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The phenomenon of population aging in rural China presents a compelling societal challenge, necessitating a growing demand for both the quantity and quality of facilities supporting the needs of older people. However, a lack of comprehensive understanding concerning the underlying mechanisms that drive the emergence of these facilities, coupled with the distinctive historical backdrop and social development stage of the nation, engenders complexities in achieving sustainable rural eldercare services. This paper endeavors to comprehensively elucidate diverse eldercare facility types in rural China, delineating their intrinsic characteristics and prerequisites for construction. Additionally, the research delves into the political and economic contexts and advancements in healthcare and eldercare services, culminating in the formulation of an integrated framework that interconnects eldercare support patterns with the political landscape and public service provisions. The implications derived from this nuanced framework provide insightful reflections on significant historical transitions, intricacies faced by rural eldercare facilities, and strategic pathways for fostering future eldercare service delivery systems and allied facilities. The paper's findings furnish insights for bolstering the well-being of the aging population in rural China and lay a substantive foundation for addressing the evolving requisites of eldercare within this distinctive context. [ABSTRACT FROM AUTHOR]

In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was conducted with 44 persons with lived experience in a BC region to identify priority SCI health-related topics. Twenty-five topics were ranked from 1–14, with bowel and bladder management ranked 1 and 4, sexual health ranked 5, and pressure injuries ranked 7. Clinical perspectives on the priorities were collected from 102 clinicians in the BC region, who independently ranked 14 of these SCI topics and considered the former 4 topics to be lower clinical priority (ranked 11–14). These priorities informed a series of SCI clinical education workshops held at healthcare facilities in three regional cities. The goals were to improve clinicians' knowledge and confidence levels when managing spinal cord injury health and to facilitate person-centred care. Positive feedback demonstrated that educational workshops supported by lived experience perspectives effectively enhanced the clinicians' understanding of spinal cord injury and their priorities. Future plans include engaging more administrators as part of this initiative and conducting workshops in other regions of BC. [ABSTRACT FROM AUTHOR]

As urbanization accelerates in China, more and more rural elders are moving to cities to live with their children. However, they face challenges in overcoming cultural, social, and economic disparities and maintaining health in urban life, and health is important human capital that may have a significant impact on the urban adaptation of rural elderly migrants (REMs). Based on the 2018 China Health and Retirement Longitudinal Study (CHARLS), this paper constructs an indicator system to measure the level of urban adaptation of REMs. The health level and urban adaptation of REMs are studied in depth, and how to better help them adapt to urban life in order to provide a healthy living environment and a good lifestyle is explored. The empirical analysis finds the following: (1) good health helps REMs achieve a better level of urban adaptation. (2) REMs with good health status are more likely to go to community clubs for activities and do physical activities and thus improve their urban adaptation level. (3) There are significant differences in the effects of health status on urban adaptation among REMs with different characteristics. REMs with better health status in the central and western regions have significantly higher levels of urban adaptation than those in the eastern regions, and men have higher levels of urban adaptation than women. Therefore, the government should construct classification measures according to the differentiated characteristics of rural elderly migrants' urban adaptation, and guide and support their stratified and orderly adaptation to urban society. [ABSTRACT FROM AUTHOR]

Collaboration between midwives and traditional birth attendants for maternal and child healthcare is a challenge in rural South African communities due to the absence of a guiding framework. To address this, this study sought to develop and validate an inclusive framework informed by the Donabedian structure–process–outcome (SPO) framework for collaboration between these healthcare professionals. Method: Key stakeholders were invited to participate in a co-creation workshop to develop the framework. Twenty (20) participants were purposively sampled based on their maternal and child healthcare expertise. A consensus design using the nominal group technique was followed. Results: Participants identified the components needed in the framework, encompassing (i) objectives, (ii) structures, (iii) processes, and (iv) outcomes. Conclusion: This paper will contribute to the development of an inclusive healthcare framework, providing insights for stakeholders, policymakers, and practitioners seeking to improve maternal and child healthcare outcomes in resource-constrained, rural settings. Ultimately, the proposed framework will create a sustainable and culturally sensitive model that optimises the strengths of midwives and TBAs and fosters improved healthcare delivery to rural South African communities. [ABSTRACT FROM AUTHOR]

WWDISA is an optional module of the DISA Laboratory Information system (LIS) that offers a web portal that allows access to test results over the internet for patient clinical management. This study aims to assess the applicability of using the WWDISA web application, and the lessons learned from its implementation in six health facilities in Mabote district, Inhambane province. Data from 2463 and 665 samples for HIV-viral load (HIVVL) tests, extracted from paper-based and WWDISA systems, respectively, were included, from January to December 2020. Data were simultaneously collected on a quarterly basis from both systems to allow comparison. The WWDISA turnaround time (TAT) from sample collection to results becoming available was found to be 10 (IQR: 8–12) days and significantly lower than the health unit manual logbook (p value < 0.001). Regarding the system efficiency, it was found that among 1978 search results, only 642 (32.5%) were found, and the main challenges according to the users were lack of connectivity (77%) and the website going down (62%). The WWDISA module has been shown to be effective in reducing the TAT, although a stable internet connection and accurate data entry are essential to make the system functional. [ABSTRACT FROM AUTHOR]

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs. [ABSTRACT FROM AUTHOR]

Background: Personal, social, and environmental factors may influence self-efficacy and social reintegration among people living with spinal cord injury or disease (SCI/D) in urban and rural areas. Novel data collection methods have the potential to characterize community participation (CP) in diverse settings. Objectives: The objectives were (1) to describe and compare self-reported community participation (Reintegration to Normal Living Index (RNLI) and Moorong Self-Efficacy Scale (MSES)) levels of individuals with SCI/D living in urban or rural Ontario, Canada; and (2) to determine the accuracy of an artificial intelligence (AI) optical mark recognition tool for extracting data from CP surveys conducted among participants after transitioning from inpatient rehabilitation to home and residing in the community. Methods: We partnered with SCI Ontario staff to collect MSES and RNLI survey data from adults with motor complete (e.g., AIS A–B) and incomplete (AIS C–D) SCI/D living in urban or rural Ontario, Canada, between January and October 2022. The Rurality Index of Ontario (RIO) from the postal code determined urban or rural residency. Optical mark recognition (OMR) software was used for survey data extraction. A Research Associate validated the extracted survey responses. Descriptive statistics, correlation analysis, and non-parametric statistics were used to describe the participants, their impairments, and their reported CP levels across urban and rural settings. Results: Eighty-five individuals with SCI/D (mean age 53.7 years, 36.5% female) completed the survey. Most of the participants resided in major urban areas (69.4%) and had traumatic injuries (64.7%). The mean total MSES score for Ontarians with SCI/D was 87.96 (95% confidence interval [CI]: 84.45, 91.47), while the mean total RNLI score for the same individuals was 75.61 (95% CI: 71.85, 79.37). Among the MSES domains, the lowest score was observed in response to sexual satisfaction (mean: 4.012, 95% CI: 3.527, 4.497), while the lowest RNLI domain item score was associated with the ability to travel out of town (mean: 5.965, 95% CI: 5.252, 6.678). Individuals with incomplete injuries in rural areas reported lower MSES and RNLI scores than those with complete motor injuries, whereas no significant differences were found in MSES and RNLI scores among urban residents based on impairment. These findings suggest that, depending on the environmental context (e.g., rural vs. urban areas), AIS categories may influence the perception of CP among people living with SCI/D. The OMR tool had 97.4% accuracy in extracting data from the surveys. Conclusions: The CP (MSES and RNLI) scores reported by individuals with SCI/D differ based on their living setting. In rural Ontario, individuals with greater functional ability reported lower CP than their counterparts living in urban settings. Although CP remains a challenge, the needs of individuals with motor incomplete SCI/D and heterogeneous levels of mobility residing in rural areas require exploration and targeted interventions. The OMR tool facilitates accurate data extraction from surveys across settings. [ABSTRACT FROM AUTHOR]

Background: Optimal glycemic management is critical since it can predict all associated essential causes of death, even after accounting for other risk factors. Objectives: This study investigated the factors associated with glycemic control in patients with type 2 diabetes mellitus (T2DM), particularly self-care behaviors. Methods: An analytical cross-sectional study examined 385 patients with T2DM in 1 general and 17 community hospitals in Kalasin Province. The samples were collected using mixed-method sampling. Data were collected using a validated questionnaire with six parts and laboratory examination records between September 2021 and December 2022. Descriptive statistics (e.g., percentages and means ± SD) were used to analyze the data. The relationship between relevant factors and lack of glycemic control was analyzed by multivariate logistic regression using SPSS version 25. Results: Results showed that most patients were female (78.18%), and the mean age was 59.84 ± 9.05 years. Additionally, a significant proportion of the patients (79.74%) had poor glycemic control. Several factors are significantly associated with poor glycemic control in patients with T2DM. These factors included subjects under the age of 60 years (OR = 2.95, 95% CI: 1.57 to 5.54; p-value < 0.001), a diabetes duration of over 10 years (OR = 3.95, 95% CI: 1.90 to 8.22; p-value < 0.001), poor knowledge about diabetes (OR = 3.92, 95% CI: 1.59 to 9.67; p-value < 0.003), and inadequate self-care behaviors (OR = 6.12, 95% CI: 3.20 to 11.68; p-value < 0.001). Conclusions: In conclusion, proper interventions for controlling glycemic level behaviors are necessary to improve proper self-care behaviors in patients who have a low knowledge level of T2DM, have had diabetes for over ten years, and are aged < 60 years. This approach can reduce the likelihood of experiencing disabilities and economic hardship. [ABSTRACT FROM AUTHOR]

Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = −0.54, 95% CI: −0.94 to −0.14; β = −0.41, 95% CI: −0.78 to −0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused significant transformations in healthcare. Many countries began the rapid development and adoption of telemedicine to avoid the spread of the pandemic and created an innovative model for healthcare delivery. This study identified the critical antecedents that affected the considered healthcare outcomes via teleophthalmology in Eastern Taiwan during the COVID-19 pandemic. Methods: This study's participants included residents of five towns in Taitung County who had experience with teleophthalmology. This study analyzed the structured questionnaires completed by the participants to validate the proposed research framework. Statistical methods were used to verify the research models, including descriptive statistical analysis, confirmatory factor analysis, and structural equation modeling. The date of this study was from 1 October 2020 to 31 July 2023. Results: The results of this study reveal that the average monthly use of teleophthalmology by individuals in rural areas increased annually. Females tended to utilize teleophthalmology services more than males. There were no significant differences across any of the constructs with respect to age or educational level. Additionally, the patients' awareness of healthcare accessibility via and the communication quality of teleophthalmology simultaneously affected teleophthalmology's adoption and service quality, which in turn jointly affected health outcomes. Both healthcare accessibility and communication quality were the antecedents of the healthcare outcomes. The health outcomes refer to the impact of teleophthalmology on the quality of the patients' health and well-being. Additionally, teleophthalmology's adoption and service quality acted as mediators. Conclusions: This study's findings are expected to increase attention to the healthcare outcomes and antecedents of teleophthalmology to promote better telemedicine practices and services for rural residents. [ABSTRACT FROM AUTHOR]

A cross-sectional study was conducted with three aims: (1) to determine the degree of compliance with physical activity recommendations among adolescents according to sex and place of residence, (2) to determine the perceived support of family and friends for physical activity among adolescents according to sex and place of residence, and (3) to analyse the influence of family and friends support on compliance with physical activity recommendations among adolescents according to sex and place of residence. A total of 694 adolescents from an inland area of Spain (14.06 ± 1.27 years) participated. Four one-day physical activity questionnaires were administered to assess physical activity and the Parental Support Scale and Peer Support to measure perceived support from family and friends regarding physical activity. Chi-square, Crammer's V and Student's tests were calculated to identify differences between variables according to sex and municipality of residence. Moreover, the initial binary logistic regression model was constructed to predict the physical activity compliance. Differences in adherence to physical activity recommendations were found according to the sex of the students (rural area: x2 = 4.192, p < 0.05; V = 0.106, p < 0.05; urban area: x2 = 8.999, p < 0.05; V = 0.167, p < 0.01). There were also sex differences in rural areas on items related to families providing transport (t = 3.878, p ≤ 0.001; d = 0.40) and doing physical activity together (t = 4.974, p ≤ 0.001; d = 0.50). It is concluded that most adolescents do not comply with physical activity recommendations. In addition, 30.4% of urban girls' compliance was predicted by the perception that their family members saw them doing physical activity and doing it with friends. [ABSTRACT FROM AUTHOR]

The "SmartCaregivers" 1.0 mobile application is a beacon of hope for caregivers (CG) in rural areas, often facing limited access to facilities and support. This study, conducted from February to August 2021, aimed to comprehensively analyze the need for developing a database system and a mobile application tailored to enhance caregiver support and resource management for long-term dependent individuals in the rural areas of Maha Sarakham province, Thailand. The research followed a rigorous research and development (R & D) approach, specifically the ADDIE model (analysis, design, development, implementation, and evaluation). Data were collected from 402 caregivers and 10 key informants through surveys and interviews, as well as from 402 caregivers during the implementation and evaluation phases. The application's impact was assessed using a quasi-experimental design with a one-group pre–post-test, and its acceptance was evaluated through the technology acceptance model (TAM). The application significantly improved caregivers' knowledge scores, with a mean increase from 10.49 ± 2.53 to 12.18 ± 2.76 post-intervention. High scores for perceived usefulness (4.36 ± 0.62) and ease of use (4.31 ± 0.59) reassure the audience about the application's effectiveness in providing rapid access to health information, aiding decision-making, and improving care coordination. The system quality was also highly rated, with users appreciating the variety of functions and structural design. This potential for transformation and improvement instills hope and optimism for the future of caregiving in rural areas. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is an important public health issue referring to concerns about the safety and efficacy of vaccination. Within a framework, this study aimed to assess the cultural adaptation, validity, and reliability of the Greek version of the adult Vaccine Hesitancy Scale (aVHS) as well as to identify the determinants of vaccine hesitancy among a large regional population in central Greece. A cross-sectional study was conducted enrolling 300 adults who had received primary healthcare services in the Health Centers and Local Health Units of the Magnesia Region from October to December 2022. The aVHS and the Life Orientation Test-Revised (LOT-R) were used to identify vaccine hesitancy and the dispositional level of optimism, respectively. For survey translation, the procedure of forward and backward translation was followed. Also, the aVHS was tested in a pilot study with a sample of 18 responders. Construct validity and internal consistency reliability were investigated via exploratory and confirmatory factor analysis and Cronbach's alpha coefficients, respectively. Simple and multiple linear regression analysis were used to determine predictors for vaccine hesitancy. Factor analyses indicated that the aVHS comprises two constructs ("lack of confidence" and "risk perception") explaining 68.9% of the total variance. The Cronbach's alpha of the total scale was 0.884, indicating its high internal consistency. Participants who lived in rural areas, had a lower annual income, and reported a lower level of optimism showed a higher lack of confidence in vaccination. On the other hand, people aged above 45 years old who had graduated from high school or elementary school and were unemployed showed greater aversion to the risks of side effects. Finally, certain socio-demographic characteristics were associated with vaccine hesitancy. Our data suggest that the aVHS is a valid and reliable instrument for measuring vaccine-related attitudes and perceptions in Greek society, providing meaningful insight into designing vaccination-related preventive interventions in the community. [ABSTRACT FROM AUTHOR]

This cross-sectional study aims to explore the dietary patterns and associated factors of adolescents, which are often overlooked in nutrition data systems. Face-to-face interviews were conducted with 304 participants aged 10 to 19 in rural northern Thailand, utilizing both open recall and list-based 24 h recall techniques, with the data recorded online. Dietary diversity (DD) was assessed using ten food groups as per the Food and Agricultural Organization guidelines. We employed binary logistic regression and multivariable logistic regression analyses. Most participants consumed items from the grains, white roots, and tubers food group, while the nuts, seeds, and pulses food group was the least consumed. The mean number of food groups consumed was 5.23 ± 0.12, with no significant differences across gender and age groups, and participants reporting no influence of mass media on food choices were more likely to have inadequate DD (AOR = 2.94; 95% CI 1.38–6.28). Conversely, those not influenced by social media when choosing food (AOR = 0.45; 95% CI 0.21–0.96), who felt relaxed during meals (AOR = 0.33; 95% CI 0.19–0.59), and with no role in family meal decisions (AOR = 0.55; 95% CI 0.31–0.95) were less likely to have inadequate dietary diversity. We suggest that assisting adolescents with mealtime management and involving them in selecting healthy menus could improve their dietary variety. Moreover, future research should further investigate these mechanisms to inform strategies for improving DD in this age group. [ABSTRACT FROM AUTHOR]

Background: The pandemic caused by the SARS-CoV-2 virus demonstrated the importance of prevention through a healthy diet and lifestyle, the most vulnerable people being those with severe chronic conditions, those who are overweight, and those with an unbalanced immune system. This study aims to examine the nutritional status and lifestyle behaviors of the Romanian population. Methods: The evaluation of the eating habits and lifestyle of the Romanian population in the post-pandemic period was carried out based on a cross-sectional observational study with the help of a questionnaire. Results: A total of 4704 valid answers were registered (3136 female and 1568 male respondents). Among the respondents, most of them belong to the young population, 2892 between the ages of 18 and 40, i.e., 61.5%. Most male respondents are overweight (1400) and obese (780). Most respondents indicated a tendency to consume 1–2 meals per day irregularly (p = 0.617). Only 974 respondents adopted a healthy diet, and 578 a healthy lifestyle. Conclusions: The present study reports low adherence to a healthy diet (20.7%) and healthy lifestyle (12.28%), especially among the young population (<30 years). In the current context, it reports a reduced tendency to consume vegetables and fruits among the population, below the daily average recommended by the nutrition guidelines, a tendency towards sedentary behavior, and even deficient hydration of some of the respondents; these negative aspects can create a long-term series of nutritional and psycho-emotional imbalances. Our results evidence that complex surveys among the population are regularly required to investigate nutritional or lifestyle deficiencies; moreover, it could be helpful in further educational measures in nutrition, food, and environmental safety. [ABSTRACT FROM AUTHOR]

Improving the quality of and access to healthcare services in rural areas is fundamental to developing sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary-care units that lack direct hospital or hospital–health centre access. The research was conducted specifically in the rural islands of the Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors, and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, an unstable working environment, educational and organisational aspects, and an insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals. [ABSTRACT FROM AUTHOR]

The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections in South Africa are increasing at alarming rates. This study's setting is no. 5, with the highest STI, pregnancy, and HIV statistics in Limpopo province among 13- to 19-year-old teenagers. This study explored preventative measures against STIs practiced by teenagers in rural areas of Limpopo province, South Africa. This study was conducted at a selected rural-based clinic using an exploratory descriptive qualitative research approach. Unstructured in-depth face-to-face interviews were used to collect data from sixteen conveniently sampled teenagers aged 13–19, consisting of 13 females and 3 males, who came to Manavhela Clinic for youth-friendly services in August/September 2022. Open-coding analysis was used to identify themes and sub-themes. Measures to ensure trustworthiness were ensured. Ethical clearance (FSH/21/PH/22/2211) was obtained, and ethics principles were observed throughout this study. Two themes emerged from data analysis: STI preventive measures practiced by teenagers and factors influencing the choice of STI preventive measures practiced by teenagers. Only a few participants aged 13 and 14 years of age practiced abstinence and condom use. Most participants were sexually active and used mythical mixtures made from boiling aloe or morula tree (which they drank before and after sex), applied plain yogurt on the vagina once a week, or practiced vaginal steaming. Participants cited patriarchy, lack of sex education in rural schools, long distances to clinics, and desire to taste sex as reasons for adopting the practiced preventive measures. Risky sexual behavior among 13- to 19-year-old teenagers is still rife in rural areas. Rural clinics in Limpopo province should intensify STI school health education and youth-friendly services programs to raise awareness and improve accessibility to condoms. [ABSTRACT FROM AUTHOR]

Introduction: Teledentistry is an emerging tool to exchange medical information and clinical images to facilitate the diagnosis, prevention, and treatment of oral diseases and patient assurance and education. Considering the shortage of oral medicine specialists in Saudi Arabia, this study aims to assess the experiences of dental specialists with tele-oral medicine and its potential applicability in addressing this shortage. Materials and methods: This was a pilot, cross-sectional study conducted among specialists in the field of oral medicine from January 2020 to March 2020. A total of 16 preselected cases with oral lesions, including clinical history and images, were developed, validated, and shared via email with study participants. Each case included questions on differential diagnosis, provisional diagnosis, and management. The responses were recorded, analyzed, and presented as means and percentages. Results: A total of 49 subjects participated in this study and more than half were under 40 years of age and two-thirds were women. A total of 23 participants had prior experience with tele-oral medicine, mainly via WhatsApp (95.7%), and these cases were received from patients, their families, friends, or other dentists. For all study cases, the correct diagnosis score ranged between 73.50 and 100%, and correct management ranged between 51 and 98%. Conclusions: Tele-oral medicine is an effective tool that may play an important role in patient management in rural regions with a shortage of oral medicine services. Further studies with larger sample sizes and in collaboration with international centers are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Since the WHO's 2021 aging redefinition emphasizes "healthy aging" by focusing on the elderly's ability to perform daily activities, sarcopenia, which is defined as the loss of skeletal muscle mass, is now becoming a critical health concern, especially in South Korea with a rapidly aging population. Therefore, we develop a prediction model for sarcopenia by using machine learning (ML) techniques based on the Korea National Health and Nutrition Examination Survey (KNHANES) data 2008–2011, in which we focus on the role of socioeconomic status (SES), social infrastructure, and quality of life (QoL) in the prevalence of sarcopenia. We successfully identify sarcopenia with approximately 80% accuracy by using random forest (RF) and LightGBM (LGB), CatBoost (CAT), and a deep neural network (DNN). For prediction reliability, we achieve area under curve (AUC) values of 0.831, 0.868, and 0.773 for both genders, males, and females, respectively. Especially when using only male data, all the models consistently exhibit better performance overall. Furthermore, using the SHapley Additive exPlanations (SHAP) analysis, we find several common key features, which mainly contribute to model building. These include SES features, such as monthly household income, housing type, marriage status, and social infrastructure accessibility. Furthermore, the causal relationships of household income, per capita neighborhood sports facility area, and life satisfaction are analyzed to establish an effective prediction model for sarcopenia management in an aging population. [ABSTRACT FROM AUTHOR]

Since 2003, 38 US states and Washington, DC have adopted legislation and/or regulations to strengthen stroke systems of care (SSOCs). This study estimated the impact of SSOC laws on stroke outcomes. We used a coded legal dataset of 50 states and DC SSOC laws (years 2003–2018), national stroke accreditation information (years 1997–2018), data from the Healthcare Cost and Utilization Project (years 2012–2018), and National Vital Statistics System (years 1979–2019). We applied a natural experimental design paired with longitudinal modeling to estimate the impact of having one or more SSOC policies in effect on outcomes. On average, states with one or more SSOC policies in effect achieved better access to primary stroke centers (PSCs) than expected without SSOC policies (ranging from 2.7 to 8.0 percentage points (PP) higher), lower inpatient hospital costs (USD 610–1724 less per hospital stay), lower age-adjusted stroke mortality (1.0–1.6 fewer annual deaths per 100,000), a higher proportion of stroke patients with brain imaging results within 45 min of emergency department arrival (3.6–5.0 PP higher), and, in some states, lower in-hospital stroke mortality (5 fewer deaths per 1000). Findings were mixed for some outcomes and there was limited evidence of model fit for others. No effect was observed in racial and/or rural disparities in stroke mortality. [ABSTRACT FROM AUTHOR]

Maintaining a healthy caloric intake and expenditure balance is challenging. The preliminary study examined (a) the associations of Body Mass Index (BMI), body image, perceived stress, mental health, dietary habits, and exercise participation among 310 female college nursing students and (b) the differences in these factors among BMI subgroups. The cutoffs for underweight, normal weight, overweight, and obesity were <18.5 kg/m2, ≥18.5 but <23 kg/m2, ≥23 but <25 kg/m2, and ≥25 kg/m2, respectively. The survey used Multidimensional Body-Self Relations Questionnaire—Appearance Scale, Perceived Stress Scale, and Chinese Health Questionnaire (CHQ). Because of a non-normal distribution, non-parametric statistics were used. The study found that BMI correlated with body image. The lower the BMI, the higher the satisfactory score the participants rated. BMI was irrelated to diet, exercise, stress, and mental health. The participants were unlikely to eat under stress and negative moods. The underweight group (17.1%) had the highest satisfactory score on their appearance evaluation. There was no difference between the overweight (14.2%) and obese (11.0%) groups. Meanwhile, the median of perceived stress was 18 and the prevalence of mental disturbance was 45.2% based on the CHQ. Underweight, overweight, obesity, high perceived stress, and poor mental health among nursing students warrant attention. Nurse educators should strengthen their coping strategies and provide support. A longitudinal study may consider incorporating coping strategies into the study design. [ABSTRACT FROM AUTHOR]

Case-based education (CBE) is a teaching method in which learners work on real-life cases to learn and apply concepts and skills they have been taught. Case report-driven medical education using the CBE framework can effectively facilitate student and resident learning, and entice them to become involved in actual clinical practice. Specific case report-driven medical education methods and learning outcomes are not clarified. This study aimed to clarify the specific learning processes and outcomes of case report-driven medical education in rural community-based medical education. Using a qualitative design based on a thematic analysis approach, data were collected through semi-structured interviews. The study participants were medical students and residents in training at a rural Japanese community hospital. Fifty-one case reports were completed and published in Cureus from April 2021 to March 2023. Participants learned about various difficulties related to volatility, uncertainty, complexity, and ambiguity (VUCA) in the medical care of various older patients, which increased their interest in family medicine. They appreciated the importance of case reports in academic careers and how their responsibilities as researchers increase with collaboration. Case report-driven medical education in community hospitals can drive medical students' and junior residents' learning regarding family medicine in the VUCA world. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the associations of social support factors with leisure-time physical activity (LTPA) of older people in Fuwen village. A cross-sectional study included 523 randomly selected elderly people (60+ years) whose LTPA levels were determined using the shortened version of the International Physical Activity Questionnaire (IPAQ-S). A modified version of the Physical Activity Social Support Scale (PASSS) was operated to gather perceived scores of the social support factors. A multivariate linear regression was performed to locate associations of perceived scores of social supports with leisure-time walking (LTW) and moderate and vigorous physical activity (MVPA). The results indicated that social support from family was positively and significantly related to LTW and MVPA in both models. The community factor was positively and significantly correlated with MVPA in both models. The sport club factor was related to LTW and MVPA to some extent. The results suggest that social support from family is the most important motivator for older people's LTW and MVPA in the village of Fuwen. Social support from the community is the motivator for older people's MVPA. The sport club factor has some effects on older people's LTW and MVPA as well. More future studies are needed to extend the database of the relationship between social support and rural older people's physical activity. [ABSTRACT FROM AUTHOR]

Background: Continuing medical training is an important component of modern medical practice because it maintains the ability of physicians to provide up-to-date patient care. This study explored pharmacists' involvement in CME activities and investigated the barriers to undertaking CME activities in Saudi Arabia. It also aimed to highlight the obstacles that prevent pharmacists from participating in CE activities. Methods: This study used a cross-sectional self-administered web-based questionnaire. It was conducted among practising pharmacists in various pharmacy fields in the Asir region of Saudi Arabia. The structured questionnaire consisted of four domains. A convenience sampling strategy was used to select and recruit study participants. The results were described in terms of frequencies and percentages. A Chi-square test was used to assess the differences for categorical data. p value of <0.05 was considered significant. Results and conclusions: A total of 173 pharmacists participated in the study. Attending the conference was the most popular activity (67%), followed by training courses (61.8%) and approved web-based activities (60.1%). Regarding barriers that prevented pharmacists from participating in CME activities, a lack of a scientific database or books was the top-rated barrier that hindered pharmacists from obtaining the required CME hours (79.8%). Another important barrier was the cost of the activities (74.6%). Regarding the area of practice for which pharmacists would be interested in attending CME activities, public health was the favourite (89.6%), followed by personal skills (82.7%). Gathering the required CME hours for re-registration was the main motive for attending CME activities in most of the pharmacy sectors. Policymakers should consider shifting the current CME system to the Continuing Professional Development (CPD) model, which promotes engagement in professional development activities that are relevant to the scope of practice. [ABSTRACT FROM AUTHOR]

Chronic diseases are a major cause of mortality and morbidity globally, with non-communicable diseases being responsible for most deaths. Older adults are at a higher risk of developing chronic diseases due to various sociodemographic and lifestyle factors such as age, sex, income, education, employment, place of residence, dietary supplementation, tobacco use, and alcohol consumption. Understanding the relationship between these factors and chronic diseases is crucial for identifying vulnerable populations and improving healthcare delivery. Through both an online and an interview-based survey, this cross-sectional study aimed to examine these associations, focusing on adults aged 50 and above, with the goal of identifying potential areas for intervention and prevention. The study found that gender, area of residence, education status, employment status, nutritional supplementation, body mass index (BMI), alcohol usage, and age are associated with the risk of chronic disease, cardiovascular disease, and diabetes. Female gender, higher educational level, employment, normal BMI, and younger age were found to be protective factors, while living in rural areas, alcohol consumption, and older age were identified as risk factors. The study recommends targeted interventions and improved access to healthcare to reduce risk factors and enhance healthcare delivery for better health outcomes. [ABSTRACT FROM AUTHOR]

Background: Universal maternal health coverage is a proven, effective strategy for maternal survival. This study aimed to describe the changes and determinants of maternal health service use between 1991 and 2015 in central China. Methods: The study was conducted in Enshi Prefecture. Women were eligible for inclusion if they were rural women who lived in villages, had live births during 1991–2015, could recall their maternal care histories, and had no communication problems. This retrospective study included 470 rural women in 9 villages and collected 770 records. The conceptual framework was designed based on the Society Ecosystem Theory. The determinants included micro-factors (individual characteristics), meso-factors (family factors, community factors, healthcare factors), and macro-factors (government-run maternal and child health programs, abbreviated as MCH programs). Multivariate logistic regressions were applied to analyze the determinants of maternal health service utilization. Results: The utilization of maternal healthcare has improved in Enshi. The hospital birth rate was 98.1% in 2009 and mostly 100% in subsequent years. The prenatal examination rate, the postpartum visit rate, and the continuum of maternal health service (CMHS) rate increased to 73.3%, 67.7%, and 53.4%, respectively, in 2009–2015. The utilization of maternal health services was affected by macro-factors, meso-factors, and micro-factors, with macro-factors being the most notable contributors. Conclusions: Despite the remarkable improvements in antenatal care (ANC) use and hospital birth, gaps in postpartum visits remain. Promoting the integrated continuum of maternal and child healthcare in ethnic minority rural areas requires the joint efforts of the government, health and other sectors, communities, families, and individuals. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems in many low- and middle-income countries (LMICs) are not yet designed to tackle the high and increasing burden of non-communicable diseases (NCDs), including hypertension. As a result, a large proportion of people with disease or risk factors are undiagnosed. Policymakers need to understand the disparity better to act. However, previous analyses on the disparity in undiagnosed hypertension, especially from LMICs, are lacking. Our study assessed the geographic and socioeconomic disparity in undiagnosed hypertension and compared it with diagnosed hypertension. Methods: We used the Basic Health Survey (Riskesdas) 2018 and performed geospatial and quantitative analyses across 514 districts in Indonesia. Dependent variables included diagnosed and undiagnosed hypertension among adults (18+ years) and by gender. Results: A high prevalence of undiagnosed hypertension at 76.3% was found, with different patterns of disparity observed between diagnosed and undiagnosed hypertension. Diagnosed hypertension was 1.87 times higher in females compared with males, while undiagnosed hypertension rates were similar between genders. Urban areas had up to 22.6% higher rates of diagnosed hypertension, while undiagnosed hypertension was 11.4% more prevalent among females in rural areas. Districts with higher education rates had up to 25% higher diagnosed hypertension rates, while districts with lower education rates had 6% higher rates of undiagnosed hypertension among females. The most developed regions had up to 76% and 40% higher prevalence of both diagnosed and undiagnosed hypertension compared with the least developed regions. Conclusion: The disparity patterning differs between diagnosed and undiagnosed hypertension among adults in Indonesia. This highlights the need for effective measures, including healthcare system reforms to tackle NCDs in LMICs. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic was and continues to be a major challenge for tourist activities worldwide. Cultural tourism was mostly hit because of the social distancing measures, travel restrictions and ban on people gatherings for cultural events. The current study is trying to provide an overall image of the challenges local cultural tourism has faced during the COVID-19 pandemic in a predominantly rural area of Romania—the Buzău Carpathians and Subcarpathians. The area has a high tourist potential stemming from the complexity and diversity of the natural landscapes and the local historical setting. The survey relies on two field campaigns carried out in 2020 when 161 questionnaires were applied to tourists, businesses and residents. The results highlight the significant impact of the COVID-19 pandemic on small businesses during and after the travel restrictions (e.g., revenue losses, temporary business shut-downs and layoffs/technical unemployment), but also on tourists' travelling preferences and sentiment and on residents' attitudes and behaviour. [ABSTRACT FROM AUTHOR]

The aim of this study was to discuss the differences in pre-hospital time intervals between rural and urban communities regarding emergency medical services (EMS). A systematic search was conducted through various relevant databases, together with a manual search to find relevant articles that compared rural and urban communities in terms of response time, on-scene time, and transport time. A total of 37 articles were ultimately included in this review. The sample sizes of the included studies was also remarkably variable, ranging between 137 and 239,464,121. Twenty-nine (78.4%) reported a difference in response time between rural and urban areas. Among these studies, the reported response times for patients were remarkably variable. However, most of them (number (n) = 27, 93.1%) indicate that response times are significantly longer in rural areas than in urban areas. Regarding transport time, 14 studies (37.8%) compared this outcome between rural and urban populations. All of these studies indicate the superiority of EMS in urban over rural communities. In another context, 10 studies (27%) reported on-scene time. Most of these studies (n = 8, 80%) reported that the mean on-scene time for their populations is significantly longer in rural areas than in urban areas. On the other hand, two studies (5.4%) reported that on-scene time is similar in urban and rural communities. Finally, only eight studies (21.6%) reported pre-hospital times for rural and urban populations. All studies reported a significantly shorter pre-hospital time in urban communities compared to rural communities. Conclusions: Even with the recently added data, short pre-hospital time intervals are still superior in urban over rural communities. [ABSTRACT FROM AUTHOR]

Background: Strengthening primary care is a key focus of the latest healthcare reforms in China. However, many challenges, including the workforce competence, still exist. This study aimed to evaluate the common disease management competency of rural primary care providers in Sichuan Province, western China. Methods: A cross-sectional study was conducted in 9 township health centers and 86 village clinics in 3 counties. Diarrhea and respiratory infection were selected as the evaluation cases. General partitioners were assessed through their abilities to (1) take history; (2) make diagnoses; (3) propose treatment; and (4) deal with clinical cases. Results: In total, 362 healthcare workers were surveyed, and 130 general practitioners were enrolled into our study. On average, rural primary care providers could only answer 46.4% of questions absolutely correctly, with 29.7% partly correctly and 23.8% incorrectly. Conclusion: We suggest strengthening training to improve rural primary care providers' competencies, especially their capacities of history taking. Policy action is also needed to address regional disparities. [ABSTRACT FROM AUTHOR]

Behavioral strengths and difficulties among children and adolescents may be significantly associated with their academic performance; however, the evidence on this issue for rural youth in developing contexts is limited. This study explored the prevalence and correlates of mental health from three specific dimensions—internalizing problems, externalizing problems, and prosocial behavior—measured by the Strengths and Difficulties Questionnaire (SDQ), and the association of these dimensions with academic performance in math among a sample of 1500 students in rural China. Our findings indicated that students in rural China had worse behavioral difficulties and poorer prosocial skills when compared to most past studies conducted inside and outside of China. In addition, total difficulties and prosocial scores on the SDQ were significantly associated with student math test scores, as students whose externalizing, internalizing, and prosocial scores were in the abnormal range scored lower in math by 0.35 SD, 0.23 SD, and 0.33 SD, respectively. The results add to the growing body of empirical evidence related to the links between social environment, mental health, and academic performance in developing countries, highlighting the importance of students' mental health for their academic performance, and of understanding risk factors in the social environment among rural youth in developing countries. [ABSTRACT FROM AUTHOR]

Online medical consultation (OMC) allows doctors and patients to communicate with each other in an online synchronous or asynchronous setting. Unlike face-to-face consultations in which doctors are only passively chosen by patients with appointments, doctors engaging in voluntary online consultation have the option of choosing patients they hope to treat when faced with a large number of online questions from patients. It is necessary to characterize doctors' preferences for patient selection in OMC, which can contribute to their more active participation in OMC services. We proposed to exploit a bipartite graph to describe the doctor–patient interaction and use an exponential random graph model (ERGM) to analyze the doctors' preferences for patient selection. A total of 1404 doctor–patient consultation data retrieved from an online medical platform in China were used for empirical analysis. It was found that first, mildly ill patients will be prioritized by doctors, but the doctors with more professional experience may be more likely to prefer more severely ill patients. Second, doctors appear to be more willing to provide consultation services to patients from urban areas, but the doctors with more professional experience or from higher-quality hospitals give higher priority to patients from rural and medically underserved areas. Finally, doctors generally prefer asynchronous communication methods such as picture/text consultation, while the doctors with more professional experience may be more willing to communicate with patients via synchronous communication methods, such as voice consultation or video consultation. [ABSTRACT FROM AUTHOR]

Background: In China, a developing country, the imbalance of development exists in different fields, and the inequalities in the distribution of healthcare services have garnered increasing attention. This study aimed to assess the healthcare services allocation and compare the latest distribution ratios of the essential healthcare indicators with the national requirement values announced by the government to research the level of healthcare development in China. Methods: Data were extracted from the Chinese Statistical Yearbook (2010–2019). The Healthcare Resource Density Index (HRDI) was used to evaluate equity in the demographic and geographical dimensions. The requirement values related to the ratio of doctors, nurses, and institution beds per thousand people were drawn from government documents. The data of healthcare serviceability indicators were compared with those requirements to check the situation of each province's medical development. Results: From 2010 to 2018, there was a sustainable upward trend in government investment, however, a noticeable drop in the investment in northeast areas was seen. Although the HRDI of the institutions, beds, doctors, and nurses experienced some small fluctuations over the years, the developing areas in the middle-west areas had almost approached the level of developed east areas. There were only four provinces that met the requirements of the government in all three indicators (the ratio of institution beds, doctors, and nurses per thousand people). Conclusion: The equality of the distribution of healthcare services in China was unfair between the eastern and middle-western areas. The government launched the developing requirements and paid additional attention to narrowing the imbalance among different economic level regions to meet the needs of the local people. Although many provinces did not meet the requirements for medical resources in 2019, the distribution of healthcare services was approached relatively equitably countrywide. [ABSTRACT FROM AUTHOR]

Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality. [ABSTRACT FROM AUTHOR]

Mild cognitive or neurocognitive impairment (MCI) may be more prevalent in rural areas. Differences between rural and urban MCI patients in terms of risk factors, course and prognosis are rarely reported. The present review aims to summarize the latest research on MCI in rural areas. A literature search was performed in the databases of PubMed, Scopus and ScienceDirect for articles published over the last decade. Eleven articles were included in this review, reporting on the differences between rural and urban MCI patients. Several risk factors, such as older age, lack of activities and food insecurity have been associated with MCI in both rural and urban areas, whereas others, such as obesity, adverse childhood experiences and plasma chemokine C-C motif ligand 11 (considered as a potential negative regulator of neurogenesis), differed according to the place of residence. No specific protective factor for rural women has been reported. There is some evidence that MCI may present earlier in rural residents, but that progression to dementia may be more rapid in urban residents. It seems that there may be clinically relevant differences in the onset, course and prognosis of MCI with regards to the place of residence (urban vs rural). Those differences should be taken into account for the design of health policies and service delivery across different settings. [ABSTRACT FROM AUTHOR]