income, minority, urban community, to develop a business plan to improve access to healthy foods. • This was done by engaging residents in community conversations and conducting a Community Food Assessment Survey, and using the data to drive the development of strategies to improve food access. What Is the Problem? • Overweight and obesity levels are at epidemic proportions in the United States. Eating healthy, unprocessed foods such as fruits, vegetables, and whole grains is one way to combat obesity. • Studies indicate that Americans who live in underserved, low-income, minority communities have poor access to nutritious, fairly priced, high-quality foods. • It becomes difficult for residents of such communities to follow recommended dietary guidelines, thus increasing their risk of obesity and other conditions such as diabetes and cardiovascular disease. • Community-based participatory research approaches are increasingly being used to solve community food access issues. What Are the Findings? • Residents are unanimously dissatisfied with the lack of a full-service grocery store in Argentine and chose the introduction of a grocery store as their top solution to food access issues in the community. • On average residents spend $104 per week for a five-person household. • On average residents had to go 3.5 to 5 miles to access the nearest full-service grocery stores, making Argentine a food desert. • An unexpectedly low percentage (10.6%) of residents surveyed reported being on the Federal Women, Infants and Children program. However 35.7% reported being on the Supplemental Nutrition Assistance Program. • Eighty percent of residents reported shopping at least weekly or more with 11% shopping for a household other than their own. • Although ratings of food quality at stores frequented were high, fruit and vegetable consumption was low owing to prohibitive costs and personal preferences. • Residents admitted to resorting to fast food establishments as a cheap way to feed their families. Who Should Care Most? • Community-based organizations and community health centers. • Residents of underserved, low-income, minority urban and rural communities. [End Page 237] • Food policy makers. • Chain and independent grocery stores. Recommendations for Action • Communities addressing food access issues should conduct culturally tailored comprehensive community food assessments to avoid wasted time on strategies that do not match the population's needs or desires. • Community organizations should consider partnering with experts from other organizations in various sectors, including academic, financial, government, and nongovernmental agencies, to help them address food access issues. • More planning grants should be made available to communities to increase the probability of success at the implementation stage. [End Page 238] Natabhona Marianne Mabachi and Kim S. Kimminau University of Kansas Medical Center, Department of Family Medicine, Research Division Copyright © 2012 The Johns Hopkins University Press

Improving Community Coverage of Oral Cholera Mass Vaccination Campaigns: Lessons Learned in Zanzibar

BackgroundRecent research in two cholera-endemic communities of Zanzibar has shown that a majority (∼94%) of the adult population was willing to receive free oral cholera vaccines (OCVs). Since OCV uptake in the 2009 campaign reached only ∼50% in these communities, an evaluation of social and cultural factors and of barriers was conducted to understand this difference for future cholera control planning.Methodology/Principal FindingsA random sample of 367 adult peri-urban and rural community residents (46.6% immunized vs. 53.4% unimmunized) was studied with a semi-structured interview that inquired about social and cultural features of cholera depicted in a vignette and barriers to OCV uptake. Symptoms (rectal pain, loose skin only in rural community) and perceived causes (uncovered food, contact with contaminated water) specific for severe diarrhea were associated with uptake. Purchasing drugs from pharmacies to stop diarrhea and vomiting was negatively associated with uptake. Increasing household size, age and previous enteric illness episode were positively related to uptake, the latter only at the rural site. The most prominent barrier to uptake was competing obligations or priorities (reported by 74.5%, identified as most important barrier by 49.5%). Next most prominent barriers were lacking information about the campaign (29.6%, 12.2%), sickness (14.3%, 13.3%) and fear of possible vaccine side effects (15.3%, 5.6%). The majority of unvaccinated respondents requested repetition of the vaccination with free OCVs.Conclusions/SignificanceFactors associated with uptake indicated a positive impact of the vaccination campaign and of sensitization activities on vaccine acceptance behavior. Unlike communities opposed to cholera control or settings where public confidence in vaccines is lacking, identified barriers to uptake indicated a good campaign implementation and trust in the health system. Despite prospects and demand for repeating the vaccination, local decision-makers should reconsider how careful logistical arrangements may improve community coverage and thus effectiveness of vaccination campaigns.

Factors impacting on the well-being of older residents in rural communities

In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes. This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors. Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI). Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8). Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.

Factors influencing social capital in rural tourism communities in South Korea

This study aimed to identify the factors influencing social capital as it affects community conflict management for community residents in rural tourism villages. An on-site survey consisting of self-administered questionnaires was conducted with residents of rural tourism communities. These self-administered surveys were obtained from 380 community residents in the study area. A factor-clustering method identified distinct segments: high social capital (52%) and low social capital (47.7%). The estimation of a binary logistic regression model determined the characteristics of community residents who were most likely to be associated with each type of social capital. Results indicated that fruit, vegetable and rice farmers who also operated farm-stay businesses and rural activity programmes for tourists had the most social. We suggest that certain types of government policy programmes are helpful for increasing social capital and managing community conflicts by means of involvement in the tourism business.

Abstract 35: 30-Day Risk-Standardized Mortality and Readmission after Ischemic Stroke in Critical Access Hospitals

Background: Critical access hospital (CAH) designation identifies hospitals providing emergency and inpatient care to residents of rural communities. Patients with cardiovascular disease and pneumonia have poorer outcomes at CAHs, but stroke outcomes have not been assessed. Objective: Compare risk-adjusted 30-day mortality and readmission rates after ischemic stroke for patients treated at critical access and non-critical access hospitals. Methods: The cohort included all fee-for-service Medicare beneficiaries 65+ years of age discharged with a primary diagnosis of ischemic stroke (ICD-9 433, 434, 436) in 2006. Risk-standardized mortality and readmission rates at 30 days were compared for patients treated at CAH versus other hospitals using hierarchical logistic regression models, adjusted for patient demographics, medical history, and comorbid conditions. Results: There were 10,267 ischemic stroke discharges from 1,165 CAHs and 300,114 discharges from 3,381 non-CAHs. Patients discharged from CAHs were older, more often women and white, and generally had more comorbid conditions. CAHs had higher unadjusted in-hospital (6.4% vs. 4.6%, p&lt;0.001) and 30-day (19.9% vs. 10.9%, p&lt;0.001) mortality rates than non-CAHs, but lower 30-day all-cause readmission (12.4% vs. 13.8%, p&lt;0.001). In risk-standardized analyses, the differences were less marked for 30-day mortality (CAHs vs. non-CAHs; 11.9%±1.4% vs. 10.9%±1.7%, p&lt;0.001), with no difference in 30-day readmission (13.7%±0.6% vs. 13.7%±1.4%, p=0.2787). Conclusions: Although there were no differences in readmission rates, stroke patients discharged from CAHs had higher unadjusted mortality than those discharged from non-CAHs. These differences, however, were at least partially explained by differences in patient characteristics. Further research is needed to identify factors contributing to these differences.

Effect of Community Population Size on Breast Cancer Screening, Stage Distribution, Treatment Use and Outcomes

Residents of rural communities have decreased access to cancer screening and treatments compared to urban residents, though use of resources and patient outcomes have not been assessed with a comprehensive population-based analysis. The objectives of this study were to investigate whether breast cancer screening and treatments were utilized less frequently in rural BC and whether this translated into differences in outcomes. All patients diagnosed with breast cancer in British Columbia (BC) during 2002 were identified from the Cancer Registry and linked to the Screening Mammography database. Patient demographics, pathology, stage, treatments, mammography use and death data were abstracted. Patients were categorized as residing in large, small and rural local health authorities (LHAs) using Canadian census information. Use of resources and outcomes were compared across these LHA size categories. We hypothesized that mastectomy rates (instead of breast-conserving surgery) would be higher in rural areas, since breast conservation is standardly accompanied by adjuvant radiotherapy, which has limited availability in rural BC. In contrast we hypothesized that cancer screening and systemic therapy use would be similar, as they are more widely dispersed across BC. Exploratory analyses were performed to assess whether disparities in screening and treatment utilization translated into differences in survival. 2,869 breast cancer patients were included in our study. Patients from rural communities presented with more advanced disease (p=0.01). On multivariable analysis, patients from rural, compared to urban, LHAs were less likely to be screening mammography attendees (OR=0.62; p<0.001). Women from rural communities were less likely to undergo breast-conserving surgery (multivariable OR=0.47; p<0.001). There was no significant difference in use of chemotherapy (p=0.54) or hormonal therapy (p=0.36). The 5-year breast cancer-specific survival for large, small and rural LHAs was 90%, 88% and 86%, respectively (p=0.08), while overall survival was 84%, 81% and 77%, respectively (p=0.01). On multivariable analysis with 7.4 years of median follow-up, neither breast cancer-specific survival (HR=1.16; 0.76-1.76; p=0.49) nor overall survival (HR=1.25; 0.92-1.70; p=0.16) was significantly worse for patients from rural compared to large LHAs. There was a significant difference in screening mammography use, stage distribution and loco-regional treatments use by population size of LHA. After controlling for differences in patient and tumour factors by LHA, survival was not significantly different.

Effect of Community Population Size on Breast Cancer Screening, Stage Distribution, Treatment Use and Outcomes

Residents of rural communities have decreased access to cancer screening and treatments compared to urban residents, though use of resources and patient outcomes have not been assessed with a comprehensive population-based analysis. The objectives of this study were to investigate whether breast cancer screening and treatments were utilized less frequently in rural BC and whether this translated into differences in outcomes. All patients diagnosed with breast cancer in British Columbia (BC) during 2002 were identified from the Cancer Registry and linked to the Screening Mammography database. Patient demographics, pathology, stage, treatments, mammography use and death data were abstracted. Patients were categorized as residing in large, small and rural local health authorities (LHAs) using Canadian census information. Use of resources and outcomes were compared across these LHA size categories. We hypothesized that mastectomy rates (instead of breast-conserving surgery) would be higher in rural areas, since breast conservation is standardly accompanied by adjuvant radiotherapy, which has limited availability in rural BC. In contrast we hypothesized that cancer screening and systemic therapy use would be similar, as they are more widely dispersed across BC. Exploratory analyses were performed to assess whether disparities in screening and treatment utilization translated into differences in survival. 2,869 breast cancer patients were included in our study. Patients from rural communities presented with more advanced disease (p=0.01). On multivariable analysis, patients from rural, compared to urban, LHAs were less likely to be screening mammography attendees (OR=0.62; p<0.001). Women from rural communities were less likely to undergo breast-conserving surgery (multivariable OR=0.47; p<0.001). There was no significant difference in use of chemotherapy (p=0.54) or hormonal therapy (p=0.36). The 5-year breast cancer-specific survival for large, small and rural LHAs was 90%, 88% and 86%, respectively (p=0.08), while overall survival was 84%, 81% and 77%, respectively (p=0.01). On multivariable analysis with 7.4 years of median follow-up, neither breast cancer-specific survival (HR=1.16; 0.76–1.76; p=0.49) nor overall survival (HR=1.25; 0.92-1.70; p=0.16) was significantly worse for patients from rural compared to large LHAs. There was a significant difference in screening mammography use, stage distribution and loco-regional treatments use by population size of LHA. After controlling for differences in patient and tumour factors by LHA, survival was not significantly different.

Assessing antibiotic resistance profiles in Escherichia coli and Salmonella species from groundwater in the Mafikeng area, South Africa

Escherichia coli and Salmonella species occur as normal flora in the gastrointestinal tract of animals and humans. However, pathogenic strains exist that cause disease in humans. Infections may result from the consumption of water and food contaminated with faeces of human and animal origin. In South Africa, residents of most rural communities rely on untreated ground water for survival. This practice results to the transfer of pathogenic micro-organism to humans and thus amplifies the need to identify contaminated water systems. Results obtained may adequately address water quality problems and hence protect public health. The study was conducted to isolate and determine the antibiotic resistance profiles of E. coli and Salmonella species from the groundwater obtained from two rural communities in the North-West province, S.A. Nineteen ground water samples were analyzed for characters of E. coli and Salmonella species. Only those isolates that satisfied all the primary (oxidase and the triple sugar iron) and secondary identification criteria (API 20E and rapid slide agglutination test) for E. coli and Salmonella species were used. A total of 63 E. coli and 64 Salmonella isolates were identified. The antibiotic susceptibilities of these isolates were evaluated against a panel of 10 antibiotics. A large proportion (56.7 to 57.6%) of the E. coli isolated from both Dibate and Verdwall were resistant to vancomycin. Similarly, large proportions (51.5 to 78.8%) of the E. coli isolated from Verdwall were resistant to ampicilin and erythromycin when compared to those isolated from Dibate. Furthermore, a higher percentage (90.0 to 100%) of Salmonellaisolated from both Dibate and Verdwall were resistant to ampicillin, erythromycin and vancomycin. AP-E-VA was the predominant phenotype for E. coli isolated from both Dibate and Verdwall in 40 and 20%, respectively, while the phenotypes AP-E-T-VA and AP-E-VA were dominant among the Salmonella species isolated in this study. The results indicated that E. coli and Salmonella could serve as indicator organisms necessary to assess the quality of ground water and their levels are critical parameters that could help to drive management strategies. This will limit the effect of these pathogens on consumers, as some water samples were visibly identified to be contaminated. Key words: Salmonella, E. coli, multiple antibiotic resistant (MAR), phenotype.

Protective factors and predictors of vulnerability to chronic stress: A comparative study of 4 communities after 7 years of continuous rocket fire

Many communities across the world are chronically exposed to extreme violence. Responses of residents from a city and rural community in Southern Israel, both exposed to 7 years of daily mortar fire, were compared to residents from demographically, socio-economically and geographically comparable non-exposed control samples to examine protective factors and predictors of vulnerability to chronic war-related attacks. Samples from a highly exposed city (Sderot) and a highly exposed rural community region (Otef Aza), along with a demographically comparable comparison non-exposed city (Ofakim) and non-exposed rural community region (Hevel Lachish), were obtained in 2007 using Random Digit Dialing. In total, 740 individuals (81.8% participation rate) were interviewed about trauma exposure, mental health, functioning and health care utilization. In the highly exposed city of Sderot, 97.8% of residents had been in close proximity to falling rockets; in the highly exposed rural community region of Otef Aza, 95.5% were similarly exposed. Despite exposure to chronic rocket attacks, residents of Otef Aza evidenced little symptomatology: only one person (1.5%) reported symptoms consistent with probable posttraumatic stress disorder (PTSD) and functioning levels did not differ from those of non-exposed communities. In contrast, posttraumatic stress (PTS), distress, functional impairment and health care utilization were substantially higher in the highly exposed city of Sderot than the other three communities. Lack of resources was associated with increased vulnerability among city residents; predictors of PTS across all samples included being female, older, directly exposed to rockets, history of trauma, suffering economic loss, and lacking social support. Increased community solidarity, sense of belonging and confidence in authorities may have served a protective function for residents of rural communities, despite the chronic attacks to which they were exposed.

Trajectories in Use of Substance Abuse and Mental Health Services Among Stimulant Users in Rural Areas

Objective: This study examined substance abuse and mental health service utilization during a three-year period among stimulant users living in rural areas. Methods: Participants (N=710) were interviewed at baseline and every six months for 36 months. One-step transition probabilities were constructed between the two types of service use for each consecutive pair of interviews to examine the resulting steady-state probabilities among multiple one-step transition matrices. Results: Most participants received no substance abuse or mental health services. On average, the probabilities of reporting use of the same types of services during the 36-month follow-up were 82% for receiving neither service, 9% for receiving only mental health treatment, 6% for receiving only substance abuse treatment, and 2% for receiving both services. Conclusions: Further study is needed to determine factors that affect the decision to seek mental health or substance abuse treatment among residents of rural communities. (Psychiatric Services 62:1230–1232, 2011)

Trajectories in Use of Substance Abuse and Mental Health Services Among Stimulant Users in Rural Areas

This study examined substance abuse and mental health service utilization during a three-year period among stimulant users living in rural areas. Participants (N=710) were interviewed at baseline and every six months for 36 months. One-step transition probabilities were constructed between the two types of service use for each consecutive pair of interviews to examine the resulting steady-state probabilities among multiple one-step transition matrices. Most participants received no substance abuse or mental health services. On average, the probabilities of reporting use of the same types of services during the 36-month follow-up were 82% for receiving neither service, 9% for receiving only mental health treatment, 6% for receiving only substance abuse treatment, and 2% for receiving both services. Further study is needed to determine factors that affect the decision to seek mental health or substance abuse treatment among residents of rural communities.

Detection of E. coli Isolates in Water from Setumo Dam Mmabatho Area – North West Province, South Africa Using mdh Specific PCR Analysis

KEYWORDS Coliform. E. coli mdh. Malate Dehydrogenase ABSTRACT Most countries including South Africa, process surface water from lakes, rivers, dams and ponds by filtration, chlorination, alum treatment before use for drinking purposes. In South Africa, the North West Province in particular, residents of most rural communities do not have access to treated water. This exposes them to contamination with pathogens such as Escherichia coli. The aim of the study was, therefore, to isolate, identify and characterize E. coli strains from water collected from Setumo Dam, located at the Modimola village, in the periphery of the Mmabatho suburban area using conventional microbiological methods and PCR analysis. Water samples were collected during the summer season from three different sites of the dam, viz; upstream, middle stream and the downstream of the dam. Tap water was used as a control during analysis. Bacterial loads were determined by spread plating on mFC and EMBA and incubating the plates aerobically at 45 o C and 37 o C, respectively for 24 hours. Blue colonies on mFC agar were counted and recorded while pure metallic sheen colonies on EMBA were identified using preliminary (oxidase test, TSI) and confirmatory (API 20E and mdh specific PCR) assays. The results obtained indicated that all the water samples were contaminated with faecal coliform bacteria. Samples from upstream had high colony counts (320 to 1624 cfu/50ml) than those from the mid-stream (56 to 90 cfu/50ml) and the downstream (26 to 44 cfu/50ml). There was no contamination from tap water. Of the 57 randomly selected E. coli colonies that satisfied the preliminary identification tests and API 20E, 46 (80.7%) were positively identified as E. coli since they possessed the mdh gene fragment. Water from the dam contained high E. coli load and it is recommended that the Local municipality makes informed decisions pertaining to the control and management of the pathogen. Improve- ment of the sanitary and water systems in the area is therefore necessary.

PERSISTENT NEUROBEHAVIORAL EFFECTS IN SCHOOLCHILDREN AND ADULTS AFTER THREE DECADES OF EXPOSURE TO DRIFT CONTAINING ORGANOPHOSPHORUOS PESTICIDES

Background and Aims: Studies by our group in 1987-1991 showed in-season reversible neurobehavioral effects of low-level, long-term exposure to organophosphorous (OP) pesticides in a cohort of agricultural workers and residents of rural communities in the Hula Valley, Israel. The residents were exposed to pesticide-drift caused by the proximity of the communities to the sprayed fields. This study aimed to review the neurobehavioral effects after three decades in the same cohort and in 8-12 years-old schoolchildren, 75% of whom are “second generation”, as at least one of their parents belonged to the original adult cohort. Methods: Neurobehavioral tests included questionnaire, Trail Making Tests A and B, Digit Span (forward and backward), Digit Symbol Tests and Purdue Pegboard. Results: Cognitive changes were observed in 98 individuals of the original adult cohort. Performance on both Trail Making Tests was significantly poorer than in the general population. The performance in Trail Making Test B was inversely correlated with the duration of OP pesticide exposure (r=-0.231; α&lt;0.01). Digit span tests were poor. Females were affected but yet performed better than males in all the tests.Preliminary analysis suggests that approximately 40% of the tested children or one of their siblings was diagnosed in the past with attention span and concentration deficits or Attention Deficit/Hyperactivity Disorder (ADD/ADHD). Conclusions: The preliminary results demonstrate persistent late neurotoxic effects of lengthy daily OP pesticide exposure in both children and adults. There may be environmental-susceptibility interactions mediating the emergence of ADHD in populations with low-level endemic exposure to OP pesticides.

Student-Led Rural Health Fairs

Residents of rural communities, especially in the Southeast, have decreased access to health care. Ensuring medical students receive adequate exposure to their issues is complicated by the urban location of most schools. We describe health fairs conducted in rural communities to suggest how having medical students use screening tools can identify patients with risk factors for disease which can offer students the opportunity to learn about rural health issues through patient counseling. The Mitchell Wolfson Sr. Department of Community Service, a University of Miami Miller School of Medicine student-led organization, conducts fairs at four sites throughout the rural Florida Keys. Medical students, under the supervision of attending physicians, offer screening and preventive health services including risk factor screening for cardiovascular disease, ophthalmological exams, dermatologic exams, osteoporosis screening, and female exams with pap smears. These fairs were reviewed. In the past three years, 1694 unique patients were seen. Many lacked a primary care provider (46%) or health insurance (43%) and were provided screening for several disorders including cardiovascular disease risk factors (hypertension, diabetes, dyslipidemia, and obesity). Screening revealed that many patients (41%) had multiple markers of elevated cardiovascular disease risk. This provided experiences to more than 200 students each year. Fairs provide medical students exposure to rural health issues through the valuable opportunity of using risk factor screening tools and counseling. This provides valuable information to patients of rural communities. Future research should examine how fairs influence student knowledge and attitudes toward rural health and affect health outcomes.

Electing Displacement: Political Cleansing in Apartadó, Colombia

This article highlights a nefarious effect of elections during civil wars by demonstrating that they can facilitate the displacement of civilians. This occurs through two main mechanisms: they reveal information about civilians' loyalties directly to armed groups; and they threaten the status quo of local elites' power, motivating them to ally with outside armed groups in order to regain it. Armed groups strategically displace civilians identified as disloyal in order to gain control over a territory. I test implications of the argument with original, micro-level quantitative and qualitative data from northwest Colombia. Using voter censuses and disaggregated electoral returns from 1991-1998, I show that residents in urban neighborhoods that supported the insurgent-backed political party, the Patriotic Union (UP), were more likely to leave the city of Apartado than neighbors in other districts. However, residents of the nearby rural communities that supported the UP were the least likely to leave. I trace the patterns of violence across the communities using local archival materials and interviews to assess how well the argument accounts for the variation observed, and to explore the unexpected outcome in the rural area. While I find that counterinsurgents attempted strategic displacement in both the city and the mountains, they only succeeded in the urban areas because residents of the rural hamlets were uniquely able to overcome the collective action problem that strategic displacement generates. The findings demonstrate that that political identities are relevant for patterns of violence, and that political cleansing resembles ethnic cleansing.

Electing Displacement: Political Cleansing in Apartadó, Colombia

This article highlights a nefarious effect of elections during civil wars by demonstrating that they can facilitate the displacement of civilians. In contrast to the perception of displacement as haphazard, the author argues that armed groups displace strategically when they attempt to gain control over a territory, and where they have information about civilians’ loyalties. Although inferring preferences is difficult in the context of civil wars, elections conducted before or during a violent conflict are one way that armed groups can identify local cleavages and ‘‘disloyal’’ residents. The author tests implications of the argument with original, microlevel quantitative and qualitative data from northwest Colombia. Using voter files and disaggregated electoral returns, the author shows that residents in urban neighborhoods that supported the insurgent-backed political party, the Patriotic Union (UP), were more likely to leave the city of Apartadó than were neighbors in other districts. However, residents of the nearby rural communities that supported the UP were the least likely to leave. The author traces the patterns of violence across the communities using local archival materials and interviews to assess how well the argument accounts for the variation observed, and to explore the unexpected outcome in the rural area. While the author finds that counterinsurgents attempted strategic displacement in both the city and the mountains, they only succeeded in the urban areas because residents of the rural hamlets were uniquely able to overcome the collective action problem that strategic displacement generates. The findings demonstrate that political identities are relevant for patterns of violence, and that cleansing occurs even in nonethnic civil wars.