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

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

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

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OBJECTIVE

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

DESIGN

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

SETTING

Rural Colombia.

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

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

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

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

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

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

Background

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

Methods

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

Results

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

Parental migration and anemia status of children in China

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

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

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

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