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Purpose: School recess provides a valuable opportunity for children's daily moderate- to vigorous-intensity physical activity (MVPA). This study aimed to quantify MVPA during school recess in a representative sample of Scottish children and examine whether recess MVPA varied by gender, socioeconomic status, season, urban/rural residency, and recess length. Method: Five-day accelerometry MVPA data were analyzed from 773 children (53.9% girls, 46.1% boys, 10- to 11-y-olds) from 471 schools. Binary logistic regression explored associations between meeting/not meeting the recommendation to spend 40% of recess time in MVPA and the aforementioned risk factors. Descriptive recess data were also analyzed. Results: Participants spent an average of 3.2 minutes (SD 2.1) in MVPA during recess. Girls engaged in 2.5 minutes (SD 1.7) of MVPA compared with 4.0 minutes (SD 2.2) for boys. Only 6% of children met the recess MVPA recommendation. The odds of girls (odds ratio 0.09; 95% confidence interval, 0.04–0.25) meeting the recommendation was lower (P <.001) compared with boys. No statistically significant differences were observed in meeting the recommendation for the other risk factors. Conclusion: Levels of MVPA during school recess are very low in Scottish children, and interventions aimed at increasing MVPA during recess are needed. [ABSTRACT FROM AUTHOR]

In public libraries, especially those in rural settings, it is important that every dime of library funding is leveraged effectively into serving the community. As part of a year-long project beginning in January 2023, we are evaluating item-level cost-effectiveness for each circulating item housed at the public library in Lakeville, Indiana. Through the use of big(ish) data, some custom Python scripting, and machine learning algorithms we hope to answer: How much money is saved by library patrons through their use of the public library's physical collection? How much money is saved by the community through the operation of a public library based on the use of the circulating collection? And are there any non-obvious traits which make an item or title a more or less cost-effective circulating asset? In this column, I will describe the scripts, share initial findings, discuss challenges, and investigate next steps. [ABSTRACT FROM AUTHOR]

Based on the TOE theoretical framework, this paper uses 40 counties in Hunan Province as cases, and applies the fuzzy set qualitative comparative analysis method (fsQCA) to explore the key conditions of the grass-roots government to promote the development of rural e-commerce in terms of the configuration and the sustained path. The study finds that: ① In promoting rural e-commerce development, strengthening organizational planning, optimizing infrastructure, improving market regulation and upgrading the level of management services are the key to the role of grassroots governments. 2 A single element does not constitute the necessary conditions for promoting rural e-commerce development, and the promotion of rural e-commerce development requires the concurrent influence of multiple factors, so the grassroots government should grasp the diversified grouping paths to promote rural e-commerce development. 3 In the multiple paths configuration, the key roles of the grassroots government in providing special e-commerce subsidies, introducing and cultivating e-commerce talents, and preparing e-commerce development plans in the process of promoting rural e-commerce development are highlighted. [ABSTRACT FROM AUTHOR]

Background: There is a critical shortage of registered nurses working in regional, rural and remote Australia. It is the people from these areas that are most likely to address this shortage. This research therefore sets out to explore the question "what is known about the experiences of regional, rural and remote Australian women undertaking a Bachelor of Nursing program delivered online?". Methods: The methodology was an integrative literature review which included: 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis and 5) conclusion. Articles identified as part of the review explored different aspects of the research question. Results: Using thematic analysis, it was possible to extrapolate four interrelating themes: (1) juggling 'women's work' and study, (2) the online learning environment is isolating, (3) the cost of clinical placement, and (4) maintaining overall wellness while studying. Conclusion: The literature consistently failed to explore the intersection of the complex challenges facing these students. What is important about this integrative literature review, however, is that the themes identified provide a small and incomplete insight into the experiences of such women, and with a workforce shortage already in play and students continuing to withdraw from their studies, there is a need to find a way to better serve regional, rural and remote Bachelor of Nursing students and their communities. [ABSTRACT FROM AUTHOR]

Background: China has the largest percentage of people with dementia (PwD) around the world. And most of them are cared for by their family members. The purpose of this study was to identify the quality of life (QoL) of family caregivers of PwD in rural China and to investigate the mediating role of social support between caregiver burden and QoL under the guidance of a stress process model. Methods: This cross-sectional design study in rural areas of Hunan province, China included 150 family caregivers of PwD. The participants completed questionnaires, including the demographic information questionnaire on caregivers and PwD, the caregiver version of QoL in Alzheimer's Disease, the Caregiver Burden Inventory, and the Multidimensional Scale of Perceived Social Support. The demographic factors associated with QoL were subjected to univariate analysis. Pearson's correlations were used to test the relationship among care burden, social support, and QoL. SPSS PROCESS Procedure was conducted to test the hypothesis of mediating effects. Results: The family caregivers of PwD exhibited a fair QoL, with a score of 29.01 ± 4.059. Pearson's correlations revealed the negative correlation of caregiver burden with social support and QoL and the positive correlation between social support and the QoL of family caregivers. The results suggest the mediating role of social support between caregiver burden and the QoL. Conclusion: The QoL of family caregivers of PwD in rural China is suboptimal and indirectly influenced by the caregiving burden through the mediating effect of social support. Strengthening social support networks, both formal and informal, is essential to reducing caregiver burden and improving the QoL of family caregivers of PwD. [ABSTRACT FROM AUTHOR]

Adolescents experience significant growth in social cognition, including perspective taking and identity formation. Due to the salience of race and ethnicity in the United States, adolescents' ethnic–racial identity (ERI) may have important implications for their sociocognitive development. The present study tested the association between ERI in early adolescence and subsequent longitudinal growth in perspective taking. Participants included 560 adolescents assessed annually over 4 years, beginning in sixth and seventh grade. Adolescents were from a small, rural community in the southeast United States and were from diverse ethnic–racial backgrounds (primarily Latine, Black/African American, and multiracial). Using linear growth curve modeling, we examined whether initial ERI predicted intercepts and slopes of longitudinal growth in perspective taking across adolescence. Results showed that the development of perspective taking differed based on initial ERI. Perspective taking increased significantly for youth with low and average levels of ERI but remained high and stable for youth at high levels of ERI. This study offers important evidence that Latine, Black, and multiracial youth who explore and find more clarity in their sense of ERI earlier in adolescence also show higher initial levels of perspective taking, which remains high across adolescence. Over time, most youth grow in perspective taking and eventually reach similar levels, but youth high in ERI reach these higher levels earlier than their peers, who had less sense of clarity about their ERI early in adolescence. This is one of the first known studies to directly test the association between ERI and perspective taking, utilizing a diverse, longitudinal sample of adolescents. Public Significance Statement: This study examines two important aspects of social cognition during adolescence: ethnic–racial identity and perspective taking. Results show that an earlier sense of ethnic–racial identity relates to higher levels of perspective taking over time. As young people navigate the complexities of a racialized social environment and their own place within, they may also be better able to understand the minds and perspectives of others, which may have important implications for their social development and well-being across adolescence. [ABSTRACT FROM AUTHOR]

Dietary diversity has been widely used as a proxy indicator for micronutrient adequacy. In low‐ and middle‐income countries (LMICs), including Rwanda, women are at high risk of inadequate micronutrient intake resulting from poorly diversified diets. This study was conducted to examine the factors associated with women's dietary diversity, with emphasis on homestead production diversity and market access in the Northern Province of Rwanda. A cross‐sectional design was used, involving 606 women aged 18–49 years. Linear regression analyses were performed to examine the association between various factors and women's dietary diversity. Results show that 84% of the sample households raised at least one livestock species. Seventy‐one percent of the households had no agricultural land. Eighty percent of those without land had a homestead garden on which they grew food crops, mainly vegetables and fruit trees. The average crop species was 2.3. On average, women consumed 3 out of 9 food groups. The homestead production diversity score was positively associated with women's dietary diversity score (β = 0.16, p < 0.001). Women's dietary diversity score was negatively associated with distance from the household to the nearest market (β = −0.08, p = 0.027) and household food insecurity (β = −0.06, p < 0.001). Maternal education (p < 0.001), household wealth index (p < 0.05), and ownership of more than 2.5 acres compared to being without land (p < 0.05) were associated with women's dietary diversity score. The dietary diversity of women could be enhanced through interventions that promote the diversity of livestock and crop species produced through homestead production. Potential interventions to explore may include integrated farming systems that combine small livestock and crop production utilising improved livestock breeds and high‐quality seeds and planting materials of high‐yielding varieties of fruits and vegetables, along with rainwater harvesting to facilitate small‐scale irrigation. The impact of such interventions on women's dietary diversity can be further reinforced by parallel programmes aimed at improving women's education and the socioeconomic status of households. Key messages: Homestead food production, maternal education, access to land, and household wealth index are positively associated with women's dietary diversity score in the Northern Province of Rwanda.Women's dietary diversity score decreases as the distance from the household to the nearest market increases and with higher levels of food insecurity.Interventions to promote the diversity of livestock and crop species produced through homestead production can potentially contribute to improving women's access to and consumption of diverse foods. Their impact can be strengthened by complementary programmes that improve women's education, market access, and households' purchasing power. [ABSTRACT FROM AUTHOR]

Low‐ and middle‐income countries shoulder the greatest burden of stunting and anaemia in children. This calls for prompt and effective intervention measures, while the contributing factors are not fully understood. This study evaluates determinants spanning from individual‐, household‐ and community levels including agroecology and antinutrients as unique sets of predictors. Primary data were collected from 660 rural households representing the midland (ML), highland, and upper highland (UHL) agroecological zones from northern Ethiopia. The study relates several predictors to stunting and anaemia in children aged 6–23 months. We found 49.1% and 49.7% of children were stunted and anaemic, respectively. Children living in the ML are approximately twice more likely to be stunted adjusted odds ratio (AOR: 1.869; 95% CI: 1.147–3.043) than in the UHL. The risk of stunting increases by 16.3% and 41.9% for every unit increase in phytate‐to‐zinc and phytate‐to‐iron molar ratios, respectively. A 10% increase in mean aggregated crop yield was observed to reduce the likelihood of stunting occurrence by 13.6%. Households lacking non‐farm income‐generating opportunities, travel longer time to access the marketplace and poor health service utilisation were associated with increased risk of stunting. Low diversity of child's diet, age of the child (18–23 months) and mothers at a younger age are significantly associated with stunting. Risk of anaemia in children is high amongst households with unimproved water, sanitation, and hygiene practices, younger age (6–11 months) and mostly occurs amongst boys. Children in the ML had a 55% reduced risk of being anaemic (AOR: 0.446; 95% CI: 0.273–0.728) as compared to the UHL. Therefore, the influence of these factors should be considered to tailor strategies for reducing undernutrition in children of 6–23 months in rural Ethiopia. Interventions should go beyond the administrative boundaries into targeting agroecological variation. Key messages: Prevalence of stunting and anaemia are significantly varied across the different agroecological zones.A lower aggregated crop productivity and higher molar ratios of phytate to iron or zinc are associated with occurrence of stunting.At the household level, use of health facilities, access to the market, and involvement in non‐farm income lower the risk of stunting, while improved water, sanitation, and hygiene reduces the occurrence of anaemia.Stunting is more common in children aged 18–23 months and with a lower dietary diversity, whereas anaemia is more common in children aged 6–11 months and amongst boys.Interventions should consider these contributing factors and go beyond the administrative boundaries into targeting community‐level contextual variations. [ABSTRACT FROM AUTHOR]

Background: Abortions in India are increasing despite the laws to legalize them. Many abortions are conducted through unsafe practices and are underreported. To determine the prevalence of abortions in women of a reproductive age group in a rural area of Delhi and to determine associated factors. Methodology: A cross-sectional study was conducted among married women in the reproductive age group residing in Barwala village, Delhi/NCR. An interview schedule was used to interview 315 women, and information was obtained for socio-demography, use of contraceptives, medical history, and history of abortions. Chi-square and Fisher's exact test were used for analyzing the association of abortions with other variables. Results: Of all 315 women, 47% had a history of one or more abortions. Of all pregnancies (n = 953), 25.6% ended in abortions (n = 244). Of the total number of abortions reported, 60.7% (n = 148) were induced, while 39.3% (n = 96) were spontaneous. Of induced abortions, only 35% were safe, while 65% were unsafe abortions. Age of mother, age at marriage, history of contraception use, and gender of first child were significantly associated with abortions. However, no significant association was found with socio-economic status, education, and occupation of women and their spouses. Only 1.3% women knew that abortions are legal in India. Conclusion: A high proportion of women are going for induced abortions, of which a greater proportion is that of unsafe abortions. There is also lack of knowledge about the legalisation of abortions in India. [ABSTRACT FROM AUTHOR]

Background: Respectful maternity care (RMC) is increasingly being accepted as an essential element for health systems. Every childbearing woman has a right to get dignified and respectful healthcare. Initial research has highlighted that disrespect and abuse are widespread, however, there is a paucity of quantitative evidence. Materials and Methods: In this community-based cross-sectional study, among 485 participants, conducted in 28 villages of Northern India, we ascertained the experience of RMC during childbirth by using the person-centered maternity care (PCMC) scale. Results: The majority (88.7%) of women experienced RMC. The domain with the lowest score was communication and autonomy (62.9%), followed by supportive care (76.1%). Self-introduction by health providers, the position of choice during delivery, relief from pain, and availability of preferred companions during delivery were the deficient areas. Women who gave birth in private health facilities were more likely to receive RMC than those who gave birth in government facilities, while those belonging to marginalized social groups had lesser odds of receiving RMC as compared to other women. Conclusion: Communication skills should be promoted to maternity care providers. Self-introduction by healthcare providers and choice of position during delivery are the deficient areas, which should be focused upon. [ABSTRACT FROM AUTHOR]

Background: India contributes to the maximum of the world's health burdens attributable to tobacco use. Exposure to secondhand smoke (SHS) is also associated with adverse health effects, causing 1.2 million deaths worldwide each year. In Delhi, 28.0% had SHS exposure at public places. About one-fifth experienced exposure to SHS at workplace. This study aimed to determine the prevalence of SHS exposure among adults in an urbanized village in Delhi. Materials and Method: It was a community-based cross-sectional house-to-house survey conducted between January 2020 and June 2021 in Aliganj, an urbanized village in Delhi. A total of 490 residents ≥15 years were included using simple random sampling. The interview was conducted by the primary author using the Global Adult Tobacco Survey (GATS). Each subject enrolled in the study was explicitly informed of the purpose of the study by the investigator and provided written informed consent before enrolment. Data were checked for errors, entered in Microsoft Excel, and analyzed in Statistical Package for the Social Sciences (SPSS). Results: Of the 490 participants, 14.7% were exposed to SHS in their house and 16.1% were exposed to SHS outside the house in the last 1 month. The majority (85.3%) believed secondhand smoking is harmful, 6.5% disagreed, and the rest were unaware. Conclusion: Though most participants knew that exposure to SHS can cause serious illness, further awareness sessions need to be conducted to improve knowledge and understanding and reduce exposure to secondhand tobacco smoke in homes. Strict adherence to no-smoking policies should be implemented as per law to reduce exposure to SHS in public areas. [ABSTRACT FROM AUTHOR]

Background: Nutrition is an indispensable part of human life. Vitamin A deficiency(VAD) is the most important cause of preventable blindness in young children. It has long been a nutritional problem of public health significance in India and continues to be so. It is estimated that 50,000 preschool children become blind every year owing to VAD, and many of them will eventually die because of increased susceptibility to infections. To estimate the prevalence of clinical forms of vitamin A deficiency among the preschool children aged 1 to 5 years in the community and to determine the risk factors associated with vitamin A deficiency among the children aged 1-5 years. Material and Methods: This community based cross-sectional study was conducted among the pre-school children of RHTC area of a medical college between March 2019 to June 2019, IEC 24/2019. The data obtained was entered in MS-EXCEL 2010 and statistical software Epi info version 7. Results: The prevalence of vitamin A deficiency in our study was found to be 5.59%. On bi-variate analysis, the prevalence of vitamin A deficiency was more among the children belonging to class 4 and class 5 BG Prasad scale and was significant (p<0.05). According to our study grade 2 and grade 3 PEM, Diarrhoeal diseases, measles infection and lack of vitamin A prophylaxis has emerged as independent risk factors. Conclusion: Strengthening of immunization is very important to avoid VAD. Tailor made dietary modifications is very much essential among children, to combat PEM and in turn infections. Sources of vitamin A rich foods and its importance in a daily diet must be emphasized. [ABSTRACT FROM AUTHOR]

Most left-behind children in rural China are raised by their grandparents, whose parenting style significantly impacts children's development. This study examined the association between grandparents' violent discipline and left-behind children's school bullying. This cross-sectional study recruited a sample of 462 left-behind children aged 10 to 15 years old (Age Mean = 12.372, 49.351% girls) from four rural primary and junior high schools in Chongqing, China. There was a significant positive association between corporal punishment (β =.236, p <.001) and psychological aggression (β =.272, p <.001) of grandparents and children's school bullying. Empathy and moral disengagement mediate the above association. Cross-gender comparisons indicated that corporal punishment had a greater positive relationship with school bullying in boys than girls (βgirls =.154, p <.01; βboys =.250, p <.001). At the same time, boys' moral disengagement was also more likely to lead to school bullying (βgirls =.233, p <.001; βboys =.337, p <.001). We discuss the implications of these findings for preventing bullying in schools for children left behind. [ABSTRACT FROM AUTHOR]

This study builds on prior work to describe the experiences of attendees at recovery community centers (RCCs) with improved ecological validity. Brief daily surveys were collected for 10 days from 94 RCC attendees from semi-rural, industrial towns. Participants reported at the end of each day whether they had visited their RCC on that day, how long they spent there, and which of nine activities they participated in while at the RCC. These activities included attending recovery meetings, such as mutual support 12-step meetings, socializing, and volunteering. RCCs were visited on 30.9% of reported days. The modal amount of time spent at the RCCs was 1–2 hours and the most frequently endorsed activity was attending recovery meetings. There was a wide range of intraclass correlation coefficients for activity endorsement (.24–.96), and for the percentage of participants who endorsed each activity (6.8%−69.3%), suggesting that RCCs facilitate individuals' participation in the activities they most need and also provide the flexibility to visit and participate in activities on days that attendees may need additional support. [ABSTRACT FROM AUTHOR]

Purpose: Rural communities face specific challenges when attempting to implement evidence-based interventions, due to their size, distance from knowledge centers, and broad responsibility for the local population. The aim of this study was to investigate the utilization of an RPC (Research Practice Collaboration) initiative as a strategy for translation and implementation of EBPs in rural municipalities seeking to develop their services for individuals with serious mental illness. Materials and Methods: Following a broad invitation consisting of a presentation of the newly produced National Psychiatry Guidelines, to four northern regions in Sweden, four municipalities participated in an RPC process that focused on the implementation of specific EBPs. Results: In addition to confirming many of the challenges in rural areas, the participants reported that the RPC process helped them to understand the relevance of these methods to their own conditions and ambitions. They were able to recognize and build on their already existing strengths and achieve incremental steps toward EBPs. Discussion: The collaborative nature of the structure and knowledge dissemination, requiring extremely tailored implementation strategies while considering the essential components in relation to local conditions, led to increased readiness to implement these practices as locally relevant. Conclusion: Research practice collaborations may contribute to the implementation of EBPs in rural areas by increasing the accessibility and relevance of these methods in these challenging conditions. Identifying structures for sustainably supporting these types of collaborations is a challenge for national actors. [ABSTRACT FROM AUTHOR]

In rural Bangladesh, older adults generally enjoy their role as grandparents and spend their leisure and inactive periods (non-involvement in income-generating activities) with their grandchildren. The life satisfaction of the older adults partly lies in their role-playing as grandparents. The aim of this study was to examine the impact of caring for grandchildren on the life satisfaction of the older adults in rural areas. A survey method was used to conduct the study, and the age of the participants was 60 years and above. Four Mohollas of Kalia Upazilla of Narail district were selected purposively, and 253 older adults (123 male & 130 female) were chosen by using a purposive sampling technique. An interview schedule (containing both open and close-ended questions) was used to collect data in the months of November and December 2018. The findings showed that activities with grandchildren and caregiving roles depended on the age structure, and families with more household income were found to enhance the life satisfaction with grandparenting. There was a significant association between the life satisfaction of older adults and their grandparenting role. By identifying some dimensions of family involvement and socio-demographic conditions, this research aims to provide a deeper understanding of the dynamics of how grandparenting impacts the life satisfaction of older adults in rural areas of Bangladesh. The results might help to minimize the shortfalls of policy regarding the well-being of the older adults by focusing on their social and psychological needs. This will ensure aging is in place for everyone. [ABSTRACT FROM AUTHOR]

Objectives: Evidence-informed population health initiatives often leverage data from various sources, such as epidemiologic surveillance data and administrative datasets. Recent interest has arisen in using area-level composite measures describing a community's social risks to inform the development and implementation of health policies, including payment reform initiatives. Our objective was to capture the breadth of available area-level composite measures that describe social determinants of health (SDH) and have potential for application in population health and policy work. Methods: We conducted a scoping review of the scientific literature from 2010 to 2022 to identify multifactorial indices and rankings reflected in peer-reviewed literature that estimate SDH and that have publicly accessible data sources. We discovered several additional composite measures incidental to the scoping review process. Literature searches for each composite measure aimed to contextualize common applications in public health investigations. Results: From 491 studies, we identified 31 composite measures and categorized them into 8 domains: environmental conditions and pollution, opportunity and infrastructure, deprivation and well-being, COVID-19, rurality, food insecurity, emergency response and community resilience, and health. Composite measures are applied most often as an independent variable associated with disparities, risk factors, and/or outcomes affecting individuals, populations, communities, and health systems. Conclusions: Area-level composite measures describing SDH have been applied to wide-ranging population health work. Social risk indicators may enable policy makers, evaluators, and researchers to better assess community risks and needs, thereby facilitating the evidence-informed development, implementation, and study of initiatives that aim to improve population health. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. There is a wide variation in the curricular emphasis and implementation nationally across programs for teaching quality improvement (QI) in family nurse practitioner (FNP) programs. This variation among curriculum plans often leaves NP graduates unsure as to how to identify and effect change within their organizations. This manuscript describes the development of an initial QI curriculum and subsequent enhancements over a 3-year time frame and outlines the curriculum development process, implementation, and program outcomes within an FNP residency program. This report also focuses on the importance of reinforcing the role of QI within the personal identity of the FNP, ensuring quality care to patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Illicit drug consumption is associated with public health effects and criminal activities. This study aimed to estimate Illicit drug consumption and annual market in the Netherlands from wastewater analysis of drug residues. Methods: Residues of cocaine, amphetamine and 3,4‐methylene dioxymethamphetamine (MDMA) were measured between 2015 and 2022 in 30 Dutch wastewater treatment plants serving both rural and urban populations. These wastewater treatment plants covered 20% of the total Dutch population. The Dutch annual retail market was estimated by extrapolating consumption to the total Dutch population, back‐calculating consumption volume, correcting for drug purity and street price collected in voluntary checking services, and accounting for the correlation of consumption and urbanity. Results: The per capita MDMA and cocaine consumption correlated positively with the urbanity of the wastewater treatment plant catchments with r2 of 31% and 64%, respectively. Amphetamine did not show a significant correlation with urbanity. The three studied drugs were conservatively estimated to cover an average annual market value of 903 (95% prediction interval 829 to 987) million Euro for the studied period. Market estimations from prevalence figures and interceptions of international trade were similar. Conclusions: Illicit drug consumption in the Netherlands appears to correlate positively with urban (in contrast to rural) areas. Wastewater analysis can be used to estimate the volume and monetary value of illicit drug markets as a proof of concept. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence of the effect of limiting off‐premises alcohol trading hours is still scarce. This study tested the effect of a small extension in trading hours on alcohol sales in alcohol monopoly outlets in Norway. Design: The extension of trading hours was implemented within a stepped‐wedge cluster‐randomized trial design. Eligible state monopoly outlets (n = 229) were clustered into trade districts (n = 62), which were block‐randomized to one of three sequences regarding date of implementation: 1 September 2020 (n = 21 districts, 82 outlets), 1 December 2020 (n = 21 districts, 73 outlets) and 1 March 2021 (n = 20 districts, 74 outlets). Outcomes were followed‐up for a 1‐year period. Setting and participants: Study participants were state monopoly outlets in urban and rural trade districts in all parts of Norway. Measurements: Monthly alcohol sales in litres of pure alcohol per trade district and per outlet were measured from March 2020 to March 2022 (primary outcome). We applied a linear mixed‐effect model with two‐way fixed effects within a difference‐in‐difference framework. As a robustness check we considered the effects of cross‐border trade and effects in subgroups of outlets. Trading hours in monopoly outlets were extended by 1 hour on Saturdays. The extension was permanent. Pre‐intervention periods and not‐yet‐treated units served as control conditions. Findings: We did not find a statistically significant effect of the small extension in trading hours on monthly alcohol sales (i) per trade district [average treatment effect: −185.5 litres, 95% confidence interval (CI) = −1159.9, 788.9] and (ii) per outlet (−35.3 litres, 95% CI = −142.1, 72.0). These findings were consistent across estimation methods and model specifications. Conclusion: There is no clear evidence that a small extension in off‐premises trading hours affected alcohol sales in monopoly outlets in Norway. [ABSTRACT FROM AUTHOR]

This study explores how left‐behind children in rural China maintain long‐distance family relationships through WeChat, highlighting the significant role of social media during family separation. It underscores the importance of considering children's voices in understanding family relationships in the digital age. Drawing on online workshops and interviews with 41 participants, the research examines how Chinese left‐behind children use WeChat to facilitate parental engagement and manage their emotions. It also investigates the challenges children face in online communication and their perspectives on grandparental involvement. This article argues that children's agency is situated within structural conditions shaped by a confluence of factors, including technological affordances, unique familial contexts, and socio‐economic inequalities. This situatedness fosters creativity, compromises, and adaptations in 'being family' at a distance. [ABSTRACT FROM AUTHOR]

A paediatric Assistive Technology (AT) Provision Program was implemented by a non-governmental rehabilitation facility in rural South India to support rehabilitation providers in providing needed AT access for children with disabilities. Capacity-building measures for providers and other supports based on the AT needs, barriers, and facilitators to AT access were implemented that aligned with the AT global report for low-middle income countries (LMIC). This study explores how the initiatives from the AT Provision Program have influenced the perspectives of rehabilitation providers on AT access. Using a qualitative design eight paediatric rehabilitation providers were purposively sampled for virtual semi-structured interviews. Findings were analysed using thematic analysis. Six overarching themes were identified: (1) Stigma associated with AT use, (2) Organisational response to changing needs, (3) Financial factors related to family socioeconomic status and the organisation providing AT services, (4) Inequity of AT service access in rural areas, (5) Provider AT awareness and confidence and, (6) Quality assurance. Rehabilitation providers' experiences informed future AT capacity-building strategies within a low-resource context. Our findings provide valuable insights for the development of comprehensive AT Provision Program initiatives to provide AT access for children with disabilities in LMIC settings. IMPLICATIONS FOR REHABILITATION: The perspectives of rehabilitation providers in low- and middle-income countries are important to expand the limited research in understanding Assistive Technology (AT) provision in these countries to advance program development and planning. Organized access to AT in rural communities, particularly in developing countries such as India, enables children with disabilities to improve their participation in social, recreational, and educational opportunities. Exploring rehabilitation providers' perspectives gives insight into barriers and opportunities surrounding AT access within their cultural context, and how it influences their clinical practice. Integrating the AT Access Principle framework from the 2022 WHO-UNICEF Global Report on AT, this study evaluates the current AT systems in rural south India and can further inform strategic planning in low-middle income countries to mitigate access barriers encountered along the AT access pathway. [ABSTRACT FROM AUTHOR]

Nearly 80 % of severe neonatal hyperbilirubinemia cases are identified too late for medical treatment in lower-middle-income countries. Parents' understanding of neonatal jaundice is crucial for early detection and effective treatment. This study evaluated the effectiveness of prenatal sensitization in improving maternal knowledge and attitude toward neonatal hyperbilirubinemia management in Bangladesh. Cluster-randomized trial. Between September 2019 and March 2021, a prospective home-based intervention trial on neonatal hyperbilirubinemia was conducted in 20 interventions and comparison clusters through community health workers (CHW). Participants were pregnant women in their second or third trimester of pregnancy. Proportion-based difference-in-difference (DID) was calculated to determine changes in the mother's knowledge and attitude towards newborn jaundice. A total of 539 pregnant women were enrolled, 273 in the intervention, and 266 in the comparison arm. Following the intervention, participant's overall knowledge level about neonatal hyperbilirubinemia increased significantly (DID: 24.9, 95%CI: 19.2, 30.7) from baseline (33.2 %) to endline (70.5 %). Knowledge of newborn jaundice management showed the most improvement (DID: 60), followed by danger signs detection (DID: 40.0). The intervention also enhanced participants' positive attitudes regarding neonatal hyperbilirubinemia (DID: 13.1, 95%CI: 8.1, 18.0). Mothers with improved knowledge of neonatal hyperbilirubinemia were nearly five times more likely to have a favorable attitude toward it than those with counterparts. CHW-led home-based prenatal sensitization interventions substantially improved mothers' awareness and attitudes toward neonatal hyperbilirubinemia detection and management. Integrating such sensitization into prenatal care of the existing health system could be a practical approach to improve neonatal health outcomes in Bangladesh. [ABSTRACT FROM AUTHOR]

The allocation of resources in elderly care institutions is directly linked to the well-being, quality of life and sustainable development of public health for the elderly. However, a disparity in elderly care resources between urban and rural areas exists. Therefore, this study aimed to explore resource allocation efficiency in China's urban and rural institutional elderly care. Employing a mixed-methods approach, the research integrated quantitative analysis with spatial-temporal assessments to investigate spatial-temporal evolution patterns of resource allocation efficiency. A Projection Pursuit Evaluation Model (PPM) utilising an Accelerated Genetic Algorithm was applied to measure the input and output of urban and rural elderly care institutions. Data Envelopment Analysis (DEA) was used to visualise the static and dynamic efficiency. Spatial analysis techniques determined the spatial evolution of resources. Significant disparities in resource allocation between urban and rural areas were identified, with rural areas facing declining numbers of elderly care institutions despite having a larger ageing population. The efficiency analysis revealed room for improvement in both urban and rural settings, emphasising the need to strengthen management and technology in elderly care institutions. Addressing the challenges of elderly care in China requires policy reform, enhanced government support and stimulation of private investment, particularly in rural areas. A shift towards quality-focused elderly care and strategic investments is crucial for equitable and efficient service provision across China. [ABSTRACT FROM AUTHOR]

To explore the client acceptability and perceived impact of pilot school-based food pantries (SBFPs) and compare client preference between SBFPs and BackPack programs (locally termed Sack Pack) in 3 rural Tennessee elementary schools. A mixed-method design, including cross-sectional surveys (n = 25) and semistructured interviews (n = 11), was used to assess and compare program acceptability. Client satisfaction was uniformly positive for both programs; however, a majority preferred the food quantity (84%), nutritional value (76%), variety (68%), quality (68%), and convenience (64%) of SBFPs. Clients reported feeding more household members with SBFPs (3.9 ± 0.9 vs 3.0 ± 1.0) compared with Sack Pack. When exploring SBFPs vs Sack Pack , 3 primary themes emerged from interviews and were supported by survey data: preferences for different program elements; food acceptability; and SBFP impact and expansion. Findings support continuing SBFPs in rural schools. Studies on expanding the use of trusted and accessible schools as potential healthful food distribution sites are warranted to support broader community food access in rural areas. [ABSTRACT FROM AUTHOR]

Objectives: To explore the rates and timing of a first follow-up visit for children and adolescents with a concussive injury and to identify factors associated with follow-up timing. Methods: A descriptive, correlational design drawing on linked, population-based administrative data of concussed children and adolescents (ages 5–18 years) from the province of British Columbia (BC), Canada. Data were accessed through Population Data BC. Descriptive statistics and binary logistic regression were used to analyze the data. Results: From January 1, 2016 to December 31, 2017, we retrieved 22,601 cases of concussion, of which 19% had an early follow-up visit (N = 4,294), 4.9% had later follow-up (N = 1,107), and 76.1% had no follow-up (N = 17,200). The factors of older age, living in a rural area, higher socioeconomic status, and seeing a specialist physician at an initial concussion diagnosis were more likely to have an early follow-up visit. Conclusion: Early follow-up is important for recovery, but most children and adolescents with a concussion do not receive follow-up in BC. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated telehealth utilization among Colorado Hispanics/Latinos during the COVID-19 pandemic. Methods: A mixed methods design was used with urban and rural patients recruited through two Colorado Federally Qualified Health Centers (FQHCs) serving large Hispanic/Latino communities. Linguistically and culturally adapted Patient Attitudes Toward Telehealth (PATAT) surveys were collected electronically. Semi-structured interviews were conducted with a purposeful sample of Spanish-speaking Hispanics/Latinos. Results: Although the FQHCs serve a Hispanic/Latino population, only 40% of survey respondents (82/204) were Hispanic/Latinos, and they reported less telehealth utilization (p <.01). Trust in telehealth seemed driven by previous use, with no differences in PATAT scores by ethnicity or geolocation. Interviews with Spanish-speaking Hispanics/Latinos showed they highly preferred in-person care, and factors that influenced telehealth utilization were situated within the intersection of culture and trust with socio-structural determinants of health. Discussion: Resolving disparities in telehealth utilization requires patient-centric approaches and equitable transcultural care for underserved Hispanic/Latino populations. [ABSTRACT FROM AUTHOR]

Introduction: We used an implementation science framework to investigate perceived health inequities in preventive health care initiatives in rural communities in the Philippines. We also identified health equity–focused quality improvement strategies. Methods: Three health care providers and 12 barangay clinic patients were interviewed. Results: Patient interviews showed that social determinants of health, respect, and attitudes toward health care providers affected patient empowerment to engage in self-management for noncommunicable diseases (NCDs). Health care providers identified six challenges in managing NCDs: (a) inefficient work processes; (b) staffing shortages; (c) insufficient access to low-cost medications; (d) inadequate primary preventive health education from the schools; (e) health care not considered a priority; and (f) lack of local government support. Discussion: Inadequate preventive health care and education intensify health access and resource inequities in rural communities in the Philippines. A multi-sectoral plan may improve rural health infrastructure and education toward improving health care access and decreasing care disparities. [ABSTRACT FROM AUTHOR]

Objective: Assess university students' SARS-CoV-2 antibody seroprevalence and mitigation behaviors over time. Participants: Randomly selected college students (N = 344) in a predominantly rural Southern state. Methods: Participants provided blood samples and completed self-administered questionnaires at three timepoints over the academic year. Adjusted odds ratios and 95% confidence intervals were estimated from logistic regression analyses. Results: SARS-CoV-2 antibody seroprevalence was 18.2% in September 2020, 13.1% in December, and 45.5% in March 2021 (21% for those with no vaccination history). SARS-CoV-2 antibody seroprevalence was associated with large social gatherings, staying local during the summer break, symptoms of fatigue or rhinitis, Greek affiliation, attending Greek events, employment, and using social media as the primary COVID-19 information source. In March 2021, seroprevalence was associated with receiving at least one dose of a COVID-19 vaccination. Conclusion: SARS-CoV-2 seroprevalence was higher in this population of college students than previous studies. Results can assist leaders in making informed decisions as new variants threaten college campuses. [ABSTRACT FROM AUTHOR]

Objectives: Coordinated care plans (CCPs) for high-cost health care system users aim to improve system-level performance. We evaluated health care resource use and costs among CCP patients (enrollees) versus a control group that did not receive coordinated care (comparators) in Southeastern Ontario. Methods: A difference-in-differences analysis of a quasi-experimental, double propensity score-matched and adjusted cohort was conducted. Linked population-based administrative data were used to measure health care utilization and costs and to identify comparators for two enrollee groups who began CCPs between April 1, 2013, and March 31, 2019. Enrollees were recruited from hospitals in Quinte or community care centres in Rural Hastings/Thousand Islands, and were 1:1 propensity score matched to comparators. Difference-in-differences estimates were calculated using generalized estimating equations for hospitalization rates, homecare visits, primary care visits, other health care resources and total costs. Results: A total of 558 enrollees in Quinte and 538 in Rural Hastings/Thousand Islands were identified and matched to comparators. Difference-in-differences estimates were significant in both enrollee groups for number of homecare visits ([IRR 1.72; 95% CI (1.44, 2.06)] and [IRR 1.73; 95% CI (1.45, 2.06)], respectively). Number of primary care visits were 1.76 times greater for Rural Hastings/Thousand Islands enrollees versus comparators [IRR 1.76; 95% CI (1.32, 2.35)]; total costs increased by 23% ([IRR 1.23; 95% CI (1.09,1.39)]. Conclusions: Homecare use significantly increased for enrollees versus comparators, indicating specific priority areas of Ontario CCPs were met. However, no reductions were shown for other health system performance indicators. We also showed increased 7-day primary care follow-up visits for community care centre-recruited patients, but not for hospital-recruited patients. Decision-makers may wish to target patients who are less advanced in their chronic disease trajectory. [ABSTRACT FROM AUTHOR]

Despite the clear efficacy and appeal of naturalistic developmental behavioral interventions for families of young children, they are often difficult for families to access due to the limited availability of trained service providers. In recent years, telehealth has emerged as an effective tool for overcoming issues related to access, especially in rural and underserved communities. However, while telehealth offers a strategy to connect with families, it does not address the limited availability of trained providers. In this article, we provide an overview of a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while building the capacity of early intervention providers. Through this model, expert consultants connect to caregivers and providers via telehealth to provide information and coaching over a limited series of visits. Collectively, child, caregiver, and provider outcomes support the effectiveness, acceptability, and feasibility of this model while demonstrating that services can be provided successfully to diverse participants. Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention–based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented including information on the role of healthcare system in supporting the workforce, the need for the healthcare organization to streamline a patient-centered approach and the implementation of moral distress consultation services.

Background: India is a country with diverse religious and cultural practices instigating skin diseases which may be missed due to lack of awareness. Contact dermatitis (CD) to lac is not uncommon yet an underreported entity. Objectives: To study clinical patterns of allergic CD due to lac bangles and to assess common contact allergens. Methodology: A retrospective study was conducted after approval by an ethical committee. Out of 850 patients attending the CD clinic from January 2021 to December 2022, the prevalence of CD lac bangles was 40 (4.7%). After obtaining consent, the history of sites, duration, morphology, and DLQI were recorded from patients' medical records. Patch testing with Indian standard series (ISS) and raw lac powder mixed with control was done. Results: A total of 40 females were evaluated. The mean duration between contact and first symptom was 14.8 ± 10.43 months. Morphology was dry eczematous in 18 (45%), lichenoid in 10 (25%), oozy eczematous in 5 (12.5%), urticarial in 5 (12.5%) and vesiculobullous in 2 (5%) patients. In 14 (35%) females, lesions were disseminated. In 12 (30%) females, CD to bindi (4), lipstick (1), Sindhoor (5), rings (1), and plastic slippers (1) were associated. The mean DLQI was 19.37 ± 3.4. Patch test results were positive with ISS allergen epoxy in 9 (22.5%) patients, nickel in 6 (15%), cobalt in 6 (15%), paraphenylenediamine in 5 (12.5%), and lac in only 2 (5%) patients. Conclusion: Data observed in the present study suggests that CD to lac is a distinct clinical entity. Low positivity with lac in patch test proposes the need for standardized testing material. [ABSTRACT FROM AUTHOR]

The menopausal transition is regarded as the critical window where midlife women experience various health challenges having debilitating impact on their wellbeing. The present cross-sectional study intends to assess cognitive outcome with changing hormonal milieu during menopausal transition and related symptoms in midlife and beyond. For this purpose, cognitive performance of women and menopausal symptoms were studied on the sample of 320 women ranging in age from 45 to 60 years. Data collection was carried out by purposive sampling method from rural areas of Haryana from March 2021 to January 2023. Findings of the study demonstrated a successive downward trend in the mean scores of orientation to time and place, registration, attention, recall, as well as language and visual spatial skills cognitive domain from premenopause to late postmenopause stage. Multivariate logistic regression analysis (adjusted for age and educational status) identified severe menopausal symptoms, i.e. heart beating quickly or strongly, difficulty in sleeping, feeling tired, feeling unhappy or depressed, and sexual dysfunction as the potential determinants of poor functioning of different cognitive domains among women transitioning menopause and beyond. Hence, it was observed that cognitive decline during menopause transition and beyond is sensitive to severe menopausal symptoms. [ABSTRACT FROM AUTHOR]

Objective: The aim is to explore the role of anthropometric traits and sociodemographic characteristics on human survival. Methods: Anthropometrics and sociodemographic data of 1944 conscripts born in the first decade of the 20th century in rural municipalities of Calabria (Southern Italy) who underwent medical examinations for military service were collected. Medical examinations were linked to individual survival data. Results: Height and type of occupation influenced life expectancy. For taller men, the risk of mortality increases by about 20% when compared with men with middle height, while farmers exhibited a significant survival advantage compared to those with other working experiences. Discussion: Height and type of occupation were associated with human mortality. These results are likely to be related to the effect of healthy dietary patterns and physical activity on life expectancy. Further studies are needed to understand to what extent these results obtained in a rural context can be generalized to other contexts. [ABSTRACT FROM AUTHOR]

Objectives: NHS England publishes monthly national and regional estimated dementia diagnosis rates (DDR) to assess the healthcare system's effectiveness in identifying dementia cases. Previous research indicates that sociodemographic factors, such as ethnic minority status, socioeconomic deprivation, and rurality, influence both healthcare quality and dementia risk. This study aimed to examine the association between these sociodemographic factors and DDR, and to estimate an ethnicity-adjusted DDR using available ethnic group data. Method: We analysed NHS Digital Primary Care Dementia Data electronic health records for July 2023. We used a linear regression model to determine the association between DDR and ethnicity, deprivation, and rurality factors using local authority region level data. We also adjusted the DDR at the level of sub-integrated care boards based on previously published odds ratios of dementia diagnosis by ethnic group. Results: Regression modelling revealed that areas with higher proportions of minority ethnic groups and greater rurality had lower DDRs. Conversely, higher levels of deprivation were linked to higher DDRs. After adjusting for different odds ratios for dementia in minority ethnic groups, the national DDR decreased by 1%, with regional diagnosis rates dropping by up to 5.4%. Conclusion: Higher regional proportional ethnic minority population and greater rurality were associated with a lower DDR which might reflect poorer access to diagnostic services. Higher deprivation levels were associated with a higher DDR which might reflect higher rates of dementia in more deprived populations. We discuss measures to improve the accuracy and utility of the DDR, with a specific focus on ethnicity. [ABSTRACT FROM AUTHOR]

A primary goal of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection against health care costs and alleviate the financial burdens of rural residents in China. This article examines whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above). The analysis utilized data from the 2007 China Household Income Project survey in rural areas and an instrumental variable estimation method in Anhui and Sichuan provinces, which exhibited heterogeneity in the NRCMI implementation schedule. The results show that NRCMI participation was not associated with changes in the CHE incidence among families. The finding is consistent with the prior literature using quasi-experimental study designs. This study provides empirical evidence for policymakers, highlighting that the impact of NRCMI participation on financial protections is limited despite its extensive population coverage. The limited effects are probably due to the low reimbursement rate and increased utilization of expensive health care services. [ABSTRACT FROM AUTHOR]

Background: While numerous studies have explored sociodemographic disparities in accessing maternity care in Pakistan, there remains a paucity of knowledge regarding the continuum of maternity care and the unequal access between urban and rural areas in the country. Thus, this study aimed to bridge this gap. Methods: We performed a secondary analysis using data from the Pakistan Demographic Health Survey (2017-18), stratifying by urban and rural residents. Poisson regression was employed to discern the sociodemographic factors associated with three crucial aspects of maternity care: adequate antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC), as well as the completion of the continuum of care (CoC). Additionally, path analysis estimated the relationship between adequate ANC, SBA, and PNC along the pathway of ongoing maternity care. Results: The results indicated higher education, wealth, living in ICT region, mobile phone ownership, internet use, TV viewership, and newspaper reading increased the likelihood of receiving ANC, SBA, PNC, and completing CoC. Conversely, higher parity, living in Baluchistan/FATA regions decreased the likelihood of receiving ANC, SBA, PNC, and completing CoC. Adequate ANC increased the likelihood of SBA, PNC, and completing CoC. However, SBA did not impact PNC along the care pathway. Conclusion: Regardless of place of residence, higher levels of education and wealth, as well as access to mass media, were found to be the most significant determinants of receiving adequate ANC, SBA, PNC, and completing CoC and should be prioritized in future policy making in Pakistan to enhance the maternal and child health. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare workforce shortages, particularly in rural areas, present a global challenge. The purpose of this study is to explore the leadership dynamics within federally qualified health centers (FQHC) in rural Oklahoma, focusing on recruitment, retention, job satisfaction and development practices. Design/methodology/approach: Eighteen managers with five or more years of tenure from Oklahoma FQHCs were interviewed. Leadership's role in influencing job satisfaction, recruitment, retention and development practices was analyzed using a multilevel ecological framework through qualitative content analysis with NVivo. Findings: The analysis includes ten key themes including the critical role of leadership in addressing recruitment and retention challenges, the importance of aligning organizational culture, rural culture, access challenges, trainings and values with workforce development initiatives, and the impact of leadership practices on job satisfaction. Originality/value: This study uniquely examines leadership strategies in rural FQHCs, integrating ecological considerations for cultural, logistical and community-specific factors. It emphasizes the pivotal role leadership plays in shaping workforce development. As rural healthcare evolves, refining these approaches is crucial for addressing workforce challenges, improving healthcare access and ensuring that rural FQHCs remain sustainable, driving positive outcomes for healthcare professionals and communities. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to formulate a consensus on primary care physicians' leadership competencies tailored to Indonesia's rural and remote health systems using the LEADS framework. Effective physician leaders are essential in these settings; however, many physicians lack the necessary leadership qualifications due to insufficient training. From a medical education perspective, this issue is further compounded by the lack of consensus on leadership course content. Design/methodology/approach: The study used a mixed-method approach with a concurrent triangulation strategy. Concurrently, a two-round Delphi study and qualitative interviews were conducted. The Delphi study involved academics, rural and remote primary care physicians, intern doctors (similar to house officers), clerks and medical students and used descriptive analysis. Semi-structured interviews, guided by an interview guide, were analysed using inductive thematic analysis. Findings: From the initial 62 LEADS framework statements, the authors identified 52 physician leadership attributes in round 1 and 41 attributes in round 2. Qualitative interviews revealed three main themes: the significance of physician leadership, the physician leadership curriculum and its potential and impact. Originality/value: The study established consensus and provided scholarly insights into the leadership development necessary for primary care physicians in rural and remote areas. This is essential for developing Indonesia's medical leadership curriculum, with the ultimate goal of improving health outcomes in these settings. [ABSTRACT FROM AUTHOR]

Lack of access to menstrual products, menstrual hygiene, and education, also known as period poverty, is a widespread issue and disproportionately impacts low-income, rural, Black, Latinx, Indigenous, and People of Color. Period poverty along with period symptoms, such as heavy and painful periods, contribute to school absenteeism impacting school connectedness and student success. The purpose of this article is to bring awareness to period poverty and encourage school nurses to intervene in individual schools, communities, and far-reaching policy spaces utilizing their expertise to secure resources. School nurses can assist in implementing interventions throughout the school year to increase student engagement, success, and overall menstrual health wellness. Through added engagement of stakeholders such as student groups, school staff and administrators, and community organizations, school nurses can help shift the narrative from a position of oppression around menstrual health to a position of empowerment. [ABSTRACT FROM AUTHOR]

Introduction: Previous research has suggested a link between the onset of Alzheimer's disease (AD) and metabolic disorder; however, the findings have been inconsistent. To date, the majority of metabolomics studies have focused on AD, resulting in a relative paucity of research on early-stage conditions such as mild cognitive impairment (MCI) underexplored. In this study, we employed a comprehensive platform for the early screening of individuals with MCI using high-throughput targeted metabolomics. Method: We included 171 participants including 124 individuals with MCI and 47 healthy subjects. Univariate statistical analysis was conducted using t -tests or Wilcoxon rank-sum tests, with p -values corrected by the Benjamini-Hochberg method. The screening criteria were set at FDR < 0.05 and fold change (FC) > 1.5 or < 0.67. Multivariate analysis was performed using orthogonal partial least squares discriminant analysis (OPLS-DA), where differential metabolites were identified based on variable influence on projection (VIP) scores (VIP > 1 and FDR < 0.05). Random forest analysis was used to further evaluate the ability of the metabolic data to distinguish effectively between the two groups. Results: A total of 14 differential metabolites were identified, leading to the discovery of a biomarker panel consisting of three plasma metabolites including uric acid, pyruvic acid and isolithocholic acid that effectively distinguished MCI patients from healthy subjects. Discussion: These findings have provided a comprehensive metabolic profile, offering valuable insights into the early prediction and understanding of the pathogenic processes underlying MCI. This study holds the potential for advancing early detection and intervention strategies for MCI. [ABSTRACT FROM AUTHOR]

Background: Health-promoting lifestyle behaviors are self-initiated behaviors that focus on life promotion through lifestyle which consists of different aspects to enhance the level of well-being. The lifestyle adopted during pregnancy has a long-term effect on the health and life quality of both mother and child. Purpose: This study aimed to assess predictors of health-promoting lifestyle behaviors among pregnant women of Siyari Rural Municipality, Rupandehi. Methods: A community-based cross-sectional analytical design was carried out in Siyari Rural Municipality, Rupandehi, Nepal. The research was conducted from March to August 2023 and the data was collected from 15th June to 15th July 2023, among 229 pregnant women. A probability proportionate sampling technique was implemented to select total participants and a pregnant was selected randomly. With ethical approval from Pokhara University, the IRC, and maintaining all ethics face-to-face interviews were conducted using a pretested structured questionnaire. Health-promoting behavior was measured using Lifestyle Profile II (HPLP-II) consisting of 6 elements health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Data was entered into Epi-Data 3.1 and analyzed using IBM SPSS Statistics 26. Results: The mean score of health-promoting behavior was 123.09 ± 13.34, and 72.9% of participants had a moderate level of health-promoting lifestyle behavior. Subscale scores showed low scores in physical activity 8.79 ± 1.66 and stress management 15.13 ± 2.09. Ethnicity (AOR: 0.09; 95% CI 0.03–0.29) and education level of the participant (AOR:0.09; 95% CI 0.01–0.66) were the greatest predictors of health-promoting lifestyle behavior among pregnant women. Conclusion: Pregnant women had moderate levels of health-promoting behavior with low scores in physical activity and stress management so the government of Nepal should enhance a balanced approach that includes prenatal exercise counseling, stress management programs along with nutrition, health checkups, and social relationships that directly lead to better pregnancy outcomes. Ethnicity and education of the participant were the greatest predictors of health-promoting lifestyle behaviors so these predictors should be properly focused on individual and health system levels to improve health-promoting behaviors during pregnancy. [ABSTRACT FROM AUTHOR]

Background: In China, although policies promoting physical-medical integration have received widespread national attention, the existence and manifestation of health equity promotion within these policies still require further exploration. Methods: This study used text analysis to examine 62 policy documents on physical-medical integration issued by various Chinese governmental departments from June 2016 to June 2023, utilizing KH Coder software for qualitative analysis. Results: The analysis revealed a strong emphasis on public health, promoting health management and disease prevention across all age groups. The policies aimed to ensure the equitable distribution of health care resources, particularly those benefiting rural and underserved populations, and they underscored the importance of collaboration among the government, sports, and health care sectors to foster sports-health integration. Conclusion: The integration of sports and health policy is a key initiative to address chronic diseases in China, as it aligns closely with health equity principles. Achieving these goals requires ongoing improvements in implementation and monitoring, with a focus on the diverse needs of various populations. [ABSTRACT FROM AUTHOR]

Background: Adverse health conditions are believed to reduce one's quality of life (QoL). However, the impact of common lifestyle-related conditions like hypertension, obesity, and diabetes on the QoL in rural communities in India remains largely unexplored. This study aims to understand the impact of hypertension, diabetes, and obesity on the QoL in rural Punjab, India. Methods: This cross-sectional study was conducted among 931 individuals of both sexes, aged 20–75 years, in the Mansa district of Punjab, India. Sociodemographic data were collected by using a pre-tested interview schedule. Somatometric measurements, blood pressure (BP), and fasting glucose were measured using standard protocols. QoL was evaluated using WHOQOL-BREF. Results: Individuals with already-diagnosed hypertension were at a significantly higher risk of poor QoL, both overall and specifically in the psychological and social relationships domains than those with normal BP. Underweight individuals exhibited a greater risk of poor QoL in the physical health domain compared to those with normal weight. Additionally, individuals with diagnosed diabetes were at an elevated risk of poor QoL in the psychological health domain compared to non-diabetics. However, neither general nor central obesity, nor newly screened cases of hypertension and diabetes (individuals who were previously unaware of their conditions), showed a significant impact on QoL. Conclusions: The study suggests that the diagnosis of hypertension and diabetes, rather than the mere presence of these conditions, may be associated with poor QoL. Counseling and awareness post-diagnosis may help reduce the effects of diagnostic labeling and counter misinformation. [ABSTRACT FROM AUTHOR]

Background: How common it is with the presence of human papillomavirus (HPV) in the healthy and diseased oral cavity is largely unknown for Africans. In this cross-sectional study we assessed the prevalence of oral HPV and the risk factors associated with HPV contraction including sexual practice in the urban and rural Zambian population. Methods: Urban (N = 188) and rural (N = 211) Zambian adults aged 21 years and older living in Ndola and Mansa, respectively, were interviewed about demographical data, oral and coital sexual history and tobacco and alcohol use. Participants were orally examined and underwent a buccal swab test for 12 high-risk HPVs (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) and two low-risk HPVs (HPV6 and 11) with real-time PCR. Results: Alcohol consumption was higher in urban participants than rural participants, i.e., 34.1% and 16.6%, respectively, consumed alcohol once a week or more (p = 0.001). Ever-smokers constituted 38.8% of urban and 32.2% of rural participants (p = 0.363). Engaging in orogenital sex was uncommon, however, more common in urban than rural participants (13.3% and 4.3%, respectively, p = 0.003). Only three participants were positive for HPV (HPV16, 35, and 45, respectively). Conclusions: Urban participants displayed higher sexual risk behaviour than rural participants. However, the prevalence of oral HPV infection in Zambia was low, which contrasts to the high incidence of cervical cancer reported for the country. [ABSTRACT FROM AUTHOR]

Tele-rehabilitation is a viable method to address healthcare access difficulties in rural parts of Africa. It involves offering remote rehabilitation services using digital technologies. This systematic review assesses the efficacy, implementation obstacles, and technological prerequisites of tele-rehabilitation programs in various environments. Evidence suggests that tele-rehabilitation has a substantial positive impact on patient outcomes, such as enhancing functional recovery and improving quality of life. Additionally, it provides cost-saving advantages by reducing the necessity for travel. Nevertheless, it is important to tackle obstacles such as technological constraints, digital literacy, and data security in order to guarantee the effective execution of the plan. It is essential to have culturally sensitive techniques and comprehensive training for healthcare providers in order to optimize the effectiveness and acceptance of these services. Future studies should prioritize investigating the long-term effects, optimizing the technology used, and integrating tele-rehabilitation programs with current healthcare systems in order to improve their sustainability. Trial registration: PROSPERO CRD42024611266. [ABSTRACT FROM AUTHOR]

Background: High unmet need for family planning combined with other factors, such as high early marriage and teenage pregnancy, increases the risk of developing obstetric fistula and other complications. This study aimed to assess spatial distribution and urban–rural disparities of unmet need for family planning among married/in-union women in Ethiopia. Methods: The study was conducted on secondary data from a cross-sectional survey that was conducted nationally between September and December 2019 using a two-stage cluster design on a total of 265 enumeration areas. A total weighted sample of 5,349 married/in-union women was included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Finally, multivariable decomposition analysis via a logit model was used to decompose the observed difference in unmet need by the compositional difference and the difference in effects of explanatory variables between places of residence. Results: Spatial distribution of unmet need for family planning was clustered in Ethiopia with a global Moran's I index value of 0.25 (p -value = 0.004). Accordingly, enumeration areas in West Hararge, Arsi, Bale, Gujji, Borena, Jimma, and East Wellega zones of Oromia region, and Gurage, Hadiya, Silte, Gedio, Sidama, Wolaita, Alaba, and Dawro zones of South Nation and Nationality People region, and the southern part of Zone 3 in Afar region were detected as hotspot areas. The decomposition results revealed that there is a significant disparity in unmet need between urban and rural resident women (0.074, p -value < 0.001). Endowment and coefficient factors accounted for the urban–rural disparity, contributing 68.32% and 31.68%, respectively. Household size, husband's opinion of family planning, community acceptance of family planning, woman's age at first sexual intercourse, and the woman's age were key determinants of the urban–rural disparity. Conclusion: The results revealed a significant disparity in the unmet need for family planning based on place of residence, with a clustered spatial distribution across the study area and notable hotspot areas. Thus, targeted interventions should focus on mobilizing resources to high-risk areas and addressing the needs of high-risk groups to reduce the observed variation. [ABSTRACT FROM AUTHOR]