Rural Community Population Research Articles

Evaluating Access to Health Care in Mothers and Caregivers of Children under Five Years of Age in Rural Communities of Yucatán, Mexico.

Populations in rural communities have more limited access to health care and attention than urban populations. The present study aimed to evaluate barriers to access to health care in mothers and caregivers of children under five years of age, twelve months after an educational intervention. The study was carried out from February to September 2022, and 472 mothers from eight communities in the state of Yucatán, in the southeast of the United Mexican States, participated. A comparative analysis was carried out on help-seeking times, obstacles to reaching it, and illnesses in children. The results revealed that the main barriers to access to care were long times to decide to seek help, lack of financial resources to pay for the transfer to another health unit, lack of someone to accompany the mother or caregiver when the child needed be transferred, and lack of transportation for the transfer. Disease knowledge remained at different levels in the eight communities; the significant differences occurred in four communities, one specifically for heart defects. It was concluded that, in the rural populations studied, there are barriers to access to health care which have to do with neglected social determinants, such as those related to conditions of gender, income, social support network, and the health system. Access to health care must be universal, so public health interventions should be aimed at reducing the barriers that prevent the population from demanding and using services in a timely manner.

Evaluating the feasibility of a tele-diagnostic auditory brainstem response service in a rural context.

There is a noticeable gap in access to audiology services in South Africa, and the gap is intensified in rural areas. Often, primary healthcare (PHC) facilities have an unequal ratio of audiologists to patients in need. Telehealth can expand the range of hearing healthcare services. This study aimed to determine whether, for infants, tele-diagnostic Auditory Brainstem Response (ABR) assessment results conducted within a mobile clinic van are comparable to face-to-face diagnostic ABR results in rural Winterveldt, Pretoria North, South Africa. The study utilised a quantitative, prospective cross-sectional comparative within-subject design. Each participant received both face-to-face and mobile tele-diagnostic ABR tests, which were then compared to evaluate the feasibility of mobile tele-diagnostic ABR testing. The Student's t-test was used to determine whether there was a difference between face-to-face and tele-diagnostic tests, and Bland -Altman plots were used to assess the level of agreement between the ABR testing results. There was a strong correlation (p 0.001) between face-to-face and mobile tele-diagnostic ABR test results for both neurological and audiological ABR tests. The study found that there was no statistical significance between face-to-face and tele-diagnostic ABR measures; additionally, the results were within clinically acceptable and normative measures. Tele-diagnostic ABR offered within a mobile clinic van is feasible as it produces similar and clinically acceptable results when compared to the traditional assessment method.Contribution:This feasibility study is a positive indicator that tele-diagnostic ABR testing through a mobile clinic van may be considered to accelerate the delivery of hearing healthcare services to the infant population in rural communities.

Assessing the health consequences of indoor air pollution from biomass fuel combustion on pediatric populations in rural communities of Pakistan

ABSTRACT Indoor air pollution arising from burning of biomass fuels poses a significant threat to child health in rural areas of Pakistan. This cross-sectional study aimed to assess health implications associated with indoor air pollution resulting from biomass burning among children under 12 years of age in rural Punjab. A questionnaire-based survey was conducted in six randomly selected rural districts of Punjab, characterized by their primary reliance on biomass fuels. The findings revealed that several characteristics, such as monthly household income, number of living rooms, secondary use of solid fuels, kitchen type, type of cooking stove, and presence of child in the kitchen with their mother, exhibited significant associations (p < 0.05) with negative health impacts among children. Reported health effects among the children included coughing (18.7%), watery eyes (17.7%), eye irritation (12.3%), runny nose (11.8%), breathing difficulties (8.5%), phlegm (38%), headache (25%), nausea (20.1%), dizziness (6.7%), asthma (6.4%), tuberculosis (1.8%), and pneumonia (1.5%).

Soil and Urine Mercury Levels in Secocha: A Case Study of Artisanal and Small-Scale Gold Mining in Peru

In recent decades, artisanal and small-scale gold mining (ASGM) has spurred population and economic growth in the small rural communities in which it is located, along with causing contamination of the soil, air, and water with grave effects on human health due to the uncontrolled use of mercury for gold processing activities. This study analyzes the levels of mercury in Secocha, an ASGM community in Arequipa, Peru. A total of 44 soil samples were taken from two ASGM commercial-extractive zones (n = 18) and non-processing urban zones (n = 26). Soil mercury analysis with atomic absorption spectrometry revealed average mercury levels of 86.11 mg/kg in commercial-extractive zone I, where ore processing has occurred for about 17 years, and mercury levels of 43.81 mg/kg in commercial-extractive zone II, where processing has occurred for about 7 years. In the urban zone, the average mercury level was 9.53 mg/kg. The average mercury concentrations for each zone exceed the relevant environmental quality standards established by the Peruvian Ministry of the Environment. In addition, urine samples were obtained from 15 miners and 15 people from the general urban population (non-miners). The average mercury level in the urine of miners was 7.04 µg/L, and in the urine of non-miners it was 0.49 µg/L. In both cases, the mercury urine level did not exceed the limits established by WHO and the Peruvian Ministry of Health, though miners’ elevated levels do raise concerns.

Perception and Relocation Intentions of Japanese Youth towards Rural Areas: A Case Study of Visitors in Hanyu-shi, Saitama Prefecture

As a highly urbanized country, Japan is facing the phenomenon of a continuous migration of young people from rural areas to cities, leading to an aging and decreasing population in rural communities. Influenced by the pandemic, people began to reconsider the issue of population concentration in large cities, causing urban residents to become interested in returning to rural areas. The focus of this study is on the perceptions and relocation intentions of Japanese youth towards rural areas, particularly in Hanyu-shi, Saitama Prefecture. Through semi-structured interviews with 26 urban university students who live in urban areas, this study explores the factors that attract or hinder them from having rural lives. The survey results show that childhood experiences and current lifestyle preferences have influenced their views on rural areas. The main hindering factors include backwards infrastructure, communication difficulties, and limited job prospects. This study reveals a significant cognitive gap in urban youth’s attitudes towards rural life in Japan. The study emphasizes the need to eliminate these hindrances and enhance the attractiveness of rural areas to promote reverse urban migration. This study provides important insights for policymakers and urban planners, highlighting the necessity of formulating development strategies that meet the needs of urban youth residents, which is crucial for the sustainable revitalization of rural Japan.

Incidence and case fatality rates of cardiovascular diseases in urban and rural community-dwelling populations in eastern, central and western regions of China

Objective: To evaluate the incidence and case fatality rate of cardiovascular disease (CVD) among populations in urban and rural communities in eastern, central and western regions of China. Methods: The present study was based on the data of the Prospective Urban and Rural Epidemiology (PURE)-China cohort, which enrolled participants who had at least one follow-up visit and complete information on age and sex. Information on baseline demographics, cardiovascular risk factors, and prevention and treatment for CVD were collected. CVD and mortality events were documented using the standardized case report form of the PURE Global Study to assess the incidence and case fatality rate of CVD among populations in urban and rural communities in eastern, central and western China. Results: This study included a total of 47 262 community-dwelling participants (age: (51.1±9.6) years; female, n=27 529, 58.2%) from 115 urban and rural communities in 12 provinces across the eastern, central, and western regions of China. Over a follow-up period of 11.9 (9.5, 12.6) years, 2 686 deaths and 5 873 cardiovascular events were documented. The incidence of CVD was 11.90 (95%CI: 11.60-12.21)/1 000 person-years. A significant difference in CVD incidence was observed across regions (Ptrend<0.001), which was highest in the western provinces (13.99 (95%CI: 13.33-14.65)/1 000 person-years), intermediate in the eastern provinces (11.92 (95%CI: 11.52-12.33)/1 000 person-years), and lowest in the central provinces (8.87 (95%CI: 8.25-9.50)/1 000 person-years). The 1-year case fatality rate of CVD demonstrated an increasing trend from eastern to western regions (eastern: 10.20% (95%CI: 6.95-14.73); central: 13.50% (95%CI: 9.90-18.14); western: 18.62% (95%CI: 14.95-22.94); Ptrend<0.001). Moreover, the incidence of major CVD was consistently higher in rural areas compared with urban areas across eastern (P<0.001), central (P=0.01) and western (P<0.001)_regions, respectively. The 1-year case fatality rate in rural areas was also significantly higher compared with that in urban areas in both eastern (P<0.001) and western regions (P=0.02). Conclusions: The incidence and case fatality rate of CVD were high among middle-aged population in China, especially those in western regions with low socioeconomic levels and in rural areas.

Cost-effectiveness of latent tuberculosis infection testing and treatment with 6-week regimen among key population in rural communities in China: a decision analysis study.

Several model studies suggested the implementation of latent tuberculosis infection (LTBI) testing and treatment could greatly reduce the incidence of tuberculosis (TB) and achieve the 2035 target of the "End TB" Strategy in China. The present study aimed to evaluate the cost-effectiveness of LTBI testing and TB preventive treatment among key population (≥ 50 years old) susceptible to TB at community level in China. A Markov model was developed to investigate the cost-effectiveness of LTBI testing using interferon gamma release assay (IGRA) and subsequent treatment with 6-month daily isoniazid regimen (6H) (as a standard regimen for comparison) or 6-week twice-weekly rifapentine and isoniazid regimen (6-week H2P2) in a cohort of 10,000 adults with an average initial age of 50 years. In the base-case analysis, LTBI testing and treatment with 6H was dominated (i.e., more expensive with a lower quality-adjusted life year (QALY)) by LTBI testing and treatment with 6-week H2P2. LTBI testing and treatment with 6-week H2P2 was more effective than no intervention at a cost of $20,943.81 per QALY gained, which was below the willingness-to-pay (WTP) threshold of $24,211.84 per QALY gained in China. The one-way sensitivity analysis showed the change of LTBI prevalence was the parameter that most influenced the results of the incremental cost-effectiveness ratios (ICERs). As estimated by a Markov model, LTBI testing and treatment with 6-week H2P2 was cost-saving compared with LTBI testing and treatment with 6H, and it was considered to be a cost-effective option for TB control in rural China.

INSTITUTIONAL ASPECT INNOVATIVE MODERNIZATION OF AGRICULTURAL PRODUCTION

The institutional determinants of innovative modernization of agricultural production are substantiated.&#x0D; It is established that the transformational features domestic agricultural production are monoculture agricultural production, its structural deformation, increased degradation of land and water resources, growing dependence of agricultural producers on imported inputs for the production process, and a reduction in the number of rural workers and the population of rural communities.&#x0D; It is argued that transformational changes in agro-industrial production should be focused on large-scale modernization changes in the production process in terms of restoring land fertility, improving the quality characteristics of food products, expanding the existing export potential of agricultural products and the share competitive products. &#x0D; It is established that the threats to the recovery of agricultural production are the narrowing of the domestic consumer market; reduction of the purchasing power of the population with a decrease in its number; reduction and blocking of exports of agricultural products; rising costs of material resources and rising costs of agricultural products and food prices.&#x0D; It is substantiated that institutional support for the innovative modernization of agro-industrial production should be accompanied by the formation of effective basic and special institutions and institutions that meet the criteria of systematicity when they are included in the hierarchical structure of norms and institutions of innovation.&#x0D; It is emphasized that the institutional support for innovative modernization should implement the following key tasks: ensuring a favorable investment climate for attracting financial resources to processing enterprises and the formation of local regional structures with low capacity for processing agricultural raw materials; creating conditions for the inclusion of agricultural producers in global value chains.&#x0D; Institutional interventions should be aimed at stimulating the diffusion and development of product innovations; supporting and shaping organizational structures for vertical and horizontal integration; supporting and shaping organizational frameworks for vertical and horizontal integration; and restructuring forms of state support for agricultural production.&#x0D; The strategic guidelines for the innovative modernization of agro-industrial production are defined: introduction of motives and incentives for structural changes in agricultural production, intensification of the development of small forms of management, integration of production processes, and use of competitive advantages.

Diagnosis on the development perception in rural populations of the influence area of the ESPAM MFL

The objective of the research was to diagnose the perception of development in rural populations in the area of influence of the Manuel Félix López Higher Polytechnic School of Agriculture of Manabí (ESPAM MFL). Indeed, statistical sampling was applied to determine the size of the population to be surveyed. The purpose of this work was to contribute to the knowledge about the perception of development that the population of rural communities has, since in order to execute any project that contributes to local development, it is necessary to have relevant and reliable information that allows to have new perspectives so that local actors (autonomous and decentralized governments) make effective decisionsin the area of influence of the Manabí Polytechnic. As a conclusion of this investigation, it is affirmed that although the majority central value is neutral, on the opinion of the population involved in the study.

Improving Telehealth Equity in Response to COVID-19 in California: ACTIVATE and Lighthouse

Background In response to the significant stressors on health care delivery created by COVID-19, CITRIS Health and partner organizations developed 2 telehealth solutions through a rapid co-design process: Lighthouse and ACTIVATE. These programs were developed to support providers serving underserved and vulnerable populations who lack the tools and resources to support patients with chronic illness or who are isolated. These challenges were exacerbated by the COVID-19 pandemic, which increased the need for resources to support vulnerable patients who could not come into a clinic in person or were isolated and lacked access to services. ACTIVATE and Lighthouse apply 2 different telehealth strategies to reach vulnerable populations. Objective This paper presents lessons learned from the design, development, and implementation of 2 innovative telehealth programs developed to improve health care delivery, access to care, digital literacy, and patient outcomes: ACTIVATE and Lighthouse. Methods ACTIVATE is a comprehensive digital health pathway for community health centers that care for those who are medically underserved. ACTIVATE is an innovative, evidence-based, and sustainable telehealth program, designed to benefit vulnerable populations in rural and agricultural communities in the California Central Valley who experience significant health disparities. Lighthouse focuses on connecting older adults in congregate affordable housing, which are settings where residents are particularly vulnerable to isolation, the lack of health care resources, and limited to no access to the internet. Lighthouse provides digital literacy training as well as access to broadband internet with the goal of increasing communication, engagement, and access to health care. Results This presentation will discuss successful design and implementation strategies as well as organizational and policy barriers to program operations. Conclusions In addition to reviewing program and implementation outcomes, strategies for replication and sustainability will be discussed. Although developed in response to COVID-19, the ultimate success of Lighthouse and ACTIVATE is dependent upon its successful scaling beyond the pandemic. Conflicts of Interest None declared.

A community-based cross-sectional study of eye care service utilization among the adult population in southern Ethiopia.

Visual impairment, which is related to many eye diseases, is a major public health problem. If detected and treated early, it can be prevented; therefore, regular use of vision services is very important. This study aimed to assess the proportion of utilization of eye care services and associated factors among the rural community population in southern Ethiopia. A community-based cross-sectional study design with a two-stage cluster random sampling technique was conducted to collect data from adults aged 40 years and above using interviewer-administered questionnaires. Kebeles were randomly selected by the lottery method, and systematic random sampling with proportional distribution was used to select the households. An adult individual was randomly selected from a household when there was more than one adult available. A binary logistic regression model was used to establish the association between eye care service utilization and the variables that might affect it. Of the 551 study population, 510 responded to this study, and the response rate was 92.6%. The mean age of the respondents was 52.2 years. The rate of eye care service utilization was 29% (95% confidence interval (0.25, 0.33)). The study shows that older participants, aged 65 and above (adjusted odds ratio: 4.04; 95% confidence interval (2.20, 7.43)), having previous eye problems (adjusted odds ratio: 10.04; 95% confidence interval (5.81, 17.33)), the presence of systemic illness (adjusted odds ratio: 2.52; 95% confidence interval (1.21, 5.21)), and having awareness about regular checkups (adjusted odds ratio: 11.75; 95% confidence interval (6.62, 20.84)) were found to be the predictors of eye care service utilization. In this study, utilization of eye care services was low. Older age, previous eye problems, systemic illness, and awareness about checkups were found to be predictors of eye care service utilization. Hence, there is a need to increase the absorption of existing ophthalmic services and create awareness of the use of ophthalmology services to reduce preventive blindness.

EFFECT OF WORK CULTURE AND HUMAN RESOURCES QUALITY ON EMPLOYEE’S PRODUCTIVITY THROUGH ORGANIZATIONAL COMMITMENT AS A MODERATOR: A STUDY IN AGENCY FOR RURAL COMMUNITY EMPOWERMENT, POPULATION ARRANGEMENT, AND WOMEN EMPOWERMENT OF NAGAN RAYA DISTRICT

The aim of this research is to analyze the influence of work culture and the quality of human resources on employee work productivity through organizational commitment as a mediating variable. The research was conducted at the agency for rural community empowerment, population arrangement, and women empowerment of Nagan Raya District, with a total of 55 employees. Data collection used a questionnaire and then the data were analyzed using statistical models for structural equation modeling (SEM) which were then operated through the SmartPLS software. The study found that work culture and human resource quality had a positive and significant effect on organizational commitment and work productivity of the agency's employees. In addition, organizational commitment also has a significant impact on employee productivity. The existence of organizational commitment is not only an important determinant of employee productivity but also mediates the influence of work culture and the quality of human resources on employee work productivity.

Public Management of Employment at the Level of Territorial Communities in the Context of Ensuring the Development of Rural Areas

United territorial communities were formed by voluntary unification of adjacent territorial communities of villages, towns, and cities. The availability, working conditions, and the level and quality of life of the population of rural communities significantly affect the development possibilities of rural areas. Problematic issues are the growth of unemployment, the demographic crisis, the intensive outflow of young people from the countryside, etc. The primary issue for anti-crisis public administration in rural areas (at the level of rural territorial communities and rural districts) is ensuring employment and self-employment of the population, increasing the level of labor income of the rural population. The low capacity of the labor market in rural territorial communities determines the need for the population to find work outside their place of residence and, in this connection, the presence of significant financial costs. The introduction of new types of activities and areas of employment for residents of the rural community must meet the needs of the market and be economically feasible, because otherwise public policy measures to support such types of employment will have a short-term nature and insignificant results. The tools of the public employment policy are: unemployment benefits, insurance of the population against job loss; assistance in professional training and retraining of personnel, conducting advanced training courses, organization and regulation of labor exchanges, public employment services; regulation of the wage level, regularization of the dismissal of employees; subsidies and benefits from tax accounting for entrepreneurs, regarding the creation of new and preservation of old jobs. Public management of employment at the level of the territorial community should be aimed at ensuring the possibility of effective economic activity of the residents of the community. At the same time, they should receive sufficient financial support to motivate work. This requires: creation of procurement points with a wide range of products with the participation of territorial communities; combining them into a procurement network; active cooperation with public administration bodies; networks of procurement points to international supply chains; ensuring their access to foreign food markets.

Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China.

There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35−59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.

Racial invariance in rural and urban contexts: comparing the structural sources of Black, White, and Latinx homicide in rural and urban counties, 2000 and 2010

Structural disadvantage has long been empirically linked to violent crime across different race/ethnic groups. More recently conceptualized as “racial invariance,” observed racial differences in crime rates are hypothesized to be the result of disparities in community-level structural conditions. However, most investigations into this hypothesis have focused on urban settings, with limited attention to rural contexts. The current study seeks to fill this gap by comparing county-level structural predictors of homicide victimization for Black, White, and Latinx populations in both urban and rural communities. Consistent with the racial invariance hypothesis, findings reveal that disadvantage strongly predicts homicide across race/ethnicity in both rural and urban counties. Closer inspection of results, however, exposes noteworthy differences in the effects in rural and urban settings.

Design and evaluation of a distributed generation system based on renewable energies applied to a rural area of the state of Veracruz

This article aims to show the dimensioning and evaluation of a Distributed Generation system based on renewable energies for its application in a rural area in the state of Veracruz, Mexico. The main motivation of this work arises from the shortage of energy or a deficient supply in numerous localities located in the state of Veracruz, derived from different reasons. A methodology based on the application of HOMER Pro software is proposed for the sizing and optimization of a renewable hybrid system, considering it as an isolated set from the supply network, achieving the optimization and evaluation from technical and economic aspects. Initially, the meteorological data of the site were obtained, from its geographical coordinates; subsequently, the demand profile of one of the households in the community is determined to extrapolate it to the total number of dwellings. The results obtained in this research can serve as a basis for its implementation and, therefore, improve the conditions in which the population of rural communities or isolated from supply networks usually live.

Facilitators and barriers to implementation of integrated community case management of childhood illness: a qualitative case study of Kapiri Mposhi District

BackgroundZambia adopted the Integrated Community Case Management (ICCM) of childhood illness strategy in May 2010, targeting populations in rural communities and hard-to-reach areas. However, evidence suggests that ICCM implementation in local health systems has been suboptimal. This study sought to explore facilitators and barriers to implementation of ICCM in the health system in Kapiri Mposhi District, Zambia.MethodsData were gathered through 19 key informant interviews with district health managers, ICCM supervisors, health facility managers, and district health co-operating partners. The study was conducted in Kapiri Mposhi district, Zambia. Interviews were translated and transcribed verbatim. Data were were analyzed using thematic analysis in NVivo 11(QSR International).ResultsFacilitators to implementation of ICCM consisted of community involvement and support for the program, active community case detection and timeliness of health services, the program was not considered a significant shift from other community-based health interventions, district leadership and ownership of the program, availability of national and district-level policies supporting ICCM and engagement of district co-operating partners. Program incompatibility with some socio-cultural and religious cotexts, stock-out of prerequisite drugs and supplies, staff reshuffle and redeployment, inadequate supervision of health facilities, and nonpayment of community health worker incentives inhibited implementation of ICCM.ConclusionThe study findings highlight key faciliators and barriers that should be considered by policy-makers, district health managers, ICCM supervisors, health facility managers, and co-operating partners, in designing context-specific strategies, to ensure successful implementation of ICCM in local health systems.

A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria.

IntroductionGlobally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria.MethodsQualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner.ResultsThis study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers’ intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers’ factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs.ConclusionsThere may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.

Incidence and risk factors of metabolic syndrome in rural community population on islands in Zhejiang province

Objective: To estimate the incidence of metabolic syndrome and explore possible risk factors for metabolic syndrome in adults of rural communities in Yuhuan county, Zhejiang province, China. Methods: During June-December, 2018, a follow-up survey was conducted in participants without metabolic syndrome at baseline survey in 2012 to obtain the information collected in questionnaire survey, anthropometric data and laboratory data. The incidence of metabolic syndrome in the participants was estimated, and Logistic regression model was used to explore the risk factors, adjusted risk ratio (aRR) and 95%CI. Results: Among 3 162 participants, 522 new metabolic syndrome cases were identified. The 6-year cumulative incidence rate of metabolic syndrome was 16.5%, and the cumulative incidence rate was higher in women (20.6%) than that in men (12.3%, P<0.001). Those incidence rates were higher in those in jobless, smoking or drinking groups. Being women (aRR=1.96, 95%CI: 1.50-2.58) and family history of hypertension (aRR=1.31, 95%CI: 1.04-1.63) were independent risk factors for metabolic syndrome. Conclusion: The follow up indicated that the incidence of metabolic syndrome was relatively high in rural adults on islands in Zhejiang, and women or those with family history of hypertension were more likely to have metabolic syndrome.

SUBCUTANEOUS ZYGOMYCOSIS PRESENTING WITH MULTIPLE SWELLINGS

Subcutaneous mycoses are a heterogenous group of fungal infections of the dermis and subcutis. They affect population in rural communities, often in humid, tropical, or subtropical regions of developing countries. They are directly inoculated into the dermis or subcutaneous tissue through a penetrating injury from vegetative materials.30 year old homemaker presented with two discrete painful hyperpigmented swellings with no surrounding satellite lesions, gradually increasing in size, on right thigh of six months duration. There was a history of penetrating trauma. No comorbidities were present .Histopathology showed septal and lobular panniculitis with foreign body granuloma. Fungal stains showed broad hyphae and Basidiobolus species growth was observed in Sabaroud dextrose agar. A diagnosis of subcutaneous zygomycoses was made and treatment with Itraconazole and potassium iodide was started, to which she responded well within 3 months of therapy. Histopathological examination is reliable and less time consuming. But culture is the gold standard investigation for conrming the diagnosis. The positivity in culture ranges from 40 to 60%, hence histopathology is the main tool for diagnosis. Treatment with itraconazole and potassium iodide has produced excellent results.