Peer effects on the adoption of biogas in rural households of Sichuan Province, China

Encouraging rural residents to adopt biogas is of great practical significance in tackling environmental degradation in China. Based on the survey data of 540 rural households in Sichuan Province, China, this paper studies the peer effects of biogas adoption in rural households, focusing on the influence of relatives and friends on the biogas adoption behavior of rural households. According to whether there is a Chinese New Year visit, the relatives and friends of rural households are divided into strong ties and weak ties. The peer effects are further discussed from the perspective of strong and weak ties, and the probability score matching (PSM) method is used to correct the estimation errors that may be caused by selection bias. In addition, the study further revealed the internal mechanism of peer effects through heterogeneity analysis. The results found that (1) the adoption of biogas by relatives and friends significantly promotes the adoption of biogas in rural households. (2) Compared with relatives and friends who did not visit during the Chinese New Year (weak ties), relatives and friends who visited (strong ties) had a more significant impact on the biogas adoption behavior of rural families. (3) Farmer groups with lower education levels and farther from the market are more affected by the peer effects and are more likely to adopt biogas. The driving effect of biogas behavior choice of relatives and friends on biogas behavior decision of rural households can provide a reference for decision-makers to make relevant measures.

Association between dependency on community resources and social support among elderly people living in rural areas in China: a cross-sectional study

BACKGROUND

The prevalence of dependency personality disorder (DPD) is high among elderly people living in rural areas. This study aims to explore the association between dependency on community resources and social support among elderly individuals living in rural areas.

METHODS

A cross-sectional study was conducted in 26 locations in China. A total of 1160 participants aged ≥ 60 years were selected using a complex multistage sampling design. All data were obtained using questionnaires via face-to-face interviews. DPD was measured using the Minnesota Multiphasic Personality Inventory-II in the standardized Chinese version. Self-efficacy was assessed using the Chinese version of the General Self-Efficacy Scale. Social support was measured using the Chinese version of the questionnaires of the Older American Resources and Services scale. Community services and resources comprised 44 items. The association between DPD and levels of social support and self-efficacy was evaluated using a logistic regression model. The association between social support and self-efficacy was assessed using analysis of covariance.

RESULTS

Univariate analysis results showed that elderly people living in rural areas had higher DPD scores and lower levels of self-efficacy compared with those living in urban areas (P < 0.001). Logistic regression analysis showed that DPD was positively associated with the received frequencies of community health service, contracted family doctor services, and regular lectures on health knowledge among the elderly people with odd ratios of 1.58 (P < 0.001), 2.03 (P = 0.013), and 2.67 (P = 0.005), respectively. Logistic regression analysis showed significant interaction between social support and self-efficacy effect on DPD was found in the additive model (P < 0.001).

CONCLUSION

DPD was associated mainly with the community resources among elderly people living in rural areas. Social support and self-efficacy were commonly associated with DPD through a synergistic effect. These results suggest that DPD among elderly people may be reduced through effective social support to directly and indirectly promote the elderly's use of community resources and improve their self-efficacy.

Psychological distress, multimorbidity and health services among older adults in rural South Australia

OBJECTIVE

Psychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization.

DESIGN

A cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013-2017 population health survey. The Modified Monash Model MM2-7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population.

RESULTS

The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ² = 14.4, p < 0.001), <80 years (χ² = 11.7, p = 0.019), lower education (χ² = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ² = 51.1, p < 001), increasing age (χ² = 173.6, p < 0.001) and lower education (χ² = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6-5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2-5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3-4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6-8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4-4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9-5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress.

CONCLUSION/IMPLICATION

Psychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.

Assessment of multiple mycotoxin exposure and its association with food consumption: a human biomonitoring study in a pregnant cohort in rural Bangladesh

Aflatoxins (AFs), ochratoxin A (OTA), citrinin (CIT), fumonisin B1 (FB1), zearalenone (ZEN), and deoxynivalenol (DON) are mycotoxins that may contaminate diets, especially in low-income settings, with potentially severe health consequences. This study investigates the exposure of 439 pregnant women in rural Bangladesh to 35 mycotoxins and their corresponding health risks and links their exposure to certain foods and local stimulants. Overall, 447 first-morning urine samples were collected from pregnant women between July 2018 and November 2019. Mycotoxin biomarkers were quantified by DaS-HPLC-MS/MS. Urinary concentration of frequently occurring mycotoxins was used to estimate dietary mycotoxin exposure. Median regression analyses were performed to investigate the association between the consumption of certain foods and local stimulants, and urinary concentration of frequently occurring mycotoxins. Only in 17 of 447 urine samples (4%) were none of the investigated mycotoxins detected. Biomarkers for six major mycotoxins (AFs, CIT, DON, FB1, OTA, and ZEN) were detected in the urine samples. OTA (95%), CIT (61%), and DON (6%) were most frequently detected, with multiple mycotoxins co-occurring in 281/447 (63%) of urine samples. Under the lowest exposure scenario, dietary exposure to OTA, CIT, and DON was of public health concern in 95%, 16%, and 1% of the pregnant women, respectively. Consumption of specific foods and local stimulants-betel nut, betel leaf, and chewing tobacco-were associated with OTA, CIT, and DON urine levels. In conclusion, exposure to multiple mycotoxins during early pregnancy is widespread in this rural community and represents a potential health risk for mothers and their offspring.

Factors related to help-seeking for cancer medical care among people living in rural areas: a scoping review

Despite the importance of timely diagnosis and access to treatment, previous studies have not adequately explored help-seeking behavior in cancer treatment among rural and remote residents. The barriers preventing help-seeking behavior also remain unclear. To address this research gap, this study conducted a scoping review to suggest a framework for eliminating barriers and facilitating help-seeking for cancer treatment among rural and remote residents. To conduct the scoping review, three English medical databases (PubMed, MEDLINE, and CINAHL) were examined for the keywords "rural," "remote," "cancer," and "help-seeking." The research objectives and study designs, participants, and excerpts describing help-seeking of the selected papers were recorded in a data charting form. Descriptions of help-seeking behavior were organized and summarized according to their meaning and integrated into factors using thematic analysis. All extracted factors related to help-seeking were sorted into four main themes according to the Ecological Model of Health Behavior, the theoretical lens for this scoping review: (1) Intrapersonal; (2) Interpersonal; (3) Groups, culture, and organizations; and (4) Policy/environment. Factors were categorized as barriers and facilitators of help-seeking. A total of 13 papers were analyzed. Intrapersonal factors such as self-reliance, symptom appraisal, and fatalism, were identified as barriers to help-seeking, whereas presentation of abnormal and serious symptoms facilitated help-seeking. Interpersonal factors such as lack of understanding of family members, influence of surrounding people, role obligations, and lack of trust in experts hindered help-seeking, whereas understanding from surrounding people such as family and friends, promoted help-seeking. Groups, cultural, and organizational factors such as prejudice, social stigma, shame, lack of anonymity, and social norms acted as barriers to help-seeking. Policy-related barriers to help-seeking included lack of medical services and physical distance from medical institutions, leading to a time burden. The study discussed the identified factors from a rural context. Future studies should consider the identified barriers and facilitators according to the four main themes in rural areas when formulating interventions to promote help-seeking. Our findings can offer a theoretical foundation to develop actionable policies, preventive strategies, and relevant interventional tools that may facilitate oncological service utilization in rural areas.

Implementing a health labour market analysis to address health workforce gaps in a rural region of India

BACKGROUND

Human Resources for Health (HRH) are essential for making meaningful progress towards universal health coverage (UHC), but health systems in most of the developing countries continue to suffer from serious gaps in health workforce. The Global Strategy on Human Resources for Health-Workforce 2030, adopted in 2016, includes Health Labor Market Analysis (HLMA) as a tool for evidence based health workforce improvements. HLMA offers certain advantages over the traditional approach of workforce planning. In 2018, WHO supported a HLMA exercise in Chhattisgarh, one of the predominantly rural states of India.

METHODS

The HLMA included a stakeholder consultation for identifying policy questions relevant to the context. The HLMA focused on state HRH at district-level and below. Mixed methods were used for data collection and analysis. Detailed district-wise data on HRH availability were collected from state's health department. Data were also collected on policies implemented on HRH during the 3 year period after the start of HLMA and changes in health workforce.

RESULTS

The state had increased the production of doctors but vacancies persisted until 2018. The availability of doctors and other qualified health workers was uneven with severe shortages of private as well as public HRH in rural areas. In case of nurses, there was a substantial production of nurses, particularly from private schools, however there was a lack of trusted accreditation mechanism and vacancies in public sector persisted alongside unemployment among nurses. Based on the HLMA, pragmatic recommendations were decided and followed up. Over the past 3 years since the HLMA began an additional 4547 health workers including 1141 doctors have been absorbed by the public sector. The vacancies in most of the clinical cadres were brought below 20%.

CONCLUSION

The HLMA played an important role in identifying the key HRH gaps and clarifying the underlying issues. The HLMA and the pursuant recommendations were instrumental in development and implementation of appropriate policies to improve rural HRH in Chhattisgarh. This demonstrates important progress on key 2030 Global Strategy milestones of reducing inequalities in access to health workers and improving financing, retention and training of HRH.

The effects of air pollution on the lung cancer mortality in rural areas of eastern China: a multi-region study

Recently, the burden of lung cancer (LC) has attracted global attention. Meanwhile, LC has become the leading cause of death in China. Many studies found a strong link between air pollutants and the risk of LC mortality in some large cities, but the results have been inconsistent, and most studies have only focused on the daily effects of six pollutants in large cities, ignoring their potential cumulative effects. This study was to investigate the weekly effects of six air pollutants (CO, NO₂, O₃, PM_2.5, PM₁₀, and SO₂) on LC mortality in rural areas of eastern China and to further clarify which population groups were susceptible to air pollution and seasonal trends. First, a generalized additive model was combined with a distributed lag nonlinear model to evaluate the individual impact of air pollution on LC deaths in each area. The random-effect model was then used to pool the associations between air pollutants and LC mortality risk in ten counties or districts. The results showed that six air pollutants had a statistically significant effect on the risk of LC mortality at different lag weeks. The effects of NO₂, PM₁₀, and CO on weekly LC mortality were strongest at a cumulative lag of 1, 0, and 1 week, respectively, the maximum cumulative risk ratio (RR) of 1.37 (95%CI: 1.23 to 1.52), 1.30 (95%CI: 1.15 to 1.46), and 1.30 (95%CI: 1.17 to 1.43), with interquartile concentrations increasing. In summary, air pollution was an important factor in LC mortality, and the effect was stronger on males, the elderly, and during cold season. It was suggested that relevant departments should formulate air pollution management measures for the elderly, males, and in different seasons in rural areas and reduce the burden of lung cancer caused by air pollution.

Treatment of decentralized low-strength livestock wastewater using microcurrent-assisted multi-soil-layering systems: performance assessment and microbial analysis

Discharge of decentralized livestock wastewater without effective treatment has become a common problem in rural areas, threatening the regional water environment. A new microcurrent-assisted multi-soil-layering (MSL) system was developed for treating rural decentralized livestock wastewater. The results showed the highest removal rates of chemical oxygen demand (COD) and total phosphorus (TP) in MSL systems reached 95.45% and 92.0%, respectively. The removal rate of total nitrogen (TN) in MSL systems ranged from 60 to 75%. The bacterial diversity changes among MSL systems showed that high-level height of bottom submergence had a positive effect on the abundance of denitrifying bacteria, while low-level height of bottom submergence had a positive impact on the abundance of nitrifying bacteria. The effect of low-level external voltage on bacterial abundance was better than that of high-level external voltage. Both high- and low-level influent C/N ratios had no significant effect on bacterial abundance. The metabolism and activity of microorganisms were promoted with microcurrent stimulation from the perspective of increased bacterial abundance in MSL systems with improved treatment performance.

Prevalence of and factors associated with acute diarrhea among children under five in rural areas in Ethiopia with and without implementation of community-led total sanitation and hygiene

Background

Since Ethiopia has been implemented the Community-Led Total Sanitation and Hygiene (CLTSH) approach to control incidence of diarrhea, few studies have compared the prevalence of diarrhea and associated factors in rural areas that have implemented this approach with those that have not implemented it, and none have examined it in the district of Menz Gera Midir in the Amhara Region of Ethiopia. This study addressed this gap.

Method

A community-based comparative cross-sectional study was conducted among 224 children under five in three randomly selected rural kebeles (the smallest administrative units in Ethiopia) where CLTSH had been implemented and 448 similar children in three other randomly selected rural kebeles where CLTSH had not been implemented during February and March, 2020. Data were collected using a structured questionnaire and an on-the-spot observational checklist. Data were analyzed using three different binary logistic regression models with 95% confidence interval (CI): the first model (Model I) was used for CLTSH-implementing kebeles, the second model (Model II) for non-CLTSH-implementing kebeles, and the third model (Model III) for pooled analysis of CLTSH-implementing and non-implementing kebeles. To control confounders, each multivariable logistic regression model was built by retained variables with p < 0.25 from the bi-variable logistic regression analysis. From the adjusted multivariable analysis of each model, variables with p-values < 0.05 were declared factors significantly associated with acute diarrhea.

Results

The prevalence of acute diarrhea among children under five from households in kebeles that had implemented CLTSH was 10.6% (95% CI:6.6–14.7%) and among those that had not implemented CLTSH 18.3% (95%CI:14.8–22.2%). In CLTSH-implementing areas, use of only water to wash hands (AOR: 3.28; 95% CI:1.13–9.58) and having a mother/caregiver who did not wash their hands at critical times (AOR: 3.02; 95% CI:1.12–8.12) were factors significantly associated with acute diarrhea. In non-CLTSH-implementing areas, unimproved water source (adjusted odds ratio [AOR]: 2.81; 95% CI:1.65–4.78), unsafe disposal of child feces (AOR: 2.10; 95% CI:1.13–3.89), improper solid waste disposal (AOR: 1.95; 95% CI:1.12–3.38), and untreated drinking water (AOR: 2.33; 95% CI:1.21–4.49) were factors significantly associated with acute diarrhea. From the pooled analysis, not washing hands at critical times (AOR: 2.54; 95% CI:1.59–4.06), unsafe disposal of child feces (AOR: 2.20; 95% CI:1.34–3.60) and unimproved water source (AOR: 2.56; 95% CI:1.62–4.05) were factors significantly associated with the occurrence of acute diarrhea while implementation of CLTSH was a preventive factor (AOR: 0.24; 95%: 0.20–0.60) for the occurrence of acute diarrhea.

Conclusion

The prevalence of acute diarrhea among under-five children in Menz Gera Midir District was lower in kebeles where CLTSH had been implemented than in kebeles where CLTSH had not been implemented. Therefore, we recommend that governmental and non-governmental sectors increase implementation of CLTSH programs, including improving handwashing at critical times, promoting safe disposal of child feces and enhancing the availability of improved water sources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03202-8.

Seeking medical services among rural empty-nest elderly in China: a qualitative study

Background

The number of empty-nest elderly in China is rapidly increasing. Empty-nest elderly could not receive adequate daily care, economic support and spiritual consolation from their children. Rural empty-nest elderly are facing more serious health challenges than those in urban areas.

Objective

This study aimed to understand the experiences of rural empty-nest elderly in seeking medical services in China.

Methods

The method of inductive content analysis was used to collect and analyze data. Data were collected by in-depth interviews. A total number of 16 participants were involved in this study. A semi-structured interview guideline, which was discussed in depth and agreed upon by all researchers, was used to encourage participants to talk about their experiences in seeking medical services.

Results

Rural empty-nest elderly is facing a great challenge in seeking medical services in China. There are some barriers for rural nest elderly to get access to healthcare services, such as low-income status, high expenditure of medical treatment and inadequate health insurance coverage. Due to the absence of the companionship of their adult children, empty-nest elderly have to rely on their neighbors and relatives to seek medical services.

Conclusions

Rural empty-nest elderly have great difficulty in seeking medical services in China. More efforts should be made to get medical services more accessible to rural empty-nest elderly.

Trends of and factors associated with access to residential toilets among the middle-aged and elderly in rural China from 2011 to 2018

BACKGROUND

At the global and country levels, several important sanitation improvement initiatives were launched in the last decade. This study aimed to explore the temporal trend of and factors associated with access to residential toilets among the middle-aged and elderly in rural China from 2011 to 2018.

METHODS

This study used the 2011, 2013, 2015, and 2018 data of China Health and Retirement Longitudinal Study (CHARLS). CHARLS was conducted among adults aged ≥ 45 years in 28 provinces of China. We used descriptive statistics and logistic regressions for data analysis.

RESULTS

We found that residential toilet coverage increased by about 6% among population aged ≥ 45 years in rural China from 2011 to 2018. The coverage of flushable toilets and toilets with seats among this sector of the population increased by more than 10% during this period. We also found that being female, higher levels of education, higher annual per capita household consumption, having running water in the residence, larger household size, and better health status were significantly associated with an increased likelihood of residential toilet ownership among population aged ≥ 45 years in rural China.

CONCLUSIONS

China made progress in sanitation improvement in rural areas from 2011 to 2018. However, considering the current coverage levels of residential toilets and the vulnerable subgroups who are more prone to toilet deprivation in rural areas, we suggest to the government to implement further targeted toilet improvement interventions to ensure universal coverage of sanitation facilities for the whole of the Chinese population.

The prevalence of elder abuse and neglect in rural areas: a systematic review and meta-analysis

PURPOSE

Many epidemiological studies have reported that elder abuse and neglect were prevalent in rural areas. However, none of them has synthesized the literature in this field. Therefore, we aimed to estimate the overall prevalence of elder abuse and neglect in rural areas through a systematic review and meta-analysis.

METHODS

PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched to identify eligible articles, with no language restrictions. Statistical analyses were conducted using Review Manager software (version 5.3). Meta-analyses and sensitivity analysis were performed using a random-effects model. All results were reported as the pooled prevalence of elder and neglect with their 95% confidence intervals (CIs). The quality of the included studies was evaluated by strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Potential publication bias was assessed by the funnel plot.

RESULTS

13 cross-sectional studies involving 10,313 participants were eligible. The prevalence of elder abuse and neglect ranged from 4.5 to 61.7% across the rural areas, and pooled prevalence estimate was 33% (95% CI 23-43). The prevalence of physical abuse was estimated at 7% (95% CI 5-9), financial abuse at 5% (95% CI 4-7), psychological/emotional abuse at 17% (95% CI 11-23), and neglect at 26% (95% CI 17-35). There was significant heterogeneity among the included studies. Stratified analyses revealed that sampling design was part of the heterogeneity source. WHO regions, gender, countries' income classification, and study quality could not explain the potential reasons for heterogeneity.

CONCLUSIONS

The pooled prevalence of elder abuse and neglect was relatively high in rural areas. Early and targeted screening and prevention are needed. There is an urgent need for high quality studies using agreed definition of elder abuse and neglect to protect the potential high risk populations.

Effects of exposure to fine particulate matter on the decline of lung function in rural areas in northwestern China

Our aim was to clarify the main factors associated with lung function and to analyze the correlation between fine particulate matter (PM_2.5) and lung function in a rural Chinese population. We analyzed data of 5195 participants in the China Northwest Natural Population Cohort: Ningxia Project who were ≥ 30 years old. They were recruited from 2018 to 2019, underwent spirometry during the physical examination, and completed a self-report questionnaire. A satellite-based spatiotemporal model was used to estimate the 2-year average PM_2.5 exposure based on participants' home addresses. A generalized linear mixed model was used to test the relationship between PM_2.5 concentration and lung function. Sex, age, exposure to cooking oil fumes, and occupational exposure were negatively correlated (P < 0.05) with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁). Educational status, economic level, tea consumption, and alcohol consumption were positively correlated (P < 0.05) with FVC and FEV₁. The adjusted results of each model revealed that FVC and FEV₁ decreased with increased exposure to PM_2.5. There was a strong negative correlation between a PM_2.5 concentration of 35.66 μg/m³ and FVC, FEV1, and FEV1/FVC, with unadjusted hazard ratios of - 0.06 (95% confidence interval, - 0.10 to - 0.01), - 0.13 (- 0.17 to - 0.10), and - 22.10 (- 24.62 to - 19.26), respectively. In conclusion, long-term exposure to high concentrations of ambient PM_2.5 is related to reduce lung function among people in rural areas in northwestern China.

Mobility enhancement among older adults 75 + in rural areas: Study protocol of the MOBILE randomized controlled trial

BACKGROUND

Maintaining mobility in old age is crucial for healthy ageing including delaying the onset and progress of frailty. However, the extent of an individuals´ mobility relies largely on their personal, social, and environmental resources as outlined in the Life-Space Constriction Model. Recent studies mainly focus on facilitating habitual out-of-home mobility by fostering one type of resources only. The MOBILE trial aims at testing whether tablet-assisted motivational counselling enhances the mobility of community-dwelling older adults by addressing personal, social, and environmental resources.

METHODS

In the MOBILE randomized controlled trial, we plan to enrol 254 community-dwelling older adults aged 75 and older from Havelland, a rural area in Germany. The intervention group will receive a tablet-assisted motivational counselling at the participant´s home and two follow-up telephone sessions. Main focus of the counselling sessions lays on setting and adapting individual mobility goals and applying action planning and habit formation strategies by incorporating the personal social network and regional opportunities for engaging in mobility related activities. The control group will receive postal general health information. The primary mobility outcome is time out-of-home assessed by GPS (GPS.Rec2.0-App) at three points in time (baseline, after one month, and after three months for seven consecutive days each). Secondary outcomes are the size of the GPS-derived life-space convex hull, self-reported life-space mobility (LSA-D), physical activity (IPAQ), depressive symptoms (GDS), frailty phenotype, and health status (SF-12).

DISCUSSION

The MOBILE trial will test the effect of a motivational counselling intervention on out-of-home mobility in community-dwelling older adults. Novel aspects of the MOBILE trial include the preventive multi-level intervention approach in combination with easy-to-use technology. The ecological approach ensures low-threshold implementation, which increases the benefit for the people in the region.

TRIAL REGISTRATION

The MOBILE trial is prospectively registered at DRKS (Deutsches Register Klinischer Studien, German Registry of Clinical Trials) DRKS00025230 . Registered 5 May 2021.

What do urban and rural hotel managers say about the future of hotels after COVID-19? The new meaning of safety experiences

The pandemic crisis has caused a change in tourism trends that affect the way hotels are managed. In accordance with the United Nations (2020), hotels must guarantee safe experiences for customers by incorporating sustainability measures. Collaboration between health and tourism authorities and the tourism industry is key. To test this proposal among hotels in Spain, 3 online focus groups and 25 personal interviews with 36 urban and 28 rural hotels were held in order to define the indicators. The questionnaire was applied to a sample of 475 urban hotels out of 443 rural hotels. The conclusions were: 1.) While in urban areas the testing protocols, especially for workers, are followed by most hotels, in rural areas hotel managers do not consider it as a priority in daily activity due to the reduced contact they have. 2.) A change in trends in the sustainable management of both rural and urban hotels is justified. 3.) Urban and rural hotels are more likely to incorporate collaborative strategies with tourism and health authorities to reduce the negative impact of COVID-19. According to the estimates of the hotels, the implementation of these measures would help to start the recovery process of the hotel industry.

Six air pollutants and cause-specific mortality: a multi-area study in nine counties or districts of Anhui Province, China

Air pollution and its negative effects on health of people have been a global concern. Many studies had found a strong association between air pollutants and risk of death, but few had focused on the effects of six pollutants and rural areas. Our study aimed to investigate the effects of six air pollutants (CO, NO₂, O₃, PM_2.5, PM₁₀, and SO₂) on non-accidental and respiratory deaths in rural areas of Anhui Province by adjusting for confounding factors, and to further clarify which populations were susceptible to death associated with air pollution. In the first phase of the analysis, the generalized additive models were combined with the distributed lag non-linear models to evaluate the individual effects of air pollution on death in each area. In the second stage, random-effects models were used to aggregate the associations between air pollutants and mortality risk in nine areas. Overall, six pollutants had the strongest effects on the risk of death on the lag 07 days. The associations between PM_2.5 and NO₂ and daily non-accidental deaths were strongest, with maximum RR (lag 07): 1.63 (1.37-1.88) and 1.67 (1.37-1.96). The maximum pooled effects of association between six air pollutants and RD were PM_2.5, with RR (lag 07): 1.89 (1.45-2.34). PM_2.5 and PM₁₀ had significant differences between the elderly and the non-elderly with respectively, RRR: 1.22 (1.04-1.41) and 1.26 (1.11-1.42). In general, we found that six air pollutants were the important risk factors for deaths (deaths from respiratory disease and non-accidental) in rural areas of Anhui Province. PM₁₀ and PM_2.5 had a considerable impact on the elderly.

Association of selenium levels with the prevention and control of Keshan disease: A cross-sectional study

PURPOSE

The prevalence of Keshan disease (KD) is low and has reached controlled or eliminated levels even in counties that had a high KD prevalence in the past. Few nationwide surveys on selenium levels in KD areas have been conducted in the past 2 decades. We conducted a cross-sectional study to investigate the selenium levels and their association with KD control and prevention in areas where KD is prevalent.

METHODS

We collected 2143 human-hair, 698 soil, 701 rice, 607 flour, 521 corn, and 330 other-food samples from 49 counties with KD and 19 non-KD counties of nine KD provinces of China. The selenium content of samples was examined with hydride generation atomic fluorescence spectrometry. The difference in selenium levels between the KD and non-KD areas was analyzed. Cochran-Armitage trend tests were used to evaluate the association between selenium levels and KD control.

RESULTS

The selenium levels in human hair, soil, staple foods, and other foods in the KD areas (0.2996 mg/kg, 0.1380 mg/kg, 0.0190 mg/kg and 0.0076 mg/kg, respectively) were lower than those in the non-KD areas (0.3700 mg/kg, 0.1930 mg/kg, 0.0240 mg/kg and 0.0165 mg/kg, respectively). The Cochran-Armitage tests showed that there was a trend for the selenium standard ratio in the counties to increase in the order of KD uncontrolled, to controlled, to eliminated (Z = 2.229, P < 0.05).

CONCLUSION

The residents in the KD areas were found to be selenium-deficient. Improving the supply of staple foods containing selenium levels exceeding 0.025 mg/kg and abundant foodstuffs might contribute to KD control and prevention.

Online Health Information-Seeking Behavior Among Korean American Immigrants in Rural Alabama: Dose Discrimination Matter?

Little attention has been paid to online health information seeking (OHIS) among immigrants residing in rural areas. This study examines the intensity of OHIS among Korean American (KA) immigrants living in rural Alabama. A total number of 261 KA immigrants aged 23 to 75 participated in the study. Multiple linear regression analyses were conducted. Age (B = - 0.044, p < 0.05), marital status (B = 1.132, p < 0.05), race/ethnic discrimination (B = 0.821, p < 0.05), having computer or tablet (B = 1.286, p < 0.05), and access to internet (B = 1.778, p < 0.01) were associated with the intensity of OHIS. Substantial efforts should be devoted to narrowing the access gap by providing offline health information services for those without internet access and with limited health literacy. Moreover, culturally competent healthcare services and information should be provided to serve racial/ethnic minority populations better.

Factors influencing the retention of secondary midwives at health centres in rural areas in Cambodia: the role of gender-a qualitative study

BACKGROUND

Retention of skilled midwives is crucial to reducing maternal mortality in rural areas; hence, Cambodia has been trying to retain at least one secondary midwife who can provide basic emergency obstetric care at every health centre even in rural areas. The factors influencing the retention of midwives, but not solely secondary midwives, have been identified; however, the security issues that affected female health workers during the conflict and the post-conflict years and gender issues have been unexplored. This study explores these and other potential factors influencing secondary midwife retention and their significance.

METHODS

Sequential two-stage qualitative interviews explored influential factors and their significance. The first stage comprised semi-structured interviews with 19 key informants concerned with secondary midwife retention and in-depth interviews with eight women who had deliveries at rural health centres. Based on these interview results, in-depth interviews with six secondary midwives who were deployed to a rural health centre were conducted in the second stage. These midwives ranked the factors using a participatory rural appraisal tool. These interviews were coded with the framework approach.

RESULTS

Living with one's parents or husband, accommodation and security issues were identified as more significant influential factors for secondary midwife retention than current salary and the physical condition of the health centre. Gender norms were entrenched in these highly influential factors. The deployed secondary midwives who were living apart from one's parents or spouse requested transfer (end of retention) to health centres closer to home, as other midwives had done. They feared gender-based violence, although violence against them and the women around them was not reported. The health workers surrounding the midwives endorsed the gender norms and the midwives' responses. The ranking of factors showed similarities to the interview results.

CONCLUSIONS

This study suggests that gender norms increased the significance of issues with deployments to rural areas and security issues as negative factors on female health workforce retention in rural areas in Cambodia. This finding implies that further incorporating gendered perspectives into research and developing and implementing gender-responsive policies are necessary to retain the female health workforce, thereby achieving SDGs 3 and 5.

Life cycle assessment of greywater treatment systems for water-reuse management in rural areas

Water scarcity is a major concern worldwide. Population growth, as well as the intensive use of water resources for industrial and agricultural activities, among others, have caused water stress in various regions of the world. Rural areas are usually more affected due to water scarcity and a lack of sanitary infrastructure. The current practices associated with urban water management have been considered inefficient to respond to these problems. In recent years, the reuse of greywater has emerged as a promising and sustainable alternative. Several pilot greywater treatment systems have been implemented in rural areas of different countries, however, studies about the environmental impacts of these decentralized systems under different scenarios are lacking. In this work, the life cycle assessment of greywater treatment systems considering several scenarios was studied. Our results showed that the decrease in environmental impacts due to the saving of drinking water is more evident when the water supply is carried out through cistern trucks. This occurs because the environmental impact of land transport of water is extremely high and represents over 89% of the global warming indicator [kg CO₂ eq] and 96% ozone depletion [kg CFC-11 eq] contributions of the system. Greywater treatment systems with backwashing and solar panels as a source of energy have lower environmental impacts, reducing CO₂ and CFC emissions by 50% for the maintenance phase and by 85% (CO₂) and 47% (CFC) for the operation phase. Furthermore, the acquisition of solar panels was economically feasible, with a payback of 19.7 years. This analysis showed the environmental feasibility of small-scale greywater treatment systems in rural areas affected by water scarcity. Furthermore, the proposed approach has contributed to understand the impact of greywater treatment systems in rural areas, which could become a support tool to integrate greywater reuse practices in different communities.

Unhealthy lifestyles, environment, well-being and health capability in rural neighbourhoods: a community-based cross-sectional study

BACKGROUND

Non-communicable diseases are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults, which may be amplified by wider determinants of health. Changes in rural environments reflect the need of better understanding the factors affecting the self-ability for making balanced decisions. We assessed whether unhealthy lifestyles and environment in rural neighbourhoods are reflected into metabolic risks and health capability.

METHODS

We conducted a community-based cross-sectional study in 15 Portuguese rural neighbourhoods to describe individuals' health functioning condition and to characterize the community environment. We followed a qualitatively driven mixed-method design to gather information about evidence-based data, lifestyles and neighbourhood satisfaction (incorporated in eVida technology), within a random sample of 270 individuals, and in-depth interviews to 107 individuals, to uncover whether environment influence the ability for improving or pursuing heath and well-being.

RESULTS

Men showed to have a 75% higher probability of being overweight than women (p-value = 0.0954); and the reporting of health loss risks was higher in women (RR: 1.48; p-value = 0.122), individuals with larger waist circumference (RR: 2.21; IC: 1.19; 4.27), overweight and obesity (RR: 1.38; p-value = 0.293) and aged over 75 years (RR: 1.78; p-value = 0.235; when compared with participants under 40 years old). Metabolic risks were more associated to BMI and physical activity than diet (or sleeping habits). Overall, metabolic risk linked to BMI was higher in small villages than in municipalities. Seven dimensions, economic development, built (and natural) environment, social network, health care, demography, active lifestyles, and mobility, reflected the self-perceptions in place affecting the individual ability to make healthy choices. Qualitative data exposed asymmetries in surrounding environments among neighbourhoods and uncovered the natural environment and natural resources specifies as the main value of rural well-being.

CONCLUSIONS

Metabolic risk factors reflect unhealthy lifestyles and can be associated with environment contextual-dependent circumstances. People-centred approaches highlight wider socioeconomic and (natural) environmental determinants reflecting health needs, health expectations and health capability. Our community-based program and cross-disciplinary research provides insights that may improve health-promoting changes in rural neighbourhoods.

Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth - an exploratory qualitative pre-post study

Background

Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions:

How is medical care currently provided to nursing home residents, and where do problems in its implementation arise?

How can video consultations be used to reduce difficulties arising in everyday care?

How does implementation of video consultations impact day-to-day nursing home care delivery?

Methods

Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis.

Results

Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly.

Conclusions

Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06950-y.

Influence of COVID-19 lockdown overlapping Chinese Spring Festival on household PM2.5 in rural Chinese homes

During the 2019 novel coronavirus (COVID-19) pandemic, many countries took strong lockdown policy to reduce disease spreading, resulting in mitigating the ambient air pollution due to less traffic and industrial emissions. However, limited studies focused on the household air pollution especially in rural area, the potential risk induced by indoor air pollution exposure was unknown during this period. This field study continuously measured real-time PM_2.5 levels in kitchen, living room, and outdoor in the normal days (Period-1) and the days of COVID-19 lockdown overlapping the Chinese Spring Festival (Period-2) in rural homes in China. The average daily PM_2.5 concentrations increased by 17.4 and 5.1 μg/m³ in kitchen and living room during Period-2, respectively, which may be due to more fuel consumption for cooking and heating caused by larger family sizes than those during the normal days. The ambient PM_2.5 concentration in rural areas in Period-2 decreased by 6.7 μg/m³ compared to the Period-1, less than the drop in urban areas (26.8 μg/m³). An increase of mass fraction of very fine particles in ambient air was observed during lockdown overlapping annual festival days, which could be explained by the residential solid fuel burning. Due to higher indoor air pollution level and longer time spent in indoor environments, daily personal exposure to PM_2.5 was 134 ± 40 μg/m³ in Period-2, which was significantly higher than that during in Period-1 (126 ± 27 μg/m³, p < 0.05). The increase of personal PM_2.5 exposure during Period-2 could potentially have negative impact on human health, indicating further investigations should be performed to estimate the health impact of global COVID-19 lockdown on community, especially in rural homes using solid fuels as the routine fuels.

First application of an Integrated Biological Response index to assess the ecotoxicological status of honeybees from rural and urban areas

Understanding the effects of environmental contaminants on honeybees is essential to minimize their impacts on these important pollinating insects. The aim of this study was to assess the ecotoxicological status of honeybees in environments undergoing different anthropic pressure: a wood (reference site), an orchard, an agricultural area, and an urban site, using a multi-biomarker approach. To synthetically represent the ecotoxicological status of the honeybees, the responses of the single biomarkers were integrated by the Integrated Biological Response (IBRv2) index. Overall, the strongest alteration of the ecotoxicological status (IBRv2 = 7.52) was detected in the bees from the orchard due to the alteration of metabolic and genotoxicity biomarkers indicating the presence of pesticides, metals, and lipophilic compounds. Honeybees from the cultivated area (IBRv2 = 7.18) revealed an alteration especially in neurotoxicity, metabolic, and genotoxicity biomarkers probably related to the presence of pesticides, especially fungicides. Finally, in the urban area (IBRv2 = 6.60), the biomarker results (GST, lysozyme, and hemocytes) indicated immunosuppression in the honeybees and the effects of the presence of lipophilic compounds and metals in the environment.

The combination of e-bike-sharing and demand-responsive transport systems in rural areas: A case study of Velenje

An analysis of the operational characteristics of the transit system serving the town of Velenje (Slovenia) revealed poor performance and the need for improvements. This paper describes the potential integration of an electric bike-sharing system and a semi-flexible demand-responsive transport system to effectively solve this issue. Additionally, general guidance is provided for transit systems with low travel demand. Appropriate transport system schedules are proposed to facilitate customers' use and thus to move demand shares away from private motorized transport. Focus group interviews, implemented to directly involve local stakeholders, revealed an overall positive perception of the proposed transport system. Furthermore, the cost analysis demonstrated that the costs of the new system would not be much higher for the municipality than those currently incurred, making it an important performance improvement achieved at low cost.

Prevalence and risk factors of intestinal protozoan infection among symptomatic and asymptomatic populations in rural and urban areas of southern Algeria

BACKGROUND

Intestinal parasitic infections are amongst the most common infections worldwide and have been identified as one of the most significant causes of morbidity and mortality among disadvantaged populations. This comparative cross-sectional study was conducted to assess the prevalence of intestinal protozoan infections and to identify the significant risk factors associated with intestinal parasitic infections in Laghouat province, Southern Algeria.

METHODS

A comparative cross-sectional study was conducted, involving 623 symptomatic and 1654 asymptomatic subjects. Structured questionnaires were used to identify environmental, socio demographic and behavioral factors. Stool specimens were collected and examined using direct wet mount, formalin-ether concentration, xenic in vitro culture and staining methods.

RESULTS

A highly significant difference of prevalence was found between symptomatic (82.3%) and asymptomatic subjects (14.9%), with the majority attributable to protozoan infection. The most common species in the symptomatic subjects were Blastocystis spp. (43.8%), E. histolytica/dispar (25.4%) and Giardia intestinalis (14.6%) and more rarely Enterobius vermicularis (02.1%), Teania spp. (0.6%) and Trichuris trichiura (0.2%), while in asymptomatic population Blastocystis spp. (8%), Entamoeba coli (3.3%) and Entamoeba histolytica/dispar (2.5%) were the most common parasites detected with no case of helminth infection. Multivariate log-linear analysis showed that contact with animals was the main risk factor for transmission of these protozoa in both populations. Furthermore, living in rural areas was significantly associated with combined protozoan infection in the asymptomatic population, whereas, in the symptomatic population an increasing trend of protozoan infection was detected in the hot season. In addition, Blastocystis spp. and G. intestinalis infection were found to be associated with host sex and contact with animals across the study period.

CONCLUSIONS

Based on these results, several strategies are recommended in order to effectively reduce these infections including good animal husbandry practices, health education focused on good personal hygiene practices and adequate sanitation.

A life-cycle assessment framework for quantifying the carbon footprint of rural households based on survey data

•

We developed an improved Life-Cycle Assessment framework for carbon footprint evaluation.

•

The LCA frameworks can identify the life-cycle boundaries of household activities.

•

The improved LCA framework helps identify specific producing and consuming activities of rural households.

•

The LCA framework enables a comprehensive and relatively precise assessment of carbon footprint at household level.

This paper presents the development of a life-cycle assessment (LCA) framework for quantifying the carbon footprint of individual households based on detailed household survey data. According to household consumption and production patterns, the comprehensive life-cycle assessment framework is designed with clarified life-cycle boundaries. The framework covers eight types of specific living activities of rural households generated from a large-scale household survey in the Three Gorges Reservoir area in China. Both carbon emissions and carbon sequestrations of households’ consumption and production activities can be assessed, and eventually the integrative carbon footprint is evaluated. The LCA framework enables comprehensive and relatively precise assessment of carbon footprint at a household level and thus adds value to studies in the fields of carbon emission reduction, carbon neutrality and climate policies.

Civic universities and bottom-up approaches to boost local development of rural areas: the case of the University of Macerata

The aim of this paper is to provide a review of the main roles HEIs can play in rural areas. A longitudinal case study about the civic engagement of the University of Macerata - UNIMC (Italy) is presented, by assessing its attempt to fulfil its third and fourth mission through the application of the Quadruple Helix and 3 Model and by implementing the Civic University's dimensions. Furthermore, these aspects have been investigated through the university-business collaboration and the community-academic-collaboration frameworks. More specifically, the paper focussed on UNIMC's commitment at a local level analysing its involvement in local and international projects for place and agri-food product marketing, place branding and rural development, promoted by a research team within the Department of Education, Cultural Heritage and Tourism.

Ecological treatment technology for agricultural non-point source pollution in remote rural areas of China

Agricultural non-point source pollution is one of the important reasons for rural water pollution, and it is also an important source of water eutrophication. In recent years, with the rapid economic growth and social changes in rural areas, large amounts of untreated domestic sewage and agricultural wastewater entering farmland require high efficiency, low operating costs, and minimal maintenance of treatment systems in rural and remote areas to minimize their impact on water and biodiversity. Since there is little research on the ecological treatment technology of agricultural non-point source pollution in China, from the perspective of controlling agricultural non-point source pollution, some ecological treatment technologies suitable for rural areas at home and abroad are summarized. This paper introduces the practical application of ecological treatment technology, the type of process, advantages and disadvantages, and the influencing factors of ecological treatment technology in the purification of sewage engineering and summarizes the removal mechanism of pollutants in ecological treatment technology. Eco-processing technologies are cost-effective in terms of their construction, maintenance, and energy needs and can be considered a sustainable wastewater treatment method, especially in remote areas and developing countries. It provides basic ideas for the construction of rural ecological treatment technology in China and puts forward suggestions and ideas for the future development trend of ecological treatment process sewage.

Developing COVID-19 emergency response centres in geographically challenged areas of Pakistan: A case study of the Aga Khan Development Network

The inevitable COVID‐19 global pandemic has severely affected Pakistan’s fragile healthcare system. The system was already facing a significant burden of noncommunicable and other infectious diseases, and the pandemic further exacerbated the disease and the healthcare burden in Pakistan. In such a situation, people who live in geographically challenged areas with limited healthcare infrastructure and resources are more vulnerable to the impacts of a pandemic. The authors share the experience of the development of emergency response centres (ERCs) in the rural remote mountainous regions of Pakistan–Chitral, an initiative that the Government of Pakistan and Aga Khan Health Service Pakistan (AKHSP) implemented to manage the increasing rates of COVID‐19 cases in these areas. The authors outline the processes that need to be undertaken to develop such healthcare facilities in a short period of time and discusses the challenges of establishing and operating these centres and the lessons learnt during and after the development of these centres in the remote mountainous regions of Pakistan.

Food insecurity and the double burden of malnutrition in Colombian rural households

OBJECTIVE

This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother.

DESIGN

A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child.

SETTING

Rural Colombia.

PARTICIPANTS

Totally, 2·350 mother-child pairs living in the same household.

RESULTS

Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)).

CONCLUSIONS

Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.

[Study on the Relationship between First-Time Complementary Feeding Practice and the Nutritional Status of Infants and Young Children in the Multi-Ethnic Rural Areas of Sichuan Province]

OBJECTIVE

To evaluate the current status of first food supplement and the nutrition of infants and young children in rural areas inhabited by people of Han, Tibetan, and Yi ethnicities in Sichuan Province, and to explore the relationship between the first ever feeding of food supplement and the nutritional status.

METHODS

Using a multi-stage randomized cluster sampling method, we selected 2 Han counties, 2 Tibetan counties and 2 Yi counties in rural areas of Sichuan Province. These counties were previously defined as economically poor counties, but had since been lifted out of poverty. They were selected for this study before they came out of poverty. Infants and young children of 12-24 months old and their main caregivers from these counties were the subjects of the study. Structured questionnaires were used to collect information concerning the sociodemographic characteristics of infants and young children and their caregivers, and the first complementary feeding for infants and young children. Infant and young children weight scales and length/height tapes were used to collect the weight and length/height data of infants and young children. Unconditional logistic regression was used to analyze the correlation between the behavior of giving supplementary food for the first time to infants and young children and their nutritional status.

RESULTS

A total of 1117 pairs of infants and children and their caregivers were investigated. Regarding the time of first supplementary food addition, nearly half of the caregivers in Han areas started adding supplementary food when the infants were 6 months old, accounting for 43.07% (171/397). Most of the caregivers in Yi and Tibetan areas started giving infants and young children supplementary food when they were less than 6 months old, accounting for 77.18% (301/390) and 47.58% (157/330), respectively. In terms of the types of supplementary food added for the first time, caregivers in Han areas mainly used homemade rice cereal, accounting for 41.56% (165/397), caregivers in Tibetan areas mainly used meat, vegetables or fruits and other complementary foods, accounting for 42.12% (139/330), and caregivers in Yi areas mainly used homemade rice cereal, accounting for 46.41% (181/390). The overall malnutrition rate of infants and young children was 28.83% (322/1117) and the malnutrition rate of infants and young children in Han, Tibetan, and Yi areas were 10.58% (42/397), 24.85 (82/330), and 50.77 (198/390), respectively. The regression analysis results show that after controlling for confounding factors, compared with Han areas, it is more likely for infants and young children in Yi areas to be malnourished ( OR=9.49, 95% CI 6.00-15.00). Compared with adding other types of complementary foods for the first time, infants and young children given iron-fortified rice cereal had a lower risk of malnutrition ( OR=0.54, 95% CI0.29-0.99).

CONCLUSION

The multi-ethnic rural areas of Sichuan Province had problems that supplementary foods are added too early, and that the types of supplementary foods added for the first time were not appropriate. In addition, the nutritional status of local infants and young children in these areas was causing concerns. The malnutrition problem of infants and young children was especially prominent in the Yi ethnic areas. Adding iron-fortified rice cereal for the first time could reduce the possibility of malnutrition in infants and young children to a certain extent. It is recommended that attention should be given to the health education intervention of the first supplementary food for infants and young children to effectively improve the nutritional status of infants and young children in these areas.

Sex-Biased Prevalence of Intestinal Parasitic Infections and Gender Inequality in Rural Nepal

OBJECTIVES

Intestinal parasitic infections (IPIs) are related to poverty and socioeconomic disparities. In rural Nepal, IPIs are highly endemic and gender inequality is still deeply rooted. This study provides a novel epidemiological assessment of IPIs in Nepal, juxtaposing spatial, age and sex stratification of prevalence.

METHODS

A PRISMA and PICO-based systematic review of peer-reviewed and grey literature provided IPI prevalence data for the Nepalese population. Demographic and environmental variables were considered to investigate differences related to dwelling area and sex. Variations among prevalence rates were calculated with 95% CI and significance level for odds ratio evaluated with chi-square test.

RESULTS

The IPI prevalence rate for the Nepalese general population was 37.6%. Moreover, IPI prevalence (52.3%) was significantly higher in rural areas than in urban areas (32.4%), and school-age girls (55.2%) were more infected than boys (48.6%).

CONCLUSIONS

The IPI infection rate appeared to be enhanced among young women living in rural Nepal, where they experienced low school attendance and heavy enrolment in agricultural work, as result of gender discrimination. Plausibly, these dynamics affect both girls' environmental exposure and fruition of periodic school-based preventive chemotherapy, thus increasing the chances of IPI infection.

An analysis of ozone pollution by using functional data: rural and urban areas of the Community of Madrid

This paper analyses the relationship between tropospheric ozone levels in rural and urban sites in the Spanish Community of Madrid (CM). The paper makes use of functional data and the Kendall's Tau functional statistic (KFT) to identify significant correlations between areas. The results are based on very detailed data, extracted from hourly records from 33 air-quality stations covering de CM during the period 2011-2018, producing more than 95,500 point observations. The results show a large degree of correlation between distant sites, whereas in a number of cases, they reveal very moderate correlations between adjacent sites. This pattern is suggestive of complex recirculation patterns.

Gender-specific prevalence and influencing factors of depression in elderly in rural China: A cross-sectional study

BACKGROUND

With an aging population, late-life depression has been a major health problem in rural China. This study aims to explore the gender-specific prevalence of geriatric depression in rural Tianjin, its influencing factors, and to provide a scientific basis for the prevention and intervention of depression in the elderly.

METHODS

A cross-sectional study of 4,933 elderly individuals in rural Tianjin was conducted using the cluster sampling method. The independent samples t-test and chi-squared test were used to assess differences in participants' characteristics by depressive symptoms, while multiple linear regressions and multiple logistic regressions were used to analyze the potential influencing factors of depression.

RESULTS

The prevalence of geriatric depression was found to be 12.2% in the study participants (9.5% in men and 14.5% in women). Gender, education, household income, employment, living alone, social activities, physical exercise and chronic diseases were associated with depression (P<0.05). In addition to the above factors, sleep duration was also related with scores on self-rating depression scale (P<0.05).

LIMITATIONS

The study used a cross-sectional approach, so causation cannot be concluded.

CONCLUSIONS

Late-life depression is a serious mental health issue in rural China, highlighting the importance of appropriate diagnosis and treatment as a priority to improve the quality of mental health.

From blanket quarantine in Wuhan to distant centralized quarantine in Shijiazhuang: the evolution of China's COVID-19 quarantine approach

With COVID-19 spreading globally, the World Health Organization (WHO) declared a pandemic on March 11, 2020. COVID-19 swept many countries and regions worldwide. An effective response to COVID-19 requires newer and more creative tools. In this paper, we discussed the evolution of China’s COVID-19 quarantine approach, compared the blanket quarantine in Wuhan and the distant centralized quarantine in rural areas of Shijiazhuang, and analyzed the important issues which authorities will have to pay attention to ensure success from the moment they begin to take close contacts to the single room isolation in a distant quarantine center. The large-scale distant centralized quarantine strategy in Shijiazhuang cut off the transmission of COVID-19 within 1 month. This strategy may inform other countries and regions of a feasible and effective approach to combat the global pandemic of COVID-19.

Modeling and Economic Analysis of Greywater Treatment in Rural Areas in Jordan Using a Novel Vertical-Flow Constructed Wetland

Water scarcity in Jordan is becoming more severe with time, which resulted in an indispensable need for economic innovative approaches to maximize the utilization of nonconventional water resources through reuse options. Within the framework of the current study, a novel vertical flow constructed wetland system was implemented for greywater treatment in four different rural areas in Jordan. In this paper, the primary objective was to develop a regression-based nonlinear model to predict BOD effluent concentration from the proposed system. The model obeyed the first-order kinetics and found to provide an efficient tool in predicting the effluent BOD value as exemplified by an R² of 0.78. Moreover, a cost analysis was carried out to verify the feasibility of the proposed system. The economic results revealed a NPV range of 295-1209 JOD (420-1730$), IRR range of 6-10.7%, and a payback period range of 8.8-15.5 years. The average calculated costs of greywater treatment using the VFCWs were found to be 0.391 (USD/m³ treated) and 0.672 (USD/kg BOD removed). Finally, the energy saving from using the proposed system was quantified and an estimate of 70 JOD (100$)/year household was obtained.

A mixed-methods analysis of mobility behavior changes in the COVID-19 era in a rural case study

Background

As a reaction to the novel coronavirus disease (COVID-19), countries around the globe have implemented various measures to reduce the spread of the virus. The transportation sector is particularly affected by the pandemic situation. The current study aims to contribute to the empirical knowledge regarding the effects of the coronavirus situation on the mobility of people by (1) broadening the perspective to the mobility rural area's residents and (2) providing subjective data concerning the perceived changes of affected persons' mobility practices, as these two aspects have scarcely been considered in research so far.

Methods

To address these research gaps, a mixed-methods study was conducted that integrates a qualitative telephone interview study (N = 15) and a quantitative household survey (N = 301). The rural district of Altmarkkreis Salzwedel in Northern Germany was chosen as a model region.

Results

The results provide in-depth insights into the changing mobility practices of residents of a rural area during the legal restrictions to stem the spread of the virus. A high share of respondents (62.6%) experienced no changes in their mobility behavior due to the COVID-19 pandemic situation. However, nearly one third of trips were also cancelled overall. A modal shift was observed towards the reduction of trips by car and bus, and an increase of trips by bike. The share of trips by foot was unchanged. The majority of respondents did not predict strong long-term effects of the corona pandemic on their mobility behavior.

Parental migration and anemia status of children in China

Previous literature on parental migration and children's health outcomes mainly focuses on subjective measures and often omits the selectivity issue. Taking advantage of a unique nationally representative longitudinal dataset from the China Health and Nutrition Survey, this paper uses anemia status as an objective measure of children's health outcomes and examines the different effects of parents' current migration status, migration history, and migration duration. The results show that father's migration does not harm children's physical health, especially for children in rural areas, for whom father's migration decreases the likelihood of being anemic; while mother's migration increases the likelihood of being anemic. Importantly, children with return migrant mothers are less likely to experience anemia. We also find that the longer the father migrated, the better the child's health, but mother's longer migration duration is more detrimental. Our findings highlight the gender dimension in the migration story and indicate that policymakers should encourage the return migration of migrant mothers.

Self-rated exhaustion disorder and associated health-related factors among municipal employees in rural areas of northern Sweden

OBJECTIVE

The aims of this study among municipal employees in rural areas of northern Sweden were to assess the prevalence of self-rated exhaustion disorder (s-ED), describe plausible between-group differences in self-reported health-related factors among employees with or without s-ED, and identify health-related factors associated with s-ED.

METHODS

In a cross-sectional study, data were collected from 1093 municipal employees (76.1% women) in two rural areas using an instrument measuring s-ED and health variables drawn from the Modern Worklife Questionnaire (MWQ), the Perceived Stress Scale (PSS), and the National Board of Health and Welfare's questions about physical activity. Comparisons were made between an s-ED and a non-s-ED group. Health-related factors associated with s-ED were identified through a logistic regression.

RESULTS

Self-rated exhaustion disorder was reported by 21.5% of the participants. Health-related factors associated with s-ED were cognitive problems, sleep problems, depressive symptoms, high stress, poor self-rated health, and stomach problems. There was no statistically significant difference in the prevalence of participants who met the criteria of physical activity among s-ED and non-s-ED group.

CONCLUSION

Findings from this study suggest that s-ED is more common among municipal employees in rural areas than in other working populations in Sweden. Several health-related factors were associated with s-ED. Regular use of a self-rated instrument in evaluating the organizational and social work environment can identify people at risk of developing exhaustion disorder and requiring long-term sick leave.

[Analysis of HBsAg screening among rural childbearing age people in Yunnan province during 2013-2017]

Objective: To explore the current status of HBV infection before pregnancy among rural childbearing age people in Yunnan province, find out the population at high risk and areas with high incidence and provide evidence for promoting pre-pregnancy aristogenesis and medical interventions for prevention of HBV infection. Methods: The subjects in the study were rural childbearing age people aged 18-49 who received the national free pre pregnancy eugenic health examination in Yunnan province during 2013-2017. Descriptive analysis was conducted for HBsAg positive rate and its difference among various characteristics. The SPSS 22.0 software was used for statistical analysis. Results: A total of 2 180 841 rural childbearing age people were surveyed, the HBsAg positive rate before pregnancy was 3.13%(68 314/2 180 841) in Yunnan. And the HBsAg positive rate was 3.56% (37 694/1 057 376) in men, higher than that in women (2.73%, 30 620/1 123 465). The HBsAg positive rate was highest in age group 41-49 years (3.77%, 3 126/82 931). The HBsAg positive rate was higher in minority ethnic group (3.77%, 27 974/742 518) than in Han ethnicity group (2.81%, 40 024/1 425 870). Moreover, the highest HBsAg positive rate of was 8.20%(851/10 378) in Yao ethnic group. The people with education level of primary education had the highest HBsAg positive rate (3.97%, 17 294/435 219). The HBsAg positive rate was highest in Xishuangbanna Dai autonomous prefecture (6.65%, 3 875/58 232) in Yunnan. Moreover, the HBsAg positive population in severe poor area (3.32%, 19 755/595 665) was higher than those in less poor area (3.17%, 29 750/939 101) or normal areas (2.91%, 18 809/646 075). There was significant difference in HBsAg positive rate among populations in different age groups, ethnic groups, education level groups, areas and economic level groups (P<0.001). Conclusions: The HBsAg positive rate in rural childbearing age people in Yunnan was related to multi factors, including sex, age, ethnic group, education level, area and economic development level. The HBsAg positive rate was higher in men, older age and lower education level, minority ethnic group (especially in Yao ethnic group), from Xishuangbanna prefecture and the poor living conditions in childbearing age population.

Population grid-based assessment of the impact of broadband expansion on population development in rural areas

This paper estimates the effect of the expansion of broadband infrastructure, which enables high-speed Internet, on population development in panel of Finnish areas in the period 2010-2018. The study differs from previous studies in that it uses accurate statistics on the availability of broadband in 1 km * 1 km population grids. Therefore, the impact of broadband availability on rural development is evaluated more accurately than previously. The results of the Difference-in-difference (DiD) regression analysis show that the availability of broadband reduces depopulation of remote and sparsely populated rural areas. In this respect, the telecommunication policy in Finland has been successful, and the findings encourage the expansion of broadband infrastructure in rural areas.

Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review

Background

Imbalance in distribution of Health Care Workers (HCWs) in a country is a global challenge. Almost all of the rural and underdeveloped areas are struggling with the shortage of HCWs, especially physicians. Therefore, this study aimed to identify factors governing the retention of physicians in rural and underdeveloped areas.

Methods

International databases including Scopus, PubMed, Web of Science, Proquest, and Embase were searched using Mesh terms in order to find peer-reviewed journal articles addressing physicians’ retention factors in rural and underdeveloped areas. The records were screened, and any duplicate results were removed. The quality of the studies was assessed according to the Critical Appraisal Skills Program developed for different types of studies. Then, through content analysis, the related factors were identified from finally selected papers, coded, and categorized.

Results

The initial search resulted in 2312 relevant articles. On the basis of specific selection criteria, 35 full-text articles were finally reviewed.. The major affecting factors in physicians’ retention in rural and underdeveloped regions were classified into the following six categories: 1) financial; 2) career and professional; 3) working conditions; 4) personal; 5) cultural; and 6) living conditions factors.

Conclusion

There is a complex interplay of factors governing physicians’ retention in rural and underdeveloped areas. If health organizations are concerned with physicians’ retention in deprived areas, they should take into account these main factors. Moreover, they should develop policies and strategies to attract and retain physicians in rural and underdeveloped areas.

Increasing access to health workers in rural and remote areas: what do stakeholders' value and find feasible and acceptable?

BACKGROUND

The primary aim of this study is to assess stakeholders' views of the acceptability and feasibility of policy options and outcome indicators presented in the 2010 World Health Organization (WHO) global policy recommendations on increasing access to health workers in remote and rural areas through improved retention.

METHODS

A survey on the acceptability, feasibility of recruitment and retention policy options, and the importance of their outcome indicators was developed. It followed a cross-sectional approach targeting health workers in rural and remote settings as well as policy- and decision-makers involved in the development of recruitment and retention policies for such areas. Respondents were asked their perception of the importance of the policy outcomes of interest, as well as the acceptability and feasibility of the 2010 WHO guidelines' policy options using a 9-point Likert scale.

RESULTS

In total, 336 participants completed the survey. Almost a third worked in government; most participants worked in community settings and were involved in the administration and management of rural health workers. Almost all 19 outcomes of interests assessed were valued as important or critical. For the 16 guideline policy options, most were perceived to be "definitely acceptable" and "definitely feasible", although the policy options were generally considered to be more acceptable than feasible.

CONCLUSION

The findings of this study provide insight into the revision and update of the 2010 WHO guideline on increasing access to health workers in remote and rural areas. Stakeholders' views of the acceptability, feasibility of policy options and the importance of outcomes of interest are important for the development of relevant and effective policies to improve access to health workers in rural and remote areas.

Characteristics and removal of microplastics in rural domestic wastewater treatment facilities of China

The environment of the countryside is different from that of the city. Studying the abundance, characteristics, and removal of microplastics (MPs) in rural domestic wastewater treatment facilities (RD-WWTFs) is of great significance for understanding the impacts of human activities on the environment of the countryside. Therefore, we studied five such facilities in the Hangzhou region of China. The abundance of MPs in the influent was 430-2154 items/m³. Micro-Raman spectroscopic analysis indicates that the main type of polymer in the influent is polypropylene (PP, 54.6%), followed by polystyrene (PS, 29.7%) and polyethylene terephthalate (PET, 9.7%). The color of MPs is mainly white and clear (62.9%), red (13.3%) and gray (12.0%). Our results show that fragments (71.3%) are the dominant shape of MPs, followed by fibers (21.5%). The characteristics of MPs, such as sizes, shapes, and types, along with the treatment process, affect the removal of MPs in RD-WWTFs. Large MPs are easily removed by anaerobic processes, while small MPs are better removed by anaerobic/anoxic/oxic processes. Fibrous MPs are more difficult to be removed than the fragmented ones. Constructed wetlands play an important role in the removal of MPs.

Profiling the participants in creative tourism activities: Case studies from small and medium sized cities and rural areas from Continental Portugal

Although cultural tourists increasingly seek to experience cultural events actively and to directly engage in creative activities, empirical knowledge about the creative tourist remains limited. This study aims to characterize the motivations and profile of creative tourists. The data was collected through a survey of participants in creative tourism activities in Portugal developed by 40 pilot institutions of the CREATOUR project during 2017 and 2018, with 814 usable questionnaires collected and validated. The questionnaire had 30 questions and marked the first time this kind of research was conducted in Portugal. The questionnaire included questions on: the composition of their travel companions, their previous participation in a creative tourism experience, reasons for visiting the destination, their characterization of the creative tourism experience, an evaluation of their creative tourism experience, and their socio-demographic profile. Using a cluster analysis to analyse the data, three clusters were found: Novelty-Seekers, Knowledge and Skills Learners, and Leisure Creative-Seekers.

Household air pollution from cooking and heating and its impacts on blood pressure in residents living in rural cave dwellings in Loess Plateau of China

Cave dwelling is an ancient and unique type of residence in the Loess Plateau of Northern China, where the economics are less-developed. The majority of the local dwellers rely on traditional solid fuels for cooking and heating, which can emit large amounts of particles into both indoor and outdoor environments. In this study, we measured the real-time household concentrations of PM_2.5 and explored the association between personal daily PM_2.5 exposure and blood pressure (BP). Cooking and heating activities with different energies made a great variation in the household PM_2.5 air pollution, and residents using biomass had the highest personal PM_2.5 exposure. Temperature and relative humidity are both significantly linear correlated with household PM_2.5 air pollution. Besides, systolic blood pressure (SBP) was demonstrated to be positively associated with personal PM_2.5 exposure: with each 10-μg/m³ incremental PM_2.5 concentration when controlling all the other factors, SBP will increase by 0.36 mmHg (95% confident interval (CI) 0.05-0.0.77 mmHg). If solid fuels could be replaced with clean energies, personal PM_2.5 exposure and SBP would reduce by more than 21% and 3.7%, respectively, calling for efficient intervention programs to mitigate household air pollution of cave dwellings and protect health of those residents.

Identification of motives and barriers to physical activity of polish young mothers

BACKGROUND

The purpose of the study was to determine the level of physical activity of young mothers living in rural and urban areas and their free time budget. The article also aims to indicate motivating factors and barriers encountered during physical activity.

METHODS

A diagnostic survey method, including two survey IPAQ questionnaires - the long version and author's questionnaire, has been applied in the study. A representative sample consisted of 1064 young mothers who gave birth in 2017. Student T test and discriminate function analysis have been used in statistical analysis.

RESULTS

No significant difference appeared between young mothers from rural areas and urban areas in the level of physical activity. At the same time, the authors of the study identified several smaller differences when analyzing particular aspects of physical activity. Young mothers from rural areas more often declared their participation in physical activity to improve their physical condition and reduce pain complaints. On the other hand, young mothers from urban areas emphasized that physical activity helps them to strengthen self-confidence and improve their position in the family. In case of the main barriers to physical activity, both group of respondents pointed to the lack of money and interest in occasional events.

CONCLUSIONS

The main conclusion is that more efforts are needed is to strengthen family support and material status of young families. It is also important to eliminate infrastructure barriers, mostly in rural areas and raise awareness on the importance of health education.

Community participation in crime prevention and control in rural Nigeria

The rural areas in Nigeria have become notorious with all kinds of crime. Inadequate amenities such as good roads and communication infrastructure in rural areas in Nigeria have made it difficult for the Nigeria Police to effectively detect and prevent crimes in rural Nigeria. It is consequent on these escalations of criminal activities that rural communities in Nigeria have evolved community policing to protect their neighbourhoods.

This article presents the benefits of using qualitative and quantitative methods of data collection to unravel the potentials inherent in informal crime prevention and control in rural localities in Nigeria. The social capital theory was used to bring out the benefits of community participation in crime control in rural Nigeria.

Findings from the study indicated high theft cases as common crime in rural Nigeria. Youths were observed to constitute greater percentage of suspects at police stations for crime. Unemployment and poverty among the rural populace especially youths were responsible for these criminalities. The absence of social infrastructure, inadequate police presence and government support to unemployed youths made the crime situations worse in rural areas. There was low level of community interactions with the police in crime prevention and control in rural Nigeria.

The study recommended increased police-public partnership in crime prevention and control in rural Nigeria.

Capturing modelled and perceived spatial access to ambulatory health care services in rural and urban areas in Germany

Studies on social and regional inequalities in access to health care often use spatial indicators such as physician density to measure access to health care. However, the concept of access is more complex, comprising, among others, patient perceptions. In this study, we evaluate the association between different spatial measures of access (i.e. physician density, distance to the nearest provider, and measures based on floating catchment area methods) and measures of perceived spatial access to ambulatory health care in rural and urban areas in Germany. Using correlation and regression analysis, we found that the significance and strength of the relation between perceived and modelled spatial access depends on the type of area and the physician group. The distance to the nearest physician is associated with perceived spatial access to GPs only in rural areas but not in urban areas. More sophisticated measures of spatial access seem not to explain perceived access better than the simpler indicators.