Atmospheric deposition of microplastics in a rural region of North China Plain

Microplastics (MPs) pollution is becoming one of the most pressing environmental issues globally. MPs in the marine, freshwater and terrestrial environments have been fairly well investigated. However, knowledge of the atmospheric-mediated deposition of MPs within rural environments is limited. Here, we present the results of bulk (dry and wet) atmospheric MPs deposition in a rural region of Quzhou County in the North China Plain (NCP). Samples of MPs in the atmospheric bulk deposition were collected for individual rainfall events over a 12-month period from August 2020 to August 2021. The number and size of MPs from 35 rainfall samples were measured by fluorescence microscopy, while the chemical composition of MPs was identified using micro-Fourier transform infrared spectroscopy (μ-FTIR). The results showed that the atmospheric MPs deposition rate in summer (892-75,421 particles/m²/day) was highest compared to 735-9428, 280-4244 and 86-1347 particles/m²/day in spring, autumn, and winter, respectively. Furthermore, the MPs deposition rates in our study were 1-2 orders of magnitude higher than those in other regions, indicating a higher rate of MPs deposition in the rural region of the NCP. MPs with a diameter of 3-50 μm accounted for 75.6 %, 78.4 %, 73.4 % and 66.1 % of total MPs deposition in spring, summer, autumn, and winter, respectively, showing that the majority of MPs in the current study were small in size. Rayon fibers accounted for the largest proportion (32 %) of all MPs, followed by polyethylene terephthalate (12 %) and polyethylene (8 %). This study also found that a significant positive correlation between rainfall volume and MPs deposition rate. In addition, HYSPLIT back-trajectory modelling showed that the farthest source of deposition MPs may have come from Russia.

Judging the sources of inferior groundwater quality and health risk problems through intake of groundwater nitrate and fluoride from a rural part of Telangana, India

Evaluation of groundwater quality and related health hazards is a prerequisite for taking preventive measures. The rural region of Telangana, India, has been selected for the present study to assess the sources and origins of inferior groundwater quality and to understand the human health risk zones for adults and children due to the consumption of nitrate ([Formula: see text])- and fluoride (F^-)-contaminated groundwater for drinking purposes. Groundwater samples collected from the study region were determined for various chemical parameters. Groundwater quality was dominated by Na⁺ and [Formula: see text] ions. Piper's diagram and bivariate plots indicated the carbonate water type and silicate weathering as a main factor and man-made contamination as a secondary factor controlling groundwater chemistry; hence, the groundwater quality in the study region is low. According to the Groundwater Quality Index (GQI) classification, 48.3% and 51.7% of the total study region are excellent (GQI: < 50) and good (GQI: 50 to 100) water quality types, respectively, for drinking purposes. However, [Formula: see text] ranged from 0.04 to 585 mg/L, exceeding the drinking water quality limit of 45 mg/L in 34% of the groundwater samples due to the effects of nitrogen fertilizers. This was supported by the relationship of [Formula: see text] with TDS, Na⁺, and Cl^-. The F^- content was from 0.22 to 5.41 mg/L, which exceeds the standard drinking water quality limit of 1.5 mg/L in 25% of the groundwater samples. The relationship of F^- with pH, Ca²⁺, Na⁺, and [Formula: see text] supports the weathering and dissolution of fluoride-rich minerals for high F^- content in groundwater. They were further supported by a principal component analysis. The Health Risk Index (HRI) values ranged from 0.20 to 20.10 and 0.36 to 30.90 with a mean of 2.82 and 4.34 for adults and children, respectively. The mean intensity of HRI (> 1.0) was 1.37 times higher in children (5.70) than in adults (4.16) due to the differences in weight size and exposure time. With an acceptable limit of more than 1.0, the study divided the region into Northern Safe Health Zone (33.3% for adults and 28.1% for children) and Southern Unsafe Health Zone (66.7% for adults and 71.9% for children) based on the intensity of agricultural activity. Therefore, effective strategic measures such as safe drinking water, denitrification, defluoridation, rainwater harvesting techniques, sanitary facilities, and chemical fertilizer restrictions are recommended to improve human health and protect groundwater resources.

[Cross-regional telemedicine services as a supplement to rural primary care: a mixed-methods analysis]

BACKGROUND

Family doctor care in rural areas is facing upheaval. On the one hand, demographic change is increasing patient demand, but on the other hand, it is also reducing physician density. In this context, telemedicine opens up new potentials for care. This study explores the possibilities of digitalization in family care with diverse stakeholders. The most important element of this work is to explore the attitudes towards telemedical supplementary options in primary care. In doing so, the chances and concerns of both general practitioners and citizens will be analyzed. The aim is to find out possibilities which can relieve GPs and support the health care provision in rural regions in the long term.

METHODOLOGY AND MATERIAL

A mixed-methods design combines findings from qualitative semi-structured guided interviews with general practitioners (N=8) with a quantitative citizen survey (N=1,276) in a rural region.

RESULTS

Concern about future health care provision is high among physicians and citizens. Although physicians see a need for action and opportunities through telemedicine measures, they also raise clear concerns about the doctor-patient relationship. The citizens are principally open to various telemedical options and can imagine using simple services such as e-prescription and e-appointment booking.

DISCUSSION

These results can serve as a basis for the further development of digital offerings of family doctors' offices as well as other model projects in rural regions, if they guarantee low-threshold access, are implemented in cooperation with doctors and patients and do not endanger the established doctor-patient relationship.

CONCLUSION

There are major concerns about the future of family physician care, especially in rural areas. The COVID-19 pandemic opens up opportunities for digitization across age boundaries. Initially, however, telemedicine care can only have a supplementary role. Low-threshold offerings in close cooperation with the family doctor are particularly promising here.

Associations of solid fuel use and ambient air pollution with estimated 10-year atherosclerotic cardiovascular disease risk

BACKGROUND

Although exposure to ambient air pollution (AAP) increases the risk for arteriosclerotic cardiovascular disease (ASCVD), evidence on the association of solid fuel use with ASCVD and its association modified by ambient air pollution remains limited.

METHODS

A total of 16,779 adults were derived from the Henan Rural Cohort Study. Concentrations of ambient air pollutants (PM₁, PM_2.5, PM₁₀, and NO₂) were estimated by a spatiotemporal model based on satellites data. Solid fuel use was assessed by a self-reported questionnaire. The associations of solid fuel use with high 10-year ASCVD risk and the modified association by exposure to air pollutants were explored using logistic regression models.

RESULTS

There were positive associations of AAP exposure with high 10-year ASCVD risk among individuals with self-cooking. The joint associations between high AAP exposures and solid fuel use with high 10-year ASCVD risk were found. Compared to clean fuel user with low PM_2.5 exposure, the odds ratios (ORs) and 95% confidence intervals (CIs) of high 10-year ASCVD risk was 1.25 (1.09, 1.42) for solid fuel user with low PM_2.5 exposure, 1.93 (1.75, 2.12) for clean fuel user with high PM_2.5 exposure, and 3.08 (2.67, 3.54) for solid fuel user with high PM_2.5 exposure, respectively. Their additive effect on high 10-year ASCVD risk was observed (relative excess risk due to interaction (RERI): 0.90 (95 %CI: 0.50, 1.30), attributable proportion due to interaction (AP): 0.29 (95 %CI: 0.19, 0.40), and synergy index (SI): 1.77 (95 %CI: 1.38, 2.26)).

CONCLUSION

This study showed a synergistic effect of AAP and household air pollution reflected by solid fuel use on high 10-year ASCVD risk, suggesting that reducing solid cooking fuels and controlling air pollution may have a joint effect on public health improvement.

Status, Sources, and Health Risk of Hexachlorocyclohexanes in the Air of the Rural Region of Zhangzhou, Southeast China

From October 2012 to September 2013, air samples of hexachlorocyclohexanes (HCHs) were collected by polyurethane foam passive air samplers (PUF-PAS) from Caiban Village (CbV), Baihua Village (BhV), Bumeishan Village (BmsV) and Qitang Village (QtV), located in the rural region of Zhangzhou, Southeast China. The test results showed that four HCH isomers (α-, β-, γ-, δ-HCH) were ubiquitous with ∑HCHs concentrations ranging from 4.80 to 41.9 pg/m³ and a mean value of 17.7 pg/m³. A seasonal variation was established in the air HCH levels. The highest ∑HCHs concentration was observed in the autumn whereas the lowest was detected in the spring. The ratio α/γ-HCH, which was used to identify the contamination source, revealed that air HCHs originated mainly from historical technical HCH residues and lindane usage. The health risk of inhalation exposure to atmospheric HCHs, assessed by the inhalation dosimetry methodology, was low and considered negligible for the local residents.

Spatial distribution of quality of groundwater and probabilistic non-carcinogenic risk from a rural dry climatic region of South India

Having safe drinking water is a fundamental human right, which affects directly the human health. In view of this, an effort has been made for understanding the spatial distribution of quality of groundwater in a rural dry climatic region of Andhra Pradesh, South India, and associated health risks with respect to pollutants of NO₃^- and F^-, which cause the potential production of non-carcinogenic risk, using entropy-weighted water quality index (EWWQI) and total chronic hazard index (TCHI), where the population rely on the groundwater resource for drinking purpose. Groundwater quality observed from the present study region has an alkaline character with brackish type. The concentrations of K⁺, HCO₃^-, TDS, Na⁺, NO₃^-, F^-, Mg²⁺ and Cl^- come under the non-permissible limits in 100%, 100%, 96.67%, 90%, 73.33%, 46.67%, 13.33% and 6.67% of the groundwater samples, which deteriorate the groundwater quality, causing the health disorders. The overall groundwater quality computed, using EWWQI, ranges from 53.64 to 216.59 (122.22), which classifies the region spatially into 55%, 10% and 35% due to influences of the geogenic and anthropogenic pollutants, which are the respective medium, poor and very poor groundwater quality types prescribed for potable water. According to the TCHI evaluated with respect to pollutants of NO₃^- and F^-, the values of TCHI for men (1.194 to 4030), women (1.411 to 4.763) and children (1.614 to 5.449) are more than its acceptable limit of one. So, the health risk of non-carcinogenic is spatially in the decreasing order of children > women > men, depending upon their sensitiveness to pollutants and also their body weights. Further, the spatial distributions of both TCH1 and EWWQI are more or less similar, following the pollution activities, which help for establishment of the fact to recognize the intensity of various vulnerable zones. Therefore, the present study suggests the suitable environmental safety measures to control the NO₃^-- and F^--contaminated drinking water and subsequently to increase the health conditions.

BTEX indoor air characteristic values in rural areas of Jordan: Heaters and health risk assessment consequences in winter season

Benzene, toluene, ethylbenzene, and xylene isomers (BTEX) are known to affect environmental air and health quality. In this study, the levels of BTEX compounds were determined in indoor air environments during the winter generated by several different heaters: diesel pot-bellied heater with chimney (DH); electric heater (EH); unfluted gas heater (GH); kerosene heater (KH); and wood pot-bellied heater with chimney (WH). The samples were collected using a diffusion passive adsorbent (activated charcoal) and then analyzed by gas chromatography-mass spectrometry (GC-MS). The results showed that the heaters differ in the quantity of BTEX released during operation. The KH was the most polluted heater based on BTEX measurement, followed by DH. The ∑BTEX for heaters were observed as follows: KH (290 μg m^-3); DH (120 μg m^-3); GH (84 μg m^-3); WH (31 μg m^-3); EH (16 μg m^-3). Toluene was the predominant compound in all air samples. In KH and DH, the toluene to benzene ratios (T/B) were higher than 4 due to fuel evaporation, while GH had a T/B ratio of 3.9, indicating that the combustion of liquefied petroleum gas (LPG) was the main source. Moreover, a risk assessment was performed to evaluate where the cancer risks (CR) for benzene and ethylbenzene exceeded the critical values (10^-6). KH was found to be the most harmful heater for residents, followed by DH and GH. For non-carcinogenic compounds, hazard quotients (HQ) were found to be less than one and thus unlikely to cause health problems.

A survey on the current status of clinical resources for diagnosis and treatment of breast cancer in rural hospitals of the Tohoku region in Japan

BACKGROUND

We administered a questionnaire survey to assess the available clinical resources for the diagnosis and treatment of breast cancer and identify the issues faced by rural hospitals in the Tohoku region in Japan.

METHODS

The term rural hospital was defined by the following three criteria: the facility is a certified regional cancer center and hospital, no breast specialist is on staff, and ≥ 10 breast surgeries per year have been performed. Thirty-eight rural hospitals were eligible, and each was sent a self-administered questionnaire consisting of 26 questions by mail.

RESULTS

Responses were received from 29 of the 38 hospitals. Most of the hospitals had adequate facilities for diagnosis and treatment, but they needed specialists' support for ≥ 2 days per month. Approximately half of the hospitals indicated that applying resources for diagnosis and treatment of breast cancer, especially during planning of treatment and management of advanced breast cancer patients, was a burden. Interestingly, the hospitals felt that being able to provide treatment to their patients was more ideal rather than referring them to urban hospital like the prefectural cancer center and hospital providing specialized cancer treatment.

CONCLUSIONS

The surveyed rural hospitals needed practical and knowledge-based support from specialists. Unfortunately, the number of specialists is currently insufficient in Tohoku. Increased number of certified physicians, clinical pathways for sharing patient's information and updated knowledge, and information and communication technology for treatment with specialists' intervention in rural hospitals may solve issues in Tohoku.

Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model

Introduction

Early access to cancer palliative care is recommended. Descriptions of structures and processes of outpatient palliative care clinics operated within smaller hospitals are scarce. This paper presents the development and operation of a fully integrated cancer and palliative care outpatient clinic at a local hospital in a rural region of Mid-Norway offering palliative care concurrent with cancer treatment. A standardized care pathway was applied.

Methods

Palliative care is in Norway part of the public healthcare system. Official recommendations recent years point out action points to improve delivery of palliative care. An integrated cancer and palliative care outpatient clinic at a local hospital and an innovative care delivery model was developed and operated in this setting. Patients were recruited for a descriptive study of the patient population. Clinical data were collected by clinical staff and 13 symptom intensities were reported by the patients.

Results

Cancer and palliative care were provided by one team of healthcare professionals trained in both fields. There was a close collaboration with the other departments at the hospital, with its affiliated tertiary hospital, and with community health and care services to provide timely referral, enhanced continuity, and improved coordination of care. Eighty-eight patients were included. Mean age was 65.6 years, the most common cancer diagnoses were digestive organs (22.7%), male genital organs (20.5%) or breast (25.0%), 75.0% had metastatic or locally advanced cancer, 59.1% were treated with non-curative intention and 93.1% had Karnofsky Performance Status ≥ 80%. Median scores of individual symptoms ranged from 0 to 3 (numerical rating scale, 0–10) and 61.0% reported at least one clinically significant symptom rating (≥ 4).

Conclusion

This delivery model of integrated outpatient cancer and palliative care is particularly relevant in rural regions allowing cancer patients access to palliative care earlier in the disease trajectory and closer to home

Palliative care is an important part of cancer care which aims at improving cancer patients’ symptom burden and quality of life and support their carers. Palliative care has traditionally been separated from cancer care. During the last decade, one has become aware of the benefits of introducing palliative care early and concurrent with cancer treatment. Most cancer patients are nowadays treated as outpatients. Availability of palliative care as a routine part of outpatient cancer clinics is therefore important. Most of the described models of early palliative care in cancer care are within large tertiary hospitals. Here it is described how early palliative care was delivered to cancer patients in an outpatient clinic in a smaller hospital in a rural region of Mid-Norway. In this integrated cancer and palliative care outpatient clinic, cancer and palliative care were provided by one team of healthcare professionals trained in both fields. The integrated outpatient clinic collaborated closely with the other hospital departments and with community health and care services. This was needed to be able to offer palliative care to all cancer patients in need of it, and closer to their home. Many of the patients attending the integrated outpatient clinic could not be cured for their cancer. They did not have many symptoms of their cancer, and they had a high functional status. This demonstrated that the integrated outpatient clinic in this local hospital was a relevant place to offer palliative care early and concurrent with cancer treatment before symptoms became severe.

Assessing heatwave impacts on cause-specific emergency department visits in urban and rural communities of Queensland, Australia

BACKGROUND

Heatwave impact on morbidity of people in rural areas has rarely been assessed in prior studies, and recently published literature has documented heatwave impact on a wide spectrum of diseases, for example, ear and eye diseases.

OBJECTIVES

To examine the associations between heatwaves and cause-specific emergency department visits (EDVs) across eight communities in both urban and rural regions throughout Queensland, Australia.

METHODS

Daily data on EDVs, air pollution and climatic conditions during the 1st January 2013 to the 31st December 2015 were obtained from relevant government agencies. Heatwave was defined as ≥ 95th percentile of the mean temperature for three or more consecutive days in each community. A quasi-Poisson generalized additive model with a distributed lag non-linear model was used to assess the heatwave impacts on EDVs. Random effect meta-analysis was performed to investigate the effects of heatwaves on cause-specific EDVs across the urban and rural regions as well as the whole Queensland. The causes of EDVs investigated in this study were infectious and parasitic diseases (ICD code: A00-B99), endocrine, nutritional and metabolic diseases (E00-E90), mental and behavioural disorders (F00-F99), diseases of the nervous system (G00-G99), diseases of the ear and mastoid process (H60-H95), diseases of the circulatory system (I00-I99), diseases of the respiratory system (J00-J99), diseases of the skin and subcutaneous tissue (L00-L99), diseases of the musculoskeletal system and connective tissue (M00-M99), diseases of the genitourinary system (N00-N99), and injury, poisoning and certain other consequences of external causes (S00-T98).

RESULTS

The meta-analysis results showed that there were significant effects of heatwaves on total EDVs and a wide-spectrum of cause-specific EDVs. For example, EDVs for endocrine, nutritional and metabolic diseases (RR: 1.18, 95% CI: 1.04-1.34), diseases of the nervous system (RR: 1.09, 95% CI: 1.02-1.17), and diseases of the genitourinary system (RR: 1.05, 95% CI: 1.00-1.09) increased substantially during heatwave days. The effect of heatwaves on total EDVs was similar for rural (RR: 1.04, 95% CI: 1.01-1.07) and urban regions (RR: 1.04, 95% CI: 1.00-1.07).

CONCLUSIONS

A wide range of diseases were sensitive to heatwave impacts. Residents in urban and rural areas were all vulnerable to heatwave impacts, calling for heat adaptation measures to be undertaken in Queensland, Australia.

Dietary fat and antioxidant vitamin intake in patients of neurodegenerative disease in a rural region of Jalisco, Mexico

OBJECTIVE

To evaluate and compare the intake of lipids and (A, E, and C) vitamins in patients with and without possible neurodegenerative diseases.

METHODS

Twenty adults with possible Alzheimer's disease or Parkinson's disease and 41 control subjects (50-89 years old) from a rural region were studied. Dietary intake was evaluated with the analysis of macronutrients and micronutrients conducted by a food frequency questionnaire and 24 hours dietary record. Analyses were adjusted for age, sex, body mass index, and energy intake. Through interrogation and use of medical record form of health secretary we obtained information about the sociodemographic characteristics. Multivariate analysis of variance to allow for covariated adjustment was used.

RESULTS

Patients had a lower energy intake, vitamin C (P = 0.016), fruits (P < 0.001), vegetables (P = 0.037), and oils and fat (P = 0.002), than the controls. Interestingly, the C vitamin intake in patients was still higher than the recommended. Patients had a higher consumption of cereals (P = 0.017), high-animal fat diet (P = 0.024), and whole milk (P < 0.001); 2.4% of the controls smoke and 5% are alcohol consumers. Eighty-five percent of patients and 78% of the controls do not have physical activity. Family history of subjects in this study indicated chronic diseases.

CONCLUSION

The subjects included in this study had a high intake of C vitamin, this is due to the consumption of fruits and vegetables. However, patients with possible Alzheimer's or Parkinson's disease had a lower intake of fruits and vegetables, which could be due to type of food to which they have access.

Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy

Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.