A comparative cross-sectional study on the quality of life in Grave's disease patients: urban vs. rural perspectives.

Grave's disease affects numerous patients globally, but its impact on health-related quality of life (HR-QoL) in relation to geographical disparities remains under-explored. This cross-sectional study aimed to assess the influence of urban versus rural residence on HR-QoL among patients diagnosed with Graves' Disease in Rajasthan, India. One hundred seven Graves' disease patients from rural and urban endocrine centers were analyzed. The rural group included 52 patients (24 males, 28 females), averaging 38.9 ± 10.9 years of age, while the urban group had 55 (13 males, 42 females) with an average age of 39.1 ± 14.2 years. We found differences between rural and urban patients in terms of gender ratio, BMI, smoking habits, and obesity. Multivariable linear regression was used in both groups to determine the association between the baseline characteristics of Graves' patients from both areas and HR-QOL. Health-related quality of life, assessed via the SF-36 questionnaire, indicated higher general health and role emotional scores among urban patients. Our study found that the duration of Graves' disease in rural centers negatively impacted physical health scores. In urban patients, age and BMI influenced physical health, while gender and disease duration affected mental health scores in rural patients. Age impacted mental health in urban patients. Rural patients had a poorer quality of life compared to urban patients. Differences in gender distribution, BMI, smoking habits, and obesity rates revealed disparities in Graves' disease between rural and urban patients in India, highlighting the need for better healthcare infrastructure and awareness in rural areas.

Role of intergenerational connections in cognitive aging: Evidence from a Chinese longitudinal study.

Objective: To explore the impact of intergenerational connections on cognitive function in middle-aged and older adults (45-60 years and over 60 years, respectively) and analyze the urban-rural and sex differences in the effects of intergenerational connections on cognitive function. Method: Based on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for four waves of data from 2011, 2013, 2015, and 2018. Cognitive function was measured via Telephone Interview for Cognitive Status-modified (TICS-m), word recall, and imitation drawing. Using a combination of cross-sectional and longitudinal research, we constructed the cross-lagged panel model (CLPM) with a sample of 1,480 participants to explore the relationship between intergenerational connections and cognitive function. Results: This study examines the impact of intergenerational connections on cognitive function in middle-aged (45-60 years) and older adults (over 60 years) using data from the CHARLS. It identifies urban-rural and sex differences, with notable effects among rural female participants. The frequency of meeting with one child negatively predicts cognitive function (ß = -0.040, p = 0.041), and the frequency of communication with one child positively predicts cognitive function (ß = 0.102, 0.068, 0.041, p < 0.001, p = 0.001, 0.045). Meanwhile, intergenerational connections with multiple children positively predicts cognitive function (ß = 0.044, p = 0.031), (ß = 0.128, 0.084, and 0.056, p < 0.001, 0.001, p = 0.008). There are urban-rural and sex differences in the effects of intergenerational connections on cognitive function; additionally, the effects of intergenerational connections on cognitive function are significant in rural female middle-aged and older adults. Discussion: This study proposes the theory of skewed intergenerational support, which suggests that as middle-aged and older adults age, the responsibility for intergenerational support is skewed toward one child. This leads to conflicts between middle-aged and older parents and the child, which further affects cognitive function. In addition, this study put forward the boat-carrying theory of intergenerational relations and "to hold a bowl of water level" is the art of dealing with intergenerational relationships.

Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study.

BACKGROUND: In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. OBJECTIVE: This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. METHODS: This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults' perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. RESULTS: The qualitative study identified the core category of "medical service relief and transformation paths for older adults in the context of digital reform." Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use (ß=.594, P<.001), perceived usefulness (ß=.544, P<.001), and promoted digital medical behavioral intentions (ß=.256, P<.001), while also reducing perceived risk (ß=-.295, P<.001). Additionally, perceived ease of use (ß=.168, P<.001) and perceived usefulness (ß=.508, P<.001) positively impacted behavioral intention, whereas perceived risk (ß=-.05, P=.037) exerted a negative influence. Furthermore, behavioral intention (ß=.641, P<.001) significantly and positively affected older adults' satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables → perceived ease of use → behavioral intention (effect size of 13.9%); (2) external variables → perceived usefulness → behavioral intention (effect size of 38.4%); (3) external variables → perceived ease of use → perceived usefulness → behavioral intention (effect size of 10.1%); and (4) a direct effect (35.5%) from external variables to behavioral intention. CONCLUSIONS: Based on the study's findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal.

Determination of appropriate policy targets to reduce the prevalence of stunting in children under five years of age in urban-poor communities in Indonesia: a secondary data analysis of the 2022 Indonesian national nutritional status survey.

OBJECTIVE: Based on previous studies, urban-poor societies are very vulnerable to stunted children under five. The study aims to determine the appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia. DESIGN: A study was conducted using a secondary data analysis. The study analysed existing data from the 2022 Indonesian National Nutritional Status Survey. SETTING AND PARTICIPANTS: At the national level, Indonesia encompassed 43 284 toddlers. INTERVENTIONS: Non-intervention study. PRIMARY AND SECONDARY OUTCOMES: The study's eight independent factors were the mother's age, education, marital status, employment, wealth, antenatal care (ANC), children's age and sex, with nutritional status as the dependent variable. We employed a binary logistic regression test for the most recent exam. RESULTS: Maternal age was related to stunted toddlers in communities of urban poor in Indonesia. The lower the education, the higher the possibility of having stunted kids. Unemployed mothers were 1.153 times more likely than employed mothers to have stunted under-five children (95% CI 1.145 to 1.160). The poorest were 1.235 times more likely to get stunted under-five than the poorer (95% CI 1.227 to 1.242). Mothers without ANC during pregnancy were 1.212 times more likely to get stunted kids than those with ANC during pregnancy (95% CI 1.186 to 1.240). All kids' ages were more probable than 0-11 to be stunted. Boys were 1.099 times more likely to be stunted than girls (AOR 1.099; 95% CI 1.093 to 1.105). CONCLUSION: The appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia were younger mothers, those with poor education, those unemployed, the most impoverished, those without ANC, those with older under-five and those with boy kids.

The impact of economic agglomeration on China's urban public health.

Introduction: This study aims to explore the impact of economic agglomeration on the urban prosperity through economies of scale and agglomeration, it may also affect the public health of the agglomeration area. Methods: This paper takes 280 cities in China as the research object, and explores the impact of economic agglomeration on public health through a two-way fixed effects model, instrumental variable method, and generalized moment estimation. Results: The results indicate that: (1) the improvement of China's economic agglomeration can significantly promote urban public health, and economic agglomeration is a prerequisite for the improvement of urban public health, but there is no reverse causal relationship. (2) The enhancement of economic agglomeration in Northeast China has the greatest promotion effect on public health, followed by the eastern, western, and central regions; The economic agglomeration enhancement of the pilot medical group in closely connected cities has a greater promoting effect on public health than the pilot medical group in non-closely connected cities. (3) Empirical results based on micro sample data show that the improvement of economic agglomeration will also promote the increase of the number of public hospitals in cities. Discussion: This study emphasizes the important role of economic accumulation in the improvement of urban public health and provides empirical support for future economic development policies and practices.

Hybrid model of care for older persons for improvement of frailty index-a community-based interventional study in an urban setting.

BACKGROUND: An older person undergoes a 'disablement' process with aging. A comprehensive geriatric assessment centered around the functional status informs the healthcare provider of their frailty status, based on which tailored interventions may be designed to help prevent/reverse frailty. This study was conducted to assess the improvement in frailty index by training older persons for self-care practices using a multi-domain behavioural intervention, assisted by their caregivers. METHODS: It is a community-based interventional trial among older persons aged ≥ 60 years and their primary caregivers conducted in an urban community for a period of 15 months. A hybrid model, which exploits the advantages of every indigenous geriatric model of care, in providing a holistic care to old persons, was developed and adopted. Intervention was designed to incorporate all domains of frailty assessed, based upon self-efficacy and social interdependence theory. Frail-VIG scale and SPPB scores were used to measure the outcomes. RESULTS: 128 older persons and their primary caregivers were recruited. Median age was 70 and 67 years in the intervention and control group respectively, with majority being males. The median frailty index at baseline was 0.36 in both the groups, with improvement in intervention group (0.20) and worsening in control group (0.44) at end-line. From the DID analysis, a reduction of 0.19 points of frailty index was observed (even after adjustment for co-variates) in the intervention group, as compared to the control group. Also, it was observed that age and gender of the old person, their per capita income and the family support played an interactive effect in improvement of the frailty index. There was a significant difference in SPPB scores as well, between the groups [5 (1) in CG vs. 7 (2) in IG, p < 0.001]. CONCLUSION: Frailty could be reversed with appropriate interventions designed on the pillars of self-efficacy, and social interdependence among family members. The hybrid model of care delineates the role of caregivers, who reinforce the old persons to follow prescribed interventions.

Rural-Urban Differences in Self-Reported Participation in Diabetes Self-Management Education.

CONTEXT: Rural America faces a dual challenge with a higher prevalence of diabetes mellitus (hereafter, diabetes) and diabetes-related mortality. Diabetes self-management education (DSME) can improve glucose control and reduce adverse effects of diabetes, but certified DSME programs remain disproportionately limited in rural counties than in urban counties. OBJECTIVE: The goal of this study is to examine the proportion of urban and rural adults who report having received DSME using a nationwide, 29-state survey while considering the potential consequences of lower service availability. DESIGN: This cross-sectional study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Residence was defined as urban (metropolitan county) vs rural (non-metropolitan county). Logistic regression, incorporated survey weights, was used to determine the odds of having received DSME by residence. SETTING: BRFSS is a nationally representative survey, and this study included participants from 29 states that were distributed throughout all regions of the United States. PARTICIPANTS: The study sample consisted of 28,179 adults who reported having diabetes, lived in one of the states that administered the diabetes module in 2019, and answered all relevant questions. MAIN OUTCOME MEASURES: The main outcome measure was whether a participant had ever received DSME. Participants were considered to have received DSME if they self-reported having ever taken a class on how to manage diabetes themselves. RESULTS: Overall, 54.5% of participants reported having received DSME; proportionately fewer rural residents (50.4%, ±1.1%) than urban residents (55.5%, ±1.0%) reported DSME. Rural disparities persisted after adjusting for demographic, enabling, and need factors (Adjusted Odds Ratio  = 0.79; CI, 0.71-0.89). By sociodemographic factors, Hispanic persons vs non-Hispanic White persons and single vs married/coupled individuals were less likely to report DSME receipt (both 0.76 [0.62-0.94]). CONCLUSIONS: Ongoing national efforts addressing rural disparities in diabetes-related complications should target individuals most at risk for missing current diabetes educational programming and design appropriate interventions.

Smoking prevalence among adults in China Mainland and their age of smoking initiation during adolescence: a national cross-sectional study.

OBJECTIVES: This study aims to calculate the national prevalence of smoking among Chinese adults and to describe the hazard of smoking initiation by age during their adolescence, as well as the disparities in sex, residence and age groups. DESIGN: A cross-sectional study. SETTING: The data were derived from a multistage sampling study conducted in 120 cities in China Mainland. PARTICIPANTS: A total of 9963 participants aged ≥19 years were included. PRIMARY OUTCOME MEASURES: Survival analysis was used to quantify the hazards of smoking initiation by a single year of age during adolescence, and the log-rank test was used to compare the hazard curves across subgroups. RESULTS: The prevalence of current smoking among males and females was 27.7% and 2.0%, respectively, and 56.2% of current smokers began smoking at or before the age of 18. The hazard of smoking initiation during adolescence for females was less than 0.5%, and the hazard for males increased gradually before 14 years of age and increased sharply at age 15 (4.34%), then peaked at age 18 (6.24%). Males in rural experienced a higher hazard of smoking initiation than those in urban (χ2=5.35, p=0.02) and no such difference was found in females. By the age of 18 years, 11.7% of participants (1.8% for females and 23.4% for males) had ever smoked. CONCLUSIONS: The prevalence of smoking among Chinese adults was lower than once reported. Males experienced higher hazards of smoking initiation at all ages than females. The hazard pattern suggests that the key focus for smoking prevention are males and adolescents aged 15-18 years, and future interventions should be delivered to the right target population at the appropriate time.

The influence of the perception, attitude, and level of trust on the uptake of COVID-19 vaccinations among pregnant women attending antenatal care clinic in mbeya urban, Tanzania.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) has been associated with adverse effects and death among people with low immunity, including pregnant women. Despite introducing the vaccine as the proper means to curb the spread of the pandemic, vaccine uptake is still low. This study assessed the influence of perception, attitude, and trust toward COVID-19 vaccine uptake among pregnant women attending Antenatal Care Clinics. METHODS: A cross-sectional study design was used, utilizing a quantitative approach with a cross-sectional analytical design conducted in Mbeya urban, distribution of sample size during data collection based on client's volume at three government health facilities (one tertiary health facility, one secondary health facility, and one primary health facility) in Mbeya Urban, Tanzania. Data were collected from 333 pregnant women who attended ANC during the data collection period using a questionnaire with closed-ended questions administered to respondents face-to-face. Data cleaning and analysis were done using Excel and Stata/SE 14.1 software for bivariate and multivariate data; Pearson's chi-squire and Fisher's test were used to analyze the independent determinants of COVID-19 vaccine uptake. RESULTS: The proportion of pregnant women vaccinated with the COVID-19 vaccine was 27%. There was a statistically significant association between the respondents' vaccine uptake with primary education and < 5 work experience to vaccine uptake P = 0.015 (AOR = 6.58; 95% CI; 1.45-29.85), and P = 0.046 (AOR = 2.45; 95% CI; 1.02-5.89) respectively. The association of attitude influence to COVID-19 vaccine uptake was statistically significant (acceptance of vaccine due to its availability, vaccine acceptance for protection against COVID-19 pandemic to respondent and her baby, experience from other vaccines) was statistically significant at P = 0.011 (AOR = 4.43; 95% CI; 1.41-13.93), P = 0.001 (AOR = 45.83; 95% CI; 18.6-112.89) respectively. The level of trust in the COVID-19 vaccine influenced respondents' association with vaccine uptake in the 2nd and 3rd trimesters of pregnancy (P = 0.633 (AOR = 1.23; 95% CI; 0.53-2.48), respectively. CONCLUSION: Pregnant women's positive attitude and trust in the COVID-19 vaccine influenced them to uptake it; our conclusion supports the WHO guidelines that the COVID-19 vaccine should be administered to pregnant women since it is a safer means to curb COVID-19 pregnancy-related complications.

Lessons for future pandemics: Temporal evolution and rural-urban variations in the impacts of the COVID-19 on opioid use treatment.

The COVID-19 pandemic introduced imminent and lasting impacts on the opioid crisis in the U.S., including a significant increase in opioid overdose and deaths and in use of telehealth in treatment. What lessons can we learn from the treatment transition during the pandemic that could help tackle the opioid crisis when future pandemics strike? In this paper, we conducted a phone survey with opioid treatment facilities in Pennsylvania to examine the COVID-19's impacts on treatment facilities and individuals with opioid use disorder during the first year of the pandemic. We separated the lockdown period (Mid-March through Mid-May, 2020) from the reopening period that followed, and urban areas from rural areas, to explore temporal evolution and rural-urban variations in the COVID-19's impacts. We found rural-urban heterogeneity in facilities' adoption of telehealth in treatment and in challenges and risk factors faced by their clients during the lockdown period. During the reopening, telehealth was adopted by most facilities, and telehealth-related challenges became less salient; however, both rural and urban facilities reported higher relapse risks faced by their clients, citing factors more likely to be at clients' end and related to socioeconomic stressors and mental health. Our results highlight the vitality of addressing socioeconomic and mental health challenges faced by individuals with OUD, via government policies and community interventions, when future pandemics strike. The findings also indicate the importance of maintaining facilities' financial well-being to provide treatment services.

Sports tourism downturn: The impact of COVID-19 on Chinese tourism among urban and rural residents under epidemic.

BACKGROUND: China's sports tourism has seen significant growth since the 2008 Olympics, only to be challenged by the coronavirus disease 2019 pandemic. This study aims to assess the impact of the pandemic on China's tourism and sports tourism, which are highly interrelated. METHOD: Data and materials from 2019 to mid-2023 were systematically collected and analyzed, focusing on seasonal tourism reports published on official local networks in China. RESULTS: The study reveals a prepandemic annual tourism consumption of 6.63 trillion CNY, a 52.1% decline during the pandemic, and a postpandemic rebound exceeding pre-coronavirus disease levels. CONCLUSION: The pandemic's impact was profound, yet the resilience of China's tourism sector is evident, with a focus on the recovery's implications for sustainable growth. Despite the pandemic's disruption, China's tourism and sports tourism sectors have demonstrated resilience and potential for continued growth, warranting ongoing attention.

Regional differences in the Association of Healthy Aging with the incidence of falls: an analysis based on the China Health and Retirement Longitudinal Study from 2011 to 2020.

Background: Falls frequently occur among the older adult population. In this study, we examined the variations in fall incidence across different regions over time, focusing on the disparities between urban and rural areas among older adult Chinese individuals, Healthy aging is comprised of five dimensions: (1) absence of chronic diseases, (2) good physical functioning, (3) normal cognitive function, (4) active social participation, and (5) absence of depression. Additionally, we explored the relationship between healthy aging and the occurrence of falls in middle-aged and older adults. Falls are defined as events that occurred within the past two years. Results: Among 9,918 participants, 33.8% lived in urban areas and 23.0% achieved healthy aging. In contrast, 66.2% resided in rural areas with 16.5% achieving healthy aging. In 2011, rural residents had a higher fall incidence rate (17% in rural vs. 13.5% in urban); by 2020, the fall rate remained higher in rural areas (19.5% in rural vs. 17.3% in urban). Unhealthy aging (HR = 1.08, 95%CI: 1.00-1.16) were risk factors for falls. Subgroup analysis revealed that in rural areas, unhealthy aging increased the risk of falls. In urban areas, the increased risk of falls associated with unhealthy aging was not significant (Rural HR = 1.11, 95%CI:1.01-1.22; Urban HR = 1.05, 95%CI: 0.93-1.18). Conclusion: Healthy aging may be more strongly associated with a lower risk of falls in rural areas, while this association might be less pronounced in urban areas due to different environmental and social factors. This highlights the need for environment-specific fall prevention strategies and targeted measures for the older adult.

The effects of substance use on non-communicable diseases among older adults aged 60 and above in the North-eastern States of India.

INTRODUCTION: The North-eastern region of India has a relatively higher prevalence of substance use, which together with poor dietary practices and a lack of physical activity is one of the key risk factors for NCDs among older adults in the region. Understanding the prevalence of NCDs and their relationship to substance use can help develop preventive strategies and sensitization in North-eastern India. OBJECTIVE: To assess the prevalence of NCDs and the strength of the association of substance abuse among the geriatric population of North-eastern states in India, for the development of preventive strategies. METHODS: Data from the Longitudinal Ageing Study in India (LASI Wave-I, 2017-18) were drawn to develop this paper. The bi-variate and binary logistic regression analyses were carried out to predict the association between non-communicable diseases and substance use adjusting select socio-demographic characteristics. RESULTS: The paper revealed the prevalence of NCDs among urban people (61.45%) is higher than among rural people (42.45%). Hypertension (37.29%) can be seen as the most prevalent disease among the following given NCDs followed by Diabetes (8.94%). The chances of having Cancer are nineteen times higher (OR = 19.8; C.I. = 18.82-20.83) if an individual has past smoking behaviour after controlling for socio-demographic and physical activity variables. CONCLUSION: Since, the high prevalence of hypertension correlated with the high level of substance abuse, require immediate attention to develop appropriate intervention strategies for its control (substance abuse) and prevention of hypertension. In a lower middle-income country like India, preventive measures, rather than curative measures will be cost-effective and helpful.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China.

BACKGROUND: High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM. METHODS: Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels. RESULTS: We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts. CONCLUSIONS: Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

The impact of family urban integration on migrant worker mental health in China.

Background: As China has undergone the processes of urbanization and economic development, a large migrant population has emerged, creating new family migration trends. Family migration brings about changes in urban integration costs and benefits, affecting health investment. Objective: The primary objective of this research is to investigate the influence of urban integration of migrant workers' families on their mental wellbeing, with the aim of offering policy recommendations conducive to the realization of a comprehensive public health strategy in China. Methods: This paper uses multi-dimensional indexes to measure family urban integration, covering economic, social and psychological dimensions, which may consider the complexity of integration. Utilizing a machine learning clustering algorithm, the research endeavors to assess the level of urban integration experienced by migrant workers and their respective families. The analysis discerns three distinct clusters denoting varying degrees of urban integration within these familial units, namely high-level, medium-level, and low-level urban integration. We applied binary logit regression models to analyze the influence of family urban integration on the mental health among migrant workers. Then we conducted a series of robustness tests. Results: The results show that family urban integration decreases the probability of depressive symptoms by 14.6 percentage points. Further mechanism tests show that family economic integration enhances the psychological wellbeing of migrant workers by elevating their income status. Family social integration decreases depressive symptoms by increasing social status. Family psychological integration increases the psychological health of migrant workers by making them more satisfied with their lives. The heterogeneity test shows that family urban integration and its different dimensions have a strong impact on the depressive symptoms of women, first-generation, and less-educated groups. Conclusions: This study finds that family urban integration and its economic, social, and psychological dimensions significantly reduced the depressive symptoms of migrant workers. The results of this study lead the authors to recommend formulating a family-centered policy for migrant workers to reside in urban areas, optimizing the allocation of medical resources and public services, and improving family urban integration among migrant workers in order to avoid mental health problems in the process of urban integration.

Knowledge of and attitude towards depression among urban and rural residents in Beijing: a cross-sectional study.

OBJECTIVES: To compare the level of knowledge of depression, recognition ability and attitudes towards depression among urban and rural residents in Beijing. DESIGN: A cross-sectional study. SETTING: Six districts in Beijing, China, 2021. PARTICIPANTS: A total of 6463 participants aged 18 years and above who had lived for more than 6 months over the last year in Beijing were selected in this study. OUTCOME: The awareness and recognition of depression and the views of residents towards people with depression. RESULTS: A total of 2554 urban and 2043 rural residents completed the survey. Urban residents of Beijing exhibited a higher average total score on the Depression Knowledge Questionnaire [(20.4±3.3) vs (18.7±3.5), p<0.001] and a higher rate of correctly identifying individuals with depression (47.9% vs 36.6%, p<0.001) than their counterparts in rural areas. Residents who correctly identified people with depression had higher scores on the Depression Knowledge Questionnaire. Depression knowledge varied significantly among urban and rural residents. The multivariate linear regression analysis revealed that rural residents scored significantly lower on measures of depression knowledge compared with urban residents (B=-0.83, 95%CI=-1.03 to -0.63, p<0.001). Older individuals (aged 50+) showed lower understanding compared with the 18-49 age group, with significant negative regression coefficients (Urban: B=-1.06, Rural: B=-1.35, both p<0.001). Higher educational levels were positively associated with greater depression knowledge (Urban: B=1.40, Rural: B=1.21, both p<0.001). Employment was linked to higher knowledge levels than unemployment (Urban: B=-0.60, Rural: B=-0.58, both p=0.00). A monthly income of 8000 yuan or more correlated with better depression understanding than lower incomes (Urban: B=0.81, Rural: B=1.04, both p<0.001). Additionally, in urban areas, unmarried residents scored higher in depression knowledge than those divorced (B=-0.55, p=0.04). Residents in urban areas had relatively positive attitudes towards individuals with depression. CONCLUSIONS: Rural residents of Beijing had lower levels of knowledge and recognition of depression and more negative attitudes towards individuals with depression than those from urban areas. The health authority needs to focus on the poor level of knowledge and increase mental health resources in rural areas as a priority site for future psychological popularisation efforts.

Place-based, intersectional variation in caregiving patterns and health outcomes among informal caregivers in the United States.

Introduction: Informal caregiving is a critical component of the healthcare system despite numerous impacts on informal caregivers' health and well-being. Racial and gender disparities in caregiving duties and health outcomes are well documented. Place-based factors, such as neighborhood conditions and rural-urban status, are increasingly being recognized as promoting and moderating health disparities. However, the potential for place-based factors to interact with racial and gender disparities as they relate to caregiving attributes jointly and differentially is not well established. Therefore, the primary objective of this study was to jointly assess the variability in caregiver health and aspects of the caregiving experience by race/ethnicity, sex, and rural-urban status. Methods: The study is a secondary analysis of data from the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention. Multivariable logistic regression or Poisson regression models assessed differences in caregiver attributes and health measures by demographic group categorized by race/ethnicity, sex, and rural-urban status. Results: Respondents from rural counties were significantly more likely to report poor or fair health (23.2% vs. 18.5%), have obesity (41.5% vs. 37.1%), and have a higher average number of comorbidities than urban caregivers. Overall, rural Black male caregivers were 43% more likely to report poor or fair health than White male caregivers (OR 1.43, 95% CI 1.21, 1.69). Urban female caregivers across all racial groups had a significantly higher likelihood of providing care to someone with Alzheimer's disease than rural White males (p < 0.001). Additionally, there were nuanced patterns of caregiving attributes across race/ethnicity*sex*rural-urban status subgroups, particularly concerning caregiving intensity and length of caregiving. Discussion: Study findings emphasize the need to develop and implement tailored approaches to mitigate caregiver burden and address the nuanced needs of a diverse population of caregivers.

Historical redlining, neighborhood disadvantage, and reports of child maltreatment in a large urban county.

BACKGROUND: Child protective services (CPS) reports are spatially concentrated in disadvantaged neighborhoods and Black children are more likely than White children to reside in these neighborhoods. Entrenched patterns of racial residential segregation reflect the lasting impact of historical redlining - a racist practice spearheaded by the federally sponsored Home Owners' Loan Corporation (HOLC) in the 1930s that assigned worst risk grades to minoritized neighborhoods. Research has established links between historically redlined areas and the present-day wellbeing of children and families; however, little is known about the relationship between historical redlining and CPS report rates in neighborhoods. OBJECTIVE: Using census tracts as a proxy for neighborhood, this study examines the relationship between historical redlining and the number of CPS reports within neighborhoods. PARTICIPANTS, SETTING, AND METHOD: This study combines data on HOLC risk grades and sociodemographic data from the American Community Survey with the aggregate number of CPS reports per census tract in Los Angeles County, CA (n = 1137). RESULTS: We used Bayesian conditionally autoregressive models to examine the relationship between historical redlining score (A = 1, B = 2, C = 3, D = 4) and the number of CPS reports within neighborhoods. In the unadjusted model, each unit increase in redlining score is associated with a 21.6 % higher number of CPS reports (95 % CI; 1.140, 1.228). In adjusted models that included concentrated disadvantage, each unit increase in redlining score is associated with a 7.3 % higher number of CPS reports (95 % CI; 1.021, 1.136). CONCLUSION: Housing policy reforms through a racial equity lens should be considered as a part of a national strategy to prevent child maltreatment.

Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study.

Background: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods: Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results: There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82-1.63), less evaluation (AOR 1.29, 95% CI 0.92-1.81), and less decision ability (AOR 1.20, 95% CI 0.86-1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56-2.13), less evaluation (AOR 1.05, 95% CI 0.61-1.79), and less decision ability (AOR 1.10, 95% CI 0.64-1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48-1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47-1.54), evaluation (AOR 0.89, 95% CI 0.50-1.57), and decision ability (AOR 0.99, 95% CI 0.55-1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48-1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62-2.44), evaluation (AOR 0.98, 95% CI 0.53-1.82), and decision ability (AOR 0.90, 95% CI 0.49-1.67), were associated with medication adherence in rural areas. Conclusions: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.

Housing instability patterns among low-income, urban Black young adults in California and associations with mental health outcomes: baseline data from a randomized waitlist-controlled trial.

BACKGROUND: Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes. METHODS: Using baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18-24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope. RESULTS: We found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns. CONCLUSIONS: High prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.