Physical activity attenuated the association of ambient ozone with type 2 diabetes mellitus and fasting blood glucose among rural Chinese population

The association of ozone with type 2 diabetes mellitus (T2DM) is uncertain. Moreover, the moderating effect of physical activity on this association is largely unknown. This study aims to evaluate the independent and combined effects of ozone and physical activity on T2DM and fasting blood glucose (FBG) in a Chinese rural adult population. A total of 39,192 participants were enrolled in the Henan Rural Cohort Study. Individual ozone exposure was assessed by using a satellite-based random forest model. The logistic regression and generalized linear models were used to evaluate the associations of ozone and physical activity with T2DM and FBG, respectively. Interaction plots were used to visualize the interaction effects of ozone and physical activity on T2DM or FBG. An interquartile range (IQR) increase in ozone exposure concentration was related to a 53.3% (odds ratio (OR),1.533; 95% confidence interval (CI), 1.426, 1.648) increase in odds of T2DM and a 0.292 mmol/L (95%CI, 0.263, 0.321) higher FBG level, respectively. The effects of ozone on T2DM and FBG generally decreased as physical activity levels increased. Negative additive interactions between ozone and physical activity on T2DM risk were observed (relative excess risk due to interaction (RERI), -0.261; 95%CI, -0.473, -0.048; attributable proportion due to interaction (AP), -0.203; 95%CI, -0.380, -0.027; synergy index (S), 0.520; 95%CI, 0.299, 0.904). The larger effects of ozone were observed among elderly and men on T2DM and FBG than young and women. Long-term exposure to ozone was associated with higher odds of T2DM and higher FBG levels, and these associations might be attenuated by increasing physical activity levels. In addition, there was a negative additive interaction (antagonistic effect) between ozone exposure and physical activity level on T2DM risk, suggesting that physical activity might be an effective method to reduce the burden of T2DM attributed to ozone exposure. Trail registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015, http://www.chictr.org.cn/showproj.aspx?proj=11375.

Water, land, and air: how do residents of Brazilian remote rural territories travel to access health services?

BACKGROUND

Ensuring adequate and safe means of travel is essential for maintaining and improving the health and well-being of residents of rural communities worldwide. This article maps costs, distances, travel times, and means of elective and urgent/emergency health transport in Brazilian remote rural municipalities.

METHODS

Multiple case studies were conducted in 27 remote rural municipalities using a qualitative method. A total of 178 key informants (managers, doctors, and nurses) were interviewed. Secondary data from national information systems were analyzed for the socioeconomic characterization, to identify the costs, distances, and travel times. Through the thematic content analysis of the interviews, the means of transport, and strategies developed by managers, professionals and users for their provision were identified.

RESULTS

The costs of traveling between remote rural municipalities and locations where most of specialized and hospital services are centered can compromise a significant part of the families' income. The insufficiency, restriction of days, times, and routes of health transport affects the selection of beneficiaries based on socioeconomic criteria in places of high vulnerability and less investment in road infrastructure. In remote rural municipalities, travelling to seek health care involves inter-municipal and intra-municipal flows, as their territories have dispersed populations. Several means of transport were identified - air, river, and land - which are often used in a complementary way in the same route. Some patients travel for more than 1000 km, with travel times exceeding 20 h, especially in the Amazon region. While the demands for urgent and emergency transport are partially met by national public policy, the same is not true for the elective transport of patients. The impossibility of providing health transport under the exclusive responsibility of the municipalities is identified.

CONCLUSIONS

For the remote rural municipalities populations, the absence of national public policies for sufficient, continuous, and timely provision of transport for health services worsens the cycle of inequities and compromises the assumption of the universal right to health care.

A Statistical Non-Parametric data analysis for COVID-19 incidence data

BACKGROUND

The impact of COVID-19 on the Global scale is tremendously drastic. There are several types of research going on across the world simultaneously to understand and overcome this dire pandemic outbreak. This paper is purely a statistical study on a distinct set of datasets regarding COVID-19 in India. The motivation of this study is to provide an insight into the rapid growth of confirmed COVID-19 cases in India.

METHODS

The rapid growth of COVID-19 cases in India started in March 2020. The main objective of this paper is to provide a solid statistical model for the policymaker to handle this kind of pandemic situation in the near future with nonlinear data. In this paper, the data was got from 1st April to 29th November 2020. To come up with a solid statistical model, various nonlinear data such as confirmed COVID-19 cases, maximum temperature, minimum temperature, the total population (state-wise), the total area in km2 (state-wise), and the total rural and urban population count (state-wise) have been analyzed. In this paper, six different Generalized Additive Models (GAM) was identified after a thorough analysis of other researchers' (Xie and Zhu, 2020; Prata et al., 2020) findings.

RESULTS

In all perspectives, the results were identified and analyzed. The GAM model regarding total COVID-19 confirmed cases, total population, and the total rural population provides the best average fit of R2 value of 0.934. As the population value is quite high, the author has concise it using logarithm to provide the best p-value of 0.000542 and 0.001407 for a relation between the total number of COVID-19 cases regarding the total population and total rural population respectively.

Adverse associations of long-term exposure to ambient ozone with molecular biomarkers of aging alleviated by residential greenness in rural Chinese adults

BACKGROUND

Both ambient ozone exposure and residential greenness are linked to the aging process. However, their interactive effect on molecular biomarkers of aging (telomere length (TL) and mitochondrial DNA copy number (mtDNA-CN)) remains unclear.

METHODS

This study was conducted among 6418 rural Chinese adults. The concentration of ambient ozone was assessed using a random forest model. Residential greenness was represented by the normalized difference vegetation index (NDVI). Molecular biomarkers of aging (relative TL and relative mtDNA-CN) were determined by quantitative real-time polymerase chain reaction. Generalized linear regression models were applied to investigate the independent and combined effects of ambient ozone and residential greenness on relative TL and relative mtDNA-CN.

RESULTS

The estimated percent changes and 95 % confidence intervals (CIs) of relative TL in response to per-unit increase in ambient ozone were -22.43 % (-23.74 %, -21.18 %), -14.19 % (-15.63 %, -12.72 %) and -4.50 % (-6.57 %, -2.27 %) for participants with low (NDVI ≤ 0.53), moderate (0.54-0.55) and high (≥0.56) residential greenness exposure, respectively, while the corresponding figures of relative mtDNA-CN were -12.63 % (-13.84 %, -11.31 %), -9.52 % (-10.60 %, -8.33 %) and 2.12 % (0.20 %, 4.19 %). Furthermore, negative interactive effects between ambient ozone and residential greenness exposure on molecular biomarkers of aging were observed (P_{for interaction} < 0.001 for relative TL, and 0.098 for relative mtDNA-CN).

CONCLUSIONS

Long-term exposure to high concentrations of ambient ozone and low residential greenness was associated with decreased mtDNA-CN and shortened TL. The adverse effect of ambient ozone exposure on molecular biomarkers of aging may be attenuated by increased residential greenness.

Preventive measures focused on the urban-rural interface protect rural food-producing communities from SARS-CoV-2

INTRODUCTION

Rural food-producing communities are fundamental for the development of economic activities associated with sustainability and food security. However, despite the importance of rurality in Colombia, preventive strategies continue to be implemented homogeneously, without considering the dynamics of SARS-CoV-2 in rural food-producing communities.

OBJECTIVE

To model real areas in Colombia involving rural and urban populations that have intrinsic SARS-CoV-2 transmission dynamics. Characterize rural-urban interactions by means of a parameter that provides different scenarios and allows us to identify interactions capable of preventing SARS-CoV-2 transmission in rural food-producing communities.

MATERIALS AND METHODS

The dynamics of SARS-CoV-2 infection was modeled in five case studies (Boyacá, Caquetá, Cundinamarca, Santander and Sucre) considering urban and rural areas and their interaction (connectivity) in the urban-rural interface. For this purpose, an epidemiological compartmental model considering a classification of individuals according to their economic activity and their epidemiological status was assessed.

RESULTS

Preventive measures focused on the urban-rural interface impact the number of deaths in rural areas. Hence, it is possible to assume that the dynamics of the disease in rural areas depend on the constant interaction with infected individuals from urban areas, which occurs due to the food production dynamics in the urban-rural interface.

CONCLUSIONS

Preventive measures should focus on places of high transmissibility and risk for rural communities, such as the urban-rural interface. This work highlights the importance of national heterogeneous preventive measures and the protection of rural communities from the social and economic impacts of SARS-CoV-2.

Associations of residential greenness with obesity and BMI level among Chinese rural population: findings from the Henan Rural Cohort Study

In recent years, increasing evidence supports the notion that obesity risk is affected by residential greenness. However, limited studies have been established in low- and middle-income countries, especially in China. The study aimed to evaluate the associations of residential greenness with obesity and body mass index (BMI) level in Chinese rural-dwelling adults. A total of 39,259 adults from the Henan Rural Cohort Study (HRCS) were included in the analyses. According to the guideline for prevention and control of overweight and obesity in Chinese adults, obesity was defined as BMI ≥ 28 kg/m². Residential greenness was measured by satellite-based normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Generalized linear mixed models were used to study the associations between exposure to residential greenness with obesity and BMI level. Higher residential greenness was significantly correlated with lower odds of obesity and BMI level. For example, in the full-adjusted analyses, an interquartile range (IQR) increase in EVI_500-m was linked with reduced odds of obesity (OR = 0.77, 95%CI 0.72-0.82) and BMI level (β =  - 0.41 kg/m², 95%CI - 0.48 to - 0.33 kg/m²). Mediation analyses showed air pollution and physical activity could be potential mediators in these associations. Besides, we found that the association of NDVI_500-m with BMI was stronger in females and low-income populations. Higher residential greenness was associated with a lower prevalence of obesity and BMI level, particularly among females and the low-income population. These relationships were partially mediated by reducing air pollution and increasing physical activity.

Addressing the opioid epidemic through community pharmacy engagement: Study protocol for a randomized controlled trial

BACKGROUND

Despite the authority to dispense naloxone, pharmacists have been reluctant to offer and dispense it, often due to discomfort communicating about the sensitive topic of opioid overdose. Because existing online naloxone trainings do not sufficiently address how to communicate effectively with patients about naloxone, Nalox-Comm, a training module designed to improve pharmacists' self-efficacy to engage in naloxone discussions, was developed.

OBJECTIVE

To describe the study protocol to evaluate the effectiveness of the Nalox-Comm training module on naloxone dispensing rates.

METHODS

A randomized controlled trial, which began in July 2021, is used to evaluate the pre-post Nalox-Comm training intervention. Sixty pharmacists are being recruited from 62 pharmacies part of a single grocery store chain in rural counties of the southeastern United States. After completing a baseline survey, pharmacists are observed by simulated patients (SPs) who rate the quality of their pre-training naloxone communication. Pharmacists are then invited to complete either a basic online naloxone training module (control group) or a newly developed Nalox-Comm training (experimental group), after which they complete a post-training survey and are observed a second time by SPs. Three months post-training, study participants complete a final follow-up survey. Naloxone dispensing records are obtained from each participating pharmacy to assess change in naloxone dispensing rates.

CONCLUSION

Informed by rural pharmacist stakeholders, the Nalox-Comm training module addresses communication barriers specific to rural communities. Compared to those in the control group, we hypothesize that pharmacies in the experimental group will dispense more naloxone in the three months post-training intervention.

The type of previous abortion modifies the association between air pollution and the risk of preterm birth

BACKGROUND

Air pollution and previous abortion have been reported to be related to preterm birth (PTB). But rare study examined the effect of air pollution on PTB risk among mothers with previous abortion.

OBJECTIVE

To estimate the effect of air pollution on PTB and the potential effect modification of previous abortion on such an association in rural part of Henan province (China).

METHOD

Based on National Free Preconception Health Examination Project (NFPHEP), information from the medical records of 57,337 mothers with previous abortion were obtained. An inverse distance-weighted model was used to estimate exposure levels of air pollutants. The effect of air pollution on the risk of PTB was estimated with a multiple logistic regression model. Stratified and interaction analyses were undertaken to explore the potential effect modification of previous abortion on this association.

RESULTS

The risk of PTB was positively associated with exposure to levels of nitrogen dioxide (NO₂; OR: 1.03; 95%CI: 1.02-1.04)], and sulfur dioxide (SO₂; 1.04; 1.02-1.07), and negatively associated with ozone (O₃) exposure (0.97; 0.97-0.98) during the entire pregnancy. Besides, we observed a positive effect of carbon monoxide (CO) exposure during the third trimester of pregnancy on PTB (1.14; 1.01-1.29). The type of previous abortion could modify the effect of air pollution on the PTB risk (P-_interaction < 0.05). Compared with mothers with previous induced abortion, mothers with previous spontaneous abortion carried a higher risk of PTB induced by NO₂, CO, and O₃.

CONCLUSIONS

The risk of PTB was positively associated with levels of NO₂, SO₂ and CO, and negatively associated with the O₃ level. The types of previous abortion could modify the effect of air pollution on PTB. Mothers who had an abortion previously, especially spontaneous abortion, should avoid exposure to air pollution to improve their pregnancy outcome.

Kitchen ventilation alleviated adverse associations of domestic fuel use and long-duration cooking with platelet indices as biomarkers of cardiovascular diseases

BACKGROUND

Abnormal platelet activity is considered as a potential mechanism of cardiovascular diseases (CVDs) related to household air pollution (HAP). However, evidence remains lacking for the association of HAP with platelet activity in low-middle income countries.

METHODS

27,349 individuals were obtained from the Henan Rural Cohort Study. A questionnaire was used to collect data on cooking fuel types, cooking frequency and time as well as kitchen ventilation which indirectly reflected HAP. Platelet activity was indicated by platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), ratio of mean platelet volume to platelet count (MPVP), platelet-large cell ratio (P-LCR) and plateletcrit (PCT). Associations of HAP with platelet activity were assessed by generalized linear mixed models.

RESULTS

Compared with the ones without cooking, participants who cooking using solid fuel, clean fuel, short- and long-duration cooking were at a high risk for increased platelet size (PDW, MPV, MPVP and P-LCR) but decreased PLT and PCT; long-duration cooking participants with non-using exhaust hood/extractor by solid fuel use were associated with a 0.259 f. (95%CI: 0.100, 0.418 fL), 0.115 f. (95%CI: 0.050, 0.181 fL), 0.001 (95%CI: 0.000, 0.003) and 0.928% (95%CI: 0.425, 1.431%) increment in PDW, MPV, MPVP and P-LCR values and these associations were prominent in women relative than that in men.

CONCLUSION

Using exhaust hood/extractor attenuated the positive associations of solid fuel use and long-duration cooking with increased platelet size in all participants and these associations were prominent in women, indicating that improving kitchen ventilation may be an effective strategy to reduce platelet dysfunction related to HAP, especially for women.

Factors associated with human papillomavirus and meningococcal vaccination among adolescents living in rural and urban areas

Background

Studies have shown that adolescent vaccination rates with human papillomavirus (HPV) and quadrivalent meningococcal conjugate (MenACWY) vaccines are lower in rural areas of the U.S. than in urban areas. We sought to determine factors associated with vaccine acceptance in these two settings.

Methods

We conducted a cross-sectional survey of 536 parents or guardians of teens age 13 through 15 years in select rural and urban counties of Minnesota and Wisconsin. We collected information on demographic variables, receipt of adolescent vaccines, and attitudes toward HPV vaccine in particular. Multivariable logistic regression models were used to assess associations between covariates and outcomes of interest (HPV vaccine receipt and MenACWY receipt).

Results

Of the 536 respondents, 267 (50%) resided in a rural county. Most respondents were female (78%) and non-Hispanic White (88%). About half (52%) of teens of the surveyed parents received the three vaccines recommended specifically for adolescents: 90% received tetanus-diphtheria-acellular pertussis (Tdap), 84% received MenACWY, and 60% received one or more doses of HPV vaccine. Rural and urban parents surveyed differed on several covariates relating to teen's health services, parent's demographics, and household characteristics. Parent's perception of the importance that their healthcare providers placed on vaccination with HPV and MenACWY were independently associated with receipt of each of those vaccines (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.90-13.96 and OR 2.15, 95% CI 1.07-4.31, respectively). Parents of vaccinated teens were less likely to report concerns about potential harm from the HPV vaccine or having heard stories about health problems caused by the HPV vaccine.

Conclusion

Teen receipt of HPV vaccine and MenACWY appears to be influenced by parents' perception of vaccine importance, provider recommendations, and concerns regarding potential harm from the HPV vaccine. Continued education of providers and parents of the importance of adolescent vaccinations is warranted.

The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations

OBJECTIVE

The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality.

METHODS

The authors collected data on psychiatry residency positions from the Veterans Affairs' Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served.

RESULTS

Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions.

CONCLUSIONS

While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.

Ambient ozone exposure combined with residential greenness in relation to serum sex hormone levels in Chinese rural adults

BACKGROUND

Long-term exposure to ambient ozone (O₃) and residential greenness independently relate to altered hormones levels in urban settings and developed countries. However, independent and their joint associations with progestogen and androgen were sparsely studied in rural regions.

MATERIALS AND METHODS

A total of 6211 individuals were recruited in this study. Random forest model was applied to predict the daily average concentrations of O₃ using the satellites data. Residential greenness was reflected by the normalized difference vegetation index (NDVI). Liquid chromatography-tandem mass spectrometry was used to measure serum progestogen and androgen concentrations. Gender and menopausal status modified associations of long-term exposure to O₃ and residential greenness with hormones levels were analyzed by generalized linear models.

RESULTS

Long-term exposure to O₃ was negatively related to 17-hydroxyprogesterone, testosterone, and androstenedione in both men and women (premenopausal and postmenopausal); the estimated β and 95% CI of ln-progesterone in response to per 10 μg/m³ increment in O₃ concentration was -0.560 (-0.965, -0.155) in postmenopausal women. Association of long-term exposure to O₃ with serum androgen levels in premenopausal and postmenopausal women were alleviated by residing in places with higher greenness. Additionally, a prominent effect of long-term exposure to O₃ related to decreased serum progestogen and androgen levels was found in participants with middle- or high-level of physical activity or lower education level.

CONCLUSIONS

The results suggested that long-term exposure to high levels of O₃ related to decreased serum androgen levels was attenuated by living in high greenness places in women regardless of menopause status. Future studies are needed to confirm the positive health effects of residential greenness on the potential detrimental effects due to exposure to O₃.

Implementation of a nutritional supplementation program in a population of Cambodian children and its impact on statural growth

BACKGROUND

Stunting is a major health problem in low-income countries. We aimed to describe the implementation of a lipid-based nutrient supplement (LNS) program in a rural neighborhood in Cambodia and to assess its impact on statural growth.

METHOD

This was a before-after comparative study. The program was promoted by the Pédiatres du Monde (PDM) organization between 2011 and 2019 in six villages in a rural area in Cambodia. The supplementation program consisted of daily administration of LNS during the third semester of pregnancy for the mothers and then between 6 and 24 months of age for the toddlers. Anthropometric data of the children were recorded during PDM visits before and after the program implementation, which allowed us to compare child growth in the two groups: control and intervention groups. Primary outcome was height-for-age between 24 and 35 months of age.

RESULTS

Overall, 198 data were collected for children between 24 and 35 months of age in the control group. A total of 347 pregnant women were enrolled in the intervention phase. A total of 188 data were collected for children between 24 and 35 months of age in the intervention group. The mean height-for-age z-score in the population receiving LNS was higher than in the control group (-1.14 vs. -1.60, p < 0.001). There was no significant difference between the two groups regarding the weight-for-height z-score (WHZ; -1.11 vs. -1.26, p = 0.18) and children in the intervention group had a higher middle upper-arm circumference z-score (MUACZ; -0.75 vs.. -1.1, p < 0.001).

CONCLUSION

LNS supplementation significantly and increased the HAZ between 24 and 35 months of age. However, the fight against malnutrition is complex and needs intervention on multiple levels.

Adverse associations of different obesity measures and the interactions with long-term exposure to air pollutants with prevalent type 2 diabetes mellitus: The Henan Rural Cohort study

BACKGROUND

Obesity and ambient air pollution are independent risk factors of type 2 diabetes mellitus (T2DM), however, the evidence regarding their joint associations on T2DM was sparsely studied in low-middle income countries.

METHODS

A total of 38,841 participants were selected from Henan Rural Cohort study which was carried out during 2015-2017. Obesity was identified by body mass index (BMI), WC (waist circumstance), WHR (waist-to-hip ratio), WHtR (waist-to-height ratio), BFP (body fat percent), and VFI (visceral fat index). Three-year averaged-concentrations of NO₂, PM₁, PM_2.5, and PM₁₀ were assessed by using the method of spatiotemporal model incorporated into the satellites data. The independent associations of obesity indicators and exposure to air pollutants on fasting blood glucose (FBG) and T2DM were assessed by generalized linear and logistic regression model, respectively, and their interaction associations on T2DM were quantified by using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S).

RESULTS

Positive associations of six obesity measures and four air pollutants with FBG levels and prevalent T2DM were observed. Obese participants measured by BMI plus high exposure to NO₂, PM₁, PM_2.5 and PM₁₀ were related to a 2.96-fold (2.66-3.29), 2.87-fold (2.58-3.20), 2.98-fold (2.67-3.32) and 3.01-fold (2.70-3.35) increased risk for prevalent T2DM, respectively; similarity of joint associations of the other obesity measures and air pollutants on T2DM were observed. The additive associations of different obesity measures and air pollutants with prevalent T2DM were further found.

CONCLUSIONS

The synergistic associations of obesity and air pollutants on FBG levels and prevalent T2DM were observed, indicating that obese participants were at high risk for prevalent T2DM in highly polluted rural regions.

Combined effects of air pollution in adulthood and famine exposure in early life on type 2 diabetes

Famine exposure or air pollution is linked to type 2 diabetes mellitus (T2DM). However, their combined effects on T2DM remain largely unknown. A total of 11,640 individuals were obtained from the Henan Rural Cohort Study. According to their birthdate, participants were divided into three famine exposure subgroups: fetal exposed, childhood exposed, and unexposed groups. The air pollutants (particles with aerodynamics diameters ≤ 1.0 µm (PM₁), ≤ 2.5 µm, and ≤ 10 µm, and nitrogen dioxide) concentrations of each individual were estimated by a spatiotemporal model. Participants were divided into low or high air pollution exposure groups taking the 1st quartile value of air pollutants as the cut-off point. Logistic regression model was used to analyze independent and joint associations between air pollution exposure, famine exposure, and T2DM. Positive associations of air pollution and famine exposure with T2DM were found. Participants who experienced fetal or childhood famine and also were exposed to high concentrations of any kind of the air pollutants had a much higher risk for T2DM than those with no famine and low air pollutants exposure (taking PM_1.0 for example, the odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.25, 2.47 for fetal famine, and OR: 1.64, 95%CI: 1.13, 2.40 for childhood famine). After stratified analysis, similar results were observed in women. The results indicated that both famine exposure in early life and air pollution exposure in adulthood are related to increased risk for prevalent T2DM, and they have combined effects on T2DM.

Identifying health care access barriers in southern rural Ecuador

Background

Access to professional health care providers in Loja Province, Ecuador can be difficult for many citizens. The Health Care Access Barrier Model (HCAB) was established to provide a framework for classification, analysis, and reporting of modifiable health care access barriers. This study uses the HCAB Model to identify barriers and themes impacting access to health care access in southern rural Ecuador.

Methods

The research team interviewed 22 participants and completed 15 participant observation studies in the study area. Interviews and a single focus group session of artisans were recorded and transcribed from Spanish to English, and thematic analysis was performed.

Results

The thematic analysis found financial, structural, and cognitive health care access barriers. Cost of medications, transportation, missed responsibilities at work and home, difficulty scheduling appointments, and misconceptions in health literacy were the predominant themes contributing to health care access. These pressure points provide insight on where actions may be taken to alleviate access barriers.

Conclusion

Modifiable health care access barriers outlined in the HCAB are evident in the study area. Further research and implementation of programs to resolve these barriers, such as the creation of health care subcenters and/or mobile clinic, insurance coverage of specialized care, increasing availability and accessibility to affordable transportation, improving roadways, introduction of a 24/7 call center to schedule medical visits, monetary incentive for primary care physicians to practice in rural and underserved areas, provision of affordable work equipment, and emphasizing the improvement of health care literacy through education, may diminish current barriers, identify additional barriers, and improve overall health in the rural area of Loja, Ecuador and similar rural regions around the world.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01660-1.

Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?

Background : Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods : Between May 2007 and January 2018, patients admitted with ACS were included. The patients' demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion : This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.

Assessing the relationship between body image and quality of life among rural and urban breast cancer survivors in China

Background

Breast cancer survivors experience altered body image and quality of life (QoL) due to the disease and its treatment. The multidimensional nature of body image and QoL makes their relationships complex. This study aimed to examine the associations between the two concepts in Chinese breast cancer survivors and test whether these associations are moderated by rural–urban residence.

Methods

A cross-sectional design was adopted. Breast cancer survivors were recruited via a convenience sampling method. Two validated questionnaires (the Body Image Self-Rating Questionnaire for Breast Cancer and 36-item Short-Form Health Survey) and questions assessing demographic and clinical covariates were administered. Multiple linear regressions were used to assess the relationship between body image and QoL domains and to examine the moderating effect of rural–urban residence.

Results

In our sample of 354 breast cancer survivors, half (50.28%) lived in rural areas. After adjusting for demographic and clinical variables, better perception of body image-related sexual activity change, role change, and psychological change was significantly associated with better physical (β ranged from − 0.15 to − 0.11, p < 0.05) and mental (β ranged from − 0.46 to − 0.34, p < 0.001) well-being. Better perception of body image-related social and behavior change was significantly associated only with better mental well-being (β ranged from − 0.40 to − 0.33, p < 0.001). The association between body image and mental well-being was much stronger in urban subjects (b = − 0.38, p < 0.001) than in rural subjects (b = − 0.20, p < 0.001).

Conclusions

Our findings suggest that multidimensional body image is associated with physical and mental well-being in Chinese breast cancer survivors. Body image appears to play a larger role in urban breast cancer survivors’ mental well-being. Our results indicate that incorporating interventions that address body image issues would be advantageous for survivorship care to enhance QoL in breast cancer survivors. Furthermore, rural–urban differences should be considered in the strategic design of survivorship care programs in rural and urban settings.

Associations of combined exposures to ambient temperature, air pollution, and green space with hypertension in rural areas of Anhui Province, China: A cross-sectional study

Hypertension (HTN) was a major preventable cause of cardiovascular disease (CVD), contributing to a huge disease burden. Ambient temperature, air pollution and green space were important influencing factors of HTN, and few studies have assessed the effects and interactions of ambient temperature, air pollution and green space on HTN in rural areas. In this study, we selected 8400 individuals randomly in rural areas of Anhui Province by a multi-stage stratified cluster sampling. A total of 8383 individuals were included in the final analysis. We collected particulate pollutants and meteorological data from the local air quality monitoring stations and National Center for Meteorological Science from January 1 to December 31, 2020, respectively. The normalized differential vegetation index (NDVI) of Anhui Province in 2020 was produced and processed by remote sensing inversion on the basis of medium resolution satellite images. The average annual mean exposure concentrations of air pollution, meteorological factors, and NDVI were calculated for each individual based on the geocoded residential address. HTN was defined according the Chinese Guidelines for Prevention and Treatment of HTN. The effects and interactions of ambient temperature, air pollution and green space on HTN were evaluated by generalized linear model and interaction model, respectively. In this study, the prevalence of HTN was 24.14%. The adjusted odd ratio of HTN for each 1 μg/m³ increasing in PM_2.5 and PM₁₀, 1 °C of ambient temperature, and 0.1 of NDVI were:1.276 (1.013, 1.043), 1.012 (1.006, 1.018), 0.862 (0.862, 0.981) and 0.669 (0.611, 0.733), respectively. The results showed that air pollutants were positively correlated with HTN, while ambient temperature and green space were negatively correlated with HTN. Meanwhile, the negative associations of green space on HTN could decrease with the increasing concentrations of air pollution, but increase with the rising of ambient temperature.

Reproducibility and relative validity of a food frequency questionnaire for a diet-related study in a rural Chinese population

BACKGROUND

This study aimed to assess the reproducibility and validity of a food frequency questionnaire (FFQ) developed for diet-related studies in a rural population.

METHODS

One hundred fifty-four healthy residents were interviewed with a 76-item FFQ at baseline (FFQ1) and 1 month later (FFQ2) to assess reproducibility, and required to complete two three-day dietary recalls (DRs) between two FFQs to determine the validity by comparing DRs with FFQ1.

RESULTS

Crude Spearman correlation coefficients between FFQ1 and FFQ2 ranged from 0.58 to 0.92 and energy-adjusted coefficients ranged from 0.62 to 0.92; weighted kappa statistic covered a spectrum from 0.45 to 0.81, depicting moderate to good agreements. For validity, there were moderate to strong associations (0.40-0.68) in most nutrients and food between FFQ1 and DRs; weighted kappa statistic demonstrated fair to moderate agreements for nutrients and food (0.21-0.49).

CONCLUSIONS

The results suggest that the FFQ has reasonably reproducibility and validity in measuring most nutrients and food intake, and it can be used to explore the dietary habits in studying the diet-disease relationship in Chinese rural populations.

Secular trends of age at menarche and the effect of famine exposure on age at menarche in rural Chinese women

BACKGROUND

Over the past few decades, more studies have suggested that the age at menarche (AAM) has continued to decline. However, the AAM for women in resource-constrained areas is not clear. Moreover, the association between the China famine and AAM is still unclear in rural regions.

AIM

The study aimed to investigate the secular trends of AAM for women born between 1935 and 2000 and to further explore the effect of famine on AAM in rural China.

SUBJECTS AND METHODS

The study included 23444 women participants from the baseline study of Henan Rural Cohort study. Changing AAM over time was analysed using linear regressions. Multinomial logistic regression was conducted to analyse the association between famine exposure and AAM subgroups.

RESULTS

The age-standardized mean AAM was 14.74 years. The average AAM declined from 16.98 years for those born in 1935 to 13.87 years for those born in 2000, a decline of 0.077 years per 1 year and 0.729 years per decade. Compared to the reference group, women exposed to famine during fetal, early childhood, middle childhood, and late childhood were 1.376 (95% CI, 1.071 - 1.769), 1.848(95% CI, 1.512 - 2.259), 2.084(95% CI, 1.725 - 2.518), and 2.146 (95% CI, 1.788 - 2.576) times more likely to be ≥18 years of AAM than unexposed famine women, respectively.

CONCLUSION

AAM showed a decreasing trend in rural China. Furthermore, both fetal and childhood famine exposure, especially in late childhood, were positively associated with increased AAM compared to unexposed famine.

Parenting practices and oral health behaviors of children in rural Egypt: gender differences in a household survey

Background

Parenting practices influence children’s health and development. The current study aimed at assessing gender differences in children’s perception of the parenting practices of both parents, and in the association between children’s oral health behaviors and parenting practices.

Methods

A cross-sectional household survey of 6–12 year old children was conducted in a rural area in Northwestern Egypt in 2019. Clinical examination assessed caries and gingivitis. The Alabama Parenting Questionnaire assessed parenting practices in five domains (positive parenting, involvement, inconsistent disciplining, poor monitoring and corporal punishment) and the World Health Organization questionnaire assessed oral health behaviors including sugar consumption and daily toothbrushing. Sugar consumption was the dependent variable in linear regression and daily toothbrushing was the dependent variable in logistic regression. Parenting practices were the explanatory variables adjusting for confounders. Effect modification by child gender was assessed.

Results

The response rate was 94.1% (n = 433), mean age = 9.9 years, 44.1% boys, 17.8% with daily toothbrushing and mean sugar consumption score = 3.4/8. Girls perceived more mothers’ positive parenting than boys (mean = 14.15 and 13.46) and boys perceived more poor monitoring and corporal punishment. Boys and girls differed in the association between sugar consumption and fathers’ inconsistent disciplining, poor monitoring (P = 0.004 and 0.02) and mothers’ corporal punishment (P = 0.02), and also daily toothbrushing and mothers’ involvement, positive parenting (P = 0.05 and 0.02), fathers’ positive parenting (P = 0.02), mothers’ inconsistent discipling and poor monitoring (P = 0.01 and 0.04).

Conclusions

There were differences between boys and girls in perceiving mothers’ and fathers’ parenting practices and in the association between these parenting practices and toothbrushing and sugar consumption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02054-z.

Sharing research results with Latina breast cancer survivors who participated in a community-engaged behavioral RCT study: a descriptive cross-sectional survey study

BACKGROUND

An often heard and justifiable concern of ethnic minorities is related to researchers' lack of attention to sharing the results of a study with participants after the study has concluded. Few studies have examined the effects of returning overall study results on participants' attitudes, especially among populations underrepresented in research. Among Latina research participants, providing a summary of study results could enhance participation in research. We assess Latina breast cancer survivors' reactions to receiving study results and their attitudes about participating in future studies.

METHODS

For this cross-sectional survey study, all women who had participated in two behavioral randomized controlled trials (RCTs) were mailed a letter summarizing the study results (using written and graphic formats) and a questionnaire assessing problems and understanding the results, importance of sharing results, willingness to participate in future studies, and format preferences for receiving the results. A postage-paid envelope for returning the completed questionnaire was included. Logistic regression examined the associations of age, education, and rural/urban residence on format preferences and willingness to participate. The survey sample consisted of 304 low-income, predominantly Spanish-speaking Latina breast cancer survivors (151 from urban and 153 from rural communities) who had participated in two RCTs testing a stress management program designed for Latina breast cancer survivors.

RESULTS

Ninety-two women returned the questionnaires (30.3%). Most of the women (91.1%) indicated that they had no trouble understanding the results of the study, and 97% agreed that it is very/extremely important for researchers to share the study result with the participants. The majority (60.2%) reported that receiving the results increased their willingness to participate in future studies. About half (51.7%) did not have a format preference, 37.4% preferred written summaries, and 10.9% preferred graphs.

CONCLUSIONS

This study is an important first step to understanding the impact of returning study results among a population that is underrepresented in research. Returning the results of studies and understanding the impact of doing so is consistent with maintaining community involvement in all phases of research. The findings suggest that sharing aggregate research results in simple language yields few problems in participants' understanding of the results and is viewed as important by participants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02931552 Date registered: October 13, 2016 and NCT01383174 Date registered: June 28, 2011.

Supportive environments during the substance use disorder epidemic in the rural United States: Provider support for interventions and expectations of interactions with providers

BACKGROUND

Harm reduction interventions, including SSP (Syringe Services Programs) and MAT (Medications for Addiction Treatment) have demonstrated the potential to help stem the epidemic of opioid use disorder. However, for that potential to be realized, people must expect that healthcare providers will be supportive if they ever seek care for substance use.

METHODS

This cross-sectional study investigated perceptions of provider support for SSP and MAT in the general population of 14 states selected specifically for 50 percent of the sample to include participants from rural counties with high rates of non-medical opioid use and injection. A survey of 3096 adults in 14 states and 675 counties within the Appalachian and Midwestern regions of the United States (collected between November of 2019 and May of 2020) examined the association between perceptions of provider support for harm reduction interventions, community members' trust of community healthcare providers, and expectations for patient-provider interactions involving disclosure of non-medical drug use.

RESULTS AND CONCLUSION

Path analysis supported the hypothesis that perceptions of provider support for harm reduction interventions predict positive expectations about patient-provider interactions and that trust in providers mediates this association. The model fit well among participants who reported past non-medical use of drugs and those who did not. In contrast to other research suggesting that trust in providers may be inconsequential during the initial stages of care, the current research suggests that trust may shape expectations about patient-provider interactions even before people use drugs. Communication of support for harm reduction interventions by providers may play an important role in promoting health care-seeking in populations that use drugs currently or who may use drugs in the future in high-risk rural areas of the United States.

Uncontrolled hypertension in a rural population of Jammu and Kashmir

AIM

Evaluation of the status of uncontrolled hypertension in diagnosed hypertensives who had been advised drug treatment in the rural areas of 6 districts in Jammu & Kashmir (J&K) and also the risk factors associated with it.

METHODS

The study was a cross-sectional observational study conducted between August 2020 to July 2021 in the form of health camps in six government health centres in 6 different rural districts. The camps were focussed on patients with hypertension, diabetes with or without heart disease. The areas included Machil in Kupwara, Khan Sahib in Budgam, Rajpora and Hawal in Pulwama, Rainawari in the Srinagar, Banihal in Ramban, and Jagti in Jammu. Enrolled patients were examined for body weight, blood pressure (BP), random blood sugar and serum lipid profile. The definition of hypertension was as per the eighth Joint National Committee (JNC-8) guidelines.

RESULTS

A total of 600 patients (50.1% males) were evaluated. Of these 335 (55%) had history of being diagnosed hypertension and had been recommended drugs for BP control Male: Female ratio 1:0.8.211(63.5%) of these had un controlled blood pressures on measurement. Two or more drugs had been prescribed in 65 (30.8%) patients, 34 (16%) were taking only single drug and 112(53%) were not on any drug. Uncontrolled hypertension was seen more often in age group of 40-60 years (49%), subjects more than 60 years had it in 40%. The comparison of risk factors between patients with diagnosed hypertension with those without it revealed use of tobacco, consumption of salted tea, presence of diabetes, dyslipidaemia as significant factors for the presence of uncontrolled hypertension.

CONCLUSION

Uncontrolled hypertension in known patients prescribed drugs is highly prevalent in the rural population of J&K. Steps to mitigate this problem are needed on top priority.