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INTRODUCTION: Pediatric testicular torsion (TT) is a urologic emergency that may result in testicular loss if left untreated. Testicular salvage is dependent on prompt intervention, and thus delays in diagnosis and management may threaten testicular viability. Knowledge of real-world Canadian practice patterns for pediatric TT will allow optimization of practices based on resource availability and geographic limitations to improve care. METHODS: An electronic survey on pediatric TT management was distributed to Canadian urologists. Descriptive statistics were performed on respondent demographic factors, hospital policies and barriers to care, surgical approaches, and transfer practices. Respondent practice patterns were analyzed based on geographic location and training. RESULTS: Thirty-four urologists responded, with most respondents operating a community practice. Ultrasonography (US) was frequently used to support TT diagnosis. Despite this, poor US access was often cited as a barrier to care, with particular impact on rural urologists. Neonatal patients and <10 years old were commonly transferred to a pediatric hospital for definitive management due to surgeon discomfort and hospital policies. Reported transport methods commonly included use of the patient's own vehicle or ambulance based on availability and timing. CONCLUSIONS: Neonatal patients and patients under 10 years old are most commonly reported to be transferred to pediatric hospitals for TT management. Patients located in rural locations and at centers with limited US access may be at risk for delayed diagnosis and treatment. Pathways for prompt management of suspected TT may better serve these younger pediatric patients. [ABSTRACT FROM AUTHOR]

This study aimed to address the direct impact of split households on smoking behaviour. Three types of spilt households (sole migration, couple migration, and family migration) were incorporated to explore the concise effect of different split household forms. This study also examined factors that contributed to the narrowing gap in smoking prevalence between 2008 and 2018. Retrospective observational study. Data were obtained from the Rural Urban Migration (RUMiC-2009) and China Household Income Project (CHIP2018). Analyses were conducted using chi-squared tests/analysis of variance tests and multiple logit regression. The order probit model with sample selection was conducted to correct for selection bias. Fairlie decomposition was used to quantify the contribution of individual variables to the observed differences in smoking prevalence. Smoking prevalence for all migrants decreased by 5.79% between 2008 and 2018. The results in 2008 reveal the positive and significant contribution of couple migration (coefficient = −0.4608; 95% CI = [−0.6453, −0.2762]) and family migration (coefficient = −0.3705; 95% CI = [−0.5959, −0.1452]) on the reduction of smoking; the finding for family migration remained robust in 2018. Measurable factors partially explain the decline in smoking disparity. The migration of families, working in the construction and manufacturing industries, and educational attainment were the largest contributing factors to the declining gap in smoking prevalence. The increase in family migration and education, and decrease in the number of workers in the construction and manufacturing industries, contributed to a decrease in smoking prevalence. Public policies should target sole migrants, couple migrants, individuals with lower education levels, and those working in the construction and manufacturing industries. [ABSTRACT FROM AUTHOR]

The ethnohistory of the Colorado River delta has been substantively misunderstood, owing to the widespread neglect and/or misinterpretations of the writings of Francisco Garcés. In 1771, 1774, and 1775–1776, Garcés undertook three entradas into the delta, and wrote a series of valuable ethnographic accounts. Not only have Garcés's locations and routes frequently been misidentified by earlier scholars, his observations on agricultural production and population size have been ignored or marginalized, enabling misconceptions about delta historical demography and adaptation to flourish. The present paper seeks to restore Garcés's accounts, making his locations and ethnographic observation intelligible and interpretable, and to show how these can help resolve extant misconceptions. Part I focuses on some key texts, tying his locations to a master map. Part II focuses on ethnolinguistic groups and settlement sites, discusses the implications for a better understanding of historical demography and agricultural adaptation in the delta. [ABSTRACT FROM AUTHOR]

Leatherjackets (Tipula spp.) are soil‐dwelling pests associated with agriculture. Land management decisions made at farm scale can have subsequent effects on their populations. Between 1980 and 2020, surveys were conducted across Scotland to collect field histories and larval population data from grassland farms. To assess the impact of management and bioclimatic factors on leatherjacket occurrence over time, this study investigated data from fields continuously sampled between 2009 and 2018. We utilized a Generalized Linear Mixed‐Effect Model on a dataset of 61 fields on 19 farms. Results indicated three significant factors affecting larval populations; field size, grazing type and application of insecticides or herbicides (referred to collectively as pesticides). Larval populations were significantly lower in fields that were larger in size and under sheep grazing, compared to no grazing. Pesticide application also caused a significant reduction in larval populations. Management variables were amalgamated to create a Management Intensity Index, revealing significantly increased larval populations under low‐management systems. These results, coupled with significant effects of bioclimatic variables, pinpoint predictive signals for high infestations and potential routes for control strategies. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted in the Marwar region of Rajasthan, focusing on the prevalence of renal organ damage in individuals with essential hypertension in the rural population. The study found a significant association between hypertension and renal damage, emphasizing the importance of early identification and intervention. Another study examined the prevalence and characteristics of hypertension in a community, finding that hypertensive individuals had higher systolic blood pressure and other indicators of target organ damage. Additionally, a study assessed the prevalence of microalbuminuria in hypertensive individuals, finding that it increased with the duration of hypertension and was more prevalent in males. [Extracted from the article]

Augmentative release of predators is used in agriculture to suppress pest populations and minimise crop damage. However, predators affect prey populations not only through consumption but by inducing changes to prey morphology, physiology, behaviour and life history. These risk‐induced trait responses can increase prey fitness, potentially reducing the efficacy of certain predators as biocontrol agents.We investigated how non‐consumptive effects contribute to the overall influence of predators by modelling the effect of the predator Podisus maculiventris on the population dynamics of a major agricultural pest, the Colorado potato beetle (Leptinotarsa decemlineata). We developed a demographic model incorporating both consumption and non‐consumptive Podisus‐induced shifts in beetle reproductive strategy. Our model combines data from multiple mechanistic experiments showing that predator‐exposed beetles produce fewer offspring but increase offspring provisioning, and that provisioned larvae have increased survival when predators are present. We simulated beetle densities across multiple beetle generations and a range of predator densities.The influence of non‐consumptive effects depended on predator density. At low predator densities, non‐consumptive effects strengthened the negative effect of predators by up to 45%, and risk‐induced changes to offspring provisioning had a stronger effect on prey densities than reduced offspring quantity. In contrast, at high predator densities, non‐consumptive effects changed the effect of predators by <5%, likely because beetle densities were very low both with and without non‐consumptive effects.Our results suggest that even adaptive responses to predation risk by prey do not necessarily reduce the ability of predators to suppress pest populations. [ABSTRACT FROM AUTHOR]

Purpose: Increasing challenges in recruiting and retaining community‐based teaching physicians (e.g., community preceptors) call for a better understanding of motivators and barriers community preceptors perceive in their teaching role. Given the importance of medical school partnerships with community‐based sites for student training, it is essential to understand the perspectives of community preceptors as teaching physicians in a context away from the medical school, such as rural, and the factors affecting their career choice to engage in teaching while practising medicine. Methods: We conducted semi‐structured interviews with rural community preceptors and used open coding to conceptualise data and axial coding to connect codes into categories. We used the socio‐cognitive career theory framework to organise categories into themes. Results: Eleven rural community preceptors from two medical schools participated. Specialties included family medicine, internal medicine and paediatrics; clinical practice and teaching experience ranged from 3–36 and 2–29 years, respectively. Readiness for teaching ('self‐efficacy') was pivotal in community preceptors' decision to teach and derived largely from vicarious learning from teaching attendings in medical school or residency; social persuasion and encouragement from clinical partners; and their accomplishments as practising physicians. However, limited faculty development, incomplete knowledge of expectations, disengagement from the medical school and lack of current mentors hindered their self‐confidence. Teaching fulfilled their aspirations ('outcome expectations') to give back to the profession, but they felt undervalued and disconnected from other clinician educators. Teaching increased job satisfaction, but clinical workload, and financial impact impeded their goals for achieving excellence ('performance'). Conclusions: Self‐efficacy was a pivotal motivator in rural community preceptors' decision to teach. Role models from early training inspired them to teach. Internal awards sustained teaching efforts. Future research should explore structural barriers influencing rural community preceptors' teaching experiences to better support their career choice to become medical educators. Understanding rural community preceptors' motivations and barriers in teaching medical students is crucial for training. This study explores the role of self‐efficacy, giving back to the profession, and disengagement from medical schools. #MedEd #RuralHealth [ABSTRACT FROM AUTHOR]

This article explores the relationship between the decoloniality debate and heritage practice in China. It argues that while postcolonial consciousness has led to efforts to pluralize voices and practices worldwide, China has remained distant from these debates and maintains an ambivalent relationship with discourses on colonialism. The article examines how Chinese cultural heritage practices reproduce hierarchies and racialized narratives to consolidate the nation, and how grassroots forms of appropriation of cultural narratives exist as limited forms of resistance. It also discusses the use of cultural heritage as a tool for social engineering and the power relations involved in heritage processes. The article focuses on two examples, Islam and Muslim culture, and rural culture, to illustrate these dynamics. It concludes by suggesting that adopting decolonial approaches in China could address issues of representation, community rights, and access to resources. [Extracted from the article]

Objectives. To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China. Design. A randomised controlled trial. Methods. A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants' health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes. Results. Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer's dyadic relationship and health-related quality of life at T1 and T2. Conclusion. The patient-family (carer) partnership intervention has the potential to improve hypertensive people's BP control and family dyad's dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087. [ABSTRACT FROM AUTHOR]

Background: More than 20 million people are infected with L. loa, and around 40 million live in high or intermediate-risk areas in West- and Central Africa. Although loiasis is associated with significant morbidity and excess mortality, little is known about the perception of loiasis by affected communities. This study assessed the knowledge, attitudes, and practices in the rural population of Sindara, Gabon, a region characterized by high loiasis prevalence. Methods: A community-based cross-sectional survey was conducted in Gabon between January and June 2022. During systematic door-to-door visits, randomly selected inhabitants were invited to participate in this questionnaire based survey. Venous blood was collected at midday from all participants for microscopic detection of filarial infection and clinical signs of loiasis were assessed. Results: A total of 150 participants were recruited, of which 66% were infected by L. loa. While almost everyone had some knowledge about L. loa, 72% of the participants understood that L. loa is a parasitic worm. The transmission of L. loa via the deer fly was known to only 21% of participants. The most frequently mentioned clinical symptoms attributed to loiasis were itching (84%), eye worm migration (59%), and conjunctivitis-like symptoms (53%). Participants who experienced migratory loiasis had better knowledge of loiasis and considered it as more serious. Traditional and herbal medicine was reported most often as an available treatment option (72%). While the formal healthcare sector was mentioned as the preferred treatment provider, 60% of the reported infections were treated by traditional medical practitioners. Conclusion: Loiasis is in general well known by this community residing in a region of high L. loa transmission. Important gaps in knowledge were discovered foremost regarding the mode of transmission. The available healthcare system does not seem to provide adequate management for loiasis. Author summary: Loiasis is a filarial disease highly prevalent in parts of Western- and Central Africa. For a long time, the disease has been considered to be a relatively benign condition, but recent studies have shown that loiasis causes significant morbidity and excess mortality. In the present study, we investigated the perception of loiasis in a highly affected community in rural Gabon to better understand the community perspective on this infectious disease. While L. loa as a disease is known to most inhabitants, the mode of transmission and prevention modalities are only poorly understood. This lack of knowledge leaves the communities with inadequate means to prevent onward transmission of this filarial disease. The contribution from media, schools and healthcare institutions in providing information about loiasis is inadequate, and the available healthcare system is insufficient to provide the necessary care for loiasis. A better understanding of loiasis by the affected communities is desirable to empower inhabitants of high-transmission regions to better protect themselves from loiasis. Improved understanding of the disease by the healthcare sector is necessary to improve the management of loiasis. [ABSTRACT FROM AUTHOR]

Simple Summary: Caseous lymphadenitis is one of the main infectious problems affecting sheep rearing areas worldwide. In Morocco, sheep farming constitutes an important socioeconomic activity and is considered to be a source of income for the local rural population. However, breeders are facing considerable economic losses due to caseous lymphadenitis. This negative impact is mainly due to the low prices and limited saleability of sheep with superficial abscesses, particularly for religious celebrations. In the present study, investigations were realised at the flock and slaughterhouse levels to determine the prevalence and risk factors implicated in caseous lymphadenitis. As a result, the form of rearing management adopted was found to impact the dissemination of caseous lymphadenitis. In conclusion, improvement of ventilation in sheep barns and implementation of periodic control of abscess cases, including their treatment with adequate procedures, are a must. Two surveys were conducted to assess the prevalence and risk factors of ovine caseous lymphadenitis (CL) and explore the association between its superficial and visceral forms in Sardi sheep in Settat province, Morocco. A total of 1521 sheep, including 318 lambs < 6 months, 572 young sheep aged 6–24 months, and 631 adult sheep > 24 months, were examined from 57 flocks. Superficial CL prevalence levels were as follows: 69/318 in lambs, 292/572 in young sheep, and 114/631 in adult sheep. Additionally, 2124 sheep, including 1813 young and 311 adult sheep, were inspected in slaughterhouses ante- and post-mortem. Among all infected animals, the prevalence of visceral abscesses was notably higher in adult sheep (83%, OR = 9.8, 95% CI = 5.5–17.2) compared to young sheep (35%). Data on flock size, sex, age, body condition score, rearing methods, and hygienic measures were collected. Suspected CL cases were confirmed using quadruplex-PCR. Poor barn ventilation, lack of abscess control, and younger age were identified as key risk factors for CL. Additionally, a high percentage (89%) of animals with thoracic abscesses did not display superficial lesions. While age and abscess control have been reported in previous studies, barn ventilation appears to be a new, but important, risk factor. In conclusion, the identified risk factors in Settat province are linked to breeding management practices. Implementing regular abscess control measures and improving barn ventilation are essential for CL prevention. [ABSTRACT FROM AUTHOR]

Despite being high health care utilizers, many women Veterans perceive their pain condition to be poorly understood by their providers, which can be a strong demotivator for seeking care. We set out to understand the priorities rural-dwelling women Veterans have for using health care for their chronic pain, and interviewed participants about their experiences with (and priorities for seeking) health care for their chronic pain. Self-Determination Theory identifies three sources of motivation (autonomy, competence, relatedness), all of which were represented through two themes that reflect rural women Veterans’ rationale for decision-making to obtain health care for chronic pain: role of trust and competing priorities. Women described their priorities for chronic pain management in terms of their competing priorities for work, education, and supporting their family, but most expressed a desire to function in their daily life and relationships. Second, women discussed the role of trust in their provider as a source of motivation, and the role of patient-provider communication skills and gender played in establishing trust. Rural women Veterans often discussed core values that stemmed from facets of their identity (e.g. gender, military training, ethnicity) that also influenced their decision-making. Our findings provide insight for how providers may use Motivational Interviewing and discuss chronic pain treatment options so that rural-dwelling women Veterans feel autonomous, competent, and understood in their decision-making about their chronic pain. We also discuss importance of acknowledging the effects of disenfranchising talk and perpetuating gendered stereotypes related to chronic pain and theoretical implications of this work. [ABSTRACT FROM AUTHOR]

Urban malaria has become a challenge for most African countries due to urbanization, with increasing population sizes, overcrowding, and movement into cities from rural localities. The rapid expansion of cities with inappropriate water drainage systems, abundance of water storage habitats, coupled with recurrent flooding represents a concern for water-associated vector borne diseases, including malaria. This situation could threaten progress made towards malaria elimination in sub-Saharan countries, including Senegal, where urban malaria has presented as a threat to national elimination gains. To assess drivers of urban malaria in Senegal, a 5-month study was carried out from August to December 2019 in three major urban areas and hotspots for malaria incidence (Diourbel, Touba, and Kaolack) including the rainy season (August-October) and partly dry season (November–December). The aim was to characterize malaria vector larval habitats, vector dynamics across both seasons, and to identify the primary eco- environmental entomological factors contributing to observed urban malaria transmission. A total of 145 Anopheles larval habitats were found, mapped, and monitored monthly. This included 32 in Diourbel, 83 in Touba, and 30 in Kaolack. The number of larval habitats fluctuated seasonally, with a decrease during the dry season. In Diourbel, 22 of the 32 monitored larval habitats (68.75%) were dried out by December and considered temporary, while the remaining 10 (31.25%) were classified as permanent. In the city of Touba 28 (33.73%) were temporary habitats, and of those 57%, 71% and 100% dried up respectively by October, November, and December. However, 55 (66.27%) habitats were permanent water storage basins which persisted throughout the study. In Kaolack, 12 (40%) permanent and 18 (60%) temporary Anopheles larval habitats were found and monitored during the study. Three malaria vectors (An. arabiensis, An. pharoensis and An. funestus s.l.) were found across the surveyed larval habitats, and An. arabiensis was found in all three cities and was the only species found in the city of Diourbel, while An. arabiensis, An. pharoensis, and An. funestus s.l. were detected in the cities of Touba and Kaolack. The spatiotemporal observations of immature malaria vectors in Senegal provide evidence of permanent productive malaria vector larval habitats year-round in three major urban centers in Senegal, which may be driving high urban malaria incidence. This study aimed to assess the presence and type of anopheline larvae habitats in urban areas. The preliminary data will better inform subsequent detailed additional studies and seasonally appropriate, cost-effective, and sustainable larval source management (LSM) strategies by the National Malaria Control Programme (NMCP). [ABSTRACT FROM AUTHOR]

Background: Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. Methods: The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations. [ABSTRACT FROM AUTHOR]

Based on fieldwork research among the Bosniak (Muslim) population in rural areas of Bosnia and Herzegovina, this article starts with the technique of summoning the dead, aimed at obtaining information about missing goods. It argues that the practice of summoning the dead, like practices aimed at magically harming others, is based on the same moral rules that govern everyday relations between the living and the dead. While these rules are generally followed and observed in everyday life, they can also be deliberately inverted to one's own advantage or to the disadvantage of others. Ultimately, I argue that the dead prove to be moral agents who act when moral norms are violated. [ABSTRACT FROM AUTHOR]

Purpose: Several model studies suggested the implementation of latent tuberculosis infection (LTBI) testing and treatment could greatly reduce the incidence of tuberculosis (TB) and achieve the 2035 target of the "End TB" Strategy in China. The present study aimed to evaluate the cost-effectiveness of LTBI testing and TB preventive treatment among key population (≥ 50 years old) susceptible to TB at community level in China. Methods: A Markov model was developed to investigate the cost-effectiveness of LTBI testing using interferon gamma release assay (IGRA) and subsequent treatment with 6-month daily isoniazid regimen (6H) (as a standard regimen for comparison) or 6-week twice-weekly rifapentine and isoniazid regimen (6-week H2P2) in a cohort of 10,000 adults with an average initial age of 50 years. Results: In the base-case analysis, LTBI testing and treatment with 6H was dominated (i.e., more expensive with a lower quality-adjusted life year (QALY)) by LTBI testing and treatment with 6-week H2P2. LTBI testing and treatment with 6-week H2P2 was more effective than no intervention at a cost of $20,943.81 per QALY gained, which was below the willingness-to-pay (WTP) threshold of $24,211.84 per QALY gained in China. The one-way sensitivity analysis showed the change of LTBI prevalence was the parameter that most influenced the results of the incremental cost-effectiveness ratios (ICERs). Conclusion: As estimated by a Markov model, LTBI testing and treatment with 6-week H2P2 was cost-saving compared with LTBI testing and treatment with 6H, and it was considered to be a cost-effective option for TB control in rural China. [ABSTRACT FROM AUTHOR]

Introduction: Non-communicable diseases (NCD) are the leading cause of adult mortality and morbidity worldwide now days. The NCD like hypertension is emerging as a major health problem in India with increasing prevalence significantly in both urban and rural population. Hence, an investigation was undertaken to find out prevalence of hypertension and its correlates among adult population living in an urban area of West Bengal. Methodology: This community based cross sectional study was conducted in Tangra area of Kolkata. A sample of 100 (45-59 years) individuals was selected by the standard random sampling technique. Chi-square test and multiple logistic regression were employed using SPSS software package. Results: The overall prevalence of hypertension was 32% and higher among participants of occupation employed/business (22%), regular alcoholic (14%), high BMI (16%). While in the bivariate analysis many of the factors correlate with hypertension, occupation, family history and body-mass index, remained significant in the multivariate analysis. Conclusions: The prevalence of hypertension in the study population was found to be on the higher side compared to previous reports from India. Strong public health measures need to be seriously implemented to combat hypertension and its consequences. [ABSTRACT FROM AUTHOR]

Background: Socio-economic status, living environments, and race have been implicated in the development of different congenital abnormalities. As orofacial clefting is the most common anomaly affecting the face, an understanding of its prevalence in the United States and its relationship with different determinants of health is paramount. Therefore, the purpose of this study is to determine the modern prevalence of oral–facial clefting in the United States and its association with different social determinants of health. Methods: Utilizing Epic Cosmos, data from approximately 180 US institutions were queried. Patients born between November 2012 and November 2022 were included. Eight orofacial clefting (OC) cohorts were identified. The Social Vulnerability Index (SVI) was used to assess social determinants of health. Results: Of the 15,697,366 patients identified, 31,216 were diagnosed with OC, resulting in a prevalence of 19.9 (95% CI: 19.7–20.1) per 10,000 live births. OC prevalence was highest among Asian (27.5 CI: 26.2–28.8) and Native American (32.8 CI: 30.4–35.2) patients and lowest among Black patients (12.96 CI: 12.5–13.4). Male and Hispanic patients exhibited higher OC prevalence than female and non-Hispanic patients. No significant differences were found among metropolitan (20.23/10,000), micropolitan (20.18/10,000), and rural populations (20.02/10,000). SVI data demonstrated that OC prevalence was positively associated with the percentage of the population below the poverty line and negatively associated with the proportion of minority language speakers. Conclusions: This study examined the largest US cohort of OC patients to date to define contemporary US prevalence, reporting a marginally higher rate than previous estimates. Multiple social determinants of health were found to be associated with OC prevalence, underscoring the importance of holistic prenatal care. These data may inform clinicians about screening and counseling of expectant families based on socio-economic factors and direct future research as it identifies potential risk factors and provides prevalence data, both of which are useful in addressing common questions related to screening and counseling. [ABSTRACT FROM AUTHOR]

Generative artificial intelligence (AI) is currently a source of angst, because of its ability to give us content that sounds uncannily like a real person, and because of concern that people will not stop at using it as a tool to generate and synthesize ideas, but instead will cede control over our words, and then our thoughts. This editorial details each article in Creative Nursing Vol. 30 Issue 2, highlighting the ways in which social media, different kinds of AI, and other tools for connectivity can be used for good: finding our purpose, uniting people over long distances, expediting knowledge implementation, managing large volumes of literature, advancing health equity, and enriching nursing education. [ABSTRACT FROM AUTHOR]

Background: Health education programs can enhance self-efficacy and disaster preparedness. However, research incorporating the Health Belief Model (HBM) in education for infectious disasters is lacking. Aims: Examine the effectiveness of an HBM-based education program on self-reported self-efficacy and self-reported preparedness for infectious disasters in rural populations. Methods: In total, 109 eligible participants were allocated to two groups: participants who received HBM-based education (n = 55) or regular education (n = 54), presented at in-person meetings, with individual follow-up conducted on WhatsApp. Self-reported self-efficacy and preparedness for infectious disasters in both groups were measured at 4 and 8 weeks. Findings: Participants showed a significant interaction between groups and in time to increase in self-reported self-efficacy and self-reported preparedness to deal with infectious disasters. After 4 and 8 weeks, the groups had statistically significant differences (p ≤.001) in all outcome measures. Conclusion: HBM-based education was associated with increased self-reported self-efficacy and self-reported infectious disaster preparedness among the rural population. Follow-up by nurses is essential to implementing continuing health belief education programs to enhance rural populations' self-efficacy and infectious disaster preparedness. [ABSTRACT FROM AUTHOR]

Little is known about the experience and impact of intersectional stigma experienced by rural young people (15–25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project's methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse. [ABSTRACT FROM AUTHOR]

Background:As a result of the COVID-19 public health emergency (PHE), telehealth utilization accelerated to facilitate health care management and minimize risk. However, those with mental health conditions and substance use disorders (SUD)—who represent a vulnerable population, and members of underrepresented minorities (e.g., rural, racial/ethnic minorities, the elderly)—may not benefit from telehealth equally. Objective:To evaluate health equality in clinical effectiveness and utilization measures associated with telehealth for clinical management of mental health disorders and SUD to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability. Methods:We performed a systematic review in PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL through November 2022. Studies included those with telehealth, COVID-19, health equity, and mental health or SUD treatment/care concepts. Our outcomes included general clinical measures, mental health or SUD clinical measures, and operational measures. Results:Of the 2,740 studies screened, 25 met eligibility criteria. The majority of studies (n = 20) evaluated telehealth for mental health conditions, while the remaining five studies evaluated telehealth for opioid use disorder/dependence. The most common study outcomes were utilization measures (n = 19) or demographic predictors of telehealth utilization (n = 3). Groups that consistently demonstrated less telehealth utilization during the PHE included rural residents, older populations, and Black/African American minorities. Conclusions:We observed evidence of inequities in telehealth utilization among several underrepresented groups. Future efforts should focus on measuring the contribution of utilization disparities on outcomes and strategies to mitigate disparities in implementation. [ABSTRACT FROM AUTHOR]

Purpose: Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention. Methods: To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories. Findings: We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas. Conclusions: Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60. [ABSTRACT FROM AUTHOR]

Next-generation sequencing has revolutionized the speed of rare disease (RD) diagnoses. While clinical exome and genome sequencing represent an effective tool for many RD diagnoses, there is room to further improve the diagnostic odyssey of many RD patients. One recognizable intervention lies in increasing equitable access to genomic testing. Rural communities represent a significant portion of underserved and underrepresented individuals facing additional barriers to diagnosis and treatment. Primary care providers (PCPs) at local clinics, though sometimes suspicious of a potential benefit of genetic testing for their patients, have significant constraints in pursuing it themselves and rely on referrals to specialists. Yet, these referrals are typically followed by long waitlists and significant delays in clinical assessment, insurance clearance, testing, and initiation of diagnosis-informed care management. Not only is this process time intensive, but it also often requires multiple visits to urban medical centers for which distance may be a significant barrier to rural families. Therefore, providing early, "direct-to-provider" (DTP) local access to unrestrictive genomic testing is likely to help speed up diagnostic times and access to care for RD patients in rural communities. In a pilot study with a PCP clinic in rural Kansas, we observed a minimum 5.5 months shortening of time to diagnosis through the DTP exome sequencing program as compared to rural patients receiving genetic testing through the "traditional" PCP-referral-to-specialist scheme. We share our experience to encourage future partnerships beyond our center. Our efforts represent just one step in fostering greater diversity and equity in genomic studies. Individuals with rare genetic disorders face a long road to obtain a diagnosis and resulting medical care. Those who live in rural areas face even more challenges due to reduced access to testing and resources. Partnerships with rural PCPs can shorten time to diagnosis by delivering specialist-supported genomic testing and counseling. [ABSTRACT FROM AUTHOR]

[Display omitted] • Saccade is less influenced by education level than MoCA. • The effect size of education level on MoCA is 11 times greater that of saccade. • Saccade is a better cognitive screening tool for individuals from rural areas. This cross-sectional study sought to evaluate the effectiveness of the Montreal Cognitive Assessment (MoCA) and saccade in discerning the cognitive function levels among community populations characterized by diverse educational backgrounds. Data from 665 Western China individuals encompassed MoCA scores and saccade performance. The study examined how education level and age influenced these assessments and highlighted the contrasting abilities of these measures in detecting cognitive abnormalities. The saccade model revealed a consistent cognitive impairment prevalence (15.5%) compared to previous clinical data (9.7% to 23.3%), while MoCA exhibited variable rates (25.1% to 52.8%). Notably, saccades and MoCA significantly diverged in detecting cognitive dysfunction. Additionally, education level had a greater impact on MoCA (effect size: 0.272) compared to saccades (0.024) affecting all MoCA sub-items, with age exerting a smaller influence on MoCA (0.037) compared to saccades (0.056). Saccades are less susceptible to the influence of education level when compared to MoCA, making saccade a potentially more suitable cognitive screening tool for rural community populations. This study represents a pioneering approach by employing saccade detection within community populations to distinguish cognitive function status. [ABSTRACT FROM AUTHOR]

Child malnutrition is a global public health problem which causes irreversible damage to physical and cognitive development in early childhood. In 2015, the National Survey of Nutrition reported that Boyacá, Colombia had a prevalence of chronic malnutrition of 11.6% above the national average, considering that Boyacá is predominantly rural territory. This article analyzes the risk factors that influenced the diets of children between 16 and 38 months among 27 rural families. Through a descriptive cross-sectional study, a survey of the socio-family characterization and knowledge, attitudes, and practices (KAP) were applied with participating families. It was found that among the nutritional risk factors in early childhood are low levels of maternal schooling, low economic income, and barriers to accessing health and education services. The results of this research enable contributions to the contextualization of public policies in health and nutrition with a territorial approach that allow the improvement of the quality of life in early childhood in rural areas. [ABSTRACT FROM AUTHOR]

Among south Asian countries, Bhutan has the second lowest poverty incidence; but, there is a large difference in poverty incidence between urban and rural areas. While urban areas registered a very small poverty incidence, 12.0% of rural population were still below the national poverty line in 2017. Poverty is by and large a rural phenominon in Bhutan. Against this background, this study examines whether Bhutan's rural economic growth was pro-poor from 2007–2017 by using the Bhutan Living Standard Surveys. It also conducts an IV probit analysis to explore the determinants of poverty. Even in rural areas, growth is necessary for the reduction of poverty. Besides relying on trickle-down effects from hydropower projects and tourism, promotion of agriculture-based small scale industries is essential for the acceleration of rural economic growth, where further development of basic industrial and transportation infrastructure and socioeconomic facilities is imperative. The country also needs to promote and strengthen basic education since education is found to have played an important role in reducing poverty. Many rural households are vulnerable to poverty. To prevent vulnerable households from falling into poverty, more effective social safety net programs may be necessary based on regional differences in factors affecting living conditions. [ABSTRACT FROM AUTHOR]

This article is furnished with a comprehensive review of nature and extent of rural livelihood diversification with special focus on North-Eastern region of India. This study reveals that the tribal communities of this region adopt livelihood diversification as a strategy of coping with risk due to persistent low agricultural productivity and population pressure. Despite this fact, the extent of diversification is low. Agriculture and land still occupies main source of income. It is evident from this article that this region has great potentialities of diversification towards multiple income sources. But difficult terrain and geographical isolation of this region make these resources yet to be properly utilised. The aim of this review article is to point out some issues related to livelihood diversification of North-Eastern region for further research and also try to attract the eyes of policy makers towards the potentialities of livelihood options available in this region. [ABSTRACT FROM AUTHOR]

The interactive effects of obesity and physical inactivity on lipid metabolism and prevalent dyslipidemia are scarcely reported in rural regions. 39029 subjects were obtained from the Henan Rural Cohort, and their metabolic equivalents (METs) of physical activity (PA) were computed. Independent associations of the obesity indices and PA with either lipid indices or prevalent dyslipidemia were analyzed by generalized linear models, and additive effects of obesity and PA on prevalent dyslipidemia were further quantified. Each obesity index was positively associated with total cholesterol, triglyceride, low-density lipoprotein or prevalent dyslipidemia but negatively associated with high-density lipoprotein, whereas the opposite association of PA with either each lipid index or prevalent dyslipidemia was observed. Joint association of PA and each obesity index with each lipid index and prevalent dyslipidemia was observed. Furthermore, the association of each obesity index in association with each lipid index was attenuated by increased PA levels. [ABSTRACT FROM AUTHOR]

Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses. [ABSTRACT FROM AUTHOR]

While violence against women and domestic violence can be seen throughout Australia, emerging evidence suggests that intimate partner femicide (IPF) is more common in rural spaces than urban ones. This study examined 100 IPF cases to determine the rate of femicide and frequency of common risk factors in rural areas of Queensland, Australia. The study also explored how victims accessed services and the characteristics of rural IPF and male offenders. Findings indicated that IPF is more common in rural areas and associated risk factors are similar between urban and rural cases. Rural IPF was more likely to occur during a current relationship and offenders were found to be less likely to conceal their actions. These differences suggest that the physical and social isolation of rural spaces may facilitate higher rates IPF. Implications discuss the need for rural-focused policies and responses. [ABSTRACT FROM AUTHOR]

Background: Cancer centers provide superior care but are less accessible to rural populations. Health systems that integrate a cancer center may provide broader access to quality surgical care, but penetration to rural hospitals is unknown. Methods: Cancer center data were linked to health system data to describe health systems based on whether they included at least one accredited cancer center. Health systems with and without cancer centers were compared based on rural hospital presence. Bivariate tests and multivariable logistic regression were used with results reported as P -values and odds ratios (OR) with 95% confidence intervals (CIs). Results: Ninety percent of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems (P =.03) with more trainees (P =.03) more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%, P =.43; adjusted OR.69, 95% CI.28-1.70). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations (P =.02) in non-metropolitan areas (P =.03). Discussion: Health systems with rural hospitals are no more likely to have a cancer center. Ongoing health system integration will not necessarily expand rural patients' access to surgical care under existing health policy infrastructure and incentives. [ABSTRACT FROM AUTHOR]

Inclusion of rural youth is of great importance to facilitate nutritional security and make the food chain more sustainable. A positive attitude is necessary for active participation in agricultural activities. This case study was an attempt to check the attitude of rural youth regarding sustainable farming and its contributing factors. The study was carried out in the Punjab province of Pakistan and a transverse research design was used for this quantitative study. An interview schedule was used for getting the face-to-face response of rural youth. To make the unknown population of rural youth in Punjab, the Fisher formula was used and a sample of 413 was selected from purposely selected three districts of Punjab. After recording data, Statistical Package for Social Sciences (SPSS) was used to analyze the data. Descriptive Statistics was used to explain the response of rural youth for the decision on the base of data. Only 53 young farmers said that they have never been part of the formal education system and maximum number of farmers was close to 24 years of age or more than that. Rural youth of Punjab is lacking in non-formal education for acquiring or maintaining their skills & interests. Unemployment and having limited farm income are the biggest challenges that rural youth is facing. Rural youth show a strong inclination towards opting for sustainable farming alongside the availability of a supportive network. Regarding to learning capacities rural youth is lacking related to knowledge, communication means, novel approaches and in promoting sustainable farming initiatives. To achieve the goal of sustainability in changing environment, rural youth must have access to continuous training, communication sources, membership, or association with organizations with novel ideas covering all the changes happening in the farming business. [ABSTRACT FROM AUTHOR]

Multimorbidity, the presence of 2 or more chronic conditions in a person at the same time, is an increasing public health concern, which affects individuals through reduced health related quality of life, and society through increased need for healthcare services. Yet the structure of chronic conditions in individuals with multimorbidity, viewed as a population, is largely unmapped. We use algorithmic diagnoses and the K-means algorithm to cluster the entire 2015 Danish multimorbidity population into 5 clusters. The study introduces the concept of rim data as an additional tool for determining the number of clusters. We label the 5 clusters the Allergies, Chronic Heart Conditions, Diabetes, Hypercholesterolemia, and Musculoskeletal and Psychiatric Conditions clusters, and demonstrate that for 99.32% of the population, the cluster allocation can be determined from the diagnoses of 4–5 conditions. Clusters are characterized through most prevalent conditions, absent conditions, over- or under-represented conditions, and co-occurrence of conditions. Clusters are further characterized through socioeconomic variables and healthcare service utilizations. Additionally, geographical variations throughout Denmark are studied at the regional and municipality level. We find that subdivision into municipality levels suggests that the Allergies cluster frequency is positively associated with socioeconomic status, while the subdivision suggests that frequencies for clusters Diabetes and Hypercholesterolemia are negatively correlated with socioeconomic status. We detect no indication of association to socioeconomic status for the Chronic Heart Conditions cluster and the Musculoskeletal and Psychiatric Conditions cluster. Additional spatial variation is revealed, some of which may be related to urban/rural populations. Our work constitutes a step in the process of characterizing multimorbidity populations, leading to increased comprehension of the nature of multimorbidity, and towards potential applications to individual-based care, prevention, the development of clinical guidelines, and population management. [ABSTRACT FROM AUTHOR]

Background: Vaccination has been an indispensable step in controlling the coronavirus disease pandemic. In early 2021, Bangladesh launched a mass vaccination campaign to boost the COVID-19 vaccination rate when doses were available and immunized millions in the country. Although deemed a success, disparities became conspicuous in vaccination coverage across population of different socioeconomic background. Methods: The purpose of this cross-sectional study was to assess the vaccination coverage for three doses and detect disparities in uptake of the COVID-19 vaccine among rural population of hard-to-reach areas and urban individuals belonging to the high-risk group -defined in our study as individuals from elusive population such as floating population/street dwellers, transgender, addicts and disabled population. We conducted household survey (n = 12,298) and survey with high risk group of people (2,520). The collected primary data were analysed using descriptive statistical analysis. Results: Our findings show that coverage for the first dose of COVID-19 vaccination was high among respondents from both rural Hard-to-reach (HTR) (92.9%) and non-HTR (94.6%) areas. However, the coverage for subsequent doses was observed to reduce significantly, especially for third dose (52.2% and 56.4% for HTR and non-HTR, respectively). Conclusion: Vaccination coverage among urbanites of high-risk group was found to be critically low. Vaccine hesitancy was also found to be high among individuals of this group. It is essential that the individuals of urban high-risk group be prioritized. Individuals from this group could be provided incentives (transport for disabled, monetary incentive to transgenders; food and medicine for drug user and floating people) and vaccination centers could be established with flexible schedule (morning/afternoon/evening sessions) so that they receive vaccine at their convenient time. Community engagement can be used for both high-risk group and rural population to enhance the COVID-19 vaccination coverage and lower disparities in uptake of the vaccine doses nationwide. [ABSTRACT FROM AUTHOR]

Background: High consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students' SSB consumption. Secondary objectives focus on caregivers' SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)]. Methods: This Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors. Results: Of the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001). Conclusions: Kids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline. Trial registration: Clincialtrials.gov: NCT03740113. Registered 14 November 2018– Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113. [ABSTRACT FROM AUTHOR]

Background: Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. Methods: RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. Results: Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. Conclusions: RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations. [ABSTRACT FROM AUTHOR]

We explore the impact of a millennium-long period of decreased rainfall during the transition from the Middle to Late Holocene on human diet and population dynamics in the northern neotropical Maya Lowlands. To do so, we use a nearby paleo-precipitation reconstruction to evaluate the timing of this period of reduced rainfall and compare those data to population proxies and stable isotopes of carbon and nitrogen from directly dated human bone spanning the interval of interest. Our results show that decreased precipitation coincided with archaeological and isotopic evidence for increasing reliance on maize as a dietary staple. Two rockshelter sites located in Southern Belize have produced a mortuary assemblage that spans the Holocene. These assemblages provide a unique opportunity to examine how early farmers during the transition to agriculture may have been affected by Middle to Late Holocene climate change. Between 5600 and 4200 cal BP lowland populations were already consuming significant amounts of maize reflected in proxies for the protein and the whole diet portions, suggesting the establishment of farming communities at least 800–2200 years before the emergence of public architecture. We demonstrate that increasing reliance on maize shows the resilience of farming populations to climate variability during this crucial period just prior to massive demographic change and the emergence of complex economic institutions. [ABSTRACT FROM AUTHOR]

Breast cancer, a global health concern predominantly affecting women, recorded 2.3 million new cases and 685,000 deaths in 2020. Alarmingly, projections suggest that by 2040, there could be over 3 million new cases and 1 million deaths. To assess breast cancer prevalence in 24 rural villages within a 60 km radius of NIMS Hospital, Tala Mod, Jaipur, Rajasthan, North India 303,121. A study involving 2023 participants conducted initial screenings, and positive cases underwent further tests, including ultrasound, mammography, and biopsy. SPSSv28 analysed collected data. Among 2023 subjects, 3 screened positive for breast lumps. Subsequent clinical examination and biopsy identified 1 normal case and 2 with breast cancer, resulting in a prevalence proportion of 0.0009 or 98 per 100,000. This study helps fill gap in breast cancer prevalence data for rural Rajasthan. The results highlight a concerning prevalence of breast cancer in the rural area near NIMS hospital, emphasizing the urgent need for increased awareness, early detection, and better healthcare access. Challenges like limited resources, awareness programs, and delayed diagnosis contribute to this high incidence. To address this, comprehensive approach is necessary, including improved screening programs and healthcare facilities in rural areas. Prioritizing rural healthcare and evidence-based strategies can reduce the burden of breast cancer and improve health outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated the relationship between adipocyte factors, insulin resistance, and other indicators with telomere length. However, these studies did not consider the influence of changes in different indicators on telomere length over time. Therefore, the aim of this study is to elucidate the impact of changes in adipocyte factors, HOMA-IR, and other indicators on the dynamic variation of telomere length. Methods: The data were from a cohort study conducted in Ningxia, China. A total of 1624 subjects were analyzed. Adipokines and relative leukocyte telomere length (RLTL) were measured, and changes in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Homeostatic Model Assessment for β-Cell Function (HOMA-β), and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated. Generalized linear models evaluated associations between changes in adipokines and RLTL changes. Furthermore, univariate analyses examined the effects of changes in adipokines and insulin resistance indicators on ΔRLTL. Results: The research findings indicate that females generally have shorter telomeres compared to males. In comparison to the low-level group of Δleptin (LEP), the high-level group of ΔLEP shows a negative correlation with ΔRLTL (B=-1.32, 95% CI (-2.38, -0.27)). Even after multivariable adjustments, this relationship persists (B=-1.31, 95% CI (-2.24, -0.23)). Further analysis reveals that after adjusting for ΔHOMA-IR, ΔHOMA-β, and ΔQUICKI, the high-level group of ΔLEP still exhibits a significant negative correlation with ΔRLTL (B=-1.37, 95% CI (-2.43, -0.31)). However, the interaction effects between ΔHOMA-IR, ΔHOMA-β, ΔQUICKI, and ΔLEP do not affect ΔRLTL. Conclusions: Elevated levels of leptin were significantly correlated with shortened telomere length. This suggests that increased leptin levels may impact overall individual health by affecting telomere length, underscoring the importance of measures to reduce leptin levels to mitigate the onset and progression of related diseases. [ABSTRACT FROM AUTHOR]

Background and objective: On the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences. Methods: We used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities. We employed two different decomposition analyses: decomposition of mean differences in utilization using the Oaxaca–Blinder decomposition framework and differences in the income-related distribution in utilization using recentered influence function regressions between rural and urban areas. Results: Significant differences exist in the type of outpatient services used by the rural and urban population groups, with those living in rural areas having 3.4 times higher odds of using primary health centers compared to outpatient hospital care. We find that the use of primary health care is pro-poor and that outpatient hospital resources is concentrated among the more affluent section of the population, with this observed inequality consistent across settings but more severe in rural areas. The rural–urban gap in utilization is primarily driven by income and residence in the eastern region, while income-related inequality in utilization is influenced, aside from income, by residence in the central region, household size, and marriage and employment status of the household head. We do not find evidence of significant mean differences in overall utilization or inequality in utilization of inpatient health care services. Conclusions: While the differences in average contacts with health services are insignificant, there are prominent differences in the level of services availed and the associated inequality among rural and urban settings in Bhutan. Besides, while there are obvious overlaps, factors influencing income-related inequality are not necessarily the same as those driving the utilization gaps. Cognizance of these differences may lead to better informed, targeted, and potentially more effective future research and policies for universal health coverage. [ABSTRACT FROM AUTHOR]

Aims Design Methods Results Conclusion Implications for the profession and/or patient care Patient or Public Contribution To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community‐dwelling older adults aged 55 and above using the protection motivation theory scale.A cross‐sectional study.The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy‐five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into ‘faller’ and ‘non‐faller’, employing IBM SPSS version 26.0 for descriptive, independent t‐test, chi‐square, bivariate correlation and linear regressions.A total of 375 older participants were included in the study. Fallers (n = 82) and non‐fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self‐rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities.Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non‐preventive behaviours, leading to a decline in fall protection motivation.These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults.Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty‐five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis. [ABSTRACT FROM AUTHOR]

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

Globally, child labor and maltreatment are considered serious public health concerns. Many child laborers in the informal sector are subjected to psychological abuse and neglect that is often akin to slavery. Our study examined the prevalence of these two forms of maltreatment among child laborers in rural Bangladesh, as well as the associated risk factors. Based on the snowball sampling technique, this study surveyed 100 child laborers employed in agricultural and domestic work in rural areas of the Sunamganj district, Bangladesh. The structured questionnaire utilizes the ICAST-CH instrument. To analyze the data, both simple and multiple linear regression analyses were conducted using two statistical software packages, SPSS and STATA. The study concluded that more than half of the child laborers have experienced psychological maltreatment "sometimes" in the form of being screamed at and insulted over the past year. In the past year, over 40% of respondents indicated they were "sometimes" deprived of food and drink and were not well cared for when they became ill. Multivariate analysis demonstrated that parents of psychologically maltreated child laborers had low educational backgrounds. A higher risk of neglect was observed among child laborers who worked for extended hours for their employers and whose families possessed limited land. In spite of the high prevalence of psychological maltreatment and neglect of child laborers in Bangladesh, the issue appears to be ignored. More comprehensive and rigorous scientific studies are required to bring about policy change. [ABSTRACT FROM AUTHOR]

This study investigated the role of resilience as a mediator and the place of residence as a moderator of parenting stress and parental burnout. The Parenting Stress Index-Short Form, Parental Burnout Assessment, and Connor-Davidson Resilience Scale were administered to 249 Chinese parents of children with ASD (M = 33.95 years, SD = 7.6). Results show that resilience partially mediates the relation between parenting stress and parental burnout. Besides, both the effect of parenting stress on parental burnout and the mediating effect of resilience are moderated by rural/urban residence. This study highlights parenting stress is a risk factor for parental burnout and resilience is the potential mechanism underlying this relation. These findings provide implications for family services for parents of children with ASD. [ABSTRACT FROM AUTHOR]

Regardless of migration of the population from rural to urban areas, traditional knowledge of medicinal and aromatic plants still exists in Bosnia and Herzegovina. An ethnobotanical interview has been conducted in 48 rural settlements. For every cited species, the form of use, useful parts, common name, and application were recorded. At the population level, frequency citation, relative frequency of citation and use value have been studied, in order to determine the significant plants for the local community. The participants use actively 91 plant species from 44 families. The highest number of medicinal plants belongs to the families Lamiaceae and Rosaceae. The respondents use mostly the leaves, followed by inflorescences, roots, fruits, and herbage. Plants are usually applied in the form of infusions, cordials, food supplements, and tonics. Even though the settlements have been affected by mass migration of the population, traditional knowledge related to the use of medicinal and aromatic plants still persists. Respondents over 45 years of age have reported that they know how to use 11 species of useful plants on the average. That average number goes much lower with young respondents up to 25 years of age. A marked decline has been noted in the intergenerational knowledge transfer and 17.53% of the younger respondents have never used any traditional medicine, irrespective of the fact that they can list up to five different plants. The presented results of this research should provide a basis for further investigations and management activities in the ethnobotany of Bosnia and Herzegovina. [ABSTRACT FROM AUTHOR]

The challenges of food security are exacerbated by the world's expanding population and diminishing agricultural land. In response, hydroponic cultivation offers a potentially more sustainable approach to growing nutrient-dense crops compared to traditional methods. Motivated by this understanding, we conducted a series of experiments to explore the behavior of Brassica juncea (Pusa Jaikisan) plant roots under various flow configurations within a controlled environment. The flow configurations considered were no-flow/flow (NF/F), continuous flow, flow/no-flow (F/NF), and stagnation. Additionally, we conducted anatomical sectioning of plant roots to study how different flow configurations affect the cellular structure of the plant root cross section. We also performed numerical simulations to investigate the internal stress generated within plant roots under various flow conditions. We observed that an increased number of cortical cells developed in response to higher internal stress in the case of continuous flow, which protected the inner vascular bundle from excessive biological stress. Comparing the designs, we found that continuous flow resulted in a longer root length compared to the F/NF and NF/F configurations. The root length per unit average flow power was highest for the 2 h F/NF case, followed by the 2 h NF/F, 3 h F/NF, and continuous flow cases. This suggests that periodic flow conditions (F/NF and NF/F) with lower average power, a necessary requirement for economical use, led to longer root lengths. Furthermore, we observed that the nitrogen uptake per unit average flow power was higher for the F/NF configuration compared to continuous flow. Consequently, we infer that in hydroponic cultivation, altering the flow configuration to a F/NF type could be more cost-effective with less nutrient solution wastage, promoting better plant root growth compared to a continuous flow scenario. [ABSTRACT FROM AUTHOR]