Women's fertility desires and contraceptive behavior in three peri-urban communities in sub Saharan Africa.

BACKGROUND: Fertility desires and contraceptive behavior often change over time. This study examined the influence of change in fertility desires on change in modern contraceptive use over time in three peri-urban communities in sub-Saharan Africa. METHODS: This multi-site study includes baseline and follow up data from 3 sites in the Family Health and Wealth Study. Following a census in each site, a probability sample of at least 500 households was obtained. Generalized linear models were employed. RESULTS: Modern contraceptive use increased in Ipetumodu, Nigeria (29.4% to 36.7%), but declined slightly in Sebeta, Ethiopia (66.9% to 61.3%) and Asawase, Ghana (12.6% to 10.8%). Across sites, at baseline and follow up, women who wanted no more children reported more contraceptive use, compared with those who wanted more children, and were more likely to shift to being contraceptive users in Ipetumodu [aOR(95% CI):1.55 (1.07,2.26)]. CONCLUSIONS: Women's fertility desires influenced their contraceptive behavior, although there were cross-site differences. Changing contraceptive demand and program factors will be important to enable peri-urban women to frame and act on their fertility desires.

Under fire: gun violence is not just an urban problem.

BACKGROUND: Gun violence continues to be a source of trauma patient morbidity and mortality annually in the United States. We sought to characterize gun violence in the combined suburban and rural county of Lancaster, PA, and compare it with gun violence results obtained in urban areas. MATERIALS AND METHODS: All gunshot wound (GSW) admissions from January 2000-December 2013 were queried from trauma registry. Patients sustaining ball bearing/ball bullet (BB) or pellet gun injury were excluded. Data collected included mortality, injury severity score (ISS), number of GSW per patient, and cost data. Linear trend tests assessed the change in mortality, patients with three or more GSWs, and patients with an ISS ≥15 and ISS ≥25 over the study period. Statistical significance was defined as P < 0.05. RESULTS: A total of 478 patients met our inclusion criteria. Linear trend tests revealed no significant changes in percent mortality (P = 0.973), percent of patients with three or more GSWs (P = 0.692), percent of patients with an ISS ≥15 (P = 0.545), and percent of patients with an ISS ≥25 (P = 0.343) over the 14-y study period. No significant change in cost per case was observed over the study period (P = 0.246); however, percent reimbursement significantly increased (P = 0.012). CONCLUSIONS: In the relatively affluent suburban and rural community of Lancaster, PA, there is a low-level pattern of gunshot violence and subsequent mortality that has not changed over time. This continuing pattern of gunshot violence speaks to the need for development of innovative preventative measures, as well as continuing efforts against gunshot violence by health care and law-enforcement personnel in suburban and urban centers alike.

Temporal and geographic shifts in urban and nonurban cocaine-related fatal overdoses in British Columbia, Canada.

PURPOSE: Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada. METHODS: We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and non-cocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases. RESULTS: During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province. CONCLUSIONS: Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.

[Adapting the answers to new problems of living in a changing society]. / Adeguare le risposte ai nuovi problemi dell'abitare in una società che cambia.

The paper focuses on the health consequences of recent social and economic changes and stresses on the issue of housing emergency, both in quantitative and qualitative terms. What emerges is a bleak picture, especially in the suburbs of large cities, with sanitation problems comparable to those of the time of the Unity of Italy. Authors then analyze the evidence of risk related to degradation of housing and present some examples that quantify the effectiveness of environmental improvement on health. The work concludes stressing the need to bring this issue back to center of the Public Health agenda, both in terms of health impact assessment, both in terms of training and awareness of the different social actors involved, also recovering a political role emphasized by Rudolf Virchow as early as the late nineteenth century.

[Complex hygienic evaluation of territory in running the objects with radiation jeopardy].

Complex hygienic evaluation of observation zone territory in long-standing running an object with radiation jeopardy revealed that radionuclides and heavy metals content of soil, surface water basins and ambient air is the same as background levels in reference territories. The authors point out possible use of the obtained values as reference levels for ecologic control in similar territories.

Higher smoking prevalence in urban compared to non-urban areas: time trends in six European countries.

We investigated differences in smoking prevalence between urban and non-urban area of residence in six Western European countries (Sweden, Finland, Denmark, Germany, Italy and Spain), and smoking prevalence trends over the period 1985-2000. In most countries, smoking prevalence was highest in urban areas, and increased with urbanization. Urban/non-urban inequalities were most pronounced among individuals with low education levels, and also among females. There were no significant differences in annual rate of change in smoking prevalence between non-urban and urban areas.

Pattern of intestinal parasites among hosptial patients at Ile-Ife.

Intestinal and extraintestinal parasitic diseases continue to constitute important public health problems in many developing African countries. While malaria continues to ravage the continent, the silent onslaught of intestinal helminthiases and protozoal infection seem not to relent. The objectives of this study was therefore to determine the prevalence of intestinal helminthic and protozoan infections and to determine the trends in intestinal parasitic infections. Results of laboratory investigations for parasitic infections during a three-year period in two succeeding decades (1988-90 and 1996-98) were analysed. During the two periods 4233 (65.1%) of 6504 and 2297 (63.1%) of 3641 clinical specimens were respectively, positive for intestinal parasites. These results are very significant as determinants of the level of environmental and domiciliary hygiene. It is concluded that the findings should be of great concern to the local Authority Health Departments which should spur the government to concerted effort aimed at ameliorating the deplorable situation brought about by indiscriminate faecal disposal.

[Tinea capitis in Creteil. Trends over ten years]. / Teignes du cuir chevelu à Créteil. Evolution sur 10 ans.

INTRODUCTION: We analyzed tinea capitis data in a Paris suburban area over a 11-year period from (1985-1995) to evaluate epidemiology trends. PATIENTS AND METHODS: The following data were collected for patients seen at the Créteil myco-dermatology clinic with cultures positive for tinea capitis: sex, age, ethnic origin, fungal culture. RESULTS: Tinea capitis was observed in 336 cases (56 p. 100 females). Eight percent of the patients were under the age of 10 years and 11 p. 100 over 20 years. Trichophyton soudanense was isolated in 45 p. 100 of the patients. Anthropophilic agents rose over the 10 year period while the number of zoophilic agents remained stable. Specific dermatophytes appeared to predominate in populations of different ethnic origin. There was a two-fold increase in the number of tinea capitis cases in the 1990-1995 period compared with the five previous years. DISCUSSION: The percentage of adults with tinea capitis (11 p. 100) is higher than the 5 p. 100 reported in the literature. The rise in the number of anthropophilic tinea capitis cases resulted from an increase in T. soudanense (originating in Africa), probably related to the increasing immigrant population. This agent was identified in 95 p. 100 of the patients of African origin. Differing lifestyles and transmission between school children makes it quite difficult to interpret the correlation between ethnic origin and specific dermatophytes.