Effects of religion, politics and distance to providers on HPV vaccine attitudes and intentions of parents in rural Utah.

PURPOSE: Human papillomavirus (HPV) causes an estimated 300,000 high grade cervical dysplasias and 36,000 preventable cancers each year in the United States alone. Despite having a safe, effective and long lasting vaccine since 2006, the rate of uptake has been suboptimal, particularly in rural areas. In 2020, Utah ranked near last in teenage HPV vaccination rates with rural areas trailing urban areas by about 18 percent. In this study, we identified factors that affect the intent of rural Utah parents to vaccinate their children against HPV. METHODS: A survey was distributed electronically to Utah residents in rural areas. Recruitment was carried out through targeted advertising, community organizations, and professional survey panels. The survey was open from Nov. 15, 2022 to April 15, 2023. A total of 410 respondents were used for analysis. Survey results were analyzed using exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. FINDINGS: Distance to care was shown to negatively influence direct intent to vaccinate, while trust in government, general vaccine attitudes, and HPV knowledge positively influence intent to vaccinate. It was found that religious practice decreased vaccine hesitancy while cautious sexual attitudes, distance to care, and general negative vaccine attitudes increased vaccine hesitancy. Conservative political identity and high income were both shown to decrease vaccine hesitancy as covariates.

Subjective well-being across the life course among non-industrialized populations.

Subjective well-being (SWB) is often described as being U-shaped over adulthood, declining to a midlife slump and then improving thereafter. Improved SWB in later adulthood has been considered a paradox given age-related declines in health and social losses. While SWB has mostly been studied in high-income countries, it remains largely unexplored in rural subsistence populations lacking formal institutions that reliably promote social welfare. Here, we evaluate the age profile of SWB among three small-scale subsistence societies (n = 468; study 1), forest users from 23 low-income countries (n = 6987; study 2), and Tsimane' horticulturalists (n = 1872; study 3). Across multiple specifications, we find variability in SWB age profiles. In some cases, we find no age-related differences in SWB or even inverted U-shapes. Adjusting for confounders reduces observed age effects. Our findings highlight variability in average well-being trajectories over the life course. Ensuring successful aging will require a greater focus on cultural and socioecological determinants of individual trajectories.

COVID-19 and protection measures adopted in rural amazon communities during the first months of the pandemic. / COVID-19 y medidas de protección adoptadas en comunidades rurales amazónicas durante los primeros meses de la pandemia.

BACKGROUND: Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. BACKGROUND: Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. BACKGROUND: Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics. OBJECTIVES.: To analyze the evolution of COVID-19 in rural populations of Loreto and Ucayali in the early stage of the pandemic. MATERIALS AND METHODS.: A community-level longitudinal observational study was conducted and based on two rounds of telephone surveys with local authorities of more than 400 indigenous and non-indigenous rural communities in Loreto and Ucayali, in July and August 2020. We collected information on cases and deaths by COVID-19 in their communities, protective measures adopted and if state assistance was received in the early stage of the pandemic. Descriptive statistics allowed us to evaluate the evolution of the pandemic after the initial outbreak and compare the trends of the two regions, as well as between indigenous and non-indigenous populations. RESULTS.: In July 2020, COVID-19 had reached 91.5% of the communities, although deaths from COVID-19 were reported in 13.0% of the communities, with rural mortality being higher in Ucayali (0.111%) than in Loreto (0.047%) and in non-indigenous communities. By August, prevalence decreased from 44.0% to 32.0% of communities, but became more frequent in indigenous communities, and those in Ucayali. Traveling to the city to receive state bonuses and difficulties maintaining social distancing contributed to the spread. CONCLUSIONS.: Our findings show the evolution of COVID-19 in rural communities and point to important areas of attention in future public policies, for the adoption of protective measures and reconsidering strategies for the distribution of assistance in the face of future pandemics. BACKGROUND: Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. BACKGROUND: Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. BACKGROUND: Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics.

OBJETIVOS.: Analizar la evolución del COVID-19 en poblaciones rurales de Loreto y Ucayali en la etapa temprana de la pandemia. MATERIALES Y MÉTODOS.: Se realizó un estudio observacional longitudinal a nivel de comunidades basado en dos rondas de encuestas telefónicas con autoridades locales de más de 400 comunidades rurales indígenas y no-indígenas en Loreto y Ucayali, en julio y agosto de 2020, para recopilar información sobre casos y muertes por COVID-19 en sus comunidades, medidas de protección adoptadas y la recepción de asistencia estatal en la etapa temprana de la pandemia. Estadísticas descriptivas permiten evaluar la evolución de la pandemia después del brote inicial y comparar las tendencias de las dos regiones, así como entre poblaciones indígenas y no-indígenas. RESULTADOS.: En julio de 2020, el COVID-19 había llegado al 91,5% de las comunidades, aunque se reportaron muertes por COVID-19 en 13,0% de las comunidades, siendo la mortalidad rural mayor en Ucayali (0,111%) que en Loreto (0,047%) y en comunidades no-indígenas. Para agosto, la prevalencia disminuyó de 44,0% a 32,0% de comunidades, pero se volvió más frecuente en las comunidades indígenas, y aquellas en Ucayali. Viajar a la ciudad para recibir bonos estatales y las dificultades para mantener el distanciamiento social contribuyeron al contagio. CONCLUSIONES.: Los hallazgos mostraron la evolución del COVID-19 en comunidades rurales y señalan áreas importantes de atención en futuras políticas públicas, para la adopción de medidas de protección y reconsiderar estrategias para la distribución de asistencia ante pandemias futuras. BACKGROUND: Motivación para realizar el estudio. Documentar la evolución del COVID-19 en poblaciones rurales Amazónicas, las cuales son aún poco conocidas. BACKGROUND: Principales hallazgos. El COVID-19 se propagó rápidamente por las comunidades rurales, extendiéndose inicialmente por los caseríos mestizos y después afectando a comunidades indígenas. La mortalidad rural varió por región y por etnia. El distanciamiento social fue difícil y los viajes para recibir bonos estatales contribuyeron al contagio. BACKGROUND: Implicancias. Conocer los factores que contribuyeron al contagio y las barreras para la adopción de medidas de protección en poblaciones rurales Amazónicas ayudarán a enfrentar pandemias futuras.

Aedes aegypti feeding behavior during dengue outbreaks in two rural areas of Peru during the Yaku cyclone and El Niño phenomenon of 2023. / Comportamiento alimentario de Aedes aegypti en brotes de dengue de dos zonas rurales del Perú durante el ciclón Yaku y El Niño Global del 2023.

BACKGROUND: Motivation for the study. Dengue epidemics caused by A. aegypti occur during climatic events in tropical countries such as Peru; however, the feeding behavior of the mosquito usually goes unnoticed. BACKGROUND: Main findings. A. aegypti populations in Marcavelica and Querecotillo showed anthropophilic feeding behavior during cyclone Yaku and in the 2023 El Niño. However, populations with different feeding patterns are not ruled out. BACKGROUND: Implications. The PCR-RFLP technique of the blood cell cytochrome B gene could be implemented in vector control policies through an entomo-virological surveillance plan. OBJECTIVE.: To determine the feeding behavior of Aedes aegypti in dengue outbreaks in two rural areas of Peru during the Yaku cyclone and El Niño phenomenon of 2023. MATERIAL AND METHODS.: Eight blood samples (8 pools) were obtained from the abdomen of 80 Aedes aegypti specimens captured in the rural districts of Querecotillo and Marcavelica during the Yaku cyclone and El Niño dengue outbreaks. DNA was extracted from the analyzed samples, then a PCR was directed at the CytB gene as a genetic marker and the PCR products were enzymatically digested with the restrictases Hae III and Mwo I. The PCR-RFLP products were visualized by agarose gel electrophoresis at 4%. RESULTS.: DNA was obtained from all samples and a 358 bp amplicon was obtained as a PCR product. Likewise, the only RFLP found in Hae III was from Homo sapiens sapiens (233 and 125 bp). RFLP was not found in Hae III of Gallus gallus and RFLP in Mwo I of Canis familiaris and Mus musculus. CONCLUSION.: Aedes aegypti showed conserved anthropophilic feeding behavior in dengue outbreaks in rural areas during the Yaku cyclone and El Niño.

Opportunities and challenges in utilizing community assets to extend chronic care management in podoconiosis endemic areas: Evidence from Northwestern Ethiopia.

Community-based chronic care intervention is important in the control and prevention of lifelong conditions such as podoconiosis and similar 'intensive disease management' neglected tropical diseases (NTDs). Despite a call for such interventions, few efforts have been made to identify opportunities and challenges related to their implementation. Employing a qualitative approach, this study explored the possibility of engaging community actors, physical places and networks to promote chronic care management in rural Ethiopia. We gathered data from affected individuals, community members, local leaders, health professionals and community health workers between April and May 2022. The study revealed that affected individuals, family members, religious leaders, traditional leaders, and health professionals have the potential to extend chronic care management in rural areas. Houses, churches, schools, and healthcare facilities are suitable venues at which to perform interventions. Strong community solidarity and political will are vital to chronic care interventions, while lack of understanding about chronic conditions, financial constraints, and limited resources at healthcare facilities could pose challenges. Using community assets has great promise for expanding chronic care management with minimal costs and efforts in under resourced areas. Achieving this will require a successful plan to coordinate the collaboration among the agents and settings.

Effect of Emergency Scenario-Based Training Program on Knowledge, Self-confidence, and Competency of Elderly Caregiver Volunteers in a Rural Thai Community: A Quasi-Experimental Study.

Background: Many older people with comorbidities encounter emergency or life-threatening situations, but the response is often neglected or delayed, resulting in increased morbidity and mortality rates. Community preparedness to reduce the impact of emergency crises on older people is essential. This study aimed to determine the effect of an emergency scenario-based training program (ESBTP) for elderly care on the knowledge, self-confidence, and competency of volunteer caregivers in a rural Thai community. Methods: The one-group pre-post-test, quasi-experimental study, was conducted with a non-randomized research sampling of 40 community healthcare volunteers in Vibhavadi district, Surat Thani, Thailand. The research was conducted between October and December 2021. The ESBTP was based on Bloom's learning theory. The research instrument was a three-part questionnaire measuring knowledge, self-confidence, and competency in geriatric life-threatening surveillance and emergency assistance (GLTSEA) at one, four, and eight weeks of training. Data were analyzed using Bonferroni statistics and repeated measures ANOVA through the software IBM SPSS version 28 with hypothesis testing at P<0.05. Results: The results revealed that at Week 1, Week 4, and Week 8, the volunteers attending the ESBTP demonstrated significantly higher GLTSEA competency (P<0.001). Otherwise, the participants were not significantly different in GLTSEA knowledge (P=0.068) and self-confidence (P= 0.052) after the training. Conclusions: Volunteers' competency increased after ESBTP, but there must be continuity in community training to develop the relevant knowledge, self-confidence, and skills for emergencies.

A ten-year overview of cancer genetic family history screening in Georgia's Latina population.

Background: Population-based cancer genetic family history (FH) screening to identify families at high risk for BRCA-associated cancers has been endorsed by national public health policies. This report aimed to describe the utilization of FH screening services from 2013 to 2022 according to rurality and socioeconomic deprivation among Latinas in Georgia. Methods: Women who attended a medical appointment at participating Georgia Public Health Clinics were invited to complete FH screening. Screening results and participant zip code were reviewed. Area deprivation index (ADI) was measured at the census block group level and dichotomized (more deprived and less deprived). Rurality was measured through Rural-Urban Commuting Area (RUCA) codes and dichotomized (urban and rural). The ADI and RUCA codes were linked to participant data by zip code to characterize FH utilization among the Latina community. Results: Of the 9,330 adult Latinas in Georgia that completed cancer genetic FH screening, 9,066 (97.17%) women screened negative, and 264 (2.83%) screened positive (i.e., FH suggestive of higher risk for carrying BRCA1/2 mutations compared to the general population). Screening completion was higher among Latinas in urban areas (n = 7,871) compared to rural areas (n = 1,459). Screening completion was also higher in more socially deprived areas (n = 5,207) compared to less socially deprived areas (n = 4,123). Conclusion: Georgia's FH screening program reached Latinas across Georgia, particularly those living in urban, socially deprived areas. To ensure equitable cancer genetic screening dissemination, future efforts should prioritize tailored outreach in rural regions and comprehensive evaluations to identify key determinants of screening trends among Georgia's Latina population.

Interfacility Transfer of Children With Time-Sensitive Surgical Conditions, 2002-2017.

Importance: Surgical care for children in the United States has become increasingly regionalized among fewer centers over time. The degree to which regionalization may be associated with access to urgent surgical care for time-sensitive conditions is not clear. Objective: To investigate whether transfers and travel distance have increased for 4 surgical conditions, and whether changes in transfers and travel distance have been more pronounced for rural vs urban children. Design, Setting, and Participants: This retrospective cross-sectional study analyzed data from 9 State Inpatient Databases from 2002 to 2017. Participants included children aged younger than 18 years undergoing urgent or emergent procedures for malrotation with volvulus, esophageal foreign body, and ovarian and testicular torsion. Exposure: Residential and hospital zip codes were categorized as rural or urban. Hospitals were categorized as pediatric hospitals, adult hospitals with pediatric services, and adult hospitals without pediatric services. Main Outcomes and Measures: Primary outcomes were transfer for care and travel distance between patients' home residences and the hospitals where care was provided. Transfer and travel distance were analyzed using multivariable regression models. Results: Among the 5865 children younger than 18 years undergoing procedures for malrotation with volvulus, esophageal foreign body, ovarian torsion, or testicular torsion, 461 (7.9%) resided in a rural area; 1097 (20.5%) were Hispanic, 1334 (24.9%) were non-Hispanic Black, and 2255 (42.0%) were non-Hispanic White; 2763 (47.1%) were covered by private insurance and 2535 (43.2%) were covered by Medicaid; and the median (IQR) age was 9 (2-14) years. Most care was provided at adult hospitals (73.4% with and 16.9% without pediatric services); the number of hospitals providing this care decreased from 493 to 292 hospitals (2002 vs 2017). Transfer was associated with rural residence (adjusted odds ratio [aRR], 2.3 [95% CI, 1.8-3.0]; P < .001) and increased over time (2017 vs 2002: aOR, 2.8 [95% CI, 2.0-3.8]; P < .001). Similarly, travel distance was associated with rural residence (adjusted risk ratio [aRR], 4.4 [95% CI, 3.9-4.8]; P < .001) and increased over time (2017 vs 2002: aRR, 1.3 [95% CI, 1.2-1.4]; P < .001). Rural children were more frequently transferred (2017 vs 2002) for esophageal foreign body (48.0% [12 of 25] vs 7.3% [4 of 55]; P < .001), ovarian torsion (26.7% [4 of 15] vs 0% [0 of 18]; P = .01), and testicular torsion (18.2% [2 of 11] vs 0% [0 of 16]; P = .04). Travel distance for rural children increased the most for torsions, from a median (IQR) of 19.1 (2.3-35.4) to 43.0 (21.6-98.8) miles (P = .03) for ovarian torsion and from 7.3 (0.4-23.7) to 44.5 (33.1-48.8) miles (P < .001) for testicular torsion. Conclusions and Relevance: In this cross-sectional study of children with time-sensitive surgical conditions, the number of hospitals providing urgent surgical care to children decreased over time. Transfers of care, especially among rural children, and travel distance, especially for those with ovarian and testicular torsion, increased over time.

Prevalence of Self-Reported Diagnosed Diabetes Among Adults, by County Metropolitan Status and Region, United States, 2019-2022.

Introduction: Previous research suggests that rural-urban disparities in diabetes mortality, hospitalization, and incidence rates may manifest differently across US regions. However, no studies have examined disparities in diabetes prevalence by metropolitan residence and region. Methods: We used data from the 2019-2022 National Health Interview Survey to compare diabetes status, socioeconomic characteristics, and weight status among adults in each census region (Northeast, Midwest, South, West) according to county metropolitan status of residence (large central metro, large fringe metro, small/medium metro, and nonmetro). We used χ2 tests and logistic regression models to assess the association of metropolitan residence with diabetes prevalence in each region. Results: Diabetes prevalence ranged from 7.0% in large fringe metro counties in the Northeast to 14.8% in nonmetro counties in the South. Compared with adults from large central metro counties, those from small/medium metro counties had significantly higher odds of diabetes in the Midwest (age-, sex-, and race and ethnicity-adjusted odds ratio [OR] = 1.24; 95% CI, 1.06-1.45) and South (OR = 1.15; 95% CI, 1.02-1.30). Nonmetro residence was also associated with diabetes in the South (OR = 1.62 vs large central metro; 95% CI, 1.43-1.84). After further adjustment for socioeconomic and body weight status, small/medium metro associations with diabetes became nonsignificant, but nonmetro residence in the South remained significantly associated with diabetes (OR = 1.22; 95% CI, 1.07-1.39). Conclusion: The association of metropolitan residence with diabetes prevalence differs across US regions. These findings can help to guide efforts in areas where diabetes prevention and care resources may be better directed.

[The 5-year relative survival rate among cancer patients in Henan province of China, 2015-2019].

Objective: To analyze the 5-year relative survival rate of cancer in Henan province based on cancer registration data. Methods: Cancer survival data were extracted from the cancer registration database of Henan province with the diagnosis date between January 1, 2010 and December 31, 2019 were included. The closing date of follow-up was set as December 31, 2019. The 5-year relative survival rate of cancer was calculated using the period survival analysis method and the Ederer II method in the R package "periodR", and the interest period was between 2015 and 2019. Results: During the period of 2015-2019, the overall 5-year relative survival rate of cancer patients in Henan province was 43.6%, and after age-standardization, it was 40.2%. The overall 5-year relative survival rate showed the characteristics of higher survival rate in females than males (45.9% vs 34.7%, Z=39.60, P＜0.001) and higher survival rate in urban areas than rural areas (44.9% vs 39.1%, Z=12.97, P＜0.001). The 5-year relative survival rate for cancer patients among children aged 0-14 was 60.2%, and for adults aged 15 and above, it was 43.5%, which was standardized to 40.2% after age adjustment. There are two types of cancers with a standardized 5-year relative survival rate exceeding 70% (thyroid cancer at 82.2% and breast cancer at 71.6%), and four cancers with a rate below 30% (pancreatic cancer at 18.2%, liver cancer at 19.6%, lung cancer at 24.0%, and gallbladder cancer at 26.6%). Conclusion: The cancer 5-year survival rate in Henan Province is lower than that of the national average, indicating the need for continued enhancement of cancer prevention and control measures.

Assessing the components of water governance in Qom province within the framework of sustainable development.

One of the most important issues and challenges for Iran, particularly in hot and arid regions such as Qom province, is the current water crisis. Research has shown that good governance is directly linked to sustainable rural development. Therefore, the present study aims to design a water governance model in rural communities of Qom province to achieve sustainable rural development. The research population comprised 163 water experts from the Agricultural Engineering Organization of Qom province and 130 experts from the Water Organization of Qom province. Based on Cochran's formula and considering the population size, a sample size of 170 individuals was calculated and selected using simple random sampling. A questionnaire was used as the main research tool for data collection, which had been validated and confirmed for its reliability. The collected data were analyzed using structural equation modeling (partial least squares method) and confirmatory factor analysis. According to the results, it was determined that in the research model for measuring sustainable development in Qom province, three factors, namely government effectiveness, participation, and technical factors, are recognized as components of sustainable development. Additionally, for measuring the factors influencing water governance, technical, economic, social, institutional, legal, and customary factors are recognized as identified factors. Previous studies have not considered the role of water governance in rural development. This study, however, has placed greater emphasis on the role of water governance in sustainable rural development through a review of various theories and perspectives on this matter.

Women's exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda.

BACKGROUND: Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda. OBJECTIVE: We aimed to investigate the association between Rwandan women's exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age. METHODS: In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women's Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy. RESULTS: Of 601 women, 47.4% (n = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01-2.03) and 1.25 (95% CI, 1.04-2.01), respectively. CONCLUSION: Women's exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women's exposure to IPV and adverse effects on child growth.

Main findings: Intimate partner violence against women correlates with child stunting, exhibiting varying prevalence rates for different forms of violence occurring both before and during pregnancy.Added knowledge: This study enriches the current literature by incorporating a temporal dimension of intimate partner violence occurring before and during pregnancy, while also shedding light on contextual factors within rural African settings where violence against women persists.Global health impact for policy and action: Improved comprehension of the types, frequency, and timing of women's exposure to intimate partner violence is crucial for designing and implementing interventions aimed at mitigating the adverse impacts of violence on child growth, particularly in resource-constrained countries such as Rwanda.

Prevalence of hypertension and factors associated with the utilization of primary health care services for hypertension among hypertensive population aged 40 years and above in Pyin Oo Lwin Township, Myanmar.

BACKGROUND: Utilization of hypertension services at primary health care levels has not been assessed at township level, since launching of PEN interventions in Myanmar. This study aimed to determine the factors associating with the utilization of primary health care services for hypertension among 40 years and above hypertensive population. METHODS: Community-based cross-sectional study was done in Pyin Oo Lwin Township, 2023. Multi stage sampling was conducted to recruit 40 years and above participants; response rate was 85%. Joint National Committee (JNC7) classification was used to define hypertension. Among hypertensive participants, descriptive analysis, Chi squared test and multiple logistic models were conducted, with a significance level of 0.05. RESULTS: Out of 1001 screening participants, prevalence of hypertension was 38.6% (386). Among 386 participants, 51.8% (200) utilized primary health care services provided by public health facilities. Rural residents (AOR = 2.79, CI = 1.68, 4.67), known hypertension (AOR = 4.36, CI = 2.39, 8.23), good perception on hypertension (AOR = 0.30, CI = 0.14, 0.62), perceived cost of travel as necessary (AOR = 0.57, CI = 0.35, 0.92) and awareness of available services (AOR = 4.11, CI = 2.55, 6.71) were associated with the utilization of primary health care services for hypertension. CONCLUSION: This study provided context-specific scientific evidence to tackle existing problems of low utilization of PHC services for hypertension. Strengthening health care infrastructure for quality hypertension care at primary health care level was also recommended.

Caregivers' perceptions of feeding practices and diet diversity among children aged 12-59 months in a rural district of South India: an analytical cross-sectional study.

OBJECTIVE: The primary objective of this study was to assess caregivers' perceptions of feeding practices (breastfeeding and complementary feeding) and diet diversity among children aged 12-59 months in a rural district of South India. The secondary objective was to identify potential predictors of these perceptions and diet diversity. DESIGN: An analytical cross-sectional study was performed from March 2023 to May 2023. SETTING: In a rural district of Tamil Nadu, South India. PARTICIPANTS: This study included 301 mothers/caregivers of children between 12 and 59 months of age in a rural district of Tamil Nadu. The research gathered demographic information from caregivers, including details such as age, educational background, occupation, relationship with the child and place of residence. Additionally, the caregivers' perspectives were evaluated through a questionnaire focused on breastfeeding/complementary feeding, and the diet diversity of the children was also assessed. OUTCOME MEASURES: The primary outcome was the perceptions of mothers/caregivers of children between 12 and 59 months of age about breastfeeding/complementary feeding practices, and the diet diversity of the children was measured. Additionally, predictors associated with these perceptions were evaluated through regression analysis. RESULTS: In the present study, 188 (62.5%) and 179 (59.5%) of the participants had good perceptions of breastfeeding practices and complementary feeding practices, respectively. This binomial regression revealed that subjects with unstable occupations (adjusted OR=2.24, 95% CI 1.25 to 4.01), schooling (7.71, 95% CI 2.73 to 8.9) and higher education (38.32, 95% CI 4.63 to 316.85) had increased chances of having good perceptions of breastfeeding practices. Subjects with unstable occupations (0.23, 95% CI 0.06 to 0.85), stable occupations (0.13, 95% CI 0.04 to 0.51), schooling (0.43, 95% CI 0.25 to 0.74), higher education (0.15, 95% CI 0.04 to 0.50) and increased birth weights (2.54, 95% CI 1.35 to 4.78) had increased chances of having good perceptions of complementary feeding practices (p<0.05). This study revealed that 86.4% of the children had adequate diet diversity. CONCLUSION: The study revealed that most caregivers, particularly mothers, possess a strong understanding of breastfeeding and complementary feeding practices, with education and occupation exerting a notable influence. However, there is a crucial necessity to translate this knowledge into practical applications to effectively obtain feeding indicators.

Status and influencing factors of knowledge, attitudes and practices relating to screening for breast and cervical cancer among rural women aged 40-65 years in China: a cross-sectional study.

OBJECTIVES: The objectives are to investigate the status of knowledge, attitudes and practices (KAP) and to identify factors related to KAP towards breast and cervical cancer screening among rural Chinese women aged 40-65 years. DESIGN AND SETTING: This cross-sectional study was conducted from July to September 2020 in rural areas of eastern China. PARTICIPANTS: This study involved 301 rural women aged 40-65 years. VARIABLES AND OUTCOMES: The questionnaire included demographic information and the KAP related to breast and cervical cancer screening. Multivariate linear regression analysis was used for the multifactor analysis. RESULTS: A total of 301 rural women aged 40-65 years participated in the survey. The overall score of KAP was (62.41±11.24), and the scores of each KAP domain relating to screening for breast and cervical cancer among participants in rural areas were (1.82±0.97), (44.52±7.20) and (16.06±4.56), respectively. The following factors were significantly associated with the total KAP Score relating to breast and cervical cancer screening among rural women aged 40-65 years, explaining 35% of the variance (p<0.001): aged 50-54 (ß=-0.160, 95% CI -7.403 to -0.794), aged 55-59 (ß=-0.266, 95% CI -10.763 to -3.757), aged 60-65 (ß=-0.243, 95% CI -12.504 to -4.331), junior high school (ß=0.186, 95% CI 1.287 to 7.064), housewife (ß=0.172, 95% CI 0.849 to 6.868), other work (ß=0.171, 95% CI 3.818 to 15.044), annual household income ranging from 50 000 to 79 999 (ß=0.281, 95% CI 3.887 to 10.458) and annual household income≥80 000 (ß=0.330, 95% CI 4.735 to 11.554). CONCLUSIONS: The status of KAP related to breast and cervical cancer screening still requires improvement. Measures to enhance the participation of the two-cancer screening should be provided to rural women aged between 50 and 65 years with lower education level and lower annual household income, especially women who are farmers.

The association between visual impairment, educational outcomes, and mental health: insights from eyeglasses usage among junior high school students in rural China.

This study examined the association between visual impairment, visual impairment corrected by wearing eyeglasses, academic performance, and mental health among junior high school students in rural China. Visual acuity assessments were conducted on 19,425 junior high school students by trained medical and research professionals to determine the presence of visual impairment. All sample students were surveyed with a questionnaire that asked about individual and family characteristics, eyeglasses ownership, and educational aspirations and included a standardized math test. Students then completed an official Chinese simplified version of the Strengths and Difficulties Questionnaire (SDQ) to assess their mental health multidimensionally. Among our sample, 37.2% of them suffered from visual impairment, but only 43.4% of the visually impaired students wore proper eyeglasses. Approximately 9.3% of students were categorized as high risk for mental health problems based on their SDQ score. A significant positive association existed between impaired vision and poorer mental health, and eyeglasses usage was associated with better mental health among visually impaired students. For students with better academic performance, eyeglasses usage associated with better mental health. Eyeglasses usage shows a positive association with higher education aspiration both for students with better and worse academic performance. The significant positive relationship between eyeglasses usage and mental health may guide future interventions and policies designed to improve student mental health by supplying them with eyeglasses.

Exploring the determinants of fertility rates in Ethiopia: a decomposition analysis using count regression models with a focus on urban and rural residence, based on the 2019 Ethiopian demographic health survey.

INTRODUCTION: Fertility refers to the biological capacity to reproduce and have children. It is a key aspect of reproductive health influenced by various factors. Therefore, this study aims to explore the determinants of fertility rates based on urban and rural settings in Ethiopia. METHOD: A stratified two-stage cluster sampling approach was used, employing data from the 2019 Ethiopian Mini Demographic and Health Survey ( https://dhsprogram.com ). The study comprised 8,885 women aged 15 to 49 years. The study employed Stata 17, and the data was described using descriptive statistics. Associations were examined using decomposition analysis and negative binomial regression. The Incidence Rate Ratio and p-value were used to determine the statistical significance of the variables examined. RESULTS: The negative binomial regression found that factors such as maternal age (IRR, 1.08, P-value,0.00), living in rural (IRR,1.09, P-value,0.00), being Muslim (IRR,1.13, P-value,0.00), being from other religious groups (IRR,1.16, P-value,0.00), having six up to nine household members (IRR,1.24, P-value,0.00), having greater than nine household member(IRR,1.14, P-value,0.04), having one child under five year (IRR,1.35, P-value,0.00), having two children under five year (IRR,1.77, P-value,0.00), and having more than two under five years (IRR,1.99, P-value,0.00), being currently pregnant (IRR,1.08, P-value,0.00), use of contraceptive(IRR,1.13, P-value,0.00) are positively associated with bearing more children. On the other hand, completing primary education (IRR,0.84, P-value,0.00), secondary education (IRR,0.61, P-value,0.00), being from the richest household (IRR = 0.94, P-value,0.00), and being single/divorced and widowed (IRR,0.49, P-value,0.00) are negatively associated with having more children because their IRR is less than one. The decomposition analysis also demonstrated that marital status has a stronger negative correlation with fertility in rural compared to urban settings. Additionally, the number of children under five exerts a greater influence on fertility in urban areas. CONCLUSION: the study found significant rural-urban differences in the factors shaping fertility in Ethiopia. While demographics like maternal age, education, and wealth influenced fertility in both settings, the relationships varied in nature and magnitude. To address this, Policymakers should develop targeted fertility programs that address the unique needs and challenges faced by rural and urban populations.

Reduction in the incidence of cognitive impairment and related costs through an innovative health awareness programme in rural Japan.

OBJECTIVES: This study examined the impact of the Center of Healthy Aging Program (CHAP) on the cognitive function and economic burden associated with dementia. METHODS: This observational study utilised Iwaki cohort data. We included participants with mini-mental state examination (MMSE) scores and categorised them into pre- and post-CHAP groups based on their year of entry into the cohort (before 2013 or after) (index year). We defined participants with suspected severe cognitive impairment and suspected mild cognitive impairment using their MMSE scores, with their incidence being the first observation meeting these definitions during the follow-up period. We compared the incidence rates between the pre- and post-CHAP groups using Cox proportional hazard analysis. Medical and caregiving costs were estimated based on the projected number of residents in Iwaki area with suspected mild cognitive impairment and sSCI during hypothetical 10 years of the CHAP implemented or not and compared. RESULTS: Of the 2,569 participants, 1716 and 853 were included in the pre- and post-CHAP groups, respectively. The incidence rate of suspected mild cognitive impairment was significantly lower in the post-CHAP group even after adjusted known factors associated with cognitive disorders. No cases of suspected severe cognitive impairment occurred in the post-CHAP group during the follow-up period. Estimated costs of JPY 1,628,450 (USD 11562.00 or EUR 10259.24, JPY 100 = USD 0.71 or EUR 0.63) and JPY 789,560 (USD 5605.88 or EUR 4974.23) per person per year were projected after 10 years with and without the CHAP, respectively. CONCLUSIONS: We demonstrated a reduction in the incidence rate of suspected mild cognitive impairment among residents who participated in the CHAP and a decrease in the medical and caregiving costs associated with suspected severe cognitive impairment.

From grandmothers to granddaughters: Generational agricultural knowledge among rural women in British Mandate Palestine.

Palestinian peasant families had to adapt and survive under political and economic conditions dictated by European occupation and Zionist settler colonialism. Women had a major role in contributing to the efforts for survival and acquiring their status in the rural economy and the wider national struggle against British policies. Rural Arab families constituted the vast majority of the Palestinian population before the Nakba, or those displaced from their villages during the war on Palestine in 1948, and the formation of the State of Israel. The agricultural knowledge Palestinian women had and passed from one generation to the other was an important element for the survival of the peasant families under the different periods in which colonial countries and Zionist settlement shook the base of their economic existence.

Association of socioeconomic and lifestyle factors with prevalence of diabetes in rural southwest China: a structural equation modelling approach.

OBJECTIVES: This study aimed to investigate the prevalence of diabetes using structural equation modelling (SEM) to examine the pathways and associations of socioeconomic and lifestyle factors on diabetes in rural southwest China. DESIGN: Data were collected from a cross-sectional health interview and examination survey among individuals aged ≥35 years in rural southwest China. Fasting blood glucose, blood pressure, height, weight and waist circumference (WC) were measured for each participant. SEM was employed to assess the relationships between demographic characteristics (sex, age and ethnicity), socioeconomic position (SEP; annual household income, education level and access to medical services), lifestyle factors (obesity status (body mass index and WC) and physical inactivity), hypertension, hyperlipidaemia and family history of diabetes. SETTING: This study was conducted in rural Yunnan Province of China. PARTICIPANTS: 7536 individuals aged ≥35 years consented to participate in the study. RESULTS: The overall prevalence of diabetes in the present study was 8.3%. Prevalence did not differ by gender (prevalence for both men and women was 8.3% (p>0.05)). The results of SEM indicated that SEP, age, ethnicity, obesity status and physical inactivity had both significant direct and indirect effects on diabetes, with total effect size of 0.091, 0.149, -0.094, 0.212 and 0.089, respectively (p<0.01). Family history of diabetes (0.128, p<0.01), hypertension (0.135, p<0.01) and hyperlipidaemia (0.137, p<0.01) were directly associated with diabetes. CONCLUSIONS: Socioeconomic and lifestyle factors have both direct and indirect effects on prevalence of diabetes in rural southwest China. Future efforts to implement comprehensive interventions to promote the prevention and control of diabetes should in particular focus on obese individuals.