Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training.

BACKGROUND AND OBJECTIVES: The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. METHODS: Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates >3 years from program completion. RESULTS: Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were >3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. CONCLUSIONS: This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study.

BACKGROUND: Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage. METHODS: A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR. FINDINGS: A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3-7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2-2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties. INTERPRETATION: Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage.

[Prevalence of noncommunicable diseases and risk factors in rural population of San Luis, Argentina] / Prevalencia de enfermedades no transmisibles y factores de riesgo en población rural de San Luis, Argentina.

The objective of this study was to estimate the prevalence of diabetes mellitus (DM) and cardiovascular risk factors in a rural population in the province of San Luis, Argentina. Cross-sectional study developed between September and November 2017 with 18-year-old inhabitants and more than four towns in the Juan Martín de Pueyrredón department, San Luis. The participants answered questions by self-report on sociodemographic aspects, habits, psychosocial and risk factors for non-communicable diseases; physical measurements, FINDIRSC questionnaire and blood sample extraction were performed. Univariate estimates stratified by sex with their 95% confidence interval (95%CI) were obtained. We worked with sample expansion factors; crude and adjusted prevalences were calculated. The population consisted of 424 men (52.5%, 95%CI: 46.0-58.9) and 384 women (47.5%, 95%CI: 41.1-54.0). The adjusted prevalences for both sexes (by self-report) were: DM 11.8% (95%CI: 8.2-15.4); arterial hypertension (AHT): 35.5% (95% CI: 31.0-40.1); high cholesterol: 20.3% (CI 16.0-24.7). Males had significantly higher desirable HDL cholesterol and elevated blood pressure than females; women abdominal obesity in greater magnitude. 16.4% (95% CI: 11.0 - 23.6) had a high-very high risk of developing type 2 DM in the next 10 years. The adjusted prevalences of DM, hypertension, and high cholesterol were lower than those of the urban population of the province of San Luis. We highlight the pioneering contribution of this work to the knowledge of the health profile of rural communities in Argentina.

El objetivo de este estudio fue estimar la prevalencia de diabetes mellitus (DM) y factores de riesgo cardiovascular en una población rural de la provincia de San Luis, Argentina. Estudio transversal desarrollado entre septiembre y noviembre de 2017 con habitantes de 18 años y más de cuatro localidades del departamento Juan Martín de Pueyrredón, San Luis. Los participantes respondieron preguntas por autorreporte sobre aspectos sociodemográficos, hábitos, factores psicosociales y de riesgo para enfermedades no transmisibles; se realizaron mediciones físicas, cuestionario FINDIRSC y extracción de muestras de sangre. Se obtuvieron estimaciones univariadas estratificadas por sexo con su intervalo de confianza del 95% (IC95%). Se trabajó con factores de expansión de la muestra; se calcularon prevalencias crudas y ajustadas. La población estuvo constituida por 424 varones (52,5%, IC95%: 46,0-58,9) y 384 mujeres (47,5%, IC95%: 41,1-54,0). Las prevalencias ajustadas para ambos sexos (por autorreporte) fueron: DM 11,8% (IC95%: 8,2-15,4); hipertensión arterial (HTA): 35,5% (IC95%: 31,0-40,1); colesterol elevado: 20,3% (IC 16,0-24,7). Los varones tuvieron colesterol HDL deseable y tensión arterial elevada en una proporción significativamente superior a las mujeres; las mujeres obesidad abdominal en mayor magnitud. El 16,4 % (IC95%: 11,0 - 23,6) ostentó riesgo alto-muy alto de desarrollar DM tipo 2 en los próximos 10 años. Las prevalencias ajustadas de DM, HTA y colesterol elevado fueron inferiores a la de la población urbana de la provincia de San Luis. Destacamos la contribución pionera de este trabajo al conocimiento del perfil de salud de las comunidades rurales de Argentina.

Prospective assessment of functional and clinical results of surgical patellar stabilization in rural and urban populations. Equal chance to success?

INTRODUCTION AND OBJECTIVE: Patella dislocation represents 3.3% of all knee injuries often leading to persistent instability. Medial patello-femoral ligament(MPFL) reconstruction is the standard method of treatment in the patellar instability. Rehabilitation after MPFL-R is a long and demanding procedure. The hypothesis presented reflects the idea that despite relatively good access to hospital care and surgical options, the post-operative rehabilitation care system is still inferior in rural areas versus the one offered in major cities and towns. MATERIAL AND METHODS: Between January 2015 - January 2018, 47 patients met the study inclusion criteria, diagnosed and operated on due to patellar instability. 8 patients were lost for full follow-up. Finally, 39 patients were included, divided into two groups - group A (19 from cities), group B (20 from rural area). Prospective KOOS and Kujala scales assessments were conducted: preoperative, 6 and 12 months after surgery. Knee isokinetic muscle strength was measured at 3 stages; prior to surgery, 6 and 12 months after reconstruction. RESULTS: All patients showed significant improvement measured in the KOOS and Kujala scales after the procedure, compared to the pre-operational results. Despite equal clinical improvement, patients from Group A(city) achieved better functional outcomes as presented in the results of knee extensor functional tests using a Biodex dynamometer. CONCLUSIONS: Rehabilitation after MPFL reconstruction improves muscle strength and clinical outcome. Patients from rural areas had inferior functional results in comparison to the patients from major cities, even 12 months after surgical patella stabilization. Despite the development of roads and transport according to the EU cohesion policy, there are still differences in rehabilitation results between rural and city areas.

Evaluating the scope of rural general surgery in British Columbia.

BACKGROUND: Rural general surgeons perform many procedures outside the conventional scope of the specialty. Unique to British Columbia, the Rural Practice Subsidiary Agreement (RSA) formally defines rurality in the province. Our goal is to understand the scope of practice for BC's rural general surgeons and whether it has been affected over time by changing privileging guidelines. METHODS: Medical Services Plan (MSP) data were collected from 2011 to 2021 for procedures billed by general surgeons in communities defined by the RSA as rural. We categorized codes from the MSP based on surgical specialty. For each community, we calculated the totals for these categories considering what other surgical specialties were present as well as changes over time. RESULTS: From 2011 to 2021, 222 905 procedures were performed in 23 rural communities in BC. Colonoscopies were the most frequently performed procedure (n = 80 114, 35.9%), followed by colorectal (n = 23 891, 10.7%) and hernia procedures (n = 20 911, 9.4%). The most common unconventional procedures were plastic surgeries (n = 8077, 3.6%). Classification within the RSA did not significantly influence the percentage of unconventional general surgery procedures performed (p = 0.4). When another surgical specialty was present, there was often a decrease in the number of that specialty's procedures performed by general surgeons. Over the past decade, rural general surgeons performed fewer unconventional general surgery procedures (p < 0.001). CONCLUSION: General surgeons working in rural communities perform a variety of procedures based on resources, community need, and access to other specialists. Over the last decade, this appears to have been influenced by new privileging guidelines. Understanding the scope of rural general surgery can inform training opportunities and, as there is a migration away from rural surgeons performing as many unconventional procedures, can elucidate the implications on patients and communities.

Uptake of COVID-19 vaccine among high-risk urban populations in Southern Thailand using the COM-B model.

BACKGROUND: The COVID-19 pandemic has imposed unprecedented suffering on social and individual levels worldwide. Vaccines against COVID-19 have been prioritized as a crucial strategy for ending the pandemic as well as minimizing its consequences. OBJECTIVES: This study aimed to determine the uptake of COVID-19 vaccine among high-risk urban populations in Southern Thailand using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. METHODS: We conducted a web-based cross-sectional study in the Hat Yai district, Songkhla province in Southern Thailand, in September and October 2021. The questionnaire was composed of sections on sociodemographic characteristics, COVID-19 vaccination status, and COM-B constructs. We employed a multivariable logistic regression analysis to determine factors associated with the uptake of the COVID-19 vaccine. We set statistical significance at p < 0.05. RESULTS: In this study, females constituted 54.7% of the total participants (n = 358), and nearly half of the participants (45.8%) were in the younger age group (18-29). Of all the participants, 59.5% (95%CI: 54.2%-64.6%) received at least one dose of the COVID-19 vaccine. Factors associated with the uptake of COVID-19 vaccine and their adjusted OR (95% CI) were being married: 3.59 (2.06-6.24), having a graduate degree: 2.34 (1.38-3.96), gainfully employed: 3.30 (1.91-5.67), having a high level of opportunity: 2.90 (1.48-5.66), and having a high level of motivation: 2.87 (1.17-17.08). CONCLUSION: The uptake of COVID-19 vaccines was moderate in this population. Moreover, the results showed that the COM-B model is useful in predicting COVID-19 vaccine uptake. The findings of this study could be used to aid future public health interventions in any event of outbreaks similar to COVID-19 disease in Thailand and beyond.

Antenatal care service utilization disparities between urban and rural communities in Ethiopia: A negative binomial Poisson regression of 2019 Ethiopian Demography Health Survey.

BACKGROUND: Although there have been consistent improvements in maternal mortality, it remains high in developing countries due to unequal access to healthcare services during pregnancy and childbirth. Thus, this study aimed to further analyze the variations in the number of antenatal care utilizations and associated factors among pregnant women in urban and rural Ethiopia. METHODS: A total of 3962 pregnant women were included in the analysis of 2019 Ethiopian Demographic and Health Survey data. A negative binomial Poisson regression statistical model was used to analyze the data using STATA version 14.0. An incident rate ratio with a 95% confidence interval was used to show the significantly associated variables. RESULTS: Of the 3962 (weighted 3916.67) pregnant women, about 155 (15.21%) lived in urban and 848 (29.29%) rural residences and did not use antenatal care services in 2019. Women age group 20-24 (IRR = 1.30, 95%CI:1.05-1.61), 25-29 (IRR = 1.56, 95%CI:1.27-1.92), 30-34 (IRR = 1.65, 95%CI:1.33-2.05), and 35-39 years old (IRR = 1.55, 95%CI:1.18-2.03), attending primary, secondary, and higher education (IRR = 1.18, 95%CI:1.07-1.30), (IRR = 1.26, 95%CI:1.13-1.42) and (IRR = 1.25, 95%CI:1.11-1.41) respectively, reside in middle household wealth (IRR = 1.31, 95%CI:1.13-1.52), richer (IRR = 1.45, 95%CI:1.26-1.66) and richest (IRR = 1.68, 95%CI:1.46-1.93) increases the number of antenatal care utilization among urban residences. While attending primary (IRR = 1.34, 95%CI:1.24-1.45), secondary (IRR = 1.54, 95%CI:1.34-1.76) and higher education (IRR = 1.58, 95%CI:1.28-1.95), following Protestant (IRR = 0.76, 95%CI:0.69-0.83), Muslim (IRR = 0.79, 95%CI:0.73-0.85) and Others (IRR = 0.56, 95%CI:0.43-0.71) religions, reside in poorer, middle, richer, and richest household wealth (IRR = 1.51, 95%CI:1.37-1.67), (IRR = 1.66, 95%CI:1.50-1.83), (IRR = 1.71, 95%CI:1.55-1.91) and (IRR = 1.89, 95%CI:1.72-2.09) respectively, being married and widowed/separated (IRR = 1.85, 95%CI:1.19-2.86), and (IRR = 1.95, 95%CI:1.24-3.07) respectively were significantly associated with the number of antenatal care utilization among rural residences. CONCLUSION: The utilization of antenatal care is low among rural residents than among urban residents. To increase the frequency of antenatal care utilization, health extension workers and supporting actors should give special attention to pregnant women with low socioeconomic and educational levels through a safety-net lens.

Multidimensional Deprivations and Associated Factors Among Older Adults in Urban Geographies of Nigeria: Implications for Poor Health Outcomes in Later Life.

Objectives: Many urban-dwelling older Nigerians are multidimensionally deprived and are unable to meet their daily financial, nutritional, and healthcare needs. This has implications for their health outcomes, yet it has been under-researched. This study assessed the multidimensional deprivation index (MDI) of urban-dwelling older Nigerians and the associated factors. Methods: The study analysed a weighted sample of 5,225 older persons aged ≥60 years from Nigeria's Demographic and Health Survey, 2018. MDI was estimated, and associations were examined using a multilevel multinomial logistic regression model. Results: Nationally, 75% of the older persons were multidimensionally deprived, with 27% severely deprived. Women (36%) were more severely deprived than men (20%). Those in the Northern regions (38%-40%) were the most deprived. Higher MD risk was associated with female gender and older ages ≥70-79 years. Conversely, lower risk was associated with households headed by family and residence in educated communities. Community variation accounts for 10.4% and 35.9% of the MD and severe MD risks, respectively. Conclusion: This study suggests socioeconomic interventions that address gender disparities and target highly deprived regions, with consideration for individual and community characteristics.

Quantitative evaluation of the global impacts of human land modification on raptors.

Raptors are threatened by anthropogenic land modifications, but targeted quantitative assessment of these impacts is lacking. We conducted the first global quantitative evaluation of the impacts of human-modified land on raptors. We used eBird data from 2001 to 2020 on 425 raptor species and occupancy models to assess the impacts of human-modified land on raptor distribution. The mean spatiotemporal correlations of human settlement, cropland, and pasture with raptor occupancy probability were -0.048 (SE 0.031), -0.134 (0.032), and -0.145 (0.032), respectively. The mean sensitivity of raptor occupancy probability to settlement, cropland, and pasture was -5.760 (2.266), -3.128 (1.540), and -2.402 (1.551), respectively. The occupancy probability of raptors with a large body mass was more negatively correlated with cropland (phylogenetic generalized least squares regressions: slope = -0.052 [SE 0.022], t = -2.335, df = 1, 407, p = 0.020, λ = 0.006) and more positively correlated with pasture (slope = 0.047 [0.022], t = 2.118, df = 1, 407, p = 0.035, λ = 0.013). The occupancy probability of raptors with a more extensive range size was more positively correlated with cropland (slope = 0.002 [0.004], t = 0.399, df = 1, 407, p < 0.001, λ = 0.000). Raptors that prefer open habitats were more positively correlated with cropland (analysis of variance: F = 3.424, df = 2, p = 0.034, λ = 0.000) and pasture (F = 6.577, df = 2, p = 0.002, λ = 0.000). In Africa and South America, where raptor species are most abundant, raptor occupancy probability decreased over 20 years, most likely due to habitat fragmentation associated with human land modification. Although raptors with different ecological characteristics had different responses to human land modification, the impacts of settlement, cropland, and pasture on mean raptor occupancy probability were negative, regardless of space and time.

Evaluación cuantitativa del impacto global de la modificación humana del uso de suelo sobre las rapaces Resumen Las rapaces se encuentran amenazadas por las modificaciones de suelo antropogénicas, pero la evaluación cuantitativa focalizada de estos impactos es muy escasa. Realizamos la primera evaluación cuantitativa mundial del impacto del suelo modificado por humanos sobre las rapaces. Usamos datos de eBird desde 2001 hasta 2020 sobre 425 especies rapaces y modelos de ocupación para evaluar el impacto del suelo modificado por humanos sobre la distribución de estas especies. La correlación espaciotemporal media de los asentamientos humanos, las tierras de cultivo y las pasturas con probabilidad de ocupación por rapaces fueron -0,048 (SE 0,031), -0,134 (0,032) y -0,145 (0,032), respectivamente. La sensibilidad media de la probabilidad de ocupación de las rapaces a los asentamientos, las tierras de cultivo y las pasturas fue de -5,760 (2,266), -3,128 (1,540) y -2,402 (1,551), respectivamente. La probabilidad de ocupación de las rapaces con gran masa corporal tuvo una correlación más negativa con las tierras de cultivo (regresiones filogenéticas por mínimos cuadrados generalizados: pendiente =-0. 052 [SE 0,022], t = -2,335, gl = 1, 407, p = 0,020, λ = 0,006) y una correlación más positiva con los pastos (pendiente = 0,047 [0,022], t = 2,118, gl = 1, 407, p = 0,035, λ = 0,013). La probabilidad de ocupación de las rapaces con un área de distribución más extensa tuvo una correlación más positiva con las tierras de cultivo (pendiente = 0,002 [0,004], t = 0,399, gl = 1, 407, p < 0,001, λ = 0,000). Las rapaces que prefieren hábitats abiertos tuvieron una correlación más positiva con las tierras de cultivo (análisis de la varianza: F = 3,424, gl = 2, p = 0,034, λ = 0,000) y los pastos (F = 6,577, df = 2, p = 0,002, λ = 0,000). En África y América del Sur, en donde son más abundantes las especies rapaces, la probabilidad de ocupación de las rapaces disminuyó a lo largo de 20 años, probablemente debido a la fragmentación de hábitat asociada con la modificación del suelo por humanos. Aunque las rapaces con características ecológicas diferentes tienen diferentes respuestas a estas modificaciones, el impacto de los asentamientos, las tierras de cultivo y las pasturas fue negativo para la probabilidad de ocupación media de las rapaces, sin importar el espacio ni el tiempo.

Influencing factors of knowledge proficiency of general practitioners in rural China for esophageal cancer prevention and treatment: a cross-sectional study.

BACKGROUND: This study aims to investigate the knowledge of rural general practitioners (GPs) in esophageal cancer (EC) prevention and treatment in China and analyze relevant influencing factors, so as to improve the ability of rural GPs in EC prevention and treatment. METHODS: This cross-sectional study was conducted from November 5, 2021, to November 20, 2021. A self-designed questionnaire was used to conduct an online survey. Multivariable logistic regression models were used to identify the influencing factors of knowledge proficiency of GPs in rural China for EC prevention and treatment. RESULTS: This study included 348 participants from 12 rural areas in Hebei Province. The mean accuracy rate on all question items was 42.3% ± 10.67%. Sex (OR = 2.870, 95% CI: 1.519-5.423), educational level (OR = 3.256, 95% CI: 1.135-9.339), and comprehension of clinical practice guidelines for EC (OR = 4.305, 95% CI: 2.023-9.161) were significant predictors for GPs' knowledge proficiency of EC prevention and treatment (P < 0.05). CONCLUSIONS: The study indicated that knowledge proficiency of rural GPs of EC prevention and control still awaits to be improved. Sex, educational level, and comprehension of clinical practice guidelines for EC were significant predictors for their proficiency.

Seasonal variations in social contact patterns in a rural population in north India: Implications for pandemic control.

Social contact mixing patterns are critical to model the transmission of communicable diseases, and have been employed to model disease outbreaks including COVID-19. Nonetheless, there is a paucity of studies on contact mixing in low and middle-income countries such as India. Furthermore, mathematical models of disease outbreaks do not account for the temporal nature of social contacts. We conducted a longitudinal study of social contacts in rural north India across three seasons and analysed the temporal differences in contact patterns. A contact diary survey was performed across three seasons from October 2015-16, in which participants were queried on the number, duration, and characteristics of contacts that occurred on the previous day. A total of 8,421 responses from 3,052 respondents (49% females) recorded characteristics of 180,073 contacts. Respondents reported a significantly higher number and duration of contacts in the winter, followed by the summer and the monsoon season (Nemenyi post-hoc, p<0.001). Participants aged 0-9 years and 10-19 years of age reported the highest median number of contacts (16 (IQR 12-21), 17 (IQR 13-24) respectively) and were found to have the highest node centrality in the social network of the region (pageranks = 0.20, 0.17). A large proportion (>80%) of contacts that were reported in schools or on public transport involved physical contact. To the best of our knowledge, our study is the first from India to show that contact mixing patterns vary by the time of the year and provides useful implications for pandemic control. We compared the differences in the number, duration and location of contacts by age-group and gender, and studied the impact of the season, age-group, employment and day of the week on the number and duration of contacts using multivariate negative binomial regression. We created a social network to further understand the age and gender-specific contact patterns, and used the contact matrices in each season to parameterise a nine-compartment agent-based model for simulating a COVID-19 epidemic in each season. Our results can be used to parameterize more accurate mathematical models for prediction of epidemiological trends of infections in rural India.

Rural-urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty.

PURPOSE: Children with medical complexity (CMC) may be at increased risk of rural-urban disparities in health care delivery given their multifaceted health care needs, but these disparities are poorly understood. This study evaluated rural-urban disparities in health care delivery to CMC and determined whether Medicaid coverage, co-occurring disability, and community poverty modified the effects of rurality on care delivery. METHODS: This retrospective cohort study of 2012-2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire included CMC <18 years. Health care delivery measures (ambulatory clinic visits, emergency department visits, acute care hospitalizations, total hospital days, and receipt of post-acute care) were compared for rural- versus urban-residing CMC in multivariable regression models, following established methods to evaluate effect modification. FINDINGS: Of 112,475 CMC, 7307 (6.5%) were rural residing and 105,168 (93.5%) were urban residing. A total of 68.9% had Medicaid coverage, 33.9% had a disability, and 39.7% lived in communities with >20% child poverty. In adjusted analyses, rural-residing CMC received significantly fewer ambulatory visits (risk ratio [RR] = 0.95, 95% confidence interval [CI]: 0.94-0.96), more emergency visits (RR = 1.12, 95% CI: 1.08-1.16), and fewer hospitalization days (RR = 0.90, 95% CI = 0.85-0.96). The estimated modification effects of rural residence by Medicaid coverage, disability, and community poverty were each statistically significant. Differences in the odds of having a hospitalization and receiving post-acute care did not persist after incorporating sociodemographic and clinical characteristics and interaction effects. CONCLUSIONS: Rural- and urban-residing CMC differed in their receipt of health care, and Medicaid coverage, co-occurring disabilities, and community poverty modified several of these effects. These modifying effects should be considered in clinical and policy initiatives to ensure that such initiatives do not widen rural-urban disparities.

Rural-urban differences in meeting of physical activity recommendations by sun exposure and protection behaviors in the United States.

OBJECTIVE: To examine associations between sun protection behaviors and physical activity (PA) by rural and urban residence in the United States. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (2013-2018), restricting to participants ages 20-59 with sun behavior data. Sunburns, sun exposure, and sun protection measures were dichotomized (yes/no): ≥1 sunburn in the past year, 2+ hour outside during workdays or non-workdays, and never/rarely/sometimes using sunscreen, wearing long sleeves, and staying in the shade. Meeting PA recommendations (yes/no) was defined as ≥150 min of vigorous/moderate or ≥ 75 min vigorous PA per week. Associations between sun behaviors and PA were analyzed using logistic regression models, which accounted for survey-weights and potential confounders, and stratified by rural-urban status. RESULTS: Rural and urban individuals meeting PA recommendations had greater odds of spending 2+ hour outside during workdays (OR: 2.26 [1.88, 2.74] and 3.95 [2.72, 5.73]) and non-workdays (OR: 2.06 [1.78, 2.38] and 3.33 [2.47, 4.46]). Among urban residents, odds of staying in the shade were lower among those who met PA recommendations (OR: 0.78 [0.66, 0.92]). We did not observe differences in sunburns or other sun behaviors by PA status, regardless of rurality. CONCLUSIONS: Meeting PA recommendations was associated with greater sun exposure in both rural and urban populations. Additional exercise location (indoors/outside) data is needed to inform PA and skin cancer prevention interventions to reduce unintended increases in sun exposure and reductions in PA, respectively, especially among rural populations.

The landscape of non-psychotic psychiatric illness in rural Canada: a narrative review.

INTRODUCTION: Canada's rural population has diverse demographic features and accounts for 18.9% of Canada's population. Indigenous Peoples (First Nations, Inuit, and Métis), who are highly represented in rural communities, have additional risk factors related to colonialism, and historical and ongoing trauma. Understanding how to best respond to elevated rates of psychiatric illness in rural and remote communities requires an understanding of the unique challenges these communities face in accessing and providing high quality psychiatric services. This article reports a review of published literature on prevalence of non-psychotic psychiatric conditions, as well as the risk and protective factors influencing rates and experience of mental illness in rural and remote communities in Canada to help inform approaches to prevention and treatment. METHODS: This focused narrative review of literature related to rural non-psychotic psychiatric illness in rural and remote Canada published over a 20-year period (October 2001 - February 2023). A review of CINAHL, Medline and Academic Search Complete databases supplemented by gray literature (eg federal and provincial documents, position papers, and clinical practice guidelines) identified by checking reference lists of identified articles, and web searches. A textual narrative approach was used to describe the literature included in the final data set. RESULTS: A total of 32 articles and 13 gray literature documents were identified. Findings were organized and described in relation to depression and anxiety and substance use suicidality and loss; rates for all were noted as elevated in rural communities. Different mental health strategies and approaches were described. Variability in degree of rurality, or proximity to larger metropolitan centers, and different community factors including cohesiveness and industrial basis, were noted to impact mental health risk and highlighted the need for enhancing family physician capacity and responsiveness and innovative community-based interventions, in addition to telepsychiatry. CONCLUSION: Further focus on representative community-based research is critical to expand our knowledge. It is also critical to consider strategies to increase psychiatric care access, including postgraduate medical training and telehealth training.

Urban vs. rural: colorectal cancer survival and prognostic disparities from 2000 to 2019.

This study aimed to analyze the differences in colorectal cancer (CRC) survival between urban and rural areas over the past 20 years, as well as investigate potential prognostic factors for CRC survival in both populations. Using registry data from Surveillance, Epidemiology, and End Results (SEER) from 2000 to 2019, 463,827 CRC cases were identified, with 85.8% in urban and 14.2% in rural areas. The mortality of CRC surpassed its survival rate by the sixth year after diagnosis in urban areas and the fifth year in rural areas. Furthermore, the 5-year overall survival (OS) of CRC increased by 2.9-4.3 percentage points in urban and 0.6-1.5 percentage points in rural areas over the past two decades. Multivariable Cox regression models identified independent prognostic factors for OS and disease-specific survival (DSS) of CRC in urban and rural areas, including age over 40, Black ethnicity, and tumor size greater than 5 cm. In addition, household income below $75,000 was found to be an independent prognostic factor for OS and DSS of CRC in urban areas, while income below $55,000 was a significant factor for rural areas. In conclusion, this study found a notable difference in CRC survival between rural and urban areas. Independent prognostic factors shared among both rural and urban areas include age, tumor size, and race, while household income seem to be area-specific predictive variables. Collaboration between healthcare providers, patients, and communities to improve awareness and early detection of CRC may help to further advance survival rates.

Rural community perceptions and practices toward the novel coronavirus (COVID-19) prevention in Konso Zone, Southern Ethiopia: a lesson for the next pandemic.

Background: Corona Virus Disease (COVID-19) has provided a lesson on preparedness and coping mechanisms for similar pandemics to different community segments. To control and prevent the spreading of COVID-19, people need to possess the correct attitude and perception to follow the appropriate practices against the causative agent. Therefore, this study aimed to assess the rural community's perceptions and practices toward COVID-19 prevention among southern Ethiopia's Konso zone rural communities. Methods: A community-based cross-sectional study conducted from April to May 2022 on 605 study participants in the Kena district of the Konso zone of Ethiopia. Participants were recruited using simple random sampling techniques. Face-to-face interviews were conducted to collect data using structured questionnaires developed from the World Health Organization guide and related literature. A logistic regression model was used to identify determinants of perception and practice. Results: Among the 564 participants, 296 (52.5%) believed they would go to the healthcare facility if they contracted COVID-19. About 276 (48.9%) perceived that COVID-19 is not a stigma and should not be concealed. About 233 (41.3%) perceived COVID-19 would be controlled. However, the majority, 451 (80%), 440 (78%), 384 (68.1%), 381 (67.6%), 337 (59.8%), and 317 (56.2%) perceived that the cause of COVID-19 is sin, eating some food items were effective against the virus, no cases in their locality, living far away from COVID-19 area, the virus does not exist, respectively. Overall, only 22.5% of the study participants have good perceptions. About 58.5% practiced handwashing to prevent COVID-19, and 45.2% covered their mouth and nose while coughing/sneezing. Among the participants, 39.8% were vaccinated, and about a quarter (24.8%) of the respondents had good prevention practices. Participants with better educational status, use of social media as a source of information, and those with better income levels are found to be protective factors while being married is a risk factor. Conclusion: The status of the participant's perception and preventive practices toward COVID-19 was meager. There was a substantial magnitude of wrong perceptions about controlling such pandemics. High inaccurate perceptions and low preventive practice need an urgent and sustained improvement strategy to tackle similar pandemics or epidemics.

Development of a survey tool to assess the environmental determinants of health-enabling food retail practice in Aboriginal and Torres Strait Islander communities of remote Australia.

BACKGROUND: Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail. METHODS: We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input. RESULTS: One-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store's health-enabling practice (n = 20) and frequency of occurrence (n = 6). CONCLUSIONS: The application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores.

Household concentrations and female and child exposures to air pollution in peri-urban sub-Saharan Africa: measurements from the CLEAN-Air(Africa) study.

BACKGROUND: Relatively clean cooking fuels such as liquefied petroleum gas (LPG) emit less fine particulate matter (PM2·5) and carbon monoxide (CO) than polluting fuels (eg, wood, charcoal). Yet, some clean cooking interventions have not achieved substantial exposure reductions. This study evaluates determinants of between-community variability in exposures to household air pollution (HAP) across sub-Saharan Africa. METHODS: In this measurement study, we recruited households cooking primarily with LPG or exclusively with wood or charcoal in peri-urban Cameroon, Ghana, and Kenya from previously surveyed households. In 2019-20, we conducted monitoring of 24 h PM2·5 and CO kitchen concentrations (n=256) and female cook (n=248) and child (n=124) exposures. PM2·5 measurements used gravimetric and light scattering methods. Stove use monitoring and surveys on cooking characteristics and ambient air pollution exposure (eg, walking time to main road) were also administered. FINDINGS: The mean PM2·5 kitchen concentration was five times higher among households cooking with charcoal than those using LPG in the Kenyan community (297 µg/m3, 95% CI 216-406, vs 61 µg/m3, 49-76), but only 4 µg/m3 higher in the Ghanaian community (56 µg/m3, 45-70, vs 52 µg/m3, 40-68). The mean CO kitchen concentration in charcoal-using households was double the WHO guideline (6·11 parts per million [ppm]) in the Kenyan community (15·81 ppm, 95% CI 8·71-28·72), but below the guideline in the Ghanaian setting (1·77 ppm, 1·04-2·99). In all communities, mean PM2·5 cook exposures only met the WHO interim-1 target (35 µg/m3) among LPG users staying indoors and living more than 10 min walk from a road. INTERPRETATION: Community-level variation in the relative difference in HAP exposures between LPG and polluting cooking fuel users in peri-urban sub-Saharan Africa might be attributed to differences in ambient air pollution levels. Thus, mitigation of indoor and outdoor PM2·5 sources will probably be critical for obtaining significant exposure reductions in rapidly urbanising settings of sub-Saharan Africa. FUNDING: UK National Institute for Health and Care Research.

Use of point-of-care ultrasound in rural British Columbia: Scale, training, and barriers.

OBJECTIVE: To determine the scale and scope of use of point-of-care ultrasound (POCUS) in rural British Columbia (BC). DESIGN: Online survey. SETTING: Rural BC. PARTICIPANTS: Physicians practising in rural BC communities. MAIN OUTCOME MEASURES: Practitioner demographic and practice characteristics, locations and frequency of POCUS use, POCUS education and training, and practitioner attitudes about and barriers to POCUS use. RESULTS: Two hundred twenty-seven surveys were completed in fall 2021, corresponding to a response rate of 11.9% of all rural practitioners in BC. A total of 52.1% of respondents worked in communities with less than 10,000 people, while 24.9% had practices with relatively large proportions of Indigenous patients (more than 20% of the practice population). Respondents reported ease of access to local POCUS devices, with use highest in emergency departments (87.2%) followed by ambulatory care clinic (54.7%) and inpatient (50.3%) settings. Use of POCUS influenced clinical decision making in half the occasions in which it was employed, including a range of diagnostic and procedural applications. Barriers to use included lack of training, limited time to perform POCUS scans, and absence of image review or consultative support. Needed support for POCUS identified by respondents included real-time image acquisition advice and funding for both device acquisition and training. Recommendations for including POCUS training in undergraduate and residency education were strongly supported. CONCLUSION: Use of POCUS in BC is expanding in frequency, scope, and scale in practices serving rural areas and in rural communities with large Indigenous populations, with practitioners reporting important improvements in clinical care as a result. Future research could help improve systemic support for POCUS use, guide needed curriculum changes in medical school and postgraduate training, and be used to inform continuing professional development needs.