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Summary: Gardening has the potential to enhance health and well-being, through increased physical activity and social connectedness. However, while much is known about the benefits of garden activities, less is known about the potential health implications of more passive forms of engagement with gardens, for example, viewing gardens. In addition, much garden research is undertaken in urban settings, leaving little known about potential health impacts for rural populations. The present study explored these research gaps by gaining an understanding of the experiences and perspectives of members of a gardening appreciation group in rural Australia: The Colac Horticultural and Marvellous Property Appreciation Society (CHAMPAS). A phenomenological, qualitative methodology was applied, using semi-structured interviews for data collection. Eleven participants were selected using purposive and snowball sampling and the data were analysed by applying interpretive, reflexive thematic analysis. Four main themes and supporting sub-themes were generated. The four main themes were: (i) motivations for maintaining participation in CHAMPAS; (ii) social connections and friendships, formed from membership; (iii) sense of community and structure of CHAMPAS and (iv) the perceived health and well-being benefits of continued involvement in this group. This study found that members perceived health and well-being benefits stemmed from CHAMPAS facilitation of social connectedness, function as a community group and a way for members to share a love for home gardening. This study provides insights into the perceived and potential health-promoting effects of garden appreciation groups for rural populations. Lay Summary: There are many health and well-being benefits of gardening. However, research is predominantly focused on the active practice of gardening in urban environments, and little is known about the passive activity of garden appreciation, nor about the benefits of this activity in rural areas. This paper explores the health promotion potential of garden appreciation groups through the experiences of members of a rural group called CHAMPAS. Eleven members of CHAMPAS were asked to talk about what kept them attending, and what health and well-being benefits the group provided them. The study found that CHAMPAS benefits stemmed from its function as a social group and a way for members to share a love for home gardening. The findings suggest that garden appreciation groups potentially provide health promotion benefits for people in rural areas. A recommendation of this paper is to undertake further research to map and analyse these benefits across rural Australia. [ABSTRACT FROM AUTHOR]

Objectives The United States has seen increasing shifts toward home- and community-based services (HCBS) in place of institutional care for long-term services and supports. However, research has neglected to assess whether these shifts have improved access to HCBS for persons with dementia. This paper identifies HCBS access barriers and facilitators, and discusses how barriers contribute to disparities for persons with dementia living in rural areas and exacerbate disparities for minoritized populations. Methods We analyzed qualitative data from 35 in-depth interviews. Interviews were held with stakeholders in the HCBS ecosystem, including Medicaid administrators, advocates for persons with dementia and caregivers, and HCBS providers. Results Barriers to HCBS access for persons with dementia range from community and infrastructure barriers (e.g. clinicians and cultural differences), to interpersonal and individual-level barriers (e.g. caregivers, awareness, and attitudes). These barriers affect the health and quality of life for persons with dementia and may affect whether individuals can remain in their home or community. Facilitators included a range of more comprehensive and dementia-attuned practices and services in health care, technology, recognition and support for family caregivers, and culturally competent and linguistically accessible education and services. Discussion System refinements, such as incentivizing cognitive screening, can improve detection and increase access to HCBS. Disparities in HCBS access experienced by minoritized persons with dementia may be addressed through culturally competent awareness campaigns and policies that recognize the necessity of familial caregivers in supporting persons with dementia. These findings can inform efforts to ensure more equitable access to HCBS, improve dementia competence, and reduce disparities. [ABSTRACT FROM AUTHOR]

This paper examines policies and practices of inclusive education for young deaf children in Ghana. Though existing Government policy promotes the principles and implementation of educational inclusion of all children in Ghana, caregivers often encounter significant challenges ensuring access to early years' education for their deaf children. We used Bronfenbrenner's (2005) bioecological systems theory and interviewed 15 educators of deaf children and 9 hearing-health clinicians, to capture different knowledge, experience, and perspectives on policy, practice, and inclusive approaches to deaf children's education. We ask: (a) How do teachers, clinicians, and caregivers connect to promote early childhood care education (ECCE) for young deaf preschoolers in Ghana? and (b) What resources and precarities are available to educators of deaf children and hearing-health clinicians in sustaining inclusive educational practices across urban and rural contexts in Ghana? We address these unanswered questions about the potential pathway to bring about changes in policy and practice in promoting successful inclusive education for deaf children in Ghana. Implications for national and international policy and practice of ECCE for deaf children are discussed and recommendations are made. [ABSTRACT FROM AUTHOR]

Background For effective Public Health measures, factors that influence Knowledge, Attitudes and Practices (KAP) need to be understood. In this paper, we document the relationship between levels of education on the KAP towards COVID-19 among the population of Edo State, Nigeria. Methods A cross-sectional KAP questionnaire was delivered across 13 communities. The study population was dichotomized into those who had or had not completed secondary education. Chi-square tests were conducted to determine statistical significance. Results Of the 538 participants, 30% had completed secondary education. Those with secondary education were significantly more likely to recognize symptoms of COVID-19 (P  < 0.001). For attitudes, only one option showed a statistically significant association with 78.4% of those who did not complete secondary education having a high confidence in the church compared with 66% of those who had (P  = 0.022). For practices, those who have completed secondary education practiced all of the supplied measures more than those who had not, except for taking herbal supplements. Discussion Higher levels of education impacts on knowledge and practices but has less impact on attitudes regarding how well certain individuals/organizations can handle the pandemic. Findings highlighted the importance of tailoring public health communication and strategies to local populations to improve the efficacy. [ABSTRACT FROM AUTHOR]

This paper explores the well-being ['well-being' and 'wellbeing' are used interchangeably in the literature. Well-being is used in this paper (except in the reference list where exact wording is maintained)] benefits of participation in a workplace choir for health service staff. A mixed method study, this project combines quantitative measures of work engagement, perceived stress, resilience levels and work absences with qualitative interviews with choir participants. It is the first study of workplace choirs in Ireland and one of very few studies internationally that research health service staff choirs. There is some preliminary evidence of benefits that choir attendance may increase positive perception of workers' mental health as well as effect depression rates. However, evidence is limited quantitatively and difficulties in measuring the health benefits of arts interventions are noted. Qualitative data, however, confirms previous study findings, namely that a workplace choir can promote social connectedness, enjoyment at work and staff engagement. Work place choir was also noted to appeal mainly to a limited demographic of work place staff and people with relatively positive health and well-being. Efforts must be made to engage staff from lower socio-economic backgrounds, diverse cultural backgrounds and male staff in work place health promotion activities, as these groups were found less likely to join a work place choir. Given the low cost and low risk of this activity, and the qualitative benefits reported, it is recommended to continue to develop and evaluate health service workplace choirs. [ABSTRACT FROM AUTHOR]

This paper considers the impact of variables at three different levels—city, community and individual—on the depression of adults aged 45 years and above in China. Evidence shows that community factors, such as infrastructure and elderly centres, are critical to reduce depression but the effect of city-level factors such as lowering income inequality and improving public health investment is different for the segments of poor and non-poor as well as the rural and urban residents. This highlights the need to consider targeted policy mix options to avoid resource misallocation. Lastly, Chinese females' depression has worsened over time with ageing, particularly those who drink alcohol or are less educated are prone to depression prompting the need for specialist women health centres. [ABSTRACT FROM AUTHOR]

Background The relationship between HIV and poverty is complex and recent studies reveal an urban--rural divide that is not well understood. This paper examines the urban--rural disparity in the relationship between poverty and HIV infection in Kenya, with particular reference to possible explanations relating to social cohesion/capital and other moderating factors. Methods Multilevel logistic regression models are applied to nationally-representative samples of 13 094 men and women of reproductive age from recent Kenya Demographic and Health Surveys. Results The results confirm a disproportionate higher risk of HIV infection among the urban poor, despite a general negative association between poverty and HIV infection among rural residents. Estimates of intra-community correlations suggest lower social cohesion in urban than rural communities. This, combined with marked socio-economic inequalities in urban areas is likely to result in the urban poor being particularly vulnerable. The results further reveal interesting cultural variations and trends. In particular, recent declines in HIV prevalence among urban residents in Kenya have been predominantly confined to those of higher socio-economic status. Conclusion With current rapid urbanization patterns and increasing urban poverty, these trends have important implications for the future of the HIV epidemic in Kenya and similar settings across the sub-Saharan Africa region. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. Conclusions Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM. [ABSTRACT FROM AUTHOR]

Rangatahi Tū Rangatira (R2R) is a national health promotion programme in Aotearoa New Zealand which aims to promote cultural and physical wellbeing for rangatahi (young people) and their whānau (family). Grounded in tikanga Māori, the programme focuses on total wellbeing, leadership and cultural awareness providing rangatahi opportunities to increase their participation in physical activity and cultural knowledge through ngā taonga tākaro (Māori ancestral games). This paper focuses on an evaluation of this innovative health promotion programme focussing on the delivery of R2R by a local iwi provider in a rural area. Kanohi ki te kanohi (face-to-face) interviews and focus groups were used to collect data from a range of stakeholders including rangatahi, whānau, programme developers, and collaborating community organizations. A whānau ora (holistic) framework incorporating five core outcomes and key indicators specific to the programme was developed to assess the impact of delivery. Results demonstrated that rangatahi and their whānau were living healthier lifestyles through being more physically active; had gained an increased desire to succeed in their education and extra curriculum activities; and felt more connected to their community and te ao Māori. This demonstrates the importance of incorporating cultural elements to support improved lifestyle changes for rangatahi and their whānau and the connection between enhanced cultural identity and good health. [ABSTRACT FROM AUTHOR]

During the 11th International Conference on Typhoid and Other Invasive Salmonelloses held in Hanoi, Vietnam, a number of papers were presented on the burden of disease, epidemiology, genomics, management, and control strategies for invasive nontyphoidal Salmonella (iNTS) disease, which is increasingly becoming an important public health threat in low- and middle-income countries, but especially in sub-Saharan Africa (sSA). Although there were minor variations in characteristics of iNTS in different settings (urban vs rural, country to country), it was observed that iNTS has gained greater recognition as a major disease entity in children younger than 5 years. Renewed efforts towards greater understanding of the burden of illness, detection and diagnostic strategies, and management and control of the disease in communities in sSA through the introduction of vaccines will be important. [ABSTRACT FROM AUTHOR]

A 7.0-magnitude earthquake hit Lushan county of Ya’an city, Sichuan Province, China, on 20 April 2013. The Lushan earthquake damage is less than the 2008 Wenchuan earthquake’s, where 70,000 houses collapsed and 2 million people across nineteen prefectures and 115 counties of Sichuan province were affected. Temple Village (fictitious name), an old village in S township, was chosen as an intervention site. As most young adults went to work in the city, the old community became dilapidated and its traditional culture, architecture, custom, skill and wisdom were dying. Social workers were unable to tackle fully this community’s multiple needs, especially those associated with environmental and physical spaces linked to notions of belonging and identity, on their own. A transdisciplinary action research team in which social workers operated hand in hand with the disciplines of architectural design became the means for exploring an alternative model of post-disaster community reconstruction that would enhance the quality of life of left-behind people in this disaster-affected community. Working together, the research team facilitated the formation of a community kitchen project that enabled villagers to create a new building and co-operative organisations for the village’s long-term sustainable development. This paper presents the participatory design process, contribution of green social work and transdisciplinary interventions in post-disaster community reconstruction. [ABSTRACT FROM AUTHOR]

Financial abuse of older people is an important issue for all safeguarding staff, particularly social workers, who are often tasked with complex case management. Financial abuse can take many forms and can occur remotely to the older person and without their knowledge. However, research in this area is limited. This study was undertaken to understand how safeguarding staff in Northern Ireland manage these cases and the challenges experienced. Fourteen safeguarding staff, including social workers and nurses, participated in two focus groups. Using thematic analysis, four areas of concern were identified. These were capacity issues, relationships, structural context and rural versus urban context. The paper concludes that changes are needed in a number of areas such as social and cultural norms, legislation, policy and practice in order to enable social work practitioners to manage cases of financial abuse of older people in a more comprehensive way. [ABSTRACT FROM AUTHOR]

This paper reports on research undertaken in an acute inpatient mental health facility in rural Australia to explore the lived experience of inpatient care. Conceptualised within a recovery framework that emphasises the biopsychosocial approach acknowledging consumers' lived experiences alongside clinical perspectives, this study contributes to addressing a gap in the literature about what consumers experience as being most important to their recovery during an episode of inpatient care. Traditionally, mental health service delivery has been weighted towards clinical recovery with a biomedical approach dominating. This is especially so in an inpatient setting. In this qualitative study, the personal and social components of recovery emerge as critical factors for consumers even in an acute phase of care indicating a need to redress the imbalance. Eight in-depth semi-structured interviews were conducted with consumers during their stay in the inpatient facility. Drawing on a hermeneutic phenomenological analysis and the use of NVivo, three themes emerged: the importance of listening, facilitating peer support and the inclusion of families. All three themes resonate with core social work practice suggesting social workers have a critical role to play in the transformation of mental health services to reflect the recovery paradigm. [ABSTRACT FROM AUTHOR]

Background Community environment might play an important role in supporting ageing in place. This paper aims to explore relocation at older age and its associations with individual and community level factors. Methods The postcodes of the 2424 people in the year-10 interview of the Cognitive Function and Ageing Study (CFAS) in England were mapped onto Enumeration Districts and linked to their corresponding Townsend deprivation score and the 2011 rural/urban categories. Multilevel logistic regression was conducted to examine the influence of the baseline individual (age, gender, education and social class) and community (rural/urban categories and area deprivation) level factors on relocation over 10 years. Results One-third of people moved residence after the age of 65 years and over. Older age, low education, low social class and living in rural areas at baseline were associated with higher probability of moving later in life. The likelihood of relocation in later life increased from least to most deprived areas (odds ratio: 2.0, 95% confidence interval: 1.4, 2.8). Conclusions Urban/rural contexts and area deprivation are associated with relocation at older age and indicate that community environment may be relevant to ageing in place. [ABSTRACT FROM AUTHOR]

Research studies and serious case reviews following child deaths often criticise social work practitioners for failing to maintain a focus on the child. This paper draws on findings from a qualitative study of child protection planning in cases of chronic child neglect to increase understanding as to why this is the case. Four key themes that appear to affect social work practice are explored. These are: generalised assessments prior to conference; a narrow interpretation of the identity of a child; superficial engagement by professionals with the wishes and feelings of the child throughout the planning process; a lack of awareness of the different needs of siblings in large families; and parenting interventions considered in a vacuum. The authors argue that part of the reason social workers have found child-centred practice in these cases difficult is a consequence of the way in which the neglected child appears to be constructed. They conclude by considering how the latest English government guidance Working Together at one level exacerbates the issue whilst also providing opportun ities for innovative practice designed to focus on the daily lived experience of the child. [ABSTRACT FROM AUTHOR]

There is increasing evidence that many homeless people have multiple and complex needs but are excluded from social work support. The data on which this pa per draws a re part of a study investigating service interfaces and interprofessional working that took place in three areas of England in 2009-11. This paper reports and discusses the ways in which some social workers employed in statutory and voluntary agencies work with people with risks of and experiences of homelessness. The findings reveal that social workers recognise and make efforts to minimise the risks of homelessness by seeking to enhance people's ability to survive adverse circumstances. Other social work practice involves responding to the needs of people who are homeless and who have possible entitlements for social care. Social work practice with people with multiple exclusions may be more visible in the voluntary sector than the statutory sector, meaning that social work skills may therefore seem less available to people with homelessness experiences or at risk of homelessness than is the case. There may be scope for the profession to articulate more clearly the potential for social work support to improve outcomes for people at risk of homelessness or with experiences of it. [ABSTRACT FROM AUTHOR]

Irish social workers historically took a central role in the development of bereavement services. In urban areas, recent research contributed to the development of new services. Less is known about the needs and experiences of patients and families accessing hospital-based services in rural parts of Ireland. Good practice initiatives developed in large urban hospitals may be harder to replicate in small rural hospitals, where physical conditions can be outdated, resources lacking and cultural factors variable. Despite a growing recognition of the psychological impact of pregnancy loss, it remains a significantly under-researched topic. This paper reports on a qualitative study of eight women's experience of care in a rural Irish hospital following pregnancy loss. Their accounts are salutary in identifying the extent to which, for some women, a sense of loss is persistent and painful. Hospital social workers can have a role to play in mediating the impact of pregnancy loss and minimising the risks of disenfranchised grief by developing tailored and appropriate responses—ones which are responsive to a spectrum of need. [ABSTRACT FROM AUTHOR]

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Populations that are reliant on subsistence farming are particularly vulnerable to climatic effects on crop yields. However, empirical evidence on the role of the timing of exposure to crop yield deficits in early-life development is limited. We examined the relationship between child survival and annual crop yield reductions at different stages of early-life development in a subsistence farming population in Burkina Faso. Using shared frailty Cox proportional hazards models adjusting for confounders, we analyzed 57,288 children under 5 years of age followed by the Nouna Health and Demographic Surveillance System (1994–2016) in relation to provincial food-crop yield levels experienced in 5 nonoverlapping time windows (12 months before conception, gestation, birth–age 5.9 months, ages 6.0 months–1.9 years, and ages 2.0–4.9 years) and their aggregates (birth–1.9 years, first 1,000 days from conception, and birth–4.9 years). Of the nonoverlapping windows, point estimates were largest for child survival related to food-crop yields for the time window of 6.0 months–1.9 years: The adjusted mortality hazard ratio was 1.10 (95% confidence interval: 1.03, 1.19) for a 90th-to-10th percentile yield reduction. These findings suggest that child survival in this setting is particularly vulnerable to cereal-crop yield reductions during the period of nonexclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Background Household contact investigation for people newly diagnosed with tuberculosis (TB) is poorly implemented, particularly in low- and middle-income countries. Conditional cash incentives may improve uptake. Methods We conducted a pragmatic, cluster-randomized, crossover trial of 2 TB contact investigation approaches (household-based and incentive-based) in 28 public primary care clinics in South Africa. Each clinic used 1 approach for 18 months, followed by a 6-month washout period, after which the opposite approach was used. Fourteen clinics were randomized to each approach. In the household-based arm, we conducted TB screening and testing of contacts at the household. In the incentive-based arm, both index patients and ≤10 of their close contacts (either within or outside the household) were given small cash incentives for presenting to study clinics for TB screening. The primary outcome was the number of people with incident TB who were diagnosed and started on treatment at study clinics. Results From July 2016 to January 2020, we randomized 28 clinics to each study arm, and enrolled 782 index TB patients and 1882 contacts in the household-based arm and 780 index patients and 1940 contacts in the incentive-based arm. A total of 1413 individuals started on TB treatment in the household-based arm and 1510 in the incentive-based arm. The adjusted incidence rate ratio of TB treatment initiation in the incentive- versus household-based arms was 1.05 (95% confidence interval:.97–1.13). Conclusions Incentive-based contact investigation for TB has similar effectiveness to traditional household-based approaches and may be a viable alternative or complementary approach to household-based investigation. [ABSTRACT FROM AUTHOR]

Background Shiga toxin-producing Escherichia coli (STEC) are enteric pathogens that cause hemolytic-uremic syndrome (HUS). Ruminants, especially cattle, are their main reservoir. This study describes the seroepidemiology of STEC in rural and urban populations in Argentina, a country with a high HUS incidence. Methods A cross-sectional study was performed in patients without gastrointestinal symptoms. IgG antibodies against Stx2 were detected by western blotting. Results Anti-Stx2 antibodies were detected in 14.56% of serum samples, more frequently in rural (19.38%) than urban residents (12%). Seropositivity was associated with lower socioeconomic status (SES). Among the other variables considered, thawing homemade hamburgers before cooking them, and the lack of knowledge about HUS were also associated with seropositivity. A multivariate logistic regression analysis performed with the variables that were statistically significant showed that only the SES index remained significant. As SES was measured based on several variables, we further analyzed each one of them and found that the lack of a high education level was statistically associated with seropositivity. Conclusions The present findings have implications for STEC prevention efforts, highlighting the importance of considering SES and risks factors linked to different SES levels when targeting consumer-level public health interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients. Research Design and Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness. Results Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults' health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g. reduced travel) and increased costs (e.g. insurance). Discussion and Implications Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults. [ABSTRACT FROM AUTHOR]

This article examines the migration motives of entrepreneurial Javanese migrants residing in the regional town of Kupang, East Nusa Tenggara—a relatively resource-poor province in Eastern Indonesia. These migrants had generally worked in agriculture in their hometowns in Java but have engaged in and/or set up informal businesses since their arrival in Kupang. Drawing on a mixed-methods approach (household survey [ n  = 344]; in-depth interviews [ n  = 28]) in 2020, we identified the diverse underlying motives of Javanese entrepreneurial migration to Kupang. Most Javanese respondents emphasised the importance of a combination of factors, including their low levels of education in Java, greater opportunities to improve their quality of life, and tolerant and welcoming locals in Kupang. Associated with these factors, others migrated to escape the difficulties of agricultural work and the need to earn more income to fund their children's education now and in the future. Our article offers new insights into how changing social and economic conditions in rural Java are increasingly driving migration to the rapidly growing urban clusters in Indonesia's outer islands, leading to changing urban form, economic trajectories, and social relations. [ABSTRACT FROM AUTHOR]

Background Increasing concerns are rising over women and adolescence in Arabic societies generally, and in Egyptian society specifically. Objectives To identify the profile and reasons of the problem of sexual harassments among female college students. Methods A cross-sectional study including randomly selected 976 female students from different faculties of Kafrelsheikh University using a predesigned questionnaire sheet. Results The main perceived concept of sexual harassment was touching body (63.9%) followed by uncomfortable behaviors by the assault (51.8%). Among urban students, 47.1% reported frequent sexual harassment as compared to 26.5% among rural students. The main motives to harassment were absence of sanctions (42.8%) followed by masculine culture. Absence of punishment ranked first (54.1%) as one of reasons for the phenomenon of harassments in the community followed by wrong concepts about women (46%). The main reaction to harassment was feeling bad and wishing to act (32.9%) followed by feeling bad but helpless (26.0%). Only 25.5% reported taking proper action. Experience of harassment was significantly more reported by urban students compared to rural ones (12.6% and 4.1%, respectively (P  = 0.001). Conclusion Sexual harassment is not uncommon from of violence especially in urban areas mainly due to absence of sanctions and majority did not have capacity to take proper actions. [ABSTRACT FROM AUTHOR]

Health is an increasingly important issue in the workplace, but the dissemination of health-promoting interventions in companies, especially in small and medium-sized enterprises (SMEs), remains limited. Inter-organizational networks seem to be a promising approach to promote and implement workplace health management (WHM) in SMEs. This study analyses the establishment and coordination of the network 'ERZgesund—Healthy Companies in the Ore Mountains' for WHM in SMEs in a rural area of Germany. The case study, which builds on a mixed method approach (expert interviews, participant observations and document analysis), finds that ERZgesund evolved from a top-down approach (politically initiated, regionally anchored and financed from promotional funds). The network's hierarchy is disproportionately vertical, and the project group has limited decision-taking power and limited opportunities to act, which has reduced their overall engagement in the network. We conclude that although long and stable relationships are important for successful networks, change—especially at the leadership level—can lead to increased engagement of network participants if the hierarchy within the network is horizontally aligned. The findings of this explorative case study contribute to the planning process, the development and implementation of network structures, and successful WHM interventions. [ABSTRACT FROM AUTHOR]

The present study utilised the social determinants of health (SDH) framework to see whether indicators of the framework have an impact on anxiety and depression of people living in rural Black Belt communities in Alabama. Data from a convenient sample of 159 African-Americans aged 18 or older were from two sites in rural Alabama. The levels of anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ9). Multiple linear regression model was used to examine the association between SDH and anxiety and depression level of participants. The mean PHQ9 score of participants was 5.57 out of twenty-seven. Four SDH were significantly related to PHQ9 levels amongst participants: participants with higher food insecurity scores, higher transportation needs and higher threats to interpersonal safety tended to have higher scores in PHQ9. Moreover, health literacy levels were negatively associated with PHQ9 scores amongst participants. Our study highlights understanding SDH specifically for residents in rural communities that are socially and culturally isolated is important for developing preventive approaches that enhance access to mental health treatments. A comprehensive public health policy that incorporates our study findings is needed for the rural areas of the USA. [ABSTRACT FROM AUTHOR]

Working with complexity is a growing concern and challenge for social workers in contemporary practice. This study explored how rural social work practitioners experience complexity in their professional judgement and decision-making, giving voice to the unique understandings and perspectives of rural health social workers (RHSWs). Complex adaptive systems (CAS) theory is used to conceptualise participants' experiences. An interpretive critical research paradigm valued the unique viewpoint of rural social workers whilst also disrupting the urban-centric focus of social work practice. The participants were recruited via their involvement in the Country Health South Australia social work leadership group. Data collected using a living lab approach, consisted of ten phone interviews sandwiched by two focus groups (n  = 14). The data were analysed using both hand-coding and computer-assisted analysis (NVivo). The results demonstrated that RHSW encounter complexity within and across three main systems: client, organisational and rural systems. Importantly, the rural system plays an equally significant role in understanding complexity in this context, with each system overlapping and influencing one another. RHSW understanding of complexity was consistent with CAS, suggesting the advantage of using this theory to underpin understandings of complexity in social work practice and specifically in the rural practice domain. [ABSTRACT FROM AUTHOR]

Context Online grocery services are an emerging component of the food system with the potential to address disparities in access to healthy food. Objective We assessed the barriers and facilitators of equitable access to healthy foods in the online grocery environment, and the psychosocial, purchasing, and dietary behaviors related to its use among low-income, diverse populations. Data Sources Four electronic databases were searched to identify relevant literature; 16 studies were identified. Results Barriers to equitable access to healthy food included cost and limited availability of online grocery services in food deserts and rural areas. The expansion of online grocery services and the ability to use nutrition assistance benefits online were equity-promoting factors. Perceived low control over food selection was a psychosocial factor that discouraged online grocery use, whereas convenience and lower perceived stress were facilitators. Findings were mixed regarding healthfulness of foods purchased online. Although few studies assessed diet, healthy food consumption was associated with online grocery use. Conclusion Researchers should assess the impact of online grocery shopping on low-income families' food purchases and diet. Systematic Review Registration PROSPERO registration no. CRD: 42021240277 [ABSTRACT FROM AUTHOR]

Background and Objectives With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in 3 domains, i.e. paid/unpaid work, caregiving, and social activities, among Chinese older adults. Research Design and Methods Data were drawn from the first wave of the China Health and Retirement Longitudinal Study, which surveys a nationally representative sample of adults aged 60 years and older (N = 7,503). We estimated Random Forest and the least absolute shrinkage and selection operator regression models (LASSO) to determine the most important factors related to active aging. Results Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multigenerational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities. Discussion and Implications The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging. [ABSTRACT FROM AUTHOR]

Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have studied its applicability to youth in international settings. The current study used a participatory approach to design a measure of empowerment for youth from a rural, Indigenous community in Guatemala and aimed to compare this new measure to extant measures. Youth co-researchers (aged 19–22) collaborated in the development of four culturally relevant empowerment scales through a formative process involving classroom observations and focus groups. Newly developed scales and two widely used, extant scales were administered to a school-based sample of 273 youth (mean age = 14.7, SD = 1.6). Exploratory factor analysis (EFA) showed that one of the newly developed PE scales called Self-Efficacy for Community Action (SECA), which was moderately correlated with the extant scales, appeared to more effectively capture empowerment in the local context than the extant measures. These results support the notion that PE is contextually dependent and suggest that youth participation may aid in instrument design. [ABSTRACT FROM AUTHOR]

Objectives Bridge employment has been encouraged by many countries worldwide as societies age rapidly. However, the health impact on bridge employment is not consistent in previous studies. This study aims to explore the association between bridge employment and long-term health outcome among the Chinese population. Methods In this prospective cohort study, we used a subset of the China Kadoorie Biobank study, in which 163,619 participants who reached the statutory age of retirement at baseline (2004–2008) were included in this study. Mortality statistics were obtained from death registries in the Death Surveillance Points system annually. We used a Cox proportional hazard model to analyze the association between bridge employment and all-cause mortality. Results Overall, we found that compared to retired/nonemployed men and women, hazards of all-cause mortality were lower in older people with bridge employment (men: 0.82, 95% confidence interval [CI]: 0.77–0.88; women: 0.79, 95% CI: 0.74–0.94) in healthy populations. The protective effect of bridge employment was stronger among older adults living in rural areas and among those from a relatively low socioeconomic status. Discussion The lower risk of all-cause mortality associated with bridge employment was consistently observed among older men and women. Our findings may provide important insights from the health dimension on the retirement policy-making in China as a hyper-aging society. [ABSTRACT FROM AUTHOR]

Navigating the recovery journey following a burn injury can be challenging. Survivor stories can help define recovery constructs that can be incorporated into support programs. We undertook this study to determine themes of recovery in a predominately rural state. Eleven purposefully selected burn survivors were interviewed using a semi-structured format. Consensus coding of verbatim transcriptions was used to determine themes of successful recovery. Four support-specific themes were identified. These included: using active coping strategies, expressing altruism through helping others, finding meaning and acceptance, and the active seeking and use of support. These themes could be incorporated into support programming and would help guide future survivors through the recovery period. [ABSTRACT FROM AUTHOR]

Background With the coronavirus disease 2019 (COVID-19) pandemic surging and new mutations evolving, trust in vaccines is essential. Methods We explored correlates of vaccine hesitancy, considering political believes and psychosocial concepts, conducting a non-probability quota-sampled online survey with 1007 Austrians. Results We identified several important correlates of vaccine hesitancy, ranging from demographics to complex factors such as voting behavior or trust in the government. Among those with hesitancy towards a COVID-19 vaccine, having voted for opposition parties (opp) or not voted (novote) were (95% Confidence Intervall (CI)opp, 1.44–2.95) to 2.25-times (95%CInovote, 1.53–3.30) that of having voted for governing parties. Only 46.2% trusted the Austrian government to provide safe vaccines, and 80.7% requested independent scientific evaluations regarding vaccine safety to increase willingness to vaccine. Conclusions Contrary to expected, psychosocial dimensions were only weakly correlated with vaccine hesitancy. However, the strong correlation between distrust in the vaccine and distrust in authorities suggests a common cause of disengagement from public discourse. [ABSTRACT FROM AUTHOR]

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly. [ABSTRACT FROM AUTHOR]

Social workers and other healthcare professionals face increasing pressure to expand access, efficiency, and quality of healthcare to rural patients. Telehealth has become a viable and necessary tool to address gaps in healthcare for rural areas. Unfortunately, little is known about the benefits and challenges of using these services to meet the needs of rural communities. This mixed-methods study examines telehealth implementation among healthcare organizations in a predominantly rural state. Seventeen providers from 11 organizations were interviewed. Most had used live video conferencing, and about a third used mobile technologies, but fewer providers had experience with store-and-forward or remote patient monitoring. Analyses of qualitative data collected via interviews revealed two main themes among benefits of telehealth implementation: (1) increased inter- and intra-agency coordination and (2) savings in time, travel, and efficiency. Three main themes emerged among barriers to telehealth: (1) organizational capacity, (2) patient skills and comfort, and (3) provider knowledge and skills. Recommendations are provided for social workers and other healthcare professionals related to expanding utilization of telehealth services to improve access to healthcare for rural populations. [ABSTRACT FROM AUTHOR]

The purpose of this study was to consider how living in an area that qualifies for a rural health grant interacts with a child's hearing status to affect early language and literacy development. Four-year-old children with hearing aids (n  = 45), cochlear implants (n  = 47), and with typical hearing (n  = 66) completed measures of spoken language knowledge and of emergent literacy skills as part of a larger longitudinal investigation. A significant interaction effect between location (rural or urban/suburban) and amplification group was detected for letter knowledge: children with hearing aids exhibit a performance that is particularly affected by rural location. Overall, children with cochlear implants performed lower across all measures than children with typical hearing, and children with hearing aids performed lower than children with typical hearing on measures of phonological awareness, vocabulary, omnibus language knowledge and articulation. [ABSTRACT FROM AUTHOR]

Over the past four decades, group-based microfinance programs have spread rapidly throughout south Asia, sub-Saharan Africa and Latin America. Recent evaluations of the programs have identified social capital as a common byproduct of frequent association by members, increasing trust, belonging and normative influence. Concurrently, social capital is increasingly recognized as an important health determinant. We present an overview of a program intervention operating in Kenya that utilizes a microfinance approach to produce social capital, and seeks to leverage that social capital to promote health at three levels—the village, group, and individual. A theory of change is presented for each of these three levels, demonstrating conceptually and with program examples how social capital can be applied to promote health. Related social theories and approaches, further research and program directions are given for each of the three levels. We identify potential to improve a broad range of health outcomes through this innovative model, which requires engagement with health promotion researchers and planners in low- and middle-income countries for further refinement and validation. [ABSTRACT FROM AUTHOR]

Background The study aimed to evaluate the validity and spatial accuracy of the Food Standards Agency Food Hygiene Rating online data through a field audit. Methods A field audit was conducted in five Lower Layer Super Output Areas (LSOAs) in the North East of England. LSOAs were purposively selected from the top and bottom quintiles of the Index of Multiple Deprivation and from urban and rural areas. The FHRS data validity against the field data was measured as Positive Predictive Values (PPV) and sensitivity. Spatial accuracy was evaluated via mean difference in straight line distances between the FHRS coordinates and the field coordinates. Results In all, 182 premises were present in the field, of which 162 were in the FHRS data giving a sensitivity of 89%. Eight outlets recorded in the FHRS data were absent in the field, giving a PPV of 95%.The mean difference in the geographical coordinates of the field audit compared to the FHRS was 110 m, and <100 m for 77% of outlets. Conclusions After an evaluation of the validity and spatial accuracy of the FHRS data, the results suggest that it is a useful dataset for surveillance of the food environment and for intervention evaluation. [ABSTRACT FROM AUTHOR]

Background Identifying risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could help health systems improve testing and screening strategies. The aim of this study was to identify demographic factors, comorbid conditions, and symptoms independently associated with testing positive for SARS-CoV-2. Methods This was an observational cross-sectional study at the Veterans Health Administration, including persons tested for SARS-CoV-2 nucleic acid by polymerase chain reaction (PCR) between 28 February and 14 May 2020. Associations between demographic characteristics, diagnosed comorbid conditions, and documented symptoms with testing positive for SARS-CoV-2 were measured. Results Of 88 747 persons tested, 10 131 (11.4%) were SARS-CoV-2 PCR positive. Positivity was associated with older age (≥80 vs <50 years: adjusted odds ratio [aOR], 2.16 [95% confidence interval {CI}, 1.97–2.37]), male sex (aOR, 1.45 [95% CI, 1.34–1.57]), regional SARS-CoV-2 burden (≥2000 vs <400 cases/million: aOR, 5.43 [95% CI, 4.97–5.93]), urban residence (aOR, 1.78 [95% CI, 1.70–1.87]), black (aOR, 2.15 [95% CI, 2.05–2.26]) or American Indian/Alaska Native Hawaiian/Pacific Islander (aOR, 1.26 [95% CI, 1.05–1.52]) vs white race, and Hispanic ethnicity (aOR, 1.52 [95% CI, 1.40–1.65]). Obesity and diabetes were the only 2 medical conditions associated with testing positive. Documented fevers, chills, cough, and diarrhea were also associated with testing positive. The population attributable fraction of positive tests was highest for geographic location (35.3%), followed by demographic variables (27.1%), symptoms (12.0%), obesity (10.5%), and diabetes (0.4%). Conclusions The majority of positive SARS-CoV-2 tests were attributed to geographic location, demographic characteristics, and obesity, with a minor contribution of chronic comorbid conditions. [ABSTRACT FROM AUTHOR]

Objectives Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. Method We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. Results Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0–1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5–576.7). Discussion Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas. [ABSTRACT FROM AUTHOR]

Objectives To determine whether exposure to an epidemic is associated with better health behaviors. Methods Using nationally representative survey data collected in 2011 and 2014, we identified middle-aged and older Chinese adults whose communities experienced an outbreak of the 2002–2004 severe acute respiratory syndrome (SARS). We estimated logistic models of health behaviors in the years after the SARS epidemic. Results Compared to those who lived in communities not hit by the epidemic, respondents who lived in communities with a SARS outbreak in 2002–2004 were more likely to get a physical examination in 2010–2011 and have their blood pressure checked and participate in regular physical exercise in the years following the SARS epidemic. These associations varied by gender and rural–urban residence. Discussion Exposure to the SARS epidemic could be positively associated with health behavior among middle-aged and older Chinese adults. [ABSTRACT FROM AUTHOR]

Background Although respiratory syncytial virus (RSV) is the most important viral cause of lower respiratory tract infection deaths in infants, there are few data on infant community deaths caused by RSV. Methods This was an active surveillance of children younger than 2 years of age in 93 villages, 5 primary health centers, and 3 hospitals serving these villages. Village health workers and counselors at the health facilities monitored all lower respiratory tract infections (LRTIs) in consented subjects. Children with severe, or very severe LRTIs and all who died, had nasopharyngeal swabs collected for detection of RSV by molecular methods. Results In the 12 134 subjects, there were 2064 episodes of severe LRTIs and 1732 of very severe LRTIs, of which 271 and 195, respectively, had RSV. Fifteen of 16 (94%) children with RSV died of LRTIs, 14 in the community and 1 in the hospital. The case fatality ratios for severe RSV LRTIs in the first 6 months of life were 3/52 (7.1%) and 1/36 (2.8%) in the community and hospital, respectively. Of those with very severe LRTIs in the community, 17.6% died. There were no very severe RSV LRTI hospital deaths. The adjusted RSV LRTI mortality rates ranged from 1.0 to 3.0/1000 child-years (CY) overall, and 2.0 to 6.1/1000 CY, accounting for 20% of the LRTI deaths and 10% of the postneonatal infant mortality. Conclusions Community deaths from RSV account for the majority of RSV LRTI deaths, and efforts at prevention should be preferentially directed at populations where access to care is limited. [ABSTRACT FROM AUTHOR]

Southern Africa remains the epicentre of the human immunodeficiency virus (HIV) epidemic with AIDS the leading cause of death amongst adolescents. Poor policy translation, inadequate programme implementation and fragmentation of services contribute to adolescents' poor access to sexual and reproductive health and rights (SRHR) services. This study assessed an integrated, school-based SRHR and HIV programme, modelled on the South African Integrated School Health Policy in a rural, high HIV-prevalence district. A retrospective cohort study of 1260 high-school learners was undertaken to assess programme uptake, change in HIV knowledge and behaviour and the determinants of barrier-methods use at last sexual intercourse. Programme uptake increased (2%–89%; P  < 0.001) over a 16-month period, teenage-pregnancy rates declined (14%–3%; P  < 0.050) and accurate knowledge about HIV transmission through infected blood improved (78.3%–93.8%; P  < 0.050), a year later. Post-intervention, attending a clinic perceived as adolescent-friendly increased the odds of barrier-methods use during the last sexual encounter (aOR=1.85; 95% CI: 1.31–2.60), whilst being female (aOR=0.69; 95% CI: 0.48–0.99), <15 years (aOR=0.44; 95% CI: 0.24–0.80), or having >5 sexual partners in the last year (aOR=0.59; 95% CI: 0.38–0.91) reduced the odds. This study shows that the unmet SRHR needs of under-served adolescents can be addressed through integrated, school-based SRHR programmes. [ABSTRACT FROM AUTHOR]

This article addresses how rural environments characterized by remoteness impact the work of police detectives in their casework. It reports on an ethnographic study of two investigative departments (working on volume crime and domestic crime) located in Northern Sweden. Interviews (N  = 27) and participant observations (N  = 56) were conducted in order to examine how investigators approached and managed rural conditions in their daily work. Findings indicate that police investigations in rural areas are characterized by constraints, such as resource shortages, extended set-up times (due to travelling), and challenges in multitasking. The findings identify two main practices for investigating crime in such settings: 'rural investigation' that entails a decentralized approach in which investigators are embedded locally; and 'investigating the rural' that entails a distanced, centralized approach. This article discusses trade-offs and predicted outcomes in crime investigation and highlights how the urban/rural binary divide encompasses a paradoxical tension that investigators must manage continuously. [ABSTRACT FROM AUTHOR]

Objectives Heterogeneity in successful aging has been found across countries. Yet, comparable evidence is sparse except in North America and Europe. Extending prior research, this study examined the prevalence and correlates of successful aging in East Asia: China, Korea, and Japan. Method We used harmonized data sets from national surveys. A total of 6,479 participants (aged between 65 and 75) were analyzed. Using Rowe and Kahn's (1987 , 1997) model, successful aging was defined as having no major diseases, no difficulty performing activities of daily living, obtaining a median or higher score on tests of cognitive function, and being actively engaged. Results The average prevalence of successful agers was 17.6%. There were variations in the global and specific measures of successful aging within and across countries, even after controlling for individual sociodemographic factors (age, gender, and education). The odds of aging successfully were highest in Japan and lowest in China, especially in the rural areas. Being younger and males were associated with a higher likelihood of successful agers in both global and specific measures. Discussion This study observed heterogeneity in successful aging in East Asia. To identify policy implications, future research should explore potential societal factors influencing individuals' opportunities for successful aging. [ABSTRACT FROM AUTHOR]

Background Due to delays in vaccinations, diphtheria-tetanus-whole-cell-pertussis (DTP) is often given with or after measles vaccine (MV)—out of sequence. We reanalyzed data from Matlab, Bangladesh, to examine how administration of MV and DTP out-of-sequence was associated with child survival. Methods In sum, 36 650 children born between 1986 and 1999 were followed with registration of vaccinations and survival. Controlling for background factors using Cox proportional hazards models, survival was analyzed between 9 and 24 months of age. We measured the mortality rate ratio (MRR) to compare vaccination groups. Oral polio vaccine (OPV) campaigns, which started in 1995, reduced the mortality rate and reduced the difference between vaccination groups. In the main analysis, we therefore censored for OPV campaigns; there were 151 nonaccident deaths before the OPV campaigns. Results Compared with MV administered alone (MV-only), DTP administered with or after MV had MRR 2.20 (1.31–3.70), and DTP-only had MRR 1.78 (1.01–3.11). Compared with MV-only, DTP administered with MV had a female-male MRR 0.56 (0.13–2.38), significantly different to DTP administered after MV, which had MRR 14.83 (1.88–117.1), test of interaction P  = .011. Compared with having DTP (no MV) as most recent vaccination, MV-only had a nonaccident MRR of 0.56 (0.32–0.99). Conclusion The negative effects of non-live DTP with or after live MV are not explained merely by selection bias. These observations support a live-vaccine-last policy where DTP should not be given with or after MV. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to assess family caregivers' primary appraisal of stressors related to COVID-19 stay-at-home orders, secondary appraisal of resources and support availability, and use of coping strategies as predictors of perceived role overload during the stay-at-home phase of the pandemic. Method Telephone interviews with 53 family caregivers of persons with dementia from rural Virginia 2 weeks after enactment of the governor's stay-at-home order using structured and open-ended questions were conducted. Results Caregivers who were more concerned about the COVID-19 pandemic were at greater odds of experiencing high role overload than those who recognized positive aspects of the pandemic, as were those who received insufficient support from family and friends. Discussion Use of the transactional model of stress responses yielded important insights about families coping with dementia. Caregivers' perceptions of the pandemic's impact varied, with differential effects on their well-being. [ABSTRACT FROM AUTHOR]

Objectives This study examines how areas with different older population compositions are affected by Coronavirus Disease 2019 (COVID-19) and whether urban and rural counties face different challenges. Methods Applying negative binomial regression to a data set of U.S. counties (N = 3,042), we estimated the relationship between older population ratios and the number of confirmed COVID-19 cases, and how this relationship changes over time in urban and rural counties, respectively. Results Although low-ratio counties show the highest number of confirmed cases of COVID-19 at the beginning of the pandemic, confirmed cases in high-ratio counties (>25% of the total population is aged 65 and older) increase exponentially with time in urban areas. High-ratio rural counties hit their peak later and recover more slowly compared to low- and medium-ratio rural counties. Discussion Both urban and rural counties with larger older populations are more vulnerable and their disadvantages in COVID-19 infections are more rapidly exacerbated over time in urban areas. This underscores the importance of early action in those counties for effective intervention and prevention. [ABSTRACT FROM AUTHOR]

Background Cross River State is making investments geared towards ensuring equitable distribution and improved retention of its frontline health workforce in remote and rural areas. This informed the conduct of a discrete choice experiment to determine the motivating factors supporting the retention of healthcare workers. Methods Study participants were 198 final year students of nursing, midwifery and community health and frontline health workers. Eight focus group discussions and 38 key informant interviews were conducted to obtain information about the dimensions of the work conditions that are important to frontline health workers when choosing to take up posting or stay in their rural work locations. Results Health workers are 2.7 times more likely to take up a rural posting or continue to stay in their present rural duty posts if they receive a salary increment. They are also four times more likely to take a rural job posting if a basic housing or a housing allowance is provided. Conclusion Improving working conditions of frontline health workers in terms of adequate staff strength, good skills mix and equipment, etc. as well as improving opportunities for career advancement will support retention in rural health posts. [ABSTRACT FROM AUTHOR]

Background Health workers are indispensable to service delivery especially in rural and remote communities where the burden of disease is high. Nigeria faces numerous human resources for health challenges, health workers are reluctant to take up rural postings, and the government is struggling to implement planned interventions due to staff shortages. This study explored the perspectives of policymakers and primary health care (PHC) managers on factors that hinder health workers from staying in rural and remote areas and strategies for improving retention. Methods We interviewed purposively selected 10 policymakers and 20 PHC managers in Bauchi and Cross River States, Nigeria. Results Respondents identified a lack of basic social amenities, the poor state of infrastructure, poor working conditions, remuneration and the barrier to career advancement as factors that impede health workers from taking up rural postings. Strategies for improving retention include enforcing bonding; paying salaries promptly, increase in rural allowances and prioritizing health workers in rural and remote areas for capacity building. Conclusion The results of the study indicate the importance of applying context-specific strategies aimed at ensuring the availability of social amenities such as roads, water, electricity, telecommunication, security, the status of infrastructure, working conditions and remunerations. [ABSTRACT FROM AUTHOR]