Health Impacts of Fine Particulate Matter Shift Due to Urbanization in China.

Rapid urbanization and industrialization have resulted in diverse anthropogenic activities and emissions between urban and non-urban regions, leading to varying levels of exposure to air pollutants and associated health risks. However, endeavors to mitigate air pollution and health benefits have displayed considerable heterogeneity across different regions. Therefore, comprehending the changes in air pollutant concentrations and health impacts within an urbanization context is imperative for promoting environmental equity. This paper uses gross domestic product (GDP)- and population-weighted methods to distinguish anthropogenic emissions from urban and non-urban areas in China and quantified their contributions to fine particulate matter (PM2.5) using the Community Multiscale Air Quality (CMAQ) model in 2010 and 2019. Anthropogenic emissions from urban and non-urban (outside urban) regions decreased by 26 and 44% from 2010 to 2019, respectively, resulting in 31 and 28% reductions of PM2.5 in China. PM2.5-related premature mortality attributed to non-urban and urban anthropogenic emission decreases by 8%. Non-urban anthropogenic activities are the main contributor to PM2.5 (56% in 2010 and 2019) and its associated premature mortality (59%), which also predominantly affects non-urban premature mortality (37-42% in 2010-2019). Population changes increase the proportion of premature mortality in urban populations (7-19%) from 2010 to 2019. This study emphasizes the shift of affected populations due to urbanization and population changes.

Treatments and prognostic factors for bone and soft tissue sarcoma in non-urban areas in Japan.

BACKGROUND: Although bone and soft tissue sarcoma is recognized as a rare cancer that originates throughout the body, few comprehensive reports regarding it have been published in Japan. PATIENTS AND METHODS: Bone and soft tissue sarcomas were tabulated from the Cancer Registries at eight university hospitals in the Chugoku-Shikoku region. Prognostic factors in cases were extracted in a single facility and have been analyzed. RESULTS: From 2016 to 2019, 3.4 patients with bone and soft tissue sarcomas per a general population of 100,000 were treated at eight university hospitals. The number of patients who underwent multidisciplinary treatment involving collaboration among multiple clinical departments has been increasing recently. In the analysis carried out at a single institute (Ehime University Hospital), a total of 127 patients (male/female: 54/73) with an average age of 67.0 y (median 69.5) were treated for four years, with a 5-year survival rate of 55.0%. In the analysis of prognostic factors by multivariate, disease stage and its relative treatment, renal function (creatinine), and a patient's ability of self-judgment, and a patient's mobility and physical capability were associated with patient prognosis regarding bone and soft tissue sarcomas. Interestingly, age did not affect the patient's prognosis (> 70 vs ≦ 70). CONCLUSIONS: Physical and social factors may affect the prognosis of patients with bone and soft tissue sarcomas, especially those living in non-urban areas.

Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia.

OBJECTIVE: Cancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location. METHODS: Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset. DESIGN: A cross-sectional study design was used. SETTING: CCTs were available Victoria-wide in 2018. PARTICIPANTS: There were 1669 CCTs and 5909 CCT participants. MAIN OUTCOME MEASURES: Rural CCT location was assessed as a binary variable with categories of 'yes' (modified Monash [MM] categories 2-7) and 'no' (MM category 1). MM categories were determined from postcodes. The highest ('least rural') MM category was used for postcodes with multiple MM categories. RESULTS: Of 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (p-value <0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (p-value <0.05) higher for non-industry than industry-sponsored trials. CONCLUSIONS: In Victoria, 10% of CCTs are at rural sites. Most rural-residing CCT participants travel to metropolitan sites, where there are more late-phase, non-solid-tumour and industry-sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.

Asthma is associated with bullying victimization in rural adolescents.

OBJECTIVE: We characterized bullying among rural adolescents and examined the association between asthma and bullying victimization. METHODS: Participants (N = 1905; 44.5% Black) were students attending rural high schools who were screened for a randomized trial to address uncontrolled asthma. Screening questions asked students about asthma diagnosis and symptoms, bullying victimization, and demographic characteristics. Logistic regression analyses with school as a fixed effect were employed to examine the extent to which demographic factors, asthma diagnosis, asthma status (i.e. current asthma, no asthma, possible undiagnosed asthma), and among those with current asthma, asthma severity, were associated with bullying victimization. Sensitivity analyses using bullying frequency as the outcome were also conducted. RESULTS: 26.0% reported being bullied. Younger age and self-identifying as White were associated with increased risk of bullying victimization. Compared to those with no asthma, those with current asthma or possible undiagnosed asthma were at increased risk for bullying victimization (adjusted odds ratio [AOR] = 2.46; 95% confidence interval (CI) = 1.76-3.46 and AOR = 2.42; 95% CI = 1.87-3.14, respectively). Among those with current asthma, persistent symptoms increased the risk for bullying victimization (AOR = 2.59; 95% CI = 1.45-4.71). Similar results were obtained with sensitivity analyses. CONCLUSIONS: In a large rural community cohort, asthma was associated with bullying victimization. Findings suggest that rural students with asthma, with or without diagnosis, could benefit from schools creating inclusive environments that reduce victimization based on this medical condition. School administrators should foster environments that are accepting of all students' abilities and statuses, and healthcare providers can provide proper asthma management education to these adolescents.

Importance of different imperviousness measures for predicting runoff and nutrient emissions from non-urban and urban land-uses at large spatial coverage.

Growing population and urbanization challenge water resources sustainability and require stringent solutions in terms of emission measurements and pollution controls. Advancements in observation techniques have improved the availability of impervious surface data that cover both urban and non-urban areas to assess the impacts of urbanization. However, most models used in macroscale studies continue to derive surface imperviousness based on land-use classes and population data, and the contributions of non-urban impervious surfaces to runoff and nutrient emissions remain largely ignored. Effects of different impervious surface data on the predicted runoff and nutrient emissions is investigated in this study for macroscale urban and non-urban areas in tandem by means of an extended urban module MONERIS - PCRaster to enable scenarios with high-resolution imperviousness data. The results showed that approximately 70% of the total runoff and nutrient emissions nationwide originated from low-to-medium populated impervious surfaces rather than from major urban catchments. Using high-resolution imperviousness data at various aggregation levels resulted in lower biased outputs of predicted runoff and nutrient emissions when compared to results using the estimated impervious data from land-use and population information. The impervious surface shares between urban and non-urban lands revealed the opposite trends of urbanization developments in the less populated areas versus an increasing contribution of emissions from non-urban areas rather than urban centers in densely populated municipalities. Overall, the non-urban impervious surface areas contributed 5-20% of the "hidden" runoff volumes and nutrient emissions from all impervious areas. The results of this study highlight the need of model adaptations regarding the increased availability of high-resolution imperviousness data and the trend of urbanization development beyond urban areas for more accurate quantification of potential flood risks and emission hotspots of macroscale urbanized areas for sustainable water resources management.

School Nursing Workforce Differences Between Urban and Non-Urban Areas: Implications for School Health Services and Equity.

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P < .001) and more likely to serve both elementary and secondary school settings (P = .002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P < .001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P < .001, for each), and suicide risk assessment and screening (P = .012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity.

Values that influence employment acceptance among physical therapists practicing in primary care shortage and non-urban designation areas.

INTRODUCTION: Physical therapists (PTs) in all United States, DC, and the US Virgin Islands have first-contact direct access privileges to examine and treat patients. Evidence supports the value of PT services in reducing annual healthcare costs, decreasing the need for prescription pain medication, and decreasing the need for outpatient physician care. PTs can play an essential role in managing patient health needs in primary care health professional shortage areas (pcHPSAs), especially in rural areas, which are disproportionately affected by shortage-related health disparities. The current study examined values that differentiated PTs who accept and maintain employment in pcHPSAs and non-urban areas, as a means of advising health agencies within these designation areas. METHODS: A survey invitation was emailed to PTs in six states. The Determinants of Employment Acceptance Survey was used to survey the importance of six factors (attachment to place, community assets, practice environment, professional advancement, relationships, and remuneration) when considering employment. RESULTS: Respondents included 373 PTs (36% pcHPSA; 33% non-urban). Professional advancement was significantly more important to PTs intending to continue their employment in a pcHPSA. Community assets were more important to PTs in non-urban areas who planned to leave their employment within 5 years. The most valued factors for PTs, regardless of practice location, were practice environment and attachment to place. CONCLUSION: Employers in rural areas or pcHPSAs who are interested in recruiting and retaining PTs should consider the importance of professional advancement, practice environment, and workplace relationships, and should use strategic measures to fortify these assets within the workplace.

Competencies required for general practitioners/family physicians in urban areas versus non-urban areas: a preliminary study.

BACKGROUND: The medical practice of general practitioners/family physicians in urban areas differs from that in rural areas, accounting for the difference in specific competencies. However, variations in competencies in community healthcare required for general practitioners/family physicians in urban areas compared with those in rural areas have not yet been fully clarified. Thus, this study aimed to elucidate the competencies required for general practitioners/family physicians, especially in those characteristic to urban areas, and compare them with those in non-urban/rural areas. METHODS: A qualitative study with individual interviews and qualitative data analysis was conducted. Participants were selected by purposive sampling, and 10 general practitioners/family physicians with clinical experience of ≥7 y after graduation and ≥ 1 y in both urban and non-urban (rural) areas in Japan were recruited. Additionally, semi-structured individual interviews in a private room around the workplace of the interviewee between September 2014 and September 2016 were conducted. For data collection, interview transcripts were analyzed according to the "Steps for Coding and Theorization" method, a sequential and thematic qualitative data analysis technique and data analysis since March 2018. RESULTS: We interviewed 10 general practitioners/family physicians of Japan and extracted 10 themes as competencies characteristic to general practitioners/family physicians in urban areas. In addition to the known competencies on urban underserved care, we newly clarified the competencies of the ability to integrate divided care and ability to coordinate and collaborate with various medical care and welfare professionals in urban areas. CONCLUSION: This study was one of the few studies describing the characteristic competencies of urban general practitioners. In summary, a competency necessary for general practitioners in urban areas is to understand the urban context and provide contextual care suitable for urban areas. In the modern age, where urban population concentration is progressing and the interest in urban health is rising, our study will give certain suggestions for primary care education and practice necessary for urban areas.

A comparison of urban and non-urban African American older adults on health-related characteristics.

Although residential geographic health disparities have been noted in the previous literature, studies are specifically lacking on intra-group health comparisons of African American older adults by residential geography. The purpose of this study was to determine if health-related characteristics of African American older adults varied by residential geography. Socioeconomic demographics, medical conditions, primary care use, and self-ratings of general health, social activity, and physical activity were compared in a community-dwelling sample of 327 urban and non-urban African American older adults. Urban and non-urban African American older adults were compared on health-related factors. Compared to urban African American older adults, those in non-urban areas had lower incomes, lower self-ratings of general health, social activity, and physical activity, and a higher frequency of arthritis and gastroenterological and urological conditions. Despite poorer general health and medical conditions, non-urban African American older adults were less likely to visit the doctor when needed. Study findings suggest residential geography may be an underappreciated underlying contributing factor to inter-group health disparities between African American and white older adults and not race alone. Therefore, social workers in public health, health care, and clinical settings should be aware of the interaction between race and residential geography.

A comparative analysis of vaccine administration in urban and non-urban skilled nursing facilities.

BACKGROUND: The U.S. population is aging at an unprecedented rate, resulting in an increased demand for skilled nursing facilities (SNFs) and long-term care. Residents of these facilities are at a high risk for pneumococcal disease or severe influenza-related illnesses and death. For these reasons, the Centers for Medicare and Medicaid Services use influenza and pneumococcal vaccination rates as a quality measure in the assessment of SNFs, as complications related to these infections increase morbidity and mortality rates. METHODS: Disparities have been reported amongst vaccination with increased rates in urban areas as compared to their non-urban counterparts. Statistical analyses were performed to compare influenza and pneumococcal vaccination in urban and non-urban SNFs to determine variables that may influence vaccination status. RESULTS: Of the 15,639 nursing homes included in the study, 10,107 were in urban areas, while 5532 were considered non-urban. We found the percent of eligible and willing residents with up-to-date influenza and pneumococcal vaccinations increased with overall five-star ratings of SNFs. Somewhat paradoxically, although urban SNFs had higher mean overall five-star ratings, they showed lower rates of influenza and pneumococcal vaccination compared to non-urban SNFs. Ordinary least squares regression analysis comparing overall ratings, type of ownership, and geographic location by region yielded statistically significant results in which the overall rating, ownership-type and certificate-type favored urban SNFs (p < 0.001). CONCLUSIONS: This is the first systematic and comparative analysis to use the Nursing Home Compare database to assess vaccine administration of urban and non-urban SNFs. The findings of this study may be used to encourage the development of programs to improve vaccination rates and the quality of care in these facilities.

Stigma as a local process: Stigma associated with opioid dependency in a rural-mixed Indiana county.

BACKGROUND: Because the nature and magnitude of stigmatizing views associated with opioid dependency vary by social, cultural, and structural factors, strategies to reduce public stigma towards opioid dependency should vary by context. We leverage a unique dataset with evidence of multiple stigmatizing views to understand how to target interventions to reduce stigma in a state disproportionately impacted by the opioid epidemic, with a specific focus on a rural-mixed county. METHODS: Data come from the representative Person-to-Person Health Study (2018-2020) of 2,050 Indiana residents, 224 from the rural-mixed Fayette County. Bivariate statistics and multivariate regression analyses were used to evaluate the association between Fayette County and measures of stigma (e.g., desire for social distance, prejudice, causal attributions) relative to the rest of Indiana. RESULTS: Fayette County statistically differed from the rest of Indiana on most demographic characteristics and measures of stigmatizing views. Multivariate regressions revealed that compared to the rest of Indiana, residence in Fayette County was associated with a higher desire for social distance, perceptions of unpredictability, and attributing opioid dependency to genetics and the way the person was raised. CONCLUSION: Our results contribute to growing evidence supporting the need for local approaches to address stigma. Stigma in Fayette County primarily reflects concerns about how people manage their opioid dependency. Strategies focusing on treatment and recovery potential, accompanied by extending the influence of supportive stakeholders and policies, will become important to address this stigma.

Differences urban versus non-urban trends in mortality from ischemic heart disease and diabetes in Italy and Spain, 2003-2019.

BACKGROUND AND AIMS: In recent years, mortality from ischemic heart disease and diabetes has decreased. There is an inequality in mortality reduction between urban and non-urban areas. This study aims to estimate the trend in mortality from ischemic heart disease and diabetes mellitus in urban and non-urban areas in Italy and Spain, throughout the first two decades of the 21st century. METHODS: Deaths and population data by age and sex, according to the area de residence, were obtained from the National Institutes of Statistics. Annual age-standardized mortality rates from ischemic heart disease and diabetes mellitus were calculated from 2003 to 2019, in each of the two areas of residence in both countries. The average annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. RESULTS: Mortality rates from both causes of death decreased between the beginning and the end of the period analysed. In Italy, the APC in was -4.0% and -3.6% in mortality rate from ischemic heart disease and -1.5% and -1.3% in mortality rate from diabetes mellitus, in urban and non-urban areas, respectively. In Spain, the APC in was -4.4% and -3.7% in mortality rate from ischemic heart disease and -3.3% and -2.0% in mortality rate from diabetes mellitus, in urban and non-urban areas, respectively. CONCLUSION: Mortality from ischemic heart disease and mortality from diabetes have shown a greater reduction in urban than in non-urban areas since the first years of the 21st century in Spain and Italy.

This study evaluated the trend in mortality from ischemic heart disease and diabetes in urban and non-urban areas in two Southern European countries, Italy and Spain, throughout the first two decades of the 21st century.A reduction in mortality from diabetes and ischemic heart disease was observed in both urban and non-urban areas in both countries.Residents in urban areas showed a greater reduction in mortality than residents in non-urban areas. The mortality advantage found in non-urban areas at the beginning of the study disappeared at the end of it or even mortality became higher in non-urban areas.

Health Disparities among Rural Individuals with Mental Health Conditions: A Systematic Literature Review.

There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.

Depressive symptoms are related to asthma control but not self-management among rural adolescents.

Background: Depression, a relevant comorbidity with asthma, has been reported to be associated with asthma morbidity. Asthma self-management is essential to asthma control and may be negatively impacted by depression. We examined these associations in rural adolescents, a group with relatively high asthma morbidity and depressive symptoms, a population often ignored in asthma research. Methods: We used baseline data from a randomized trial of an asthma intervention for adolescents in rural South Carolina (n = 197). Adolescents completed the Center for Epidemiological Studies-Depression (CES-D), three indices of asthma self-management (the Asthma Prevention Index, the Asthma Management Index and the Asthma Self-Efficacy Index), and the Asthma Control Test (ACT). Poisson and linear regression tested associations between depression, self-management, and asthma control. The models controlled for demographic variables and included school as a fixed effect. Results: Most participants (mean age = 16.3 ± 1.2 years) self-identified as female (68.5%) and Black (62.43%). The mean CES-D score was 19.7 ± 10.3, with 61.4% of participants at risk for depression. The depressive symptoms were significantly related to asthma control [ß = -0.085, 95% confidence interval (CI) = -0.14 to -0.03] but not to prevention [relative risk (RR) = 1.00, 95% CI = 0.99-1.01], management (RR = 1.00, 95% CI = 0.99-1.01), or self-efficacy (ß = -0.002, 95% CI = -0.01 to 0.01). Conclusions: In this sample of rural adolescents, as depressive symptoms increased, asthma control declined. Depressive symptoms were not associated with asthma self-management, suggesting that the aspects of self-management we assessed are not an avenue by which depression impacts asthma control. Additional research is needed to further understand the relationship between depressive symptoms, asthma self-management, and control.

Modeling spatio-temporal assessment of land use land cover of Lahore and its impact on land surface temperature using multi-spectral remote sensing data.

Urban sprawl, also widely known as urbanization, is one of the significant problems in the world. This research aims to assess and predict the urban growth and impact on land surface temperature (LST) of Lahore as well as land use and land cover (LULC) with a cellular automata Markov chain (CA-Markov chain). LULC and LST distributions were mapped using Landsat (5, 7, and 8) data from 1990, 2004, and 2018. Long-term changes to the landscape were simulated using a CA-Markov model at 14-year intervals from 2018 to 2046. Results indicate that the built-up area was increased from 342.54 (18.41%) to 720.31 (38.71%) km2. Meanwhile, barren land, water, and vegetation area was decreased from 728.63 (39.16%) to 544.83 (29.28%) km2, from 64.85 (3.49%) to 34.78 (1.87%) km2, and from 724.53 (38.94%) to 560.63 (30.13%) km2, respectively. In addition, urban index, a non-vegetation index, accurately predicted LST, showing the maximum correlation R2 = 0.87 with respect to retrieved LST. According to CA-Markov chain analysis, we can predict the growth of built-up area from 830.22 to 955.53 km2 between 2032 and 2046, based on the development from 1990 to 2018. As urban index as the predictor anticipated that the LST 20-23 °C and 24-27 °C, regions would all decline in coverage from 5.30 to 4.79% and 15.79 to 13.77% in 2032 and 2046, while the temperature 36-39 °C regions would all grow in coverage from 15.60 to 17.21% of the city. Our results indicate severe conditions, and the authorities should consider some strategies to mitigate this problem. These findings are significant for the planning and development division to ensure the long-term usage of land resources for urbanization expansion projects in the future.

Competency lists for urban general practitioners/family physicians using the modified Delphi method.

BACKGROUND: In recent years, the growing global urbanization and urban population have resulted in the emergence of various health problems unique to urban areas. Therefore, training general practitioners and family physicians who can tackle the complex health problems of urban areas and improve the health of urban people is one of the most important issues of our time. However, findings on competencies for urban general practitioners (GP) and family physicians (FP) were limited. This study aimed to identify their comprehensive and content-validated list of competencies. METHODS: We used the modified Delphi method to develop a content-validated competency list. First, we analyzed and synthesized the competencies extracted from the literature review using qualitative thematic analysis methods to create an initial competency list of 34 items. We then assembled 39 expert panelists in four groups of study participants: physicians, nurses, patients, and medical education specialists. The expert panelists were asked to indicate their level of agreement with the lists and provide revised comments on the description of each competency via a web-based questionnaire. Their responses were analyzed quantitatively and qualitatively by the research team and used to revise the list. These processes were repeated, and the survey was completed when it was determined that consensus had been reached. RESULTS: Three rounds of Delphi were conducted. 39 responded in the first round, 38 in the second round, and 36 in the third round. The initial list of competencies was revised and consolidated from 34 to 14 items in the first round, bringing the total to 20 items along with six new items proposed by the panelists. In the second round, it was revised and consolidated into a list of 18 items. In the third round, all 18 items were considered to have been agreed upon by the panelists, so the survey was closed. CONCLUSION: We identified a comprehensive 18-item list of competencies for urban GP/FP in a content-validated manner. Several are newly discovered competencies in this study. The findings of this study will be useful for the future training of urban GP/FP and for solving urban health problems.

Community drug retail outlet staff's knowledge, attitudes and practices towards non-prescription antibiotics use and antibiotic resistance in the Amhara region, Ethiopia with a focus on non-urban towns.

INTRODUCTION: Some evidence suggests that knowledge and attitudes towards rational antibiotic use influences dispensing practice in community drug retail outlets. However, there is limited evidence in resource limited countries, including Ethiopia. We aimed to assess the knowledge and attitudes surrounding antibiotic use or supply and antibiotic resistance, and the non-prescribed antibiotic dispensing practices in community drug retail outlets in non-urban Ethiopia. METHODS: We conducted a cross-sectional survey of community drug retail outlet staff in the Amhara region, Ethiopia with a focus on non-urban towns. An expert validated self-administered questionnaire was used. Following exploratory factor analysis and best items selection, we summarised our findings and assessed factors associated with non-prescribed antibiotic dispensing. The data were analysed using Stata Statistical Software version 17. P-values < 0.05 were considered significant. RESULTS: A total of 276 participants from 270 drug outlets completed the questionnaire. The participants median age was 30 (Interquartile range (IQR) = 25-35) years and 79.7% were pharmacy assistants. The majority demonstrated good levels of knowledge about antibiotic use or supply and antibiotic resistance (77.9% and 76% of the participants responded correctly to more than half of the items, respectively). We identified four attitude domains: the role of antibiotics in recovering from diseases regardless of their cause (median score = 2 (IQR = 2-4), beliefs inconsistent with good practice); professional competency to supply non-prescribed antibiotics, and the non-prescribed antibiotics supply (median score for each domain = 4 (IQR = 4-5), attitudes consistent with good practice); and positive attitudes towards actions to prevent antibiotic resistance and promote appropriate antibiotic use (median score = 4 (IQR = 4-5). Fifty eight percent of the participants reported that they had dispensed antibiotics without a prescription. Participants who did not perceive that they were competent to supply non-prescribed antibiotics (adjusted odds ratio = 0.86, 95% confidence interval = 0.78-0.93) were less likely to report non-prescribed antibiotics dispensing. CONCLUSION: While most of the participants had appropriate knowledge about and attitudes to antibiotic use and antibiotic resistance, basic knowledge and attitude gaps remain. Despite Ethiopia's regulatory restrictions, the non-prescribed antibiotic provision continues to be a common practice. Our study highlights the need for multifaceted interventions that may include a strict regulatory system, staff training and public education.

Is greener better? Associations between greenness and birth outcomes in both urban and non-urban settings.

BACKGROUND: Beneficial effects of greenness on birth outcomes have been reported, but few studies have investigated the associations in both urban and non-urban settings. We aimed to evaluate and compare linear and nonlinear associations between greenness and birth outcomes in urban and non-urban settings. METHODS: From October 2015 to December 2018, participants were recruited into the Maoming Birth Cohort Study. A total of 11 258 live birth records were obtained. Greenness exposure was assessed using the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Linear regression and nonlinear restricted cubic spline models were implemented to investigate the associations between greenness and birthweight, birth length, gestational age, preterm birth, low birthweight, small for gestational age and the potential for effect variation under urban or non-urban settings, after adjusting for covariates. RESULTS: A 0.1-unit increase in NDVI-500m was significantly associated with an increase of 35.4 g in birthweight [95% confidence interval (CI): 13.2, 57.7], 0.15 cm in birth length (95% CI: 0.03, 0.26), 0.88 days in gestational age (95% CI: 0.05, 1.71) and lower odds of low birthweight [odds ratio (OR) = 0.69, 95% CI: 0.56, 0.85] and preterm birth (OR = 0.70, 95% CI: 0.58, 0.85). No association with head circumference was observed. For all outcomes, no significant linear associations were observed among non-urban dwellers. Inversed 'U-shaped' associations between greenness exposure and birth outcomes were observed in the total study population. CONCLUSIONS: Greenness exposure was associated with increased gestational age, birthweight and birth length in urban dwellers. Nonlinear associations assessed by restricted cubic splines suggested that health benefits could be larger when increasing greenness levels from low to medium compared with increasing greenness from medium to high levels. Further studies adopting nonlinear methods are warranted to verify our findings.

Investigating the severity of non-urban road traffic accidents in typical regions of Sichuan and Guizhou, China.

OBJECTIVE: The traffic characteristics of Sichuan and Guizhou differ from those of other regions due to its unique geographical features. In addition, accident studies in China mainly focus on urban roads in the eastern and central regions. However, studies on western regions, especially non-urban roads, are scarce. Thus, this study aims to explore the factors that influence the severity of accidents on non-urban roads in typical regions of Sichuan and Guizhou. METHODS: A total of 541 cases from 2014 to 2020 were selected from the database of the China In-Depth Accident Study, where 18 variables, which may exert an impact on accident severity, were extracted after screening. First, heterogeneity of data was eliminated through latent class analysis (LCA). The ordered probit (OP) model was then conducted for each class to obtain significant variables that exert an impact on accident severity. The study quantified the degree of influence of the significant variables using marginal effect analysis. RESULTS: The LCA results demonstrate that data were categorized into the following classes, namely, (a) two-vehicle accidents involving trucks, (b) pedestrian and multiple-vehicle accidents, (c) two-wheeler accidents, and (d) single-vehicle accidents. The OP results show that most variables could exert impact on accident severity, and some of them exerted varying levels of influence on the severity of different classes, whereas others only influence a specific class. CONCLUSION: According to this study, we obtained the accident characteristics of these regions and put forward some targeted suggestions to further improve the level of road traffic safety. The findings can provide support for the construction of transportation in line with the regional characteristics in China.

Longitudinal analysis of HIV outcomes for persons living with HIV in non-urban areas in southern Alberta, Canada.

BACKGROUND: Many challenges remain in successfully engaging people with HIV (PWH) into lifelong HIV care. Living in non-urban or rural areas has been associated with worse outcomes. Uncertainties remain regarding how to provide optimal HIV care in non-urban areas. METHODS: Using a retrospective descriptive analysis framework, we compared multiple measurable HIV care metrics over time on the basis of urban versus non-urban residency, under a centralized HIV care model. We examined rates of HIV diagnosis, access to and retention in HIV care, and longitudinal outcomes for all newly diagnosed PWH between January 1, 2008, and January 1, 2020, categorized by their home location at the time of HIV diagnosis in southern Alberta. RESULTS: Of 719 newly diagnosed PWH, 619 (86%) lived in urban areas and 100 (14%) lived in non-urban areas. At HIV diagnosis, the groups had no significant differences in initial CD4 count or clinical characteristics (p = 0.73). Non-urban PWH, however, had slightly longer times to accessing HIV care and initiating antiretroviral therapy (ART) (p < 0.01). Non-urban PWH showed trends toward slightly lower retention in care and lower sustained ART use, with higher rates of unsuppressed viral loads at 12, 24, and 36 months after diagnosis (p < 0.01). However, by 2020 both cohorts had suppression rates above 90%. CONCLUSIONS: Sustained retention in care was more challenging for non-urban PWH; however, adherence to ART and viral suppression rates were more than 90%. Although encouraging, challenges remain in identifying and reducing unique barriers for optimal care of PWH living in non-urban areas.

HISTORIQUE: Il reste de nombreux défis à relever pour mobiliser les personnes atteintes du VIH (PAV) à adhérer aux soins du VIH jusqu'à la fin de leurs jours. La résidence en région non urbaine ou rurale est associée à des résultats cliniques plus négatifs. Il reste des incertitudes quant aux moyens d'offrir des soins optimaux du VIH hors des régions urbaines. MÉTHODOLOGIE: Au moyen d'une analyse descriptive rétrospective, les chercheurs ont comparé de multiples mesures des soins du VIH au fil du temps d'après le lieu de résidence en milieu urbain ou non urbain, en fonction d'un modèle de soins du VIH centralisé. Ils ont examiné les taux de diagnostic du VIH, l'accès aux soins du VIH et la rétention de ces soins, ainsi que les résultats cliniques longitudinaux de toutes les PAV nouvellement diagnostiquées entre le 1er janvier 2008 et le 1er janvier 2020, classées d'après leur lieu de résidence au moment du diagnostic de VIH dans le sud de l'Alberta. RÉSULTATS: Sur les 719 PAV nouvellement diagnostiquées, 619 (86 %) vivaient en région urbaine et 100 (14 %), en région non urbaine. Au diagnostic du VIH, les groupes ne présentaient pas de différence significative pour ce qui est de la numération initiale des CD4 ou des caractéristiques cliniques (p = 0,73). Cependant, il fallait légèrement plus de temps aux PAV de milieu non urbain pour accéder aux soins du VIH et entreprendre une thérapie antirétrovirale (TAR) (p < 0,01). Ainsi, 12, 24 et 36 mois après le diagnostic, les PAV des milieux non urbains affichaient des tendances vers une rétention légèrement plus faible des soins et une utilisation soutenue légèrement plus faible du traitement antirétroviral (TAR), de même que des charges virales non supprimées plus élevées (p < 0,01). Cependant, en 2020, les deux cohortes présentaient des taux de suppression supérieurs à 90 %. CONCLUSIONS: Il était plus difficile de maintenir une rétention soutenue des soins pour les PAV hors des milieux urbains, mais l'adhésion au TAR et les taux de suppression virale étaient supérieurs à 90 %. C'était encourageant, mais il reste des défis pour déterminer et réduire les obstacles à des soins optimaux chez les PAV qui habitent hors des milieux urbains.