The flip-side of social capital: the distinctive influences of trust and mistrust on health in rural China.

Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China--trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context--village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China.

Estimulación temprana y desarrollo madurativo del niño en zonas rurales del estado de Jalisco / Anticipted stimulation and child's maturative evolution in Jalisco Stat's rural zones

La deprivación social y el bajo nivel socioeconómico en las familias de los niños menores de 4 años ha mostrado ser un problema en el desarrollo madurativo y psicológico de los mismos, que impacta no solo en el momento mismo, sino en todo su futuro escolar y de calidad de vida. La estimulación temprana ayuda a acelerar el desarrollo normal del niño. En todo México, y por ende en el Estado de Jalisco, la Dirección de Educación Inicial opera un Programa de Estimulación Temprana para niños menores de 4 años a través de padres de familia, ¿puede lograrse un impacto significativo en el desarrollo madurativo a través de la capacitación de los padres para que estimulen a sus hijos?. El trabajo es de tipo transversal con la participación de 986 niños que habitaban en zonas rurales del Estado de Jalisco, y de los cuales 986 recibieron 40 semanas de estimulación temprana a través de sus padres y 974 no la recibieron quedando como grupo control. Todos los grupos de niños participantes en este estudio Obtuvieron promedios de desarrollo madurativo bajos, sin embargo, en todos los grupos por edad el promedio más alto en las calificaciones de las escalas madurativas fue siempre para los grupos de niños estimulados. El no haber participado del Programa de Estimulación Temprana de la Dirección de Educación Inicial mostró ser un importante factor de riesgo (OR 2,44) para la presencia de un nivel de desarrollo madurativo "bajo". Se concluye que el Programa de Estimulación Temprana a través de padres de familia está siendo eficaz en paliar los efectos que la pobreza y la deprivación social está ocasionando sobre los niños pequeños en nuestro Estado, aunque es clara la función paliativa, ya que quedan por resolver los problemas de nutrición, salud, violencia y tantos otros que acompañan la vida en pobreza (AU)

The Index of Multiple Deprivation 2000 and accessibility effects on health.

STUDY OBJECTIVE: To investigate whether the Index of Multiple Deprivation 2000 (IMD) is more strongly related to inequalities in health in rural areas than traditional deprivation indices. To explore the contribution of the IMD domain "geographical access to services" to understanding rural health variations. DESIGN: A geographically based cross sectional study. SETTING: Nine counties in the south west region of England. PARTICIPANTS: All those aged below 65 who reported a limiting long term illness in the 1991 census, and all those who died during 1991-96, aged less than 65 years. MAIN RESULTS: The IMD is comparable with the Townsend score in its overall correlation with premature mortality (r(2) = 0.44 v 0.53) and morbidity (r(2) = 0.79 v 0.76). Correlation between the Townsend score and population health is weak in rural areas but the IMD maintains a strong correlation with rates of morbidity (r(2) = 0.70). The "geographical access to services" domain of the IMD is not strongly correlated with rates of morbidity in rural areas (r(2) = 0.04), and in urban areas displays a negative correlation (r(2) = -0.47). CONCLUSIONS: The IMD has a strong relation with health in both rural and urban areas. This is likely to be the result of the inclusion of data in the IMD on the numbers of people claiming benefits related to ill health and disability. The domain "geographical access to services" is not associated with health in rural areas, although it displays some association in urban areas. This domain is potentially important but, as yet, inadequately specified in the IMD for the purposes of health research.

Lung function and respiratory symptoms of pesticide sprayers in state farms of Ethiopia.

Chemical pesticides are health hazards affecting the livelihood of those who are occupationally engaged in spraying farm fields. The objective of the study was to determine the extent of the hazard of chemical pesticide application by farm workers in selected farms. The major parameters used were measurements of lung function and respiratory symptoms. The design of the study was cross-sectional and was conducted in four state farms. Lung function and respiratory symptoms of 102 pesticide sprayers of state farms of Ethiopia and of 69 non-sprayers were assessed All data were analysed by decade age groups adjusting for smoking habits. The results of lung function and respiratory symptoms of 102 pesticide sprayers and of 69 non-sprayers are presented. The 15-24 years age group of pesticide sprayers had significantly reduced forced expiratory vital capacity (FVC) and forced expiratory volume in one second (FEV1), as compared to that of similar age group non-sprayers. Analysis of variance on FVC and FEV for the five predictors (age, height, weight, chest circumference and FFM) of the non-sprayers was highly significant (F = 4.647, 5.563 & P = 0.001, 0.000 for FVC and FEV1 respectively). 5.9% and 16.7% of the pesticide sprayers had symptoms of cough and breathlessness respectively. Pesticide applications resulted in reduced lung function and evoking respiratory symptoms. Pesticide sprayers need to be sensitised to the hazardous consequences of pesticide applications for human health and the environment and should be encouraged to wear personal protective devices during work on farms.

Calculating multirace categories and race-specific rates: a cautionary note to rural health researchers and analysts.

CONTEXT: Revised federal standards for racial and ethnic data have resulted in 57 new self-selected multirace categories that cannot be directly compared with traditional "one-race-only" categories. "Bridge methods" are available, but each produces different estimates of single-race populations, raising concern about the potential influence on calculated rates for rural and nonmetropolitan areas. PURPOSE: to examine the potential impact of several bridge methods when calculating race-specific mortality rates. METHODS: Population and mortality data were collected for 75 counties in Arkansas, and race-specific mortality rates were calculated using 3 deterministic bridging methods: (1) Equal Fractions, (2) Largest Group, and (3) Largest Group Other Than White. The mortality rates were compared at the state and metropolitan/nonmetropolitan levels, as well as for 4 rural substate regions. FINDINGS: Variable rates were obtained from different methods. Estimated mortality rates for the largest single-race groups, White and Black, varied only slightly by method at the state and nonmetropolitan/metropolitan levels. The rural substate regions with the smallest Black populations showed the greatest variation between method-estimated rates for Blacks. CONCLUSIONS: The results suggest that the smallest minority race categories are exceedingly susceptible to the impact of bridge method selection, especially in nonmetropolitan substate regions.

Patterns of local migration and their consequences in a rural Ethiopian population.

AIMS: In the context of the Butajira Rural Health Programme (BRHP) in Ethiopia, which has maintained demographic surveillance in selected communities since 1987, this paper investigates patterns of migration and their consequences within that population over a ten year period 1987-1996. METHODS & RESULTS: Based on observations of over 336,000 person-years in nine rural villages and one small town, 48% of individuals migrated in or out of the study area at some stage, as recorded in monthly household visits. There was a net incidence of migration into the urban area, particularly among young adults. Mortality was higher among residents compared with in-migrants, with rates of 10.5 (95% CI 7.5 to 14.9) and 8.2 (95% CI 5.8 to 11.7) per 1,000 person-years respectively after adjustment for age, sex and area of residence, a rate ratio of 1.3. Fertility among in-migrant and resident women was similar, at rates of 0.26 and 0.28 births per reproductive year respectively. CONCLUSIONS: The causes of the observed differences in mortality are not clear, though they may be partly due to self-selection effects among migrants, and may have important implications for future health policy and planning in Ethiopia and other similar settings.

Medical expenditure and rural impoverishment in China.

Thanks to continued economic growth and increasing income, the overall poverty rate has been on the decline in China. However, due to escalating medical costs and lack of insurance coverage, medical spending often causes financial hardship for many rural families. Using data from the 1998 China National Health Services Survey, the impact of medical expenditure on the poverty headcount for different rural regions was estimated. Based on the reported statistics on income alone, 7.22% of the whole rural sample was below the poverty line. Out-of-pocket medical spending raised this by more than 3 percentage points. In other words, medical spending raised the number of rural households living below the poverty line by 44.3%. Medical expenditure has become an important source of transient poverty in rural China.

Measuring perceived health outcomes in non-western culture: does SF-36 have a place?

This study explored the usefulness of a generic health assessment tool SF-36 in measuring perceived health outcomes in a developing-country setting. The adapted Bangla version was administered in 10 villages of Matlab sub-district in Bangladesh during second half of 1999. Respondents included currently-married males and females selected randomly from households stratified according to their association with women-focused development interventions of BRAC. Findings revealed that the respondents from BRAC households perceived their health status marginally better than the poor non-member group in most domains studied, sometimes significantly so, e.g. general and mental health (p < 0.05). The respondents from BRAC reported better 'current health' than their non-member counterparts. The gender difference in assessment of health status was noted among the groups. Age, education, and poverty were important determinants of perceived health status. SF-36 proved to be a useful tool for self-assessment of health status and group comparison when properly modified for cross-cultural adaptation.

Deprivation and poor health in rural areas: inequalities hidden by averages.

Poor health and social deprivation scores in 570 wards in East Anglia, UK, were much less associated in rural than in urban areas. The deprivation measure most closely related to poor health in the least accessible rural wards was male unemployment, but use of this measure did not remove the urban-rural gradient of association strength. Neither did replacing wards by smaller enumeration districts as the units of analysis. The differences between urban and rural correlations were removed by restricting the comparison to wards with the same unemployment range and combining pairs of rural wards with similar deprivation values. Apparent differences between rural and urban associations are therefore not due to the choice of deprivation indices or census areas but are artifacts of the greater internal variability, smaller average deprivation range and smaller population size of rural small areas. Deprived people with poor health in rural areas are hidden by favourable averages of health and deprivation measures and do not benefit from resource allocations based on area values.

The urban and rural divide for women giving birth in NSW, 1990-1997.

OBJECTIVE: To examine trends in the pregnancy profile and outcomes of urban and rural women. METHODS: Data were obtained from the NSW Midwives Data Collection on births in NSW, 1990-1997. Associations between place of residence (urban/rural) and maternal factors and pregnancy outcomes were examined, including changes over time. RESULTS: From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan, 5% large rural centres, 8% small rural centres, 11% other rural areas and 1% remote areas. Rural mothers were more likely to be teenagers, multiparous, without a married or de facto partner, public patients and smokers. Births in rural areas declined, particularly among women aged 20-34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and low Apgar scores (all women) and small-for-gestational- age (SGA) (Indigenous women only). CONCLUSIONS: The profile of pregnant women in rural NSW is different from their urban counterparts and is consistent with relative socioeconomic disadvantage and possibly suboptimal maternity services in some areas. While increased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons the increased risk of stillbirth are unclear. Although there does not appear to be an increase d risk of preterm birth for rural women this may be masked by transfer of high risk pregnancies interstate. IMPLICATIONS: Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweight and perinatal death.

[Support program for the implementation of the Bamako initiative: analysis of the creation of eight health districts, Gnagna province]. / Programme de soutien à la mise en place de l'Initiative de Bamako: analyse de la création de huit aires de santé, province de la Gnagna (burkina Faso).

The implementation of the Bamako initiative is a central pillar of the health policy of Burkina Faso. The NGO, ASI, working with the health authorities, has set up a program involving the creation of eight health districts in the province of Gnagna. The program covers a population of 115,000 inhabitants in 134 villages and was progressively established between 1994 and 1997. The health districts were set up in phases (2 in the first year and 3 in each of the following two years). The method used to select the members of the village management committees is one of the key aspects of the program. It required a large amount of effort to increase the awareness of villages, and much activity because each committee is elected by the various villages of the district. The training of the managers of these committees and of the managers of the pharmaceutical warehouses in each district is also a key element. In our initial assessment, we noted balance in the accounting of the pharmaceutical warehouses of each district, adhesion of the population to the program, dynamics in the management committees and, above all, the autonomy of the committees. The first results in terms of health are very fragmentary and difficult to interpret because the program has been running for such a short time. We considered the long-term elements of the program, the necessity to set up a system for monitoring activities and the quality of care. An initial assessment showed a clear improvement in the availability of drugs in the 8 districts. Health promotion activities have not yet been developed in these districts. This type of program requires the follow up and support of the management committees, and will be the object of the second phase, begun in 1998.

Control de la presión arterial en una comunidad campesina Yamparaez (Departamento de Chuquisaca) / Control of the blood pressure in a rural community of Yamparaez (Department of Chuquisaca)

Presentamos este trabajo realizado en la comunidad campesina de origen quechua Yamparaéz del departamento de Chuquisaca, con una población de 840 habitantes (según el Instituto Nacional de Estadística). se ha examinado e interrogado a 299 personas de ambos sexos (35) a partir de los 20 años hasta por encima de los 70 años. Se han realizado un control de la presión arterial, medidads antropométricas de talla y peso. También se ha efectuado una encuesta sobre los hábitos dietéticos, consumo de sal, masticación de coca, ingestión de bebidas alcohólicas. Al azar y pese a la susceptibilidad y confianza se han tomado muestras de sangre y orina a 10 personas del grupo en estudio, para dosificar sodio, potasio. Se ha mandado a realizar u estudio químico de las tabletas de "Llijta", que los campesinos ingieren durante la masticación de coca, para comnocer su contenido de sodio, potasio y calcio. Del estudio efectuado en esta comunidad campesina, se establece que la hipertensión arterial se presenta menos de 1. Los valores de la media aritmética para ala presión arterial en los varones, presión sistólica de 110,11 y la diastólica 72,33mm Hg. en mujeres 107,9 y 68,6mm Hg. Se concluye que las bajas cifras de la presión arterial, estarían supeditadas a factores ambientales, como ser una mínima ingesta de sodio en la alimentación, bastante cantidad de potasio, las labores agrícolas, la falta de stress, dieta en base a carbohidratos, esacasa o ninguana corriente migratoria. Factores genéticos de adaptación

A sampling framework for rural and remote doctors.

A pilot survey by telephone interview, followed by a questionnaire of all rural doctors identified in Queensland, was used develop both a definition of rural practice that distinguishes it from urban general practice and a classification of rural and remote practice which assists in sampling of rural doctors. Questionnaire responses in specific geographic areas were compared using chi-square and Mantel-Haenszel chi-square tests. Several factors were found to differentiate rural from urban general practice consistently, thereby enabling a functional definition of rural practice to be developed. Within the broad group of rural doctors, gradients in practice characteristics were found to differentiate doctors in larger rural centres from those in smaller, more remote communities. These gradients were related to the distance and time of travel from support services. They formed the basis of a complex classification of rural and remote general practice. This functional definition of rural and remote medical practice should be considered by researchers of rural medicine issues when sampling rural and remote doctors. The strategies used in this study could be adapted for use in considering practice characteristics of other rural health professions.