Local County Research Articles

"We're Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can": Barriers and Recommendations for Use of Local Funds.

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future.

Increasing Access to Care: Impact of a Student-Led Fee Assistance Application Clinic.

Patients seen at student-run free clinics are often limited in the extent of services they can receive through these outpatient clinics. We initiated a student-led program assisting patients to apply for the local county hospital's fee assistance program, facilitating access to a wider range of healthcare services for a reduced cost.

Infectious Disease Education in a Carceral Setting: Insights from a Jail-Based Medical Student-Led Health Literacy Initiative.

Incarceration is associated with adverse health outcomes, including higher rates of infectious diseases. Poor health literacy in this population is a likely contributing factor, making health education a potential tool to help address these health disparities. This article aims to describe the implementation of a novel medical student-led educational initiative in the jail setting as a tool to promote health literacy and decrease the infectious disease burden in the correctional setting. A four-part infectious disease health education curriculum was developed and tailored to a carceral context. The course was offered on a voluntary basis to members of a reentry program at a local county jail. Pre- and postcourse surveys were used to evaluate the course effectiveness. The results demonstrated a statistically significant increase in the participants' reported confidence for recognizing the symptoms of and seeking appropriate treatment for common infections, including sexually transmitted, respiratory, and blood-borne infections. To the authors' knowledge, this is one of the first medical student-led programs of its kind to be described in existing literature. This program hopes to continue refining its curricular offerings and serve as a model for medical schools across the country to increase trainee engagement.

Leveraging Multi-Sectoral Partnership for Colorectal Cancer Education and Screening in the African American Community: A Protocol and Preliminary Results.

Colorectal cancer (CRC) awareness and screening rates are still low in African Americans (AAs), especially for those who do not have regular access to health care. We established a multi-sector community partnership between academia, health system, cancer advocacy, and local county treasurer's office (CTO), to test a pilot CRC screening intervention using a tailored educational brochure and fecal immunochemical test (FIT). Participants were recruited at a local CTO in an urban midwestern region. Once eligible, participants were assigned to 2-by-2 intervention arms by educational strategy (brochure vs. no brochure) and FIT provision strategy (direct provision by onsite staff vs. indirect provision via phone/online request). We compared the effect of different strategies on FIT return rates. Of 1500 individuals approached, 212 were eligible for the study. The final sample consisted of 209 participants who were predominantly men (57%) and AAs (85%). No differences were found in the return rates by educational brochure (24% [brochure] vs. 23% [no brochure]; p = 0.82). In regard to FIT provision strategy, direct FIT provision yielded higher return rates than indirect provision (31% vs. 15%; p = 0.01). When the four groups were compared, direct provision with education brochure yielded the highest return rates (33.9%), followed by direct provision only (27.5%), indirect provision only (18%), and indirect provision with a brochure (12.2%). For community-based CRC screening intervention using stool-based test, the direct provision of FIT kits with educational brochure outperforms the other three strategies.

The Spatiotemporal Characteristics and Mechanism of Rural Spatial Shrinkage in Local County, Southeast China

The rapid urbanization process has brought about the shrinkage of rural space as a typical issue. Nevertheless, due to the dearth of effective assessment approaches, the patterns of rural spatial shrinkage remain poorly grasped. This study intends to establish a quantitative assessment model to scientifically disclose the spatiotemporal characteristics and mechanisms of rural spatial shrinkage. The “Population-Industry-Function-Land” (PIFL) assessment model has been rigorously constructed, encompassing eight assessment indices, such as the ratio of permanent residents, rural population density, and the rate of abandoned cultivated land. The model was adopted to conduct an analysis of the spatial shrinkage scenarios of the 18 administrative villages in Panxi Town spanning from 2011 to 2021. The results indicate that the temporal dimension of rural spatial shrinkage exhibits an accelerating trend, with discernible declines or increases in the ratio of permanent residents, rate of the elderly labor force, and housing vacancy rate. The shrinkage of rural spaces displays spatial heterogeneity, with more pronounced shrinkage characteristics observed in villages located further from the central town. According to the comprehensive shrinkage index, the villages are categorized into four types: relative shrinkage (0.2447 ≤ Z ≤ 0.2462), mild shrinkage (0.2463 ≤ Z ≤ 0.4423), moderate shrinkage (0.4424 ≤ Z ≤ 0.6125), and severe shrinkage (0.6126 ≤ Z ≤ 0.7988). The research findings possess significant reference value for the governance of rural spatial shrinkage.

The Status Quo and Problems of Red Cultural Sites in the New Era and Their Exploration Paths: Taking the Luxi Region as an Example

Red cultural site is the carrier of red culture, containing profound revolutionary history and value of the times, we should deeply excavate the intrinsic potential of red cultural sites, pay attention to the ontological protection of red cultural sites, develop and improve the red cultural innovation projects, and strengthen the red culture itself and supporting the construction. This paper takes the old revolutionary area of Luxi as an example, conducts field investigation and visits based on the local county records and party history materials, and investigates a total of five red cultural sites and memorial halls in Luxi, focusing on the actual achievements and problems exposed in the protection and development of the current red cultural sites, to provide references and thinking for the protection, development, and innovative utilization of red cultural sites in the new era of our country.

Decentralized trial recruitment methods to facilitate broad coverage across urban and rural counties for a blood-based test in early colorectal cancer detection.

1607 Background: Based on the 2022 census, 20% of the U.S. population lives in rural areas. Recent literature suggests that individuals in these areas may encounter health disparities, potentially leading to higher mortality from colorectal cancer (CRC) when compared to their urban counterparts. The PREEMPT CRC is a prospective, multicenter clinical study designed to validate an investigational blood test (MyTectCRC) intended to provide a convenient and accessible option for CRC screening. PREEMPT CRC included a decentralized clinical trial (DCT) site to broaden enrollment from a wider range of geographical areas, including traditionally underrepresented rural regions. This analysis evaluates demographic characteristics of participants from rural and urban areas enrolled in two distinct strategies within the DCT sites. Methods: Eligibility criteria for PREEMPT CRC have been previously described (NCT04369053). All DCT activities occurred under one clinical study ‘Metasite’, enabled by a multichannel recruitment strategy that included 1) Direct-to-Participant (DTP) via digital enrollment and 2) Site-Based (SB) partners who supported the principal investigator by identifying participants scheduled to receive a screening colonoscopy. Participant zip codes were mapped to local counties and aligned with either 1) Metropolitan (Urban) or 2) non-Metropolitan (Rural) counties. Enrolled participants were analyzed for demographics and lifestyle behaviors such as tobacco, alcohol, and drug use. Results: The DCT site enrolled 12,137 participants, where 7,634 used DTP and 4,503 used SB. Of all DCT participants, 24.4% resided in rural areas. DTP's rural population recruitment (27.8%) was double that of the SB (13.5%). The female and male distribution was similar across the groups. A larger percentage of participants from underrepresented races overall were enrolled from urban areas; however, there were some noticeable trends in the rural population. For participants who resided in rural areas and reported their race, 12.5% of DTP participants were Black and 1.2% were Asian, compared to 9.6% and 1.2%, respectively, in SB. For participants in rural areas who reported ethnicity, within DTP, 5.1% identified as Hispanic/Latinx, compared to 14.3% Hispanic/Latinx in SB. Lifestyle behavior factors were similar between DTP and SB participants who resided in rural and urban areas. Conclusions: Through the use of a DCT, the PREEMPT CRC study reached rural areas especially through DTP methodology. Furthermore, the use of SB versus DTP showed certain shifts in demographics, these differences highlight the effectiveness of targeted outreach strategies and reflect the importance for integration of multiple methods and tools to enhance essential population characteristics across geographical locations. Clinical trial information: NCT04369053 .

An empirical study on the impact of green transition of farmland use on agricultural economic growth: A case of Hubei Province of China

Farmland use challenges reflect the current complexities facing China's agricultural economic development. This study focuses on 70 counties in Hubei Province of China, with the objective of exploring the spatial relationship between green transition of farmland use and agricultural economic growth. Furthermore, it seeks to quantify their effects and assess regional heterogeneity. Here are the findings: (1) There is a notable positive spatial correlation observed between agricultural economic growth and the various subsystems as well as factor layers of the green transition of farmland use. (2) The optimization of the quantity and form of farmland has a positive promoting effect on agricultural economic growth in both the local county and adjoining counties. In contrast, the spatial pattern, ecological function, intensive use, and environmental friendliness of farmland have a negative effect. (3) The influence factors of the green transition of farmland use on agricultural economic growth show significant spatial heterogeneity, with the overall effect degree being in the following order: northern hillock, central plain, western mountain range, and eastern hills. The influence on neighboring agricultural economic growth also exhibits significant spatial differentiation, with the overall effect degree following this order: eastern hills, northern hillock, central plain, and western mountain range. Targeted suggestions are proposed to promote the green transition of farmland use and achieve sustainable agricultural economic growth.

Does settlement land expansion necessarily induce the decrease of cultivated land? Differences in national scale and local counties of China

With the extensive industrialization and urbanization taking place in China during the recent decades, land use throughout the country has experienced profound changes influenced not only by the demand for population growth and living standard improvement but also by the constraints of series of land use policies. However, whether the conflict between the expansion of settlement land (SL) and the loss of cultivated land (CL) have been resolved at the national scale or transferred between the local regions remains unclear. Based on yearly ESA CCI land use and land cover products from 1992 to 2020, the long-term trends of quantity and spatial pattern of SL expansion and CL change in China from national and local views were investigated using trend statistic methods, and finally a comprehensive zoning framework was proposed to recognize the trade-off and synergies relationships between SL expansion and CL change. There are a continuous expansion of SL with global linear trends showing three breakpoints in 2000, 2005, and 2012, and a fluctuation decline of CL presented with four breakpoints in 1997, 2002, 2006, and 2013. Aggregation and dispersion tendencies with linear characteristics of SL expansion and CL change were found with breakpoints in 2001, 2008, 2012, and 2016 and breakpoints in 2001 and 2010, respectively. A spotty spatial pattern of SL was shown spatially coincident with urban agglomerations in China while the planar continuous characteristic was found for CL. Local counties were classified into five tradeoff and synergies zones (TSZs), where general synergies (G-S) and decoupling (D) of SL expansion and CL change were rare cases and the different change in quantity and trend of SL expansion and CL change in local counties was concealed by the national trend. A few scattered counties were belonging to G-S and D TSZs, while most of the counties in the central-east and western China were in General-Tradeoff (G-T) and Superior-Tradeoff (S-T) TSZs. Counties in south and north China with higher percentages of CL were more prevalent in Superior-Synergy (S–S) TSZ. Our findings explicated the complex relationships between SL expansion and CL change of China at the national scale and in local counties, which pointed out the differences of unified land use management activities across scales and could provide insights for future policy-making and management measures of land use to both ensure the national food security and promote regional sustainable development more synchronously.

Insights from Developing and Implementing a Novel School Community Collaborative Model to Promote School Safety.

School Resource Officer (SRO) programs do not reduce school violence and increase school discipline. We describe the use of a culturally responsive framework to form a school community collaborative among students, parents, staff, administrators, and law enforcement to reform an SRO program, promote school safety, and reduce punitive measures. Members of a participating school district, a local county, and a university collaborated. Adapting an identified culturally responsive model, a racially/ethnically diverse school community co-developed and implemented a School Community Collaborative (SCC) to address a school safety priority (SRO program reform). The main outcomes were SCC model development and implementation, policy change, and school community feedback. Sixteen community members participated in the 5-week SCC with students, staff, law enforcement, and parents. The SCC revised the district's SRO memorandum of understanding (MOU) with law enforcement. Participants reported favorable feedback, and 89% reported the inclusion of diverse voices. Co-development and implementation of an SCC process with schools were feasible. School SCC participated in a community-engaged evaluation and revision of an MOU.

505 Use of Expanded Access at Michigan Medicine and Associations with Neighborhood Factors

OBJECTIVES/GOALS: Socioeconomic status (SES) affects risk of disease and access to therapies. The expanded access (EA) pathway allows for the clinical use of investigational products for patients who have serious illness but no Food and Drug Administration (FDA)-approved therapeutic options. The SES of patients who receive EA is unknown. METHODS/STUDY POPULATION: We reviewed the patients who were approved for treatment through a single-patient EA pathway between 2018 and 2023. Using Michigan Medicine (MM) DataDirect software linked to the MM electronic medical record system, we linked the EA pathway patients to neighborhood data from the National Neighborhood Data Archive (NaNDA) to compare neighborhood related markers of affluence among EA patients and others treated at MM. We used descriptive statistics to compare variables between EA pathway patients and residents of the state of Michigan or the local county surrounding MM (Washtenaw County), using US Census tract data to provide context for these findings. RESULTS/ANTICIPATED RESULTS: MM patients who received EA treatments were more likely to come from neighborhoods that showed markers of high SES compared to residents of the state of Michigan but not Washtenaw County. This includes the proportion of persons living in poverty (12.5% EA / 13.4% Michigan / 12.4% Washtenaw) and education in the form of a bachelor’s degree or higher (32.2% / 30.6% / 57.2%). This varied by the disease being treated. Oncology patients were more likely to be from areas with less poverty and more education (12.4% / 76.8%) than the EA average. EA patients being treated for infectious diseases were from areas with more poverty and less education (13.5% / 26.7%). DISCUSSION/SIGNIFICANCE: Patients treated at Michigan Medicine using treatments obtained through the EA pathway came from areas that were, on average, more affluent than residents of the state of Michigan as a whole. This finding warrants more research to ensure equitable access to these therapies for patients in disadvantaged neighborhoods.

The National Nutrition Improvement Program and the equity of educational opportunities: evidence from rural China

ABSTRACT The Children’s Nutrition and Health Poverty Alleviation Project is a vital initiative of the Chinese government to boost education, narrow urban-rural educational gaps, and ensure equal educational opportunities. Based on the 2015 China Health and Nutrition Survey (CHNS) data, this paper empirically evaluates the impact of the National Nutrition Improvement Program on the equity of rural educational opportunities using Differences-in-Differences (DID) method of the cross-sectional data. Findings indicate that Nutrition Improvement Program (NIP), by providing free nutritious lunches for children, reduced the opportunity cost of children going to school, and significantly promoted the improvement of children’s education level. The implementation of the one-semester policy increased children’s educational years by an average of 0.14, which is attributed to the fact that the NIP has contributed to children’s access to higher levels of education, because we found that the NIP had no significant impact on children’s primary and junior high school enrolment, but significantly increased senior high school and university enrolment by 5.8 and 4.2% points. Heterogeneity analysis reveals a stronger impact on children with less-educated, poorer fathers and a greater effect on boys than girls. Additionally, central pilot counties experience a more significant policy effect than local pilot counties.

Spontaneous Fistula and Abdominal Wall Endometriosis Due to Occult Existence of Unicornuate Right Uterus with Rudimentary Non-Communicating Functioning Left Horn.

Accurate diagnosis of Müllerian duct anomalies (MDA) remains a clinical challenge even by direct surgical inspection. Although obstetrical complications are more frequent in women with MDA, some subtypes allow normal reproduction, further delaying the diagnosis. Unicornuate uterus with a rudimentary non-communicating functioning horn is a rare form of MDA, susceptible to many gynecologic and obstetric complications such as miscarriages, premature birth, hematosalpinx, endometriosis, and chronic pelvic pain. We present an entire case pictorial assay including preoperative imaging as well as the surgical correction of the uterine anomaly and the associated complication of an occult unicornuate right uterus with rudimentary non-communicating functioning left horn (Class U4aC0V0/ European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) and its natural evolution following a previous incomplete surgical treatment. The patient had an emergency left adnexectomy for hematosalpinx and ovarian endometrioma at her local county hospital. After five years, the patient presented with severe dysmenorrhea and abdominal endometriosis due to blocked retrograde menstruation from a rudimentary, non-communicating functioning horn. Surgical treatment with the resection of the rudimentary uterine horn, together with the abdominal wall endometriosis lesions, was carried out with good outcomes.

"Blocks for Freedom": Sewing for Voting in Post-Jim Crow Mississippi

Abstract: This article examines a voting rights campaign known as "Blocks for Freedom" that was launched in 1966 to help a group of rural African American women in Clay County, Mississippi, protect their right to vote. These Black women faced significant obstacles to vote even after the passage of the 1965 Voting Rights Act. Local white vigilantes and county administrators used violence and the threat of informal economic sanctions to punish Black citizens who registered to vote. "Blocks for Freedom" sought to circumvent these limitations by creating jobs for Black women that would offer a living wage and protect their ability to cast ballots. Led by poor women in Mississippi and civil rights advocates in New York City, this innovative campaign shows how grassroots activists encountered voter suppression techniques employed to dilute the Black vote after the Civil Rights Movement.

COVSIM: A stochastic agent-based COVID-19 SIMulation model for North Carolina

We document the evolution and use of the stochastic agent-based COVID-19 simulation model (COVSIM) to study the impact of population behaviors and public health policy on disease spread within age, race/ethnicity, and urbanicity subpopulations in North Carolina. We detail the methodologies used to model the complexities of COVID-19, including multiple agent attributes (i.e., age, race/ethnicity, high-risk medical status), census tract-level interaction network, disease state network, agent behavior (i.e., masking, pharmaceutical intervention (PI) uptake, quarantine, mobility), and variants. We describe its uses outside of the COVID-19 Scenario Modeling Hub (CSMH), which has focused on the interplay of nonpharmaceutical and pharmaceutical interventions, equitability of vaccine distribution, and supporting local county decision-makers in North Carolina. This work has led to multiple publications and meetings with a variety of local stakeholders. When COVSIM joined the CSMH in January 2022, we found it was a sustainable way to support new COVID-19 challenges and allowed the group to focus on broader scientific questions. The CSMH has informed adaptions to our modeling approach, including redesigning our high-performance computing implementation.

An Approach to Enhancing Medication Treatment for Opioid Use Disorder in the HEALing Communities Study.

The HEALing (Helping to End Addiction Long-term) Communities Study (HCS) aims to test the effectiveness of the Communities That HEAL intervention in decreasing opioid overdose deaths in 67 communities across four U.S. states. This intervention enlists a collaborative team of researchers, academic experts, and community coalitions to select and implement interventions from a menu of evidence-based practices, including medications for opioid use disorder (MOUD). The HCS's New York team developed an integrated network systems (INS) approach with a mapping tool to coach coalitions in the selection of strategies to enhance medication treatment. With the INS approach, community coalitions develop a map of service delivery venues in their local county to better engage people with medication treatment wherever this need arises. The map is structured around core services that can provide maintenance MOUD and satellite services, which include all settings where people with opioid use disorder are encountered and can be identified, possibly given medication, and referred to core programs for ongoing MOUD care. This article describes the rationale for the INS mapping tool, with a discussion framed by the consolidated framework for implementation research, and provides a case example of its application.

Spatial and moderating effects of greenspace on the association between air pollution and lung cancer incidence

Lung cancer remains the primary cause of death globally. Studies have increasingly explored the role of greenspace in mitigating lung cancer risks, yet research gaps persist. First, while the direct spatial effect of greenspace has received attention, its potential spillover effects, driven by human mobility and air pollution dispersion, remain underexamined. Second, despite prevalent assertions of greenspace as an air purifier, the extent to which it moderates the air pollution-lung cancer association has yet to be fully understood. Third, the evaluation of greenspace's effects, predominately analyzed linearly a priori, demands exploration into their potential nonlinearity. We utilize three-year lung cancer datasets from 228 counties in China, to investigate the spatial, moderating, and threshold effects of greenspaces on lung cancer incidence in relation to air pollution. Employing spatial econometric and threshold models, our findings indicate that greenspace reduces lung cancer incidence in both local and neighboring counties. We also observe a diminution in the detrimental impact of air pollution on lung cancer incidence in areas with higher greenspace, especially when the Normalized Difference Vegetation Index surpasses a given threshold. These insights contribute to an enhanced understanding of greenspace's role in lung cancer prevention and could inform policies on greenspace expansion prioritization.

First Responders During COVID-19: Career Calling, PTSD, and Work Self-Efficacy

Introduction: During the COVID-19 pandemic, first responders were identified as a high-risk group for developing symptoms of post-traumatic stress disorder (PTSD) and depression, which are commonly associated with negative thoughts about oneself. This may pose risk to perceptions of work self-efficacy, an integral component of employee well-being and occupational functioning. In line with the Job Demands-Resources Model (Demerouti et al., 2001), the present study examined whether the degree to which first responders’ perceived career calling (i.e., a “summons” to work) served as a protective factor in the relationship between PTSD symptoms associated with the COVID-19 pandemic and perceptions of self-efficacy in the workplace. MethodsParticipants were 138 first responders from local county police and fire departments who completed online screening measures for probable PTSD and depression, as well as self-reports of work self-efficacy and career calling, between May and June 2020. Statistical analysis occurred between 2020-2021. ResultsModeration analysis, controlling for depression and relevant covariates, revealed an interaction between PTSD symptoms and career calling, ΔR2 = .04, p = .017. At low levels of career calling, there was a significant and negative relationship between PTSD symptoms and work self-efficacy (b = ‒0.14, p = .023), but not among first responders with average or high calling (p’s > .58). Positive screening rates were 22% for probable PTSD and 19% for depression. ConclusionsPerceiving a career calling may help protect first responders during COVID-19 from the deleterious effects of PTSD symptomatology on work self-efficacy. Prevention efforts targeting first responders with low calling strength may be warranted.

A Needs Assessment of Mental Healthcare Among inmates in Madison County Jail: Recommendations for Improvement

The current study examined the inmates’ mental healthcare needs in local county jails in Madison County, Illinois and explored approaches for future improvement. It used a mixed method with both a quantitative descriptive study design and a qualitative case study design. Non-probability sampling was used to recruit study participants. Mental health screening data from 222 adult inmates at a local Madison County jail were included in the quantitative study, and 15 professionals working with Madison County’s criminal justice system participated in the qualitative case study to complete an online in-depth survey. Results indicated that at the initial screening, about 30.6% of inmates reported that they had a psychiatric history (n=68), and 69.4% did not think that they ever had a psychiatric history (n=154). However, at the second assessment, 50 (23%) more inmates showed psychiatric symptoms. Female inmates were more likely to report a psychiatric history than males (40% vs. 30%); inmates who were younger than 48 years old had a higher rate of psychiatric history than those at the age of 48 and above (43.7% vs. 33%); and Hispanic inmates had the highest rate of psychiatric history compared to other races (75.0%). Participants in the case study stated that there was a significant lack of mental healthcare services provided in diagnosis, treatment, and referral while a considerable proportion of jail inmates were suffering from serious mental illness. Recommendations were made for future improvement, such as strengthening partnerships with mental health professionals and agencies to ensure the adequate and prompt mental health services in jails; increasing facilities to host mentally ill inmates; improving the comprehensiveness and accuracy of mental health screening/assessment tools. The study advocated for structural/systemic changes and more innovative and evidence-based practice to address inmates’ mental health concerns.

The Development of Standard Designs of Primary School Buildings in Lithuania During the 1920s and 1930s

Summary This article analyses the development of standard designs of primary school buildings in Lithuania during the 1920s and 1930s. This process aimed to create simple and comfortable standard school buildings and provide them to the primary schools operating in the country. The article presents the development of standard designs that took place at that time, explaining the circumstances of their emergence, and comparing the main designs of such buildings developed at that time. To reveal this process as best as possible, the influence of the then Ministry of Education of Lithuania, local former Lithuanian county municipalities, and various architectural specialists in the standardisation of buildings for primary schools and the development of standard designs are presented and analysed. This aims to introduce the readers to the still little-known process that took place in the architecture of Lithuania during the 1920s and 1930s.