Associations between digital literacy, health literacy, and digital health behaviors among rural residents: evidence from Zhejiang, China.

OBJECTIVE: Within the digital society, the limited proficiency in digital health behaviors among rural residents has emerged as a significant factor intensifying health disparities between urban and rural areas. Addressing this issue, enhancing the digital literacy and health literacy of rural residents stands out as a crucial strategy. This study aims to investigate the relationship between digital literacy, health literacy, and the digital health behaviors of rural residents. METHODS: Initially, we developed measurement instruments aimed at assessing the levels of digital literacy and health literacy among rural residents. Subsequently, leveraging micro survey data, we conducted assessments on the digital literacy and health literacy of 968 residents in five administrative villages in Zhejiang Province, China. Building upon this foundation, we employed Probit and Poisson models to empirically scrutinize the influence of digital literacy, health literacy, and their interaction on the manifestation of digital health behaviors within the rural population. This analysis was conducted from a dual perspective, evaluating the participation of digital health behaviors among rural residents and the diversity to which they participate in such behaviors. RESULTS: Digital literacy exhibited a notably positive influence on both the participation and diversity of digital health behaviors among rural residents. While health literacy did not emerge as a predictor for the occurrence of digital health behavior, it exerted a substantial positive impact on the diversity of digital health behaviors in the rural population. There were significant interaction effects between digital literacy and health literacy concerning the participation and diversity of digital health behaviors among rural residents. These findings remained robust even after implementing the instrumental variable method to address endogeneity issues. Furthermore, the outcomes of robust analysis and heterogeneity analysis further fortify the steadfastness of the aforementioned conclusions. CONCLUSION: The findings suggest that policymakers should implement targeted measures aimed at enhancing digital literacy and health literacy among rural residents. This approach is crucial for improving rural residents' access to digital health services, thereby mitigating urban-rural health inequality.

Patterns and predictors of help-seeking intentions for suicidal ideation compared to other health conditions among rural Chinese adults.

Psychological help-seeking for suicidal ideation is a critical aspect of effective suicide prevention. Past research has documented low help-seeking amongst rural residents in China. This study investigates the patterns and predictors of help-seeking intentions for suicidal ideation versus mental (depression) and physical (heart disease) health conditions among Chinese rural residents using General Help-Seeking Questionnaire Vignette version. A total of 143 rural participants from sixteen villages in Hubei province of China completed the survey via home-visiting interviews. Results revealed a general trend that the help-seeking intentions decreased as the helping sources shifted from close others (spouses, family, etc.) to professional helpers and online sources. Additionally, rural residents with higher educational levels, high self-efficacy, and more severe suicide ideations were more willing to seek help; and suicide literacy was found to be negatively associated with help-seeking intentions. The implications of the research findings are discussed.

How does diagnosis-related group payment impact the health care received by rural residents? Lessons learned from China.

OBJECTIVES: There is growing evidence that differences exist between rural and urban residents in terms of health, access to care and the quality of health care received, especially in low- and middle-income countries (LMICs). To improve health equity and the performance of health systems, a diagnosis-related group (DRG) payment system has been introduced in many LMICs to reduce financial risk and improve the quality of health care. The aim of this study was to examine the impact of DRG payments on the health care received by rural residents in China, and to help policymakers identify and design implementation strategies for DRG payment systems for rural residents in LMICs. STUDY DESIGN: Health impact assessment. METHODS: This study compared the impact of DRG payments on the healthcare received by rural residents in China between the pre- and post-reform periods by applying a difference-in-difference (DID) methodology. The study population included individuals with three common conditions; namely, cerebral infarction, transient ischaemic attack (TIA), and vertebrobasilar insufficiency (VBI). Data on patient medical insurance type were assessed, and those who did not have rural insurance were excluded. RESULTS: This study included 13,088 patients. In total, 33.63% were from Guangdong (n = 4401), 38.21% were from Shandong (n = 5002), and 28.16% were from Guangxi (n = 3685). The DID results showed that the implementation of DRGs was positively associated with hospitalization expense (ß4 = 0.265, P = 0.000), treatment expense (ß4 = 0.343, P = 0.002), drug expense (ß4 = 0.607, P = 0.000), the spending of medical insurance funds (ß4 = 0.711, P = 0.000) and out-of-pocket costs (ß4 = 0.164, P = 0.000). CONCLUSIONS: The findings of this study suggest that the implementation of DRG payments increases health care costs and the financial burden on health systems and rural patients in LMICs. This is contrary to the original intention of implementing the DRG payment system.

Buying a Wealthy Dream: Determinants of Rural Residents' Lottery Purchase Behavior in China.

The expansion of illicit lottery activities has caused significant harm to both agricultural production and the livelihood of rural residents. An analysis of the factors that influence rural residents' participation in underground lotteries can provide crucial insight for regulating the lottery industry's development. This study examines the present state of rural residents' participation in underground lotteries, investigates the factors that impact their participation using the Double-Hurdle model, and further employs the ISM model to evaluate the correlations and hierarchical structure among the factors, using field survey data collected from 603 rural residents in S Province, China. The findings reveal that 53.07% of the respondents have participated in underground lotteries. Risk preference, information acquisition, social networks, age, education, family burden, percentage of agricultural labor, agricultural business scale, and household income significantly affect whether residents purchase lotteries (WPL). All factors, except the percentage of agricultural labor and agricultural business scale, also significantly impact underground lottery spending (LS). Among the significant influencing factors, rural residents' risk preference is the direct surface factor, whereas agricultural business scale, household income, information acquisition, and social networks are the middle indirect factors, and residents' age, education, family burden, and percentage of agricultural labor are the deep-rooted factors. It is recommended to regulate the lottery industry's development can be achieved by enhancing entertainment and cultural activities, expanding economic opportunities, enhancing rural education, increasing law awareness, and improving the public welfare lottery business model. The conclusions offer a valuable reference point for the standardized development of the lottery industry and the promotion of social stability in rural areas.

Exploring the Impact of Digital Literacy and Policy Cognition on Rural Residents' Eco-friendly Behaviors.

The active participation of rural residents in ecological protection is crucial for preserving the rural environment and advancing ecological civilization. However, existing literature often neglects the impact of rural residents' digital literacy and policy cognition on their adoption of eco-friendly behaviors. In the digital age, rural residents can efficiently access and utilize ecological information, deepen their policy cognition, and consequently, become more actively involved in ecological protection through enhancing their digital literacy. This enhancement is crucial for ensuring the smooth implementation of rural ecological policies at the grassroots level, thereby providing a strong impetus for the further development of rural ecological protection. Therefore, based on survey data from 851 respondents in four counties and cities in Hainan Province, this paper uses the Ordered Probit model to analyze the impact of digital literacy on rural residents' adoption of eco-friendly behaviors, supported by theoretical mechanism analysis. The results indicate that: (1) Digital literacy enhances the adoption of eco-friendly behaviors among rural residents; (2) The mechanism analysis shows that digital literacy promotes such adoption through improved policy cognition. Consequently, the government should actively promote digital technology education and training to improve rural residents' digital literacy. Therefore, targeted digital skills training policies should be developed according to the individual characteristics of rural residents. Additionally, promoting digital literacy to improve policy cognition will likely lead to greater engagement in eco-friendly behaviors.

Impact of pension income on healthcare utilization of older adults in rural China.

OBJECTIVE: In China, rural residents experience poorer health conditions and a higher disease burden compared to urban residents but have lower healthcare services utilization. Rather than an insurance focus on enhanced healthcare services utilization, we aim to examine that whether an income shock, in the form of China's New Rural Pension Scheme (NRPS), will affect outpatient, inpatient and discretionary over-the-counter drug utilization by over 60-year-old rural NRPS residents. METHODS: Providing a monthly pension of around RMB88 (USD12.97), NRPS covered all rural residents over 60 years old. Fuzzy regression discontinuity design (FRDD) was employed to explore the NRPS causal effect on healthcare services utilization, measured by outpatient and inpatient visits and discretionary over-the-counter drug purchases. The nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 provided the data. RESULTS: Without significant changes in health status and medication needs, 60-plus-year-old NRPS recipients significantly increased the probability of discretionary OTC drug purchases by 33 percentage points. NRPS had no significant effect on the utilization of outpatient and inpatient utilization. The increase in the probability of discretionary OTC drug purchases from the NRPS income shock was concentrated in healthier and low-income rural residents. Robustness tests confirmed that FRDD was a robust estimation method and our results are robust. CONCLUSION: NRPS was an exogenous income shock that significantly increased the probability of discretionary over-the-counter drug purchases among over 60-year-old rural residents, but not the utilization of inpatient or outpatient healthcare services. Income remains an important constraint for rural residents to improve their health. We recommend policymakers consider including commonly used over-the-counter drugs in basic health insurance reimbursements for rural residents; provide health advice for rural residents to make discretionary over-the-counter drug purchases; and to mount an information campaign on over-the-counter drug purchasing in order to increase the health awareness of rural residents.

The Effect of "Offline-to-Online" Trust Transfer on the Utilization of Online Medical Consultation Among Chinese Rural Residents: Experimental Study.

BACKGROUND: Online medical consultation can serve as a valuable means for rural residents to access high-quality health care resources, thereby mitigating the geographic and economic disadvantages prevalent in rural areas. Nevertheless, due to lower cognitive abilities, rural residents often face challenges in trusting and making effective use of online medical consultations. More likely, adopting a bounded rational decision-making model that facilitates the "offline-to-online" trust transfer could prove to be a potentially effective approach. This strategy aims to encourage less technologically experienced rural residents to trust and make use of online medical consultations. OBJECTIVE: This study aims to characterize the status of "offline-to-online" trust transfer among rural residents in the context of internet health care, and analyze its direct impact on facilitating the utilization of online medical consultation. Additionally, we investigate the family spillover effect of "offline-to-online" trust transfer in promoting the use of online medical consultation among rural family members, considering its distributional effect across various education levels of the population. METHODS: A multistage stratified random sampling method was used to survey participants in rural areas of China from July to September 2021, encompassing a total of 2597 rural residents from 960 rural households. Propensity score values were estimated using logit regression, and the propensity score matching method, using the K-nearest neighbor matching, radius matching, and kernel matching methods, was applied to create matched treatment and control samples of rural residents based on their experience of "offline-to-online" trust transfer. Subsequently, we calculated average treatment effect scores to compare the differences in utilizing online medical consultation between the treatment and control rural samples. RESULTS: As many as 551/960 (57.4%) rural residents experienced an "offline-to-online" trust transfer, with a higher likelihood observed in the older population with lower levels of education and higher satisfaction with local health care services. Furthermore, rural residents who underwent "offline-to-online" trust transfer were 37%-40% more likely to utilize online medical consultation compared with those who did not experience this trust transfer. Additionally, family members of householders who underwent "offline-to-online" trust transfer were 25%-28% more likely to utilize online medical consultation than those whose householders did not experience this trust transfer. Notably, when compared with populations with high-level education, the "offline-to-online" trust transfer had more significant direct and spillover effects on the utilization of online medical consultation services among rural residents with low-level education. CONCLUSIONS: To enhance the "offline-to-online" trust transfer among rural residents and its facilitation in their utilization of online medical consultation, as well as other mobile health (mHealth) and ubiquitous health (uHealth) services, we recommend that online health care providers adopt a "patient-oriented" service model. This approach aims to elevate rural residents' satisfaction with local health care services and harness the trust-building functions inherent in physician-patient relationships and among family members.

The impact of COVID-19 on health literacy among Chinese rural residents.

The outbreak of the Coronavirus disease 2019 (COVID-19) pandemic is an opportunity to improve the health literacy of rural residents. This study aims to explore the levels of health literacy among rural residents during the COVID-19 pandemic and investigate the effects of COVID-19-related variables on the health literacy of rural residents. A total of 882 rural residents aged 15-69 years in Shaanxi province participated in this study and completed the questionnaires about health literacy and COVID-19-related variables. These results showed that although overall health literacy and three aspects of health literacy among rural residents were low and lower than those of Chinese national residents, there was no significant difference in health literacy about safety and emergency between rural residents and Chinese national residents. Additionally, COVID-19-related variables significantly predicted health literacy (i.e. scientific health, safety and emergency and infectious disease prevention). Importantly, unlike other types of health literacy, the effect of a COVID-19-related variable (i.e. the frequency of exposure to news about the COVID-19 pandemic) on infectious disease prevention was only slightly smaller than the effect of high education on infectious disease prevention, and low education was no longer a significant predictor of infectious disease prevention. To conclude, rural residents in Shaanxi province have low health literacy. Education is a major factor affecting the health literacy of rural residents, and the frequency of exposure to news about the pandemic may compensate for the negative impact of low education on health literacy.

[Current Situation and Influencing Factors of Delay in Seeking Medical Treatment Among Residents in Rural Areas of Sichuan Province].

Objective To understand the current situation and explore the influencing factors of delay in seeking medical treatment for common symptoms of residents in the rural areas of Sichuan province. Methods In July 2019,multi-stage random sampling was carried out in Zigong city,Sichuan province,and the data were collected by face-to-face questionnaire interview.The residents who had lived at hometown for more than half a year in the past year and had seen a doctor in the most recent month were surveyed.Logistic regression was adopted to predict the influencing factors of delay in seeking medical treatment. Results A total of 342 subjects were enrolled,and the incidence of delay in seeking medical treatment was 13.45%(46/342).Compared with the young and middle-aged(<65 years)people,the elderly(≥65 years)people were more likely to have delay in seeking medical treatment (OR=2.187,95%CI=1.074-4.457,P=0.031).The rural residents who gave higher score of the overall quality of township health centers were less likely to have delay in seeking medical treatment (OR=0.854,95%CI=0.735-0.992,P=0.039). Conclusions The occurrence of delay in seeking medical treatment for common symptoms of rural residents in Sichuan province is low.Age and the overall quality evaluation of township health centers affect the occurrence of delay in medical treatment among the rural residents in Sichuan province.Efforts should be made to improve the awareness of disease prevention among the elderly in rural areas.The investment in health resources in township health centers should be increased to strengthen the introduction and training of talents.These measures can improve the health services in township health centers,guide residents to make timely use of health resources,and reduce the occurrence of delay in seeking medical treatment.

[Comparative Analysis of Influencing Factors of Health Service Utilization Among Urban and Rural Residents in Tibet].

Objective: To examine the differences and commonalities of factors influencing the utilization of health services among urban and rural residents in Tibet and to identify vulnerable populations in the utilization of health services, thereby providing references for the formulation of local health policies and the allocation of health resources. Methods: Using the Tibetan area data from the Sixth National Health Service Survey, we conducted statistical analysis of the health service utilization status of 8 297 residents of agro-pastoral areas and 2 179 residents of urban areas with χ 2 test and logistic regression model. Results: The two-week outpatient visit rates of residents in agro-pastoral areas and that of the urban residents were 65.3% and 57.1%, respectively, and the one-year hospitalization rates were 8.3% and 8.9%, respectively. The influencing factors of two-week outpatient visits for rural and pastoral residents included urban and rural health insurance coverage, Three Guarantees in One coverage, distance to medical facilities, chronic disease status, physical examination, family doctor contract status, employment status, and health status self-assessment. The influencing factors of two-week outpatient visit for urban residents included chronic disease status, urban and rural medical insurance coverage, health status self-assessment, health records, and physical examination. The factors influencing hospitalization for agro-pastoral residents were sex, age, marital status, urban and rural medical insurance coverage, Three Guarantees in One coverage, critical illness insurance, health self-assessment, mobility, health records, physical examination, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. Conclusion: The urban and rural residents in Tibet have relatively poor health and their awareness of seeking early medical help after they fall ill is relatively weak. The health institutions concerned should dedicate more attention to the vulnerable populations who have difficulty accessing health services, focus on the commonly shared influencing factors of health service utilization among urban and rural residents, take into account the differences, rationally allocate health resources, and improve the effective utilization rate of health services among residents in Tibet.

Research on the design of serious illness insurance scheme in Shanghai based on micro-simulation.

BACKGROUND: Urban and rural residents' basic medical insurance (URRBMI) is an institutional arrangement for rural residents and unemployed urban residents in China. The serious illness medical insurance system (SIMIS) was established to provide additional medical cover. At present, the SIMIS payment method in China is based on large expenses, and only a few areas, such as Shanghai, pay according to the treatment of serious diseases. This study aims to simulate and analyse the effect of the two payment methods on SIMIS in Shanghai. METHODS: We developed a micro-simulation model to predict the number and characteristics of SIMIS participants among urban and rural residents in Shanghai and to simulate the process of medical treatment, medical consumption, and medical insurance payments for each insured person from 2020 to 2025. We then summarised and analysed the payment compensation effect, and compared it with Shanghai's current policies. RESULTS: The payment of SIMIS according to high expenses, the total medical expenses of seriously ill patients show an increasing trend, with an average annual growth rate of 3.56%. The URRBMI fund payment covers 56%-58% of total medical expenses, and the SIMIS fund covers 5%-7% of the total medical expenses. Both cover 62%-63% of total medical expenses. Self-payment under SIMIS covers 22%-23% of the total medical expenses, total self-payment covers 14%-15% of the total medical expenses, and the medical expenses borne by individuals cover 36%-38% of the total medical expenses.The fund expenditure is 213 million yuan and average annual cost borne by individual patients ranges from 40 000 to 60 000 yuan. CONCLUSIONS: The policy of designing SIMIS according to national guidelines does not meet the development needs of Shanghai. Shanghai should take the current policy of paying compensation according to the treatment of serious illness as the policy basis, consider the security needs of patients with large medical expenses outside the scope of protection, and adjust policies appropriately to prevent poverty caused by illness.

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China's urban and rural residents' medical insurance.

BACKGROUND: With the rapid growth of the ageing population, the operating burden of China's basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. METHODS: We used an actuarial science method and took the urban and rural residents' basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. RESULTS: Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. CONCLUSIONS: The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.

To centralize or to decentralize? A systematic framework for optimizing rural wastewater treatment planning.

Untreated rural sewage seriously affects the universal access to clean water of rural residents. The lack of decision-support tools in rural sewage treatment (RuST) planning makes it difficult for RuST system to achieve the expected results and is not conducive to the optimal allocation of limited funds. Hence, there is an urgent need to develop a decision-support framework for large-scale RuST planning. For the first time, RuST planning decision-support framework was developed using divide-and-conquer strategy based on rural residents' spatial pattern (RESP) and the optimal pattern of RuST. This framework can be transferred to other countries/regions easily by correcting RESP dataset according to the spatial and environmental characteristics. We confirmed that the variation of RESP made the ideal RuST pattern varied significantly under different topography. And community-based pattern could be the optimal pattern for large-scale RuST planning, when spatial obstacle and RESP were fully considered. The price of onsite sewage treatment facility is the most significant factor for RuST planning. In our selected case, requited onsite facility accounted for 65.51%. For the total investment, the cost of sewer systems accounted for 56.01%, and the average investment in plains, hills, platforms and mountains was 1401, 1803, 1903 and 1859 USD/household, respectively. We expect this research could provide reference for RuST planning in other developing countries/regions all around the world.

[Dietary Patterns and Their Association with Diabetes Mellitus in Middle-Aged and Older Rural Population in Xinxiang County, Henan Province].

OBJECTIVE: To analyze the prevalence of diabetes mellitus among middle-aged and older rural adults of Xinxiang county, Henan Province and its correlation with dietary patterns. METHODS: The study was done based on the data collected from a cross-sectional survey of Xinxiang County, which was part of the Prospective Cohort Study on the Common Chronic Non-Communicable Diseases in Rural areas of Henan Province. Randomized cluster sampling was used to select adult respondents (≥18 years old) from among the residents of 17 villages in Xinxiang county. The respondents completed questionnaires, and underwent physical examinations and laboratory tests between April, 2017 and June, 2017. A total of 7604 individuals aged between 45 and 79 were included in our study. Dietary patterns were established through factor analysis and the dietary pattern factor scores were divided into quartiles (Q1-Q4). The relationship between dietary patterns and diabetes mellitus was analyzed with multivariate logistic regression model. RESULTS: Out of the total of 7604 middle-aged and older rural adults in Xinxiang County, Henan Province, 1604 had diabetes mellitus, suggesting a 21.1% prevalence of diabetes mellitus. Factor analysis was used to establish four dietary patterns, namely animal-based diet, vegetable-egg diet, mixed diet and traditional diet. Subjects of these four dietary patterns displayed different demographic characteristics. There were no statistical difference in anthropometricor clinical indicators between the quartile with the lowest dietary pattern factor score (Q1) and the quartile with the highest dietary pattern factor score (Q4) for subjects with animal-based diet ( P>0.05). Compared with those in the Q1 quartile of vegetable-egg diet, subjects in the Q4 quartile of vegetable-egg diet showed lower levels of high-density lipoprotein cholesterol (HDL-C), along with different distribution of fasting blood glucose (FBG), showing statistically significant difference ( P<0.05). In comparison to subjects in Q1 quartile of mixed diet, those in Q4 quartile showed lower levels of systolic blood pressure (SBP), the difference being statistically significant ( P<0.05). In the traditional diet group, subjects in the Q4 quartile had lower waist circumference (WC), but higher levels of HDL-C than those of subjects in Q1 quartile. In addition, the distribution of glycated-hemoglobin (HbA1c) and FBG were different, the difference being statistically significant ( P<0.05). The results of multivariate logistic regression analysis demonstrated that traditional diet could be a protective factor of diabetes mellitus (odds ratio [ OR]=0.810, 95% CI: 0.690-0.952, P trend<0.05) after adjusting for multiple confounding factors. CONCLUSION: The prevalence of diabetes in middle-aged and older rural residents is relatively high in Xinxiang County, Henan Province, and there may be a protective relationship between traditional diet and diabetes mellitus.

Association between perceived environmental pollution and health among urban and rural residents-a Chinese national study.

BACKGROUND: China's economic boom has led to severe environmental pollution, which has created significant health risks for residents. Although current studies have found urban residents can sense the harmful effects of environmental pollution in China, few studies have talked about their rural counterparts' attitudes towards the health impacts of environmental pollution. Similarly, little research has talked about the inequality of environmental awareness between urban and rural residents. METHODS: Descriptive and analytical statistics were used for the data analyses based on a national survey, namely, The 3rd Survey on the Status of Chinese Women in 2010, which was jointly conducted by the All China Women's Federation and the China Statistical Bureau in 2010. A total of 24741observations were selected. RESULTS: Among urban residents, 67.21% reported that their total health was good, which was 1.35% lower than the reported rate of their rural counterparts; 25.88% of urban residents reported that their total health was general, which was nearly 3% higher than the reported rate of their rural counterparts; 6.91% of urban residents reported that their total health was poor, which was 1.63% lower than the reported rate of their rural counterparts. The study also found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts. Perceived air pollution, and perceived noise pollution both had a negative effect on urban residents' good health (B = - 0.14, p < 0.05; B = -0.23, p < 0.001). Perceived garbage pollution had a positive effect on urban residents' poor health (B = 0.33, p < 0.01). Perceived water pollution had no significant effect on urban residents' health. The four types of perceived environmental pollution all had insignificant effects on rural residents' health. CONCLUSIONS: Rural residents lack awareness of the impacts of environmental pollution on health, which may create risks and vulnerability within the rural environment and the livelihood of these residents. Great attention should be paid to the impacts of environmental pollution on the health of not only urban residents but also rural residents, which will highly improve the support of green development among the public in China.

Factors Associated with Depressive Symptoms Among Rural Residents from Remote Areas.

This study aimed to investigate the risk factors for depressive symptoms among rural residents in Brazil. A representative sample of two hundred eighty-eight volunteers aged from 18 to 65 years was included and determining factors for high BDI-II score were investigated through a multivariate logistic model. Sadness, loss of pleasure, crying, worthlessness and loss of interest in sex are more likely to be observed in females, and risk factors to this high depression score among rural residents were shown to be: female gender, tobacco use, pesticide application, poor self-perceived health and presence of chronic disease. These data contribute to the knowledge of factors determining depressive symptoms among rural residents and may help to expand health policies to improve quality of rural life on these communities and others with similar characteristics.

[Interpretation for the group standard of Health check-up guide for rural residents].

With the acceleration of the population aging in China, the health problems and the demands of health services such as health check-up for rural residents should attract the attention of the whole society. The group standard entitled Health check-up guide for rural residents (T/CHAA 005-2019), was written by experienced researchers from Chinese Center for Disease Control and Prevention and other professional institutes coordinated by Chinese Health Association. The standard aims to establish a service model that takes health information collection as a means, health risk assessment, health risk intervention and information services as the core, improving the health of rural residents as the target.

[Health check-up guide for rural residents (T/CHAA 005-2019)].

This standard stipulates the principles, institutional requirements, inspection items, service modes, data management and utilization requirements for carrying out the health check-up for rural residents. It is applicable to the standardized management of the health check-up for rural residents aged 15 years old and above under the relevant national laws and regulations.

COMPARATIVE CHARACTERISTICS OF THE PARAMETERS' CHANGES OF SKIN AND FAT FLEXURES THICKNESS OF EXTREMETIES AT YOUTH UNDER THE CONDITION OF HIGHER EDUCATION.

OBJECTIVE: The aim: To determine and compare annual changes of skin and fat flexures thickness of the extremities of rural and urban youths during training at a university. PATIENTS AND METHODS: Materials and methods: 200 practically healthy young men (100 residents of the village, 100 residents of the city) were studied at the 1st, 2nd and 3rd courses of their education at the University of Life Safety by means of Shephard R. method. RESULTS: Results: Based on the data we`ve got, the annual reduction of most indicators of the thickness of the fat layer of the upper and lower extremities was supervised. The most substantial decrease was supervised during the first year. The intra-group annual changes were significantly smaller throughout the first year of study, both in the rural and urban groups. CONCLUSION: Conclusions: Significant differences in intra-group and inter-group indicators were found between youth living in the city and rural residents. In addition, significant differenceswere found in the thickness of the skin and fat flexures in youngers of both groups during the three years of education process.

Self-reported data in environmental health studies: mail vs. web-based surveys.

BACKGROUND: Internet has been broadly employed as a facilitator for epidemiological surveys, as a way to provide a more economical and practical alternative to traditional survey modes. A current trend in survey research is to combine Web-based surveys with other survey modes by offering the participant the possibility of choosing his/her preferred response method (i.e. mixed-mode approach). However, studies have also demonstrated that the use of different survey modes may produce different responses to the same questions, posing potential challenges on the use of mixed-mode approaches. METHODS: In this paper, we have implemented a statistical comparison between mixed-mode survey responses collected via mail (i.e. paper) and Web methods obtained from a cross-sectional study in non-urban areas of Denmark. Responses provided by mail and Web participants were compared in terms of: 1) the impact of reminder letters in increasing response rates; 2) differences in socio-demographic characteristics between response groups; 3) changes on the likelihood of reporting health symptoms and negative attitudes towards environmental stressors. Comparisons were mainly performed by two sample t-test, Pearson's Chi-squared test and multinomial logistic regression models. RESULTS: Among 3104 contacted households, 1066 residents decided to participate on the study. Out of those, 971 selected to respond via mail, whereas 275 preferred the Web method. The majority of socio-demographic characteristics between these two groups of respondents were shown to be statistically different. The use of mailed surveys increased the likelihood of reporting health symptoms and negative attitudes towards environmental stressors, even after controlling for demographic characteristics. Furthermore, the use of reminder letters had a higher positive impact in increasing responses of Web surveys when compared to mail surveys. CONCLUSIONS: Our main findings suggest that the use of mail and Web surveys may produce different responses to the same questions posed to participants, but, at the same time, may reach different groups of respondents, given that the overall characteristics of both groups considerably differ. Therefore, the tradeoff between using mixed-mode survey as a way to increase response rate and obtaining undesirable measurement changes may be attentively considered in future survey studies.