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Background: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. Methods: An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. Results: Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. Conclusion: Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals. [ABSTRACT FROM AUTHOR]

The high level of inequality in South Africa has widened the gap between rural and urban schools, and the performance of rural schools has been continuously declining compared to urban schools. Poor performance in rural schools is perpetuated by parents being absent from their children's education because the socio-economic conditions and their educational background do not allow them to commit their time and energy towards education. Learners are left on their own to decide their future. The disparity between rural and urban schooling was further exposed by the COVID-19 pandemic. As schools were closed during lockdown, teaching and learning was suspended in rural schools, however, in urban schools teaching and learning continued through online platforms. The lockdowns gave parents an opportunity to teach, advocate, and create conducive spaces to help their children focus on learning. During lockdowns, parents were expected to act as teachers in their homes to educate their children, and therefore, school closure presented opportunities for parents to actively participate in their children's education. However, their socio-economic conditions and poor educational backgrounds continue to threaten effective parental engagement, posing a threat to the academic success of rural learners. Despite attempts by the government to introduce school governing bodies in schools as a structure to integrate schools and parents, the problem of little parental engagement remains unresolved. The purpose with this study was to empower parents in rural areas to effectively participate in their children's education. [ABSTRACT FROM AUTHOR]

There is an increasing demand for community-based palliative care services in regional Australia, but feasibility and economic benefits are unclear. This study describes the financial components of service delivery, economic viability from a provider perspective, and potential cost-savings from a health service perspective. We used case study methodology and obtained data from the service provider performance measurement data, annual reports, and internal records. Economic viability included an appraisal of all financial activity, cash on hand, total assets, and liabilities from July 2019 to June 2022. Direct service provision data determined the value for money given total costs and outcomes. Annual cost savings due to decreased utilisation of other healthcare services were estimated using case study data and cost estimates from the literature. The service is largely funded by the government (61%) and community donations & fundraising (34%). Applying a conservative cost estimate based on a reduction of healthcare use (hospitalisations and emergency admissions), cost savings are estimated to range from AU$730 000 to AU$980 000 per year for the cohort of n = 160 clients in the last year of life alone. Average costs per person per year of providing palliative care services were much lower for these clients (AU$6194) compared to the national average for in-home (AU$8000) or hospital-based palliative care services (AU$15 373). The case study site is a viable community-based service but is highly dependent on government funding. It provides excellent value for money from a health service perspective and provides cost saving. Future studies should investigate the generalizability of results. [ABSTRACT FROM AUTHOR]

Abstract Background The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. Methods An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. Results Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. Conclusion Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

Abstract Background Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect pregnancy early, but it is not widely available. Our study explored the acceptability and potential of home pregnancy testing delivered by community health volunteers (CHV) on antenatal care initiation in rural Kenya. Methods This study was part of a public health intervention to improve uptake and quality of ANC. Between November and December 2020, we conducted 37 in-depth interviews involving women who tested positive or negative for a urine pregnancy test provided by CHVs; CHVs and their supervisors involved in the delivery of the pregnancy tests; facility healthcare workers; and key informants. Using Sekhon et al.‘s framework of acceptability, the interviews explored participants’ perceptions and experiences of home pregnancy testing, including acceptability, challenges, and perceived effects on early ANC uptake. Data were analysed thematically in NVivo12 software. Results Home pregnancy testing was well-received by women who trusted test results and appreciated the convenience and autonomy it offered. Adolescents cherished the privacy, preferring home testing to facility testing which could be a stigmatising experience. Testing enabled earlier pregnancy recognition and linkage to ANC as well as reproductive decision-making for those with undesired pregnancies. Community delivery of the test enhanced the reputation and visibility of the CHVs as credible primary care providers. CHVs in turn were motivated and confident to deliver home pregnancy testing and did not find it as an unnecessary burden; instead, they perceived it as a complement to their work in providing ANC in the community. Challenges identified included test shortages, confidentiality and safeguarding risks, and difficulties accessing facility-based care post-referral. Newly identified pregnant adolescents hesitated to seek ANC due to stigma, fear of reprimand, unwanted parental notification, and perceived pressure from healthcare workers to keep the pregnancy. Conclusion Home pregnancy testing by CHVs can improve early ANC initiation in resource-poor settings. Mitigating privacy, confidentiality, and safeguarding concerns is imperative. Additional support for women transitioning from pregnancy identification to ANC is essential to ensure appropriate care. Future research should focus on integrating home pregnancy testing into routine community health services.

Abstract Background Sub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region. Aim This study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana. Methods Individual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University’s Research Ethics Committee approved the study protocol prior to data collection. Results Three main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services. Conclusion Nurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers’ perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services.

The current scenario calls for a social transformation in line with what is proposed in the report on the Sustainable Development Goals set out by UNESCO in Agenda 2030. Within this framework, a new paradigm for teaching literature in preservice teacher education is needed. This research proposes an ethnographic case study based on participant observation (Lapassade, 2001) through an extended stay in the context of the study, a municipal library in a rural community that was at a critical juncture. With the aim of revitalising the library and promoting reading among the younger population, while respecting the diversity that characterises this context, the City Council, with the participation of the school's students and their families, set up a reading workshop during the school year based on the wordless picturebook, chosen for its generic specificity (Colón y Tabernero, 2018). The results of the qualitative analysis show that the participants felt welcomed by a reading format that was hospitable to all readers, so that the wordless picturebook contributed to the creation of a narrative community (Han, 2023) in the transformed space of the library, which changed the attitudes of all its members towards reading. [ABSTRACT FROM AUTHOR]

Background: Onchocerciasis, an infectious disease due to Onchocerca volvulus, is endemic in the Centre region of Cameroon and is thought to be risk factor of epilepsy. This study aimed to describe demographic, clinical, diagnostic and treatment characteristics of pediatric epilepsy in onchocerciasis endemic rural setting in Centre region of Cameroon. Patients and Methods: In this cross-sectional health facility-based study in the rural locality of Ntui, in the Center Region of Cameroon, 107 consecutive children diagnosed with epilepsy based on clinical findings were recruited from December 2017 to April 2018. Data collected included sociodemographic data, personal and family history, clinical data, paraclinical, diagnostic and therapeutic aspects. Results: The mean age of children was 12.6 ± 3.8 years. Epilepsy-related family history (84.1%) and parental consanguinity (6.5%) were reported. Generalized tonicclonic seizures were predominant (82.2%) and clinical diagnosis was done in 96.3% of patients. Out of the 21 children examined by medical doctor, only 23.8% of them were consulted by pediatrician and 3.8% had electroencephalogram results. Carbamazepine (57.5%) was the main anti-epilepsy drug administered as monotherapy. Onchocerca volvulus microfilariae were detected in 10.2% (5/49) of children and 19.6% of them received ivermectin. Conclusion: Four over 5 children with epilepsy in Ntui present GTC seizure with more than half of them been on a monotherapy with carbamazepine. About one over ten children with epilepsy was diagnosed with onchocerciasis. Two over 5 patients consulted a traditional healer. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region. Aim: This study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana. Methods: Individual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University’s Research Ethics Committee approved the study protocol prior to data collection. Results: Three main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services. Conclusion: Nurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers’ perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services. [ABSTRACT FROM AUTHOR]

Objective:The pandemic has pushed hospital system to re-evaluate the ways they provide care. West Tennessee Healthcare (WTH) developed a remote patient monitoring (RPM) program to monitor positive COVID-19 patients after being discharged from the hospital for any worsening symptomatology and preemptively mitigate the potential of readmission. Methods:We sought to compare the readmission rates of individuals placed on our remote monitoring protocol with individuals not included in the program. We selected remotely monitored individuals discharged from WTH from October 2020 to December 2020 and compared these data points with a control group. Results:We analyzed 1,351 patients with 241 patients receiving no RPM intervention, 969 patients receiving standard monitoring, and 141 patients enrolled in our 24-h remote monitoring. Our lowest all cause readmission rate was 4.96% (p = 0.37) in our 24-h remote monitoring group. We also collected 641 surveys from the monitored patients with two statistically significant answers. Discussion:The low readmission rate noted in our 24-h remotely monitored cohort signifies a potential opportunity that a program of this nature can create for a health care system struggling during a resource-limited time to continue to provide quality care. Conclusion:The program allowed the allocation of hospital resources for individuals with more acute states and monitored less critical patients without using personal protective equipment. The novel program was able to offer an avenue to improve resource utilization and provide care for a health system in a rural area. Further investigation is needed; however, significant opportunities can be seen with data obtained during the study. [ABSTRACT FROM AUTHOR]

Purpose: Rural community-based organizations (CBOs) serving immigrant communities are critical settings for implementing evidence-based interventions (EBIs). The Implementation Studio is a training and consultation program focused on facilitating the selection, adaptation, and implementation of cancer prevention and control EBIs. This paper describes implementation and evaluation of the Implementation Studio on CBO's capacity to implement EBIs and their clients' knowledge of colorectal cancer (CRC) screening and intention to screen. Methods: Thirteen community health educators (CHEs) from two CBOs participated in the Implementation Studio. Both CBOs selected CRC EBIs during the Studio. The evaluation included two steps. The first step assessed the CHEs' capacity to select, adapt, and implement an EBI. The second step assessed the effect of the CHEs-delivered EBIs on clients' knowledge of CRC and intention to screen (n = 44). Results: All CHEs were Hispanic and women. Pre/post-evaluation of the Studio showed an increase on CHEs knowledge about EBIs (pre: 23% to post: 75%; p < 0.001). CHEs' ability to select, adapt, and implement EBIs also increased, respectively: select EBI (pre: 21% to post: 92%; p < 0.001), adapt EBI (pre: 21% to post: 92%; p < 0.001), and implement EBI (pre: 29% to post: 75%; p = 0.003). Pre/post-evaluation of the CHE-delivered EBI showed an increase on CRC screening knowledge (p < 0.5) and intention to screen for CRC by their clients. Conclusion: Implementation Studio can address unique needs of low resource rural CBOs. An implementation support program with training and consultation has potential to build the capacity of rural CBOs serving immigrant communities to implementation of cancer prevention and control EBIs. Clinical Trials Registration Number: NCT04208724 registered. [ABSTRACT FROM AUTHOR]

An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities. [ABSTRACT FROM AUTHOR]

Abstract Background Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state. Methods Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals. Results The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [

Background The study aimed at determining the prevalence of adherence to routine non-pharmacological interventions such as counseling, diet and regular physical exercises among patients in a rural health facility setting of Uganda. Methodology: A cross-sectional survey design was used to study 328 Patients who had spent at least 2 years with Chronic Illnesses such as Diabetes, HIV and hypertension accessing services at Luweero Health Centre IV. Simple random sampling technique was used to select the patients during visiting hours at the respective clinics from 20th of June 2018 to 20th of July 2018. The data was entered and analyzed using Statistical Package for Social Sciences (SPSS-Version 20). Results: A total of 326 patients with Chronic Illnesses were studied. 236 (72.4%) were having HIV, 54 (16.6%) were hypertensive, 25 (7.7%) were diabetic, and 11(3.4%) were having both HIV and hypertension. The prevalence of adherence to routine counseling is 69.6%, and this is highest among patients with hypertension (81.5%) and lowest among patients with Diabetes ( 56%). The prevalence of adherence to special diet is 71.5%, and is highest among patients with HIV and hypertension and those with HIV alone (91.1%) and lowest among patients with Hypertension (20.4%). The prevalence of adherence to routine physical exercises is 23.0%. This is highest among patients with Diabetes (48%) and lowest among patients with HIV (17.7%). Conclusion: Majority (71.5%) of patients with chronic illnesses adhered to special diet, followed by counselling (69.6%) and only 23% of the patients adhered to physical exercises. Recommendation: The non-pharmacologic interventionists should design and institute group visiting mechanisms especially among patients that are unmarried if routine adherence is to be improved.

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Background: The external auditory canal's unique anatomical characteristics made the presence of foreign bodies (FBs) a clinical challenge, particularly in rural settings without ready access to tertiary care and specialist intervention. Aims: Our study surveys the experience in aural FBs surgical management in a rural Australian tertiary center. It proposes a safe, easy, and affordable technique to remove stones from the ear canal. Methods: We have completed a 10-year retrospective surgical chart review, including 474 patients (52 adults and 428 children) requiring surgical management to remove aural FBs at the Royal Darwin Hospital, Northern Territory, Australia. We surveyed for patient demographics, foreign-body description, complications, location, and removal attempts. We identified what factors determine the need for surgical management and propose a technique for a safe, uncomplicated, and affordable removal of stones from the ear canal after applying this method in a small subgroup. Results: The most common FBs requiring surgery in children were stones. A predominance in the Aboriginal population from remote communities was found, leading to a nasal bridle magnet technique to remove stones in rural settings. This method reduces the number of extraction attempts of the most frequent FB found in children's ears, aiming to minimize complications, negative experiences, and health cost. Conclusion: Contrary to international literature, stones were found to be the most common FB in remote aboriginal populations. The proposed technique reduces the number of extraction attempts of the most frequent FB found in children's ears, aiming to minimize complications, negative experiences, and health cost. [ABSTRACT FROM AUTHOR]

Background: Paradigm shift from communicable to non-communicable disease generated need to study further for non-communicable disease. Hypertension is serious medical condition which can affects other organs of body and can lead to death. The burden of hypertension is felt disproportionately in low- and middle-income countries, where two thirds of cases are found, largely due to increased risk factors in those populations in recent decades. Aims & Objectives: To estimate the prevalence and associated risk factors of hypertension in young and middle-aged population (15-45years) Methodology: A cross- sectional community-based study was conducted in young and middle age population of rural setting of Aliabada village during period of September, 21 to February 2022. Total 246 participants were enrolled in study by simple random sampling from sampling frame of 5431 participants. Principal instrument for data collection was questionnaire form consist of socio-demographic details and risk factors of hypertension. Blood pressure of participants was measured and recorded in data collection form. Data were entered and analyzed in SPSS version 21. Multiple logistic regression was used to identify associated risk factors for hypertension. Results: Prevalence of hypertension was 17.03%. Higher age (AOR: 3.23 CI: 1.19-9.24, p=0.019), High salt intake> 10gms/day (AOR: 5.32 CI: 2.75-21.05, p=0.002), Obesity (BMI >25) (AOR: 0.27 CI: 0.11-0.72, p=0.007), and high stress score (27-40) (AOR:3.69 CI: 1.68-13.52, p=0.001) were significantly associated with increased risk of hypertension. While Gender, Marital status, education, and social class was showed higher odds of developing risk of hypertension suggested by Crude Odds Ratio but this was nonsignificant association. Conclusion: Overall prevalence of hypertension was 17.03%. Age, Salt intake, Obesity and Stress were independent risk factors for hypertension. [ABSTRACT FROM AUTHOR]

This needs assessment study aimed to characterize domains of service needs of persons with developmental disabilities (PDD) and their families. Participants were 96 adults with DD (n = 5), their family members (n = 40), and service providers (n = 31). Seventy-six participants completed a survey on needs (education and early intervention, healthcare, and self-advocacy). Another 20 participants completed focus group interviews (family members, n = 14, service providers, n = 6). Following a descriptive analysis of quantitative data and content analysis of qualitative data, results show very high needs for services in the following domains: (a) training for skills in self-advocacy for persons with DD and their families, (b) healthcare access--health insurance and specialty care access, and (c) access to post-secondary education for persons with DD, and disability-specific education/training for service providers. Implications for rehabilitation services include addressing these needs through transition services with self-advocacy training, post-secondary education preparation, and informational service on healthcare access. [ABSTRACT FROM AUTHOR]

Background: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state. Methods: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals. Results: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [< 45 years aOR 6.17 (3.24–11.76); 45–64 years aOR 2.36 (1.29–4.32)], low- and middle-income [< $50,000 aOR 2.85 (1.32–6.11); $50,000-$74,999 aOR 3.06 (1.50–6.23)], and no health insurance [aOR 3.56 (1.21–10.49)]. Transportation delays were associated with being non-White [aOR 8.07 (1.54–42.20)], no bachelor's degree [≤ high school aOR 3.06 (1.02–9.18); some college aOR 4.16 (1.32–13.12)], and income < $50,000 [aOR 8.44 (2.18–32.63)]. Those who did not have a primary care provider were 80% less likely to have transportation delays [aOR 0.20 (0.05–0.80)]. Conclusions: Delayed care affects more than one-third of Nebraskans, primarily due to financial concerns, and impacting low- and middle-income families. Transportation-related delays are associated with more indicators of low socio-economic status. Policies targeting minorities and those with low- and middle-income, such as Medicaid expansion, would contribute to addressing disparities resulting from delayed care. [ABSTRACT FROM AUTHOR]

This study aimed to determine the experiences of students in remote areas upon their Learning Modality, Modular. The researcher focused on finding out the following: Students ’Most Outstanding Experiences; Challenges Faced by Students; Students' Methods of Solving Their Problems. Descriptive phenomenological is used in the research. Respondents of this study were selected using random sampling. Respondents of this study were from in Juban National High School which consists of 25 Senior high students living in remote areas. Semi-structured questionnaire was used in an interview to gather the needed data. This study finds out students’ experiences in remote areas on their Modular Learning according to the learning modules, internet connection, time, and financial. Absence of knowledge in answering modules, slow internet connectivity, lack of modulation time and finance for transportation and other educational expenses have impact on the learning of the participants during Modular Learning. This study proposed to the Department of Education (DepEd) to provide an adequate funding in the manufacture of learning modules for the effectivity of students’ learning. Provides a better internet connection and time frame are to consider. Wider information, methods and learning are to be shared and discussed to be use by the students in remote areas in the present condition of Education.

An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities.

Abstract Background Attendance of maternal and infant care services in rural Chad are consistently low. Our study aimed to assess the use of antenatal (ANC) and postnatal care (PNC) services, health facility delivery and infant health services after 4 years of a health systems intervention for improving the infrastructure, supplies, training and sensitization for maternal and infant health in two districts of rural Chad. Methods Data from a repeated cross-sectional household survey conducted in Yao and Danamadji in 2015 and in 2018 were analyzed. A stratified two-stage cluster sampling methodology was applied to achieve a representative sample of the rural settled and mobile population groups in the study area. A generalized linear model was applied to determine the health care utilization rates. Multivariate regression models were used to assess the association between the programme intervention and utilization outcomes of selected maternal and infant health services. Results Complete datasets were available for 1284 households at baseline. The endline analysis included 1175 households with complete survey data. The use of at least one ANC amongst pregnant women increased in both settled communities (from 80% in 2015 to 90% in 2018) and amongst mobile pastoralist communities (from 48% in 2015 to 56% in 2018). The rate of home delivery among settled communities and mobile pastoralists changed little between baseline and endline and remained high for both population groups. Individuals that were covered by the health systems intervention were however significantly more likely to attend ANC and less likely to give birth at home. PNC services only showed improvements amongst the settled communities (of 30%). Infants’ reported health outcomes and vaccination coverage considerably improved; the latter especially among mobile pastoralist (from 15% in 2015 to 84% in 2018). Conclusion A combination of health systems strengthening interventions was associated with an increased use of certain maternal and infant health services. However, to facilitate equitable access to and use of health care services in particular in times of increased vulnerability and by certain population groups in hard-to-reach areas, reinforced health education and culturally adapted communication strategies, including gender-specific messaging will be needed over a sustained period.

Play has important benefits for adults' and children's physical health and mental well-being. However, little is known about the factors that deprive both children and adults in rural South Africa of play. Understanding these factors provides a critical step in developing interventions to enhance play as one of the capabilities according to Nussbaum that are necessary to achieve well-being. This study looked at the determinants of adults' and children's play deprivation in rural communities in South Africa using a qualitative exploratory design to guide the collection and analysis of the data. Data were collected through semistructured interviews from a sample of 53 stakeholders and parents who were purposefully selected, and analysed through thematic analysis. The study findings indicated that play deprivation in adults and children is a result of limited or lack of recreational activities, parental factors, unsafe environments, disability and sickness, adults' busy schedules and financial factors in the household which inhibit the capability of playing freely. This ultimately obstructs both adults and young people from yielding the benefits of play. To enhance the playing capability and the well-being of people in rural communities, it is necessary for all the barriers that contribute to playing deprivation at all levels to be alleviated. [ABSTRACT FROM AUTHOR]

While community-based programmes have gained recognition as an effective mental health intervention to improve the well-being and promote quality of life, their implementation remains a challenge. This is attributable to lack of necessary skills amongst professionals who have a responsibility to establish and manage these programmes. This article provides a framework for social workers to develop and implement community-based programmes for rural people with mental illness and their families. The framework was developed from an in-depth literature review and a comprehensive empirical study into the factors that influence the functioning and well-being of people with mental illness and their families at Mashashane, a rural community in the Limpopo Province of South Africa. The article argues that incorporating community inputs in the development of a framework ensures the relevance of the interventions to the identified needs and increases the likelihood of community acceptance. [ABSTRACT FROM AUTHOR]

Background: Research published during the early fentanyl period exposed a growing concern of unwitting fentanyl exposure and a general willingness to use fentanyl test strips (FTS). A paucity of FTS studies over the last several years has restricted our ability to understand FTS use in the late fentanyl era. The South Atlantic FTS Study (SAFTSS) was established to investigate contemporaneous changes in FTS use and drug use behavior among a rural cohort of PWID., Methods: Between June 2021 and March 2022, a total of 541 PWID completed an in-person survey. Baseline survey questions included demographics, socioeconomic characteristics, and drugs used. FTS questions covered lifetime use, past 6-months, and past 30-day use and included reasons for using FTS, levels of access, and confidence testing illicit opioids and stimulants. Multivariable analyses examined significant baseline correlates of lifetime and 30-day FTS use., Results: Overall, more than half (58%; N=315) used FTS in their lifetime. Among lifetime FTS users, almost half (47%) used FTS in the past 6 months and 30% in the past 30 days, with an average of 13 months from last FTS use and the baseline survey. The most common reason for not using FTS was "not having them with me when I use drugs." Less frequent reasons were "I already know it's fentanyl" followed by "FTS take too much time to use." Among past 30-day FTS users, 74% used FTS on heroin, 55% on methamphetamine, and 33% on fentanyl. Consumer confidence using FTS was higher with illicit opioids (66%) but lower for methamphetamine (43%). In both the lifetime and past 30-day models, PWID with FTS use were more likely than non-users to have witnessed an overdose in the past six months (lifetime aOR = 2.85, p<.001; 30-day aOR=2.57, p<.01). Virtually no differences in drug use behaviors were found when comparing past 30-days FTS use to no FTS use. Women (aOR=1.68, p<.05) and non-white PWID (aOR=2.43, p<.05) were more likely than men and white PWID to have used FTS., Conclusions: Declines in FTS use are consistent with what syringe services programs have been signaling for years. Needs assessments to gauge interest in FTS before scaling up can help ensure funding better spent on naloxone and syringes is not allocated to idle FTS. Increased FTS among women and racial minorities presents opportunities for tailored interventions. Recognizing trauma associated with witnessing overdoses as a growing component of the opioid epidemic is a critical first step toward addressing the full spectrum of drug-related harm., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background and Purpose: To determine if any difference exists in safety and outcomes of thrombolytic therapy for acute ischemic stroke administered via telemedicine, based on the subspeciality of the treating neurologist., Methods: We performed a retrospective cross-sectional study using data from our local stroke registry of thrombolytic therapy administered via telemedicine at our rural stroke network over 5 years. The cohort was divided in 2 groups based on the subspecialty of the treating neurologist: vascular neurology (VN) and neurocritical care (NCC). Demographics, clinical characteristics, stroke metrics, thrombolytic complications, and final diagnosis were reviewed. In-hospital mortality and mRS and 30 days were noted., Results: Among 142 patients who received thrombolytic therapy via telemedicine, 44 (31%) were treated by VN specialists; 98 (69%) by NCC specialist. There was no difference in baseline characteristics and stroke metrics between the 2 groups. Compared to NCC, VN had a trend toward higher, but non-significant, sICH (6% vs 1%, P = 0.05). In a logistic regression analysis, correcting for NIHSS, SBP, door-to-needle time, and use of antiplatelet therapy, the type of neurology subspecialty was not independently associated with development of sICH (OR: 0.141, SE: 0.188, P = 0.141). The rate of in-hospital mortality was also similar between VN and NCC (7% vs 5%, P = 0.8). In a model that accounted for stroke severity, no association was established between the type of neurology subspecialty and mRS at 30 days (OR: 1.589, SE: 0.662, P = 0.266)., Conclusions: Safety and outcome of thrombolytic therapy via telemedicine was not influenced by the subspecialty of treating neurologist. Our study supports the expansion of telemedicine for acute stroke patients in rural and underserved areas., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction Heart failure (HF) poses a substantial and escalating medical and economic challenge, marked by significant morbidity and mortality. It stands as the primary cause of hospital admissions among the elderly, contributing significantly to healthcare expenditures in developed nations. Evaluating cardiac and pulmonary function remains challenging, necessitating careful interpretation to mitigate misdiagnosis and inappropriate treatment. Remote monitoring has emerged as a preventive strategy to curb HF-related hospitalizations, emphasizing the importance of early detection of impending acute HF decompensation. Implantable cardiac defibrillators (ICDs) capture various parameters, including heart rhythm, pacing percentages, thoracic impedance, and physical activity. Objective In this study, we aim to investigate the effectiveness of HeartLogic (Boston Scientific, Marlborough, Massachusetts) parameters in accurately distinguishing HF patients from individuals with alternative diagnoses. Methods This cross-sectional study was conducted at Cabell Huntington Hospital, St. Mary's Medical Center in Huntington, West Virginia, between 2021 and 2022. The study involved a retrospective chart review of electronic medical records, approved by the institutional review board, encompassing patients aged >18 admitted with Heartlogic-capable devices. The analysis included demographic variables, admission and discharge diagnoses, length of hospital stays, health literacy index, and thoracic impedance. Results Of the initially included 26 patients, 19 met all inclusion criteria. The demographic profile highlighted a predominantly older population with a male preponderance and a notable incidence of congestive heart failure (CHF). Physiological changes, particularly in thoracic impedance and the HeartLogic Index, demonstrated significant alterations. Logistic regression analysis revealed that changes in health literacy index and thoracic impedance significantly contributed to predicting the change in CHF diagnosis. Conclusion This study, conducted in a rural setting, demonstrates the capability of the HeartLogic algorithm in predicting HF events, providing valuable insights into its utility in diverse clinical environments. The findings emphasize the potential of this technology to enhance diagnostic accuracy and improve patient outcomes. Despite inherent limitations, this analysis contributes unique perspectives, particularly in the context of a specific and underexplored rural population in West Virginia., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Marshall University Joan C. Edwards School of Medicine issued approval 2001324-1. This cross-sectional study was performed at Cabell Huntington Hospital, St. Mary’s Medical Center in Huntington, West Virginia (WV) between 2021 and 2022. The study methodology entailed a meticulous retrospective examination of patients' electronic medical records (EMR). Approval for this study protocol was secured from the institutional review board (IRB) of Marshall University Joan C. Edwards School of Medicine, Huntington, WV (IRB NO: 2001324-1), and a waiver was obtained for informed consent. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zaheer et al.)

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Limited quantitative research has examined similarities and differences between the academic achievement and discipline outcomes, including suspensions, of students with disabilities in rural and urban schools. Therefore, we leveraged a statewide longitudinal data set to explore academic achievement and discipline outcomes for students with disabilities in rural schools and compared those outcomes to students with disabilities in urban schools. We then followed up with analyses to evaluate differences by disability category. The full data set of students in urban and rural schools included 1,306,134 observations from 366,529 unique students with disabilities across 11 consecutive years. We used a series of linear mixed-effects models to evaluate academic achievement for students in Grades 3 to 8 and generalized linear mixed-effects models to evaluate two discipline outcomes, in- and out-of-school suspensions. Overall, we found that students with disabilities in rural schools had lower reading scores, fewer in-school suspensions, and more out-of-school suspensions. Unique patterns across disability categories also emerged. [ABSTRACT FROM AUTHOR]

Throughout history, the practice and persistence of health behaviours and attitudes based on traditional medicine have been observed. To determine whether there are health myths and beliefs in the study population, to describe these myths and beliefs, to determine whether they have persisted over time and to compile the most common myths and beliefs in Sierra de Cádiz. This is a descriptive, observational, cross-sectional study. Our data collection tool was a questionnaire completed by 45 health care professionals in the study area. A total of 73.3% of the population had health-related myths or beliefs, of which 70% resorted to healers and the use of a herpes remedy. This study opens and motivates new research lines and highlights the need to develop educational campaigns and implement health-education programmes in which traditional medicine is involved. [ABSTRACT FROM AUTHOR]

A massive demonstration in Jakarta called "Aksi Bela Islam" (Action to Defend Islam) marks a continuity of the Islamist currents in post-New Order Indonesia. Many observers called it "Islamic populism", a populist, cross-class alliance on behalf of the Islamic masses or "ummah" against capitalist development that has marginalized Muslims in the struggle for access to economic and political resources. However, despite this refreshing approach, many studies on Islamic populism still concentrate on the state (instead of capital) and the urban areas in explaining the development of Islamic populism. This article, therefore, offers a different approach to analyzing Islamic populism through the understanding of capitalism as a social relation and shifts to the countryside as its empirical basis by focusing on the case study of Bulak village in West Java. By combining insights from the literature on agrarian change and populism as a political strategy and adopting qualitative methods namely in-depth interviews (including oral history) and field observation, this article found that contemporary Islamic populism in Indonesia is a result of the specific development of capitalist relations in the context of rural agrarian change. In addition, it also found that Islamic populism is not a phenomenon confined to the urban areas, since it also spreads to the countryside. Moreover, Islamic populism in the countryside has distinctiveness, related to context, social background, and the ways it is mobilized. [ABSTRACT FROM AUTHOR]

Abstract Background Family caregivers are key actors in the ageing society. They are mediators between practitioners and patients and usually provide also essential daily services for the elders. However, till now, few services have been deployed to help caregivers in their care tasks as in improving their mental health which can experience sever burden due to caregiving duties. The purpose of the study is to implement a community-based participatory research project to co-design an innovative organizational model of social services for family caregivers of elderly health consumers living in remote rural areas in Italy. Methods This is a community-based participatory research project in the remote area of Vallecamonica involving four main phases. These included a quantitative analysis of caregiver needs, a scoping review on existing services for caregivers, co-design workshops with local stakeholders and caregivers to create a novel service the piloting and a first implementation of the service and the assessment of project transferability to other contexts. Results As the hours dedicated to elder care increases, both objective and developmental caregiver’s burden significantly increases. Conversely, higher levels of engagement were associated with lower physical and emotional burden, and caregiver engagement was positively correlated with their perceived self-efficacy in managing disruptive patient behaviours. Based on these preliminary results, four co-design workshops with caregivers were conducted and led to the definition of the SOS caregivers service, built on four pillars structured upon the previous need analysis: a citizens’ management board, training courses, peer-to-peer meetings, and project and service information. We found that co-design is an effective means of creating new services for family caregivers, whose experiential knowledge proved to be a key resource for the project team in delivering and managing services. Less positively, the transferability analysis indicated that local municipalities remain reluctant to acknowledge caregivers’ pivotal role. Conclusions A dedicated support service for caregivers can ameliorate caregiving conditions and engagement levels. The service has resulted a successful co-productive initiative for a psycho-social intervention for family caregivers. For the future, we suggest that family caregiver should be considered an active partner in the process of designing novel psycho-social services and not just as recipients to enhance a better aging-in-place process.

Introduction: Programs that have proven to be successful in the prevention of adolescent pregnancy, sexually transmitted diseases and acquired immunodeficiency virus (HIV) are characterized by offering comprehensive care that includes: sex education, promotion of life skills, access to health counseling and family planning. The rural population presents specific social and cultural situations that make it distinctive: low levels of education, accessibility and articulation with sectors, which leads to the development of a different approach by the nurse in the territory. Objective: to describe the nurse's experience in the approach to sexual and reproductive health in young people and adolescents in rural areas. Method: qualitative study with phenomenological approach. Results: four categories emerged: the first one emphasizes sexual and reproductive health education for young people and adolescents, a dynamic approach in rural areas. It is followed by the approach to sexual and reproductive health in rural youth and adolescents. The third involves the construction of the experience in the territory, and the fourth is about the pandemic that redesigned care. Conclusion: nurses must join forces with other stakeholders to enhance activities aimed at the adolescent population in rural areas, for which they must develop skills and get to know the territory in which they intervene in order to understand its worldviews. At the same time, they should rely on differential care strategies, which, according to their experiences, have proven to provide the best experience in sexual and reproductive health. [ABSTRACT FROM AUTHOR]

The service utilisation of persons with dementia (PwD) and their caregivers is subject to lively debate. The reasons for non‐utilisation are manifold and heterogeneous. Conceptual models and explanatory frameworks may help identify predictors of the usage of health services. Literature examining the utilisation of home care services for PwD is scarce. This study explored predictors of home care nursing utilisation of PwD and their informal caregivers in a rural setting, according to the Andersen Behavioural Model of Health Care Use. A mixed‐methods study was conducted in a rural area of Austria. In using non‐random multistage sampling, anonymous questionnaires were distributed to collect data on family caregivers of PwD. Data were analysed using sequential binary logistic regression to characterise home care service users. To reflect the complexity of the Andersen model, a regression tree model was used. In total, 107 family caregivers completed the survey. Predisposing factors for home care nursing utilisation were higher age of the caregiver, female gender of PwD and kinship of the PwD and caregiver. Disruptive behaviour and independence in activities of daily living of PwD were associated with need factors for service use. According to the Andersen model, the predisposing and need factors contributed most to the explanation of home care nursing utilisation. The enabling factors employment, education and income tend to predict service use. Our findings indicate that higher age of the family caregiver and female gender of PwD are the main predictors for utilisation of home care nursing in a rural setting. To improve utilisation, the advantages of professional care services should be promoted, and the awareness about the variety of services available should be increased. To ensure a better understanding of the barriers to accessing home care, PwD should more often be included in healthcare service research. [ABSTRACT FROM AUTHOR]

Abstract Background Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women’s and Children’s Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. Methods We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. Results Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman‘s body and uterus. Further women are advised to conceive soon so that they get rid of infections. Conclusion Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

Background Cardiometabolic diseases pose a significant public health challenge globally, particularly among healthcare workers, who often face heightened occupational stress and lifestyle challenges. This study aims to assess the prevalence of cardiometabolic risk factors and their determinants among healthcare workers at Acharya Vinoba Bhave Rural Hospital, a tertiary care hospital in rural Wardha, Maharashtra, India. Methods A cross-sectional study design was employed, involving the recruitment of healthcare workers from various job roles. Data on demographic characteristics, behavioral risk factors, anthropometric measurements, biochemical parameters, and mental health status was collected using standardized instruments and procedures. Statistical analysis included descriptive statistics, inferential tests, and multivariate analyses to identify significant associations and predictors of cardiometabolic risk factors. Expected results Anticipated findings include a notable prevalence of cardiometabolic risk factors among healthcare workers, including elevated BMI, fasting blood glucose, dyslipidemia, and hypertension. Behavioral risk factors such as physical inactivity, unhealthy dietary habits, tobacco use, and alcohol consumption are expected to be prevalent. Additionally, varying degrees of psychological distress, including depression, anxiety, and stress, are anticipated. Significant associations between cardiometabolic risk factors and demographic variables are expected to be identified. Conclusion The study findings provide valuable insights into the prevalence and determinants of cardiometabolic risk factors among healthcare workers in a rural setting. These insights can inform targeted interventions and public health strategies aimed at improving the cardiovascular health and overall well-being of healthcare workers, ultimately contributing to the enhancement of healthcare delivery and outcomes in rural areas., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Datta Meghe Institute of Higher Education & Research issued approval DMIHER(DU)/IEC/2024/138. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sharma et al.)

Background: The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings., Methods: The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality., Results: Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers., Conclusion: Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement., (© 2024. The Author(s).)

Background: The SARS-CoV-2 pandemic is affecting millions of people living in rural areas of Low- and Middle-Income Countries and is causing an already anticipated devastating effect on the health and economics of these populations. More information is needed to modify behaviors that may counterbalance the consequences of mass spread of the virus in these underserved communities. This study aimed to identify factors associated with a persistent SARS-CoV-2 seronegative status 1 year after a massive infection outbreak in middle-aged and older adults living in rural Ecuador. Methods: Individuals enrolled in the Atahualpa Project Cohort as of March 2020 received 5 rounds of tests for determination of SARS-CoV-2 antibodies in blood. Individuals who remained seronegative up to April 2021 were considered "persistently seronegative." An adjusted Poisson regression model was fitted to estimate the incidence risk ratio of factors directly or inversely associated with a persistent seronegative status. Results: A total of 673 individuals received baseline tests. Thirty-one declined consent or died and 429 seroconverted, leaving 213 seronegative subjects. Average SARS-CoV-2 incidence rate was 9.87 events (95% C.I.: 8.91-10.83) per 100 person-months of observation. The use of flushing toilet systems (instead of open latrines) increased 1.5 times the possibility of remaining seronegative. Likewise, every additional bedroom in the house increased by 15% the possibility of remaining seronegative. In contrast, every additional person in the house and having high cholesterol levels significantly reduced the possibility of remaining seronegative. Conclusions: The use of flushing toilet systems and the number of bedrooms in the house directly influenced the possibility of remaining seronegative among individuals living in this rural setting. Study results also demonstrated a sustained transmission of the virus even after a significant proportion of the population has been infected. Our findings reinforce the mass spread of SARS-CoV-2 in rural communities. [ABSTRACT FROM AUTHOR]

Introduction: The longitudinal integrated clerkship (LIC) curriculum model focuses on patient-centered care and continuity of clinical and cultural learning between medical students, patients, clinicians, and a system of care. In rural settings, participating medical students are expected to have an interest in rural medicine and an involvement in the community. Many schools in the USA, Canada, and Australia have implemented LICs in undergraduate programs in different ways. However, a few published reports in Introduction: The longitudinal integrated clerkship (LIC) curriculum model focuses on patient-centered care and continuity of clinical and cultural learning between medical students, patients, clinicians, and a system of care. In rural settings, participating medical students are expected to have an interest in rural medicine and an involvement in the community. Many schools in the USA, Canada, and Australia have implemented LICs in undergraduate programs in different ways. However, a few published reports in modified LIC was implemented as part of integrated multidisciplinary rural clerkships for fourth-year students, and for fifth-year students undertaking clinical placements. Clinical clerkships in rural settings took place over 12 weeks for fourth-year students and over 14 weeks for fifth-year students. Practical exposure included the clinical areas of internal medicine, psychiatry, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and family medicine, in outpatient and inpatient settings. The DREEM questionnaire was used to evaluate students' perceptions of learning climate. Data analysis was performed to determine the different size of hospitals and other factors associated with a favorable educational environment. Results: The response rate to the questionnaire was 96%. The overall DREEM score average was 137.7/200. Students' perceptions of learning and of teaching had mean scores of 30.1/48 and 35.7/44, respectively. Students' academic self-perceptions scored 18.7/32. Students' perceptions of atmosphere scored 30.4 of 48, and social self-perceptions scored 18.3/28. The academic subscale had the lowest percentage of scores regarded as confidence in knowledge gain. The factors associated with positive educational environment were staff as principal preceptors and large hospitals. Conclusions: LIC implementation in a community health system is a model for expanding clinical clerkships. Good infrastructure of the host hospital and enthusiastic preceptors are the key success factors. Staff supervision is essential to encourage student learning, especially in academic environments. Large hospitals have better infrastructure to support learning processes than small hospitals. Thailand. [ABSTRACT FROM AUTHOR]

Antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were detected in 303/673 rural Ecuadorian adults (45%), 77% of whom had compatible clinical manifestations. Seropositivity was associated with the use of open latrines. Our findings support the fears of mass spread of SARS-CoV-2 in rural Latin America and cannot exclude a contributing role for fecal-oral transmission. [ABSTRACT FROM AUTHOR]

Background: Family caregivers are key actors in the ageing society. They are mediators between practitioners and patients and usually provide also essential daily services for the elders. However, till now, few services have been deployed to help caregivers in their care tasks as in improving their mental health which can experience sever burden due to caregiving duties. The purpose of the study is to implement a community-based participatory research project to co-design an innovative organizational model of social services for family caregivers of elderly health consumers living in remote rural areas in Italy.Methods: This is a community-based participatory research project in the remote area of Vallecamonica involving four main phases. These included a quantitative analysis of caregiver needs, a scoping review on existing services for caregivers, co-design workshops with local stakeholders and caregivers to create a novel service the piloting and a first implementation of the service and the assessment of project transferability to other contexts.Results: As the hours dedicated to elder care increases, both objective and developmental caregiver's burden significantly increases. Conversely, higher levels of engagement were associated with lower physical and emotional burden, and caregiver engagement was positively correlated with their perceived self-efficacy in managing disruptive patient behaviours. Based on these preliminary results, four co-design workshops with caregivers were conducted and led to the definition of the SOS caregivers service, built on four pillars structured upon the previous need analysis: a citizens' management board, training courses, peer-to-peer meetings, and project and service information. We found that co-design is an effective means of creating new services for family caregivers, whose experiential knowledge proved to be a key resource for the project team in delivering and managing services. Less positively, the transferability analysis indicated that local municipalities remain reluctant to acknowledge caregivers' pivotal role.Conclusions: A dedicated support service for caregivers can ameliorate caregiving conditions and engagement levels. The service has resulted a successful co-productive initiative for a psycho-social intervention for family caregivers. For the future, we suggest that family caregiver should be considered an active partner in the process of designing novel psycho-social services and not just as recipients to enhance a better aging-in-place process. [ABSTRACT FROM AUTHOR]

Introduction: the cancellation of elective surgery is still a worldwide challenge and this is associated with emotional and economical trauma for the patients and their families as well as a decrease in the efficiency of the operating theatre. This study aimed at determining the prevalence and factors associated with cancellation and deferment of elective surgery in a rural private tertiary teaching hospital in Western Uganda. Methods: a crosssectional study design was conducted. Data was collected from 1st July 2019 to 31st December 2019. Patients scheduled for elective surgery and either cancelled or deferred on the actual day of surgery were included in the study. Statistical analysis was done using STATA version 15. Results: four hundred patients were scheduled for elective surgery during the study period, among which 90 (22.5%) were cancelled and 310 (78.5%) had their surgeries as scheduled. The highest cancellation of elective surgical operations was observed in general surgery department with 81% elective cases cancelled or deferred, followed by orthopedic department 10% and gynecology department 9%. The most common reasons for cancellation were patient-related (39%) and health worker-related (35%) factors. Other factors included administrative (17%) and anesthesia related factors (9%). Cancellation was mainly due to lack of finances which accounted for 23.3% of the patients, inadequate patient preparation (16.6%) and unavailability of surgeons (15.5%). Major elective surgeries were cancelled 1.7 times more than minor electives surgeries [adjusted prevalence ratio 1.7 (95%CI: 1.07-2.73) and p-value: 0.024]. Conclusion: cancellation and deferment of elective surgeries is still of a major concern in this private rural tertiary hospital with most of the reasons easily preventable through proper scheduling of patients, improved communication between surgical teams and with patients; and effective utilization of available resources and man power. [ABSTRACT FROM AUTHOR]

A sudden increase in adult mortality associated with respiratory diseases was noticed in Atahualpa (a rural Ecuadorian village), coinciding with the introduction of SARS-CoV-2 in the region. From a total of 1,852 individuals aged ≥18 years, 40 deaths occurred between January and June, 2020. In addition, a seroprevalence survey showed that 45% of the adult population have SARS-CoV-2 antibodies. Verbal autopsies revealed SARS-CoV-2 as the most likely cause of death in 29 cases. The mean age of suspected or confirmed SARS-CoV-2 cases was 76.9 ± 12.1 years, while that of those dying from unrelated causes was 60.3 ± 20.4 years (p = 0.003). The overall mortality rate was 21.6 per 1,000 population (95% C.I.: 15.9 – 29.2), almost three-quarters of it due to SARS-CoV-2 (15.7 per 1,000; 95% C.I.: 11 – 22.4). This configures a 266% of excess mortality when compared to 5.9 per 1,000 (95% C.I.: 3.3 – 10.6) deaths from other causes. When SARS-CoV-2 mortality rate was calculated in individuals aged ≥60 years, it raised up to 68.9 per 1,000 (95% C.I.: 47.8 – 98.4). After peaking in April and May, mortality significantly decreased. It is possible that the high proportion of infected individuals and the resulting herd immunity contributed to the observed reduction in mortality.

Little is known about the barriers to HIV status disclosure among HIV-positive women residing in Nigerian rural settings. A qualitative interview study was carried out with 17 women with HIV at a primary care clinic in a Nigerian rural setting. Collected data were thematically analyzed. The results revealed barriers such as the fear of stigmatization which was associated with factors such as socio-cultural factors and residing in rural settings. Further, poor support from HIV-care providers and socioeconomic dynamics were identified as barriers. The implication of findings for theory and practice were discussed. [ABSTRACT FROM AUTHOR]