Rural East Research Articles

Cervical Cancer Prevention in Racially Disparate Rural Populations.

Background: Undergoing a timely Pap smear, high-risk human papilloma virus (HPV)- and colposcopy-based testing can reduce HPV-associated cervical cancer (CC) development in women. However, in rural areas, women and minorities without insurance do not undergo periodic assessment and remain at greater risk of HPV infection and CC. Methods: In this study, 173 women from rural East Texas with various ethnic backgrounds were examined thorough HPV/Pap-based testing and colposcopic assessment. Results: Of the 113 informative cases, 77% (87/113) were positive for high-risk HPV infection and 23% of subjects (26/113) were negative. Associations between HPV positivity with young age (p = 0.002), and a low number of pregnancy (p = 0.004) and births (p = 0.005) were evident. Women with long-term use of contraceptives (OR 1.93, 95% CI, 0.80–4.69) were associated with increased risk of HPV infection. African-American women had a higher risk of abnormal Pap outcome compared to Caucasians (OR 5.31, 95% CI, 0.67–42.0). HPV seemed to be a predictor of abnormal Pap outcome (OR 1.77, 95% CI, 0.48–6.44) in these subjects. Unmarried/widowed/divorced women had an increased abnormal Pap test outcome compared to married women or women living with a partner (p = 0.01), with over 278% increased odds (OR 3.78 at 95% CI, 1.29–11.10). Insured women undergoing periodic checkups were detected early with high-risk HPV infection and abnormal Pap test/colposcopic outcome. Conclusions: Comprehensive and timely screening of uninsured women and minorities in rural East Texas are warranted, which could potentially prevent the onset of HPV-associated CC.

Determinants of objectively measured physical activity in rural East Timorese children.

The human juvenile period evolved as a period of learning and physical development in a family environment that subsidizes the costs of these processes. Children allocate energy to physical activity, maintenance, and growth. How energy is allocated has consequences for adult body size and other life-history traits. In subsistence agriculture populations, where child contributions to the household economy are common and energy availability is low, trade-offs in energy expenditure between activity and growth may help explain poor growth. Using accelerometry, we measured physical activity over 2 years in 88 free-living children aged 5-19 years in two ecologically varying communities in rural Timor-Leste. We model characteristics related to variation in activity, and subsequently, activity is modeled against growth, illness, and aspects of household and local ecology using linear mixed models. Physical activity in Timorese children is characterized by high levels of moderate ( = 8.8 h/day), no sustained vigorous, and little sedentary activity ( = 4.6 h/day). Children in the mountainous community show a slight trade-off between activity and growth (P = .077). Males down-regulate both growth and activity relative to females. Variation in household characteristics does not predict child activity. Both activity and growth are lower in the mountainous community than in the flat, coastal community. Household demands on child behavior may constrain children's ability to moderate activity relative to nutritional status. Activity in this population is high relative to other subsistence populations, possibly because children face the dual pressures of contributing to household subsistence and attending school.

Poor supply chain management and stock-outs of point-of-care diagnostic tests in Upper East Region's primary healthcare clinics, Ghana.

IntroductionSeveral supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana’s primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region’s (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies.Material and methodsWe conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic’s compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables.ResultsOverall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%–82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%–95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%–57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region.DiscussionThere is poor supply chain management of POC diagnostic tests in UER’s PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.

Environmentally Friendly Power Generation Technology with Solar PV-Biogas in Rural Areas of Eastern Java

Increasing human activity has an impact on energy needs. Electrical energy is the most dominant type of energy used daily. the increase in electricity demand in East Java was due to an increase in industrial activity in several cities in East Java, such as Surabaya, Mojokerto, Sidoarjo. Meanwhile, the electrical energy needs of several rural areas in East Java, such as in Bodowoso, Bangkalan, Sumenep have not been fulfilled due to geographical factors. The solution to fulfillment of electricity in rural areas can utilize the potential of alternative energy, such as solar energy and biogas. The high potential of solar energy and biogas can be used as an energy source for solar PV-biogas hybrid power plants. The aim of the study was to study the application of a solar PV-biogas power plant model in rural areas. The research method of the solar PV-biogas hybrid power plant is carried out in several stages to assess the potential for the application of hybrid power plants in rural areas in eastern Java. The research method uses a 100 Wp solar PV hybrid system model and 1 KW biogas generator set by analyzing the potential of electricity produced on average per day. The results of the study of the analysis of the potential application of solar PV-biogas power plants show the configuration of the power plant model of generating solar PV-biogas generators produced by solar PV electric power 1.260 kW per day and 0,379 kW KW biogas generator with a total electrical energy of 1,639 kW / day. Electric energy consumption per family head is an average of 1 kWh / day. the application of a solar PV-biogas hybrid power plant still with a surplus of 0,639 KW. the model of solar PV-biogas generator has a good effective and efficient to be applied in rural Java east.

Stepping up to market participation of smallholder agriculture in rural areas of Indonesia

PurposeThe purpose of this paper is to analyse factors that determine farmers’ intention to commercialise vegetable-based agribusiness ventures in rural areas and assess the effect of commercialisation on farmers’ income.Design/methodology/approachThe study used a regression approach. Market participation and farmers’ income were hypothesised to be dependent on other external factors. This study employed data compiled from a quantitative survey of 357 farm households located in four major vegetable producing regions of rural East Java and Bali, Indonesia.FindingsResults indicate that household attributes, business environment, supporting facilities and farm characteristics determined farmers to commercialise vegetable farming. Access to credit, seed technology and farm site played high contribution to the market participation. Ultimately, commercial vegetable farming provides an economic advantage regarding increased income. Land fragmentation and status of landholding were identified to influence the net revenue of vegetable farming.Research limitations/implicationsThis study has a limitation concerning the number of samples and the availability of data and information. The number of samples is 357 which is about 4 per cent of the total population.Practical implicationsEstablishment of vegetable agribusiness terminals with all market infrastructures, adequate access to market information, credit and human capital investment through training and extension services are also required, will boost market participation. Re-structuring land ownership might be the best step to augment farmers’ income, through consolidation of fragmented fertile lands devoted to intensive vegetable farming.Originality/valueThis study was purposely conducted in rural areas where there were subsistence farmers, as this is to improve farmers’ income by commercialising vegetable crops. A novel feature of this finding is the role of access to credit in the commercialisation of vegetable farming and the impact of landholding status on the profitability of intensive farming of high-valued vegetables.

Costs of Integrating Hypertension Care into HIV Care in Rural East African Clinics

Background: Sub-Saharan Africa faces twin epidemics of HIV and non-communicable diseases including hypertension. While integration of hypertension care into the chronic HIV-focused healthcare infrastructure is a key global priority, cost estimates for integration are largely unavailable. In the SEARCH Study, we performed population-based testing for HIV and hypertension and offered integrated streamlined chronic care. Here, we estimate costs for hypertension care integrated with HIV care for HIV-positive individuals, and the cost for hypertension care for HIV-negative people concomitantly in the same clinics. Methods: SEARCH (NCT:01864603) conducted community health campaigns for diagnosis and linkage to care for both HIV and hypertension. HIV-positive patients received hypertension/HIV care jointly including blood pressure monitoring and medications; HIV-negative patients received hypertension care alone at the same clinics. Within 10 Ugandan study communities during 2015-2016, we estimated incremental annual per-patient costs for hypertension care using standard micro-costing techniques, time-and-motion personnel studies, and administrative/clinical records review. Findings: Overall, 70 HIV-positive and 2355 HIV-negative participants received hypertension care. For HIV-positive participants, average incremental cost of hypertension care was $6.29/person/year, representing a 2.1% marginal increased cost over previously published estimates for HIV care alone. For HIV-negative persons, hypertension care cost $11.39/person/year, a 3.8% marginal increase over HIV care costs. Key costs for HIV-positive patients included hypertension medications ($6.19/patient/year; 98% of total) and laboratory testing ($0.10/ patient/year;2%). Key costs for HIV-negative patients included medications ($5.09/patient/year;45%) and clinic staff salaries ($3.66/patient/year;32%), while minor costs included laboratory testing ($0.10/patient/year;1%), fixed costs ($1.98/patient/year;17%) and other recurring costs ($0.56/patient/year;5%). Interpretation: For only 2-4% estimated additional costs, hypertension care was added to HIV care, and also expanded to all HIV-negative patients in prototypic Ugandan clinics, demonstrating substantial synergy. Our results should encourage accelerated scale-up of hypertension care into existing clinics to address the growing hypertension epidemic, secondarily reduce HIV care-related stigma, and improve community health. Funding: Research reported in this manuscript was supported by Division of AIDS, NIAID, of the National Institutes of Health under award number U01AI099959 and in part by the President’s Emergency Plan for AIDS Relief (PEPFAR), and Gilead Sciences. Declaration of Interest: Related to work in this manuscript, all authors declare no conflicts of interests. Ethical Approval: The SEARCH Study was approved by institutional review boards at Makerere University College of Health Sciences (Kampala, Uganda), the Kenya Medical Research Institute (Nairobi, Kenya), and the University of California, San Francisco, as well as by the Uganda National Council for Science and Technology.

Environmental Factors and Prevalence of Hookworm infection and Strongyloidiasis in Rural East Kalimantan, Indonesia

The prevalence of hookworm infection and strongyloidiasis is serious public health concern globally. In rural East Kalimantan, Indonesia has high-risk environmental factors of the prevalence of hookworm infection and strongyloidiasis. In this study would show the infection rates, correlation analysis between environmental risk factors and prevalence of hookworm infection with statistical analysis. We performed a cross-sectional study among 213 participants from rural community of East Kalimantan Province, Indonesia. In this study used two diagnostic methods: Kato Katz and Koga agar plate culture/KAP culture for diagnosing of hookworm and Strongyloides infections. Chi-square analysis was used for study correlation between environmental factors and hookworm infection. Hookworm, strongyloides, and ascaris infections were found in this study; 44.1%, 16.4%, and 7.5% respectively. Environmental risk factors such as; rainy season, quality of soil and infection hookworm and strongyloides in pet have significant correlation (p-value < 0.05) with hookworm infection and strongyloidiasis. The prevalence of hookworm infection and strongyloidiasis has correlation with environmental factors, and the finding in this research could be contributed to decreasing program of hookworm infection and strongyloidiasis especially in rural community area.

STRATEGIC DESIGN OF AGRICULTURAL FINANCING IN RURAL AREA BASED ON COMPETITIVENESS OF BMT

The existence of Baitul Maal wat Tamwil (BMT) in East Java is expected to be an alternative in capital problem, especially on micro / small farm in rural East Java. The role of BMTs can be analyzed based on the internal and external conditions of BMT institutions that perform structural functions as financial service cooperatives and cultural functions as social institutions in the redistribution of Islamic wealth. This study used a mixed case study method with descriptive analysis. Field studies were conducted in November 2016-February 2017 in Surabaya, Tulung Agung, Pasuruan, and Gresik in East Java using primary and secondary data. Secondary data sourced from BMT financial report during 2013-2015. Further analysis of internal and external BMT conditions through Focus Group Discussion (FGD). The result of institutional analysis, mention that healthy institution and competitiveness to channel agriculture financing both structurally and culturally. The BMT management response to the internal and external environment is in the position of being (average). Analysis of EFE (External Factor Evaluation) and IFE (Internal Factor Evaluation) is possible for the institution to combine growth strategies (grow) and development (build). The recommended of alternative institutional strategy to BMT in agricultural financing in rural East Java is market penetration and product development.

Quinine, Whisky, and Epsom Salts: Amateur Medical Treatment in the White Settler Communities of British East and South-Central Africa, 1890–1939

Summary Between 1890 and 1939, many migrants settled in rural areas in Britain’s newly occupied territories in East and South-Central Africa. A number of these settlers produced memoirs about their lives in colonial Africa, many of which contain rich domestic detail, including about health and home medical treatment. This paper examines a selection of memoirs by women who lived in rural British East and South-Central Africa. First, it explores the literary presentation of disease, injury and home treatment in these memoirs, arguing that anecdotes about health played powerful and complex roles. Secondly, it illustrates that most authors regularly treated injuries and illnesses for themselves and their families, making home treatment an important part of their health care. Lastly, it highlights that these memoirs reveal a distinctive set of medicines and techniques used for amateur medical treatment. Overall, this paper positions amateur medical practice as an essential element of health care in the region.

Prevalencia de complicaciones de la diabetes y comorbilidades asociadas en medicina familiar del Instituto Mexicano del Seguro Social

The prevalence of chronic complications and comorbidities in patients with type 2 diabetes (T2D) has increased worldwide. To compare the prevalence of complications and chronic comorbidities in patients with T2D at 36 family medicine units of five chapters of the Mexican Institute of Social Security (IMSS). Complications (hypoglycemia, diabetic foot, kidney disease, retinopathy, ischemic heart disease, cerebrovascular disease and heart failure) and comorbidities (liver disease, cancer and anemia) were identified according to codes of the International Classification of Diseases, 10th Revision. Comparisons were made by chapter, age, gender and evolution time. Complications and comorbidities were more common in subjects aged ≥ 62 years. Out of 297 100 patients, 34.9 % had any complication; microvascular complications (32 %) prevailed in the industrial North, whereas macrovascular complications (12.3 %) did in the rural East, and comorbidities (5 %) in southern Mexico City. Complications predominated in men (any complication, 30.2 %). Heart failure and comorbidities were more common in women (5.6 % and 4.9 %, respectively). T2D complications and comorbidities showed geographic and gender differences, and were greater with older age and longer evolution time. It is urgent for strategies for the prevention of complications and comorbidities to be reinforced in patients with T2D.

Investigating the Establishment and Sustainability of Professional Learning Communities in Rural East Texas: The Principals' Perspectives

The role of principals, especially in rural schools, where educational outcomes fall below the national average, is significant in implementing changes in the school. The focus of this qualitative study was to explore factors that principals deem most crucial to establishing and maintaining Professional Learning Communities (PLCs). Moreover, elements linked to how principals perceive the practicality of developing and supporting PLCs in rural schools were examined. The researcher conducted in-depth, semi-structured interviews with principals to determine their perceptions about attributes most important in establishing PLCs. Seven principals with a minimum number of 3 years in the position were included in the study. Findings indicated that buy-in from teachers and mutual trusts were substantial factors influencing the leadership component of PLCs in rural schools. As the researchers concluded, principals must intentionally facilitate connecting the PLC framework using professional development to affect organizational change and subsequently impact campus learning.

"Hurdles on the path to 90-90-90 and beyond": Qualitative analysis of barriers to engagement in HIV care among individuals in rural East Africa in the context of test-and-treat.

BackgroundDespite substantial progress, gaps in the HIV care cascade remain large: globally, while about 36.7 million people were living with HIV in 2015, 11.9 million of these individuals did not know their HIV status, 12.7 million were in need of antiretroviral therapy (ART) and 13.0 million were not virally suppressed. We sought to deepen understanding of the barriers to care engagement at three critical steps of the care cascade proposed to make greatest impact for attaining the UNAIDS 90-90-90 targets aimed at shutting down the HIV epidemic.MethodsAnalyses were conducted among HIV-infected adults in rural East Africa. Qualitative data were collected using in-depth interviews among 63 individuals participating in an ongoing test-and treat trial (NCT01864683) in its baseline year (July 2013-June 2014). Audio recordings were transcribed, translated into English, and coded using Atlas.ti software. Data were analyzed using a thematic framework for explaining barriers to care engagement that drew upon both theory and prior empirical research in similar settings.ResultsMultiple barriers to engagement in care were observed. HIV-related stigma across dimensions of anticipated, internalized and enacted stigma manifested in denial and fears of disclosure, and influenced lapses in care engagement across multiple steps in the cascade. Poverty (lack of food and transport), lack of social support, work interference, prior negative experiences with health services, drug side effects, and treatment fatigue also negatively affected ART adherence and viral suppression. Gender differences were observed, with work interference and denial disproportionately affecting men compared to women.ConclusionMultiple barriers to HIV care engagement still pervade rural sub-Saharan settings threatening the realization of the UNAIDS 90-90-90 targets. To control the epidemic, efforts need to be accelerated to combat stigma. Patient economic empowerment, innovative drug formulations, as well as more patient-responsive health systems, may help overcome barriers to engagement in care.

Investigation of the Role of Rural Tourism Development in the Promotion of Rural Social Welfare Indexes (Case Study: East Azerbaijan Province)

Purpose- The aim of this study was to investigate the role of tourism development in the promotion of social welfare in rural East Azerbaijan province. Design/methodology/approach- The research paper is based on analytical-explanatory technique; it was carried out through a survey. The research population comprises the residents of the tourist villages. Five hundred (500) participants were selected as the sample size based on Cochran formula. Experts confirmed the face validity of the questionnaire. They performed a pilot study on 60 questionnaires within the same region. The applied questionnaire was 0.885 to 0.894 reliable based on the obtained data using Cronbach alpha. Finding- Spearman’s correlation test revealed that all research variables were positively and significantly related to tourism except sense of safety and security as well as improvement of consumption patterns. In addition, results of Mann-Whitney test showed that tourism and social welfare were more associated with tourist villages of East Azerbaijan than that of other non-tourist villages. In addition, the results of regression analysis revealed that 9 variables out of 11 obtained 89% of the variations. Accordingly, the variables of quality of life, occupation, and future expectancy have been more effective. Research limitations/implications- The recommendations in this research paper can be used in different areas of tourism management and development of villages in this region.

The Poverty Of Rural And Role And Development Of Agricultural Sector In East Java

Agricultural activities mostly rely on rural area, unfortunately the poverty rate in rural areas is still quite high in the period 2010-2016. The number of poverty is 15.26% -11.77%. Although the poverty rate decreases but is still higher than in the city that is around 10.58% -7.87% (in the same period). The objectives of this study are (1) to estimate the role of the agricultural sector on regional performance and (2) to describe qualitatively the relationship of the agricultural sector to poverty. The research uses Input Output (IO) method with non-survey technique. The data used for the analysis are IO data of 2006 and 2015 originated from Badan Pusat Statistik (BPS) Indonesia. The analysis shows that the role of agriculture sector in terms of demand and supply is still small in the economic development of East Java. On average, the role is still very small compare to the industrial sector and other sectors. Furthermore, poverty still accumulates in rural areas, where rural areas have a high association with the agricultural sector. This shows that the agricultural sector has no strong interconnectedness and connection with the industrial sector. Thus the industry has not relied strongly on the agricultural sector in East Java. This is one reason why poverty is high in rural East Java.

Early Adopters of Human Immunodeficiency Virus Preexposure Prophylaxis in a Population-based Combination Prevention Study in Rural Kenya and Uganda.

Global guidelines recommend preexposure prophylaxis (PrEP) for individuals with substantial human immunodeficiency virus (HIV) risk. Data on PrEP uptake in sub-Saharan Africa outside of clinical trials are limited. We report on "early adopters" of PrEP in the Sustainable East Africa Research in Community Health (SEARCH) study in rural Uganda and Kenya. After community mobilization and PrEP education, population-based HIV testing was conducted. HIV-uninfected adults were offered PrEP based on an empirically derived HIV risk score or self-identified HIV risk (if not identified by score). Using logistic regression, we analyzed predictors of early PrEP adoption (starting PrEP within 30 days vs delayed/no start) among adults identified for PrEP. Of 21212 HIV-uninfected adults in 5 communities, 4064 were identified for PrEP (2991 by empiric risk score, 1073 by self-identified risk). Seven hundred and thirty nine individuals started PrEP within 30 days (11% of those identified by risk score; 39% of self-identified); 77% on the same day. Among adults identified by risk score, predictors of early adoption included male sex (adjusted odds ratio 1.53; 95% confidence interval, 1.09-2.15), polygamy (1.92; 1.27-2.90), serodiscordant spouse (3.89; 1.18-12.76), self-perceived HIV risk (1.66; 1.28-2.14), and testing at health campaign versus home (5.24; 3.33-8.26). Among individuals who self-identified for PrEP, predictors of early adoption included older age (2.30; 1.29-4.08) and serodiscordance (2.61; 1.01-6.76). Implementation of PrEP incorporating a population-based empiric risk score, self-identified risk, and rapid initiation, is feasible in rural East Africa. Strategies are needed to overcome barriers to PrEP uptake, particularly among women and youth. NCT01864603.

Characteristics of antimicrobial stewardship programmes in rural East Texas hospitals

Antimicrobial stewardship programmes (ASPs) serve as the primary method to prevent and manage the development of antimicrobial resistance. Rural settings may lack the recommended personnel and resources needed to provide antimicrobial stewardship services. An electronic survey was distributed via e-mail to pharmacy directors or antimicrobial stewardship programme directors of licensed hospitals within Public Health Region 4/5N of East Texas. Sixty percent of ASPs were established <12 months prior to the survey administration. All ASPs had pharmacist involvement, with only one (5%) having formal infectious diseases (ID) training through postgraduate education. Ninety percent of ASPs had a physician champion, with five (27.8%) physicians having formal ID training. Most institutions lacked one or more recommended antimicrobial stewardship practices. When compared with ASPs established for <12 months, ASPs existing for at least 12 months were more likely to have protocols to change antimicrobials from intravenous to enteral forms (100% vs 50%, P=0.042), provide education to patients and families on appropriate antimicrobial use (87.5% vs 33.3%, P=0.028), and track antimicrobial purchasing costs (87.5% vs 33.3%, P=0.028). Institutions in rural settings require additional resources, personnel, and time to implement ASPs and perform various antimicrobial stewardship practices.

Associations between barriers to self-care and diabetes complications among patients with type 2 diabetes

AimsTo determine which barriers to care are associated with type 2 diabetes complications in an area in rural East England. Methods3649 individuals with type 2 diabetes from 62 general practices were contacted via postal invitation which included a 33 item Barriers-to-Diabetes-Care Survey. Barriers were grouped into five priori major categories: educational, physical, psychological, psychosocial, and systems. The associations of reported barriers, both individually and as a group, with self-reported complications were assessed using logistic regression. Results39.5% of participants had self-reported diabetes complications. Physical health barriers (OR = 3.3; 95%CI: 2.7, 4.0), systems barriers (OR = 1.6; 95%CI: 1.3, 2.0) and psychological barriers (OR = 1.3 (95%CI: 1.1, 1.5) were associated with diabetes complications. In subcategories, presence of comorbidities (OR = 4.8; 95%CI: 3.9, 5.9), financial difficulties (OR = 1.7; 95%CI: 1.3, 2.1), absence of services (OR = 2.0; 95%CI: 1.4, 3.0), feeling others should bear more financial responsibility for their care (OR = 1.6 (95%CI: 1.1, 2.1), no access to diabetes service (OR = 1.3; 95%CI: 1.1, 1.5), feeling worried about their diabetes (OR = 1.5; 95%CI: 1.2, 2.0) and lack of readiness to exercise (OR = 1.4; 95%CI: 1.2, 1.7) were associated with diabetes complications. ConclusionsBarriers to self-care are significantly more common among those with, than those without, diabetes complications. Systematic identification and management of different barriers to self-care could help personalise care for those with diabetes related complications.

Marketing Aspects of Vegetables: Comparative Study of Four Regions in East Java and Bali

One of the factors that determines the success or failure of agribusiness is ability of farmers to sell the product. Thus, marketing is an important part of vegetable farming. Good marketing process leads to commercialization, and unsuccessful in this step leads to inadequate income. This study aims to explore the marketing aspects of vegetables using descriptive analysis of vegetable marketing relates issues. The aspects include sources of information, traders, time to sell, use of mobile phone in marketing and the potential constraints. Marketing characteristics of each region were discussed by comparing and contrasting one to another. Data for this study were gathered from a quantitative investigation of 360 farm households situated in four main vegetable producing regions of rural East Java and Bali, Indonesia. The results show that farmers relied on traders and neighbouring farmers as the trusted sources market information. The ways of farmers to sell the product to the market varied across regions. Commonly, farmers had frequent buyers or costumers to sell the products without any special commitment. In majority, farmers contacted a few of traders to sell the product about three days before harvesting. Highly fluctuation of prices was perceived to be the most important constraint among other factors limiting good marketing. Thus, there is a need to address such constraints to help farmers to get fairness.

Administrative versus field work activities in urban and rural East Indonesian region: analysis of 85 health center managers from the 2012 IFLS East

Purpose: This study aimed to determine managerial factors that can affect outside services of primary health care centers in urban and rural areas.Methods: This study was a quantitative research using secondary data from the IFLS East 2012, with a cross-sectional survey design. The study population was 1690 primary healthcare leaders who were scattered over 7 provinces in the East Indonesia region (Nusa Tenggara Timur, Kalimantan Timur, Sulawesi Tenggara, Maluku, Maluku Utara, Papua Barat, and Papua). Selected samples were 97 primary healthcare leaders based on IFLS East 2012. Sampling was from 7 provinces, based on Susenas July 2010 data. Results: A primary healthcare leader who was not a doctor and stayed in the village (rural) had more outdoor activities compared to a doctor who stayed in the city (urban). Primary healthcare which was led by a leader who was not a medical doctor and was located in the village (rural), conducted counseling and children examination 15 times more often compared to primary healthcare providers which was located in the city (urban).Conclusion: Primary healthcare leaders who were a medical doctor were more likely to do outdoor activity for administration duties such as meetings and seminars. Primary healthcare leaders who were not a medical doctor were more likely to do outdoor activity such as counseling and children examination. Primary healthcare which was located in the village (rural) had more outdoor activity rather than the one that was located in the city (urban).

Serum 25-hydroxyvitamin D, calcium and parathyroid hormone levels in Native and European populations in Greenland

Ca homoeostasis is important to human health and tightly controlled by powerful hormonal mechanisms that display ethnic variation. Ethnic variations could occur also in Arctic populations where the traditional Inuit diet is low in Ca and sun exposure is limited. We aimed to assess factors important to parathyroid hormone (PTH) and Ca in serum in Arctic populations. We included Inuit and Caucasians aged 50-69 years living in the capital city in West or in rural East Greenland. Lifestyle factors were assessed by questionnaires. The intake of Inuit diet was assessed from a FFQ. 25-Hydroxyvitamin D (25OHD2 and 25OHD3) levels were measured in serum as was albumin, Ca and PTH. The participation rate was 95 %, with 101 Caucasians and 434 Inuit. Median serum 25OHD (99·7 % was 25OHD3) in Caucasians/Inuit was 42/64 nmol/l (25, 75 percentiles 25, 54/51, 81) (P<0·001). Total Ca in serum was 2·33/2·29 mmol/l (25, 75 percentiles 2·26, 2·38/2·21, 2·36) (P=0·01) and PTH was 2·7/2·2 pmol/l (25, 75 percentiles 2·2, 4·1/1·7, 2·7) (P<0·001). The 69/97 Caucasians/Inuit with serum 25OHD <50 nmol/l differed in PTH (P=0·001) that rose with lower 25OHD levels in Caucasians, whereas this was not the case in Inuit. Ethnic origin influenced PTH (β=0·27, P<0·001) and Ca (β=0·22, P<0·001) in multivariate linear regression models after adjustment for age, sex, BMI, smoking, alcohol and diet. In conclusion, ethnic origin influenced PTH, PTH response to low vitamin D levels and Ca levels in populations in Greenland. Recommendations are to evaluate mechanisms underlying the ethnic influence on Ca homoeostasis and to assess the impact of transition in dietary habits on Ca homoeostasis and skeletal health in Arctic populations.