Study In Rural Area Research Articles

Assessment of self-care practices among hypertensive patients: a clinic based study in rural area of Singur, West Bengal

Background: Hypertension, also known as high blood pressure is a global public health concern. It is an important modifiable risk factor for cardiovascular disease and stroke. It remains silent, being generally asymptomatic during its clinical course and it accounts for a large proportion of cardiovascular deaths; lifestyle modification is the first line of intervention for all patients with hypertension, yet it was never been empirical. The aim of the study was to assess the pattern of self-care practices, if any and also to find out the factors associated with it, among the hypertensive patients in the outpatient department. Methods: A clinic-based, observational, cross-sectional study was conducted at health center under RHU & TC, Singur, which is the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata among 124 hypertensive subjects. Binary logistic regression was done to find out the factors associated with the self-care practices using SPSS software. Results: In the present study, 62.9% of study participants suffering from hypertension had unfavourable self-care practices. Logistic regression showed age above 60 years (OR-3.1), primary level education (OR-5.6), poor socio economic status (OR-2.4), widow/separated (OR-3.3) and people with self-perceived poor health status (OR-2.8)had significant association with unfavourable self-care practices. After adjusting with other variables, age (AOR-2.3) and education (AOR-3.8) remained significant predictor of outcome. Conclusions: The findings revealed that the self-care practices among hypertensive patients were unfavourable in rural area. This calls for a deep need in increasing the awareness about healthy lifestyle among hypertensive patients. This study provides key elements to affect policy changes and social interventions.

Distribution of corneal thickness and its determinants in 6–12-year-old children in an Iranian general population

PurposeTo determine the central corneal thickness (CCT), apex, and paracentral thicknesses and their determinants in children aged 6–12 years. MethodsThe present study was part of the phase 1 of Shahroud School Children Eye Cohort Study in 2015. Cluster sampling was done in urban areas while all children were invited to participate in the study in rural areas. The Pentacam HR was used for measurements. CCT was measured within the central 3 mm zone of the cornea, and corneal thickness 3 mm further from the center was considered paracentral thickness. ResultsOf 6624 students who were selected, 5620 (84.8%) participated in the study. Among 4956 students, studied in this report, 52.2% were boys, and the mean age of the study participants was 9.75 ± 1.71 years (6–12). The mean CCT and apical thickness was 556.29 ± 34.04 and 557.43 ± 34.03 μm, respectively. The mean paracentral thickness was 657.62 ± 39.11 μm in the superior, 632.65 ± 37.63 μm in the inferior, 648.64 ± 38.75 μm in the nasal, and 617.36 ± 37.19 μm in the temporal region. A multiple regression model showed that CCT decreased by 4.70 μm with every 1 diopter increase in the mean keratometry and increased by 20.06 μm with every 1 mm increase in the anterior chamber depth (ACD) (Both P-Value < 0.001). Age, sex, ethnicity and residence place were also found to be associated with CCT. ConclusionsThis study is the first to describe the distribution of corneal thickness in Iranian children with a large sample size. This study showed that corneal thickness was significantly correlated with younger age, female gender, urban residence, and a number of biometric variables.

Evaluation of Frailty and Social Support of the Elderly in the Context of Social Vulnerability: A Study in Rural Area

Evaluation of Frailty and Social Support of the Elderly in the Context of Social Vulnerability: A Study in Rural Area

Evaluating the Situation of Environmental Culture’s Reproduction in Rural Areas (Case Study: A Pilot of Carbon Sequestration Project in Jazmourian)

Evaluating the Situation of Environmental Culture’s Reproduction in Rural Areas (Case Study: A Pilot of Carbon Sequestration Project in Jazmourian)

Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6\u201323\xa0months in Southern Benin

Poor complementary feeding practices have detrimental effects on child growth, development and survival. This cross-sectional study in rural areas of southern Benin examined some determinants of complementary feeding practices using socioeconomic and dietary data collected among 1225 primary caregivers. Determinants of complementary feeding practices in the study areas are multidimensional and include many interacting factors such as socio-economic aspects, farming practices, household demographics, cultural practices and geography. Child age, diversity of food groups produced, income allocated to feeding, commune of residence, ethnicity, caregivers’ occupation, marital status and household size were identified as the main factors affecting complementary feeding practices. Food group diversification in farm-systems and overall social behavior and support as well as women’s empowerment are necessary to improve children’s diets. Reducing women’s workload through improved working conditions appears crucial to decrease time burdens and allow more time for child care. Multisectoral interventions should be embraced to improve complementary feeding practices in Benin.

Interactive relations of type 2 diabetes and abdominal obesity to cognitive impairment: A cross-sectional study in rural area of Xi'an in China

AimsType 2 diabetes and obesity, which are frequently comorbid, have been associated with cognitive impairment. We aim to examine the potential modulating effect between obesity and diabetes on cognitive impairment. MethodsWe recruited 865 adults (aged ≥55years) lived in a village of Xi'an in China from October 2014 to March 2015. All participants underwent biomedical and neuropsychological assessment. Relations of diabetes and abdominal obesity to cognitive impairment were examined in multiple regression models. ResultsA total of 155 participants (17.9%) presented with the diagnosis of cognitive impairment. Diabetes or obesity alone wasn't significantly associated with cognitive impairment. Interaction analysis showed a significant interaction between abdominal obesity and diabetes on cognitive impairment. Stratified multivariate analysis revealed that the association between diabetes and cognitive impairment was positive in participants with abdominal obesity (OR 2.436, 95% CI 1.345–4.411, p=0.003, in diabetics with high WC, and OR 2.348, 95% CI 1.373–4.014, p=0.002, in diabetics with high WHR), but negative in those without abdominal obesity. ConclusionsType 2 diabetes interacts with abdominal obesity to be associated with an increased risk of cognitive impairment by more than two times.

Gene-environment interaction: Does fluoride influence the reproductive hormones in male farmers modified by ERα gene polymorphisms?

The occurrence of endemic fluorosis is derived from high fluoride levels in drinking water and industrial fumes or dust. Reproductive disruption is also a major harm caused by fluoride exposure besides dental and skeletal lesions. However, few studies focus on the mechanism of fluoride exposure on male reproductive function, especially the possible interaction of fluoride exposure and gene polymorphism on male reproductive hormones. Therefore, we conducted a cross-sectional study in rural areas of Henan province in China to explore the interaction between the estrogen receptor alpha (ERα) gene and fluoride exposure on reproductive hormone levels in male farmers living in the endemic fluorosis villages. The results showed that fluoride exposure significantly increased the serum level of estradiol in the hypothalamic-pituitary-testicular (HPT) axis in male farmers. Moreover, the observations indicated that fluoride exposure and genetic markers had an interaction on serum concentration of follicle-stimulating hormone and estradiol, and the interaction among different loci of the ERα gene could impact the serum testosterone level. Findings in the present work suggest that chronic fluoride exposure in drinking water could modulate the levels of reproductive hormones in males living in endemic fluorosis areas, and the interaction between fluoride exposure and ERα polymorphisms might affect the serum levels of hormones in the HPT axis in male farmers.

The Relationship between Maternal Diseases during Pregnancy and Low Birth Weight: a Nested Case-Control Study in Rural Areas of Kurdistan Province (West of Iran)

Background: Low birth weight (LBW) is considered as one of the important health indicators in evaluating prenatal care as well as determining scale of infants' health in the society. The study aimed to investigate maternal diseases during pregnancy and its impact on LBW in rural areas of Kurdistan province, Iran. Materials and Methods: This study was conducted in nested case-control study method in rural areas of Kurdistan province- Iran in 2015-2016. In this study, 182 infants less than 2,500gr as case and 364 infants weighing 2,500 g and more as control were entered the study. Information about case and control groups was extracted by investigating records of pregnant women care. Data was analyzed using software Stata-12 with point and interval estimation of odds ratio (OR) using conditional logistic regression. Results: The results of single-variable analysis of conditional logistic regression showed that there is a statistical relationship between blood pressure during pregnancy, iron deficiency anemia, mother's thyroid problems, oral and dental problems, and history of bleeding during pregnancy in case and control groups (P<0.05). The results of multivariate analysis in the presence of other factors affecting underweight during pregnancy showed that there was statistically significant relationship between iron deficiency anemia (OR=23.86, 95%CI, 9.31-61.11), blood pressure during pregnancy (OR=13.8, 95%CI, 13.8-60.65), history of bleeding during pregnancy (OR=9.21, 95%CI, 3.39-25.01), and low birth weight (P<0.05).Conclusion: The results of this study indicated significant relationship between the diseases of pregnancy (such as blood pressure during pregnancy, iron deficiency anemia, and history of bleeding during pregnancy) and Low birth weight in infants. The birth of a LBW infant can be to a large extent prevented by diagnosing and preventing these diseases and required trainings for pregnant women.

Effects of road construction noise on golden‐cheeked warblers: An update

ABSTRACTPreviously, we reported results from an impact assessment that examined the effects of road construction noise on habitat selection and productivity of an endangered songbird, the golden‐cheeked warbler (Setophaga chrysoparia; warbler hereafter), in rural Texas, USA. We found no evidence that road construction or traffic noise negatively influenced warbler territory density, territory placement, pairing success, or fledging success during 3 years of road construction activities (2007–2009). In addition, warblers exhibited few acute responses to construction noise played at close range (2008–2009). Herein, we expanded on previous results to include an additional year of construction data (2010) and 3 years of post‐construction data (2011–2013) because birds may exhibit delayed responses to disturbance. We also examined the potential influence of road construction noise and activity on warbler song characteristics because birds may sing at higher minimum frequencies if loud noise masks their communication signals. Similar to previous findings, we found no evidence that road construction or traffic noise negatively influenced warblers in our rural study area. However, noise levels varied little across experimental and control study sites, with increasing distance from the road, or between the construction and post‐construction phases of our study. Warblers may respond negatively to louder noise or other disturbances that accompany construction activities (e.g., vibrations), but our comparisons across study sites, the results of our playback experiment, and data collected during concurrent studies in urban Texas and on military land suggest this is unlikely. © 2017 The Wildlife Society.

A Cross‐Sectional Study in Rural Areas of Myanmar: The Impacts of Dietary Behaviors and Nutrition Intervention on 6‐ to 72‐Month‐Old Children

BackgroundMyanmar is the largest country in Southeast Asia geographically, with over 50 years of internal conflicts. Over half of the children suffer from malnutrition and face a higher risk of morbidity and mortality. However dietary behaviors in this area are seldom reported and its effects on child's health are still unknown.ObjectivesThe objectives of this study were: 1) to explore the possible dietary behaviors that might be associated with malnutrition, and 2) to assess the health effects of the nutrition promotion program.MethodsNine villages in the mountainous peripheral areas of Kachin, Shan, and Kokang were selected using convenience sampling. A nutrition promotion program by Health Poverty Action (HPA) was conducted in these areas half a year ago, and nutrition packages (FERROVIT, MEGA, Thailand: containing ferrous fumarate, folic acid and vitamin B12) and relief food (rice) were assigned to the head of the village or village doctors, then assigned to the target families according to personal experience. For assessment, a cluster sampling method was used for household selection and 141 children aged 6 to 72 months old participated in this study and provided the blood samples. A food frequency questionnaire was used to obtain data on dietary behaviors. Illness and nutrition related symptoms in the past three months were obtained from local medical records and caregivers' recall. Hemoglobin concentration, blood trace elements and anthropometric indicators were measured. The study was conducted in compliance with the Declaration of Helsinki and approved by local government. Written consent was obtained from all the primary caregivers.ResultsSignificant insufficient intake of food was found in the studied children. In total, 58.3% of children consumed eggs less than once a week and for meat 25.0% of children consumed it less than once a week. In weaned children, 72.4% consumed dairy products less than once a week. The intake frequencies of eggs, meat and dairy products were all positively associated with the height‐for‐age Z score and hemoglobin levels. Children with a higher frequency of egg intake were more likely to have a lower chance of diarrhea and fever. Children with a higher meat intake were more likely to have a lower rate of fever. There were no associations between food intake frequencies and blood trace elements' levels. For the nutrition promotion program, the coverage rate of the nutrition package and relief food in studied children was 37.5% and 4.7% respectively and more were assigned to children under 24 months old. The hemoglobin of children who received or did not receive nutrition package was 91.8±21.4 g/L and 104.1±16.2 g/L respectively. Meanwhile, a lower blood iron level and a higher occurrence of fever were found in children who received the nutrition package.ConclusionChildren in the mountainous peripheral areas of Myanmar still face a threat of food shortage and this contributes to malnutrition. Assign nutrients package by villages head can general cover the target malnourished population. However, the health effects were limited, partly because of the limited intervention time and partly due to a lack of constant following up and assessment.Support or Funding InformationSupported by Health Poverty Action Eastern Asia Programme Office

Social determinants of morbidity during infancy: Results from a cross-sectional study in rural areas of Assam, India

Background: Assam, one of the seven North Eastern states of India has achieved the highest decline in maternal and child mortality compared to other states, still neonatal mortality and infant mortality rates are very high. Apart from other causes, certain social factors unique to Indian subcontinent are also responsible for high mortality and morbidity among children here. Objectives: To know the prevailing morbidity conditions among the infants and to assess the social determinants of morbidity of infants in rural areas of Assam. Materials and Methods: It was a cross-sectional study conducted among 250 rural families having an infant in each family. The primary caregiver was interviewed using pre-tested semi-structured interview schedules and investigators also clinically evaluate the index child for any morbidity. Data collected regarding various sociodemographic variables of the family, morbidity status of the infant and also the environmental variables relevant to the study were analyzed tabulated and percentages, and proportions were calculated. Chi-square test was done to see the relationship between the factors. Results: The study observed that prevalence of teenage mothers was high (32.4%). Most of the mothers were primipara (41.2%), and were belonging to nuclear families of lower socioeconomic strata (57%). In our study, acute respiratory infections (33.3%), fever (24.6%), and diarrhea (21.7%) were found to be the most common morbidities among infants. Statistically significant association was also found between morbidity of infants and male gender (p=0.003) and numbers of siblings (p=0.005), use of sanitary water source (p=0.001), and excreta disposal (p=0.001). Conclusion: This study observed that social factors which influence infant morbidity included male gender and numbers of siblings, use of sanitary water source and excreta disposal, less education of mothers, less family income, and lower social class of the family.

Serum enzymes markers in myocardial infarction: A study of rural area

Background: Acute Myocardial Infarction is the reduction of coronary flow to such an extent that supply of oxygen to the myocardium do not need the oxygen demand of myocardial tissues. The diagnosis of AMI cannot be fulfilled unless the elevated levels of serum cardiac enzymes particularly CK-MB iso-enzyme activity. The rate of release of cardiac enzymes is highly diagnostic.Aims and Objectives: Therefore, the present thesis aim is-in evaluating, whether the elevated levels of cardiac marker enzymes can be compared to the extent of the Myocardial infarction.Material and Methods: Therefore the present study was undertaken on 50 patients of MI and 50 patients of control. They were group according to the age and sex. The activity of different cardiac enzymes were studied.Result: The AMI patients had significantly elevated levels of 90% patients of high LDH values and 86% patients have elevated levels of AST. The significant elevation of serum enzymes as compared to the control.Conclusion: The magnitude of the elevated levels of enzymes can be compared to the extent of the myocardial infarction. Serum GGT can also be useful marker of oxidative stress in myocardial infarction.Asian Journal of Medical Sciences Vol.8(2) 2017 34-37

FMCG Marketing: A Study in Rural Areas of India

Fast moving consumer goods (FMCG), are the goods purchased by the consumers for their own use and purchased continuously and quite frequently. The price per unit of such products usually is low, but the consumption is very high due to the requirements of everyone. Over centuries, India has always been a country inhabiting a big chunk of world population. And from such a perspective, the FMCG market potential has always been very big. At the same time, it has remained the most attractive destination for companies: both national and global. The consumer markets in India are constantly evolving. The first phase of consumer market evolution in the 1980s and the 1990s was characterised by some major structural changes: changes in income distribution, increased product availability (in terms of both quality and quantity), increased competition, increased media penetration and improved advertisement (impacting lifestyle). From the consumer's standpoint, all these developments gradually led to increase of consumer awareness and propensity to consume. The late 1990s witnessed a surge in consumer finance products owing to steady financial sector reforms in the economy and innovative marketing.

Studying Factors Affecting Quality of Life Using Multilevel Models: A Case Study in Rural Areas of Kangavar County

Purpose: Quality of life is a broad concept, which its importance is increasingly growing. This concept in general term is used to describe how humans meet their needs or the extent to which individuals and communities are satisfied with the realm of life. Because resource are always limited at all levels of planning, it must be based on the efficient use of resources. Therefore, all available rural resources and their relationships at various levels should be identified. That is because one factor or cause from a higher level as a modifier variable has an impact on the relationship of two dependent variable at a lower level and would strengthen or weaken this relationship. Methods:Therefore, in this research factors affecting the “quality of life” were studied in rural areas of Kangavr City with an emphasis on location and in the form of multi-level (three levels) factors. Data structure is hierarchical and has common features in every level, in a way that 250 observations were classified in 76 villages and 5 rural districts. Results: The results show that individual factors affect the performance of higher-level variables i.e., village administration. And these two levels have an impact on the higher-level variables like the population density and so on. Conclusion: Finally, the effects of villages and rural districts are significant, and have a significant effect on the predicted relationships.

Prevalence and risk factors of intestinal protozoan infections: a population-based study in rural areas of Boyer-Ahmad district, Southwestern Iran.

BackgroundParasitic infections are still a significant health problem in rural areas in developing countries including Iran. There is no recent population-based data about the prevalence of human intestinal parasites in most rural areas of Iran. The current study aimed to determine the prevalence of intestinal protozoan infection in inhabitants of rural areas of Boyer-Ahmad district, Southwestern Iran.MethodsA total of 1025 stool samples were collected from the inhabitant of 50 randomly selected villages in Boyer-Ahmad Township. The stool samples were evaluated by parasitological methods including, direct wet-mounting, formalin ethyl acetate concentration, zinc sulfate floatation, and Trichrome permanent stain for detection of protozoan infections. Diarrheic samples were further evaluated with a modified Ziehl–Neelsen staining method for detection of coccidian parasites.ResultsThe prevalence of both pathogenic and nonpathogenic intestinal parasites in the population was 37.5% (385 out of 1025 cases), some individual with multiple infections. Giardia lamblia was detected in 179 (17.46%), Blastocystis hominis in 182 (17.76%), Entamoeba histolytica/dispar in 9 (0.87%), Endolimax nana in 216 (21.07%), Entamoeba coli in 151 (14.73%), Ioedamoeba butschlii in 45 (4.39%), Chillomastix mesnili in 22 (2.14%), Trichomonas hominis in 2 (0.19%) and Dientamoeba fragillis in 2 (0.19%) of cases. Multivariate logistic regression revealed significant associations between protozoan infection (pathogenic protozoa) and contact with animals (OR yes/no = 2.22, p < 0.001) and educational status (OR higher/illiterate = 0.40, P = 0.01).ConclusionFindings of this study demonstrated that protozoan infection rate in rural areas of southwestern Iran is still high and remained as a challenging health problem in these areas.

A mother's choice: a qualitative study of mothers' health seeking behaviour for their children with acute diarrhoea.

BackgroundDiarrhoea presents a considerable health risk to young children and is one of the leading causes of infant mortality. Although proven cost-effective interventions exist, South Africa is yet to reach the Sustainable Development Goals set for the elimination of preventable under-five mortality and water-borne diseases. The rural study area in the Eastern Cape of South Africa continues to have a parallel health system comprising traditional and modern healthcare services. It is in this setting that this study aimed to qualitatively examine the beliefs surrounding and perceived quality of healthcare accessed for children’s acute diarrhoea.MethodsPurposive sampling was used to select participants for nine focus-group-discussions with mothers of children less than 5 years old and 11 key-informant-interviews with community members and traditional and modern practitioners. The focus-group-discussions and interviews were held to explore the reasons why mothers seek certain types of healthcare for children with diarrhoea. Data was analysed using manual thematic coding methods.ResultsIt was found that seeking healthcare from traditional practitioners is deeply ingrained in the culture of the society. People’s beliefs about the causative agents of diarrhoea are at the heart of seeking care from traditional practitioners, often in order to treat supposed supernatural causes. A combination of care-types is acceptable to the community, but not necessarily to modern practitioners, who are concerned about the inclusion of unknown ingredients and harmful substances in some traditional medicines, which could be toxic to children. These factors highlight the complexity of regulating traditional medicine.ConclusionSouth African traditional practitioners can be seen as a valuable human resource, especially as they are culturally accepted in their communities. However due to the variability of practices amongst traditional practitioners and some reluctance on the part of modern practitioners regulation and integration may prove complex.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1911-7) contains supplementary material, which is available to authorized users.

Traffic-related air pollution and hyperactivity, dyslexia and dyscalculia in German adolescents

Introduction: Few studies have examined the link between air pollution exposure and cognitive development and brain function. Our aim was to explore associations with hyperactivity problems, dyslexia and dyscalculia using adolescent participants from two German birth cohorts. Methods: Hyperactivity problems (normal/borderline/abnormal) were assessed using the German parent-completed (10 years) and self-completed (15 years) Strengths and Difficulties Questionnaires. Parent-reported dyslexia and dyscalculia at age 10 and 15 years was defined using parent-completed questionnaires. Individual-level nitrogen dioxide (NO2), particulate matter (PM)10 mass, PM2.5 mass and PM2.5 absorbance concentrations were assigned to each child's birth, 10-year and 15-year home address. Longitudinal associations between the air pollutants with hyperactivity (assessed using mixed-effects ordinal response models) and dyslexia and dyscalculia (assessed using generalized estimation equations) were adjusted for host and environmental covariates. Odds ratios and 95% confidence intervals are given per interquartile range increase in pollutant concentration. Results: In the full population (N=4684), nearly all effect estimates were above one but only a few associations reached statistical significance (between PM2.5 mass (1.81 [1.04, 3.16] per 4.0 µg/m3) and PM2.5 absorbance (1.43 [1.12, 1.83] per 0.4 10-5/m) at the 15-year address with hyperactivity (also significant for the 10-year address estimates) and between NO2 at the birth address (1.20 [1.02, 1.42] per 5.5 µg/m3) and PM2.5 mass at the 10-year address (2.86 [1.19, 6.90] per 4.0 µg/m3) with dyscalculia. Effect estimates appeared larger in the urban study area than the rural study area. Stratification by moving did not yield consistent trends. Conclusions: In this large study on German adolescents, we found limited evidence to support a link between air pollution exposure and hyperactivity, dyslexia and dyscalculia.

Índice de masa corporal y percepción de mujeres mayas obesas de Quintana Roo, México

&lt;p&gt;&lt;strong&gt;Antecedentes: &lt;/strong&gt;La preocupación por el cuerpo y las prácticas alimentarias de riesgo son dos temas que últimamente han cobrado interés entre las/os nutricionistas, pues además de observar estas características en mujeres de población urbana de diversas edades, estudios realizados en zonas rurales, con población mestiza e indígena de México, evidencian que el problema ya se presenta en mujeres pobres y marginadas. &lt;strong&gt;Objetivo:&lt;/strong&gt; conocer la percepción corporal de mujeres que viven en zonas mayas de México. &lt;strong&gt;Métodos:&lt;/strong&gt; El estudio tuvo dos fases: una cuantitativa, a través de la aplicación de un cuestionario y otra cualitativa que consistió en la realización de grupos focales. Se pesó y midió a mujeres en la comunidad maya de Chun-Yah en el estado de Quintana Roo y se les solicitó que eligieran una figura anatómica con la que se identificaran según su percepción. &lt;strong&gt;Resultados:&lt;/strong&gt; Se obtuvo su índice de masa corporal, su percepción y su deseo por tener un determinado cuerpo. Se encuestó a 51 mujeres mayas en la primera fase quienes tuvieron un promedio de peso de 65 Kg, de estatura de 1.42 m y un IMC de 31.5 kg/m², y más de la mitad se percibieron delgadas. Durante la realización de los grupos focales se detectó una ambivalencia entre su percepción y deseo pues en la comunidad la gordura no es tan estigmatizada. &lt;strong&gt;Conclusiones:&lt;/strong&gt; se discute la necesidad de realizar más estudios empíricos en poblaciones rurales y discutir categorías de análisis diferentes a las biomédicas, como medicalización, lipofobia y discurso médico.&lt;/p&gt;

Medical care ideals among urban and rural residents in Thailand: a qualitative study.

BackgroundHealth care is generally considered to be more highly valued in urban areas than in rural areas. However, studies have reported that there is no difference in the health care values of urban and rural areas in the Kingdom of Thailand, with some studies even indicating that these values are stronger in rural areas. We, therefore, conducted interviews and implemented a qualitative investigation and analysis aimed at elucidating ideals relating to the medical environment among the Kingdom’s urban and rural citizens.MethodsThe study targeted Thai citizens residing in urban and rural areas. The city of Khon Kaen, located in Khon Kaen Province in northeastern Thailand, was selected as the urban area for the study. We selected Donyang village, located in the same province, as the rural study area. In July 2014, we conducted semi-structured group interviews, applying the Constructivist Grounded Theory (CGT) analytical approach.ResultsWe interviewed ten people in Khon Kaen (the urban area) and seven people from Donyang village (the rural area). Five major and distinctive themes emerged from the interviews. These were: locally appropriate standards of medical care, support for local lifestyles, satisfaction with local medical personnel, healthy lifestyles that do not rely on medical services, and desire for regional autonomy/desire to serve the region in terms of medical care. All of these themes were evident in both study areas. Thus, rather than relying on advanced medical services, both urban and rural Thai citizens expressed the desire to continue living within communities (considered as “families”), contributing to them, and tending to all of their health care needs within their communities.ConclusionsThis study revealed five common themes relating to forms of medical care regarded as ideal among urban and rural citizens of Thailand. Its findings could potentially have important implications for areas characterized by urban–rural inequities relating to the accessibility and utilization of medical services.

Cohort Effects in the Prevalence and Survival of People with Dementia in a Rural Area in Northern Sweden.

Recent studies suggest that trends in cardiovascular risk may result in a decrease in age-specific prevalence of dementia. Studies in rural areas are rare. To study cohort effects in dementia prevalence and survival of people with dementia in a Swedish rural area. Participants were from the 1995-1998 Nordanstig Project (NP) (n = 303) and the 2001-2003 Swedish National study on Aging and Care in Nordanstig (SNAC-N) (n = 384). Overall 6-year dementia prevalence and mortality in NP and SNAC-N were compared for people 78 years and older. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for dementia occurrence using the NP study population as the reference group. Cox regression models were used to analyze time to death. The crude prevalence of dementia was 21.8% in NP and 17.4% in SNAC-N. When the NP cohort was used as the reference group, the age- and gender-adjusted OR of dementia was 0.71 (95% CI 0.48-1.04) in SNAC-N; the OR was 0.47 (0.24-0.90) for men and 0.88 (0.54-1.44) for women. In the extended model, the OR of dementia was significantly lower in SNAC-N than in the NP cohort as a whole (0.63; 0.39-0.99) and in men (0.34; 0.15-0.79), but not in women (0.81; 0.46-1.44). The Cox regression models indicated that the hazard ratio of dying was lower in the SNAC-N than NP population. Trends toward a lower prevalence of dementia in high-income countries seem to be evident in this Swedish rural area, at least in men.