Prevalence and influencing factors of anaemia among pregnant women in rural areas of Northwestern China

OBJECTIVES

Anaemia during pregnancy is a significant public health problem that adversely impacts both the mother and foetus. However, the factors influencing maternal anaemia in deprived areas of Northwestern China have not yet been thoroughly investigated. This study aimed to describe the prevalence and potential influencing factors of anaemia among expectant mothers in rural areas of Northwestern China.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

A cross-sectional survey of 586 expectant mothers was conducted to investigate the prevalence of anaemia, prenatal healthcare coverage, dietary diversity and nutrient supplementation intake. The study population was selected from the sample areas using a random sampling method. Data were collected through a questionnaire, and haemoglobin concentrations were measured by a capillary blood test.

RESULTS

The results show that 34.8% of the study population were anaemic, with 13% having moderate-to-severe anaemia. The results of the regression analysis showed that diet was not significantly associated with haemoglobin concentrations or the prevalence of anaemia. However, regular prenatal healthcare attendance was found to be an important influencing factor for both haemoglobin concentration (β = 3.67, P = 0.002) and the prevalence of anaemia (odds ratio = 0.59, P = 0.011).

CONCLUSIONS

Pregnant women receiving regular prenatal care were less likely to be anaemic; thus, it is essential to implement strategies to improve attendance at maternal public health services to reduce the prevalence of maternal anaemia.

Subterranean transport of microplastics as evidenced in karst springs and their characterization using Raman spectroscopy

The increasing use of plastic materials has led to accumulation of large amounts of plastic waste in environment and a global challenge to be tackled with. The natural process of macro-plastics aging generates a multitude of secondary microplastic fragments accumulating in all areas of the planet. The pollution with microplastics of large water bodies, such as rivers, seas and oceans was already proven, but the presence of microplastics even in karst spring water was not reported yet. In this study, Raman micro-spectroscopy was used to confirm the presence of microplastics in the spring water samples collected from two rural karst springs in the Apuseni Mountains (Țarina and Josani), North-Western Romania. Two sets of water samples of 1000 L collected in spring time 2021 and one in autumn 2021 were filtered and analyzed. Using the Python programming language and combining two separate Raman databases, one for plastics and the other for pigments, we established a customized database to unambiguously identify the type of plastic and pigment present in the discovered micro-fragments. The generated reference pigment-plastic spectra were compared to those of potential microplastics found on filters and Pearson's coefficient was used to measure the level of similarity. The presence of microplastics in karst spring waters was confirmed and a quantitative estimation expressed as number of fragments or fibers per liter was 0.034 in Josani and 0.06 in Țarina karst spring. Five months later sampling (autumn 2021) revealed 0.05 microplastics per liter. The spectral results revealed that most microplastics found were dominated by polyethylene terephthalate (PET), followed by polypropylene and interestingly, abundant blue micro-fragments were identified according to their copper phthalocyanine pigments (pigment Blue 15) or indigo carmine (pigment Blue 63) characteristic spectral fingerprints, which surpassed the inherent spectral background level characteristic for the Raman spectra of naturally contaminated waste micro-samples. Their origin in mountain karst spring waters and potential decrease in time is discussed.

Analysis of the tick communities associated to domestic mammals in rural areas of the Yungas montane forest from Argentina

The aim of this work was to describe the tick community associated to domestic mammals in rural areas from the Yungas lower montane forest of Argentina. The circulation of tick-borne pathogens was also analyzed. Samples of ticks parasitizing cattle, horses, sheep and dogs were carried out in different seasons, and questing ticks were collected from vegetation and analyzed to detect the presence of Rickettsia, Ehrlichia, Borrelia and Babesia by a battery of different PCRs. The structure of the tick communities was analyzed through the Chao1 species richness estimator, the Shannon-Wiener index and the Horn index of community similarity. Eight tick species were collected in the study area: Amblyomma sculptum, Rhipicephalus microplus, Amblyomma hadanii, Dermacentor nitens, Amblyomma ovale, Haemaphysalis juxtakochi, Ixodes pararicinus and Rhipicephalus sanguineus sensu stricto. However, A. sculptum was by far the dominant species in the tick assemblages analyzed, and this was reflected in the low diversity values obtained. Dermacentor nitens, A. sculptum and R. microplus were the three species associated to horses. The predominance of A. sculptum was also observed in the tick samples obtained from dogs, even on two tick species, namely A. ovale and R. sanguineus s.s., which have dogs as the principal domestic host. Rhipicephalus microplus and A. sculptum were the most abundant ticks on cattle, while few specimens of I. pararicinus, A. hadanii and D. nitens were found on bovines. Dermacentor nitens ticks were found to be infected with B. caballi, which indicate the circulation of this pathogen of horses in the Yungas area. The detection of a strain of Borrelia sp. belonging to the B. burgdorferi s.l. complex in I. pararicinus is consistent with previous findings made in Argentina, but the public health relevance of this vector-microorganism association is far from being similar to that occurs in the northern hemisphere because there are practically no records of these tick species parasitizing humans in South America. The tick community of rural areas of the Yungas lower montane forest is composed by species which are potential vectors of pathogenic microorganism with veterinary and public health importance, circulating in a human-wildlife-livestock interface.

Vertical tubular flocculator: Alternative technology for the improvement of drinking water treatment processes in rural areas

The guarantee of access to safe drinking water for rural communities is a great challenge due to the increase in contamination and deterioration of water sources. Rural areas face technological, financial, and operational limitations, having poor water quality, generally. The purpose of this study was to evaluate the efficiency of a vertical tubular flocculator (VTF) to be used as part of the purification process in rural areas where small flows are used. An experimental treatment system (ETS) implemented in the field was used. The VTF was implemented using PVC pipes and fittings. Tests were carried out with the same raw water used from a conventional treatment plant with aluminum sulfate as a coagulant. The optimal coagulant dose applied in the ETS was determined by the jar test. In the VTF, the length, turbidity, and flow of the raw water were varied. The hydraulic behaviour of the VTF was evaluated with the analysis of the time distribution curve of concentration of a tracer applying the Wolf-Resnick model. A low residence time VTF was obtained, representing a new efficient flocculation model for the reduction of turbidity and colour. The results showed that the turbidity of the raw water, the residence time, and the degree of agitation are important parameters in the operation and efficiency of a VTF. There was a predominance of plug flow in the reactor. The obtained results were compared with the efficiency of a conventional water treatment plant used in the study site. The results obtained indicated that this ETS that integrates a VTF with settling and filtration can be a useful tool for rural areas. It was recommended to replicate this study with wastewater, other dimensions of the VTF, to establish a specific methodology for the design of the VTF, to evaluate the dosage with dose bombs for improving the results of VTF, and to elaborate a hydraulic model for VTF.

A qualitative exploration of Chinese rural older adults' adaption experience to disability in Henan Province

BACKGROUND

The global population is ageing in a serious way and the number of disabled elderly people is increasing. Disability is a combination of physical and functional impairments, activity limitations, and social participation restrictions that significantly affect the quality of life of older adults. This study used the Roy adaptation model to examine the adaptive strategies of rural disabled elderly.

METHODS

An interview outline was prepared based on the Roy Adaptation Model, in-depth interviews were conducted with eligible rural elderly with disabilities using purposive sampling. Interview data were analyzed using the colaizzi method to obtain relevant themes and sub-themes of the adaptation experience.

RESULTS

Fifteen eligible disabled elderly participated in the interview, with an average age of 73.7 years old, showing different adaptation experiences in different aspects, a total of 5 themes and 18 sub-themes were extracted: (a)physiological function adaptation: learning to monitor physiological indicators, active medical compliance behavior, active rehabilitation exercise, adjusting lifestyle and coping with failure, (b) self-concept adaptation: adjustment of gratitude mentality, self-consolation, transferring the attention, seeking emotional comfort, and negative emotional response, (c) role function adaptation: positive self-care role, negative family role and escape of social role, (d) interdependence adaptation: actively seeking support and complex social coping, and (e) adaptation influencing factors: personal factors, caregiver factors and the policy factors.

CONCLUSIONS

The disabled elderly show different adaptation strategies in four ways, and are affected by personal factors, caregiver factors and policy factors. A multi-faceted support system for the disabled elderly is recommended, and the caregivers should be trained in all-round care knowledge and skills.

Exploring the antenatal care challenges faced during the COVID-19 pandemic in rural areas of Indonesia: a qualitative study

INTRODUCTION

The COVID-19 pandemic affected almost all healthcare services in Indonesia, including antenatal care (ANC). Pregnant women were a vulnerable group during the pandemic since the Indonesian government's policies at the time influenced the delivery of ANC services, particularly in rural areas. Investigating the ANC challenges faced during the pandemic from the perspectives of pregnant women and healthcare providers is important for our understanding of ANC provision. This study, therefore explores barriers to ANC appointments faced during the COVID-19 pandemic in rural areas of Indonesia from the perspectives of pregnant women and health care providers.

METHODS

This was a qualitative exploratory descriptive study involving 31 participants, consisting of 25 pregnant women and six healthcare providers who were selected via a purposive sampling method. Thadeus and Maine's Three Delays Model was used as the theoretical framework. Data were collected between March and August 2021, through two focus group discussions (FGDs), ten in-depth interviews, and field notes. Data were analyzed using a thematic analysis method.

RESULTS

Three themes describing barriers to ANC during the COVID-19 pandemic in rural areas of Indonesia emerged from this study. Those themes were: (1) The fear of being infected with COVID-19, related to anxiety, perceived vulnerability, and the desire to protect oneself and loved ones; (2) The stay-at-home policy, related to transport barriers and restricted social activity; and (3) Re-designed ANC services, related to ANC adjustments, high-risk pregnancies, insufficient information, and adherence to COVID-19 preventive behaviors.

CONCLUSION

Based on the Three Delays Model, several challenges to carrying out ANC during the COVID-19 pandemic in rural areas of Indonesia were identified. These findings demonstrate the need to formulate and implement ANC packages to facilitate pregnant women's access to health care services.

Current prevalence and geographic distribution of helminth infections in the parasitic endemic areas of rural Northeastern Thailand

BACKGROUND

Helminth infection is a global health issue that not only causes acute helminthiasis but long-term infection may lead to complicated symptoms as well as severe complications. The World Health Organization cooperated with the Ministry of Public Health in many countries, particularly where high prevalence, spending a lot of resources for limiting the infection. In Thailand, the incidence of parasitic helminth infections was continuously declined in the last few decades according to several campaigns for parasitic elimination. However, the rural community in the northeast of Thailand where the highest prevalence of the country still needs to be monitored. This present study aims to report the current prevalence of parasitic helminth infections in Nakhon Ratchasima and Chaiyaphum provinces where sharing a huge area of the northeastern region of Thailand but only a few studies have been published.

METHODS

The stool specimens were collected from 11,196 volunteers and processed by modified Kato-Katz thick smear, PBS-ethyl acetate concentration techniques, and PCR. The epidemiological data were collected, analyzed, and used for generating of parasitic hotspots.

RESULTS

The results indicated that O. viverrini remains the major parasite in this area with a total prevalence of 5.05% followed by Taenia spp., Hookworms, T. trichiura, and Echinostoma spp., respectively. Mueang district of Chaiyaphum province has the highest prevalence especially O. viverrini with a prevalence of 7.15% that higher than the latest national surveillance. Interestingly, the prevalence of O. viverrini was hugely reported (more than 10%) in five subdistricts. The geographic localization of O. viverrini infections revealed that a lot of water reservoirs such as the lakes or branches of the river in the two-most prevalent subdistricts. Our finding indicated that gender and age were insignificantly different.

CONCLUSION

This finding suggested that the parasitic helminth infection in the rural areas of northeast of Thailand remains high and the housing location is a major contributing factor for the parasitic infection.

Leaching risk of antibiotic resistance contamination from organic waste compost in rural areas

Composting is an important decentralized technology for treating multiple biodegradable organic wastes in rural areas. However, compared to industrial composting (i.e., time and temperature protocols), rural composting is less well-controlled, and the risk of antibiotic resistance genes (ARGs) in these composts needs to be determined. We performed a quantitative determination of ARGs and both prokaryotes and eukaryotes to investigate the liquid-solid leaching ratio and the relationship between ARGs and microbial communities in solid and water extracts of composts collected from rural areas. We observed a high level of sulfonamides resistance genes and tetracyclines resistance genes (10^-4-10^-2 copies/16S copies). Tet-C and tet-X show the strongest leaching potential in rural organic waste composts with complex hosts in solid and liquid phases. This study showed high ARG abundances in compost solid and water extracts, highlighting the leaching risk of compost ARGs when exposed to runoff or groundwater during open storage and field application.

Influencing factors for decision-making delay in seeking medical care among acute ischemic stroke patients in rural areas

OBJECTIVE

To explore the factors influencing decision-making delay in seeking medical care for patients with acute ischemic stroke (AIS) in rural areas.

METHODS

From September to December 2021, we conducted a questionnaire survey of 260 patients with AIS who were hospitalized in the neurology departments of four county-level hospitals in Daqing. A decision-tree and logistic regression model was used to investigate the elements contributing to decision-making delays.

RESULTS

This study found that the decision-making delay rate for rural patients with AIS was 71.5%. The results of the univariate analysis showed that factors associated with decision-making delay included educational level, National Institute of Health stroke scale (NIHSS) score, self-assessed health, monthly income, social support, attitude toward medical help-seeking, health belief, and family dynamics (P < 0.05). Further, we combined logistic regression (LR) and decision-tree (DT) models for multivariate analysis, and finally obtained five factors affecting decision-making delay in AIS patients in rural areas: disease severity, health belief, monthly income (common factors), educational level (only DT model), and social support (only LR model).

CONCLUSIONS

This study found that a few variables, including disease severity, educational level, monthly income, health belief, and social support, affected rural AIS patients' decision-making delay in seeking medical care.

PRACTICE IMPLICATIONS

To achieve the goal of reducing decision-delay and increasing thrombolysis rate, this study thoroughly examined the influencing factors of decision-making delay in seeking medical care of rural AIS patients from various angles. This analysis provides guidance for medical and healthcare professionals on how to best provide future health education for the high-risk population for stroke in rural areas.

Associations between trace level thallium and multiple health effects in rural areas: Chinese Exposure and Response Mapping Program (CERMP)

Thallium (Tl) is a cumulative high toxicant in the environment, but few studies have investigated the comprehensive health effects underlying chronic Tl exposure at trace levels. This study aims to evaluate the liver, kidney, lung and other potential health effects associated with chronic Tl exposure at trace levels in rural areas of China. Urinary Tl concentrations of 2883 adults from rural areas of 12 provinces in China were measured and 2363 participants were involved in the final analysis. Indicators of liver and kidney functions in the serum, as well as the lung function indicators, were determined in the participants. General linear regression and restricted cubic spline regression were combined to study the associations between urinary Tl and health indicators or outcomes. In this study, the detected rate of Tl in the urine of the participants was 97.28 %. When the urinary Tl concentration was ranged at the fourth quintile, the risk of having liver function disorder was 70 % higher [Odds ratio (OR) = 1.70 (95 % confidence intervals (CI): 1.30, 2.22)] in all the participants, whereas the farmers were more likely to have the disorder [OR = 2.08 (95 % CI: 1.49, 2.92)] than the non-farmers [OR = 1.20 (95 % CI: 0.77, 1.88)]. Nonlinear associations between most of the liver health indicators and urinary Tl were identified, of which serum bilirubin was strongly associated with the elevation of urinary Tl when its concentration was >0.40 μg/g creatinine. Besides, urinary Tl was negatively associated with lung health indicators. Our study proposes the safety re-assessment of the current exposure level of Tl in the environment, especially in rural areas of China.

Generalized anxiety disorder among rural primary and middle school students during the outbreak of COVID-19: a multicenter study in three southern Chinese cities

BACKGROUND

The major public health crisis caused by the rapid spread of the coronavirus disease 2019 (COVID-19) and the large-scale public health measures such as social isolation and school closures enforced by some countries have severely affected on the physical and mental wellbeing of children and adolescents globally. This study aimed to estimate the prevalence of the psychological impact and investigate the similarities and differences in the influential factors for generalized anxiety disorder among rural adolescents as a relatively lesser noticed population the outbreak of COVID-19.

METHODS

From May 11 to 22, 2020, a total of 1,179 adolescents, including Grade 5-6 in primary school and Grade 7-8 in middle school, were selected by multistage sampling in three Southern Chinese cities (Shantou, Guangdong Province; Hezhou, Guangxi Province; Nanchong, Sichuan Province), and completed the questionnaires including sociodemographic, generalized anxiety disorder, academic stress, coronaphobia, knowledge of COVID-19, and precautionary measures. ANOVA, Chi-square test, Kruskalwallis H test and multivariate linear regression were performed in the statistical analysis.

RESULTS

The average scores of generalized anxiety disorder during the past two weeks were 3.43 (SD 4.46), 4.47 (SD 5.15), and 4.10 (SD 4.94) in Shantou, Hezhou and Nanchong, respectively. For the pooled data, academic stress (P < 0.001), coronaphobia (P < 0.001), and precautionary measures (P = 0.002) contributed to the prediction of anxiety scores. Academic stress was significantly associated to anxiety symptoms in all cities (P all < 0.001). Coronaphobia was also significantly associated to anxiety symptoms in all cities (P all < 0.001).

CONCLUSION

This study highlights the urgent need for researchers and policymakers to focus on the mental health of rural children and adolescents during the COVID-19 epidemic. The adolescents with academic stress and coronaphobia, the greater the risk that adolescents will suffer from anxiety, suggesting mental health counseling and professional family support are needed.

Does labor transfer affect rural household cooking fuel choice? Examining the role of income

It's the direction of all humankind's joint efforts to develop clean cooking fuels and reduce carbon emissions vigorously. While most studies found that householder and family characteristics influence household cooking fuel choice, few studies focus on the relationship between labor transfer and the choice of clean cooking fuels. Based on the three-phase survey data of the China Labor-Force Dynamic Survey in 2012, 2014, and 2016, this paper analyzes the influence of labor transfer on rural households' cooking fuel choice. It focuses on the mediating role of income and the heterogeneity of labor transfer on household cooking fuel choice under different educational levels and location conditions. The results show that (1) from 2012 to 2016, there are regional differences in the development of clean cooking fuels; (2) labor transfer can promote households to choose clean cooking fuels, and this result remains robust after controlling for endogeneity; (3) labor transfer indirectly influences household cooking fuel choice through affecting family income; and (4) the impact of labor transfer on household cooking fuel choice varies with different education levels and location conditions. Therefore, analyzing the optimization of rural cooking energy structure from the perspective of labor transfer plays an important role in ensuring the sustainable development of clean cooking fuels in rural areas.

Less car, more bicycle? Generation Y as pioneers of changing everyday mobility in Germany

Background

The paper examines whether the widespread assumption holds that younger birth cohorts (referred to as Millennials or Generation Y) act as pioneers of changing everyday mobility.

Methodology

Based on the time-series dataset "Mobility in Germany" (Mobilität in Deutschland), cohort-specific changes in everyday bicycle and car use that have occurred between 2002 and 2017 are analyzed. The empirical analyses are differentiated by age-group and settlement type. Additionally, socio-structural factors are taken into account.

Results

The results show a decline in the predominant everyday use of cars in metropolitan cities, especially among Generation Y. However, the Millennials do not emerge as pioneers of the trend toward predominant bicycle use. The results challenge the assumption that changes in everyday mobility are essentially driven by generational change.

[Vascular surgery care in rural areas-Adaptation to demographic and epidemiological requirements]

Introduction

The demographic development in Germany, especially in Saxony-Anhalt (SA), also poses challenges for vascular surgery, as the incidence of vascular diseases has increased following demographic change. For example, the prevalence of peripheral arterial occlusive disease (PAOD) in industrialised countries is estimated at around 10-20% in people over 60 years of age; thus, the number of people affected will also increase here with demographic change. Especially in rural areas, it seems to be more difficult for patients to reach appropriate specialist treatment.

Material and methods

A compact narrative brief review, based on selective references from the current medical-scientific literature and our own experiences from daily practice in setting up a vascular surgery department in a rural area.

Results

In 2020, the population in the rural district of Jerichower Land (SA) was approximately 89,403 (male: 44,489; female: 44,914). The age distribution in the age groups relevant for PAOD is as follows: 65-74 years-total, 12.38%; 75 years and older-total, 13.85%; average age, 48.36 years (population density, 56.4/km²). According to the SA Association of Statutory Health Insurance Physicians, there were 605 patients for every doctor in Burg (SA) in 2019.There was a total of 5087 people in need of long-term care in the district in 2019. With such a low population density, low doctor density, high mean age, high proportion of people over 75 years of age and a high number of people in need of care, limited mobility and accessibility to vascular surgery care are to be expected, which was also reflected in the high number of PAOD of stage IV (FONTAINE) in the initial patient clientele.Every establishment of a vascular surgery department is associated with a considerable financial and material investment, which the provider of the facility must be prepared to make.In addition to the material investment, the availability of appropriately qualified staff to implement and maintain continuity of care must also be seriously considered.

Conclusion

The high proportion of residents at risk of and suffering from PAOD in a rural area with low population and doctor density allows investment in the establishment of a new vascular surgery department to ensure local care in this patient group with limited mobility and self-help, thus, ultimately from an appropriate health policy perspective but also from the perspective of a relevant revenue outlook.

The rural consumer adoption of sustainable energy: a PLS-SEM-ANN approach of conceptual model development and cross-country validation of Pakistan and Malaysia

Sustainable and alternative energy sources of biofuel and solar power panel have been revolutionizing the lives and economy of many countries. However, these changes mainly occur in the urban areas and the rural population section has long been ignored by policy makers and government in the provision of energy. It is only recently that solar and biofuel are finally making in road to provide cheap and clean energy sources to rural population. As a result, literatures on consumer behavior of rural population towards sustainable energy sources are still very scarce. The present research aims to fulfill this gap by developing a conceptual model to investigate the adoption of solar power and biofuel energy resources in the cross-cultural setting of Malaysia and Pakistan. The data was collected from the rural areas of Pakistan and Malaysia. The two-stage data analysis method of partial least squares structural equation modeling (PLS-SEM) and artificial neural network (ANN) have been applied to satisfy both linear and non-linear regression assumptions, respectively. The results show that consumer in rural areas of Pakistan are willing and possess intention to adopt both biofuel and solar power for commercial and domestic use. Additionally, the results confirm that branding, economic, and altruistic factors are important in yielding intention to use towards biofuel and solar power panel in Pakistan which are validated by the results obtained in Malaysia. Other factors such as climate change awareness, retailer services quality, and ease of use are also important. The results offer wide-ranging theoretical and managerial implications.

A county-level study of the effects of state-mandated COVID-19 lockdowns on urban and rural restaurant visits using consumers' cell phone geo-location data

Aim

US federal, state, and local governments implemented numerous COVID-19 shelter-in-place orders (lockdowns) starting in March 2020 to ensure social distancing regulations and help stop the spread of COVID-19. It is important to know how these lockdowns affected businesses, such as restaurants, in regions that vary in terms of poverty status and geography. In this paper, we analyze the differential changes in rural and urban restaurant visits by the restaurants' NAICS codes following the COVID-19 lockdowns. Our analysis contributes to the public policy literature and helps operational planning for food distribution during a pandemic.

Methods

Since urban and rural consumer behavior and food resources are significantly different, it is crucial to conduct a comparative analysis. Our study applies a difference-in-differences model to capture the differential effects lockdowns have on urban and rural restaurants.

Results

We find that restaurant visits declined significantly in both rural and urban counties after shelter-at-home orders. The decrease in total restaurant visits was almost twice as high in urban counties as in rural counties. We also find that visits to fast-food restaurants increased in rural counties during shelter-at-home orders.

Conclusions

These results contribute to previous studies on the dearth of healthy food in rural and poorer regions, and inform important public policy response in the wake of the COVID-19 pandemic.

Effectiveness of Pfumvudza as a resilient strategy against drought impacts in rural communities of Zimbabwe

Pfumvudza is a Zimbabwean vernacular language term literally referring to the blooming of new leaves during the spring season signalling the beginning of a new farming season. It used to refer, to the conservation agriculture concept, a crop production intensification approach under which farmers ensure the efficient use of resources on a small area of land in order to optimise its management. The research assessed the effectiveness of Pfumvudza as a resilient strategy against climate change induced drought impacts in rural communities Zimbabwe, case of Munyarari ward 20. The descriptive case study was used triangulating data collection methods. The sample size was 96 households who practised Pfumvudza (20% of the target population) and all the 18 households (100%) which did not practise Pfumvudza. These were randomly sampled from five conveniently selected villages in the ward. Four key informants were purposively selected. Data was analysed using SPSS and content analysis. Climate change induced drought impacts greatly affected communal farmers who depended on rain fed agriculture. This led to food insecurity which attracted donor aid year after year. Pfumvudza improved yields and reduced donor aid in the area. Mann-Whitney test results indicated that there was a difference between yields of crops before and after Pfumvudza scheme. Mann-Whitney test results also revealed that there was a significance difference between those who practiced Pfumvudza and those who did not. It was concluded that Pfumvudza increased resilience against climate change induced drought impacts and improved yields in rural communities of Zimbabwe where it was implemented. The research recommends farmers to fully embrace the Pfumvudza strategy so as to realize high yields and improve food security.

Multidimensional evaluation of healthy life expectancy indicators based on mental health among the rural older population: A large-scale cross-sectional study

BACKGROUND

This study aimed to estimate healthy life expectancy (HLE) regarding anxiety, depression and their comorbidity among rural older adults.

METHODS

A total of 12,851 subjects (5790 men and 7061 women) enrolled from the Henan Rural Cohort Study were used to evaluate healthy status expectancy (HSE), and 10,096 (4475 men and 5621 women) of them were used to estimate health-adjusted life expectancy (HALE). The life expectancy was calculated using period life table, and HSE and HALE indicators were calculated via the Sullivan method.

RESULTS

For participants aged 60, the depression-free life expectancy (DFLE), anxiety-free life expectancy (AFLE), and depression- and anxiety-free life expectancy (DAFLE) were 23.0993, 23.3314, and 22.7206 years, respectively. The quality-adjusted life expectancy (QALE) of those with neither anxiety nor depression, with anxiety, with depression, and with comorbidity was 22.0727, 20.8751, 18.1484, and 17.0823 years, respectively. The ratio of DFLE (AFLE) to LE increased with age among both genders, while the DAFLE/LE showed a decreasing trend. Regardless of HSE or HALE indicators, women tended to have higher HLE, while HLE/LE was lower than men. Furthermore, all HLE indicators associated with anxiety were the largest in both genders compared to indicators regarding depression.

LIMITATIONS

The HLE may be overestimated ignoring institutional population in the study.

CONCLUSION

Anxiety and depression played essential roles in the quality of life among rural older adults, especially depression. Comorbidity would intensify the adverse effect in rural areas, especially for older men. More attention should be paid to the psychological problems among rural older population.

Rural revival? The rise in internal migration to rural areas during the COVID-19 pandemic. Who moved and Where?

During the outbreak of the COVID-19 pandemic, anecdotal evidence of a "rural revival" emerged mirroring the "urban exodus" hypothesis. Currently, we know that internal migration to rural areas increased in some countries during 2020, although not with the intensity speculated by the media. However, little is known about the attributes of rural areas attracting migrants, demographic composition of migration inflows, and if counterurbanisation movements persisted over 2021. Drawing on administrative population register data, we analysed the main types of rural areas pulling internal migrants in Spain and their demographic characteristics, namely age, sex and place of birth during 2020 and 2020, using the period 2016-2019 as a benchmark. Our results show that in-migration increased in rural areas close to cities and with high prevalence of second homes during 2020, while out-migration declined. Exceptionally high inflows persisted over 2021, but outflows converged to figures observed prior to the pandemic. Inflows to rural areas comprised internal migrants across a wide age spectrum, from young adults and families to retired individuals. These flows also comprised foreign-born, particularly populations of a wide age range from Latin American countries.

How can Quality of Life be Achieved in a Sustainable Way? Perceptions of Swiss Rural Inhabitants

Rural regions in Europe are often structurally weaker than urban areas and are subject to strong socio-economic development. At the same time, they offer opportunities for a high quality of life and sustainability. The key question of this article is how quality of life in high-income countries can be achieved more sustainably. Little is known about the perception of the rural population itself on the reconciling of high quality of life with sustainability. Thus, based on a concept of sustainable quality of life, qualitative interviews with 90 rural residents were conducted to ask them which factors benefit sustainable quality of life. In the perception of the interview participants, a change in attitudes and values would be a starting point for shaping many other areas to enhance sustainable quality of life; social and legal norms should provide reference points for individuals and economic actors; infrastructure should support individuals in their ecological behaviour; and the economy should serve the common good. We derive four strands of recommendations for decision-makers from these results: the enhancement of education on applicable environmental behaviours, equal access to renewable energies and local productions and services.

Pandemic mobility, second homes and housing market change in a rural amenity area during COVID-19 - The Brecon Beacons National Park, Wales

The Covid-19 pandemic has been presented as a critical change driver for rural amenity areas, precipitating urban flight and a decentralisation of housing choice and investment. House prices in both near-urban and more distant rural markets saw considerable growth in 2020 and 2021, linked to a mix of second home investment, expanded demand for holiday letting, migration to exploit flexible-working opportunities, and homebuying for early retirement. These demand-side pressures, apparently accentuated by the pandemic, combine with supply-side constraints on development in rural areas (which can accommodate a limited amount of additional housing) to produce significant housing stress. However, processes affecting some areas, in different parts of the world, have arguably been generalised to all areas, and localised processes remain under-investigated. This monograph explores the experience of the Brecon Beacons National Park in Wales, UK - an amenity area with good connectivity to a number of major urban centres and therefore sources of extra-local housing demand. Focusing on second home buying, as a leading element of extra-local pressure in amenity areas, the monograph considers the particular circumstances of this area. It shows that a combination of amplified demand-side factors, linked to the pandemic, and heightened supply-side constraints, due to a phosphate crisis affecting the National Park's major river catchments, requires a programme of actions that extends beyond the housing domain in order to resolve escalating housing market challenges and associated community and economic risks.

Outdoor air pollution enhanced the association between indoor air pollution exposure and hypertension in rural areas of eastern China

Recently, the high prevalence of hypertension (HTN) has caused serious disease burden. Previous studies mostly focused on the separate association between outdoor or indoor air pollution and HTN, and did not explore their possible interaction with HTN. To explore this issue, this study investigated the relationship between indoor and outdoor air pollution and HTN and their possible interactions among adult residents in 14 rural areas in eastern China. The generalized linear model (GLM) and interplot model were used to evaluate the separate effects and potential interaction of outdoor or indoor air pollutants on HTN. In separate analyses, we found a significant positive association between outdoor and indoor air pollution and HTN, and a significant negative association between range hood use and HTN. In the interaction analysis, outdoor air pollution could significantly enhance the positive effects of indoor air pollution on HTN. In addition, PM_2.5 and O₃ could significantly reduce the protective effect of range hoods use on HTN. Finally, we found that females were more susceptible to both indoor and outdoor air pollution.

Short-term exposure to six air pollutants and cause-specific cardiovascular mortality of nine counties or districts in Anhui Province, China

Recently, the burden of cardiovascular disease (CVD) has attracted global attention. Meanwhile, CVD has become the leading cause of death in China. Some epidemiological studies have indicated that ambient air pollution may contribute to increased mortality from CVD diseases. Many studies have found a strong association between air pollutants and the risk of CVD deaths in some big cities, but few have focused on the effects of six pollutants in rural areas. Our study aimed to investigate the effects of six air pollutants (CO, NO₂, O₃, PM_2.5, PM₁₀, and SO₂) on CVD deaths of rural areas in Anhui Province and to further clarify which populations were susceptible to air pollution. First, the generalized additive models were combined with the distributed lag nonlinear models to evaluate the individual effects of air pollution on CVD deaths in each area. Then, random-effects models were used to aggregate the associations between air pollutants and CVD mortality risk in nine regions. Overall, all six pollutants had a statistically significant effect on the risk of CVD deaths on the lag 07 days. The associations between PM_2.5, PM₁₀, and SO₂ and daily CVD deaths were strongest, with maximum cumulative RR (lag 07) of 1.91 (1.64-2.18), 2.27 (1.50-3.05), and 2.13 (1.44-2.82). In general, we found that six air pollutants were the important risk factors for CVD and specific CVD deaths in Anhui Province. The elderly were susceptible to PM_2.5, PM₁₀, and SO₂.

The effect of air pollution and emotional and behavioral problems on preschoolers' overweight and obesity

Childhood overweight and obesity (OWO) has risen dramatically in both developed and developing countries over the past few decades, creating a huge burden of disease. Ambient air pollution and emotional and behavioral problems are important influencing factors of OWO in preschoolers, but few studies have evaluated the impact of air pollution and emotional and behavioral problems on OWO of preschoolers in rural areas and their potential interactions. This study selected 3802 preschool children from 26 kindergartens in 4 rural areas of Anhui Province for a cross-sectional study. A total of 3636 individuals were included in the final analysis. In this study, outdoor air pollutants (PM_2.5 and O₃) were derived from the China Air Pollution Tracking (TAP) data set, matching preschoolers' external air pollution exposure according to their kindergarten address codes to neighborhoods or administrative villages. OWO were assessed based on WHO Child Growth and Development Standards. Generalized linear model (GLM) and interplot model were used to evaluate the separate effects and potential interactions of air pollutants and emotional and behavioral problems on preschoolers' OWO. In the separate analysis, we found a significant positive association between air pollution and emotional and behavioral problems and OWO among preschoolers. In the interaction analysis, air pollution could enhance the positive effect of emotional and behavioral problems on OWO in preschoolers. In addition, the effect of air pollution and emotional and behavioral problems on overweight and obesity was stronger in preschoolers aged 5 to 6 years. Finally, we also found a stronger positive association between emotional and behavioral problems among girls, macrosomia, non-left-behind children, and preschoolers without eating problems. This study provided a scientific basis for the control of air pollution and overweight and obesity among preschool children in Anhui Province.

Thyroid-disrupting effects caused by exposure to alternative flame retardants from groundwater contamination in rural central China

Accumulating evidence reveals that exposure to alternative flame retardants (AFRs) results in defective thyroid functions. AFRs are detectable in various environmental media in developed cities in China. However, few studies have reported the contamination levels of AFR in groundwater in rural areas, indicating an urgent need to investigate exposure of AFRs and perform health risk assessment for populations that use groundwater as the main source of drinking water. This study investigated the concentrations of AFRs in groundwater in rural areas of central China. Moreover, Nthy-ori-3-1 cells were used to determine the thyroid cytotoxicities and thyroid-interfering effects of a single AFR as well as the mixtures of AFRs based on the AFR contamination levels in real-world. The results revealed that all classes of AFRs were detectable in rural areas in central China. Dechlorane plus, hexabromocyclododecane, bromophenols (BPs), novel brominated flame retardants (NBFRs) and organophosphate flame retardants (OPFRs) exhibited spatial contamination patterns, with an average concentrations (median) of 157.89 ± 88.61 (185.47) pg/L, 0.09 ± 0.29 (not detectable) ng/L, 5.20 ± 5.92 (3.43) ng/L, 3338.11 ± 3758.78 (2836.72) pg/L, and 79.35 ± 97.19 (53.62) ng/L, respectively. The half maximal effective concentrations (EC₅₀) of BPs, OPFRs, and NBFRs ranged 98.4-4012 μM, 42.0-2506 μM, and 10.1-203.7 μM, respectively. Several AFRs exhibited more cytotoxic effects than did traditional brominated flame retardants. It is intriguing that several single AFRs and mixtures at environmentally-relevant exposure levels promoted the viability of Nthy-ori-3-1 cells. Taken together, our study demonstrates that AFRs are present in the groundwater in rural areas in central China and AFRs exhibit thyroid disrupting effects.