Residents Of Rural Areas Research Articles

How the National Health Insurance Coverage policy changed the use of lenvatinib for adult patients with advanced hepatocellular carcinoma: a retrospective cohort analysis with real world big data

BackgroundTo establish a long-term mechanism to control the cost burden of drugs, the Chinese government organized seven rounds of price negotiations for the national reimbursement drug list (NRDL) from 2016 to the end of 2022. The study aimed to evaluate the impact of the National Health Insurance Coverage (NHIC) policy on the use of lenvatinib as the first-line treatment for advanced hepatocellular carcinoma (HCC) within a specific medical insurance region from the micro perspective of individual patient characteristics.MethodsThe data of HCC patients that received lenvatinib from September 2019 to August 2022 was retrieved from the Medical and Health Big Data Center and longitudinally analyzed. Contingency table chi-square statistics and binary logistic regression analysis were used to compare the differences in the categorical variables. Interrupted time-series (ITS) regression analysis was performed to evaluate the changes in the utilization of lenvatinib over 36 months. Multiple linear regression was used to analyze the impact of receiving lenvatinib on the total hospitalization expenses of hospitalized patients with advanced HCC.ResultsA total of 12,659 patients with advanced HCC were included in this study. The usage rate of lenvatinib increased from 6.19% to 15.28% over 36 months (P < 0.001). By controlling the other factors, consistent with this, the probability of patients with advanced HCC receiving lenvatinib increased by 2.72-fold after the implementation of the NHIC policy (OR = 2.720, 95% CI:2.396–3.088, P < 0.001). Older, residency in rural areas, lack of fixed income, treatment at hospitals below the tertiary level, and coverage by urban-rural residents’ basic medical insurance (URRBMI) were the factors affecting the use of lenvatinib among patients with advanced HCC (P < 0.05). After the implementation of the NHIC policy, the total hospitalization expenses increased (Beta=-0.040, P < 0.001). However, compared to patients who received lenvatinib, the total hospitalization expenses were higher for those who did not receive the drug (US$5022.07 ± US$5488.70 vs. US$3701.63 ± US$4330.70, Beta = 0.062, P < 0.001).ConclusionsThe NHIC policy has significantly increased the utilization of lenvatinib. In addition, we speculate that establishing multi-level medical insurance systems for economically disadvantaged patients would be beneficial in improving the effectiveness of the NHIC policy in the real world.

Measures to Narrow the Gap of Basic Medical and Health Services for Urban and Rural Residents

Health is the foundation of economic and social development, and people's health and longevity is an important symbol of national prosperity and national strength. Since the reform and opening up, our country has made remarkable achievements in the reform and development of health field. A sound medical and health service system is the basis for reducing the occurrence of diseases and ensuring residents' equal access to medical and health services. With the implementation of the "Healthy China 2030" Plan and a series of policies, promoting a healthy lifestyle and improving the level of basic medical and health services have become the fundamental direction of current medical and health development. Under the guidance of this development direction, in view of the inherent problems of basic medical and health services in rural areas of Hebei Province, it is necessary to fully investigate and understand the actual needs of residents in rural areas, increase the supply body of basic medical and health service resources, and solve the problem of insufficient total amount and uneven distribution of basic medical and health resources. Make up for the weak basic medical and health service foundation in rural areas of Hebei Province, strive to build a people-oriented basic medical and health service system that is balanced between urban and rural areas, and consciously transfer human, material and financial resources in urban areas to rural areas, so as to lay a solid foundation for protecting the health level of rural residents.

Anxiety, depression, and their comorbidity among Chinese college students during the COVID-19 lockdown in the post-epidemic era: an online cross-sectional survey

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic continues to affect the mental health of college students in the post-epidemic era. We assessed the status and related factors of college students who are vulnerable to anxiety and depression during the COVID-19 lockdown.MethodsThis cross-sectional study was conducted two weeks after the beginning of the COVID-19 lockdown, from November 6, 2022, to December 2, 2022, with 1176 valid samples using convenience sampling. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to measure levels of anxiety and depression in college students. Factors related to anxiety, depression, and their comorbidity were analyzed using binary logistic regression.ResultsThe prevalence of anxiety, depression, and their comorbidity were 27.04%, 34.10%, and 25.60%, respectively. There was a higher risk of anxiety, depression, and their comorbidity among those who were currently living in rural areas. Compared with individuals with low monthly living expenses, those with higher monthly living expenses were less prone to anxiety, depression, and their comorbidity.ConclusionsHigh prevalence of anxiety, depression, and their comorbidity were detected among college students during the COVID-19 lockdown. These were most common among college students who were senior students, had abnormal body mass index (BMI), were rural area residents, did study arts and humanities, were one-child in the family, and had low monthly living expenses and poor academic performance. Intervention practitioners and policymakers should formulate individualized prevention and intervention measures during the COVID-19 lockdown in the post-epidemic and possible future pandemics for college students.

A COMPARATIVE STUDY OF FIRST EPISODE STATUS EPILEPTICUS AND MULTIPLE EPISODES OF STATUS EPILEPTICUS IN EMERGENCY DEPARTMENT OF TERTIARY HOSPITAL OF BUNDELKHAND REGION, CENTRAL INDIA

Objective: Status epilepticus (SE) is a medical emergency that necessitates prompt and intensive treatment to prevent damage to the brain and other complications. SE can occur in any age group, but it is most observed in infants and the elderly. The diagnosis of convulsive SE is primarily clinical, but neuroimaging and laboratory studies are required to identify the underlying cause when convulsion is subsided. Bundelkhand region is a proposed state, located between Uttar Pradesh and Madhya Pradesh in central India, has a population of approximately 18 million, with around 14 million residing in rural areas (Census 2011). This region is infamous for its backward healthcare and education systems. This study aims to compare the outcomes of individuals experiencing their first episode of SE versus those with multiple episodes in terms of seizure control or progression to refractory or super-refractory status, considering the underlying causes. Methods: A total of 100 participants were selected for the study at MLB Medical College, Jhansi, between March 2020 and November 2021. Before participation, written informed consent was obtained after explaining the study’s objectives and procedures in detail. Data were recorded on an Excel sheet and analyzed using the Statistical Package for the Social Sciences software, applying appropriate statistical tests when necessary. Results: Among the 100 patients with SE, the common etiological factors were anticonvulsant drug withdrawal (33%) and central nervous system (CNS) infections (33%), followed by metabolic encephalopathy (17%), cerebral vascular accidents (12%), and hypoxemic encephalopathy (5%). The patients were managed according to standard protocols and drug availability. The outcomes were categorized as seizure control, hospital death, or development of refractory or super-refractory status. Among the patients, 35% developed refractory SE, and within that group, 29% progressed to super-refractory status. Conclusion: The fatality rate of SE was 14.0%. Predictors of higher mortality rates included the first episode of SE, patient’s age, lack of response to initial antiepileptic drugs, duration of convulsions, and untreatable underlying causes. Etiologies such as CNS infections and anticonvulsant drug withdrawal were considered preventable and have better outcomes.

Advancing Development: The Impact of Geoscience Education in Nigeria’s Rural Coastal Areas of the Niger Delta Region

The Niger Delta region of Nigeria is a significant ecological and environmental zone that is classified as a rural coastal area. The development of this region is critical to Nigeria’s socio-economic growth. One of the key factors that have been identified to have a significant impact on the development of this region is geosciences education. Geoscience education helps to develop a better understanding of the natural environment, including the processes that have shaped it and the various resources available to it. This abstract presents an analysis of the impact of geoscience education in the rural coastal areas of the Niger Delta region of Nigeria. A review of existing literature on geosciences education and its impact on the development of rural coastal areas was conducted. The results show that geoscience education has significant potential in the development of the Niger Delta region of Nigeria. The research also indicates that geoscience education enhances awareness of the environmental challenges facing the region, engenders better adaptation to climate change, and underscores the importance of natural resources. Furthermore, geoscience education improves the competitiveness of the rural coastal area residents in the area of agriculture, fisheries, mining, and tourism. Therefore, it is recommended that geoscience education should be included in the curriculum of primary and secondary schools in the rural coastal areas of the Niger Delta region of Nigeria. As well as providing more opportunities for tertiary education and training in relevant geoscience subjects. Furthermore, the importance of these subjects should be widely publicized among community leaders, stakeholders, and residents to ensure they understand the positive impact on education and their development.

A study on the sample representativeness of the Wisconsin Alzheimer’s Disease Research Center Clinical Core participants versus the Wisconsin state population

AbstractBackgroundUnderstanding how representative a research sample is compared to the population can help inform future recruitment planning, data analysis strategies, and interpretation of the generalizability of the findings. We compared the demographics, rural residence, neighborhood socioeconomic disadvantage, and vascular risk factors between the Wisconsin Alzheimer’s Disease Research Center (ADRC) Clinical Core participants versus the Wisconsin state adult population.MethodThe ADRC participant sample (n = 678) included all active participants as of November 30, 2021. The state population statistics were estimated using multiple national and state data sources. Differences between the sample versus the population were tested using the one‐sample z‐test, the one‐sample Wilcoxon signed rank test, the exact binomial test, and the exact Monte Carlo multinomial test. Except for age, comparisons were performed for two age groups: 45‐64 years and ≥ 65 years, separately.ResultThe ADRC participants are older than the state population. For each age group, compared to the state population, the ADRC participants include more women and greater proportions of Black and American Indians, have higher levels of educational attainment, have smaller percentages living in rural areas and more disadvantaged neighborhoods, and show lower vascular risks. The sample versus population differences are greater for the ≥ 65 years group (the group at higher risk for AD) than the 45‐64 years group for most metrics, however, are smaller for sex and neighborhood disadvantage.ConclusionThe ADRC targets recruiting middle‐aged and older adults with dementia, mild cognitive impairment, or increased risk for AD. Thus, the participants are not a suitable sample for epidemiology studies on AD prevalence. Oversampling underrepresented racial groups would alleviate the lack of statistical power associated with small or unbalanced sample sizes and increase the precision in effect size estimates for studies on racial disparities. Future recruitment should endeavor to include participants from a broader range of educational backgrounds and more residents in rural areas and disadvantaged neighborhoods. These subpopulations have inequitable access to quality health care and are at greater risk. Properly representing them in research would allow conclusions to be generalizable to these subpopulations and support policy making to meet their needs.

Abstract A137: Drive time to physicians and outcomes for bladder cancer

Abstract Introduction: Poor geographic access to cancer care providers can delay treatment and limit access to high quality care. Previous research has shown that for patients with bladder cancer, time to cystectomy and receipt of neoadjuvant chemotherapy are associated with improved survival. Travel burden may be an important barrier to timely guideline-concordant treatment and is particularly relevant for residents of rural areas, which are often medically underserved. This study examines the association between drive time to medical oncologists and urologists and clinical outcomes for muscle-invasive bladder cancer (MIBC) patients. Data and Methods: We used information on physician location from the Centers for Medicare and Medicaid Services and patient-level data from the 2010-2016 Pennsylvania Cancer Registry linked to Pennsylvania Healthcare Cost Containment Council (PHC4) inpatient discharge data through 2018. We examined patients in Pennsylvania with a first lifetime bladder cancer diagnosis who underwent radical cystectomy at a non-federal short-term general hospital identified in PHC4. Outcomes examined were surgery within 90 days, receipt of neoadjuvant chemotherapy, 90-day mortality and 90-day readmission. We estimated multivariable linear regression models at the patient level. Our primary exposures were the natural log number of minutes from the patient’s home census tract centroid to the nearest medical oncologist and the nearest urologist. We controlled for patient age, sex, race/ethnicity, tumor size, tumor node involvement, and Elixhauser comorbidity index. We included a control for whether the patient received neoadjuvant chemotherapy in models estimating the association between drive times and cystectomy within 90 days. We also controlled for area-level characteristics, including ZIP code median and area deprivation index quartile. Standard errors were clustered at the county level.Results: The study included 954 patients with MIBC, 1,520 medical oncologists, and 976 urologists in Pennsylvania. Mean (SD) drive time to the nearest oncologist was 17.1 (11.4) minutes and median drive time was 14.4 minutes. Mean drive time to the nearest urologist was 13.9 (9.2) minutes and median drive time was 11.7 minutes. A 30-minute increase in drive time to the nearest urologist was associated with a 12.5 percentage point lower likelihood of undergoing cystectomy within 90 days (95% CI: -24.3 to -0.6). A 30-minute increase in drive time to the nearest oncologist was associated with an 11.9 percentage point lower likelihood of receiving neoadjuvant chemotherapy (95% CI: -23.4 to -0.4). Drive time was not significantly associated with 90-day mortality or readmission within 90 days. Conclusions: Drive time to both oncologists and urologists is associated with timely receipt of guideline-recommended care for patients with MIBC. Understanding the impact of geographic access to medical oncologists and urologists on clinical outcomes for patients with MIBC can inform providers and policymakers in addressing geographic equity in cancer care. Citation Format: Sruthi Muluk, Coleman Drake, Zhaojun Sun, Manisha Bhattacharya, Bruce Jacobs, Lindsay M. Sabik. Drive time to physicians and outcomes for bladder cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A137.

The Role of Cell-Mediated Immunity Deficiency in the Clinical Evolution of Patients with Tuberculosis Associated with HIV Infection

HIV infection induces severe immunosuppression, considered the major risk factor for tuberculosis (TB). Objective — to evaluate the clinical characteristics of patients with TB-HIV co-infection based on the level of immune deficiency to establish recommendations for improving clinical case management. Materials and methods. A prospective, selective study included 86 TB patients, divided into the study group with 38 cases of TB evolved into acquired immunodeficiency syndrome (AIDS), established with a CD4+ level ≤ 200/μL and the control group with 48 TB cases having CD4+ ≥ 200/μL. Results and discussion. The study assessed the impact of the severity of the cell mediated immune deficiency associated with HIV infection on the clinical evolution of TB and the final therapeutic outcome. Laboratory indicators characterizing TB in AIDS included general leukocytosis, lymphocytopenia, eosino­philia, anemia and, in rare cases, thrombocytopenia. All AIDS patients were untreated with ARV, and only one-third were in the early stages of symptomatic HIV infection. Risk factors for TB in AIDS included rural residence, low education levels and mental disorders. Treatment success was low, and the death rate was high in both groups, emphasizing the impact of associated conditions. Despite differences in the serum level of CD4+ cells, the rate of therapeutic success was equally low in both groups, with one-third continuing antituberculosis treatment. The death rate was insignificantly higher in the TB on AIDS group (23.4 %) vs. 18.7 % in early HIV stages due to comorbidities associated with HIV infection. Conclusions. The study identified risk factors for TB in patients diagnosed with AIDS stage of symptomatic HIV infection, including residence in rural areas, low education levels and mental and behavioral disorders associated with multiple causes such as alcohol consumption, drug use and toxoplasmosis of the central nervous system. Recommendations include complex screening for TB and HIV in all socially vulnerable groups, reinforced by primary prevention and an individualized therapeutic approach.

Parental co-residence and young adults' mental health.

The growing trend towards young adults staying in the parental home has garnered much recent scholarly interest. However, less is known about which young adults are living at home, and the impacts this has over young adults' lives. Using The Household, Income and Labour Dynamics in Australia (HILDA) dataset, this study examines the profiles of co-residing young adults and how these have changed over the first two decades of the 21st century. It then analyses the associations between co-residence and young adults' mental health, applying a propensity score modelling approach to determine differences in mental health between young adults living at home and their counterparts living independently. Results indicate that rates of co-residence have increased over the 2000s, most steeply amongst those residing outside of major cities (by 46%), older adults (by 36%), females (by 28%), and low-income groups (by 10%). Findings show a significant negative association between co-residence and mental health (a 4-point difference on the 100-point scale, 95% CI -5.93, -2.14). However, the greatest differential in mental health between co-resident and independent young adults is observed amongst those for whom rates of co-residence have increased most dramatically, i.e., females and older adults (a 6-point difference in mental health) and residents of regional and rural areas (a 5-point difference in mental health). We situate this discussion in the context of intensifying housing market constraints, considering how the transformation of the Australian housing system into a vehicle for wealth accumulation has generated barriers to residential independence.

Depressive symptoms among adults: Baseline findings of PURE Malaysia cohort study

IntroductionIn Malaysia, the prevalence of depression has increased from 1.8 % to 2.3 % within a decade. Thus, this study was performed to identify depressive symptoms and its associated factors among Malaysian adults. MethodsA cross-sectional study was conducted among the adult population aged 35–70 residing in rural and urban areas in Malaysia. Depressive symptoms were assessed using the short form Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Composite International Diagnostic Interview (CIDI) questionnaire. Logistic regression models were fitted to identify the associated factors related to depressive symptoms. ResultsAbout 3.7 % (95 % CI: 2.33–4.83) of the respondents reported having depressive symptoms. Younger adults aged 35–40 years old (AOR: 3.087; 95 % CI: 2.021–4.717), females (AOR: 2.318; 95 % CI: 1.669–3.219), widows and divorcees (AOR: 2.294; 95 % CI: 1.085–4.848), smokers (AOR: 1.843; 95 % CI: 1.334–2.545) and alcohol consumers (AOR: 1.843; 95 % CI: 1.264–2.688) showed a higher odds compared to their other counterparts. Underweight individuals (AOR: 1.899; 95 % CI: 1.177–3.065) and those diagnosed either with hypertension (AOR: 1.442; 95 % CI: 1.11–1.873), diabetes (AOR: 1.554; 95 % CI: 1.133–2.13), angina (AOR: 2.73; 95 % CI: 1.596–4.67), COPD (AOR: 4.187; 95 % CI: 1.528–11.472) or asthma (AOR: 1.906; 95 % CI: 1.309–2.774) were more likely to have depressive symptoms. Additionally, individuals with difficulty trusting people (AOR: 1.477; 95 % CI: 1.024–2.13) and those reported to experience either home or work-related stress (AOR: 2.584; 95 % CI: 2.003–3.331) were more prone to have depressive symptoms. ConclusionIn this broad population-based study, about 3.7 % (95 % CI: 2.33–4.83) of respondents reported having depressive symptoms. Timely and well targeted collaborative intervention on the identified risk factors by the relevant authorities, would mitigate their effect on the quality of life and retard the progression into depression, especially among younger adults.

Association between Heavy Metal Exposure and Idiopathic Aplastic Anemia in Adolescents and Adults:a Case Control Study from Northern India

Introduction:Compared to western world the incidence of AA in South Asian countries is higher. There are studies to suggest that incidence of this disease is 2-3 times higher in LMICs. Besides immune mediated pathophysiology and inherited presdispostion, toxic insult to the hematopoietic elements due to chemotherapy, radiation exposure, drugs,and environmental toxins such as pesticides and heavy metals have been associated with Aplastic Anemia.The higher incidence of AA in lower socio-economic status and its association with drinking water habits, industrial exposure suggests a possible link with heavy metals in the pathogenesis of disease. Methodology:Fifty patients diagnosed with idiopathic aplastic anaemia and 50 age and gender matched healthy controls were included in the study. 2 ml of blood and 20 hair shafts were collected as samples from each subject for the analysis of arsenic, lead, cadmium, mercury, and thallium in both samples by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Results:The total study population consisted of 61 males and 39 females. 42% of the cases were residents of rural areas, and 58% belonged to urban areas. 54% participants among the controls belonged to rural areas. Among the total population, 48% cases and 58% controls were using tap water as major source of water. Out of the total participant in the study, 10% of the cases and 12% of the controls were found to be exposed to pesticides previously, however no direct occupational exposure of heavy metal was found among the study population. Twenty-three patients (46%) had NSAA, and 15 patients had SAA (30%) while 12 patients (24%) had VSAA.Mean values of arsenic in blood of patients and controls are 3.52±2.9mcg/L,and 0.0mcg/L respectively and the difference was statistically significant (p &amp;lt;0.001) however the mean arsenic values in hair of cases and controls were not different significantly(0.13±0.1mg/g and 0.15±0.1mg/g;p=0.16).Mean values of cadmium in blood of patients and controls were 2.5±1.9mcg/L and 0 mcg/L (p &amp;lt;0.001). Mean values of cadmium in hair of patients and controls are 0.10±0.16, 0.13±0.28 respectively.We noticed blood cadmium higher than safer limits in 24% of cases none in the controls.We found 6% of cases had higher than permissible limit of mercury level and 8% of cases have higher than permissible limit of lead level in their hair samples which represent chronic exposure. Conclusion: We found higher mean values of blood Arsenic and blood Cadmium in cases compared to controls. Upto one fourth cases had higher than safety levels of cadmium in their blood. Although causal association cannot be determined in this study our results indicate that heavy metal toxicity may be one of the reasons for AA in regions with higher environmental exposure and soil and water contamination.

The Use of Complementary and Alternative Medicine and Coping with Stress by Patients with Gynecological Cancer: A Cross-Sectional Study in Türkiye

Introduction: Gynecological cancers are long-term, challenging, and stressful diseases. In Türkiye, the majority of patients with gynecological cancer use complementary and alternative medicine (CAM). Considering the stress that gynecological cancer patients are exposed to, patients need to know how to cope with stress. Objective: This study aimed to determine the use of CAM and coping with stress by patients with gynecological cancer and the relationships between them and the factors that predict the approaches to coping with stress in women with gynecological cancer in Türkiye. Methods: This is a descriptive and cross-sectional study. The study was conducted with 204 patients between April and August 2022. The data of the study were collected by face-to-face interview and filled out by the patients using the Descriptive Information Form and the Stress Coping Styles Scale (SCSS). Number, percentage, mean, χ², one-way ANOVA, t test, and the Spearman correlation analysis were used in the data analysis. To analyze the multivariate independent associations between variables, a multivariate ordinal logistic regression model was used, with the SCSS domains as dependent variables. A 95% confidence interval was calculated, and all statistical tests had an alpha level of 0.05. Results: The mean age of the patients was 58.38 ± 12.64 years (32–80). The prevalence of CAM use by patients was 39.2%, and the most common types of CAM were herbal products (43.8%) and supplication (42.5%). The reasons for using CAM were relaxation (symptomatic)-feeling healthy (63.8%) and treating cancer (36.2%). No statistically significant difference was found between the use of CAM and their approaches to coping with stress (p > 0.05). As a result of multivariate ordinal logistic regression analysis, education level under high school, having ovary, cervix, and endometrium cancer, being in the first stage of cancer, receiving chemotherapy, receiving surgical treatment, having another cancer patient in the social environment and increased interest in a partner after the diagnosis of cancer was associated with an effective coping with stress (p < 0.05, adjusted R² = 0.27, 0.79, and 0.32, respectively). Not working, experiencing an abortion, having another cancer patient in their social environment, being in the third stage of cancer, having an extended family, and living in a rural area of residence were associated with ineffective coping with stress (p < 0.05, adjusted R² = 0.20 and 0.24, respectively). Conclusions: The prevalence of CAM use by patients was low. While determining the approaches of the patients to cope with stress, their education level, place of residence, family type, diagnosis of cancer, stage of cancer, treatment, partner support, and stressful life events should be considered. As nurses, we need to be more knowledgeable about the use of CAM to provide correct guidance to our patients for access to accurate and effective information. We need to determine our patients’ stressors and how our patients cope with stress.

Миграционные процессы на селе и альтернативная занятость сельского населения

Abstract. Rural territories of the country have always played a primary role in the formation and maintenance of a high image of the state in the international arena, since it is rural territories that lay the food security of the country as a whole, which turns into national security. The purpose of the study is to determine the directions of migration flows and their scale. Research methods are analysis and synthesis of statistical and analytical materials of the Federal Service for Labor and Employment of the Russian Federation, materials of scientific conferences and periodicals. This article discusses the development of such a direction of alternative employment as social entrepreneurship, based on the realization of people's social needs. It is proposed to develop alternative types of employment in rural areas as one of the ways to reduce unemployment and retain local residents in rural areas. Results. The study found that migration processes cover a significant part of the rural population in the regions of the country every year. Over the past twenty years, it has decreased by 3%. People are rapidly moving to the city. In 2021, the leader in the number of retired residents from rural areas is the Volga Federal District – 80,520 people, the 2nd place belongs to the Central Federal District – 53,497 people and the 3rd place is occupied by the Siberian Federal District – 52,439 people. The main factor that can restrain such changes is the activation in the development of alternative employment of the population. Scientific novelty. Based on the analysis of statistical data and research, promising areas of sustainable development of rural areas have been identified. The development of various types of alternative employment will help not only to maintain the population of rural residents, but also to launch the mechanism of reverse migration from the city to the village – ruralization.

Body Mass Index Asian populations category and stroke and heart disease in the adult population: a longitudinal study of the Indonesia Family Life Survey (IFLS) 2007 and 2014

BackgroundA substantially elevated Body Mass Index (BMI) is one of the largest global modifiable risk factors for stroke and heart diseases. Most studies classify BMI according to the WHO BMI cut-off point in stroke and heart disease studies. However, there is a limited understanding of the association between the BMI cut-off point in the Asian population category and stroke and heart disease. This study aimed to investigate the incidence rate ratio of stroke and heart disease by BMI categories for the Asian population.MethodsA 7-year prospective longitudinal study (2007–2014) was conducted on 6,688 adult Indonesian individuals (≥ 35 years) residing across 13 different provinces in Indonesia during the survey periods. Data on BMI were collected in 2007. Information on stroke and heart disease was obtained in both 2007 and in 2014. A multivariate-adjusted Poisson regression model was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) of either stroke or heart disease or both stroke and heart disease by BMI.Results Among the 6,688 eligible participants, 334 (5%) were judged as stroke and heart disease in 2014. The IRR (95% CI) of stroke and heart disease for participants with obesity was 2.57 (1.64–4.04) compared with those within normal weight. This incidence rate ratio was more pronounced among middle-aged adults (< 55 years) rather than the older adults (≥55 years).The IRR of stroke and heart disease among obese middle-aged adults was 4.18 (95% CI 2.10–8.31).ConclusionsAn association was observed between obesity and the risk of stroke and heart disease, especially in middle-aged adults. These findings suggest that lowering BMI through the adoption of healthy dietary habits and increasing physical activity, particularly among middle-aged adults with high education, occupational employment, and residence in either urban or rural areas, may be beneficial for preventing stroke and heart disease.

Empirical Study on Influencing Factors of Rural Environmental Behavior in Informatization

INTRODUCTION: With the advent of the information technology era, rural areas face new environmental protection challenges and opportunities. The rapid development of information technology provides new possibilities for changes in rural ecological behavior. However, understanding the influencing factors of rural environmental behavior in the context of information technology remains an important research topic. OBJECTIVES: This study aims to reveal the influencing factors of rural environmental behavior in the context of information technology to help governments and policymakers develop effective environmental protection strategies. Specifically, the researchers will focus on the extent to which factors such as education level, ecological awareness, economic status, and social participation influence the environmental behavior of rural residents. METHODS: A questionnaire survey was used in this study, and residents of a particular rural area were selected as the research subjects. A questionnaire containing questions on education level, environmental awareness, economic status, social participation, and environmental behavior was designed, and a large amount of data was collected through random sampling. Statistical analysis methods, such as regression and correlation analyses, were used to process and interpret the data. RESULTS: The study's results showed that the education level significantly affected the environmental behavior of rural residents. Residents with higher levels of education were more inclined to take positive ecological protection actions such as waste separation and energy conservation. In addition, environmental awareness was also found to be closely related to environmental behavior, with residents with higher ecological awareness being more concerned about environmental protection and taking action accordingly. Economic status and social participation affected rural residents' environmental behavior to a certain extent but to a lesser extent than education level and ecological awareness. CONCLUSION: Rural environmental behavior in the context of informatization is affected by a combination of factors. To promote rural ecological protection, the government should strengthen investment in education and improve rural residents' education level and environmental awareness. In addition, social organizations and public participation should also be supported to encourage rural residents to actively participate in environmental protection actions. These measures will help to promote a change in ecological behavior in rural areas and achieve the goal of sustainable development.

Knowledge and coping style about depression in medical students: A cross-sectional study in China.

The current study aimed at ascertaining the depression levels of medical students and their knowledge levels of depression, and exploring the relationship between the level of knowledge and coping styles of the medical students on depression. An online-based survey was developed in Changzhi Medical College. The questionnaire included demographic and socioeconomic data, questions about depression knowledge and copying styles of depression, and the Zung Self-Rating Depression Scale (SDS). A total of 1931 questionnaires were returned by respondents. The medical students produced a mean SDS score of 44.29 (SD = 11.67). The prevalence of depression was 29.7%. Sophomore, female, and poor family relationships were parameters associated with a higher SDS score. The total correct rate for knowledge of depression was 64.14%. There were statistical differences between with depression students and non-depression students on the rate of the correct answers in the following questions:"Female has more probability", "Depression can be adjusted by oneself", "Associated with one's character", "Know cure method of depression", "Know drug use of depression", "Know depression influence for health", and "Know prevention method of depression". Depression students were more likely to have a lower rate of correct answer for above questions. Asking for help from psychological consultation was the primary coping mechanism among the medical students. The logistic regression analysis results found that depressed students who chose the coping way of no ways of coping were more likely to be females OR = 1.470 (1.078, 2.005), residents in rural area OR = 1.496 (1.038, 2.156), in poor family relationships OR = 2.428 (1.790, 3.293), and have lower cognitive level of depression knowledge OR = 1.920 (1.426, 3.226). It is necessary to focus on mental health of medical students, especially in female, residents in rural area, in poor family relationships, and having lower cognitive level of depression knowledge. Medical students were insufficient on depression knowledge and coping styles, and efforts that train students know risk of impaired mental health could also improve diagnosis and treatment.

Гендерный дискурс в конфессиональном пространстве современной Кабардино-Балкарии (на материале социологического исследования)

The article is based on the materials of a sociological survey conducted in April-May 2023 among the youth of the Kabardino-Balkarian Republic “Gender preferences of young people in the spiritual sphere in the Kabardi-no-Balkarian Republic”. The results of the survey demonstrated the increasing interest in Islam on the part of the region’s new generation. Thus, more than 50 % of young men and women assign a key role to Shariah in regulating social relations and ensuring the protection of people’s rights. The remainder consider the laws of the state to be their priority. A small part of the respondents gave their preference to adats and these are, as a rule, residents of rural areas. Precedence of the religious component over the national component in marriage is shown. The revealed degree of prevalence of demonstrative models of Islamic behavior gave grounds to assert that the majority of interviewed men and women welcome the wearing of Muslim Islamic clothing. It is concluded that there is a growing consolidation of Muslims aged 18 to 30 years. It has already become obvious today that it is a real social force that may eventually become dominant in the region.

Patients with diabetes in rural underserved areas

Patients with diabetes in rural underserved areas Richard J. Santen, MD, Emeritus Professor of Medicine at the University of Virginia in Charlottesville, Virginia, USA, delineates the characteristics of patients with diabetes residing in rural underserved areas, including the role of meal replacements for weight loss. Patients with diabetes residing in rural, economically challenged and medically underserved areas generally lack endocrinologists for consultative evaluation and management. (1,2) One solution to the problem is recruiting retired endocrinologists to care for these patients by telemedicine. This can be facilitated by partnering with rural, community health clinics. In the United States, a Federal program funds 1,400 rural clinics and supports the providers and clinical educators to instruct patients regarding diabetes mellitus management, nutrition, laboratory testing, and radiology. My experience over the last six years, as a partially retired endocrinologist, indicates that such a program is beneficial and results in lowering the hemoglobin A1c levels in patients with diabetes (3).

Intersectoral care for children with autism spectrum disorder in Kazakhstan: Parents perspective

Abstract Background The prevalence of autism spectrum disorder (ASD) is steadily increasing worldwide, including in Kazakhstan. Recognizing the significance of early detection and providing intersectoral assistance encompassing social, medical, and educational support, it is essential for promoting children's socialization in their daily lives. The purpose was to analyze the provision of comprehensive assistance to parents of ASD children. We conducted a descriptive qualitative study that involved semi-structured face-to-face interviews with parents of ASD children. 60 respondents (51,7% under 34 years old, 45,0% - 35-44 years and 3,3% up to 45 years) participated in our study. Framework Analysis used to interpret results. Results The average age of ASD children was 6.3. 26.0% of families were single-parent households, 30.0% residents in rural areas, 66.6% had one working parent, and 58.3% had obtained higher education. 52 parents note partial support from the government, mainly the expenses of parents are associated with the purchase of books, receiving other supporting services as sports activities. Due to long waiting list from the government parents noted the other services related to out-of-pocket payments as ABA therapy, a visit to a neurologist, correctional trainings. All parents noted that they want to receive information through organizing seminars, including psychological support. Conclusions Intersectoral collaboration plays a crucial role in facilitating comprehensive assistance for ASD children and meeting their needs through government support. Improving access to transportation, resource books, organizing seminars, and implementing programs to reduce waiting lists for medical and pedagogical specialists are necessary steps. Funding The Ministry of Science and Higher education of Kazakhstan (BR18574199 «Integrating children with autism spectrum disorder into the social and educational environment based on comprehensive support: challenges and benefits). Key messages • To achieve the SDG the decision makers of all three sectors in Kazakhstan need to improve care program for ASD children. • It is necessary to expand and revise the provision of services to ensure access to educational, medical services.

Sustainable Agriculture Development in India: Emerging Issues, Challenges and Opportunities

Agriculture is one of the most prominent sectors of the Indian economy. It is the source of livelihood for almost two third of the rural population workforce in the country residing in rural areas. In the present scenario, agriculture has progressed substantially well and is becoming more and more efficient over time. The achievements of quantum jump in the production and productivity can be attributed to the introduction and breeding of high yielding variety (HYV), which adequately demonstrated the vast potential of science-led revolutions viz., Green, White and Blue. Despite these appreciable achievements, challenges associated with climate risk and depleting natural resources. Almost 40.0 per cent of the crop land has been degraded in less than four decades, and almost 25.0 billion tonnes of top soil were being lost to erosion every year. The instinct performance of Indian agriculture depends on the performance of abundant resources, the sustainable strategies and methods adopted to face dryness due to the decrease in the rainfall, the agriculturist has to use the innovative strategies. It is in this context that the present paper seeks to draw the attention and need of a thorough study regarding sustainable agriculture development (SAD) in India. To achieve social and economic equality, sustainable agriculture methods must strike a balance between environmental health and economic prosperity. As a result, good management of both natural and human resources is critical. The Indian government has taken several efforts to promote long-term sustainable agricultural development.