How sediment dredging alters phosphorus dynamics in a lowland rural river?

China's lowland rural rivers are facing severe eutrophication problems due to excessive phosphorus (P) from anthropogenic activities. However, quantifying P dynamics in a lowland rural river is challenging due to its complex interaction with surrounding areas. A P dynamic model (River-P) was specifically designed for lowland rural rivers to address this challenge. This model was coupled with the Environmental Fluid Dynamics Code (EFDC) and the Phosphorus Dynamic Model for lowland Polder systems (PDP) to characterize P dynamics under the impact of dredging in a lowland rural river. Based on a two-year (2020-2021) dataset from a representative lowland rural river in the Lake Taihu Basin, China, the coupled model was calibrated and achieved a model performance (R2>0.59, RMSE<0.04 mg/L) for total P (TP) concentrations. Our research in the study river revealed that (1) the time scale for the effectiveness of sediment dredging for P control was ∼300 days, with an increase in P retention capacity by 74.8 kg/year and a decrease in TP concentrations of 23% after dredging. (2) Dredging significantly reduced P release from sediment by 98%, while increased P resuspension and settling capacities by 16% and 46%, respectively. (3) The sediment-water interface (SWI) plays a critical role in P transfer within the river, as resuspension accounts for 16% of TP imports, and settling accounts for 47% of TP exports. Given the large P retention capacity of lowland rural rivers, drainage ditches and ponds with macrophytes are promising approaches to enhance P retention capacity. Our study provides valuable insights for local environmental departments, allowing a comprehensive understanding of P dynamics in lowland rural rivers. This enable the evaluation of the efficacy of sediment dredging in P control and the implementation of corresponding P control measures.

Disentangling microbial coupled fillers mechanisms for the permeable layer optimization process in multi-soil-layering systems.

The multi-soil-layering (MSL) systems is an emerging solution for environmentally-friendly and cost-effective treatment of decentralized rural domestic wastewater. However, the role of the seemingly simple permeable layer has been overlooked, potentially holding the breakthroughs or directions to addressing suboptimal nitrogen removal performance in MSL systems. In this paper, the mechanism among diverse substrates (zeolite, green zeolite and biological ceramsite) coupled microorganisms in different systems (activated bacterial powder and activated sludge) for rural domestic wastewater purification was investigated. The removal efficiencies performed by zeolite coupled with microorganisms within 3 days were 93.8% for COD, 97.1% for TP, and 98.8% for NH4+-N. Notably, activated sludge showed better nitrification and comprehensive performance than specialized nitrifying bacteria powder. Zeolite attained an impressive 89.4% NH4+-N desorption efficiency, with a substantive fraction of NH4+-N manifesting as exchanged ammonium. High-throughput 16S rRNA gene sequencing revealed that aerobic and parthenogenetic anaerobic bacteria dominated the reactor, with anaerobic bacteria conspicuously absent. And the heterotrophic nitrification-aerobic denitrification (HN-AD) process was significant, with the presence of denitrifying phosphorus-accumulating organisms (DPAOs) for simultaneous nitrogen and phosphorus removal. This study not only raises awareness about the importance of the permeable layer and enhances comprehension of the HN-AD mechanism in MSL systems, but also provides valuable insights for optimizing MSL system construction, operation, and rural domestic wastewater treatment.

Mortality Rate of COVID-19 With Comorbid Pneumonia in a Rural Area.

BACKGROUND: A myriad of risk factors and comorbidities have been determined to influence COVID-19 mortality rates; among these is pneumonia. This study considers pneumonia as a risk factor for increased mortality in patients admitted with COVID-19 in a rural healthcare system. We predicted that the presence of pneumonia of any kind would increase mortality rates in patients admitted with COVID-19. METHODS: A retrospective observational study was conducted using data collected from hospitals in the Freeman Health System (FHS) located in Joplin and Neosho, Missouri. Data were collected between April 1, 2020, and December 31, 2021. Using International Classification of Diseases, Tenth Revision (ICD-10) codes, the investigators identified five distinct patient populations: patients with COVID-19 and pneumonia due to COVID-19 (P1); patients with COVID-19 but without pneumonia due to COVID-19 (P2); patients with COVID-19 and any type of pneumonia (P3); patients with COVID-19 but without any type of pneumonia (P4); and patients without COVID-19 and with any type of pneumonia (P5). In order to understand how pneumonia influences COVID-19 outcomes, the investigators used Wald's method and a two-sample proportion summary hypothesis test to determine the confidence interval and to compare the mortality rates between these populations, respectively. RESULTS: The population of patients with COVID-19 and any type of pneumonia (P3) and the population of patients with COVID-19 and pneumonia due to COVID-19 (P1) showed the highest mortality rates. The population of patients with COVID-19 but without any type of pneumonia (P4) had the lowest mortality rate. The data revealed that having pneumonia combined with COVID-19 in any patient population led to a higher mortality rate than COVID-19 alone. CONCLUSION: Mortality rates were higher among COVID-19 patients with pneumonia compared to COVID-19 patients without pneumonia. Additionally, pneumonia, by itself, was found to have a higher mortality rate compared to COVID-19 alone.

Cost-Benefit Analysis of the CT of the Face in the Evaluation of Traumatic Facial Fractures in an Appalachian Tri-state Geriatric Population.

OBJECTIVE: This study aimed to evaluate the cost vs. benefits of the CT face imaging study in the trauma workup of those over the age of 65. METHODS: We performed a retrospective chart review of 169 trauma patients in our trauma database aged 65 years or older who underwent a CT of the head, a CT of the face, or a CT of the head and CT of the face that resulted in findings of a facial fracture from 2017-2022. Injuries and the treatment they received were documented. If a patient underwent both a CT of the face and a CT of the head, then the author first viewed the CT of the head, documented any injury, and then recorded treatment based on the CT of the head. The CT of the face was then viewed, injuries were recorded, and treatment based on the CT of the face was documented. Statistical analysis was then performed using the paired T-test, McNemar test, and number needed to harm analysis. RESULTS: Of the 169 patients sampled, 159 underwent both CT of the head and the face. There were no patients who underwent a CT of the face exclusively, and only 10 patients underwent a CT of the head exclusively. Of the 159 that had both a CT of the head and the face, the average number of injuries noted on CT of the head + CT of the face vs. CT of the head was 2.42 vs. 1.36, P<.0.0001. The number needed to avoid missing a surgical facial fracture when only a CT of the head was obtained was 14.68. CONCLUSION: The risks of missing a surgical facial fracture outweigh the monetary, radiation, and patient-desired necessity benefits of only performing a CT of the head. A CT of the face should be included in the trauma workup for those over the age of 65 when facial fractures are suspected.

Disparities in outpatient rural cholecystectomy outcomes.

BACKGROUND: Previous studies showed comparable outcomes for common in-patient general surgery operations, but it is unknown if this extends to outpatient operations. Our aim was to compare outpatient cholecystectomy outcomes between rural and urban hospitals. METHODS: A retrospective cohort analysis was done using the Nationwide Ambulatory Surgery Sample for patients 20-years-and-older undergoing cholecystectomy between 2016 and 2018 â€‹at rural and urban hospitals. Survey-weighted multivariable regression analysis was performed with primary outcomes including use-of-laparoscopy, complications, and patient discharge disposition. RESULTS: The most common indication for operation was cholecystitis in both hospital settings. On multivariable analysis, rural hospitals were associated with higher transfers to short-term hospitals (adjusted odds ratio [aOR] 2.40, 95%CI 1.61-3.58, p â€‹< â€‹0.01) and complications (aOR 1.39, 95%CI 1.11-1.75, p â€‹< â€‹0.01). No difference was detected with laparoscopy (aOR 1.93, 95%CI 0.73-5.13, p â€‹= â€‹0.19), routine discharge (aOR 1.50, 95%C I0.91-2.45, p â€‹= â€‹0.11), or mortality (aOR 3.23, 95%CI 0.10-100.0, p â€‹= â€‹0.51). CONCLUSIONS: Patients cared for at rural hospitals were more likely to be transferred to short-term hospitals and have higher complications. No differences were detected in laparoscopy, routine discharge or mortality.

Effectiveness of oral health interventions for schoolchildren from disadvantaged backgrounds: a systematic review protocol.

Disadvantaged schoolchildren from rural and low socioeconomic backgrounds face persistent oral health inequalities, specifically dental caries, and periodontal diseases. This protocol aims to review the effectiveness of promotive and preventive oral health interventions for improving the oral health of primary schoolchildren in these areas. We will search the PubMed, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Library, Web of Science, Dentistry and Oral Sciences databases for studies published from 2000-2023. The review includes randomised/nonrandomised controlled trials and community trials evaluating the effectiveness of promotive and preventive oral health interventions on at least one of these outcomes: changes in dental caries status, periodontal disease status, oral hygiene status/practices, sugar consumption, or smoking behaviours. Two reviewers will independently assess the searched articles, extract the data, and assess the risk of bias in the studies using the Cochrane Risk of Bias 2 (ROB 2) for randomised controlled trials and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomised controlled trials. Both narrative and quantitative analyses will be conducted. However, only narrative synthesis will be performed if the data are substantially heterogeneous. The synthesised evidence from this review can inform policymakers on evidence-based interventions to improve the oral health outcomes of schoolchildren from rural and low socioeconomic backgrounds. Systematic Review Registration PROSPERO (Registration number: CRD42022344898).

Urban-rural disparities in minimum acceptable diet intake among children aged 6-23 months in Ethiopia: A multivariable Decomposition analysis of Ethiopian demographic and health survey 2019.

Introduction: The achievement of the minimum acceptable diet intake (MAD) stands at 14% among urban and 10% among rural under-five children in Ethiopia. Consequently, identifying the determinants of the urban-rural gap is vital for advancing Sustainable Development Goals (SDGs), fostering healthier communities, and developing evidence-driven approaches to enhance health outcomes and address disparities. Objective: The objective of the study was to decompose the urban-rural disparities in minimum acceptable diet intake in Ethiopia using the Ethiopian Mini-Demographic and Health Survey 2019 data. Method: The study was conducted using the Ethiopian Demographic and Health Survey 2019 report. A total of 1,496 weighted children aged 6-23 months were included using stratified sampling techniques. The main outcome variable minimum acceptable diet was calculated as a combined proportion of minimum dietary diversity and minimum meal frequency. A decomposition analysis was used to analyze the factors associated with the urban-rural discrepancy of minimum acceptable diet intake, and the results were presented using tables and figures. Result: The magnitude of minimum acceptable diet among children aged 6-23 months in Ethiopia was 11.0%. There has been a significant disparity in the intake of minimum acceptable diet between urban and rural under-five children with 14 and 10%, respectively. Endowment factors were responsible for 70.2% of the discrepancy, followed by 45.1% with behavioral coefficients. Educational status of college and above was responsible for narrowing the gap between urban and rural residents by 23.9% (ß = 0.1313, 95% CI: 0.0332-0.245). The number of children in the household and the age of the child between 18 and 23 months were responsible for widening the gap in minimum acceptable diet intake discrepancy between urban and rural residents by 30.7% and 3.36%, respectively (ß = -0.002, 95% CI: -0.003 to -0.0011 and ß = -30.7, 95% CI: -0.025 - -0.0085). From the effect coefficients, the effect of institutional delivery was responsible for 1.99% of the widening of the gap between urban and rural residents in minimum acceptable diet intake (ß = -0.0862, 95% CI: -0.1711 - -0.0012). Conclusion: There is a significant variation between urban and rural residents in minimum acceptable diet. The larger portion of the discrepancy was explained by the endowment effect. Educational status of mothers with college and above, parity, age of child, and place of delivery were the significant factors contributing to the discrepancy of minimum acceptable diet intake between urban and rural residents.

Parenting style and the non-cognitive development of high school student: evidence from rural China.

Introduction: Understanding the relationship between parenting style and the non-cognitive development of high school students is crucial, particularly in rural China. Non-cognitive abilities, including traits such as emotional regulation, resilience, and interpersonal skills, play a significant role in students' overall development and future success. This study aims to investigate how different parenting styles impact non-cognitive abilities among high school students in rural China. Methods: This study surveyed 6,549 high school students and their primary caregivers in rural China. The students had an average age of 17.61 years, with 48% being male, and 62% of Han ethnicity. Primary caregivers self-reported their parenting styles, while the students' non-cognitive abilities were assessed using the Big Five Inventory-Short (BFI-S). The relationship between parenting style and non-cognitive development was analyzed using two distinct methods: two dimensions (authoritative and authoritarian) and four categories of parenting styles. Results: The study revealed that an authoritative parenting style had a positive impact on the non-cognitive abilities of students. Conversely, a negative association was observed between the authoritarian parenting style and the students' non-cognitive development. This association was more pronounced in the non-cognitive developmental scores of girls compared to boys. Additionally, parents from wealthier families or those with higher levels of education were more likely to adopt an authoritative parenting style rather than an authoritarian one. Discussion: The results of this study highlight the significant influence of parenting styles on the non-cognitive development of high school students in rural China. Authoritative parenting, characterized by warmth and structure, appears to foster better non-cognitive outcomes, while authoritarian parenting, marked by strictness and less warmth, is associated with poorer non-cognitive development. The gender differences observed suggest that girls may be more sensitive to variations in parenting style. Furthermore, the socioeconomic and educational background of parents plays a crucial role in determining the parenting style adopted. These findings underscore the importance of developing and implementing parenting training interventions in rural China, aimed at promoting authoritative parenting practices to enhance the non-cognitive development of students.

The impact of social capital on rural residents ' income and its mechanism analysis -Based on the intermediary effect test of non-agricultural employment.

Agricultural, rural, and farmer-related issues are of pivotal importance, significantly influencing the evolution of our party, nation, and state. Central to these multifaceted issues, the farmer's plight is three-fold: low earnings, the hardship of income augmentation, and a pronounced socioeconomic divide between rural and urban areas. The crux of resolving these agricultural, rural, and farmer-related issues lies in elevating the income levels of farmers. Utilizing data from the China Family Panel Studies (CFPS) 2018, this study probes the influence of social capital on the earnings of rural dwellers and delves into the intermediary role of non-agricultural employment. The findings indicate a substantial and positive correlation between social capital and rural income. The conclusions remain robust even after applying instrumental variable methods to counteract endogeneity. Mediation analysis reveals that social capital significantly boosts opportunities for non-agricultural employment, which, in turn, enhances the income of rural residents. Therefore, the roles of social capital and non-agricultural employment in income augmentation warrant careful consideration.

A Mixed-Method Study of the Utilization and Determinants of Private Health Insurance Schemes in the Residents of Rural Communities in Central India: A Study Protocol.

Background Private health insurance plays a critical role in healthcare financing, yet its utilization and determinants in rural settings still need to be studied, particularly in Central India. This study aims to address this gap by investigating the utilization and determinants of private health insurance schemes among residents of rural communities in Central India. Materials and methods A convergent parallel mixed-method study design, consisting of quantitative and qualitative approaches, will be employed. Quantitative data will be collected through structured questionnaires administered to residents aged 18 and above within the field practice area of a tertiary medical college hospital. Qualitative data will be gathered through in-depth interviews with key stakeholders. Statistical analysis will include descriptive and inferential statistics, while thematic analysis will be employed for qualitative data (CTRI Number CTRI/2024/06/069155). Conclusion The findings of this study will provide valuable insights into the utilization and determinants of private health insurance schemes in rural communities of Central India. By identifying barriers and facilitators to insurance uptake, policymakers and healthcare providers can develop targeted interventions to improve healthcare access and affordability in rural areas. In addition, the study will contribute to the existing literature on private health insurance utilization in India, informing future research endeavors and policy initiatives.

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth.

Introduction C-reactive protein (CRP) is a widely used laboratory test for assessing infections, inflammatory diseases, and malignancies, playing a critical role in clinical diagnosis and management. Despite its utility, CRP measurement practices vary among physicians, often influenced by training and clinical experience. This study explores general physicians' perceptions of CRP measurement in clinical practice, focusing on its diagnostic value, associated dilemmas, and impact on clinical growth and decision-making. Methods This qualitative study employed thematic analysis to examine the perceptions of general physicians at Unnan City Hospital, Unnan, Japan regarding CRP measurement. Sixteen general physicians were selected through purposive sampling and participated in one-on-one semi-structured interviews. The interviews were conducted in Japanese, recorded, transcribed verbatim, and analyzed inductively to identify themes. The analysis involved iterative coding and extensive discussion among the research team to ensure the reliability and validity of the findings. Results Three main themes emerged from the analysis: the usefulness of CRP for diagnosis and collaboration, dilemmas associated with CRP usage, and clinical growth through reconsideration of CRP's importance. Physicians highlighted CRP's value in distinguishing inflammatory from non-inflammatory diseases, predicting clinical courses, and facilitating communication with specialists. However, dilemmas arose from discrepancies between CRP levels and clinical symptoms, the influence of various non-specific factors, and habitual testing driven by training, leading to unnecessary tests and diminished clinical skills. Participants recognized the need to view CRP as one of many diagnostic tools, cultivate a habit of questioning its necessity, and reflect on its use to enhance clinical reasoning and professional growth. Conclusions CRP measurement is a valuable diagnostic tool, but effective use requires a balanced and critical approach. Discrepancies between CRP levels and clinical symptoms can lead to over-reliance on laboratory results and unnecessary testing. General physicians should integrate CRP within a broader diagnostic framework, combining it with patient history, physical examination, and other tests. Reflecting on the necessity and implications of CRP measurements can improve clinical reasoning and decision-making, ultimately enhancing patient care and resource management. Future research should explore similar perceptions in diverse healthcare settings and develop strategies to optimize CRP use in clinical practice.

Healthy diet habits attenuate the association of poor sleep quality with nonfatal ischemic stroke: A prospective rural cohort.

OBJECTIVES: The combined impact of sleep quality and diet habits on ischemic stroke remains unclear, particularly in rural populations. Therefore, this study aimed to estimate the individual and joint associations of sleep quality and diet habits with nonfatal ischemic stroke among rural adults. METHODS: A total of 22 536 participants free of stroke were enrolled from the Henan Rural Cohort. Sleep quality and diet habits were evaluated with the Pittsburgh Sleep Quality Index and food frequency questionnaire, respectively. The ischemic stroke incidence was analyzed using Kaplan-Meier curves. Cox regression and restricted cubic spline were employed to estimate the correlation of sleep quality or diet habits with ischemic stroke. RESULTS: During an average 3.92 y of follow-up, 665 ischemic stroke patients were identified. The adjusted hazard ratio (95% confidence interval) of ischemic stroke risk compared with good sleep quality was 1.276 (1.057-1.542). The hazard ratio (95% confidence interval) of nonfatal ischemic stroke compared with unhealthy diet habits was 0.693 (0.589-0.814). The restricted cubic spline indicated that the risk of ischemic stroke increased with the increase of the Pittsburgh Sleep Quality Index. And the higher the diet quality score, the lower the risk of ischemic stroke. (Ptrend < 0.05). Further analysis indicated that the association of poor sleep quality with ischemic stroke was alleviated by healthy diet habits (P < 0.05). Additionally, a robust correlation remained after excluding individuals with ischemic stroke in the first year. CONCLUSIONS: Poor sleep quality was positively associated with nonfatal ischemic stroke among rural adults, and healthy diet habits attenuated this relationship. Developing healthy diet and sleep habits may have potential health implications for preventing ischemic stroke. TRIAL REGISTRATION: The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (registration no. ChiCTR-OOC-15006699). Date of registration: July 6, 2015.

Insights from a COVID-era health needs assessment of rural Midwestern Latinos.

Latino health and well-being are crucial to the growth and vibrancy of rural areas across the United States, particularly at a time when the demographics of many rural communities are transitioning from minority Latino to majority Latino populations. This manuscript details the findings of a study that explored the health and healthcare benefit status of 524 Latino households in rural Indiana during the COVID-19 pandemic. Via 20-minute, door-to-door interviews conducted by bilingual researchers, survey participants answered questions about access to healthcare services and benefits, dietary and safety habits, medical issues, and vaccination status. The study found that slightly more than half of those surveyed were enrolled in healthcare benefit plans; approximately a third were unsatisfied with their health/health status; almost two-thirds had not received a flu shot and were eating fast food/processed food on a daily basis. Top health concerns reported included: stress (52%), vision problems (34%), neck and back pain (30%), headaches/migraines (28%), anxiety and depression (28%) and weight problems (26%). The study also discovered that half of the respondents could not identify a primary healthcare provider (PCP) by name and that pregnant women faced a lack of resources for maternal health in the county where the study was conducted. The results indicate that Latinos in rural communities continue to endure significant health issues and barriers to healthcare. The study provides an excellent model of how a rural community can monitor the health of its residents, which can inform health interventions for underserved populations.

Q fever endocarditis of the tricuspid valve transmitted in an urban setting with no livestock exposure: Case report.

BACKGROUND: Coxiella burnetii is a bacterium with extreme tenacity and contagiousness that is mainly transmitted by inhalation of contaminated aerosols. Nevertheless, a transmission by ticks is under discussion. We report a case of Q fever in an urban environment and far away from sheep breeding that caused a rare right-sided endocarditis. CASE PRESENTATION: A 55-year-old man who was in good health before the event developed a C. burnetii -endocarditis of the tricuspid valve. He had no contact with sheep and no recent travel in a rural or even endemic area. The infection originated in a strictly urban environment, and the patient's occupation as a cemetery gardener in Berlin, coupled with the close temporal and local exposure to wild boar, made a transmission by these animals a plausible hypothesis. The infection was confirmed by the German Reference Laboratory, and the patient recovered completely after treatment with doxycycline and hydrochlorquine. CONCLUSIONS: The specialities of this case report are the right-sided endocarditis and the transmission of C. burnetii in a metropolitan area without sheep contact. We think that this case should serve to increase awareness of the potential for Q fever infection even in non-rural areas.

Modelling Alternative Economic Incentive Schemes for Semi-Natural Grassland Conservation in Estonia.

Semi-natural grasslands (SNGLs) in Estonia are threatened by abandonment. This threat is leading to concerns about the degradation of biodiversity within grassland communities. Despite the high relevance of economic incentives in this context, how such incentives influence land managers' decision-making regarding the agricultural use of SNGLs has not been investigated. To obtain its socio-ecological implications for policy-making, we developed regionally specific agricultural scenarios (compensation payments, livestock capacity, hey export, and bioenergy production) and an interdisciplinary modelling approach that made it possible to simulate agricultural land use changes through land managers' responses to varied economic conditions. Through this approach, we found that some economic factors hampered the use of SNGLs: the moderate profitability of beef production, labour shortages, and the relatively high profitability of mulching. We observed a positive relationship between SNGLs and habitat suitability for breeding and feeding birds. However, due to the high maintenance costs of SNGLs, the modelling results indicated that increasing the use of SNGLs through public budgets caused crowding-out effects, i.e., the deteriorating market integration of regional agriculture. This study emphasises the need for policy measures aimed at cost-effective, labour-efficient management practices for SNGLs.

A Scoping Review of Trauma, Mental Health and First Responders in Australia.

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer-reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders.

The impact of digital governance on the health of rural residents: the mediating role of governance efficiency and access to information.

Background: Digital transformation in rural areas has become a key policy priority worldwide. China is also implementing a digital village strategy and actively promoting the digital transformation of rural governance to improve the well-being of rural residents. The literature suggests that digital governance is linked to health, but the mechanisms behind this relationship remain unclear. Methods: Using data from the 2021 China Land Economic Survey (CLES), this paper examines the impact of digital governance on the health, longevity, and mental health of rural residents. To enhance the robustness of the conclusions, this paper also introduces a dual machine learning model to solve the endogeneity problem of the model. Conclusion and discussion: This study concludes that digital governance has a significant positive impact on the health of rural residents. This finding remains consistent even after addressing endogeneity issues and conducting numerous robustness tests. Mechanistic analyses indicate that digital governance can enhance rural residents' health by improving village governance (environmental governance) and increasing the efficiency of access to personal information. Further analysis reveals that digital governance significantly increases the life expectancy of rural residents but that its effect on mental health is not significant. This study provides new insights into how digital governance affects health, with important implications for health policy development.

Where have I got to? Associations of age at marriage with marital household assets in educated and uneducated women in lowland Nepal.

Background: Women's underage marriage (<18 years) is associated with adverse maternal and child health outcomes. Poverty in the natal household has been widely considered to be a key risk factor for underage marriage, but the evidence base is unreliable. When investigating this issue, most studies use marital wealth inappropriately, as a proxy for wealth in the natal household. In contrast, we investigated whether the timing of women's marriage was associated with the wealth of the households they marry into, and how this may vary by women's education level. This approach allows us to explore a different set of research questions which help to understand the economic value placed on the timing of women's marriage. Methods: We used data on 3,102 women aged 12-34 years, surveyed within 1 year of marriage, from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Linear mixed-effects regression models investigated independent associations of women's marriage age and education level with marital household wealth, and their interactive effects. Models adjusted for marital household traits. We analysed the full sample, and then only the uneducated women, who comprised a substantial proportion in our sample. Results: In the full sample, we found that each later year of women's marriage was associated with 1.5% lower asset score for those with primary education, and with 0.3% and 1.3% higher asset score for those with lower secondary or secondary/higher education, respectively. For uneducated women, relative to marrying ≤14 years, marrying at 15, 16, 17 and ≥18 years was associated with 1.5%, 4.4%, 2.4% and 6.2% greater marital asset score respectively. Conclusion: On average, marrying ≥18 years was associated with greater marital assets for secondary-educated women. There were only very modest benefits in terms of marital household wealth for delaying marriage beyond 16 years for uneducated women or those with low education. These findings elucidate potential trade-offs faced by families, including decisions over how much education, if any, to provide to daughters. They may help to understand the economic rationale underpinning the timing of marriage, and why early marriage remains common despite efforts to delay it.

Perceptions of Supportive Factors for Reducing Risk of Maternal Mortality Among Women With Substance Use Disorders in a Rural Setting.

OBJECTIVE: To describe perceptions of supportive factors for reducing the risk of maternal mortality among women with substance use disorders (SUDs) in a rural setting. DESIGN: Qualitative descriptive design. SETTING/LOCAL PROBLEM: Participants were recruited from a rural setting in a U.S. Midwest state where rates of maternal substance use and maternal mortality are high. PARTICIPANTS: Sixteen participants were recruited from a maternal residential substance use treatment center. INTERVENTION/MEASUREMENTS: Semistructured interviews were used during which participants described their perceptions of maternal mortality and their related experiences. We analyzed the transcribed interviews using a basic inductive content analysis to yield themes and subthemes. RESULTS: We identified three main themes: Social Networks, Respectful Perinatal Care, and Residential Substance Use Treatment. CONCLUSION: Our findings suggest that nurses and other health care providers should be knowledgeable of resources to increase the social networks of women with SUD, recognize and manage the biases and judgments they may hold against women with SUD, and advocate for and refer women with SUD to residential substance use treatment.