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Zhang X, Wang W, Zeng J, Ye Q, Lai X, Cai X, Diao X, Huang J, Li K. Adherence to the atrial fibrillation better care pathway and its associated factors among rural patients with atrial fibrillation in China: A cross-sectional study. Heart Lung 2024; 66:23-30. [PMID: 38520987 DOI: 10.1016/j.hrtlng.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The atrial fibrillation better care (ABC) pathway is an effective strategy for the integrated management of atrial fibrillation (AF). Current data on adherence to the ABC pathway among rural patients with AF in China are limited. OBJECTIVES To investigated adherence to the ABC pathway and its associated factors among rural patients with AF in China. METHODS In the cross-sectional study, we recruited 870 rural patients with AF from July 2022 to July 2023 in China. AF-related sociodemographic and clinical data was collected. RESULTS Among the 870 rural patients with AF, 437 (50.23 %) were male, 714 (82.07 %) were ≥65 years old. The level of adherence to ABC pathway was extremely low (5.75 %), and its associated factors included patients ≥75 years (compared with those <65 years, OR=0.165, 95 %CI: 0.065-0.417, P < 0.001), junior middle school and senior middle school education or above (compared with primary school education or below, OR=3.441, 95 %CI: 1.144-10.351, P = 0.028; OR=11.438, 95 %CI: 3.758-34.814, P < 0.001), average monthly household income per capita 1000-3000 RMB and >3000 RMB (compared with <1000 RMB, OR=3.993, 95 %CI: 1.343-11.877, P = 0.013; OR=4.474, 95 %CI: 1.478-13.541, P = 0.008), persistent AF (compared with paroxysmal AF, OR=0.062, 95 %CI: 0.008-0.466, P = 0.007) and multimorbidity (OR=0.356, 95 %CI: 0.163-0.781, P = 0.010). CONCLUSIONS There is an urgent need to develop targeted interventions and national policies to improve the adherence to the ABC pathway of rural AF patients in China.
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Affiliation(s)
- Xiaomin Zhang
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Wenxuan Wang
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Jianqing Zeng
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Qirao Ye
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Xinwei Lai
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Xiaomei Cai
- Chronic Disease Management Center, People's Hospital of Shangyou County, Ganzhou, China
| | - Xiulin Diao
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Jun Huang
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhong Shan Second Road, Guangzhou 510080, China
| | - Kun Li
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China.
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Gichuyia CM, Mtimet N, Fèvre EM, Thomas LF, Gathura PB, Onono JO, Akaichi F. Consumer preferences and willingness to pay for safe pork products in rural Kenya. Meat Sci 2024; 211:109450. [PMID: 38350245 DOI: 10.1016/j.meatsci.2024.109450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/15/2024]
Abstract
Designing interventions to support the safe development of rapidly growing livestock value chains in sub-Saharan Africa requires a clear understanding of consumer demands. This study aimed to determine purchase patterns, consumers' preferences, and willingness to pay for safe pork attributes; specifically, the presence of a veterinary inspection stamp and the cleanliness of the butchery. A discrete choice experiment-based survey was used to investigate the purchasing behavior of 401 pork consumers: 253 buying raw pork for household consumption, and 148 buying cooked pork for out-of-home consumption. The study findings indicate that the average quantity of pork purchased by consumers was approximately 0.4 Kg per transaction, with the majority of consumers making several purchases per week. The average price per Kg of pork was KES 310 (Approx. 2.60 USD) at the time of the study. Data from the choice experiment showed that consumers were willing to pay a price premium of KES 245 (Approx. 2.1 USD) and KES 164 (Approx. 1.4 USD) per Kg for evidence of better veterinary meat inspection and higher butchery hygiene respectively; further, these were the two most important attributes they considered while making a pork purchase decision. These findings highlight the potential to leverage consumers' willingness to pay to improve the food safety within pork value chains in this context. Investing to increase consumer awareness on food safety issues should be considered to generate an effective market demand, especially in rural areas with relatively lower literacy levels.
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Affiliation(s)
- Cianjo M Gichuyia
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, P. O. Box 29053, 00625, Kangemi, Kenya; International Livestock Research Institute (ILRI), P.O. Box 30709, 00100 Nairobi, Kenya.
| | - Nadhem Mtimet
- International Fund for Agricultural Development (IFAD), 1191 Nile Corniche, Boulaq, Cairo, Egypt.
| | - Eric M Fèvre
- International Livestock Research Institute (ILRI), P.O. Box 30709, 00100 Nairobi, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, L69 3BX Liverpool, UK.
| | - Lian F Thomas
- International Livestock Research Institute (ILRI), P.O. Box 30709, 00100 Nairobi, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, L69 3BX Liverpool, UK.
| | - Peter B Gathura
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, P. O. Box 29053, 00625, Kangemi, Kenya.
| | - Joshua O Onono
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, P. O. Box 29053, 00625, Kangemi, Kenya.
| | - Faical Akaichi
- Department of Land Economy Environment and Society, Scotland's Rural College (SRUC), Edinburgh, UK.
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Zoellner JM, You W, Porter K, Kirkpatrick B, Reid A, Brock D, Chow P, Ritterband L. Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2024; 21:46. [PMID: 38664715 PMCID: PMC11046896 DOI: 10.1186/s12966-024-01594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND High consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students' SSB consumption. Secondary objectives focus on caregivers' SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)]. METHODS This Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors. RESULTS Of the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001). CONCLUSIONS Kids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline. TRIAL REGISTRATION Clincialtrials.gov: NCT03740113. Registered 14 November 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113 .
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA.
| | - Wen You
- Department of Public Health Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
| | - Kathleen Porter
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Brittany Kirkpatrick
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Annie Reid
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Donna Brock
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Phillip Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
| | - Lee Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
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Leutsch F, Solovieva A. Incidence of histologic chorioamnionitis in a rural community hospital. Ir J Med Sci 2024; 193:791-796. [PMID: 37639160 DOI: 10.1007/s11845-023-03505-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Histological chorioamnionitis (HCA) is a pathological condition defined as an acute inflammation of the amniochorionic membranes which has been linked to a wide range of adverse neonatal events. AIM The purpose of this study is to identify the incidence of HCA in the rural population and evaluate whether there are significant differences in these incidences within the different clinical parameters of delivery method, gravidity, gestational age, previous cesarean section, reason for cesarean section and body mass index (BMI). METHODS A retrospective chart review was conducted on 462 consecutive deliveries that occurred in a rural hospital during a four-year period. Data collected was analyzed using independent sample T-tests, chi-squared tests, and descriptive statistics, with a p-value of < 0.05. RESULTS Overall incidence of HCA was 15.9% (73/459), with a term incidence of 16.2% (68/421) and preterm incidence of 13.2% (5/38). The incidence of HCA was significantly higher in vaginal deliveries (18.8%; n = 54/288) than C-section deliveries (11.1%; n = 19/171) (p = 0.03). Incidence of clinical chorioamnionitis was 0.43% (2/462), with 2.74% (2/73) of HCA manifesting clinically. CONCLUSIONS Evaluation of the incidence of HCA and associated clinical parameters in this study showed a marked decrease in the incidence of HCA when compared to other studies. Strategies to reduce the incidence of HCA include reducing the length of labor via active labor management. We hypothesize that these findings are due to the consistent use of active labor management and our rural study population, but further investigation is required to confirm this.
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Lavigne JE, Stover AN, Gamble A, Tudor G, Cross WF, Carpenter DM. A randomized controlled trial protocol for a virtual, scalable suicide prevention gatekeeper training program for community pharmacy staff (Pharm-SAVES). Contemp Clin Trials Commun 2024; 38:101268. [PMID: 38380343 PMCID: PMC10878835 DOI: 10.1016/j.conctc.2024.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
Background Suicide prevention gatekeeping is a skill that may support community (retail) pharmacists in managing patients who present with suicide warning signs. A brief, virtual, case-based training intervention was tailored to the retail setting (Pharm-SAVES). To test training effectiveness, a randomized controlled trial (RCT) protocol was developed for use in pharmacies across four states. Objective To introduce the trial protocol for assessing the effectiveness for increasing the proportion of staff who recognize patients displaying warning signs and self-report engaging in gatekeeping, including asking if the patient is considering suicide. Methods This study uses a parallel cluster-randomized controlled trial to recruit 150 pharmacy staff in community pharmacies in four states with two groups (intervention and control). The control group completes Pharm-SAVES online suicide prevention gatekeeper training and all assessment surveys at baseline after training and at 1-month follow-up. The experimental group completes all control group training and assessments plus interactive video role-play patient cases. Conclusion We hypothesize that compared to those in the control group, experimental group trainees exposed to the interactive video role play patient cases will be more likely to recognize warning signs in patient cases and self-report engaging in gatekeeping.
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Affiliation(s)
- Jill E. Lavigne
- Wegmans School of Pharmacy, St John Fisher University, United States
| | | | - Abigail Gamble
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Gail Tudor
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Wendi F. Cross
- University of Rochester School of Medicine and Dentistry, United States
| | - Delesha M. Carpenter
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
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Beasleigh S, Bish M, Mahoney AM. The learning needs and clinical requirements of post graduate critical care nursing students in rural and regional contexts: A scoping review. Aust Crit Care 2024; 37:326-337. [PMID: 37541909 DOI: 10.1016/j.aucc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES The objective of this review was to establish the learning needs and clinical requirements of postgraduate critical care nursing students preparing for clinical practice in rural and regional contexts. REVIEW METHOD USED Scoping review. DATA SOURCES Published and unpublished empirical studies. REVIEW METHODS A scoping review based on database searches (CINAHL and Medline) using Aromataris and Munn's four-step search strategy, plus subsequent forward reference search strategy was undertaken, applying predetermined selection criteria. The review aligned to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review. Studies were uploaded into Endnote 20© for storage and into Covidence 2.0© for data extraction. Screening was undertaken by a primary reviewer, with a secondary reviewer evaluating the studies identified as relevant by the first reviewer. Qualitative codes were derived, and reflexive thematic analysis synthesised the results of the review, using Braun and Clarke's six-phase process. RESULTS Nine foundational learning needs for critical care nursing students were extracted from the literature. The nine established foundational learning needs were: behavioural attributes/personal base; critical thinking and analysis; ethical practice; identification of risk; leadership, collaboration, and management; professional practice; provision and coordination of clinical care; research knowledge, standards of care, and policy development; and the health consumer experience. Discerning learning needs specific to rural and regional critical care nursing students was difficult. Only one study that met the inclusion criteria was identified. This study identified some instances of interest in relation to rural and regional learning needs. These instances were related to preparation of rural students for low-volume, high-stake situations; transfer of critically ill patients; stabilisation and preparation of critically ill patients; and care of specific patient groups such as, critically ill, bariatric, paediatric, obstetric, trauma, and patients with behavioural issues. CONCLUSIONS Limited literature exists within the rural and regional critical care nursing educational context, making it difficult to determine the unique learning needs of students within this group. This scoping review lays the groundwork for further research into the needs of critical care nursing students situated within the rural and regional context.
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Affiliation(s)
- Sarah Beasleigh
- La Trobe Rural Health School, La Trobe University, Australia.
| | - Melanie Bish
- La Trobe Rural Health School, La Trobe University, Australia
| | - Anne-Marie Mahoney
- La Trobe Rural Health School, La Trobe University; Australian Centre for Evidence Based Aged Care (ACEBAC), Australia
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Proffitt R, Robinson EL, Reeder B, Leary E, Botkin L, Marushak S, Popejoy LL, Skubic M. Smart Technology for Aging and Reducing Disability (STAReD): Study protocol for a randomized pragmatic clinical trial. Contemp Clin Trials 2024; 138:107461. [PMID: 38280484 PMCID: PMC10922904 DOI: 10.1016/j.cct.2024.107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/27/2023] [Accepted: 01/24/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND There is a critical need to improve quality of life for community-dwelling older adults with disabilities. Prior research has demonstrated that a smart, in-home sensor system can facilitate aging in place for older adults living in independent living apartments with care coordination support by identifying early illness and injury detection. Self-management approaches have shown positive outcomes for many client populations. Pairing the smart, in-home sensor system with a self-management intervention for community-dwelling older adults with disabilities may lead to positive outcomes. METHODS This study is a prospective, two-arm, randomized, pragmatic clinical trial to compare the effect of a technology-supported self-management intervention on disability and health-related quality of life to that of a health education control, for rural, community-dwelling older adults. Individuals randomized to the self-management study arm will receive a multidisciplinary (nursing, occupational therapist, and social work) self-management approach coupled with the smart-home sensor system. Individuals randomized to the health education study arm will receive standard health education coupled with the smart-home sensor system. The primary outcomes of disability and health-related quality of life will be assessed at baseline and post-intervention. Generalizable guidance to scale the technology-supported self-management intervention will be developed from qualitatively developed exemplar cases. CONCLUSION This study has the potential to impact the health and well-being of rural, community-dwelling older adults with disabilities. We have overcome barriers including recruitment in a rural population and supply chain issues for the sensor system. Our team remains on track to meet our study aims.
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Affiliation(s)
- Rachel Proffitt
- Department of Occupational Therapy, College of Health Sciences, University of Missouri.
| | - Erin L Robinson
- School of Social Work, College of Health Sciences, University of Missouri
| | | | - Emily Leary
- Thompson Laboratory for Regenerative Orthopaedics, Department of Orthopaedic Surgery, School of Medicine, University of Missouri
| | - Leah Botkin
- Department of Occupational Therapy, College of Health Sciences, University of Missouri
| | - Sheila Marushak
- Department of Occupational Therapy, College of Health Sciences, University of Missouri
| | | | - Marjorie Skubic
- Department of Electrical Engineering and Computer Science, College of Engineering, University of Missouri
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Suwanchatchai C, Buaphan S, Khuancharee K. Determinants and prevalence of relapse among patients with substance use disorder in a rural population: A retrospective observational study. J Subst Use Addict Treat 2024; 157:209244. [PMID: 38056631 DOI: 10.1016/j.josat.2023.209244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/04/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Substance use relapse after successful detoxication and rehabilitation is one of the most important aspects of addiction worldwide. This study aims to examine the current prevalence of relapse and to determine the factors associated with relapse among patients with substance use disorder (SUD) in a rural population. METHODS This single-centered retrospective observational study enrolled a total of 915 patients with SUD who visited Banna hospital, Nakhon Nayok province, Thailand, from January 1, 2019, to December 31, 2021. Multiple logistic regression models determined the factors associated with relapse among the patients with SUD. RESULTS The substance use relapse rate in this rural Thai population was 24 % (95%CI 21.16-26.70). Multivariate analysis revealed that being over 40 years of age, single, and unemployed, and having no legal history were associated with relapse among the patients with SUD. Furthermore, family disputes, addicted friends, and addicted close relatives resulted in a major significant increase in the risk of substance use relapse. CONCLUSIONS The current study confirmed that family disputes, addicted friends, and addicted close relatives were the main associations with addiction relapse. Therefore, addiction rehabilitation programs based on the findings of the current study may reduce and contribute to preventing the risk of substance use relapse.
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Affiliation(s)
- Chawin Suwanchatchai
- Department of Preventive and Community Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok 26120, Thailand
| | | | - Kitsarawut Khuancharee
- Department of Preventive and Community Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok 26120, Thailand.
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Lu Y, Liu Q, Huang C, Tang X, Wei Y, Mo X, Huang S, Lin Y, Luo T, Gou R, Zhang Z, Qin J, Cai J. Association between plasma and dietary trace elements and obesity in a rural Chinese population. Br J Nutr 2024; 131:123-133. [PMID: 37439087 DOI: 10.1017/s0007114523001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Trace elements may play an important role in obesity. This study aimed to assess the plasma and dietary intake levels of four trace elements, Mn, Cu, Zn and Se in a rural Chinese population, and analyse the relationship between trace elements and obesity. A cross-sectional study involving 2587 participants was conducted. Logistic regression models were used to analyse the association between trace elements and obesity; restricted cubic spline (RCS) models were used to assess the dose-response relationship between trace elements and obesity; the weighted quantile sum (WQS) model was used to examine the potential interaction of four plasma trace elements on obesity. Logistic regression analysis showed that plasma Se concentrations in the fourth quartile (Q4) exhibited a lower risk of developing obesity than the first quartile (Q1) (central obesity: OR = 0·634, P = 0·002; general obesity: OR = 0·525, P = 0·005). Plasma Zn concentration in the third quartile (Q3) showed a lower risk of developing obesity in general obesity compared with the first quartile (Q1) (OR = 0·625, P = 0·036). In general obesity, the risk of morbidity was 1·727 and 1·923 times higher for the second and third (Q2, Q3) quartiles of dietary Mn intake than for Q1, respectively. RCS indicated an inverse U-shaped correlation between plasma Se and obesity. WQS revealed the combined effects of four trace elements were negatively associated with central obesity. Plasma Zn and Se were negatively associated with obesity, and dietary Mn was positively associated with obesity. The combined action of the four plasma trace elements had a negative effect on obesity.
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Affiliation(s)
- Yufu Lu
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Qiumei Liu
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Chuwu Huang
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Xu Tang
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Yanfei Wei
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Xiaoting Mo
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Shenxiang Huang
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Yinxia Lin
- School of Public Health, Guangxi Medical University, Shuangyong Road No.22, Nanning530021, Guangxi, People's Republic of China
| | - Tingyu Luo
- School of Public Health, Guilin Medical University, 20 Lequn Road, Guilin, Guangxi, People's Republic of China
| | - Ruoyu Gou
- School of Public Health, Guilin Medical University, 20 Lequn Road, Guilin, Guangxi, People's Republic of China
| | - Zhiyong Zhang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, People's Republic of China
| | - Jian Qin
- Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Guangxi Medical University, Nanning530021, People's Republic of China
- Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, School of Public Health, Guangxi Medical University, Nanning530021, People's Republic of China
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, Nanning530021, People's Republic of China
| | - Jiansheng Cai
- School of Public Health, Guilin Medical University, 20 Lequn Road, Guilin, Guangxi, People's Republic of China
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, Guangxi, People's Republic of China
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Li J, Li Y, Wang C, Mao Z, Yang T, Li Y, Xing W, Li Z, Zhao J, Li L. Dietary Potassium and Magnesium Intake with Risk of Type 2 Diabetes Mellitus Among Rural China: the Henan Rural Cohort Study. Biol Trace Elem Res 2023:10.1007/s12011-023-03993-6. [PMID: 38049705 DOI: 10.1007/s12011-023-03993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
Previous studies exploring the relationship between dietary potassium and magnesium intake and the risk of type 2 diabetes mellitus (T2DM) have yielded inconsistent results and the lack evidence from rural China. Therefore, we aimed to investigate the association between dietary potassium and magnesium intake and the risk of T2DM in rural China. Data was collected from the Henan Rural Cohort Study in 2017. A validated semi-quantitative food frequency questionnaire assessed dietary potassium and magnesium intake. Logistic regression models were used to calculate odds ratio (ORs) and 95% confidence intervals (CIs) to evaluate the effect of dietary potassium, magnesium and the potassium-magnesium ratio on the risk of T2DM. A total of 38384 individuals were included in the study, and 3616 participants developed T2DM. Logistic regression analysis revealed that the OR (95% CI) of the highest versus dietary potassium and magnesium and potassium-magnesium ratio intakes were 0.67 (0.59, 0.75), 0.76 (0.67, 0.88), and 0.57 (0.50, 0.66), respectively, compared to the subjects with the lowest quartile of intakes. In addition, gender partially influences the relationship between dietary magnesium and T2DM prevalence (P-interaction = 0.042). The group with the highest dietary potassium and dietary magnesium intake had the lowest risk of T2DM, with an OR (95% CI) of 0.63 (0.51-0.77). Dietary potassium and magnesium intake are important modifiable risk factors for T2DM in rural China. Dietary potassium intake > 1.8g/day, dietary magnesium intake > 358.6mg/day and < 414.7mg/day and potassium-magnesium ratio >5.1 should be encouraged to prevent better and manage T2DM.
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Affiliation(s)
- Jia Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Tianyu Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Yan Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Wenguo Xing
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Zhuoyang Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Jiaoyan Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China
| | - Linlin Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, People's Republic of China.
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Camponogara JG, de Ferreira TGM, Pelissari TR, Anversa AM, Moreira CHC, Bier CAS. Demographics, smoking status, and systemic health factors associated with apical periodontitis in a Brazilian rural population: a cross-sectional study. Clin Oral Investig 2023; 27:7319-7325. [PMID: 37857733 DOI: 10.1007/s00784-023-05322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To determine whether the systemic diseases diabetes mellitus (DM) and arterial hypertension (AH), and smoking status are associated with apical periodontitis (AP) in a representative rural population. MATERIALS AND METHODS Cross-sectional study using a representative sample of individuals obtained from a population-based epidemiological survey carried out in the rural area of the city of Rosário do Sul, RS, Brazil, from March 2015 to May 2016. Data were collected through structured questionnaires and clinical examination. Binary logistic regression analysis was performed to identify variables independently associated with AP. RESULTS Of the 584 individuals included in the study, 353 (60.4%) had AP. The presence of AP was independently associated with age ≥ 40 years (odds ratio [OR] = 1.867, 95% confidence interval [CI]: 1.193-2.923, p = 0.006), non-white ethnicity (OR = 1.509, 95% CI: 1.029-2.115, p = 0.035), active or former smoker (OR = 2.087, 95% CI: 1.241-3.510, p = 0.006) and DM or prediabetes (OR = 1.676, 95% CI: 1.150-2.443, p = 0.007). CONCLUSION The study identified significant associations between AP and demographics, smoking status, and systemic disease in a Brazilian rural population. CLINICAL RELEVANCE The study emphasized the significance of comprehending and managing associated factors in preventing and treating AP.
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Affiliation(s)
- Jeanni Gonçalves Camponogara
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Ticiane Góes Mário de Ferreira
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Thayná Regina Pelissari
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Alessandro Meneghetti Anversa
- Graduate Program in Health Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26A (Medicina), Santa Maria, RS, 97105-900, Brazil
| | - Carlos Heitor Cunha Moreira
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Carlos Alexandre Souza Bier
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil.
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12
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Hou X, Li R, Wang J, Wei D, Yang X, Liao W, Yuchi Y, Liu X, Huo W, Mao Z, Liu J, Wang C, Hou J. Gender-specific associations between mixture of polycyclic aromatic hydrocarbons and telomere length. Environ Geochem Health 2023; 45:9583-9598. [PMID: 37773482 DOI: 10.1007/s10653-023-01752-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
Evidence shows the relationships of individual environmental PAHs by their urinary metabolites with relative telomere length (RTL), which may be affected by biological gender differences. Since plasma parent PAHs are not metabolized, it may reflect human exposure to PAHs more realistically in daily life. Thus, exploring joint associations between plasma parent PAHs and RTL is urgent, which may identify the major contributor to its adverse effect. In this study, 2577 participants were obtained from the Henan Rural Cohort. The level of PAHs in blood samples was detected by gas chromatography coupled with tandem mass spectrometry. RTL in blood samples was detected by quantitative polymerase chain reaction. Generalized linear models or quantile g-computation were performed to evaluate the associations between the individual or a mixture of PAHs and RTL. Results from generalized linear models showed that each unit increment in BghiP value corresponded to a 0.098 (95%CI: 0.067, 0.129) increment in RTL for men; each unit increment in BaP, BghiP and Flu value corresponded to a 0.041 (95%CI: 0.014, 0.068), 0.081 (95%CI: 0.055, 0.107) and 0.016 (95%CI: 0.005, 0.027) increment in RTL for women. Results from quantile-g computation revealed that each one-quantile increment in the mixture of 10 PAHs corresponded to a 0.057 (95%CI: 0.021, 0.094) and 0.047 (95%CI: 0.003, 0.091) increment in RTL values of women and men, but these associations were mainly ascribed to three PAHs for women (BaP, Flu and BghiP) and men (BaP, BghiP and Pyr), respectively. Similar results were found in smoking men and cooking women without smoking. Our study found that exposure to 10 PAHs mixture was positively associated with RTL across gender, mainly attributed to Flu, BaP and BghiP, implicating that gender-specific associations may be ascribed to tobacco and cooking smoke pollution. The findings provided clues for effective measures to control PAHs pollutants-related aging disease.Clinical trial registration The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375 .
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Affiliation(s)
- Xiaoyu Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Juan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xiaohuan Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Yinghao Yuchi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Junlin Liu
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China.
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13
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Qiu J, Chang Z, Wang K, Chen K, Wang Q, Zhang J, Li J, Yang C, Zhao Y, Zhang Y. The predictive accuracy of coronary heart disease risk prediction models in rural Northwestern China. Prev Med Rep 2023; 36:102503. [PMID: 38116288 PMCID: PMC10728432 DOI: 10.1016/j.pmedr.2023.102503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
Abstract
Cardiovascular risk models developed may have limitations when applied to rural Chinese. This study validated and compared the Framingham Risk Score (FRS) and Prediction for Atherosclerotic Cardiovascular Disease Risk in China (PAR) models in predicting 10-year risk of coronary heart disease (CHD) in a rural cohort in Ningxia, China from 2008 to 2019. The FRS and PAR models were validated by estimating predicted events, C index, calibration χ2 and plots. 1381 adults without CHD at baseline were followed up for 9.75 years on average. 168 CHD cases were observed. The FRS and PAR underestimated CHD events by 22 % and 46 % for the total population, while overestimated for males by 152 % and 78 %, respectively. The C index was slightly higher for PAR than FRS. Both models showed weak calibration with chi-square values above 20 (p < 0.001). Bland-Altman plots indicated FRS predicted higher CHD risk than PAR, lacking consistency. Overall, FRS and PAR demonstrated limited performance in predicting 10-year CHD risk in this rural population. PAR had slightly better discrimination than FRS, but require further improvement in calibration and individual risk estimation to suit the rural population in Northwest China.
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Affiliation(s)
- Jiangwei Qiu
- School of Public, Ningxia Medical University, Yinchuan, China
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, China
| | - Zhenqi Chang
- School of Public, Ningxia Medical University, Yinchuan, China
| | - Kai Wang
- School of Public, Ningxia Medical University, Yinchuan, China
- The Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, China
| | - Kexin Chen
- School of Public, Ningxia Medical University, Yinchuan, China
| | - Qingan Wang
- School of Public, Ningxia Medical University, Yinchuan, China
- The Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, China
| | - Jiaxing Zhang
- School of Public, Ningxia Medical University, Yinchuan, China
- The Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, China
| | - Juan Li
- School of Public, Ningxia Medical University, Yinchuan, China
| | - Chan Yang
- School of Public, Ningxia Medical University, Yinchuan, China
- Department of Community Nursing, School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Yi Zhao
- School of Public, Ningxia Medical University, Yinchuan, China
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, China
- The Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, China
| | - Yuhong Zhang
- School of Public, Ningxia Medical University, Yinchuan, China
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, China
- The Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, China
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14
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Dursun F, Elshabrawy A, Wang H, Kaushik D, Liss MA, Svatek RS, Gore JL, Mansour AM. Impact of rural residence on the presentation, management and survival of patients with non-metastatic muscle-invasive bladder carcinoma. Investig Clin Urol 2023; 64:561-571. [PMID: 37932567 PMCID: PMC10630682 DOI: 10.4111/icu.20230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE To assess the impact of rural and remote residence on the receipt of guidelines-recommended treatment, quality of treatment and overall survival (OS) in patients with non-metastatic muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS Patients with MIBC were identified using National Cancer Database. Patients were classified into three residential areas. Logistic regression models were used to assess associations between geographic residence and receipt of radical cystectomy (RC) or chemoradiation therapy (CRT). Models were fitted to assess quality benchmarks of RC and CRT. RESULTS We identified 71,395 patients. Of those 58,874 (82.5%) were living in Metro areas, 8,534 (11.9%) in urban-rural adjacent (URA), and 3,987 (5.6%) in urban-rural remote to metro area (URR). URR residence was significantly associated with poor OS compared to URA and Metro residence (HR 0.87, 95% CI 0.81-0.94 and HR 0.90, 95% CI 0.87-0.93, p<0.001). There was no difference in the likelihood of receiving RC and CRT among different residential areas. Among patients who underwent RC; individuals living in URR were less likely to receive neoadjuvant chemotherapy and adequate lymph node dissection, and had a higher probability of positive surgical margin than those living in metro areas. For those who received CRT; individuals living in Metro areas were more likely to receive concomitant systemic therapy compared to URR. CONCLUSIONS Rural residence is associated with lower OS for MIBC patients and less likelihood of meeting quality benchmarks for RC and CRT. This data should be used to guide further health policy and allocation of resources for rural population.
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Affiliation(s)
- Furkan Dursun
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Ahmed Elshabrawy
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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15
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Zhang K, Feng Y, Chai Y, Wang C, Yu S. Association between dinner timing and glucose metabolism in rural China: A large-scale cross-sectional study. Nutrition 2023; 115:112158. [PMID: 37544210 DOI: 10.1016/j.nut.2023.112158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Meal timing is a major risk factor for metabolic disease. The aim of this study was to assess the relationship between dinner timing and glucose metabolism in the rural Chinese population. METHODS This cross-sectional study included 7701 participants from a Henan rural cohort study. Basic information was collected by in-person questionnaires. Multiple linear regression analysis was used to evaluate the relationship between dinner timing and fasting insulin (FINS), fasting plasma glucose (FPG), and homeostatic model assessment for insulin resistance (HOMA-IR). Restricted cubic spline was employed to investigate the dose-response relationship between dinner timing and FINS, FPG, and HOMA-IR. A generalized linear model was used to explore the interaction effect of age and dinner timing on FINS, FPG, and HOMA-IR. RESULTS After adjusting for confounding factors, FINS concentration was reduced by 0.482 mmol/L (P < 0.001) for each hour delay in dinner timing. Furthermore, the HOMA-IR index decreased by 0.122 mmol/L for each hour delay. The results indicated a noticeable trend of decreasing values associated with later dinner timing (FINS: Poverall association < 0.001, Pnonlinear association = 0.144; HOMA-IR: Poverall association = 0.001, Pnonlinear association = 0.186). The interaction between age and dinner time significantly correlated with FINS and HOMA-IR (P < 0.05). This relationship was statistically significant before 69 y (P < 0.05). CONCLUSION A significant association between dinner timing and glucose metabolism was observed in the rural Chinese population. Delayed dinner timing may be associated with lower fasting insulin. The negative effect of dinner timing on FINS and HOMA-IR was diminished with age.
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Affiliation(s)
- Kaiyang Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yinhua Feng
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Chai
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Songcheng Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China; School of Nursing and Health, Zhengzhou University, Zhengzhou, China.
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Palomin A, Takishima-Lacasa J, Selby-Nelson E, Mercado A. Challenges and Ethical Implications in Rural Community Mental Health: The Role of Mental Health Providers. Community Ment Health J 2023; 59:1442-1451. [PMID: 37314531 DOI: 10.1007/s10597-023-01151-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023]
Abstract
This manuscript reviews the unique challenges, barriers, and ethical implications of providing mental health services in rural and underserved areas. Community mental health centers in rural areas are often underserved due to shortages of mental health providers and limited resources. Individuals living in rural areas are at increased risk of developing mental health condition with limited access to mental health clinicians and healthcare facilities. These access to care issues are often exacerbated by geographical barriers as well as social, cultural, and economic challenges. A rural mental health professional may encounter several barriers to providing adequate care to individuals living in rural areas. For example, limited services and resources, geographic barriers, conflict between professional guidelines and community values, managing dual relationships, and challenges pertaining to confidentiality and privacy are several barriers to providing adequate care in rural areas. We will briefly summarize the primary ethical domains that are especially influenced by rural culture and the complex responsibilities of mental health providers in rural areas including barriers to care, crisis intervention, confidentiality, multiple relationships/dual roles, limits of competency, and rural mental healthcare practice implications.
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Affiliation(s)
- Amanda Palomin
- Department of Psychological Science, University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX, 78539, USA.
| | | | | | - Alfonso Mercado
- Department of Psychological Science, University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX, 78539, USA
- School of Medicine, Department of Psychiatry, The University of Texas Rio Grande Valley, Edinburg, USA
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Aregay A, O'Connor M, Stow J, Ayers N, Lee S. Palliative care in Ethiopia's rural and regional health care settings: a qualitative study of enabling factors and implementation challenges. BMC Palliat Care 2023; 22:156. [PMID: 37845671 PMCID: PMC10580684 DOI: 10.1186/s12904-023-01283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Palliative care is limited in Ethiopia, particularly in rural areas, where more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia's rural and regional health care settings. METHODS A qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders. RESULTS Participants indicated that despite a few leaders being aware of the inclusion of palliative care in the Ethiopia national policies and guidelines, palliative care is not, integrated into the existing health care system. Other participants responded that palliative care is not well integrated into the undergraduate and postgraduate courses except for limited content in the diploma and a few postgraduate courses. Participants described the challenges for palliative care implementation as follows: many lacked awareness about palliative care; and chronically ill patients other than those with HIV received inadequate care, limited to physical care, some pain management, and psychosocial support rather than comprehensive palliative care. In addition, some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers. CONCLUSIONS Enablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models.
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Affiliation(s)
- Atsede Aregay
- Health and Nursing Sciences, University of Agder, Kristiansand, Norway.
- School of Nursing, Mekelle University, Tigray, Ethiopia.
| | - Margaret O'Connor
- Nursing and Midwifery, Monash University, Melbourne, Australia
- Melbourne City Mission Palliative Care, Melbourne, Australia
| | - Jill Stow
- St Vincent's Private Hospital, Melbourne, Australia
| | - Nicola Ayers
- Nurse Lecturer, School of Nursing, BPP University, London, UK
| | - Susan Lee
- Nursing and Midwifery, Monash University, Melbourne, Australia
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Tan YR, Jawahir S, Doss JG. Oral healthcare seeking behavior of Malaysian adults in urban and rural areas: findings from the National Health and Morbidity Survey 2019. BMC Oral Health 2023; 23:719. [PMID: 37798660 PMCID: PMC10552245 DOI: 10.1186/s12903-023-03470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The development and implementation of appropriate strategies to enhance oral health in the community can be aided by an understanding of oral healthcare seeking behavior among urban and rural populations. The purpose of this study was to identify the factors associated with oral healthcare seeking behavior of the Malaysians in urban and rural locations who self-reported dental problems. METHODS The National Health and Morbidity Survey 2019, a cross-sectional nationwide household survey that focused on non-institutionalised Malaysians, provided the data for this study on adults in Malaysia who were 18 years of age and older. A two-stage stratified random sampling technique was employed to ensure national representativeness. Data was collected using a multilingual (Malay and English), structured, and validated questionnaire via face-to-face interviews from July to October 2019. The dependent variable was oral healthcare seeking behavior (sought oral healthcare and self-medication). Independent variables were predisposing, enabling and health needs factor based on Andersen's Behavioral Model. Descriptive statistics were used to describe the characteristics and oral healthcare seeking behavior of the respondents. The relationship between the independent and dependent variables were investigated using multivariable logistic regression analysis. RESULTS The analysis comprised a total of 10,134 respondents, representing about 18.2 million Malaysian adults aged 18 and above. The overall prevalence of Malaysian adults who self-reported dental problems was low (5.5%) and was slightly higher in the rural than urban population. Almost half sought treatment from healthcare practitioners, and almost a quarter self-medicated. Ethnicity was associated with seeking healthcare and self-medication among urban dwellers. Among the rural population, income level was associated with seeking healthcare while education level was associated with self-medication. CONCLUSION Disparities in oral healthcare seeking behaviors exist between Malaysians living in urban and rural areas. Future policies should adopt focused strategies that concentrate on oral healthcare accessibility and health literacy of the vulnerable and rural populations to achieve the best oral healthcare for this population group.
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Affiliation(s)
- Yeung R'ong Tan
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Jennifer Geraldine Doss
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Li S, Chen Y, Zhang L, Li R, Kang N, Hou J, Wang J, Bao Y, Jiang F, Zhu R, Wang C, Zhang L. An environment-wide association study for the identification of non-invasive factors for type 2 diabetes mellitus: Analysis based on the Henan Rural Cohort study. Diabetes Res Clin Pract 2023; 204:110917. [PMID: 37748711 DOI: 10.1016/j.diabres.2023.110917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
AIM To explore the influencing factors of Type 2 diabetes mellitus (T2DM) in the rural population of Henan Province and evaluate the predictive ability of non-invasive factors to T2DM. METHODS A total of 30,020 participants from the Henan Rural Cohort Study in China were included in this study. The dataset was randomly divided into a training set and a testing set with a 50:50 split for validation purposes. We used logistic regression analysis to investigate the association between 56 factors and T2DM in the training set (false discovery rate < 5 %) and significant factors were further validated in the testing set (P < 0.05). Gradient Boosting Machine (GBM) model was used to determine the ability of the non-invasive variables to classify T2DM individuals accurately and the importance ranking of these variables. RESULTS The overall population prevalence of T2DM was 9.10 %. After adjusting for age, sex, educational level, marital status, and body measure index (BMI), we identified 13 non-invasive variables and 6 blood biochemical indexes associated with T2DM in the training and testing dataset. The top three factors according to the GBM importance ranking were pulse pressure (PP), urine glucose (UGLU), and waist-to-hip ratio (WHR). The GBM model achieved a receiver operating characteristic (AUC) curve of 0.837 with non-invasive variables and 0.847 for the full model. CONCLUSIONS Our findings demonstrate that non-invasive variables that can be easily measured and quickly obtained may be used to predict T2DM risk in rural populations in Henan Province.
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Affiliation(s)
- Shuoyi Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Ying Chen
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Liying Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Jing Wang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Yining Bao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Feng Jiang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Ruifang Zhu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, PR China.
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China; Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia.
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Akinlotan M, Khodakarami N, Primm K, Bolin J, Ferdinand AO. Travel for medical or dental care by race/ethnicity and rurality in the U.S.: Findings from the 2001, 2009 and 2017 National Household Travel Surveys. Prev Med Rep 2023; 35:102297. [PMID: 37559948 PMCID: PMC10407956 DOI: 10.1016/j.pmedr.2023.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
The travel burden for medical or dental care is a well-documented barrier to healthcare access, particularly in rural areas. There is limited research providing national estimates of the travel trends for medical/dental care, particularly among racial/ethnic groups, and among rural and urban populations. We analyzed data from the 2001, 2009, and 2017 National Household Travel Surveys. Main outcomes were the average travel distance (in miles), average travel time (in minutes), and travel burden, characterized as the percentage of trips lasting ≥ 30 miles or minutes for medical/dental care. We used ordinary least squares and multivariable logistic regressions to examine trends in the travel time/distance and travel burden, controlling for socio-demographic and travel dynamics. Among rural residents, the average travel distance for medical/dental care increased by 17.8% between 2001 and 2017, while no increase was observed among urban residents. Thirty-six percent of trips among rural residents lasted ≥ 30 minutes in 2001 but increased to 47.4% in 2017. Logistic regression estimates show that though Blacks experienced higher odds of a travel time burden compared to Whites, the burden lessened over time. In 2017, urban Blacks (OR = 0.41, 95% C.I. = 0.26,0.66), and rural Blacks (OR = 0.16, 95% C.I. = 0.05,0.55) were less likely to spend ≥ 30 minutes traveling for medical/dental care compared to Whites, using the year 2001 as the baseline. The travel distance and time for medical/dental care have increased in rural areas. However, the travel burden among rural and urban Black residents has decreased. Continuing to alleviate excess burdens of transportation may be beneficial.
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Affiliation(s)
| | - Nima Khodakarami
- Department of Health Policy & Administration, Penn State Beaver, USA
| | - Kristin Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, USA
| | - Jane Bolin
- Southwest Rural Health Research Center, Texas A&M School of Public Health, USA
- Texas A&M College of Nursing, USA
- Department of Health Policy & Management, Texas A&M School of Public Health, USA
| | - Alva O. Ferdinand
- Southwest Rural Health Research Center, Texas A&M School of Public Health, USA
- Department of Health Policy & Management, Texas A&M School of Public Health, USA
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21
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Liu B, Liu X, Sun C, Zhuo Z, Wei S, Liu Z, Zhang S, Chen Y, Tian Y, Kang N, Hou J, Wang C. Association of at-home and out-of-home eating frequency with the estimated 10-year arteriosclerotic cardiovascular disease risk in rural population: the Henan Rural Cohort Study. Eur J Nutr 2023; 62:2929-2938. [PMID: 37405440 DOI: 10.1007/s00394-023-03200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Insufficient evidence currently exists regarding the relationship between eating frequency and arteriosclerotic cardiovascular disease (ASCVD). Thus, the objective of this study was to explore the association of at-home eating (AHE) and out-of-home eating (OHE) frequency with 10-year ASCVD risk. METHODS A total of 23,014 participants were included from the Henan Rural Cohort Study. A face-to-face questionnaire was used to acquire data on the frequency of OHE and AHE. The relationship of OHE and AHE frequency with 10-year ASCVD risk was evaluated by logistic regression. Mediation analysis was conducted to evaluate whether BMI mediated the association of OHE and AHE frequency with 10-year ASCVD risk. RESULTS The adjusted OR and 95% CI of 10-year ASCVD risk for participants who ate out 7 or more times a week was 2.012 (1.666, 2.429) compared with participants who had OHE 0 times. Compared to those who had AHE ≤ 11 times, the adjusted OR and 95% CI for the participants eating every meal at home (21 times) was 0.611 (0.486, 0.769). The relationship of OHE and AHE frequency with 10-year ASCVD risk was mediated by BMI, and the proportion of BMI explained was 25.3% and 36.6%. CONCLUSIONS The OHE frequency was associated with increased 10-year ASCVD risk, while AHE was related to decreased 10-year ASCVD risk, and BMI may play a partial mediating role in the relationship. Implementing health promotion strategies that promote AHE and discourage frequent OHE may prove to be an effective approach to preventing and controlling ASCVD. TRIAL REGISTRATION NUMBER ChiCTR-OOC-15006699 (2015-07-06).
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Affiliation(s)
- Beibei Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Chunyang Sun
- Department of Preventive Medicine, School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Zhuang Zhuo
- School of Life Science, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shouzheng Wei
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zihan Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Sen Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Yifei Chen
- Department of Preventive Medicine, School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yuan Tian
- Department of Preventive Medicine, School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China.
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22
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Nielsen S, O'Neil B, Chang CP, Mark B, Snyder J, Deshmukh V, Newman M, Date A, Galvao C, Henry NL, Lloyd S, Hashibe M. Determining the association of rurality and cardiovascular disease among prostate cancer survivors. Urol Oncol 2023; 41:429.e15-429.e23. [PMID: 37455231 PMCID: PMC10787808 DOI: 10.1016/j.urolonc.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Rural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship. MATERIALS AND METHODS Data were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1-3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years. RESULTS Results revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008). CONCLUSIONS This study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event.
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Affiliation(s)
| | - Brock O'Neil
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Chun-Pin Chang
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| | - Bayarmaa Mark
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT
| | - Vikrant Deshmukh
- Department of Health Sciences, University of Utah, Salt Lake City, UT
| | - Michael Newman
- Department of Health Sciences, University of Utah, Salt Lake City, UT
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
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23
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Werts SJ, Robles-Morales R, Bea JW, Thomson CA. Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01464-4. [PMID: 37768420 DOI: 10.1007/s11764-023-01464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Little is known about the intersection between age and rurality as characteristics that impact lifestyle behavior change for cancer survivors. This review aims to summarize the current literature on lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. METHODS A systematic search of five databases identified randomized controlled trials and controlled clinical trials that targeted diet, physical activity, alcohol consumption, or tobacco use change in adult cancer survivors living in rural areas of the world. RESULTS Eight studies met the inclusion criteria. Most studies were conducted in either Australia or the USA, included survivors at least 6 weeks post-treatment, and half included only breast cancer survivors, while the other four included a mix of cancer types. All but one had a physical activity component. No articles addressed changes in alcohol or tobacco behavior. Seven (87.5%) had a fully remote or hybrid delivery model. Most of the physical activity interventions showed significant changes in physical activity outcomes, while the dietary interventions showed changes of clinical but not statistical significance. CONCLUSIONS Few studies have been conducted to implement and evaluate the effectiveness of lifestyle behavior change interventions among older rural survivors of cancer. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with this population. IMPLICATIONS FOR CANCER SURVIVORS Effective diet and physical activity interventions exist, albeit limited in terms of effective lifestyle behavior change intervention tailored to older, rural survivors of cancer, particularly in relation to alcohol and tobacco behaviors.
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Affiliation(s)
- Samantha J Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Rogelio Robles-Morales
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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24
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Hou X, Mao Z, Song X, Li R, Liao W, Kang N, Zhang C, Liu X, Chen R, Huo W, Wang C, Hou J. Synergistic association of long-term ozone exposure and solid fuel use with biomarkers of advanced fibrosis. Environ Sci Pollut Res Int 2023; 30:85318-85329. [PMID: 37382821 DOI: 10.1007/s11356-023-28337-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
This study aims to explore the association of combined exposure to cooking fuel type and ambient ozone (O3) levels with hepatic fibrosis indices among rural adults. A total of 21,010 participants were derived from the Henan Rural Cohort. Information regarding cooking fuel type was collected through a questionnaire, and the concentration of ground-level O3 for each subject was obtained from the Tracking Air Pollution in China (TAP) dataset. A generalized linear model was used to examine the independent association of cooking fuel type or O3 exposure with hepatic fibrosis indices (FIB-4, APRI, and AST/ALT), and their possible interactions with advanced fibrosis were conducted. Compared to clean fuel users, solid fuel users had increased the risk of advanced fibrosis, the adjusted odds ratio (OR) of its assessment by FIB-4 1.240 (1.151, 1.336), by APRI 1.298 (1.185, 1.422), and by AST/ALT 1.135 (1.049, 1.227), respectively. Compared to low O3 exposure, the adjusted ORs of advanced fibrosis assessed by FIB-4, APRI, and AST/ALT in women with high O3 exposure were correspondingly 1.219 (1.138, 1.305), 1.110 (1.017, 1.212), and 0.883 (0.822, 0.949). The adjusted ORs of advanced fibrosis assessed by FIB-4, APRI, and AST/ALT for solid fuel users with high O3 exposure relative to clean fuel users with low O3 exposure in women were 1.557 (1.381, 1.755), 1.427 (1.237, 1.644), and 0.979 (0.863, 1.108), respectively. Significant additive effect of O3 exposure and solid fuel use on FIB-4-defined advanced fibrosis was observed in women, which was quantified by RERI (0.265, 95%CI: 0.052, 0.477), AP (0.170 95%CI: 0.045, 0.295), and SI (1.906, 95%CI: 1.058, 3.432). Solid fuel users with high O3 exposure were significantly associated with elevated hepatic fibrosis indices among rural women, suggesting that poor air quality may induce hepatocellular injury, and women might be more vulnerable to air pollution. The findings indicate that using cleaner fuels in cooking is an effective measure to maintain sustainable development of the environment and gain beneficial effect on human health. Clinical trial registration: The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.
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Affiliation(s)
- Xiaoyu Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xiaoqin Song
- Physical Examination Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Caiyun Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China.
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Pérez-Milena A, Ramos-Ruiz JA, Zafra-Ramirez N, Noguera-Cuenca C, Rodríguez-Bayón A, Ruiz-Díaz B. Qualitative study on the use of emergency services by people with serious mental disorder in Spain. BMC Prim Care 2023; 24:125. [PMID: 37340353 PMCID: PMC10280892 DOI: 10.1186/s12875-023-02078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The population with severe mental disorders (SMD) is a frequent user of emergency services. Situations of psychiatric decompensation can have devastating consequence and can cause problems in getting urgent medical care. The objective was to study the experiences and needs of these patients and their caregivers regarding the demand for emergency care in Spain. METHODS Qualitative methodology involving patients with SMD and their informal caregivers. Purposive sampling by key informants in urban and rural areas. Paired interviews were carried out until data saturation. A discourse analysis was conducted, obtaining a codification in categories by means of triangulation. RESULTS Forty-two participants in twenty-one paired interviews (19 ± 7.2 min as mean duration). Three categories were identified. 1º Reasons for urgent care: poor self-care and lack of social support, as well as difficulties in accessibility and continuity of care in other healthcare settings. 2º Urgent care provision: trust in the healthcare professional and the information patients receive from the healthcare system is crucial, telephone assistance can be a very useful resource. 3º Satisfaction with the urgent care received: they request priority care without delays and in areas separated from the other patients, as well as the genuine interest of the professional who attends them. CONCLUSIONS The request for urgent care in patients with SMD depends on different psychosocial determinants and not only on the severity of the symptoms. There is a demand for care that is differentiated from the other patients in the emergency department. The increase in social networks and alternative systems of care would avoid overuse of the emergency departments.
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Affiliation(s)
- Alejandro Pérez-Milena
- "El Valle" Primary Care Center, Andalusian Public Health System, 4 Human Rights Street, 23009, Jaén, Spain.
| | - Juan Andrés Ramos-Ruiz
- Multiprofessional Teaching Unit of Family and Community Care Jaén North - Northeast, Andalusian Public Health System, Linares, Spain
| | - Natalia Zafra-Ramirez
- Multiprofessional Teaching Unit of Family and Community Care Jaén - South Jaén, Andalusian Public Health System, Jaén, Spain
| | | | - Antonina Rodríguez-Bayón
- Multiprofessional Teaching Unit of Family and Community Care North - Northeast Jaén, Andalusian Public Health System, Jaén, Spain
| | - Beatriz Ruiz-Díaz
- "El Valle" Primary Care Center, Andalusian Public Health System, 4 Human Rights Street, 23009, Jaén, Spain
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26
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Qian Y, Asad S, Park EM, Mills JA, Kent EE. Rural resilience during COVID-19: the lived experience of North Carolinian rural-dwelling cancer caregivers. Support Care Cancer 2023; 31:396. [PMID: 37318622 PMCID: PMC11071545 DOI: 10.1007/s00520-023-07840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To illuminate the lived experience of resilience in rural-dwelling North Carolinian cancer caregivers at the intersection of cancer and the COVID-19 pandemic. METHODS In spring, 2020, we recruited self-identified primary caregivers (CGs) for a relative/friend with cancer living in a rural area. We conducted cross-sectional semi-structured interviews and then thematically analyzed transcripts to identify and categorize instances of stressors and benefit-finding. RESULTS Of the 24 participants, 29% were < 50 years old, 42% identified as non-Hispanic Black, 75% were women, and 58% were spousal CGs. Most care recipients (CRs) had stage IV cancer (n = 20) and cancer types varied. Participants played a variety of roles in caregiving and experienced stressors related to caregiving demands (e.g., conflicts with other responsibilities), rurality (e.g., transportation), and the COVID-19 pandemic (e.g., new visitor policy at hospital). Despite stressful experiences, participants also identified many positive aspects of their caregiving. Five domains of benefit-finding were identified: appreciation (e.g., gratitude toward their ability to care for CRs), CG-CR dyad relationship dynamics (e.g., increased closeness), interpersonal relationship dynamics (e.g., perceived peer support), faith (e.g., ability to cope through praying), and personal growth (e.g., new skills learned from caregiving). CONCLUSION Rural-dwelling cancer caregivers from mixed sociodemographic backgrounds identified a diverse range of benefits from caregiving, despite experiencing multiple stressors, including emergent stressors from the COVID-19 pandemic. Healthcare delivery serving rural communities may consider expanding transportation assistance and boosting benefit-finding to ameliorate stress in cancer caregivers.
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Affiliation(s)
- Yiqing Qian
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Asad
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-B McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC, 27599-7411, USA
| | - Eliza M Park
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jiona A Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-B McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC, 27599-7411, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Wei D, Wang L, Xu Q, Wang J, Shi J, Ma C, Geng J, Zhao M, Liu X, Hou J, Huo W, Li L, Jing T, Wang C, Mao Z. Exposure to herbicides mixtures in relation to type 2 diabetes mellitus among Chinese rural population: Results from different statistical models. Ecotoxicol Environ Saf 2023; 261:115109. [PMID: 37300918 DOI: 10.1016/j.ecoenv.2023.115109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although it has been reported that herbicides exposure is related to adverse outcomes, available evidence on the associations of quantitatively measured herbicides with type 2 diabetes mellitus (T2DM) and prediabetes is still scant. Furthermore, the effects of herbicides mixtures on T2DM and prediabetes remain unclear among the Chinese rural population. AIMS To assess the associations of plasma herbicides with T2DM and prediabetes among the Chinese rural population. METHODS A total of 2626 participants were enrolled from the Henan Rural Cohort Study. Plasma herbicides were measured with gas chromatography coupled to triple quadrupole tandem mass spectrometry. Generalized linear regression analysis was employed to assess the associations of a single herbicide with T2DM, prediabetes, as well as indicators of glucose metabolism. In addition, the quantile g-computation and environmental risk score (ERS) structured by adaptive elastic net (AENET), and Bayesian kernel machine regression (BKMR) were used to estimate the effects of herbicides mixtures on T2DM and prediabetes. RESULTS After adjusting for covariates, positive associations of atrazine, ametryn, and oxadiazon with the increased odds of T2DM were obtained. As for prediabetes, each 1-fold increase in ln-transformed oxadiazon was related to 8.4% (95% confidence interval (CI): 1.033, 1.138) higher odds of prediabetes. In addition, several herbicides were significantly related to fasting plasma glucose, fasting insulin, and HOMA2-IR (false discovery rates adjusted P value < 0.05). Furthermore, the quantile g-computation analysis showed that one quartile increase in multiple herbicides was associated with T2DM (OR (odds ratio): 1.099, 95%CI: 1.043, 1.158), and oxadiazon was assigned the largest positive weight, followed by atrazine. In addition, the ERS calculated by the selected herbicides from AENET were found to be associated with T2DM and prediabetes, and the corresponding ORs and 95%CIs were 1.133 (1.108, 1.159) and 1.065 (1.016, 1.116), respectively. The BKMR analysis indicated a positive association between mixtures of herbicides exposure and the risk of T2DM. CONCLUSIONS Exposure to mixtures of herbicides was associated with an increased risk of T2DM among Chinese rural population, indicating that the impact of herbicides exposure on diabetes should be paid attention to and measures should be taken to avoid herbicides mixtures exposure.
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Affiliation(s)
- Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Lulu Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Qingqing Xu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Juan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jiayu Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Cuicui Ma
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jintian Geng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Mengzhen Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Tao Jing
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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Zheng Y, Liu X, He Y, Yuchi Y, Zhao H, Li L, Huo W, Mao Z, Hou J, Wang C. Prevalence and morphological subtype distributions of anaemia in a Chinese rural population: the Henan Rural Cohort study. Public Health Nutr 2023; 26:1254-1263. [PMID: 36788680 PMCID: PMC10346018 DOI: 10.1017/s1368980023000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study aimed to evaluate the recent prevalence and the distributions of morphological subtypes of anaemia in the rural population. DESIGN Anaemia was defined according to the WHO and the Chinese criteria, and the morphological subtypes of anaemia were classified based on the erythrocyte parameters. The age-standardised prevalence was calculated according to the data of the Population Census 2010 in China. SETTING A cross-sectional study in Henan Province. PARTICIPANTS 33 585 subjects aged 18-79 years old. RESULTS The standardised prevalence of anaemia across the WHO and the Chinese definitions was 13·63 % and 5·45 %, respectively. Regardless of which criteria was used, the standardised prevalence of anaemia was higher among women than among men and that increased with age in men, while markedly decreased after menopause in women. There were shifts in morphological patterns of anaemia using the WHO and the Chinese criteria that the standardised prevalence of microcytic anaemia was 3·74 % and 2·97 %, normocytic anaemia was 9·20 % and 2·34 %, and macrocytic anaemia was 0·75 % and 0·14 %, respectively. Besides, there were differences in the influencing factors of anaemia according to different criteria or gender. However, age, education level and renal damage were consistently significantly associated with anaemia in all participants. CONCLUSIONS Anaemia may still be a serious health problem in rural China. It is necessary to reformulate prevention and management strategies to reduce the disease burden of anaemia.
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Affiliation(s)
- Yiquan Zheng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Yaling He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Yinghao Yuchi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Hongfei Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
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Pickson RB, Boateng E, Gui P, Chen A. The impacts of climatic conditions on cereal production: implications for food security in Africa. Environ Dev Sustain 2023:1-28. [PMID: 37363033 PMCID: PMC10221758 DOI: 10.1007/s10668-023-03391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
Climate change is a confounding factor that affects food security in several ways. Although the analyses of earlier studies in this area were largely non-technical, new analytical techniques have been developed to comprehensively evaluate climate change patterns and their implications for food security. In this study, we use recent developments in panel econometrics, which consider cross-sectional dependence and parameter heterogeneity, to examine the effects of climatic conditions on cereal farming in Africa from 1970Q1 to 2017Q4. The results show that rainfall positively affects cereal crops, although average temperatures are typically unfavourable. In the country-specific scenarios, we observed significant variations in the influence of climatic conditions on cereal production. The causality test results show a two-way causal relationship between climatic conditions-rainfall and temperature-and cereal production. It is suggested that African governments and non-governmental organisations support farmers' adaptation to climate change by implementing policies that prioritise farmers' capacity building and ensure that extension service officers engage with farmers intensively.
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Affiliation(s)
| | - Elliot Boateng
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for African Research, Engagement and Partnerships (CARE-P), University of Newcastle, Newcastle, Australia
| | - Peng Gui
- Nanchang University, Nanchang, China
| | - Ai Chen
- Nanchang University, Nanchang, China
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Harris ML, Bennion E, Magnusson KR, Howard VJ, Wadley VG, McClure LA, Levine DA, Manly JJ, Avila JF, Glymour MM, Wisco JJ, Thacker EL. Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment. Neuroepidemiology 2023; 57:218-228. [PMID: 37231876 DOI: 10.1159/000530961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/02/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Rural versus urban living is a social determinant of cognitive health. We estimated the association of rural versus urban residence in the USA with incident cognitive impairment (ICI) and assessed effect heterogeneity by sociodemographic, behavioral, and clinical factors. METHODS The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) is a population-based prospective observational cohort of 30,239 adults, 57% female, 36% Black, aged 45+ years, sampled from 48 contiguous states in the USA in 2003-2007. We analyzed 20,878 participants who at baseline were cognitively intact with no history of stroke and had ICI assessed on average 9.4 years later. We classified participants' home addresses at baseline as urban (population ≥50,000), large rural (10,000-49,999), or small rural (≤9,999) by Rural-Urban Commuting Area codes. We defined ICI as ≥1.5 SD below the mean on at least 2 of the following tests: word list learning, word list delayed recall, and animal naming. RESULTS Participants' home addresses were 79.8% urban, 11.7% large rural, and 8.5% small rural. ICI occurred in 1,658 participants (7.9%). Small rural residents had higher odds of ICI than urban residents, adjusted for age, sex, race, region, and education (OR = 1.34 [95% CI: 1.10, 1.64]), and after further adjustment for income, health behaviors, and clinical characteristics (OR = 1.24 [95% CI: 1.02, 1.53]). Former smoking versus never, nondrinking versus light alcohol drinking, no exercise versus ≥4 times/week, CES-D depressive symptom score of 2 versus 0, and fair versus excellent self-rated health had stronger associations with ICI in small rural areas than in urban areas. For example, in urban areas, lack of exercise was not associated with ICI (OR = 0.90 [95% CI: 0.77, 1.06]); however, lack of exercise combined with small rural residence was associated with 1.45 times the odds of ICI compared with ≥4 bouts of exercise/week in urban areas (95% CI: 1.03, 2.03). Overall, large rural residence was not associated with ICI; however, black race, hypertension, and depressive symptoms had somewhat weaker associations with ICI, and heavy alcohol drinking a stronger association with ICI, in large rural areas than in urban areas. CONCLUSION Small rural residence was associated with ICI among USA adults. Further research to better understand why rural residents are at higher risk for developing ICI and mechanisms to ameliorate that risk will support efforts to advance rural public health.
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Affiliation(s)
- Matthew L Harris
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- University at Buffalo Jacobs School of Medicine, State University of New York, Buffalo, New York, USA
| | - Erica Bennion
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristine R Magnusson
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer J Manly
- Department of Neurology, Columbia University, New York, New York, USA
| | - Justina F Avila
- Department of Neurology, Columbia University, New York, New York, USA
| | - Maria M Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jonathan J Wisco
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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Zheng L, Yu Y, Tian X, He L, Shan X, Niu J, Yan J, Luo B. The association between multi-heavy metals exposure and lung function in a typical rural population of Northwest China. Environ Sci Pollut Res Int 2023; 30:65646-65658. [PMID: 37085680 DOI: 10.1007/s11356-023-26881-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Heavy metal exposure is acknowledged to be associated with decrease of lung function, but the relationship between metals co-exposure and lung function in rural areas of Northwest China remains unclear, particularly in an area famous for heavy metal pollution and solid fuel use. Therefore, the purpose of this study is to explore the effects of heavy metal exposure on lung function and the potential impacts of living habit in a rural cohort of Northwest China. METHODS The study area included five villages of two regions in Northwestern China-Gansu province. All participants were recruited from the Dongdagou-Xinglong (DDG-XL) rural cohort in the study area. Urine levels of 10 common and representative heavy metals were detected by ICP-MS, including Cobalt (Co), Nickel (Ni), Molybdenum (Mo), Cadmium (Cd), Stibium (Sb), Copper (Cu), Zinc (Zn), Mercury (Hg), Lead (Pb), and Manganese (Mn). The lung function was detected by measuring percentages of predicted forced vital capacity (FVC%) and predicted forced expiratory volume in one second (FEV1%) as well as the ratio of FEV1/FVC. We also analyzed the association between heavy metals and pulmonary ventilation dysfunction (PVD). Restricted cubic spline, logistic regression, linear regression, and bayesian kernel machine regression (BKMR) model were used to analyze the relationship between heavy metal exposure and lung function. RESULTS Finally, a total of 382 participants were included in this study with an average age of 56.69 ± 7.32 years, and 82.46% of them used solid fuels for heating and cooking. Single metal exposure analysis showed that the higher concentration of Hg, Mn, Sb, and lower Mo may be risk factors for PVD. We also found that FEV1% and FVC% were negatively correlated with Sb, Hg, and Mn, but positively correlated with Mo. The effect of mixed heavy metals exposure could be observed through BKMR model, through which we found the lung function decreased with the increase of heavy metal concentration. Furthermore, the males, BMI ≥ 24 kg/m2 and who used solid fuels showed a higher risk of PVD when exposed to Co, Zn, and Hg. CONCLUSIONS Our results suggested that heavy metal exposure was associated with decrease of lung function regardless of single exposure or mixed exposure, particularly for Sb, Hg, Mn and those who use solid fuels.
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Affiliation(s)
- Ling Zheng
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China
| | - Yunhui Yu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China
| | - Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China
| | - Xiaobing Shan
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China
| | - Jingping Niu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China
| | - Jun Yan
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Gansu, 730000, China.
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Lu C, Gordon AC, Murphy P, Sicely L, Aiono S. Use of radiological information system data in Clinical Portal database to screen for missed abdominal aortic aneurysms. Ann R Coll Surg Engl 2023; 105:422-427. [PMID: 36239932 PMCID: PMC10149271 DOI: 10.1308/rcsann.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION New Zealand lacks a formal abdominal aortic aneurysm screening programme and owing to its rural nature, many patients have limited access to vascular surgery. Patients with vascular emergencies often have limited treatment options locally, especially if they present perimortem. In our small hospital in Whanganui, with the nearest vascular centre more than 150km away, there are cases of aneurysms diagnosed incidentally on radiology reporting but lost to follow-up. METHODS Clinical Portal (CP) is a widely used patient-centred dashboard for viewing health information that is managed by Orion Health. A search strategy utilising the CP common database was devised that aimed to find aneurysms which were not followed up. This search was performed retrospectively for all imaging within a 5-month period. RESULTS Some 294 scans were flagged and 53 patients with aneurysms were found. Of these patients, 36 had follow-up by the ordering provider and 17 (32%) were found to have been lost to follow-up. CONCLUSIONS Our pilot study demonstrated high rates of loss to follow-up and a lack of communication of important health information across multiple health disciplines in the region, and represents a potential method for identifying 'lost' aneurysms. For patients in rural communities, this may be critical to preventing future complications from aneurysmal disease.
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Affiliation(s)
- C Lu
- Whanganui District Health Board, New Zealand
| | - AC Gordon
- Whanganui District Health Board, New Zealand
| | - P Murphy
- Whanganui District Health Board, New Zealand
| | - L Sicely
- Whanganui District Health Board, New Zealand
| | - S Aiono
- Whanganui District Health Board, New Zealand
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Dalve K, Ellyson AM, Gause EL, Lyons VH, Schleimer JP, Kuklinski MR, Oesterle S, Briney JS, Weybright EH, Rowhani-Rahbar A. School Handgun Carrying Among Youth Growing Up in Rural Communities. J Adolesc Health 2023; 72:636-639. [PMID: 36528518 DOI: 10.1016/j.jadohealth.2022.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To characterize school handgun carrying and violence risk factors among rural youth. METHODS Using a sample of rural youth (n = 1995), we quantified the proportion who carried a handgun to school, carried but not to school, and did not carry across grades 7-12 and endorsed risk factors for violence in individual, peer, school, and community domains. RESULTS Overall, 3% (95% confidence interval [CI]: 2%-4%) of youth ever carried to school; 15% (95% CI: 14%-16%) carried but not to school; and 82% (95% CI: 80%-84%) never carried. Violence risk factors (e.g., attacking someone) were more commonly endorsed by youth who carried to school (84%; 95% CI: 73%-95%) than those who carried but not to school (51%; 95% CI: 44%-58%) and did not carry (23%; 95% CI: 20%-26%). DISCUSSION Carrying a handgun to school in rural areas is not common; however, it is associated with risk factors for violence. Understanding violence risk factors among youth who carry handguns to school could inform violence prevention programs in rural areas.
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Affiliation(s)
- Kimberly Dalve
- Department of Epidemiology, University of Washington, Seattle, Washington; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
| | - Alice M Ellyson
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Emma L Gause
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Vivian H Lyons
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | - Julia P Schleimer
- Department of Epidemiology, University of Washington, Seattle, Washington; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, Arizona
| | - John S Briney
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | | | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
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Kimenai DM, Shah ASV. Change in cardiovascular health status: The impact of societal risk factors. Int J Cardiol 2023; 376:137-138. [PMID: 36754213 DOI: 10.1016/j.ijcard.2023.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Anoop S V Shah
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Quilliam C, Wong Shee A, Corboy D, Glenister K, King O, Mc Namara K, Alston L, Aras D, Beauchamp A, McKinstry C. Design and implementation characteristics of research training for rural health professionals: a qualitative descriptive study. BMC Med Educ 2023; 23:200. [PMID: 36997913 PMCID: PMC10064554 DOI: 10.1186/s12909-023-04169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Research capacity and capability of rural health professionals is essential to the delivery of evidence-based care and for informing strategies to address rural health inequities. Effective implementation of research education and training is fundamental to building rural health professional research capacity and capability. A lack of overarching guidance to inform the delivery of research education and training in rural health services can contribute to gaps in capacity-building approaches. The aim of this study was to identify characteristics of the design and implementation of current research training for rural health professionals in Victoria, Australia, to inform a future model for rural health professional research capacity and capability building. METHODS A qualitative descriptive study was undertaken. Key informants, with extensive knowledge of research education and training in rural health services in Victoria, were invited to participate in semi-structured telephone interviews via snowballing recruitment methods. Interview transcripts were analysed inductively, with themes and codes mapped to the domains of the Consolidated Framework for Implementation Research. RESULTS Of the 40 key informants approached, 20 agreed to participate including 11 regional health service managers, five rural health academics and four university managers. Participants suggested that research training varied in quality and relevance to rural health professionals. Training costs and lack of tailoring to the rural context were key barriers, whereas experiential learning and flexible modes of delivery enabled training uptake. Health service and government policies, structures, and processes both enabled or stifled implementation opportunities, with rural health professional networks from different regions offering capacity for research training development, and government departmental structures hampering training coordination. Tension between research activities and clinical practice, and health professional knowledge and beliefs, shaped the delivery of training programs. Strategically planned and evaluated research training programs and education via co-design with rural health professionals and use of research champions were strongly recommended by participants. CONCLUSIONS To optimise research training for rural health professionals and increase the quality and quantity of relevant rural health research, a systematically planned, implemented, and resourced region-wide research training model is required.
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Affiliation(s)
- Claire Quilliam
- Department of Rural Health, The University of Melbourne, 49 Graham Street, Shepparton, VIC, 3630, Australia.
| | - Anna Wong Shee
- Grampians Health, 102 Ascot St Sth, Ballarat, VIC, 3350, Australia
- Deakin Rural Health, Deakin University, Princes Hwy, Warrnambool, VIC, 3280, Australia
| | - Denise Corboy
- Blue Sky Mind Research Consultancy, Lake Wendouree, Victoria, 3350, Australia
| | - Kristen Glenister
- The University of Melbourne, Docker Street, Wangaratta, VIC, 3677, Australia
| | - Olivia King
- Western Alliance Academic Health Science Centre, 25 Ryot Street, Warrnambool, VIC, 3280, Australia
| | - Kevin Mc Namara
- Deakin Rural Health, Deakin University, Princes Hwy, Warrnambool, VIC, 3280, Australia
| | - Laura Alston
- Deakin Rural Health, Deakin University, Princes Hwy, Warrnambool, VIC, 3280, Australia
- The Global Obesity Centre, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
- Research Unit, Colac Area Health, 2-28 Connor St, Colac, VIC, 3250, Australia
| | - Drew Aras
- Western Alliance Academic Health Science Centre, 25 Ryot Street, Warrnambool, VIC, 3280, Australia
| | - Alison Beauchamp
- Monash Rural Health, Monash University, 15 Sargeant St, Warragul, VIC, 3820, Australia
| | - Carol McKinstry
- La Trobe University, Edwards Rd, Flora Hill, Victoria, 3552, Australia
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Kate MP, Samuel C, Singh S, Jain M, Kamra D, Singh GB, Sharma M, Pandian JD. Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial. J Stroke Cerebrovasc Dis 2023; 32:107107. [PMID: 37003249 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up. METHODS In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas. RESULTS A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001). CONCLUSION Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour. CLINICAL TRIAL REGISTRATION NUMBER ctri.nic.in, CTRI/2018/09/015709.
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Affiliation(s)
- Mahesh Pundlik Kate
- Associate Professor, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 7-132C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G2E3, Canada.
| | - Clarence Samuel
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Shavinder Singh
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Maneeta Jain
- Senior Consultant, Healthcare Financing, National Health Systems Resource Centre, India
| | - Deepshikha Kamra
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - G B Singh
- State Programme Officer, National Programme for Prevention of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Programme, Government of Punjab, Chandigarh, India
| | - Meenakshi Sharma
- Scientist-G, Program Officer: Cardiovascular Diseases and Neurology, Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Jeyaraj Durai Pandian
- Professor of Neurology and Principal, Christian Medical College, Ludhiana, India; School of Nursing, University of Central Lancashire, Preston, United Kingdom; NIHR Global Health Research Group on Improving stroke care in India, United Kingdom
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Gomes R, Nederveld A, Glasgow RE, Studts JL, Holtrop JS. Lung cancer screening in rural primary care practices in Colorado: time for a more team-based approach? BMC Prim Care 2023; 24:62. [PMID: 36869308 PMCID: PMC9982804 DOI: 10.1186/s12875-023-02003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Despite lung cancer being a leading cause of death in the United States and lung cancer screening (LCS) being a recommended service, many patients eligible for screening do not receive it. Research is needed to understand the challenges with implementing LCS in different settings. This study investigated multiple practice members and patient perspectives impacting rural primary care practices related to LCS uptake by eligible patients. METHODS This qualitative study involved primary care practice members in multiple roles (clinicians n = 9, clinical staff n = 12 and administrators n = 5) and their patients (n = 19) from 9 practices including federally qualified and rural health centers (n = 3), health system owned (n = 4) and private practices (n = 2). Interviews were conducted regarding the importance of and ability to complete the steps that may result in a patient receiving LCS. Data were analyzed using a thematic analysis with immersion crystallization then organized using the RE-AIM implementation science framework to illuminate and organize implementation issues. RESULTS Although all groups endorsed the importance of LCS, all also struggled with implementation challenges. Since assessing smoking history is part of the process to identify eligibility for LCS, we asked about these processes. We found that smoking assessment and assistance (including referral to services) were routine in the practices, but other steps in the LCS portion of determining eligibility and offering LCS were not. Lack of knowledge about screening and coverage, patient stigma, and resistance and practical considerations such as distance to LCS testing facilities complicated completion of LCS compared to screening for other types of cancer. CONCLUSIONS Limited uptake of LCS results from a range of multiple interacting factors that cumulatively affect consistency and quality of implementation at the practice level. Future research should consider team-based approaches to conduct of LCS eligibility and shared decision making.
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Affiliation(s)
- Rebekah Gomes
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Russell E Glasgow
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA.,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Jamie L Studts
- Department of Medicine, Division of Medical Oncology, and University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jodi Summers Holtrop
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
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Nilles JD, Lim D, Boyer MP, Wilson BD, Betar RA, Showalter HA, Liu D, Ananieva EA. The occurrence of bone and joint cancers and their association with rural living and radon exposure in Iowa. Environ Geochem Health 2023; 45:925-940. [PMID: 35381949 PMCID: PMC8983034 DOI: 10.1007/s10653-022-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Primary bone and joint cancers are rare and understudied, yet these neoplasms are difficult to treat and impact all age groups. To explore the long-term changes in the occurrence of bone and joint cancers, patients diagnosed with these neoplasms between 1975 and 2016 were identified in the Surveillance Epidemiology and End Results of the National Cancer Institute of the USA. The age-adjusted incidence (AAIR) and mortality (AAMR) rates were calculated for three decades and compared to AAIR and AAMR in years 1975-1984. By using the population-based cancer registries of the USA, Iowa was identified as a state with increased cases of bone and joint malignancies. The bone and joint cancer cases in Iowa were correlated with the percentage of rural population, the average farmland size, or the residential radon levels. Results demonstrated that the mean AAIR of bone and joint cancers for US female and male patients (< 50 years of age) increased from 0.57 (95% C.I. 0.55-0.63) and 0.76 (95% C.I. 0.69-0.82) for years 1975-1984 to 0.71 (95% C.I. 0.66-0.76) and 0.94 (95% C.I. 0.87-1.07) for years 2005-2014, respectively. The increase in bone and joint cancer cases in Iowa positively correlated with the percentage rural population (R = 0.222, P < 0.02), and the average farmland size (R = 0.236, P < 0.02) but not the radon levels (R = - 0.038, P < 0.7). The findings revealed that patients younger than 50 years of age and those who resided in rural areas and engaged in farming were more likely to be diagnosed with primary bone and joint cancers.
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Affiliation(s)
- Jonathan D Nilles
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Dooyoung Lim
- Department of Public Health, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Michael P Boyer
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Brittany D Wilson
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Rebekah A Betar
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Holly A Showalter
- Waukee Aspiring Professional Experience (APEX), 295 SE Ashworth Road, Waukee, IA, 50263, USA
| | - Darren Liu
- Department of Public Health, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Elitsa A Ananieva
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA.
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Zhang Y, Zhang Q, Li SZ, He MG, Wang NL. Anterior segment measurements and determinants of angle width with short, medium, and long axial lengths in a rural Chinese population. Heliyon 2023; 9:e14174. [PMID: 36923839 PMCID: PMC10009089 DOI: 10.1016/j.heliyon.2023.e14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
Purpose To report the anterior segment measurements and investigate the determinants of angle width with short, medium, and long axial length (AL) in a rural Chinese population. Design Observational, population-based, cross-sectional study. Methods Subjects aged ≥35 years who underwent complete ocular examinations during the follow-up of the Handan Eye Study were included. Ocular data of the right eye were analyzed. Anterior segment parameters were obtained and stratified by age and sex. AL was categorized into short (<22.0 mm), medium (22.0-23.5 mm), and long (>23.5 mm) subgroups. Linear regression analyses were performed to identify the parameters associated with angle width (angle opening distance at 500 μm from the scleral spur (SS) [AOD500]). Results The final analysis included 4435 subjects (58.0 [49.0, 64.0] years old, 44.1% males). Smaller AOD500 was significantly associated with female sex (P = 0.032), larger iris thickness at 750 μm from the SS (IT750) (P < 0.001), larger lens vault (LV) (P < 0.001), and smaller anterior chamber volume (ACV) (P < 0.001) in the short AL subgroup; larger sphere equivalent (SE), IT750, iris curvature (IC), and LV and smaller ACV (all P < 0.001) in the medium AL subgroup; and larger SE, IT750, IA, IC, and LV and smaller ACV (all P < 0.001) in the long AL subgroup. Conclusions Our study provides the anterior segment parameters of a large rural Chinese population. IT750, ACV, and LV were found to be the most important factors associated with angle width.
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Affiliation(s)
- Ye Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qing Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Si Zhen Li
- Nanjing Tongren Hospital, Jiangsu, China
| | - Ming Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Ning Li Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing, China
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Kang N, Wu R, Liao W, Zhang C, Liu X, Mao Z, Huo W, Hou J, Zhang K, Tian H, Lin H, Wang C. Association of long-term exposure to PM 2.5 constituents with glucose metabolism in Chinese rural population. Sci Total Environ 2023; 859:160364. [PMID: 36427733 DOI: 10.1016/j.scitotenv.2022.160364] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Evidence on the associations of fine particulate matter (PM2.5) constituents and glucose metabolism is limited in resource-limited areas. This study aimed to explore the associations of PM2.5 constituents with glucose metabolism in rural areas, and to further specify the most responsible constituent. METHODS A total of 38,442 adults were recruited from the Henan Rural Cohort Study during 2015-2017. Three-year averaged concentrations of PM2.5 mass and its constituents (black carbon (BC), ammonium (NH4+), nitrate (NO3-), organic matter (OM), inorganic sulfate (SO42-), soil particles (SOIL) and sea salt (SS)) were estimated by a hybrid satellite-based model. Generalized linear model was applied to explore the associations of PM2.5 mass and its constituents with type 2 diabetes mellitus (T2DM), fasting blood glucose (FBG), insulin, and HOMA-β. Proportion and residual analyses were employed to specify the most responsible constituent. RESULTS The adjusted odds ratio (OR) for T2DM associated with 1 μg/m3 increase was 1.02 for PM2.5 mass, 1.28 for BC, 1.15 for NH4+, 1.08 for NO3-, 1.10 for OM, 1.11 for SO42-, and 1.12 for SOIL. Significant associations of PM2.5 mass and its constituents with elevated FBG, decreased insulin and HOMA-β were also observed. Proportion and residual analyses indicated that BC was the most responsible constituent, in which 1 percentage increment in the proportion of BC in PM2.5 corresponded with 1.51-fold risk for T2DM, 0.17 mmol/L increase in FBG, 2.18 μU/mL decrease in insulin, and 38.26 % decrease in HOMA-β; and 1 μg/m3 increment in the PM2.5-adjusted BC corresponded with 1.59-fold risk for T2DM, 0.53 mmol/L increase in FBG, 4.79 μU/mL decrease in insulin, and 91.32 % decrease in HOMA-β. CONCLUSIONS PM2.5 mass and its constituents (BC, NH4+, NO3-, OM, SO42-, SOIL) were associated with T2DM, increased FBG, decreased insulin and HOMA-β, of which BC was most responsible for these associations. TRIAL 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.
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Affiliation(s)
- Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ruiyu Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Caiyun Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Hezhong Tian
- State Key Joint Laboratory of Environmental Simulation & Pollution Control, School of Environment, Beijing Normal University, Beijing, China
| | - Hualiang Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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Buligon MP, Marin JA, Wolle CFB, Liedke GS, Sfreddo CS, Bier CAS, Moreira CHC, Morgental RD. Apical periodontitis and associated factors in a rural population of southern Brazil: a multilevel analysis. Clin Oral Investig 2023. [PMID: 36746818 DOI: 10.1007/s00784-023-04886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aims to evaluate the association between apical periodontitis (AP) and sociodemographic/clinical factors in a probability sample of individuals living in a rural area of southern Brazilian. MATERIALS AND METHODS A cross-sectional study was conducted involving 584 non-edentulous adult individuals who had undergone a full-mouth radiographic survey. Periapical status was analysed using the periapical index (PAI). Endodontic status was evaluated considering the occurrence of voids in the filling material and the root filling length. Crown status was classified based on the presence of caries, restorations, and prosthetic crowns. Sociodemographic variables, frequency of dental care, and periodontal disease were also registered. The data were analysed using hierarchical multilevel Poisson regression analysis. The multilevel structure was composed of three models: sociodemographic variables, clinical variables, and clinical variables adjusted by sociodemographic variables (α = 5%). RESULTS The prevalence of AP in the sample was 60.45%. AP was significantly associated with age, skin colour, schooling, periodontal disease, and frequency of dental care (P < 0.005). Among the 10,396 teeth evaluated, 868 (8.35%) had AP, which was significantly associated with tooth group, dental arch, crown status, and endodontic treatment (P < 0.005). CONCLUSIONS The prevalence of AP was high in the population studied. An older age, black/brown skin colour, low level of schooling, infrequent dental care, severe periodontal disease, mandibular teeth, posterior teeth, inadequate crown status, and having undergone endodontic treatment were significantly associated with the outcome. Clinical relevance This study about a rural probability sample reinforces that AP is still a recurrent oral health problem.
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Chauhan S, Sekher TV. Early marriage and marital satisfaction among young married men in rural Uttar Pradesh, India. BMC Res Notes 2023; 16:6. [PMID: 36707850 PMCID: PMC9881292 DOI: 10.1186/s13104-023-06271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Lack of reliable and valid scales of Indian origin prompt researchers to borrow the marital satisfaction scale developed in different settings. The lack of a reliable scale to understand marital satisfaction in India prompted us to examine the marital satisfaction among young married men using ENRICH Marital Satisfaction (EMS) Scale developed in the Western context. Assessing the reliability of the EMS scale on the rural population of Lalitpur and Shrawasti, Uttar Pradesh, India; this study examines the determinants of marital satisfaction among young married men. RESULTS Cronbach's alpha coefficient of 0.936 confirms the high reliability of the EMS scale for the surveyed population in two districts of India. Men belonging to households with higher monthly income (OR- 3.33; 95% C.I. - 1.71-6.50) were more likely to be satisfied in their marriage than their counterparts. Similarly, fathers', mothers', and married men's educational status were other important determinants of marital satisfaction. The study emphasizes the importance of family education as a strong predictor of marital satisfaction, and therefore policymakers may look into this aspect.
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Affiliation(s)
- Shekhar Chauhan
- grid.419349.20000 0001 0613 2600Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - T. V. Sekher
- grid.419349.20000 0001 0613 2600Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
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Couto AN, Pohl HH, Bauer ME, Schwanke CHA. Accuracy of the triglyceride-glucose index as a surrogate marker for identifying metabolic syndrome in non-diabetic individuals. Nutrition 2023; 109:111978. [PMID: 36842288 DOI: 10.1016/j.nut.2023.111978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed to verify the performance of the triglyceride-glucose (TyG) index in predicting metabolic syndrome (MetS) using three different criteria in healthy individuals living in rural areas. In addition, it aimed to estimate the TyG index cutoff point in the prediction of MetS. METHODS The study was a cross-sectional study of healthy individuals (aged ≥18 y) living in rural areas of southern Brazil. Individuals with diabetes mellitus were excluded. The variables investigated were waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, fasting glucose, and TyG index. MetS was defined using three criteria: harmonized, International Diabetes Foundation, and National Cholesterol Education Program Adult Treatment Panel III. The Poisson regression model was used for the multivariate analysis. The performance of the TyG index in identifying MetS was determined by receiver operating characteristic curves. RESULTS A total of 133 individuals were included in this study, with a mean age of 49.0 ± 13.5 y; 54.1% were female. The TyG index performed better in predicting MetS through the harmonized criteria, with area under the curve (AUC) = 0.889 (95% confidence interval [CI], 0.829-0.949), followed by the International Diabetes Foundation criteria, with AUC = 0.877 (95% CI, 0.814-0.940), and the National Cholesterol Education Program criteria, with AUC = 0.867 (95% CI, 0.797-0.937). The TyG index cutoff points defined for the harmonized and International Diabetes Foundation criteria were ≥ 8.61, and ≥ 8.79 for the National Cholesterol Education Program Adult Treatment Panel III. CONCLUSIONS The TyG index proved to be valid for diagnosing MetS. The largest AUC of the TyG index was identified for the harmonized criteria. Thus, the TyG index can be used to diagnose MetS in individuals living in rural areas.
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Affiliation(s)
- Analie Nunes Couto
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
| | - Hildegard Hedwig Pohl
- Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Moisés Evandro Bauer
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratory of Immunobiology, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; National Institute of Science and Technology - Neuroimmunomodulation (INCT-NIM), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasília, Brazil
| | - Carla Helena Augustin Schwanke
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Woollett A, Duncan J, Voskoboynik M, Shackleton M, Dooley M, Blum R, McPhee N, Wright T, Wong ZW, Dixon J, Jane SM. A capability framework to inform the fundamental requirements for clinical trial unit development, growth and long term success in outer metropolitan and rural areas. Contemp Clin Trials Commun 2023; 32:101072. [PMID: 36712185 DOI: 10.1016/j.conctc.2023.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Background Participation in clinical trials is linked to improved patient outcomes. Despite this, most trial participants either reside in, or are treated in metropolitan areas. TrialHub developed hub-and-spoke models to support and grow clinical trial units in outer metropolitan and regional/rural centres in order to boost clinical trial engagement and reduce demands of trial participation on patients from outer metropolitan and regional/rural areas. The aim of this project was to establish a capability framework for clinical trial unit growth and development. Methods An integrative methods study design was used to inform the co-design and development of the capability framework based on data collected in Victoria during 2020-21. This included reviews of the literature and of existing local resources, infrastructure, and staffing; as well as education, mentoring and support, and a needs assessment through multidisciplinary working groups. Results We developed a capability framework based on the level of support required for outer metropolitan and regional/rural centres with diverse existing capabilities across Victoria. The framework applies a maturity model to assess resources, processes and practices which impact the capacity and capability of centres to conduct trials safely and sustainably. Each level of the model uses a consistent set of factors to describe the core elements required for safe clinical trial delivery. This benchmarking allows targeted investment to ensure safe and high-quality delivery of trials at newly establishing trial units. Conclusion The capability framework developed by TrialHub provides a basis for staged, planned and successful trial unit development and trial implementation. Further validation of the framework is required.
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Osegueda ER, Chi X, Hall JM, Vadaparampil ST, Christy SM, Staras SAS. County-Level Factors Associated With HPV Vaccine Coverage Among 11-Year-Olds to 12-Year-Olds Living in Florida in 2019. J Adolesc Health 2023; 72:130-137. [PMID: 36244897 DOI: 10.1016/j.jadohealth.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the United States, human papillomavirus (HPV) vaccine initiation and up-to-date (UTD) status are associated with multiple factors at the individual level such as racial/cultural (e.g., race, immigration status), socioeconomic status (e.g., living below poverty level, education), and healthcare access (e.g., insurance status/type). HPV vaccination rates differ dramatically by US geographic areas and within states. To tailor interventions to local areas, it is important to understand county-level characteristics associated with HPV vaccination rates. METHODS Using linear regression, we assessed the association between county-level HPV vaccination initiation and UTD rates for 11-year-olds to 12-year-olds in Florida (collected from the Florida SHOTS immunization registry) and county-level variables. Factors found significant in bivariate analysis and with a variance influence factors <4 were included in multivariable models. RESULTS In 2019, county-level HPV vaccine coverage among Florida 11-year-olds to 12-year-olds ranged from 31% to 92% initiation and 3%-36% UTD. Counties with the lowest HPV vaccine coverage were concentrated in Florida's North-Central and Panhandle regions. In multivariable models, counties with primarily rural populations had lower vaccination initiation and UTD coverage. Above and beyond the association with rurality, UTD coverage was associated with family physicians per 100,000 residents and uninsured or Medicaid-enrolled populations. DISCUSSION While Florida county-level HPV vaccine initiation rates among 11-year-olds to 12-year-olds varied by county in 2019, UTD rates remained universally low despite recommendations. Tailoring interventions toward healthcare access in rural communities may increase HPV vaccine coverage.
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Affiliation(s)
- Eduardo R Osegueda
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; Institute of Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida
| | | | | | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; Institute of Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida.
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Banerjee A, Paul B, Das R, Bandyopadhyay L, Bhattacharyya M. Utilisation of adolescent reproductive and sexual health services in a rural area of West Bengal: A mixed-method study. Malays Fam Physician 2023; 18:26. [PMID: 37205146 PMCID: PMC10187467 DOI: 10.51866/oa.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Introduction Despite policy actions and strategic efforts for improving the reproductive and sexual health of adolescents by promoting the uptake of adolescent reproductive and sexual health (ARSH) services, the utilisation rate remains significantly low, especially in rural areas of India. This study aimed to assess the utilisation of these services by adolescents in rural West Bengal and its associated determinants. Method This mixed-method study was conducted from May to September 2021 in the Gosaba rural block of South 24 Parganas, West Bengal. Quantitative data were collected from 326 adolescents using a pre-tested structured questionnaire. Qualitative data were collected via four focus group discussions among 30 adolescents and key-informant interviews among six healthcare workers. Quantitative data were analysed using SPSS, while qualitative data were analysed thematically. Results Ninety-six (29.4%) adolescents had utilised ARSH services at least once during adolescence. The factors associated with non-utilisation of ARSH services were younger age, female sex, increasing reproductive health stigma and decreasing parent-adolescent communication related to sexual health. Qualitative exploration revealed that unawareness regarding services, perceived lack of privacy and confidentiality at healthcare facilities and disruption of services post-emergence of the COVID-19 pandemic were some major barriers to ARSH service utilisation. Conclusion A multi-component strategy, including promotion of adolescent-friendly health clinics, community support interventions associated with motivation and counselling of parents regarding the importance of adolescent reproductive health, is needed to improve the utilisation of ARSH services. Necessary steps to correct the deficiencies at the facility level should also be prioritised.
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Affiliation(s)
- Ankush Banerjee
- MBBS, MD, Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India.
| | - Bobby Paul
- MBBS, DCH, MD (PSM), Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Ranjan Das
- MBBS, MD (PSM), Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Lina Bandyopadhyay
- MBBS, MD (PSM), Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Madhumita Bhattacharyya
- MBBS, MD (Pediatrics), Department of Maternal and Child Health, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
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Van Hove C, Haq A, Phillips A, Sidebottom A, Vacquier M, Benson G, Knickelbine T, Miedema MD. Estimated versus observed 10-year atherosclerotic cardiovascular event rates in a rural population-based health initiative: The Heart of New Ulm Project. Am J Prev Cardiol 2023; 13:100449. [PMID: 36636122 DOI: 10.1016/j.ajpc.2022.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Assess discrepancy between estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk and observed 10-year event rates in a rural population participating in cardiovascular health initiative. Methods The study included a rural sample of individuals participating in the Heart of New Ulm (HONU), a population-based health initiative aimed at reducing ASCVD risk in a rural community. HONU conducted over 100 baseline screening events with 5221 individuals participating in 2009. For this analysis, we included participants who were aged 40-79 years, free of ASCVD at baseline, and had adequate data to calculate 10-year ASCVD risk. Electronic health record data and state death records were used to determine rates of non-fatal myocardial infarction and stroke, and ASCVD death from 2010-2019. ASCVD event rates were compared to estimated 10-year risks calculated using the Pooled Cohort Equations, stratified by sex and clinically relevant risk categories. Results The sample (n = 2819, mean ± SD age 56.1 ± 9.9 years, 59.6% female) had a low prevalence of tobacco use (8.1% current smokers) and diabetes (6.5%) and a high prevalence of hypertension (44.4%) and hyperlipidemia (56.6%). The median estimated 10-year ASCVD risk for the entire sample was 5.7% (IQR 2.3-13.5%) with an observed 10-year ASCVD event rate of 3.4%. The largest gap between observed and estimated risk was in those at intermediate/high (≥7.5%) ASCVD risk (median 10-year risk 15.8% [IQR 10.4-29.0], observed ASCVD event rate 6.4%). Conclusio In a sample of rural participants exposed to a multifaceted ASCVD prevention initiative, observed rates of ASCVD were substantially lower compared to estimated ASCVD risk. The potential for significantly lower than predicted ASCVD event rates in certain populations should be included in the clinician-patient risk discussion.
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Kang N, Song X, Zhang C, Li R, Yuchi Y, Liao W, Hou X, Liu X, Mao Z, Huo W, Hou J, Wang C. Association of household air pollution with glucose homeostasis markers in Chinese rural women: Effect modification of socioeconomic status. Ecotoxicol Environ Saf 2022; 248:114283. [PMID: 36371884 DOI: 10.1016/j.ecoenv.2022.114283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Socioeconomic status (SES) was a crucial influencing factor of household air pollution (HAP). However, few studies have explored the potential effect modification of SES on the associations of HAP with type 2 diabetes mellitus (T2DM) and glucose homeostasis. METHODS A total of 20900 participants were obtained from the Henan Rural Cohort. HAP reflected by cooking fuel type and cooking duration was assessed via questionnaire. SES was evaluated by two dimensions: educational level and average monthly income. Associations of cooking fuel type, cooking duration with T2DM and glucose homeostasis indices (insulin, fasting plasma glucose (FPG), and HOMA-β) were assessed by the generalized linear model. Analyses were also conducted in different SES groups to explore the potential effect modification. RESULTS Significant negative association of cooking fuel type and cooking duration with T2DM, FPG, and HOMA-β was not observed. However, cooking with solid fuel and long-duration cooking were associated with decreased insulin level in women, and the adjusted coefficients were - 0.35 (95% confidence interval (95% CI): - 0.53, - 0.17) and - 0.36 (95% CI: -0.50, -0.21), respectively. Results from stratified analyses showed that these associations were more prominent in women with low average monthly income, with corresponding coefficient of - 0.57 (95% CI: -0.77, -0.37) for cooking with solid fuel and - 0.34 (95% CI: -0.52, -0.16) for long-duration cooking. Among women with low average monthly income, the largest decreased insulin level was observed in those who cooked with solid fuel, long-duration and poor kitchen ventilation, while the negative association of cooking fuel type and cooking duration with insulin level was slightly alleviated in the good kitchen ventilation group. CONCLUSIONS Low average monthly income aggravated the negative association of HAP and insulin level among rural women, while improving kitchen ventilation may be a practical intervention. 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.
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Affiliation(s)
- Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaoqin Song
- Physical Examination Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Caiyun Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yinghao Yuchi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaoyu Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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Masaba BB, Mmusi-Phetoe R, Rono B, Moraa D, Moturi JK, Kabo JW, Oyugi S, Taiswa J. The healthcare system and client failures contributing to maternal mortality in rural Kenya. BMC Pregnancy Childbirth 2022; 22:903. [PMID: 36471265 PMCID: PMC9721048 DOI: 10.1186/s12884-022-05259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government's provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. METHODS An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. RESULTS Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients' ANC non-adherence. CONCLUSION In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.
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Affiliation(s)
- Brian Barasa Masaba
- grid.412801.e0000 0004 0610 3238Department of Health Studies, College of Human Sciences, School of Social Sciences, University of South Africa (UNISA), P.O. Box 392, Pretoria, South Africa
| | - Rose Mmusi-Phetoe
- grid.412801.e0000 0004 0610 3238Department of Health Studies, College of Human Sciences, School of Social Sciences, University of South Africa (UNISA), P.O. Box 392, Pretoria, South Africa
| | - Bernard Rono
- grid.33058.3d0000 0001 0155 5938Centre of Microbiology Research, Kenya Medical Research Institute (KEMRI), P.O. Box 54840-00200, Nairobi, Kenya
| | - Damaris Moraa
- School of Nursing, Kaimosi Friends University, P.O. Box 385, Kaimosi, Kenya
| | - John K. Moturi
- grid.494616.80000 0004 4669 2655School of Nursing, Kibabii University, P.O. Box 1699, Bungoma, Kenya
| | - Jane W. Kabo
- grid.494616.80000 0004 4669 2655School of Nursing, Kibabii University, P.O. Box 1699, Bungoma, Kenya
| | - Samuel Oyugi
- grid.442475.40000 0000 9025 6237Department of Clinical Nursing and Health Informatics, Masinde Muliro University of Science and Technology, P.O. Box 190, Kakamega, Kenya
| | - Jonathan Taiswa
- grid.442475.40000 0000 9025 6237Department of Clinical Nursing and Health Informatics, Masinde Muliro University of Science and Technology, P.O. Box 190, Kakamega, Kenya
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Liu X, Dong X, Song X, Li R, He Y, Hou J, Mao Z, Huo W, Guo Y, Li S, Chen G, Wang C. Physical activity attenuated the association of ambient ozone with type 2 diabetes mellitus and fasting blood glucose among rural Chinese population. Environ Sci Pollut Res Int 2022; 29:90290-90300. [PMID: 35867296 DOI: 10.1007/s11356-022-22076-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoqin Song
- Physical Examination Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yaling He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuming Guo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gongbo Chen
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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