Large Rural Towns Research Articles

Incidence of occult appendiceal neoplasm in patients over 40 years with acute appendicitis: A single-institution review.

To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis. The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively. Retrospective cohort study. Modified Monash category 3 (large rural town). Patients aged 40 years and over undergoing appendicectomy for appendicitis. Incidence of appendiceal neoplasm within appendicectomy specimen. A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40-95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic-type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology. Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic.

Does Geography Play a Role in the Receipt of End-of-Life Care for Advanced Cancer Patients? Evidence from an Australian Local Health District Population-Based Study.

Objectives: To assess the influence of geographic remoteness on health care utilization at end of life (EOL) by people with advanced cancer in a geographically diverse Australian local health district, using two objective measures of rurality and travel-time estimations to health care facilities. Methods: This retrospective cohort study examined the association between rurality (using the Modified Monash Model) and travel-time estimation, and demographic and clinical factors, with the receipt of >1 inpatient and outpatient health service in the last year of life in multivariate models. The study cohort comprised of 3546 patients with cancer, aged ≥18 years, who died in a public hospital between 2015 and 2019. Results: Compared with decedents from metropolitan areas, decedents from some rural areas had higher rates of emergency department visits (small rural towns: aRR 1.29, 95% CI: 1.07-1.57) and ICU admissions (large rural towns: aRR 1.32, 95% CI: 1.03-1.69), but lower rates of acute hospital admissions (large rural towns: aRR 0.83, 95% CI: 0.76-0.90), inpatient palliative care (PC) (regional centers: aRR 0.85, 95% CI: 0.75-0.97), and inpatient radiotherapy (lowest in small rural towns: aRR 0.07, 95% CI: 0.03-0.18). Decedents from rural and regional centers had lower rates of outpatient chemotherapy and radiotherapy use, yet higher rates of outpatient cancer service utilization (p < 0.05). Shorter travel times (10-<30 minutes) were associated with higher rates of inpatient specialist PC (aRR 1.48, 95% CI: 1.09-1.98). Conclusions: Reporting on a series of inpatient and outpatient services used in the last year of life, measures of rurality and travel-time estimates can be useful tools to estimate geographic variation in EOL cancer care provision, with significant gaps uncovered in inpatient PC and outpatient service utilization in rural areas. Policies aimed at redistributing EOL resources in rural and regional communities to reduce travel times to health care facilities could help to reduce regional disparities and ensure equitable access to EOL care services.

Learning Management Based on Information and Communication Technology in Improving Student Learning Outcomes

Information and communication technology (ICT) is strongly tied to learning in the digital age, thus teachers and students must be able to use digital tools in all learning processes. It is evident that information technology significantly contributes to pupils' increased creativity in both large cities and rural towns. To fulfil all educational goals in general and school goals in particular, ICT application for increasing learning needs to be planned and evaluated according to the needs of students, teachers, and the school itself. According to the problem's issue, a literature review was used to collect data for this study. The study's findings indicate that planning is done to make the most of the ICT-based learning process. Planning starts by examining the requirements and circumstances of the school, including all of its strengths and weaknesses, and then evaluation is done to determine the ICT's dependability and strengths and weaknesses. For ICT to be used in the learning process, there must be a reliable internet connection. If there are issues with the learning process, the root reason may be quickly determined, and the primary solution is sought right away. According to the study's findings, ICT-based learning management can significantly enhance students' ability to learn to contemporary needs and the Merdeka curriculum.

Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study.

To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM). A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake. Twelve regional and rural Local Government Areas in North-East Victoria, Australia. Data were collected from 2456 grade 4 (approximately 9-10 years) and grade 6 (approximately 11-12 years) students. The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)). Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.

Long telephone consultations for GP appointments: evidence versus policy.

Long telephone consultations for GP appointments: evidence versus policy.

From the city to the countryside: indicators of artisanal glass production in the central Iberian Peninsula (8th-9th centuries)

The current work presents the production and distribution of glass in the Emiral period in Spain. The study of the rural areas of the central Iberian Peninsula allows to identify some forms of production in large rural towns. Through the systematic study of the Dehesa de Navalvillar, including some archaeometric analyses, we have been able to establish that in the early Emiral period glass was produced in metallurgical workshops that left traces of occasional glass manufacture, probably carried out by itinerant craftsmen. With this article, we would like to contribute to the debate on glass production by introducing a new, multidisciplinary study of the rural world and the transformations that took place in the 8th century with the arrival of the Arabs in the Iberian Peninsula. The findings indicate artisanal production, circulation, and recycling of materials during the Emiral Period, where for the first time we find regional production in rural centres in addition to production in urban centres.

Associations among maternal characteristics, labour interventions, delivery mode and maternal antenatal complications in a NSW large rural town, and comparison to NSW state data.

To determine associations between maternal characteristics, labour interventions, delivery mode and maternal antenatal complications in a NSW rural hospital, and compare these to state data. Data (maternal characteristics, labour type, delivery mode and maternal antenatal complications) pertaining to women who had delivered a singleton birth at Griffith Base hospital were analysed. Retrospective data analysis of Griffith Base Hospital 'eMaternity' database SETTING: Single large rural town in NSW. Women who delivered a singleton birth between July 2018 and June 2019 inclusive at Griffith Base Hospital. 1. Comparison of maternal characteristics of age, BMI, gravida, parity and gestation data between labour type (spontaneous, augmented, induced and planned caesarean section) and delivery modes (vaginal, instrumental vaginal and caesarean section). 2. Associations between labour type, augmentation or induction method, delivery mode and maternal antenatal complications. 3. Multiple regression analysis for influence of age, BMI, parity and labour type on emergency caesarean section outcome. 4. Comparison of maternal, labour and delivery data with NSW state data. Among 457 women, there were higher rates of obesity and spontaneous labour, lower rates of planned caesarean section and augmented labour, and similar rates of induction of labour and emergency caesarean section, compared with NSW. Emergency caesarean section was significantly associated with older age (β=0.163), and labour augmentation (β=0.114) and induction (β=0.169). Labour augmentation with synthetic oxytocin, and induction with balloon catheter, were associated with the highest rates of emergency caesarean section. This large rural town had fewer labour and delivery medical interventions compared with NSW overall. Augmentation and induction of labour contribute to increasing caesarean section rates: directly via associations with emergency caesarean section, and indirectly because previous caesarean section was the most common reason for elective caesarean section.

Rurality as a predictor of perinatal mental health and well-being in an Australian cohort.

Perinatal emotional well-being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well-being. This study compares perinatal well-being between women living in metropolitan and rural regions. Prospective, longitudinal cohort. Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2-MM3 and 43 in rural to remote MM4-MM7. The Structured Clinical Interview for DSM-IV (SCID-IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post-natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality.

The effect of location on physical activity: Implications for active travel

Using an online stated preference survey and secondary data across four different geographic settings in the contiguous United States (U.S.), this paper elucidates the relationships between physical activity levels, built environment, and access to infrastructure (connectivity). Secondary data were collected to characterize the area surrounding respondents' reported residences. We estimated two multi-group structural equation models to measure how statistical constructs vary across settings. The models' results suggest that the built environment has a lower effect on respondents' physical activity in isolated rural and suburban areas than in urban areas and large rural towns, which are denser and promote higher physical activity levels. We conclude that the built environment and access to infrastructure have a non-monotonic relationship with physical activity when considering the levels of rurality.

Mandatory bulk billing policies may have differential rural effects: an exploration of Australian data.

Over the course of the COVID-19 pandemic, Australian general practices have rapidly pivoted to telephone and video call consultations for infection control and prevention. Initially these telehealth consultations were required to be bulk billed (doctors could only charge fees equivalent to the national Medicare Benefits Schedule (MBS)). The potential impact of this policy on general practices &minus; and particularly rural general practices - has been difficult to assess because there is limited published data about which practices are less likely to bulk bill and therefore more impacted by mandatory bulk billing policies. There was concern that bulk billing only policies could have a broader impact on rural practices, which may rely on mixed or private billing for viability in small communities where complex care is often needed. This study aimed to understand the patterns of bulk billing nationally and explore the characteristics of practices more or less likely to bulk bill patients, to identify the potential impact of a rapid shift to bulk billing only policies. General practice bulk billing patterns were described using aggregate statistics from Australian Department of Health public MBS datasets. Bulk billing rates were explored over time by rurality, and state or territory. Next, questions about bulk billing were included in a cross-sectional survey of practices conducted in 2019 by General Practice Supervisors Australia (GPSA). Practice bulk billing patterns were explored by rurality, state or territory and practice size at univariate level before a multivariate logistic regression model was done, including the statistically significant variables. Nationally, bulk billing rates for general practice non-referred attendances increased over 2012-2019 from 82% to 86% but declined slightly in Modified Monash Model (MMM)2&minus;7 (rural areas) at the end of this period. Further, bulk billing rates varied by rurality, and were highest in very remote (MMM7) (89-91%) and metropolitan areas (MMM1) (83-87%) and lowest in regional centres (MMM2) (76-82%) over this period. The results from the GPSA survey concurred with national data, showing that the proportion of practices bulk billing all patients was highest in metropolitan locations (28%) and lowest in regional centres and large rural towns (MMM2&minus;3) (16%). Smaller practices (five or fewer general practitioners) were more likely to bulk bill all patients than were larger ones (six or more general practitioners). Multivariate modelling showed that bulk billing all patients was statistically significantly (p<0.05) less likely for larger practices compared with smaller ones, and for rural practices (MMM2&minus;7) compared with those in metropolitan areas. Mandatory bulk billing policies should accommodate the fact that bulk billing varies by context, including rurality and the size of a practice, and has been decreasing in rural areas over recent years. Rapidly pivoting to bulk billing only service models may put pressure on rural and large practices unless they have time to adjust their business models and have ways to offset the loss of billings. Policies that allow for a range of billing arrangements may be important for practices to fit billings to their local context of care, including in rural settings, thereby supporting business viability and the availability of sustainable primary care services.

Characterizing the Health of Older Rural Australians Attending Rural Events: Implications for Future Health Promotion Opportunities.

This paper describes the health of older Australians (>65 years) attending rural events to inform health promotion interventions for rural populations. This cross-sectional study collected survey data and objective health measures between 2017 and 2020 at two events held in rural New South Wales, Australia. Participants included in the analysis were adults > 65 years of age. Data included demographic and health information, anthropometric measures (height, weight, waist circumference), and dietary and physical activity data. A total of 256 people > 65 years participated. Our sample, which was mostly male (59.0%), contained people aged between 66 and 75 years (72.3%). Participants lived in either a large rural (34.0%) or small rural town (22.3%), with low levels of education (60.9% did not complete high school). Dietary quality was rated as below average. All but 17.2% of the participants reported having a health condition. The risk of a health condition was associated with increasing age, lower education, and higher waist circumference, but not remoteness. Rural events may provide an opportunity to access, engage with, and understand the health of older rural Australians, especially males. They may offer ideal contexts for health and nutrition promotion opportunities in rural areas where access to health professionals is limited.

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine.

Anxiety and depression are the most common mental health disorders experienced by Australians. These disorders are commonly found in people who use methamphetamine; however, much of this research has involved participants recruited from treatment settings who inject methamphetamine. We therefore explored (1) the prevalence of moderate to severe anxiety and depression in a community-recruited cohort who smoked methamphetamine and (2) examined potential factors associated with moderate to severe anxiety or depression in this cohort. Data were derived from baseline surveys of 725 participants of the prospective 'VMAX' study, recruited from metropolitan and non-metropolitan areas of Victoria, Australia, via snowball and respondent-driven sampling. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 instruments. Independent associations between moderate to severe scores on these measures and demographic, socio-economic, substance use and other health and social characteristics were examined using multivariable logistic regression. More than half (60%) of the participants were classified as experiencing moderate to severe anxiety and/or depression. In the multivariable models, having poor/very poor self-rated health, methamphetamine dependence and being unemployed were associated with higher odds of experiencing both moderate to severe depression and moderate to severe anxiety. Living in a large rural town, identifying as Aboriginal and Torres Strait Islander and smoking methamphetamine were associated with lower odds of experiencing moderate to severe depression. Being female was associated with higher odds of experiencing moderate to severe anxiety. The high rates of anxiety and/or depression found in the VMAX cohort were associated with demographic, socio-economic, substance use and other health and social factors. The prevalence of moderate to severe anxiety is a novel finding that warrants further study. Further work is needed to determine how anxiety and depression change over time among people who smoke methamphetamine, to help identify key intervention points.

Psychological distress in young Australian women by area of residence: findings from the Australian Longitudinal Study on Women's Health

Background: The association between psychological distress and area of residence has been extensively discussed and debated. However, the focus has been largely on men and area of residence is often dichotomised to urban and rural. The aim of this study is to examine the association between psychological distress and area of residence in young Australian women using a broader geographical measure.Methods: Data were from 8961 women aged 19–26 in the 1989–95 cohort of the Australian Longitudinal Study on Women's Health in 2015. The association between area of residence (measured by the Modified Monash Model) and psychological distress (measured by the K10), adjusted for demographic factors, indicators of socioeconomic position and health behaviour characteristics, was analysed using logistic regression.Results: Women in regional centres had lower odds of high to very high psychological distress compared with women in metropolitan areas (adjusted odds ratio 0.73 (95% confidence interval 0.60–0.89)). Women living in large rural towns, medium rural towns and small rural towns/remote/very remote communities had similar levels of psychological distress as women living in metropolitan areas.Limitations: ALSWH uses self-report questionnaires which may introduce potential self-report bias. The small sample size in areas outside of metropolitan areas resulted in the need to collapse small rural towns, remote communities and very remote communities into one category.Conclusions: The subtle regional differences in levels of psychological distress in young women in Australia highlights the importance of the link between health and where people live and suggests further work is required to understand the regional differences and encourage location specific mental health services.

Effect of rurality and socioeconomic deprivation on presentation stage and long-term outcomes in patients undergoing surgery for colorectal cancer.

Geographical remoteness and socioeconomic status (SES) are important factors affecting presentation stage and survival for colorectal cancer. A series of patients from a single institution in northern New South Wales was studied to determine if rural isolation or SES affected presentation and survival in patients undergoing resection. Consecutive colorectal cancer resections performed at Lismore Base Hospital from 2011 to 2019 were identified. Patient residential addresses were categorized by the Modified Monash Model (MMM), an Australian Government definition of rural isolation, and Socioeconomic Index for Areas (SEIFA) quintiles, an Australian Bureau of Statistics index of socioeconomic deprivation. Univariate and Cox regression survival analysis was performed on data from histopathology and clinical notes matched with survival data. A total of 405 patients were included in MMM categories 3 (n=207, 51.1%), 4 (n=69, 17%) and 5 (n=129, 31.9) corresponding to large, medium and small rural towns. MMM 3 was associated with emergency cases (25.6% versus 18.7%, P < 0.001), nodal disease (44.4% versus 38.4%, P=0.018) and T3/4 tumours (82.1% versus 73.7%, P < 0.001) compared with isolated patients without difference in 5-year survival (P=0.370). Disadvantaged SEIFA quintiles 1/2 demonstrated increased poor differentiation (23.0% versus 15.4%, P < 0.001) and vascular invasion (15.8% versus 9.1%, P < 0.001) with reduced 5-year survival (57.0% versus 70.4%, P=0.039). Independent predictors of survival included age, emergency cases, group stage, lymphatic invasion and low lymph node yield. A 'rural reversal' may be present for patients in northern New South Wales; however, SES and established clinicopathological factors are the strongest predictors of survival in our population.

Lower average daily step count is associated with poorer executive function and rurality in a veteran cohort

AbstractBackgroundAn active lifestyle is associated with better cognitive health in older individuals. This relationship is understudied in U.S. Veterans, a population at risk of cognitive impairment due to the high prevalence of associated risk factors and comorbidities. Passive monitoring of daily activities provides objective measures of activity that may serve as a sensitive index of day‐to‐day function and dementia risk.MethodParticipants (age &gt; 57) were enrolled as part of Collaborative Aging Research using Technology (CART), a multi‐site study examining the feasibility of unobtrusive remote sensing and monitoring of physical, cognitive, and health‐related activities. The Veteran cohort consists of volunteers living in largely rural communities in the Pacific Northwest, self‐identified as being a Veteran, and included their cohabitant, if applicable. Daily step counts were acquired using a wrist‐worn device. Baseline one‐month averages were compared with rurality and cognitive function.Result114 nondemented participants residing in 67 homes underwent neuropsychological assessment and passive monitoring of daily activities (55% male, age 70.7, MOCA 23.4). 70% resided in a rural area (rural‐urban commuting area (RUCA) score &gt; 4 ) and 29% had &gt; three vascular risk factors. Participants with 14+ days of gait activity measured within a one‐month period near baseline cognitive assessments not using a walker in the home were included (n = 107). Average daily step count obtained over an average of 27.7 days was 3,065 (median 2,515) and was greater in large rural towns compared with small‐isolated rural (p = 0.07) or urban (p = 0.04) towns. After adjusting for potential confounders, lower average daily steps were associated with worse performance in executive function, a relationship observed in Veterans in large rural, but not urban or small rural towns.ConclusionIn a cohort comprised primarily of rural Veteran’s and their spouses, lower average number of steps per day is associated with poorer executive function and this relationship varied by rurality. Real‐world monitoring of daily activities may identify those at greatest risk of cognitive decline for interventional studies aimed at dementia prevention in older individuals, and is of particular relevance in rural settings, where access to specialty care is limited.

Contribution of Social Determinant of Health Factors to Rural-Urban Preventive Care Differences Among Medicaid Enrollees.

1) Assess whether rural-urban disparities are present in pediatric preventive health care utilization; and 2) use regression decomposition to measure the contribution of social determinants of health (SDH) to those disparities. With an Ohio Medicaid population served by a pediatric Accountable Care Organization, Partners For Kids, between 2017 and 2019, we used regression decomposition (a nonlinear multivariate regression decomposition model) to analyze the contribution of patient, provider, and SDH factors to the rural-urban well-child visit gap among children in Ohio. Among the 453,519 eligible Medicaid enrollees, 61.2% of urban children received a well-child visit. Well-child visit receipt among children from large rural cities/towns and small/isolated towns was 58.2% and 55.5%, respectively. Comparing large rural towns to urban centers, 55.8% of the 3.0 percentage-point difference was explained by patient, provider, and community-level SDH factors. In comparing small/isolated town to urban centers, 89.8% of the 5.7 percentage-point difference was explained by these characteristics. Of provider characteristics, pediatrician providers were associated with increased well visit receipt. Of the SDH factors, unemployment and education contributed the most to the explained difference in large rural towns while unemployment, education, and food deserts contributed significantly to the small/isolated town difference. The receipt of pediatric preventive care is slightly lower in rural communities. While modest, the largest part of the rural-urban preventive care gap can be explained by differences in provider type, poverty, unemployment, and education levels. More could be done to improve pediatric preventive care in all communities.

Contextualizing place and health in rural America: Cancer information seeking across four categories of an urban/rural continuum.

e18124 Background: Cancer is the second leading cause of death in the United States. Despite decreases in cancer mortality overall, rural populations continue to have higher prevalence and slower reduction of cancer death rates. As a preventive approach to combat cancer, the National Cancer Institute continues to prioritize providing the public with health information. Yet, little is known about cancer information-seeking across rural America. Methods: Using Rural-Urban Commuting Area Codes (RUCAs), from the 2018 Health Information National Trends Survey (HINTS-5) database we analyze the odds of looking for information about cancer across four geo-political contexts (n = 2,625): urban, large-rural, small-rural, and isolated-rural areas, thus giving us a potentially more detailed understanding of place and health across the urban-rural continuum. Using an established social determinants framework, a series of logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (CIs). Results: Across all models, those living in large rural towns had about 1.5 times the odds of looking for cancer information compared to urban-dwellers (p &lt; 0.05) while those living in remote rural areas had about 0.5 times the odds (p &lt; 0.05). There was no difference for those living in small rural towns. Additionally, gender, race/ethnicity, marital status, education, housing status, and internet availability were independently associated with information-seeking (p &lt; 0.05). Conclusions: In this study, compared to urban-dwellers, those living in large rural towns appeared to have increased odds of looking for cancer information while those living in isolated rural areas had decreased odds. Understanding this relationship between place and health has implication for the allocation of resources and the design of interventions aimed at increasing information about cancer.

390. Sociodemographic Factors Associated With Patients Hospitalized for Coccidioidomycosis in California and Arizona, State Inpatient Database 2005–2011

BackgroundCoccidioidomycosis is endemic in the Southwestern United States. Disseminated infection can be life-threatening and is responsible for hospitalization and healthcare resource utilization. There are limited data evaluating factors associated with coccidioidomycosis hospitalization.MethodsWe conducted a cross-sectional study to assess sociodemographic and comorbidity factors associated with hospitalization due to coccidioidomycosis in California and Arizona compared with hospitalization for other causes. We analyzed hospital discharge data obtained from the State Inpatient Dataset (SID) for both California and Arizona for years 2005–2011. Multivariable logistic regression modeling was used to analyze factors associated with coccidioidomycosis.ResultsA total of 23,758 hospitalizations due to coccidioidomycosis occurred during the study period in the two states. Arizona had an over six-fold higher coccidioidomycosis hospitalization incidence rate compared with California, 198.9 vs. 29.6/100,000 person-years. In the multivariable model patients aged (40–49) years had a higher odds of hospitalization due to coccidioidomycosis vs. young adults (18–29) years (aOR = 1.50 [95% CI 1.43–1.59]). African Americans had higher odds of hospitalization due to coccidioidomycosis vs. Caucasians (aOR = 1.98 [95% CI 1.89–2.06]). Residing in a large rural town had a higher odds of hospitalization due to coccidioidomycosis vs. residing in an urban area (aOR = 2.28; 95% [CI 2.19–2.39]). Higher comorbidities were associated with an increased odds for hospitalization due to coccidioidomycosis (aOR = 1.02 [95% CI 1.02–1.03]) for each point in the Elixhauser score). Uncomplicated diabetes and chronic pulmonary disease was also associated with hospitalization due to coccidioidomycosis (aOR = 1.47 [95% CI 1.41–1.52] and (aOR = 1.59 [95% CI 1.54–1.65]), respectively.ConclusionWe found sociodemographic factors and comorbidities associated with hospitalizations due to coccidioidomycosis compared with hospitalization due to other causes. Identifying persons at highest risk for hospitalization with coccidioidomycosis may be helpful for future prevention efforts.Disclosures All authors: No reported disclosures.

2422 - "Rur-Ban" Rail-Trail Business Impact: Case Study of the Mon River Trails System in West Virginia, USA

Background The Mon River Trails System (MRTS) is a network of 48 miles of trails in north central West Virginia that has been in operation in-whole or in-part since 1998. It runs through the rural core city of Morgantown - a densely populated town with a large university and strong economy that is surrounded by an historically rural landscape and culture (a rur-ban area). Rail-trails have a multitude of potential community benefits, including economic - expanded tourism, redevelopment of blighted industrial areas, and the creation of a sense of place. As rural trails such as the MRTS mature, localities are working creatively to spur investment along and near these trails. Much can be learned for future long-distance trail projects from mature trails such as the MRTS that traverse isolated rural to large rural core town areas. Thus, the purpose of this project was to conduct a case study assessment of the business impact of the MRTS and identify the lessons learned that may be applicable in other rural core settings. Methods Our study was guided by six research questions which will be described during the presentation. We collected the following data: Surveys (n=61) from businesses within four blocks of the trail; Interviews of 17 business owners that opened since trail construction; Interviews of 2 business owners that located their business on the trail after it was built but did not stay; Assessed values of properties within one block of the trail, dating back to pre-construction (1994–2016); Focus group with local government, trail advocacy, and visitors’ bureau representatives; and Focus group with directors & county officials in charge of three local Tax Increment Financing (TIF) districts. Results In combination, the multiple sources of data highlight three key points: Unlike many other trails studied to date, the MRTS is a local transportation and recreation hub, not a tourism-driven trail; The trail has a multitude of secondary community benefits, including social space, an event location for non-profits, resident and workforce recruitment and retention; and Median property values (including land and building) along the trail have increased 172.6% since 2004; relative to a 68.3% in countywide median home values. Conclusions Practice Implications: Proper trail development requires collaborative public-private planning, creative funding, and incentives for economic development from the outset. More details about the benefits of the MRTS and implications, including policy and economic development suggestions, will be presented.

Duration and setting of rural immersion during the medical degree relates to rural work outcomes.

Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (<50 000 population) (relative risk ratios [RRR] 2.97; 95% CI, 1.82-4.83). These findings inform medical schools about effective rural immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors.