Semi-rural Settings Research Articles

Distance from care predicts in-hospital mortality in HIV-infected patients with severe sepsis from rural and semi-rural Virginia, USA.

There are few data regarding outcomes from severe sepsis for HIV-infected patients living in rural or semi-rural settings. We aim to describe the characteristics and predictors of mortality in HIV-infected patients admitted with severe sepsis to the University of Virginia located in semi-rural Charlottesville, Virginia, USA. We queried the University of Virginia Clinical Data Repository for cases with ICD-9 codes that included: (1) infection, (2) acute organ dysfunction, and (3) HIV infection. We reviewed each case to confirm the presence of HIV infection and severe sepsis. We recorded socio-demographic, clinical, and laboratory data. We used a generalised linear mixed-effects model to assess pre-specified predictors of mortality. We identified 74 cases of severe sepsis in HIV-infected patients admitted to University of Virginia since 2001. The median (IQR) age was 44 (36-49), 32 (43%) were women, and 56 (76%) were from ethnic minorities. The median (IQR) CD4+ T-cell count was 81 (7-281) cells/µL. In-hospital mortality was 20%. When adjusted for severity of illness and respiratory failure, patients who lived >40 miles away from care or had a CD4+ T cell count <50 cells/µL had > four-fold increased risk of death compared to the rest of the study population (AOR = 4.18, 95% CI: 1.09-16.07, p = 0.037; AOR = 4.33, 95% CI: 1.15-16.29, p = 0.03). In HIV-infected patients from rural and semi-rural Virginia with severe sepsis, mortality was increased in those that lived far from University of Virginia or had a low CD4+ T cell counts. Our data suggest that rural HIV-infected patients may have limited access to care, which predisposes them to critical illness and a high associated mortality.

The epidemiology and aetiology of diarrhoeal disease in infancy in southern Vietnam: a birth cohort study

Previous studies indicate a high burden of diarrhoeal disease in Vietnamese children, however longitudinal community-based data on burden and aetiology are limited. The findings from a large, prospective cohort study of diarrhoeal disease in infants in southern Vietnam are presented herein. Infants were enrolled at birth in urban Ho Chi Minh City and a semi-rural district in southern Vietnam, and followed for 12 months (n=6706). Diarrhoeal illness episodes were identified through clinic-based passive surveillance, hospital admissions, and self-reports. The minimum incidence of diarrhoeal illness in the first year of life was 271/1000 infant-years of observation for the whole cohort. Rotavirus was the most commonly detected pathogen (50% of positive samples), followed by norovirus (24%), Campylobacter (20%), Salmonella (18%), and Shigella (16%). Repeat infections were identified in 9% of infants infected with rotavirus, norovirus, Shigella, or Campylobacter, and 13% of those with Salmonella infections. The minimum incidence of diarrhoeal disease in infants in both urban and semi-rural settings in southern Vietnam was quantified prospectively. A large proportion of laboratory-diagnosed disease was caused by rotavirus and norovirus. These data highlight the unmet need for a rotavirus vaccine in Vietnam and provide evidence of the previously unrecognized burden of norovirus in infants.

The relationship between air pollution and asthma in Malaysian schoolchildren

Rapid increases in traffic volumes in countries such as Malaysia may lead to exposure to poor air quality both outdoors and indoors. This study investigated asthma symptoms among Malaysian schoolchildren in relation to indoor and outdoor air pollution in urban and semi-rural settings in a school-based cross-sectional study of 1,952 schoolchildren living in urban and semi-rural areas. Parents completed a questionnaire including questions on asthma symptoms and environmental risk factors. Air pollutant concentrations were measured at 16 schools. Analysis used multiple logistic regression controlling for sociodemographic and indoor air pollution factors. A total of 11.4, 7.6, 9.5 and 7.0 % schoolchildren had asthma, current wheeze, dry cough at night and wheezing after exercise, respectively. Asthma and dry cough were significantly higher among urban schoolchildren. A 10-μg/m3 increase in outdoor NO2 level was associated with a twofold increase in the reporting of current wheeze (odds ratio (OR) 1.90; 95 % confidence interval (CI) 1.02–3.52); a 10-μg/m3 increase in indoor PM2.5 was similarly associated with a twofold increase in the reporting of wheeze during exercise (OR 2.08; 95 % CI 1.02–4.26). Secondhand smoke (SHS), mold and the presence of new furniture at home were also linked to asthma symptoms. NO2 concentrations in urban Malaysia frequently exceed those of the international standards. Exposure to traffic-related air pollution may be linked to asthma symptoms among children in Malaysia.

Factors Influencing the Persistence of Tobacco Smoking in Public Places in Tanzania: A Cross-Sectional Study in Urban, Rural and Semi-Rural Settings

Background: In 2003 the government of Tanzania enacted the Tobacco Products (Regulation) Act 2003, which, among other things, prohibited smoking in public places. However, smoking has persisted despite the existence of the Act. This study aims to establish the reasons behind the persistence of tobacco smoking in public places. ②Methods: This was a cross-sectional study where data were collected using pre-tested, self-administered questionnaires with both open and closed questions and documentary reviews. The study was conducted in urban, rural and semi-rural areas in three districts located in eastern, central and northern Tanzania. Quantitative data were analyzed using SPSS ver. 15. Qualitative data were analyzed manually using a thematic content approach. ③Results: The study involved 240 participants, of whom 67% were males. Overall smoking prevalence was 26.5% (36.3% for males and 6.4% for females, p 0.05). About 40% of the smokers were between 25-35 years old and 52.4% had primary school as their highest level of education. About 56% of participants said they were aware of the Tobacco Regulation Act, but the majority could neither define it nor state the penalties for its infringement. Only 59.5% were aware that tobacco smoking causes lung cancer. About 4 out of 10 cigarette smokers do not adhere to NO SMOKING warnings. ④ Conclusions: Cigarette smoking in public places in Tanzania has persisted mainly due to low awareness and passive implementation of the Tobacco Regulation Act, 2003. Other causes are aggressive advertising and promotion by the tobacco industry and insufficient awareness about the health effects associated with tobacco smoking. This study calls for an increase in cigarette taxation, sensitization about the dangers of both smoking and second-hand smoke and active enforcement of the act as immediate intervention strategies.

Self-referral to physiotherapy: deprivation and geographical setting: Is there a relationship? Results of a national trial

Objectives To establish the level of self-referral in urban, semi-rural and rural primary care settings, encompassing a range of deprivation, in Scotland. Design of study Quasi-experimental. Setting Twenty-nine general practices throughout Scotland. Participants Three thousand and ten patients (>16 years) and physiotherapists from throughout Scotland. Method Practices were classified in terms of their location and level of deprivation (DEPCAT scores). Historical data were used to establish national referral rates in these settings. Self-referral was introduced in each setting and the proportions of patients referring themselves or being referred by their general practitioner (GP) were collated over a full year. A further category of ‘GP-suggested’ referral was also included. Results There were different rates of referral according to setting ( P < 0.001). A national adult referral rate of 53.5/1000 was identified. Rural areas experienced the highest rates (66/1000) of referral compared with urban (44.5/1000) and semi-rural (49/1000) settings. An overall ‘true’ self-referral rate of 22% was found. Rural areas experienced the highest levels of both self- and GP-suggested referrals (32% and 26%, respectively). An increase in total referral numbers was experienced in less than 20% of locations after introducing self-referral, all of which had a history of underprovision. Self-referrers came from all socio-economic settings, although differences were observed between the groups ( P < 0.001). Conclusions Introducing self-referral does not appear to result in an increase in the overall referral rate when reasonable levels of service are already being provided in line with national rates according to geographical setting. Deprivation does not appear to exert a major influence on referral rates. However, the rate of self-referral in the long-term future is impossible to predict.

Referring for knowledge base: What is the case for referral?

Referring for knowledge base: What is the case for referral?

Population-dynamics models and a sequential test in the analysis of the influence of household setting on the spread of Variola minor

The Wald sequential probability ratio test was used to analyze the effects of household setting upon dates of onset of Variola minor (alastrim) during an epidemic occurring in Braganga Paulista County, Brazil, in 1956. Four population-dynamics models were used, depending upon whether the probability of occurrence of new cases was assumed to be (a) a function of the number of infectives (Simple Birth); (b) a function of the number of remaining uninfected susceptibles (Simple Death); (c) a function of both the number of infectives and a constant removal rate due to isolation, recovery or death (Simple Birth-Death) and, (d) a function of a “parameter of contagiousness” so as to increase with increasing numbers of infectives and decrease with time since the last infective (Polyá). The last two processes gave larger numbers of significant differences related to environment. These differences were consistent with generally accepted knowledge and with notions intuitively derived from the empirical findings. Environment was thus often found to differentiate subsequent cases (seemingly resulting from within-household spread) while only rarely affecting the rate of occurrence of cases introducing the disease into households (seemingly resulting from between-households spread). Rural and semi-rural settings showed greater similarity than either did with the urban environment.

A Residential Program for the Developmentally Disabled

Malcolm J. Collins, MSW, Ph.D., is supervising Program Analyst, Region IV, Massachusetts De partment of Mental Health, Wakefield, Massa chusetts. At the time of writing, he was Direc tor, Community Residence Program, Walter E. Fernald State School, Waverly, Massachusetts. Doris H. Rodman, MSW, is Director of Social Work, Walter E. Fernald State School. doing strengthen their capacity to cope.3 Small residences located throughout the region, be sides providing a home for those able to obtain outside employment, would offer avenues for the residents' social and personal development. The five houses that exist at present are all typical of their communities. Each accommo dates six to eight residents and three staff mem bers; each can also provide temporary emer gency housing—for example, for developmen tal^ disabled persons who have been living lo cally with their relatives. One house is for men, three are for women, and one is for both. Three are in or near Boston, two in semirural set tings. All residents pay their own way with income from employment, unemployment in surance, public welfare assistance, or some com bination of these. Some are in competitive employment, some work in sheltered workshops or day activity centers. The houses are almost self-supporting. Staff, who are paid salaries by the state department of mental health, receive free lodging but pay for food. Staff responsibilities include the houses' operation and financial management. Interested individuals or groups, such as the local Association for Retarded Children, sign the lease for a residence. One local association