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Introducción. Este artículo analiza la labor profesional de los trabajadores sociales del medio rural en el marco internacional a través de una revisión sistemática de la literatura publicada entre 2009 y diciembre de 2022. En particular, se pretende dar respuesta a los siguientes interrogantes: ¿cuál es el estado del arte del Trabajo Social rural? y ¿cuál es la metodología empleada en las investigaciones disponibles? Metodología. Para ello se realizó un estudio bibliométrico según criterios PRISMA en las bases de datos Google Scholar, SSCI y Web of Science. Las palabras clave utilizadas (en castellano e inglés) fueron: trabajo social rural (rural social work), intervención social (social intervention), áreas rurales (rural areas). Estos descriptores se combinaron con el operador booleano AND. Se identificaron 509 artículos, de los cuales 18 fueron analizados por adecuarse a los criterios de elegibilidad del presente trabajo. Resultados. Los principales temas de estudio son las oportunidades y limitaciones de la actividad profesional en los medios rurales y las vulnerabilidades de estos territorios. Los resultados revelan que estos entornos no son atractivos para el ejercicio profesional del Trabajo social debido a la movilidad y el aislamiento. Se constata que la brecha territorial empeora el bienestar de los colectivos excluidos y dificulta su acceso a los servicios sociales. Discusión. Resulta llamativo que la labor de los trabajadores sociales rurales ocupe un lugar secundario en numerosas investigaciones. Pese a los avances, hay una evidente laguna de conocimiento sobre el Trabajo Social rural en España. Del mismo modo, este tema ha sido insuficientemente tratado en el marco internacional. Conclusiones. Las conclusiones aluden a la importancia de paliar la dispersión de este campo de conocimiento y de incorporar la variable territorial en los análisis y diagnósticos profesionales. Con esta contribución, pretendemos aportar evidencia de que la labor de los traba, Introduction. In this article, we present a systematic review of the international literature on the professional work of rural social workers published between 2009 and December 2022. The specific objective was to answer the following questions: What is the state of the art of rural social work? What methodology is used in the available research? Methodology. A bibliometric study was conducted according to PRISMA criteria in Google Scholar, SSCI, and Web of Science databases. The keywords used (in Spanish and in English) were: trabajo social rural (rural social work), intervención social (social intervention), and áreas rurales (rural areas). These descriptors were combined with the boolean operator AND. A total of 509 articles were identified, of which 18 met the study eligibility criteria and were analysed. Results. The main study topics were the opportunities and limitations of professional activity in rural environments, and the vulnerabilities of these territories. The results revealed that these environments are not attractive for the professional practice of social work due to mobility issues and isolation. This territorial divide was found to worsen the well-being of excluded groups and to hinder their access to social services. Discussion. Strikingly, the work of rural social workers occupies a secondary place in numerous studies. Despite the progress made, there is a glaring gap in knowledge about rural social work in Spain. The topic has also been insufficiently dealt with internationally. Conclusions. It is important to address the knowledge dispersion that is visible in this field and to incorporate the territorial variable in professional analyses and diagnoses. The present contribution provides evidence that social work is essential for the future of the rural world.

Introduction: Nutrition represents a sociocultural process of international relevance, yet there has been limited research development from a cultural perspective. Objective: To interpret the perceptions related to nutrition among peasant families residing in a municipality in the rural area of the department of Caldas (Colombia). Methodology:this study employed interpretive ethnography, using purposive sampling. Seven peasant families participated through participant observation and ethnographic interview. Spiral analysis was performed with the support of Atlas ti software. Results: The emergent category “With food we take care of ourselves, we nourish ourselves, we unite” was, supported by three subcategories. Conclusions: Food consumption has several implicit and heterogeneous meanings, specifically nutritional intake, illness and as a demonstration of affection., Introducción: la alimentación es un proceso sociocultural de relevancia internacional con escasos desarrollos investigativos desde la visión cultural. Objetivo: interpretar las percepciones relacionadas con la alimentación en las familias campesinas de un municipio de la zona rural del departamento de Caldas (Colombia). Metodología: etnografía interpretativa con muestreo intencional. Participaron siete familias campesinas a través de observación participante y entrevista etnográfica. Análisis en espiral con el apoyo del software Atlas ti. Resultados: emergió la categoría denominada “Con la comida nos cuidamos, nos nutrimos, nos unimos” sustentada en tres subcategorías. Conclusiones: el consumo de alimentos tiene varios significados implícitos y de carácter heterogéneo, en específico el aporte nutricional, la enfermedad y como demostración de afecto.

Polygamy is the practice of marriage to multiple partners. Approximately 6-11% of households in Uganda and 4-11% of households in Kenya are polygamous. The complex families produced by polygamous marriage customs give rise to additional considerations for healthcare providers and public health messaging around HIV care. Using 27 in-depth, semi-structured qualitative interviews with participants in two studies in rural Kenya and Uganda, we analysed challenges and opportunities that polygamous families presented in the diagnosis, treatment and prevention of HIV, and provider roles in improving HIV outcomes in these families. Overall, prevention methods seemed more justifiable to families where co-wives live far apart than when all members live in the same household. In treatment, diagnosis of one member did not always lead to disclosure to other members, creating an adverse home environment; but sometimes diagnosis of one wife led not only to diagnosis of the other, but also to greater household support.

As representative of the water-energy-food nexus, fossil fuel development and industrial agriculture are rural industries that continue to expand and increasingly occur in the same areas. Being a top agricultural export county and the fossil fuel capital of California while ranking among the worst in the US for industrial pollution, Kern County is a poster child of rural nexus development and, thus, an essential place for initiating sustainability transitions. Such transitions rely on policy support and the adoption of methods by individuals and communities who may disagree with such changes. While sense of place and impact perceptions are recognized as playing critical roles in sustainability management, they have yet to be utilized in nexus research. A survey (N = 256) of the perceived impacts of nexus industries with place meaning and place attachment as possible drivers for perceptions was conducted in nexus industry pollution exposure risk zones. Factor analysis and bivariate correlations showed that place meaning and place attachment are drivers for perceptions while also being drivers for concern for changes in nexus industries. While perceptions of impacts indicated contested place meanings, participants strongly perceive the economy and environment as being in decline. To build support for sustainability policy, directing funds from Kern Countys renewable energy industry to local sectors of society, implementation of regenerative agriculture, cooperative management, and nurturing place meaning as aligned with natures restorative quality are important paths forward. These nexus management foci could strengthen place attachment, build trust in government, and repair environmental alienation.

Combined water, sanitation, and handwashing (WSH) interventions could reduce fecal contamination along more transmission pathways than single interventions alone. We measured Escherichia coli levels in 3909 drinking water samples, 2691 child hand rinses, and 2422 toy ball rinses collected from households enrolled in a 2-year cluster-randomized controlled trial evaluating single and combined WSH interventions. Water treatment with chlorine reduced E. coli in drinking water. A combined WSH intervention improved water quality by the same magnitude but did not affect E. coli levels on hands or toys. One potential explanation for the limited impact of the sanitation intervention (upgraded latrines) is failure to address dog and livestock fecal contamination. Small ruminant (goat or sheep) ownership was associated with increased E. coli levels in stored water and on child hands. Cattle and poultry ownership was protective against child stunting, and domesticated animal ownership was not associated with child diarrhea. Our findings do not support restricting household animal ownership to prevent child diarrheal disease or stunting but do support calls for WSH infrastructure that can more effectively reduce household fecal contamination.

BACKGROUND: A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change. OBJECTIVES: Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change. METHODS: We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters. RESULTS: Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null. DISCUSSION: Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measur

PURPOSE: To examine changes in rural and urban Veterans utilization of acute inpatient care in Veterans Health Administration (VHA) and non-VHA hospitals following access expansion from the Veterans Choice Act, which expanded eligibility for VHA-paid community hospitalization. METHODS: Using repeated cross-sectional data of VHA enrollees hospitalizations in 9 states (AZ, CA, CT, FL, LA, MA, NY, PA, and SC) between 2012 and 2017, we compared rural and urban Veterans probability of admission in VHA and non-VHA hospitals by payer over time for elective and nonelective hospitalizations using multinomial logistic regression to adjust for patient-level sociodemographic features. We also used generalized linear models to compare rural and urban Veterans travel distances to hospitals. FINDINGS: Over time, the probability of VHA-paid community hospitalization increased more for rural Veterans than urban Veterans. For elective inpatient care, rural Veterans probability of VHA-paid admission increased from 2.9% (95% CI 2.6%-3.2%) in 2012 to 6.5% (95% CI 5.8%-7.1%) in 2017. These changes were associated with a temporal trend that preceded and continued after the implementation of the Veterans Choice Act. Overall travel distances to hospitalizations were similar over time; however, the mean distance traveled decreased from 39.2 miles (95% CI 35.1-43.3) in 2012 to 32.3 miles (95% CI 30.2-34.4) in 2017 for rural Veterans receiving elective inpatient care in VHA-paid hospitals. CONCLUSIONS: Despite limited access to rural hospitals, these data demonstrate an increase in rural Veterans use of non-VHA hospitals for acute inpatient care and a small reduction in distance traveled to elective inpatient services.

IntroductionIn South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of these interventions in reproductive and sexual autonomy and contraception has not been examined.Methods and analysisA two-arm, parallel, cluster randomised controlled trial will evaluate the impact of TARANG (Transforming Actions for Reaching and Nurturing Gender Equity and Empowerment), a life skills and reproductive health empowerment group-based intervention for newly married women, compared with usual services in the community in rural and tribal Rajasthan, India. TARANG will also provide light-touch sessions to husbands and mothers-in-law of newly married women. We will test the impact of TARANG in 80 village clusters among 800 eligible households comprising newly married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy within 1 year at the time of enrolment, their husbands and mothers-in-law who consent to participate. Women in the intervention villages will receive 14 sessions over a 6-month period, while husbands and mothers-in-law will receive 1 and 4 sessions (respectively) each. Three rounds of surveys will be collected over 18 months. Control villages will receive the intervention after the endline surveys. Primary outcomes include rate of unintended pregnancy and modern contraceptive use. We plan to start recruitment of participants and data collection in April 2024. We will estimate unadjusted and adjusted intention-to-treat effects using survival analysis and mixed models.Ethics and disseminationStudy protocols have been reviewed and approved by the human subjects review boards at the University of California, San Francisco, and the Centre for Media Studies, India (IRB00006230) and ACE Independent Ethics Committee, Bangalore (NET0062022). Results will be disseminated in international peer-reviewed journals and conferences, to

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A booster round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

While many studies have found positive correlations between greenness and human health, rural Central Appalachia is an exception. The region has high greenness levels but poor health. The purpose of this commentary is to provide a possible explanation for this paradox: three sets of factors overwhelming or attenuating the health benefits of greenness. These include environmental (e.g., steep typography and limited access to green space used for outdoor recreation), social (e.g., chronic poverty, declining coal industry, and limited access to healthcare), and psychological and behavioral factors (e.g., perceptions about health behaviors, healthcare, and greenness). The influence of these factors on the expected health benefits of greenness should be considered as working hypotheses for future research. Policymakers and public health officials need to ensure that greenness-based interventions account for contextual factors and other determinants of health to ensure these interventions have the expected health benefits.

IntroductionIdentifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.MethodsIn-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.ResultsIndividuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselve

Substantial evidence indicates that medical mistrust, resulting from experiences with discrimination and marginalisation, is a determinant of health disparities in minority populations. However, this research is largely limited to the US and other industrialised countries. To broaden our understanding of the role of medical mistrust on health-care decision making, we conducted a study on healthcare experiences and perceptions in a rural, underserved indigenous community in northwest Namibia (n = 86). Mixing semi-structured interview questions with the medical mistrust index (MMI), we aim to determine the relevance of the MMI in a non-industrialised population and compare index scores with reports of healthcare experiences. We find that medical mistrust is a salient concept in this community, mapping onto negative healthcare experiences and perceptions of discrimination. Reported healthcare experiences indicate that perceived incompetence, maltreatment and discrimination drive mistrust of medical personnel. However, reporting of recent healthcare experiences are generally positive. Our results indicate that the concept of medical mistrust can be usefully applied to communities in the Global South. These populations, like minority communities in the US, translate experiences of discrimination and marginalisation into medical mistrust. Understanding these processes can help address health disparities and aid in effective public health outreach in underserved populations.

El estudio, contextualizado a nivel regional y nacional, de la repercusión que tuvo en el municipio de Fuente Álamo de Murcia la Ley sobre fomento de población rural y nuevas bases para el establecimiento de colonias agrícolas, de 3 de junio de 1868, constata, mediante metodologías de análisis histórico-geográfico, la distinción como «colonias agrícolas» de tres grandes fincas emplazadas en su término. Propiedades, que, favorecidas por dicha normativa, se convirtieron en ejemplos de desarrollo rural, logrando, al amparo de sus promotores y los beneficios de la ley, fijar población al campo y alcanzar excelentes producciones de reconocimiento incluso internacional., The study, contextualized at the regional and national level, of the impact that the Law on the promotion of rural population and new bases for the establishment of agricultural colonies, of June 3, 1868, had in the municipality of Fuente Álamo de Murcia, confirms, through geographical and historical analysis methodologies, the distinction as “agricultural colonies” of three large farms located in its territory. Properties that, favored by said law, became examples of rural development, achieving, under the protection of their promoters and the benefits of the law, establishing population in rural areas and achieving excellent productions of even international recognition.

[Abstract]: Foot problems are very common in the community. Studies indicate that between 18% and 63% of people have foot pain or stiffness and that foot problems have a large impact on people's functional decline and a significant detrimental impact on measures of quality of life related to health. The general objective of this research was to compare foot health in people from the rural population compared to people from the urban population and its relationship with quality of life. A case–control descriptive study was developed with a sample of 304 patients, 152 patients from the rural population and 152 patients from the urban population. Quality of life was measured through the SF-36 Health Questionnaire in its Spanish version. The rural population group had a mean age of 46.67 ± 13.69 and the urban population group 49.02 ± 18.29. Regarding the score of the lowest levels of quality of life related to foot problems, the rural population group compared to the urban population group showed: for body pain (52.21 ± 30.71 vs. 67.80 ± 25.28, p < 0.001); and for mental health (69.58 ± 18.98 vs. 64.60 ± 14.88, p < 0.006). Differences between groups were analysed using Student's t-test for independent samples, which showed statistical significance (p < 0.05). This research offers evidence that the rural population presents better levels of mental health and lower levels of bodily pain in the domains of the SF-36 Health Questionnaire comparing with the urban population.

PURPOSE: Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm-related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults. METHODS: We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past-month alcohol use on handgun carrying in the subsequent 12 months using population-average generalized estimating equations with logistic regression on multiply imputed data. FINDINGS: During adolescence (ages 12-18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19-26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence. CONCLUSIONS: Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm-related harm among young people in rural areas.

BACKGROUND: Rural residents have a higher prevalence of colorectal cancer (CRC) mortality compared to urban individuals. Policies have been aimed at improving access to CRC screening to reduce these outcomes. However, little attention has been paid to other determinants of CRC-related outcomes, such as stage at diagnosis, treatment, or survivorship care. The main objective of this analysis was to evaluate literature describing differences in CRC screening, stage at diagnosis, treatment, and survivorship care between rural and urban individuals. MATERIALS AND METHODS: We conducted a systematic review of electronic databases using a combination of MeSH and free-text search terms related to CRC screening, stage at diagnosis, treatment, survivorship care, and rurality. We identified 921 studies, of which 39 were included. We assessed methodological quality using the ROBINS-E tool and summarized findings descriptively. A meta-analysis was performed of studies evaluating CRC screening using a random-effects model. RESULTS: Seventeen studies reported disparities between urban and rural populations in CRC screening, 12 on treatment disparities, and 8 on staging disparities. We found that rural individuals were significantly less likely to report any type of screening at any time period (pooled odds ratio = 0.81, 95% CI, 0.76-0.86). Results were inconclusive for disparities in staging at diagnosis and treatment. One study reported a lower likelihood of use of CRC survivorship care for rural individuals compared to urban individuals. CONCLUSION: There remains an urgent need to evaluate and address CRC disparities in rural areas. Investigators should focus future work on assessing the quality of staging at diagnosis, treatment, and survivorship care in rural areas.

ObjectiveThe vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity and mortality worldwide. We used a population-based cross-sectional cohort design to: (1) examine the sociodemographic risk factors and structural barriers associated with pregnancy care-seeking and institutional delivery, and (2) investigate the influence of residential distance to the nearest primary health facility in a rural population in Mali.MethodsA baseline household survey of Malian women aged 15-49 years was conducted between December 2016 and January 2017, and those who delivereda baby in the 5 years preceding the survey were included. This study leverages the baseline survey data from a cluster-randomised controlled trial to conduct a secondary analysis. The outcomes were percentage of women who received any antenatal care (ANC) and institutional delivery; total number of ANC visits; four or more ANC visits; first ANC visit in the first trimester.ResultsOf the 8575 women in the study, two-thirds received any ANC in their last pregnancy, one in 10 had four or more ANC visits and among those that received any ANC, about one-quarter received it in the first trimester. For every kilometre increase in distance to the nearest facility, the likelihood of the outcomes reduced by 5 percentage points (0.95; 95% CI 0.91 to 0.98) for any ANC; 4 percentage points (0.96; 95% CI 0.94 to 0.98) for an additional ANC visit; 10 percentage points (0.90; 95% CI 0.86 to 0.95) for four or more ANC visits; 6 percentage points (0.94; 95% CI 0.94 to 0.98) for first ANC in the first trimester. In addition, there was a 35 percentage points (0.65; 95% CI 0.56 to 0.76) decrease in likelihood of institutional delivery if the residence was within 6.5 km to the nearest facility, beyond which there was no association with the place of delivery. We also found evidence of

The objective of the research were to carry out an analysis of the agricultural situation of the Mexican Republic (1968-2018). For the study, descriptive statistics, economic theory, regression models and the data index of "agriculture and rural development" of the World Bank were used. The agricultural GDP of Mexico represents a little more than 3 %, with 12.81 % of the economically active population dedicated to primary activities and 25 million people living in rural areas in 2018. The surface agricultural area is 1 068 910 km2, with 239 250 km2 of arable land, 659 476 km2 of forest area and cereals are produced in a 94 260 km2. There is an average use of 96 tractors/100 km2, the average fertilizer consumption is 73 kg/ha and 5 % of the agricultural area is irrigated. In the medium term, the harvest index, the cereal yield, the cereal production, the animal production index and the food production index will continue to grow through time. In the medium and long term, the decrease in the number of people dedicated to agricultural activities will continue and, in percentage terms the added value generated by agriculture will continue to decrease. In the short term, negative growth rates for the rural population are expected to continue., El objetivo de la investigación fue efectuar un análisis de la situación agrícola de la República mexicana (1968-2018). Para el estudio se utilizó estadística descriptiva, teoría económica, los modelos de regresión y el índice de datos de “agricultura y desarrollo rural” del Banco Mundial. El PIB agrícola de México representa un poco más del 3% en la producción nacional, con 12.81 % de la población económicamente activa que se dedica a las actividades primarias, y 25 millones de personas que viven en el área rural en el año 2018. La superficie agrícola es de 1 068 910 km2, tierras cultivables de 239 250 km2, superficie forestal de 659 476 km2 y se producen cereales en una superficie de 94 260 km2. Hay una utilización promedio de 96 tractores/100 km2. El consumo promedio de fertilizante fue de 73 kg/ha y el 5 % de la superficie agrícola es de regadío. En el mediano plazo, el índice de cosecha, el rendimiento de los cereales, la producción de cereales, el índice de producción animal y el índice de producción de alimentos continuarán creciendo a través del tiempo. En el mediano y largo plazo continuará la disminución de las personas dedicadas a las actividades agrícolas y, en términos porcentuales, seguirá disminuyendo el valor agregado generado por la agricultura. En el corto plazo, se prevé se sigan presentando tasas negativas del crecimiento de la población rural.

This article, through the review of 106 cases published between 2007 and 2022, addresses these transformations in terms of changes in the availability, access, and control of assets for the livelihood of the population, using the livelihoods approach. Systemic mapping was used as the methodology, which describes relevant evidence on a specific topic, using open-ended questions and information synthesis through matrices classifying categories. In most cases, tourist activities are carried out in protected natural areas. Transformations are highlighted that can improve access to assets but also increase the vulnerability of people who closely depend on natural resources and supplement their income through seasonal and informal jobs related to tourism. Additionally, recommendations are presented from tourist initiatives that have successfully integrated tourism into livelihoods without undermining sustenance., Este artigo, através da revisão de 106 casos publicados entre 2007 e 2022, aborda estas transformações em termos de mudanças na disponibilidade, acesso e controle dos bens disponíveis para o sustento da população, utilizando a abordagem dos Meios de Subsistência. Foi utilizado o mapeamento sistêmico como metodologia para descrever evidências relevantes sobre um tema específico, com questões abertas e síntese de informações por meio de matrizes. Na maioria dos casos, as atividades turísticas ocorrem em áreas naturais protegidas. São destacadas transformações que podem melhorar o acesso aos ativos, mas também aumentar a vulnerabilidade das pessoas que dependem estreitamente dos recursos naturais e complementam o seu rendimento através de empregos sazonais e informais provenientes do turismo. Além disso, são apresentadas recomendações de iniciativas turísticas que conseguiram integrar o turismo nos meios de subsistência sem prejudicar o sustento., Este artículo, mediante la revisión de 106 casos publicados entre 2007 y 2022, aborda dichas transformaciones en términos de los cambios en la disponibilidad, acceso y control de los activos disponibles para el sustento de la población, utilizando el enfoque de los medios de vida. Se usó el mapeo sistémico para la metodología, que describe evidencias relevantes de un tema específico, con preguntas abiertas y síntesis de información mediante matrices de clasificación de categorías. En la mayoría de los casos, las actividades turísticas se desarrollan en áreas naturales protegidas. Se destacan transformaciones que pueden mejorar el acceso a los activos, pero también aumentar la vulnerabilidad de las personas que dependen estrechamente de recursos naturales y complementan sus ingresos mediante trabajos estacionales e informales provenientes del turismo. Adicionalmente, se presentan recomendaciones desde iniciativas turísticas que han logrado integrar el turismo a los medios de vida sin socavar el sustento.

This article, through the review of 106 cases published between 2007 and 2022, addresses these transformations in terms of changes in the availability, access, and control of assets for the livelihood of the population, using the livelihoods approach. Systemic mapping was used as the methodology, which describes relevant evidence on a specific topic, using open-ended questions and information synthesis through matrices classifying categories. In most cases, tourist activities are carried out in protected natural areas. Transformations are highlighted that can improve access to assets but also increase the vulnerability of people who closely depend on natural resources and supplement their income through seasonal and informal jobs related to tourism. Additionally, recommendations are presented from tourist initiatives that have successfully integrated tourism into livelihoods without undermining sustenance., Este artigo, através da revisão de 106 casos publicados entre 2007 e 2022, aborda estas transformações em termos de mudanças na disponibilidade, acesso e controle dos bens disponíveis para o sustento da população, utilizando a abordagem dos Meios de Subsistência. Foi utilizado o mapeamento sistêmico como metodologia para descrever evidências relevantes sobre um tema específico, com questões abertas e síntese de informações por meio de matrizes. Na maioria dos casos, as atividades turísticas ocorrem em áreas naturais protegidas. São destacadas transformações que podem melhorar o acesso aos ativos, mas também aumentar a vulnerabilidade das pessoas que dependem estreitamente dos recursos naturais e complementam o seu rendimento através de empregos sazonais e informais provenientes do turismo. Além disso, são apresentadas recomendações de iniciativas turísticas que conseguiram integrar o turismo nos meios de subsistência sem prejudicar o sustento., Este artículo, mediante la revisión de 106 casos publicados entre 2007 y 2022, aborda dichas transformaciones en términos de los cambios en la disponibilidad, acceso y control de los activos disponibles para el sustento de la población, utilizando el enfoque de los medios de vida. Se usó el mapeo sistémico para la metodología, que describe evidencias relevantes de un tema específico, con preguntas abiertas y síntesis de información mediante matrices de clasificación de categorías. En la mayoría de los casos, las actividades turísticas se desarrollan en áreas naturales protegidas. Se destacan transformaciones que pueden mejorar el acceso a los activos, pero también aumentar la vulnerabilidad de las personas que dependen estrechamente de recursos naturales y complementan sus ingresos mediante trabajos estacionales e informales provenientes del turismo. Adicionalmente, se presentan recomendaciones desde iniciativas turísticas que han logrado integrar el turismo a los medios de vida sin socavar el sustento.

The objective of the research were to carry out an analysis of the agricultural situation of the Mexican Republic (1968-2018). For the study, descriptive statistics, economic theory, regression models and the data index of "agriculture and rural development" of the World Bank were used. The agricultural GDP of Mexico represents a little more than 3 %, with 12.81 % of the economically active population dedicated to primary activities and 25 million people living in rural areas in 2018. The surface agricultural area is 1 068 910 km2, with 239 250 km2 of arable land, 659 476 km2 of forest area and cereals are produced in a 94 260 km2. There is an average use of 96 tractors/100 km2, the average fertilizer consumption is 73 kg/ha and 5 % of the agricultural area is irrigated. In the medium term, the harvest index, the cereal yield, the cereal production, the animal production index and the food production index will continue to grow through time. In the medium and long term, the decrease in the number of people dedicated to agricultural activities will continue and, in percentage terms the added value generated by agriculture will continue to decrease. In the short term, negative growth rates for the rural population are expected to continue., El objetivo de la investigación fue efectuar un análisis de la situación agrícola de la República mexicana (1968-2018). Para el estudio se utilizó estadística descriptiva, teoría económica, los modelos de regresión y el índice de datos de “agricultura y desarrollo rural” del Banco Mundial. El PIB agrícola de México representa un poco más del 3% en la producción nacional, con 12.81 % de la población económicamente activa que se dedica a las actividades primarias, y 25 millones de personas que viven en el área rural en el año 2018. La superficie agrícola es de 1 068 910 km2, tierras cultivables de 239 250 km2, superficie forestal de 659 476 km2 y se producen cereales en una superficie de 94 260 km2. Hay una utilización promedio de 96 tractores/100 km2. El consumo promedio de fertilizante fue de 73 kg/ha y el 5 % de la superficie agrícola es de regadío. En el mediano plazo, el índice de cosecha, el rendimiento de los cereales, la producción de cereales, el índice de producción animal y el índice de producción de alimentos continuarán creciendo a través del tiempo. En el mediano y largo plazo continuará la disminución de las personas dedicadas a las actividades agrícolas y, en términos porcentuales, seguirá disminuyendo el valor agregado generado por la agricultura. En el corto plazo, se prevé se sigan presentando tasas negativas del crecimiento de la población rural.

Introduction: Annually,1,35 million lives are lost due to road accidents; their occurrence has been related, in addition to behavioral factors, to social inequalities. Objective: To analyze urban-rural social inequalities in mortality from traffic accidents in Colombia from 1998-2019. Methods and materials:Ecological study based on the analysis of standardized mortality rates adjusted for age and sex of urban and rural population groups stratified by sex. Joinpoint regression analyses were performed, and absolute and relative simple inequality measures were calculated. Results: There were 139.323 deaths from road accidents; in Colombia mortality rates from this cause has been decreasing. In urban areas, the reduction is more significant than in rural areas. Disparities in mortality between urban and rural areas have been narrowing, however, in the case of men and women, they have been increasing. Discussion: Reducing the mortality rate from road accidents suggests that road safety interventions have been effective. Behavioral factors can explain the higher mortality in men. Urban-rural inequalities can be related to development dynamics. Conclusions: There is a significant reduction in the mortality rate due to road accidents in urban areas. There are urban-rural inequalities in mortality from this cause. Road safety policies must be based on an integrative approach linked to other political agendas., Introducción: anualmente se pierden 1,35 millones de vidas por causa de siniestros viales; su ocurrencia se ha relacionado, además de factores comportamentales, con desigualdades sociales. Objetivo: analizar las desigualdades sociales urbano-rurales en la mortalidad por siniestros viales en Colombia para el periodo 1998-2019. Materiales y métodos: estudio ecológico a partir del análisis de las tasas de mortalidad ajustadas de los grupos poblacionales urbanos y rurales estratificados por sexo. Se hicieron análisis con regresión de Joinpoint y se calcularon medidas de desigualdad simple absoluta y relativa. Resultados: se registraron 139323 muertes por siniestros viales, en Colombia la tasa de mortalidad por esta causa se ha venido reduciendo. En contraste con las áreas rurales, en las áreas urbanas esta reducción es más significativa. Existen desigualdades en la mortalidad entre las áreas urbanas y rurales que han venido estrechándose. No obstante, en el caso de hombres y mujeres ha venido incrementándose. Discusión: la reducción de la tasa de mortalidad por siniestros viales sugiere que las intervenciones en seguridad vial han sido efectivas. La mayor mortalidad en hombres puede explicarse a partir de factores comportamentales. Las desigualdades urbano-rurales pueden estar relacionadas con las dinámicas de desarrollo. Conclusiones: se registra una reducción en la tasa de mortalidad por siniestros viales, la cual es más significativa en áreas urbanas. Existen desigualdades urbano-rurales en la mortalidad por esta causa. Las políticas de seguridad vial deben partir de un enfoque integrador vinculado con otras agendas políticas.

There has been growing concern about the health effects of agricultural pollutants among the rural populations, who by virtue of living near the sources of these pollutants are among the most exposed. The aim of this thesis was to make use of large national administrative databases to identify possible links between living near sources of agricultural pollutants, namely pesticides used in crops and livestock farming emissions, and health of the Dutch rural population that could point to more specific (groups of) exposures for further confirmatory research. From the Dutch Environmental Longitudinal Study (DUELS), a national census-based cohort, we selected about 4 million subjects living in rural areas for whom we computed the average number of cattle, pigs, chicken, and mink present in 500m, 1000m, 1500m and 2000m around their residences. Using Cox proportional hazards regression and adjusting for potential confounders at individual and neighborhood level, we found evidence that living up to 2000m of pig farms was associated with increased respiratory mortality, namely from chronic lower respiratory diseases. Using the same cohort but restricted to ~3.1 million subjects, we studied the potential effects of living near pesticide-treated crops and cause-specific mortality. We estimated the area of specific crop groups cultivated within buffers of 50m, 100m and 250m around subjects’ residences and the amount of fungicides, herbicides and insecticides used within those buffers. Using the previous statistical approach, we observed overall decreased mortality risks but noted an increased risk for chronic lower respiratory diseases mortality and proximity to maize cultivation. We found no evidence of an association between the amount of pesticides used and cause-specific mortality. Using the Public Health Monitor national survey from 2012, we selected ~217.000 participants who lived in rural areas. As previously, we estimated area of specific crop groups cultivated near pa

Objective: To analyze the behavior of pesticide poisoning associated with lethality in rural and urban populations in Colombia from 2007 to 2017. Methodology: Retrospective observational study that included a descriptive cross-sectional study and an ecological design that analyzed aggregate measures of morbidity, mortality, and risk attributable to the population in rural and urban areas. In the cross-sectional study, the relative risk was estimated to measure the factors associated with lethality among intoxications using Poisson regression with logarithmic function. For the time series, the trends were established with simple linear regression, and the seasonal decomposition was performed using the multiplicative model. Autocorrelations were tested using the Box-Ljung statistic. Results: Between 2007-2017; 89 490 cases were reported. The Morbidity due to poisoning showed a higher proportion in the rural population 36.03 cases per 100 000; this indicator was three times higher than in urban areas (12.33 cases per 100 000). The mortality rates in rural and urban areas were 1.00 and 0.13 cases per 100 000, respectively. The relative risk of fatality in case of intoxication was associated with the intention of suicide in the rural population Relative Risk (RR): 5.9 (95% CI: 5.0-6.9). Conclusion: A higher proportion of lethality associated with these events occurred in populations living in rural areas and reporting cases of suicidal intent. In addition, morbidity and mortality due to pesticide poisoning had the highest proportion in rural areas and a growing trend over time., Objetivo: Analisar o comportamento das intoxicações por pesticidas associadas com letalidade em população rural e urbana na Colômbia desde 2007 até 2017. Metodologia: Estudo observacional retrospectivo que incluiu um estudo descritivo transversal e um planejamento ecológico que analisou medidas agregadas de morbilidade, mortalidade e risco atribuíveis à população em áreas rurais e urbanas. No estudo transversal estimou-se o risco relativo para medir os fatores associados à letalidade entre as intoxicações por meio do uso da regressão de Poisson com função logarítmica. Para as séries temporais, foram estabelecidas as tendências com regressão linear simples, e realizou-se a decomposição sazonal por meio do modelo multiplicativo. As autocorrelações foram comprovadas por meio do estatístico de Box-Ljung. Resultados: Entre 2007-2017 foram reportados 89490 casos. A morbilidade por intoxicação mostrou uma proporção maior na população rural (36,06 casos por 100000); esse indicador foi três vezes maior que nas zonas urbanas (12,33 casos por 100000). As taxas de mortalidade nas zonas rurais e urbanas foram de 1,00 e 0,13 casos por 100000, respectivamente. O risco relativo de mortalidade em caso de intoxicação associou-se com a tentativa de suicídio na população rural Risco Relativo (RR): 5,9 (95% CI: 5,0-6,9). Conclusões: Uma proporção maior de letalidade associada a esses eventos teve lugar em populações que habitam áreas rurais e que reportam casos de tentativa de suicídio. Além disso, a morbimortalidade por intoxicação por pesticidas apresentou uma proporção maior em zonas rurais e uma tendência crescente no tempo., Objetivo: Analizar el comportamiento de las intoxicaciones por plaguicidas asociadas a letalidad en población rural y urbana en Colombia desde 2007 hasta 2017. Metodología: Estudio observacional retrospectivo que incluyó un estudio descriptivo transversal y un diseño ecológico que analizó medidas agregadas de morbilidad, mortalidad y riesgo atribuibles a la población en áreas rurales y urbanas. En el estudio transversal se estimó el riesgo relativo para medir los factores asociados a la letalidad entre las intoxicaciones mediante el uso de la regresión de Poisson con función logarítmica. Para las series temporales, se establecieron las tendencias con regresión lineal simple, y se realizó la descomposición estacional mediante el modelo multiplicativo. Las autocorrelaciones se comprobaron mediante el estadístico de Box-Ljung. Resultados: Entre 2007-2017 se reportaron 89 490 casos. La morbilidad por intoxicación mostró una mayor proporción en la población rural (36,03 casos por 100 000); este indicador fue tres veces mayor que en las zonas urbanas (12,33 casos por 100 000). Las tasas de mortalidad en las zonas rurales y urbanas fueron de 1,00 y 0,13 casos por 100 000, respectivamente. El riesgo relativo de mortalidad en caso de intoxicación se asoció a la intención de suicidio en la población rural Riesgo Relativo (RR): 5,9 (95% CI: 5,0-6,9). Conclusiones: Una mayor proporción de letalidad asociada a estos eventos ocurrió en poblaciones que viven en áreas rurales y que reportan casos de intención de suicidio. Además, la morbimortalidad por intoxicación por plaguicidas presentó una mayor proporción en zonas rurales y una tendencia creciente en el tiempo.

Despite dramatic reductions in global risk exposures to unsafe water sources, lack of access to clean water remains a persistent problem in many rural and last-mile communities. A great deal is known about demand for household water treatment systems; however, similar evidence for fully treated water products is limited. This study evaluates an NGO-based potable water delivery service in rural Bihar, India, meant to stand-in for more robust municipal treated water supply systems that have yet to reach the area. We use a random price auction and discrete choice experiment to examine willingness to pay (WTP) and stated product preferences, respectively, for this service among 162 households in the region. We seek to determine the impact of short-term price subsidies on demand for water delivery and the extent to which participation in the delivery program leads to changes in stated preferences for service characteristics. We find that mean WTP for the first week of service is roughly 51% of market price and represents only 1.7% of median household income, providing evidence of untapped demand for fully treated water. We also find mixed evidence on the effect of small price subsidies for various parts of the delivery service, and that one week of initial participation leads to significant changes in stated preferences for the taste of the treated water as well as the convenience of the delivery service. While more evidence is needed on the effect of subsidies, our findings suggest that marketing on taste and convenience could help increase uptake of clean water delivery services in rural and last-mile communities that have yet to receive piped water. However, we caution that these services should be seen as a stopgap, not a substitute for piped municipal water systems.

BACKGROUND: The Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs. METHODS: Diverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation. RESULTS: A total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicat

Attention bias confers risk for anxiety development, however, the influence of sociodemographic variables on the relationship between attention bias and anxiety remains unclear. We examined the association between attention bias and anxiety among rural Latinx youth and investigated potential moderators of this relationship. Clinical symptoms, demographic characteristics, and a performance-based measure of attention bias were collected from 66 rural Latinx youth with clinical levels of anxiety (33.3% female; Mage = 11.74; 92.4% Latinx, 7.6% Mixed Latinx). No moderating effects for age or gender were found. Youth below the poverty line displayed an attention bias away from threat in comparison to youth above the poverty line, who displayed an attention bias towards threat. Among youth below the poverty line, this bias away from threat was associated with increased anxiety. Findings highlight the importance of economic adversity in understanding the relationship between attention bias and anxiety.

Rurality has served as a key concept in popular and scientific understandings of the US overdose crisis, with White, rural, and low-income areas thought to be most heavily affected. However, we observe that overdose trends have risen nearly uniformly across the urban-rural designations employed in most research, implying that their importance has likely been overstated or incorrectly conceptualized. Nevertheless, urbanicity/rurality does serve as a key axis to understand inequalities in overdose mortality when assessed with more nuanced modalities-employing a more granular analysis of geography at the sub-county level, and intersecting rurality sociodemographic indices such as race/ethnicity. Using national overdose data from 1999-2021, we illustrate the intersectional importance of rurality for overdose surveillance. Finally, we offer recommendations for integrating these insights into drug overdose surveillance moving forward.

Background: We developed a program that encourages interaction among older people living at home by combining face-to-face and online activities and examined its effects on older adults' psychosocial health.Methods: In this mixed-methods study, we recruited 11 women and 6 men (Mage = 79.5 +/- 6.4 years), who lived in a rural community and participated in a senior citizen club. The intervention was conducted for 13 months, comprising monthly face-to-face group and social media activities. For the program process evaluation, we collected focus-group interview data on participants' perceptions of their personal lives, club membership, and community post-intervention. For the outcome evaluation, we collected six outcome measures pre- and post-intervention: loneliness, subjective health, subjective well-being, self-esteem, social support and social activity satisfaction. Finally, through the integration of the process-outcome evaluation, we inferred what effects the program had on participants' psychosocial health.Results: In the process evaluation, we identified four themes: 'Stimulation brought about by relationships with peers,' 'Realization as to where they feel they belong,' 'Rethinking of oneself in the community,' and 'Awareness of attachment to and coexistence with the community.' In the outcome evaluation, the outcome measures were maintained without significant decline post-intervention.Conclusion: Through the integration of the process-outcome evaluation, we deduced three effects of the program on psychosocial health: (1) fulfilment of subjective health, (2) maintenance and assurance of moderate distance connectedness and (3) orientation toward aging in place.Implications for practice: This study offers a promising opportunity for further development and research into community-based preventive nursing care intervention strategies to maintain the psychosocial health of homebound older people in communities with social activity groups.

The article presents data reflecting the territorial peculiarities of rural population dynamics and shows their dependence on external factors (primarily, the development of agriculture). The database includes 14 indicators of the regional spatial differentiation of rural population development in Russia between 2010-2020. A typology of regions based on eight economic and ecological parameters is provided. The dataset covers the statistical indicators of 85 Russian regions from 2010 to 2020, published by the Federal State Statistics Service and the Unified Interdepartmental Information and Statistics System. The results are presented in seven tables and six maps. The dataset can be used by federal and regional authorities elaborating science-­based rural development programmes and strategies, as well as experts on rural development.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified., CC BY 4.0NCD Risk Factor Collaboration (NCD-RisC)This study was funded by the UK Medical Research Council (grant number MR/V034057/1), the Wellcome Trust (Pathways to Equitable Healthy Cities grant 209376/Z/17/Z), the AstraZeneca Young Health Programme and the European Commission (STOP project through EU Horizon 2020 research and innovation programme under Grant Agreement 774548). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission. We thank W. Dietz, L. Jaacks and W. Johnson for recommendations of relevant citations. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

BackgroundWe assessed built environment (residential density, landuse mix and aesthetics) and HIV linkage to care (LTC) among 1,681 (18-49 years-old) residents of 15 Mpumalanga villages, South Africa.MethodsMultilevel models (linear-binomial) were used for the association between built environment, measured using NEWS for Africa, and LTC from a clinical database of 9 facilities (2015-2018). Additionally, we assessed effect-measure modification by universal test-and-treat policy (UTT).ResultsWe observed, a significant association in the adjusted 3-month probability of LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2-10.1), however, no association for land-use mix (RD%: 2.4, 95%CI: -0.4, 5.2) and aesthetics (RD%: -1.2, 95%CI: -4.5-2.2). Among those diagnosed after UTT, residents of high land-use villages were more likely to link-to-care than those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1-8.1, p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: -2.1-8.0, p > 0.10).ConclusionFindings suggest, better built environment conditions (adequate infrastructure, proximity to services etc.) help facilitate LTC. Moreover, UTT appears to have a protective effect on LTC.

BACKGROUND: Social network analysis can elucidate tuberculosis transmission dynamics outside the home and may inform novel network-based case-finding strategies. METHODS: We assessed the association between social network characteristics and prevalent tuberculosis infection among residents (aged ≥15 years) of 9 rural communities in Eastern Uganda. Social contacts named during a census were used to create community-specific nonhousehold social networks. We evaluated whether social network structure and characteristics of first-degree contacts (sex, human immunodeficiency virus [HIV] status, tuberculosis infection) were associated with revalent tuberculosis infection (positive tuberculin skin test [TST] result) after adjusting for individual-level risk factors (age, sex, HIV status, tuberculosis contact, wealth, occupation, and Bacillus Calmette-Guérin [BCG] vaccination) with targeted maximum likelihood estimation. RESULTS: Among 3 335 residents sampled for TST, 32% had a positive TST results and 4% reported a tuberculosis contact. The social network contained 15 328 first-degree contacts. Persons with the most network centrality (top 10%) (adjusted risk ratio, 1.3 [95% confidence interval, 1.1-1.1]) and the most (top 10%) male contacts (1.5 [1.3-1.9]) had a higher risk of prevalent tuberculosis, than those in the remaining 90%. People with ≥1 contact with HIV (adjusted risk ratio, 1.3 [95% confidence interval, 1.1-1.6]) and ≥2 contacts with tuberculosis infection were more likely to have tuberculosis themselves (2.6 [ 95% confidence interval: 2.2-2.9]). CONCLUSIONS: Social networks with higher centrality, more men, contacts with HIV, and tuberculosis infection were positively associated with tuberculosis infection. Tuberculosis transmission within measurable social networks may explain prevalent tuberculosis not associated with a household contact. Further study on network-informed tuberculosis case finding interventions is warranted.

Population mobility is associated with higher-risk sexual behaviors in sub-Saharan Africa and is a key driver of the HIV epidemic. We conducted a longitudinal cohort study to estimate associations between recent mobility (overnight travel away from home in past six months) or migration (changes of residence over defined geopolitical boundaries) and higher-risk sexual behavior among co-resident couples (240 couples aged ≥ 16) from 12 rural communities in Kenya and Uganda. Data on concurrent mobility and sexual risk behaviors were collected every 6-months between 2015 and 2020. We used sex-pooled and sex-stratified multilevel models to estimate associations between couple mobility configurations (neither partner mobile, male mobile/female not mobile, female mobile/male not mobile, both mobile) and the odds of higher-risk (casual, commercial sex worker/client, one night stand, inherited partner, stranger) and concurrent sexual partnerships based on who was mobile. On average across all time points and subjects, mobile women were more likely than non-mobile women to have a higher-risk partner; similarly, mobile men were more likely than non-mobile men to report a higher-risk partnership. Men with work-related mobility versus not had higher odds of higher-risk partnerships. Women with work-related mobility versus not had higher odds of higher-risk partnerships. Couples where both members were mobile versus neither had greater odds of higher-risk partnerships. In analyses using 6-month lagged versions of key predictors, migration events of men, but not women, preceded higher-risk partnerships. Findings demonstrate HIV risks for men and women associated with mobility and the need for prevention approaches attentive to the risk-enhancing contexts of mobility.

The coronavirus 2019 (COVID-19) pandemic has had significant impacts on health systems, population dynamics, public health awareness, and antibiotic stewardship, which could affect antibiotic resistant bacteria (ARB) emergence and transmission. In this study, we aimed to compare knowledge, attitudes, and practices (KAP) of antibiotic use and ARB carriage in Ecuadorian communities before versus after the COVID-19 pandemic began. We leveraged data collected for a repeated measures observational study of third-generation cephalosporin-resistant E. coli (3GCR-EC) carriage among children in semi-rural communities in Quito, Ecuador between July 2018 and September 2021. We included 241 households that participated in surveys and child stool sample collection in 2019, before the pandemic, and in 2021, after the pandemic began. We estimated adjusted Prevalence Ratios (aPR) and 95% Confidence Intervals (CI) using logistic and Poisson regression models. Child antibiotic use in the last 3 months declined from 17% pre-pandemic to 5% in 2021 (aPR: 0.30; 95% CI 0.15, 0.61) and 3GCR-EC carriage among children declined from 40 to 23% (aPR: 0.48; 95% CI 0.32, 0.73). Multi-drug resistance declined from 86 to 70% (aPR: 0.32; 95% CI 0.13; 0.79), the average number of antibiotic resistance genes (ARGs) per 3GCR-EC isolate declined from 9.9 to 7.8 (aPR of 0.79; 95% CI 0.65, 0.96), and the diversity of ARGs was lower in 2021. In the context of Ecuador, where COVID-19 prevention and control measures were strictly enforced after its major cities experienced some of the worlds the highest mortality rates from SARS-CoV-2 infections, antibiotic use and ARB carriage declined in semi-rural communities of Quito from 2019 to 2021.

Dengue has historically been considered an urban disease associated with dense human populations and the built environment. Recently, studies suggest increasing dengue virus (DENV) transmission in rural populations. It is unclear whether these reports reflect recent spread into rural areas or ongoing transmission that was previously unnoticed, and what mechanisms are driving this rural transmission. We conducted a systematic review to synthesize research on dengue in rural areas and apply this knowledge to summarize aspects of rurality used in current epidemiological studies of DENV transmission given changing and mixed environments. We described how authors defined rurality and how they defined mechanisms for rural dengue transmission. We systematically searched PubMed, Web of Science, and Embase for articles evaluating dengue prevalence or cumulative incidence in rural areas. A total of 106 articles published between 1958 and 2021 met our inclusion criteria. Overall, 56% (n = 22) of the 48 estimates that compared urban and rural settings reported rural dengue incidence as being as high or higher than in urban locations. In some rural areas, the force of infection appears to be increasing over time, as measured by increasing seroprevalence in children and thus likely decreasing age of first infection, suggesting that rural dengue transmission may be a relatively recent phenomenon. Authors characterized rural locations by many different factors, including population density and size, environmental and land use characteristics, and by comparing their context to urban areas. Hypothesized mechanisms for rural dengue transmission included travel, population size, urban infrastructure, vector and environmental factors, among other mechanisms. Strengthening our understanding of the relationship between rurality and dengue will require a more nuanced definition of rurality from the perspective of DENV transmission. Future studies should focus on characterizing details of s

BackgroundMental health disorders (MHD) impose a considerable burden on public health systems. With an increasing worldwide trend in urbanization, urban mental health stressors are affecting a larger population. In this study, we evaluated the epidemiology of mental health disorders in the citizens of Tehran using the Tehran Cohort Study (TeCS) data.MethodsWe utilized data from the TeCS recruitment phase. A total of 10,247 permanent residents of Tehran metropolitan (aged 15 years and older) were enrolled in the study from March 2016 to 2019 via systematic random sampling from all 22 districts of Tehran. The participant's demographic, socioeconomic, and medical characteristics were evaluated by conducting comprehensive interviews. The standardized Persian version of the General Health Questionnaire version 28 was utilized to assess the mental status of the patients according to four central mental health disorders.ResultsAlmost 37.1% of Tehran residents suffered mental health problems (45.0% of women and 28.0% of men). The greatest incidence of MHDs was seen in the 25-34 and over 75 age groups. The most common mental health disorders were depression (43%) and anxiety (40%), followed by somatization (30%) and social dysfunction (8.1%). Mental health disorders were more frequent in the southeast regions of the city.ConclusionsTehran residents have a significantly higher rate of mental health disorders compared to nationwide studies, with an estimated 2.7 million citizens requiring mental health care services. Awareness of mental health disorders and identifying vulnerable groups are crucial in developing mental health care programs by public health authorities.

Animal tolerance towards humans can be a key factor facilitating wildlife-human coexistence, yet traits predicting its direction and magnitude across tropical animals are poorly known. Using 10,249 observations for 842 bird species inhabiting open tropical ecosystems in Africa, South America, and Australia, we find that avian tolerance towards humans was lower (i.e., escape distance was longer) in rural rather than urban populations and in populations exposed to lower human disturbance (measured as human footprint index). In addition, larger species and species with larger clutches and enhanced flight ability are less tolerant to human approaches and escape distances increase when birds were approached during the wet season compared to the dry season and from longer starting distances. Identification of key factors affecting animal tolerance towards humans across large spatial and taxonomic scales may help us to better understand and predict the patterns of species distributions in the Anthropocene.

BackgroundIn South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status.MethodsWe analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects.ResultsGreater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status.ConclusionsEmpowerment-based interventions, particularly those targeting women's involvement in household decisions

Contextualization: Colombia is the main producer and exporter of cape gooseberry (Physalis peruviana L.) in the world, with Nariño being the fourth most important department. This crop has become a significant source of income for small producers who base their economy on small-scale agriculture, characterized by family labor. This study was carried out in the southern (former province of Obando) and northern (municipality of San Pablo) areas of the department, considered productive niches for cape gooseberry. Research gap: At the national level, studies on rural poverty have been scarce despite their importance in the definition of public policies to improve the quality of life of the population, especially when viewed from the point of view of dispersed rural areas where a wide variety of agricultural products are produced, including the so-called promising production systems such as uchuva. Purpose of the study: To analyze the socioeconomic conditions and the determinants of poverty that affect the quality of life of uchuva producers in the department of Nariño. Methodology: A technical and socioeconomic characterization survey was designed and applied between 2019 and 2020 to 133 cape gooseberry producers. Based on the information obtained, poverty indicators by UBN (Unsatisfied Basic Needs), MPI (Multidimensional Poverty Index), and their determinants were estimated using a logit econometric model. Results and conclusions: The existence of 50.4% of households in poverty was identified by UBN; 34.54% by MPI and the existence of 4.6 times the probability of being poor when economic dependence predominates (economic burden that falls on the productive population of a household); 2.08 times less when there is a higher level of education and 1.31 times less when there is more land in the farm. Finally, the importance of formulating differentiated policies between urban and rural areas aimed at poverty reduction, particularly through access to education and technical, Contextualización: Colombia es el principal productor y exportador de uchuva (Physalis peruviana L.) en el mundo, siendo Nariño el cuarto departamento en orden de importancia. Este cultivo se ha convertido en una fuente significativa de ingresos para pequeños productores que basan su economía en agricultura a pequeña escala, caracterizada por contar con mano de obra familiar. El presente estudio se desarrolló en las zonas sur (Ex provincia de Obando) y norte (municipio de San Pablo) del departamento, considerados como nichos productivos de la uchuva. Vacío de la investigación: A nivel nacional los estudios de pobreza rural han sido escasos a pesar de su importancia en la definición de políticas públicas para la mejora en la calidad de vida de los pobladores, más aún si es visto desde las zonas rurales dispersas en donde se produce una amplia variedad de productos agropecuarios, incluidos los denominados sistemas productivos promisorios como el caso de la uchuva. Propósito de estudio: Analizar las condiciones socioeconómicas y los determinantes de pobreza que inciden en la calidad de vida de los productores de uchuva del departamento de Nariño. Metodología: Se diseñó una encuesta de caracterización técnica y socioeconómica, aplicada entre 2019 y 2020 a 133 productores de uchuva. A partir de la información obtenida, se estimaron indicadores de pobreza por NBI (Necesidades Básicas Insatisfechas), IPM (Índice de Pobreza Multidimensional) y sus determinantes a partir de un modelo econométrico logit. Resultados y conclusiones: Se identificó la existencia de un 50,4% de hogares en pobreza por NBI; 34,54% por IPM y existencia de 4,6 veces de probabilidad de ser pobre cuando predomina la dependencia económica (medida de razón sobre la carga económica que recae sobre la porción de la población productiva de un hogar); 2,08 veces menos si existe mayor nivel educacional y 1,31 veces menos al tener mayor área en la finca. Finalmente, se evidenció la importancia de formular polít

BACKGROUND: Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood. METHODS: We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at baseline and after four years of follow-up using household surveys and blood pressure data. Hypertension was a mean systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg, or current use of anti-hypertension medication. Control was a mean blood pressure <140/90 mm Hg. The effects of sex and age on the treatment cascade at follow-up were assessed. Multivariate Poisson regression models were used to estimate prevalence ratios along the treatment cascade at follow-up. RESULTS: Prevalence along the treatment cascade increased from baseline (B) to follow-up (F): awareness (64.4% vs. 83.6%), treatment (49.7% vs. 73.9%), and control (22.8% vs. 41.3%). At both time points, women had higher levels of awareness (B: 70.5% vs. 56.3%; F: 88.1% vs. 76.7%), treatment (B: 55.9% vs. 41.55; F: 79.9% vs. 64.7%), and control (B: 26.5% vs. 17.9%; F: 44.8% vs. 35.7%). Prevalence along the cascade increased linearly with age for everyone. Predictors of awareness included being female, elderly, or visiting a primary health clinic three times in the previous 3 months, and the latter two also predicted hypertension control. CONCLUSIONS: There were significant improvements in awareness, treatment, and control of hypertension from baseline to follow-up and women fared better at all stages, at both time points.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified., CC BY 4.0NCD Risk Factor Collaboration (NCD-RisC)This study was funded by the UK Medical Research Council (grant number MR/V034057/1), the Wellcome Trust (Pathways to Equitable Healthy Cities grant 209376/Z/17/Z), the AstraZeneca Young Health Programme and the European Commission (STOP project through EU Horizon 2020 research and innovation programme under Grant Agreement 774548). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission. We thank W. Dietz, L. Jaacks and W. Johnson for recommendations of relevant citations. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Objective: Determine the change in spending on ultra-processed foods (AUP) in family farmers in rural Peru in 2009 and 2019. Methodology: Secondary analysis study of the National Household Survey (ENAHO) for the years 2009 and 2019. The study population was family farmers from the rural area of Peru. The average monthly expenditure on AUP consumed within the home for the years 2009 and 2019 was determined and the differences in expenditure were estimated for the total rural domain and the geographic domains of the north, center and south coast, northern, central, and southern Sierra and jungle. Student’s T-test and the Z-test of proportions were used to assess the average and percentage change in total spending on the purchase of AUP. Results: The average spending on AUP was S/82.56 in 2009 and S/74.18 in 2019, this reduction was significant for the total Rural domain and in 5 of 7 domains (p<0.05), these results were similar in the percentage of total spending devoted to the purchase of AUP.Conclusions: The results of the study show that the average spending on AUP of family farmers in rural areas in 2019 had a small but significant reduction compared to spending in 2009; this trend was maintained in 5 of 7 study domains., Objetivo: Determinar el cambio del gasto en alimentos ultraprocesados (AUP) en agricultores familiares del área rural del Perú, en los años 2009 y 2019. Metodología: Estudio de análisis secundario de la Encuesta Nacional de Hogares (ENAHO) del año 2009 y 2019. La población de estudio fueron los agricultores familiares del área rural del Perú. Se determinó el gasto promedio mensual en AUP consumidos dentro del hogar para el año 2009 y 2019 y se estimaron las diferencias en el gasto para el dominio rural total y los dominios geográficos costa norte, centro y sur, sierra norte, centro y sur y selva. Se usó la prueba T de Student y la prueba Z de proporciones para evaluar el cambio promedio y porcentuales del gasto total destinado a la compra de AUP. Resultados: El promedio de gasto en AUP fue de S/82,56 en 2009 y de S/74,18 en 2019, esta reducción resultó significativa para el dominio rural total y en 5 de 7 dominios (p<0,05), estos resultados fueron simi-lares en el porcentaje del gasto total destinado a la compra de AUP. Conclusiones: Los resultados del estudio muestran que el promedio de gasto en AUP de agricultores fami-liares de zona rural del año 2019 tuvo una pequeña pero significativa reducción comparado con el gasto en 2009, esta tendencia se mantuvo en 5 de 7 dominios de estudio.

Introduction: peasant families have social supports in various dimensions that provide family well-being. The objective was to understand the social supports to maintain health that peasant families have in the municipality of Villamaría (Caldas, Colombia). Method: interpretive ethnography, intentional sampling with participant observation and ethnographic interviews with seven families from five villages in the rural area. 29 family visits were made from September 2017 to November 2018. Four-phase spiral analysis proposed by McFarland and Leininger, supported by Atlas ti software. Results: the social supports that peasant families consider important to maintain their health are condensed into a holistic pattern called “we survive thanks to family, neighbors, work, God, and those who help us.” It expresses heterogeneity and they are essential for the maintenance of family health. Conclusions: the social support networks of rural families are constituted as diverse and necessary elements to maintain family health, which motivates health professionals to transcend care focused on the health–disease process., Introducción: las familias campesinas poseen apoyos sociales en varias dimensiones que proporcionan bienestar familiar. El objetivo fue comprender los apoyos sociales que tienen las familias campesinas del municipio de Villamaría (Caldas, Colombia) para mantener la salud. Método: etnografía interpretativa, muestreo intencional con observación participante y entrevistas etnográficas a siete familias de cinco veredas de la zona rural. Se realizaron 29 visitas familiares entre septiembre de 2017 y noviembre de 2018. Análisis en cuatro fases en espiral propuesto por McFarland y Leininger, con el apoyo del software Atlas ti. Resultados: los soportes sociales que las familias campesinas consideran importantes para mantener su salud se condensan en un patrón de carácter holístico denominado “sobrevivimos gracias a la familia, los vecinos, el trabajo, “Dios”, y quienes nos ayudan”. Demuestran heterogeneidad y son fundamentales para el mantenimiento de la salud familiar. Conclusiones las redes de apoyo social de las familias campesinas se constituyen como elementos diversos y necesarios para mantener la salud familiar, lo que motiva a los profesionales de la salud a trascender las atenciones enfocadas en el proceso salud–enfermedad.

The purpose of the study was to understand the sociocultural configurations about diseases of a group of peasants in Córdoba, Colombia, through a micro-ethnographic design and the application of semi-structured interviews, conversations and observations to 20 members of the community, between October 2020 and March 2021. The interviews were transcribed and organized in matrices for their categorization and analysis using Bardin technique. The disease is conceived from two constructions: being sick is not being able to work and being sick is restlessness and anguish; Both configurations are built from the link between the opportunities to work and do activities from daily life, but they are altered by problems in the provision of the health service. It is concluded that the sociocultural configuration of the diseases overcomes the vision of physical imbalance because it is perceived into daily life activities, the ways of living, and the solidarity networks woven by the peasants as a strategy against the negligence of the state ineffectiveness of health system in Colombian rural areas., El propósito del estudio fue comprender las configuraciones socioculturales sobre las enfermedades construidas por un grupo de campesinos en el Departamento de Córdoba, Colombia, mediante un diseño micro etnográfico y la aplicación de entrevistas semiestructuradas, conversaciones y observaciones a 20 miembros de la comunidad, entre octubre de 2020 y marzo de 2021. Las entrevistas fueron transcritas, organizadas en matrices y procesadas para su posterior organización, categorización y análisis con apoyo de la técnica de Bardin. Se develan dos construcciones para concebir la enfermedad: estar enfermo es no poder trabajar y estar enfermo es intranquilidad y angustia; ambas configuraciones se construyen a partir del vínculo con las oportunidades para trabajar y realizar acciones de la vida cotidiana, pero están permeadas por el déficit en la prestación del servicio de salud y las dificultades para acceder a este. Se concluye que la configuración sociocultural de las enfermedades supera la visión de desequilibrio físico del individuo al enunciarse en el ámbito de las prácticas cotidianas, los modos de vivir y las redes de solidaridad tejidas por los campesinos como estrategia de resistencia ante el olvido estatal y la ineficacia de los abordajes del sector salud en zonas rurales colombianas., O objetivo do estudo foi compreender as configurações socioculturais sobre doenças de um grupo de camponeses em Córdoba, Colômbia, por meio de um desenho microetnográfico e da aplicação de entrevistas semiestruturadas, conversas e observações a 20 membros da comunidade, entre outubro 2020 e março de 2021. As entrevistas foram transcritas e organizadas em matrizes para sua categorização e análise pela técnica de Bardin. A doença é concebida a partir de duas construções: estar doente é não poder trabalhar e estar doente é inquietação e angústia; Ambas as configurações são construídas a partir da ligação entre as oportunidades de trabalho e de realização das atividades do cotidiano, mas são alteradas por problemas na prestação do serviço de saúde. Conclui-se que a configuração sociocultural das doenças supera a visão do desequilíbrio físico, pois é percebida nas atividades do cotidiano, nos modos de viver e nas redes solidárias tecidas pelos camponeses como estratégia contra o descaso do Estado inefetividade da saúde sistema nas áreas rurais colombianas.

Introduction: peasant families have social supports in various dimensions that provide family well-being. The objective was to understand the social supports to maintain health that peasant families have in the municipality of Villamaría (Caldas, Colombia). Method: interpretive ethnography, intentional sampling with participant observation and ethnographic interviews with seven families from five villages in the rural area. 29 family visits were made from September 2017 to November 2018. Four-phase spiral analysis proposed by McFarland and Leininger, supported by Atlas ti software. Results: the social supports that peasant families consider important to maintain their health are condensed into a holistic pattern called “we survive thanks to family, neighbors, work, God, and those who help us.” It expresses heterogeneity and they are essential for the maintenance of family health. Conclusions: the social support networks of rural families are constituted as diverse and necessary elements to maintain family health, which motivates health professionals to transcend care focused on the health–disease process., Introducción: las familias campesinas poseen apoyos sociales en varias dimensiones que proporcionan bienestar familiar. El objetivo fue comprender los apoyos sociales que tienen las familias campesinas del municipio de Villamaría (Caldas, Colombia) para mantener la salud. Método: etnografía interpretativa, muestreo intencional con observación participante y entrevistas etnográficas a siete familias de cinco veredas de la zona rural. Se realizaron 29 visitas familiares entre septiembre de 2017 y noviembre de 2018. Análisis en cuatro fases en espiral propuesto por McFarland y Leininger, con el apoyo del software Atlas ti. Resultados: los soportes sociales que las familias campesinas consideran importantes para mantener su salud se condensan en un patrón de carácter holístico denominado “sobrevivimos gracias a la familia, los vecinos, el trabajo, “Dios”, y quienes nos ayudan”. Demuestran heterogeneidad y son fundamentales para el mantenimiento de la salud familiar. Conclusiones las redes de apoyo social de las familias campesinas se constituyen como elementos diversos y necesarios para mantener la salud familiar, lo que motiva a los profesionales de la salud a trascender las atenciones enfocadas en el proceso salud–enfermedad.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.