Interbirth interval practices among reproductive age women in rural and Urban kebeles in Farta Woreda: Case-control study.

BACKGROUND: Closely spaced births have been reported all over the world especially in developing countries, and they have been correlated with poor maternal and infant health. Enhancing optimal birth interval is one of the key strategies to promote the health status of mothers and their children. However, factors affecting short birth intervals have not been identified in the study area and region. This study was aimed to assess determinants of short birth interval practice among reproductive women in Farta woreda, Ethiopia, 2019. METHODS: Community based unmatched case-control study design was conducted from February to March 2019. The sample size of 303 (101 case and 202 controls) was included by using multistage sampling and then study participants were selected by simple random sampling technique. The data was collected by structured and pre-tested face-to-face interviewer-administered questionnaires from the selected respondents. The collected data were entered with Epi-Data version 4.2 and analyzed by using SPSS version 23 software. Bivariate and multivariate analyses were used to examine the association. Odds ratios, 95% CI, and P-value <0.05 were used to determine the statistical association. RESULTS: Women who had no formal education (AOR = 2.15, 95% CI (1.19, 3.88), had not a history of antenatal care follow up (AOR = 2.66, 95% CI (1.55, 4.56)), did not use modern contraceptives before getting the latest pregnancy (AOR = 3.48, 95% CI (1.74, 6.95)) and duration of breastfeeding less than 24 months (AOR = 3.59, 95% CI (2.06, 6.24)) were significantly associated with short birth interval. CONCLUSIONS AND RECOMMENDATION: Maternal education, duration of breastfeeding, contraceptive utilization, and antenatal follow-up were identified as the predictor variables of short birth interval practice. Therefore, providing health information for reproductive-age women about the benefit of contraceptive utilization, breastfeeding practice and antenatal care follow up to minimize problems resulting from the short birth intervals.

Which Definition of Rurality Should I Use?: The Relative Performance of 8 Federal Rural Definitions in Identifying Rural-Urban Disparities.

BACKGROUND: The federal government uses multiple definitions for identifying rural communities based on various geographies and different elements of rurality. OBJECTIVES: The objectives of this study were to: (1) assess the degree to which rural definitions identify the same areas as rural; and (2) assess rural-urban disparities identified by each definition across socioeconomic, demographic, and health access and outcome measures. RESEARCH DESIGN: We determined the rural status of each census tract and calculated the rural-urban disparity resulting from each definition, as well as across the number of definitions in which tracts were designated as rural (rurality agreement). SUBJECTS: The population in 72,506 census tracts. MEASURES: We used 8 federal rural definitions. Population characteristics included percent with a bachelor's degree, income below 200% poverty, population density, percent with health insurance and whether various health care services were within 30 minutes driving time of the tract centroid. RESULTS: The rural population varied from slightly < 6.9 million people to >75.5 million across definitions. The largest rural-urban disparities were found using Urban Influence Codes. Urbanized Area and Urbanized Cluster tended to generate smaller disparities. Population characteristics such as population density and percent White had notable discontinuities across levels of rurality, while others such as percent with a bachelor's degree and income below 200% poverty varied continuously. CONCLUSIONS: Rural-urban populations and disparities were sensitive to the specific definition and the relative strength of definitions varied across population characteristics. Researchers and policymakers should carefully consider the choice of outcome and region when deciding the most appropriate rural definition.

County Reclassifications and Rural-Urban Mortality Disparities in the United States (1970-2018).

Objectives. To demonstrate how inferences about rural-urban disparities in age-adjusted mortality are affected by the reclassification of rural and urban counties in the United States from 1970 to 2018.Methods. We compared estimates of rural-urban mortality disparities over time, produced through a time-varying classification of rural and urban counties, with counterfactual estimates of rural-urban disparities, assuming no changes in rural-urban classification since 1970. We evaluated mortality rates by decade of reclassification to assess selectivity in reclassification.Results. We found that reclassification amplified rural-urban mortality disparities and accounted for more than 25% of the rural disadvantage observed from 1970 to 2018. Mortality rates were lower in counties that reclassified from rural to urban than in counties that remained rural.Conclusions. Estimates of changing rural-urban mortality differentials are significantly influenced by rural-urban reclassification. On average, counties that have remained classified as rural over time have elevated mortality. Longitudinal research on rural-urban health disparities must consider the methodological and substantive implications of reclassification.Public Health Implications. Attention to rural-urban reclassification is necessary when evaluating or justifying policy interventions focusing on geographic health disparities.

Metropolitan Reclassification and the Urbanization of Rural America.

We highlight the paradoxical implications of decadal reclassification of U.S. counties (and America's population) from nonmetropolitan to metropolitan status between 1960 and 2017. Using data from the U.S. Census Bureau, we show that the reclassification of U.S. counties has been a significant engine of metropolitan growth and nonmetropolitan decline. Over the study period, 753-or nearly 25% of all nonmetropolitan counties-were redefined by the Office of Management and Budget (OMB) as metropolitan, shifting nearly 70 million residents from nonmetropolitan to metropolitan America by 2017. All the growth since 1970 in the metropolitan share of the U.S. population came from reclassification rather than endogenous growth in existing metropolitan areas. Reclassification of nonmetropolitan counties also had implications for drawing appropriate inferences about rural poverty, population aging, education, and economic growth. The paradox is that these many nonmetropolitan "winners"-those experiencing population and economic growth-have, over successive decades, left behind many nonmetropolitan counties with limited prospects for growth. Our study provides cautionary lessons regarding the commonplace narrative of widespread rural decline and economic malaise but also highlights the interdependent demographic fates of metropolitan and nonmetropolitan counties.

Health-related quality of life and determinants in North-China urban community residents.

BACKGROUND: The objectives of this study were to investigate the HRQoL of residents living in central urban areas (CUA) and developing neighborhoods (DN) areas of North-China and to examine the relationship between health conditions and the physical and mental components of quality of life. METHODS: A stratified random sample was taken and health survey scoring system questionnaire SF-36 was used to conduct the HRQoL survey among community residents in the two selected districts in 10 cities. A general questionnaire was also administered with questions that collected general information, population demographic characteristics and health behaviours, social relationships and perception of life satisfaction. RESULTS: Five thousand eight hundred eighty-one questionnaires were returned from 6059 invitations with a effective response rate of 97%. The residents in DN had a higher score of physical function, role limitation due to physical problems and vitality than those living in CUA. The prevalence of several chronic diseases was lower in DN's residents than CUA's residents. Age, presence/absence of chronic diseases, leisure time exercise, regular daily routine, sleep quality, appetite, family and social relationships and life satisfaction were significant determinants of HRQoL. CONCLUSIONS: Residents living in newly developed neighborhoods in China while keeping some habits and lifestyles of their original rural communities are healthier in terms of chronic diseases and HRQoL. Together with other risk factors chronic diseases are an important determinant on HRQoL. Several healthy habits and behaviors such as having a regular daily routine and exercising during leisure time improved HRQoL in Chinese urban communities. Targeted policies of public health based on these findings can better the health-related quality of life.

Does "Rural" Always Mean the Same? Macrosocial Determinants of Rural Populations' Health in Poland.

Rural areas, as well as urban ones, are not homogeneous in terms of social and economic conditions. Those surrounding large urban centers (suburban rural areas) act different roles than those located in remote areas. This study aims to measure the level of inequalities in social determinants of health (SDH) between two categories of rural areas. We pose the following research hypotheses: (hypothesis H1) rural areas in Poland are relatively homogenous in the context of SDH and (hypothesis H2) SDH affects life expectancies of rural residents. Based on data covering all rural territories, we found that rural areas in Poland are homogenous in SDH. We also find important determinants of health rooted in a demographic structure-the feminization index and a ratio of the working-age population. On the other hand, we cannot confirm the influence of commonly used SDH-GDP and unemployment rate.

Depression and binge drinking in farm and non-farm rural adults in Saskatchewan, Canada.

INTRODUCTION: Despite some attention paid to farm stress in the popular press, recent Canadian research examining the mental wellbeing of farming populations relative to other rural dwellers is sparse. International research on the topic has shown inconsistent findings and has mainly focused on men. The objective of the present study was to examine the correlates of mental health among rural Saskatchewan women and men, positioning farm/non-farm residence as a main explanatory variable, and depression and binge drinking as measures of mental health. METHODS: The cross-sectional sample consisted of 1701 women (47.8% farm) and 1700 men (53.3% farm) who participated in the 2014 phase of the Saskatchewan Rural Health Study, a prospective cohort study primarily examining the respiratory health of rural people in the southern part of the province of Saskatchewan, Canada. Data were collected using mailed self-report questionnaires and included measures of mental health assessing health professional diagnosed depression and binge drinking, in addition to a broad array of demographic characteristics, stressors and resources. Multiple logistic regression was the primary method of analysis; generalized estimating equations were utilized to account for household clustering. All analyses were conducted separately for women and men and by mental health indicator. RESULTS: Farm/non-farm residence was related to depression but only under particular circumstances, which in turn differed by gender. In women, non-farm residents with two or more chronic conditions reported more depression than their farm counterparts (odds ratio (OR)=2.62; 95% confidence interval (CI) 1.28-5.36); non-farm men with secondary school education reported greater depression than farm-dwelling men (OR=2.93; 95%CI 1.31-6.59). The remaining correlates of depression were generally consistent with previous research in rural populations, including younger age, being non-partnered (men only), higher stress, greater financial strain (women only) and lower social support (women only). Binge drinking was significantly elevated in non-farm women (OR=1.68; 95%CI 1.21-2.33) and non-farm men (OR=1.70; 95%CI 1.33-2.17) compared to the farming population. Among women only, not having access to a regular family doctor/nurse practitioner was associated with an increased likelihood of binge drinking (OR=2.05; 95%CI 1.13-3.71) compared to women perceiving better access. CONCLUSION: The present study is one of very few recently published quantitative studies of the correlates of mental health among farm and non-farm adults in rural Canada. The findings suggest that non-farm dwellers in rural Saskatchewan may be more vulnerable to compromised mental health than their farming counterparts. Additional research employing a longitudinal design and enhanced measurement is required to confirm or refute these findings.

Defining Rural: The Predictive Value of Medical School Applicants' Rural Characteristics on Intent to Practice in a Rural Community.

PURPOSE: To understand the predictive value of medical student application characteristics on rural practice intent. METHOD: The authors constructed a linked database of 2012-2017 medical school matriculants from American Medical College Application Service applications and Association of American Medical Colleges Matriculating Student Questionnaire (MSQ, 2012-2017) and Graduation Questionnaire (GQ, 2016-2018). Using logistic regression, they compared application variables (birth, high school, childhood county, and self-declared geographical origin) to students' MSQ and GQ intent to practice rurally. Rural practice intent from matriculation to graduation was compared using the McNemar test for paired nominal data. RESULTS: The number of students meeting inclusion criteria was 115,027. More students self-declared rural origin (18,662; 16.4%) than were identified using geographically coded variables (6,097-8,784; 6.1%-8.1%). Geographically coded rural variables were all strongly and similarly associated with rural practice intent, with rural high school being the most predictive on both MSQ (odds ratio [OR], 6.51; CI, 6.1-7.0) and GQ (OR, 5.4; CI, 4.9-6.0). Self-declared geographical origin was associated with a similar rural practice intent on both MSQ (OR, 6.93; CI, 6.5-7.3) and GQ (OR, 5.69; CI, 5.2-6.2). Rural practice intent declined for all groups from matriculation to graduation. CONCLUSIONS: Considering students who self-declare as rural identifies a larger group of rural medical school applicants than more "objective" geographic variables, without negatively impacting students' predicted interest in eventual rural practice. Further research should track actual practice location and explore strategies to mitigate declining rural career interest.

Examining Key Stakeholder and Community Residents' Understanding of Environmental Influences to Inform Place-Based Interventions to Reduce Obesity in Rural Communities, Kentucky 2015.

PURPOSE: Rural residents report high rates of obesity, physical inactivity, and poor eating habits. The objectives of this study were to (1) use the collective impact model to guide efforts to elicit community members' perceptions of county-specific factors influencing high obesity rates; (2) determine the association between utilization of food retail venues and concern about obesity and healthy eating; and (3) determine community members' utilization of physical activity infrastructure and concern about physical inactivity. METHODS: The study was conducted in 6 rural counties in Kentucky with adult obesity prevalence rates >40%. Community stakeholders met to assess counties' needs and assets in implementing interventions to reduce obesity in their communities. A random-digit dial survey (n = 756) also was conducted to examine awareness and availability of community resources for healthy eating and physical activity. FINDINGS: Stakeholders identified lack of access to fruits and vegetables and poor physical activity infrastructure as contributors to obesity. Reporting moderate and serious concern about obesity and healthy eating was associated with higher odds of shopping at a supercenter compared with those expressing little concern. Reported access to information about physical activity opportunities was associated with higher odds of reporting the availability of safe places for physical activity, sidewalks, and trails compared with those who reported that information was difficult to obtain. CONCLUSIONS: This study elicits community-identified barriers to healthy behaviors and provides foundational data to inform future place-based obesity reduction interventions.

Do the classification of areas and distance matter to the assessment results of achieving the treatment targets among type 2 diabetes patients?

BACKGROUND: Type 2 diabetes is a major health concern all over the world. The prevention of diabetes is important but so is well-balanced diabetes care. Diabetes care can be influenced by individual and neighborhood socio-economic factors and geographical accessibility to health care services. The aim of the study is to find out whether two different area classifications of urban and rural areas give different area-level results of achieving the targets of control and treatment among type 2 diabetes patients exemplified by a Finnish region. The study exploits geo-referenced patient data from a regional primary health care patient database combined with postal code area-level socio-economic variables, digital road data and two grid based classifications of areas: an urban-rural dichotomy and a classification with seven area types. METHODS: The achievement of control and treatment targets were assessed using the patient's individual laboratory data among 9606 type 2 diabetes patients. It was assessed whether hemoglobin A1c (HbA1c) was controlled and whether the recommended level of HbA1c was achieved in patients by different area classes and as a function of distance. Chi square test and logistic regression analysis were used for testing. RESULTS: The study reveals that area-level inequalities exist in the care of type 2 diabetes in a detailed 7-class area classification but if the simple dichotomy of urban and rural is applied differences vanish. The patient's gender and age, area-level education and the area class they belonged to were associated with achievements of control and treatment targets. Longer distance to health care services was not a barrier to good achievements of control or treatment targets. CONCLUSIONS: A more detailed grid-based area classification is better for showing spatial differences in the care of type 2 diabetes patients. Inequalities exist but it would be misleading to state that the differences are simply due to urban or rural location or due to distance. From a planning point of view findings suggest that detailed geo-coded patient information could be utilized more in resourcing and targeting the health care services to find the area-level needs of care and to improve the cost-efficient allocation of resources.

Knowledge and associated factors towards type 2 diabetes among a rural population in the Red River Delta region, Vietnam.

INTRODUCTION: Knowledge about type 2 diabetes (T2D) and attitude towards the condition are known to affect compliance and play an important role in diabetes management. T2D knowledge is a prerequisite for individuals and communities to take action on control of the disease. METHODS: A cross-sectional study was designed to identify knowledge and related factors towards T2D, risk factors, complications, prevention and treatment of the disease. A total of 2580 subjects representative of the general population aged 40-64 years was recruited from a typical province of Red River Delta region, Vietnam. The trained surveyors interviewed subjects directly to collect data, using a structured questionnaire. To evaluate the overall knowledge of T2D, 14 questions were used to calculate the 100 points. Total knowledge score was classified into the following four categories: highly insufficient (≤25 points), insufficient (26-50 points), satisfactory (51-75 points), and highly satisfactory (>75 points). Association between inadequate knowledge (<50 points) and variables was evaluated using multivariate logistic regression. RESULTS: The highly insufficient, insufficient, satisfactory, and highly satisfactory levels of the overall knowledge were 75, 17.9, 6.8, and 0.3%, respectively. Of the total population, more than 65% thought that there is no cure for diabetes, and more than 90% did not know the essential combination of drugs, diet, and physical activity in T2D treatment. Less than 10% of the population understood the concept of T2D, its risk factors, complications, approaches to prevention and treatment. The rural-urban difference of T2D knowledge was found in rates of understanding at least one risk factor (34.8% vs 63%), all the three methods for T2D prevention (1.7% vs 10.3%), and three combined approaches for T2D treatment (8.9% vs 16.4%). Age, residence, educational level, and occupation were the most significant factors associated with inadequate knowledge. CONCLUSIONS: The study shows a low level of diabetes knowledge among the general population aged 40-64 years in the Red River Delta, and significantly lower awareness in rural areas compared with urban areas. The limited awareness has indicated the urgent need for communication and education to improve the T2D knowledge of the Vietnamese population on risk factors, serious level, complications, prevention and treatment, taking into account the age, residence, educational level, and occupation of the subjects.

A Rural Taxonomy of Population and Health-Resource Characteristics.

This policy brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics; and discusses how this classification tool can be utilized by policy makers and rural communities. Key Findings. (1) We classified 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. (2) In descending order, the most significant dimensions in our classification were facility resources, provider resources, economic resources, and age distribution. (3) Each type of rural place was distinct from other types of places based on one or two defining dimensions.

Availability, Price, and Quality of Fruits and Vegetables in 12 Rural Montana Counties, 2014.

We assessed the consumer food environment in rural areas by using the Nutrition Environment Measures Survey for Stores (NEMS-S) to measure the availability, price, and quality of fruits and vegetables. We randomly selected 20 grocery stores (17 rural, 3 urban) in 12 Montana counties using the 2013 US Department of Agriculture's rural-urban continuum codes. We found significant differences in NEMS-S scores for quality of fruits and vegetables; of 6 possible points, the mean quality score was 4.5; of rural stores, the least rural stores had the highest mean quality scores (6.0). Intervention strategies should aim to increase fruit and vegetable quality in rural areas.

2013 NCHS Urban-Rural Classification Scheme for Counties.

OBJECTIVES: This report details development of the 2013 National Center for Health Statistics' (NCHS) Urban-Rural Classification Scheme for Counties (update of the 2006 NCHS scheme) and applies it to health measures to demonstrate urban-rural health differences. METHODS: The methodology used to construct the 2013 NCHS scheme was the same as that used for the 2006 NCHS scheme, but 2010 census-based data were used rather than 2000 census-based data. All U.S. counties and county-equivalent entities are assigned to one of six levels (four metropolitan and two nonmetropolitan) based on: 1) their February 2013 Office of Management and Budget designation as metropolitan, micropolitan, or noncore; 2) for metropolitan counties, the population size of the metropolitan statistical area (MSA) to which they belong; and 3) for counties in MSAs of 1 million or more, the location of principal city populations within the MSA. The 2013 and 2006 NCHS schemes were applied to data from the National Vital Statistics System (NVSS) and National Health Interview Survey (NHIS) to illustrate differences in selected health measures by urbanization level and to assess the magnitude of differences between estimates from the two schemes. RESULTS AND CONCLUSIONS: County urban-rural assignments under the 2013 NCHS scheme are very similar to those under the 2006 NCHS scheme. Application of the updated scheme to NVSS and NHIS data demonstrated the continued usefulness of the six categories for assessing and monitoring health differences among communities across the full urbanization spectrum. Residents of large central and large fringe metro counties differed substantially on many health measures, illustrating the importance of continuing to separate these counties. Residents of large fringe metro counties generally fared better than residents of less urban counties. Estimates obtained from the 2013 and 2006 schemes were similar.

Estudo Etnobotânico de plantas medicinais utilizadas pela Comunidade do Sisal no município de Catu, Bahia, Brasil / Ethnobotanical study of medicinal plants used by the Sisal Community in the city of Catu, Bahia, Brazil

A utilização de plantas medicinais é instintiva nos animais, visto que alguns destes buscam raízes, cascas, folhas ou frutos na tentativa de resolver seus males. O homem, por sua vez, aprendeu a utilizar estas informações empiricamente para fazer uso destes vegetais. A medicina popular é uma importante alternativa, provavelmente, a mais usada para a cura de doenças por parte de populações indígenas, quilombolas ou rurais. A Etnobotânica, por sua vez, encarrega-se de estudar e interpretar essa relação dos homens com o mundo vegetal. Devido ao seu grande potencial biológico e cultural, o Brasil apresenta uma infinidade de conhecimentos tradicionais e espécies vegetais importantes, o que torna esse país uma grande fonte de pesquisa na área. Visando avaliar o conhecimento tradicional da população rural do Sisal, Catu/Bahia, relacionado ao uso de plantas medicinais, este trabalho iniciou-se em julho de 2009, constando de entrevistas semi-estruturadas e estruturadas, gravações, registros fotográficos, coleta do material botânico indicado nas entrevistas com os informantes, tratamento do material coletado e incorporação ao Herbário da Universidade do Estado da Bahia (HUNEB). Foram identificadas e coletadas 54 espécies distribuídas em 46 gêneros e 28 famílias, sendo Lamiacaeae e Asteraceae as mais representativas. A maioria das plantas é constituída de ervas e cultivada nos quintais dos moradores. O estudo revelou que a comunidade apresenta uma medicina popular bastante rica, com grande diversidade de espécies vegetais e usos por parte da população.

The use of medicinal plants is instinctive in animals, since some of these seek roots, bark, leaves or fruits in an attempt to cure their diseases. Man, in turn, learned to use this information on the use of these plants empirically. Folk medicine is an important alternative, probably the most used to cure diseases by indigenous peoples, Afro-descendants and rural populations. Ethnobotany, in turn, undertakes to study and interpret the relationship of men with the plant world. Because of its great biological and cultural potential, Brazil has a wealth of traditional knowledge and important plant species, what makes this country a great source of research in the area. To evaluate the traditional knowledge of the rural population of Sisal, city of Catu, state of Bahia, Brazil, related to use of medicinal plants, this work began in July 2009, consisting of semi-structured and structured interviews, recordings, photographs, collection of botanical material indicated in the interviews with informants, treatment of the collected material and incorporation into the Herbarium of the University of Bahia (HUNEB). We identified and collected 54 species in 46 genera and 28 families, being Asteraceae and Lamiacaeae the most representative. Most plants are herbs grown in the backyards of the residents. The study revealed that the community has a very rich folk medicine, with a great diversity of plant species and uses by the population.

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

[Morphological and molecular identification of canine filariae in a semi-rural district of the Metropolitan Region in Chile]. / Identificación morfológica y molecular de filarías caninas en una comuna semi-rural de la Región Metropolitana, Chile.

INTRODUCTION: To date, there has been no definitive confirmation of the presence of zoonotic dirofilariasis in dogs in Chile. OBJECTIVES: To study the presence of dirofilarias in blood samples from dogs collected in a semi-rural district near Santiago and to compare their frequency in dogs with and without dermatological manifestations. METHODS: We examined 100 blood samples for dog filariae infections using microscopic methods (modified Knott technique). 50 dogs presented dermatological symptoms or signs compatible with filarial infections and 50 were asymptomatic. ITS-2 and 12s rDNA gene amplification by PCR and sequencing were performed in samples microscopically positive for microfilariae. Results. We observed microfilariae in 22 dogs (22%). Of these, 16/50 (32%) were symptomatic and 6/50 (12%) were asymptomatic (p = 0.02). Morphologically, the majority of micro-filariae were similar to Dirofilaria repens, although many had a bigger size than previously described. Nucleotide sequencing of the amplified genes showed no more than 95% homology with the D. repens sequences available for comparison. D. reconditum and D. dracunculoides infections were also identified. CONCLUSIONS: These features might indicate the presence of new species of Dirofilaria or a D. repens close related variant in Chile.

Does availability of physical activity and food outlets differ by race and income? Findings from an enumeration study in a health disparate region.

BACKGROUND: Low-income, ethnic/racial minorities and rural populations are at increased risk for obesity and related chronic health conditions when compared to white, urban and higher-socio-economic status (SES) peers. Recent systematic reviews highlight the influence of the built environment on obesity, yet very few of these studies consider rural areas or populations. Utilizing a CBPR process, this study advances community-driven causal models to address obesity by exploring the difference in resources for physical activity and food outlets by block group race and income in a small regional city that anchors a rural health disparate region. To guide this inquiry we hypothesized that lower income and racially diverse block groups would have fewer food outlets, including fewer grocery stores and fewer physical activity outlets. We further hypothesized that walkability, as defined by a computed walkability index, would be lower in the lower income block groups. METHODS: Using census data and GIS, base maps of the region were created and block groups categorized by income and race. All food outlets and physical activity resources were enumerated and geocoded and a walkability index computed. Analyses included one-way MANOVA and spatial autocorrelation. RESULTS: In total, 49 stores, 160 restaurants and 79 physical activity outlets were enumerated. There were no differences in the number of outlets by block group income or race. Further, spatial analyses suggest that the distribution of outlets is dispersed across all block groups. CONCLUSIONS: Under the larger CPBR process, this enumeration study advances the causal models set forth by the community members to address obesity by providing an overview of the food and physical activity environment in this region. This data reflects the food and physical activity resources available to residents in the region and will aid many of the community-academic partners as they pursue intervention strategies targeting obesity.

NCHS urban-rural classification scheme for counties.

OBJECTIVES: This report details the National Center for Health Statistics' (NCHS) development of the 2006 NCHS Urban-Rural Classification Scheme for Counties and provides some examples of how the scheme can be used to describe differences in health measures by urbanization level. METHODS: The 2006 NCHS urban-rural classification scheme classifies all U.S. counties and county-equivalents into six levels--four for metropolitan counties and two for nonmetropolitan counties. The Office of Management and Budget's delineation of metropolitan and nonmetropolitan counties forms the foundation of the scheme. The NCHS scheme also uses the cut points of the U.S. Department of Agriculture Rural-Urban Continuum Codes to subdivide the metropolitan counties based on the population of their metropolitan statistical area (MSA): large, for MSA population of 1 million or more; medium, for MSA population of 250,000-999,999; and small, for MSA population below 250,000. Large metro counties were further separated into large central and large fringe metro categories using classification rules developed by NCHS. Nonmetropolitan counties were assigned to two levels based on the Office of Management and Budget's designated micropolitan or noncore status. The 2006 scheme was applied to data from the National Vital Statistics System (NVSS) and the National Health Interview Survey (NHIS) to illustrate its ability to capture health differences by urbanization level. RESULTS AND CONCLUSIONS: Application of the 2006 NCHS scheme to NVSS and NHIS data shows that it identifies important health disparities among communities, most notably those for inner city and suburban communities. The design of the NCHS Urban-Rural Classification Scheme for Counties makes it particularly well-suited for assessing and monitoring health differences across the full urbanization continuum.

Identificación morfológica y molecular de filarías caninas en una comuna semi-rural de la Región Metropolitana, Chile / Morphological and molecular identification of canine filariae in a semi-rural district of the Metropolitan Region in Chile

Introduction: To date, there has been no definitive confirmation of the presence of zoonotic dirofilariasis in dogs in Chile. Objectives: To study the presence of dirofilarias in blood samples from dogs collected in a semi-rural district near Santiago and to compare their frequency in dogs with and without dermatological manifestations. Methods: We examined 100 blood samples for dog filariae infections using microscopic methods (modified Knott technique). 50 dogs presented dermatological symptoms or signs compatible with filarial infections and 50 were asymptomatic. ITS-2 and 12s rDNA gene amplification by PCR and sequencing were performed in samples microscopically positive for microfilariae. Results. We observed microfilariae in 22 dogs (22%). Of these, 16/50 (32%) were symptomatic and 6/50 (12%) were asymptomatic (p = 0.02). Morphologically, the majority of micro-filariae were similar to Dirofilaria repens, although many had a bigger size than previously described. Nucleotide sequencing of the amplified genes showed no more than 95% homology with the D. repens sequences available for comparison. D. reconditum and D. dracunculoides infections were also identified. Conclusions: These features might indicate the presence of new species of Dirofilaria or a D. repens close related variant in Chile.

Introducción: A la fecha no hay datos concluyentes en Chile respecto a la presencia de dirofilariasis zoonótica en perros. Objetivos: Identificar la presencia de dirofilarias en sangre de perros de una comuna semi-rural cercana a Santiago y comparar su frecuencia en animales con y sin manifestaciones dermatológicas. Materialy Métodos. Se examinó un frotis sanguíneo de 100 perros en busca de microfilarias mediante observación microscópica (técnica de Knott modificada). Cincuenta perros presentaban síntomas o signos dermatológicos que se han asociado a esta parasitosis y 50 eran asintomáticos. Se amplificaron los genes ITS-2 y 12s ADNr de filarías en las muestras con microfilarias al frotis, secuenciando los fragmentos amplificados. Resultados: Se observaron microfilarias en 22 perros (22%), 16/50 (32%) sintomáticos y 6/50 (12%) asintomáticos (p = 0,02). Morfológicamente, la mayoría de las microfilarias observadas fueron similares a D. repens; sin embargo, una gran proporción mostró un tamaño mayor al descrito para esta especie. Las secuencias nucleotídicas de los genes amplificados mostraron una homología no mayor al 95% con las secuencias de D. repens disponibles para comparación. Se identificaron además dos especies poco patógenas, D. reconditum por morfología y secuenciación genética y D. dracunculoides por morfología. Conclusiones: Los resultados indican la existencia de una nueva especie de Dirofilaria cercanamente relacionada a D. repens o de una variante de esta especie.