Rural Research Articles

Barriers to Colonoscopy Quality Measurement in Rural Wisconsin.

Patients in rural areas have reduced colonoscopy access, which is critical for colorectal cancer prevention. General surgeons perform most colonoscopies in rural areas. The Surgical Collaborative of Wisconsin's Rural Task Force identified colonoscopy as a high priority initiative due to high volume and lack of quality measure access, both necessary for assessing and improving performance. Assess the capacity for colonoscopy quality measurement and improvement in rural Wisconsin hospitals. In October 2019-January 2020, the Surgical Collaborative of Wisconsin, Rural Wisconsin Health Cooperative, and Wisconsin Collaborative for Healthcare Quality collaborated to design/distribute a survey to 44 Rural Wisconsin Health Cooperative hospitals (n = 25 completed, response rate 57%). Descriptive statistics summarized survey items. Surgeons in each of six rural hospitals participated in stakeholder interviews. Rural Wisconsin Health Cooperative hospitals. Colonoscopy providers, procedure volume/capacity, informatics and quality measurement infrastructure, barriers to quality measurement and improvement. Most colonoscopy providers in rural hospitals were surgeons (66.3%) followed by family/internal medicine (20.0%) and gastroenterologists (13.8%). Average hospital volume/week was 19.9 colonoscopies (SD = 13.4). Hospitals reported operating at ~75% capacity. Withdrawal time was the most tracked measure (44.0%), followed by adenoma detection (36.0%), and cecal intubation (28.0%) rates. Approximately one-third of hospitals (36.0%) utilized procedure reporting software. Most hospitals (80.0%) did not have access to onsite pathology. Surgeons reported barriers to quality measurement/improvement, including insufficient resources for electronic medical record-based reporting and the need for targeted educational opportunities that do not require travel. Single state; may not represent experience of all rural hospitals. The lack of access to colonoscopy quality measures suggests the opportunity to develop a flexible approach that considers reporting software availability and electronic medical record differences. Improving access to measures and education/training opportunities may improve availability of high-quality colonoscopy for patients in rural Wisconsin. See Video Abstract.

Hillforts – built by collective action or coercive leadership? Socio-economic and military organization in eastern Norway AD 1–600

In this article, we will examine the socio-economic and military landscape of the Early Iron Age (AD 1–600) in the historical county of Vingulmark, which consisted of the area from Eiker in the west to Bohuslän in the east. Our starting point is hillforts, which are usually interpreted as places of refuge for people in rural areas in times of unrest. In Norway, around 450 hillforts are known, mainly dated to the period AD 200–550. Vingulmark contains 109 of them, thus almost a quarter of the known hillforts. We discuss why there are so many hillforts in Vingulsmark, and the relation between hillforts and central farms / places in Vingulmark. Are the hillforts the result of community solutions in farming communities or was the construction of the hillforts controlled by elites from one or more centres, under threats of coercion? We will assess the hillforts in relation to socio-economic relations, settlement expansion, central farms and central places in a landscape perspective with the application of anarchist theories and collective action theory. Keywords: hillforts, conflict, socio-economic and military organization, communities, leadership

Evaluating Growth Performance and Economic Efficiency of Indian Major Carps in Integrated Fish-duck Farming Systems

The experiment was conducted in three villages in Namakkal district to evaluate the effects of an integrated fish-duck farming system on the physico-chemical and biological parameters of pond ecosystems, as well as on overall fish production. This eight-month trial took place from July 2016 to February 2017. Ponds were stocked with fingerlings at a density of 6,000 per hectare, using Indian major carps like Catla (Catla catla), Rohu (Labeo rohita), and Mrigala (Cirrhinus mrigala) in a 4:3:3 ratio to maximize energy utilization through polyculture. Indian Runner ducks (Anas platyrhynchos) were included in the system to provide meat and naturally fertilize the ponds through excreta while grazing freely. In this village-based cultural practice, fish were not given supplementary feed. Instead, the ducks were fed with household food scraps and agricultural by-products, such as broken cereal grains and rice bran, which are readily available in rural areas. The study revealed that water quality parameters such as pH, dissolved oxygen, and alkalinity were significantly higher in the integrated ponds compared to control ponds (without ducks). Additionally, plankton levels (both phytoplankton and zooplankton) improved markedly in the integrated ponds. The Indian major carps in the integrated ponds also achieved better body weight than those in the control ponds. This improved growth rate contributed to a yield of 8,928 kg/ha/year in the integrated system, compared to 5,145 kg/ha/year in the control ponds. These results demonstrate that integrated fish-duck farming is more profitable than non-integrated systems (control) under rural conditions in Tamil Nadu, as it yields higher fish production without additional inputs.

Lady health workers smoking cessation initiative in rural Pakistan

Abstract Background In Pakistan, tobacco smoking and indoor smoke from cooking fires pose significant health risks. Lady Health Workers (LHWs) play a crucial role in improving healthcare access, particularly in rural areas. This study aimed to explore the practicality of training LHWs to deliver health education aimed at reducing household exposure to tobacco smoke and indoor biomass smoke, while also documenting baseline exposure levels and assessing the immediate impact on household awareness and intentions to reduce exposure. The Program Over 170 LHWs were trained and equipped with health education resources to raise awareness about the risks of tobacco and biomass smoke exposure. The training was designed to be integrated into their routine duties. Results Over 24 weeks, the program was delivered to 25,760 households in Gujranwala district. Approximately half of these households had at least one person who smoked, with 90% smoking indoors. Many (85%) households used indoor cooking fires. Only 24% of household head-women were aware of the health risks associated with indoor smoke exposure. Awareness of less harmful alternatives to smoking was low. Most households had someone who wanted to stop smoking and 51 women and 146 men agreed to try a tobacco harm reduction (THR) product. Primary health units’ staff appreciated the project, especially the training provided. They believed the program could be sustainable, and LHWs expressed interest in continuing it. Conclusion The study demonstrated the practicality of training LHWs to deliver health education on reducing tobacco and biomass smoke exposure in rural settings. The program effectively raised awareness and showed potential for sustainable integration into existing healthcare structures, highlighting the value of community-centric approaches in low-resource settings.

Association Between Social Determinants of Health and Patient Portal Utilization in the United States

(1) Background: Differences in health outcomes across populations are due to disparities in access to the social determinants of health (SDoH), such as educational level, household income, and internet access. With several positive outcomes reported with patient portal use, examining the associated social determinants of health is imperative. Objective: This study analyzed the association between social determinants of health—education, health insurance, household income, rurality, and internet access—and patient portal use among adults in the United States before and after the COVID-19 pandemic. (2) Methods: The research used a quantitative, retrospective study design and secondary data from the combined cycles 1 to 4 of the Health Information National Trends Survey 5 (N = 14,103) and 6 (N = 5958). Descriptive statistics and logistic regression were conducted to examine the association between the variables operationalizing SDoH and the use of patient portals. (3) Results: Forty-percent (40%) of respondents reported using a patient portal before the pandemic, and this increased to 61% in 2022. The multivariable logistic regression showed higher odds of patient portal utilization by women compared to men (AOR = 1.56; CI, 1.32–1.83), those with at least a college degree compared to less than high school education (AOR = 2.23; CI, 1.29–3.83), and annual family income of USD 75,000 and above compared to those <USD 20,000 (AOR = 1.59; CI, 1.18–2.15). Those with access to the internet and health insurance also had significantly higher odds of using their patient portals. However, those who identified as Hispanic and non-Hispanic Black and residing in a rural area rather than urban (AOR = 0.72; CI, 0.54–0.95) had significantly lower odds of using their patient portals even after the pandemic. (4) Conclusions: The social determinants of health included in this study showed significant influence on patient portal utilization, which has implications for policymakers and public health stakeholders tasked with promoting patient portal utilization and its benefits.

Abstract 4134851: Demographic and regional disparities in cerebrovascular disease mortality among adult patients with pre-existing atherosclerosis in the United States from 1999-2020

Introduction: Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD. Methods: CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC). Results: A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 - 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 - 5.5), Hispanics (4.1, 95% CI: 4.0 - 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 - 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 - 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B). Conclusions: Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.

Exploring factors influencing pedestrian accident severity: a multi-source study in the city of Berlin

Abstract Background Road safety remains a critical concern in Europe’s transport sector. In urban areas, where 40% of total road fatalities occur, pedestrians are particularly vulnerable, since according to road safety data accidents involving a pedestrian are 2.8 and 15 times more probable to be fatal than in rural areas and motorways respectively. In line with the Vision Zero concept and the European Commission’s directives, many EU members are taking steps to improve road safety. Accordingly, the identification of the key factors behind pedestrian accident occurrence and pedestrian accident severity in urban areas is ever more relevant. Methodology The proposed methodology employs traditional logistic regression models and artificial neural networks, using accident data from Berlin, Germany, sourced from the Berlin Open Data portal. The dataset comprises information on 3,257 accidents involving pedestrians in 2018 or 2019, including details about involved vehicles, accident details, and injury severity information. Additionally, the dataset was augmented with average network speed data from Uber Movement and road network information from Geographic Information System (GIS) applications. Results Formal analysis results indicated several factors as significant to accident severity, such as involvement of bicycle or heavy vehicles, lighting conditions, speed limit and accident type. Additionally, a comparison between modelling approaches shows a clear performance advantage of ANNs over statistical models. Research findings provide insight for various stakeholders working to enhance pedestrian safety in urban areas.

An assessment of household solid waste management in Mainpuri, Uttar Pradesh, India

<p>Rapid industrialization, urbanization, population growth, and migration from rural areas have resulted in increased solid waste generation in developing cities, which is commonly regarded as the most significant urban issue. The improper disposal of waste and inefficient collection methods is a significant problem in most of the municipalities in Indian cities. This challenge is further compounded by unscientific waste treatment practices, lack of modern technology, and limited resources. This study aims to assess the status of solid waste generation and disposal across different household income groups and to evaluate how Mainpuri manage and handles the solid waste management system. The study is based on primary data collected through a household survey in Mainpuri city, covering a sample of 1,836 households from various income groups. The data used in this assessment was collected from household surveys and government records. Although there is a recycling plant in operation, its capacity is inadequate to address the increasing waste generation and demands of the community. This shortfall underscores the need for enhanced waste management strategies and infrastructure to effectively cope with the rising volumes of solid waste. As a result, large quantities of solid waste accumulate in low-lying areas near the Isan River and the proximity of the plant. Without a comprehensive solid waste management plan in the municipality, the situation is likely to deteriorate further. Mainpuri City urgently needs a sustainable strategy to effectively manage its solid waste, addressing both current challenges and future demands. Implementing such a strategy is essential for improving public health, environmental conditions, and overall quality of life in the city.</p>

Morphological and agronomic evaluation of short-cycle native maize varieties (Zea mays L.)

Objective: The objective of this study was to analyze the morphological composition and agronomic behavior of five varieties of Zea mays L. Two Zapalote Chico, two Zapalote Grande and an improved variety (V-424) which are characterized by having a short vegetative cycle Desing/methodology/approach: The maize varieties evaluated were sourced from various locations within the municipality, with explicit consent from the producers, who provided the seeds for the study. Four native cultivars (treatments) were selected from the Zapalote Chico and Zapalote Grande races and one improved and open-pollinated maize variety (V-424 or Tuxpeño Precoz) as a control, released by INIFAP. The local farmers assigned the common names to the evaluated maize varieties, except for V-424. The varieties were distributed in a randomized block design with four replications, resulting in a total of 20 experimental units. Each unit consisted of four furrows, each measuring 4 meters in length. Results: The findings of this study on native short-cycle maize varieties in Chiapas have significant implications at the genetic, social, cultural, economic, and environmental levels. Each of these aspects provides crucial guidance for decision-making related to the utilization, management, and conservation of local maize varieties. A key outcome of this study is the recognition of native maize as a repository of essential genes for food security in rural areas. Short-cycle landraces exhibit unique genetic adaptations that enable them to thrive under the specific agroclimatic conditions of the Frailesca region in Chiapas. Limitations on study/implications: none Findings/conclusions: The native maize varieties exhibited significant genetic variability across the variables under consideration. The Zapalote Chico race is characterized by its favourable characteristics, as recognized by farmers, including early maturity, drought resistance, lodging resistance, and resistance to the fall armyworm. These qualities make it a promising candidate for future research and for inclusion in genetic improvement programs, whether conventional or participatory. It is crucial to continue promoting agroecological inputs with the goal of fostering the development of resilient agroecosystems and, consequently, enhancing the well-being of farmers and the conservation of native maize reservoirs.

Abstract 4128698: Mental Health and Sleep Quality as Determinants of Physical Activity Levels in Depressed Rural Patients with Coronary Heart Disease

Background: Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psychological distress, and physical activity among depressed rural CHD patients have not been examined. Purpose: The purpose of this study was to determine the association of sleep quality (i.e., sleep fragmentation [frequent sleep interruption] and nocturnal/sleep movement [increased rates of movement, ‘tossing and turning’ during sleep]) and psychological distress (i.e., anxiety and perceived stress) with levels of physical activity (i.e., sedentary, light, and moderate to vigorous) in depressed rural patients with CHD. Methods: A total of 142 depressed rural CHD patients (aged 57.0±11.9 years, 97% White) completed surveys on demographic characteristics, anxiety (Brief Symptom Inventory), and stress (Perceived Stress Scale-4). Participants also wore accelerometer activity monitors for seven days (ActiGraph GT9X Link) to capture physical activity levels and sleep quality. Three different hierarchical regression models were conducted to predict each level of physical activity (sedentary, light, and moderate-vigorous) with predictor variables entered in blocks. Block 1 included demographic variables (i.e., age, sex, marital status, employment status). Block 2 included sleep quality measures, and Block 3 included psychological distress. Results: Participants spent 466±126.0 min/day while awake being sedentary, 483±119.9 min/day in light activity, and 90±65.9 min/day in moderate to vigorous activity. We found that stress was significantly associated with greater sedentary time (B = 6.56, p = .043) and less time in light activity (B = -7.99, p = .024). Nocturnal/sleep movement was significantly associated with increased sedentary time (B = 3.14, p < .001) and decreased time in light (B = -5.29, p =.002) and moderate-vigorous activity (B = -2.58, p = .003). Anxiety was not associated with physical activity. Conclusions: Poor sleep quality and greater perceived stress are associated with a more sedentary lifestyle, a major risk factor for CHD. Addressing both stress and sleep management may play a role in reducing CHD risks associated with inactivity among depressed rural patients with CHD.

Factors Associated with Food Waste Among University Students in Colombia

(1) Background: Globally, millions of tons of food are wasted annually, with a significant portion occurring at the household level. This study aimed to quantify food waste generated by university students and identify key factors associated with this behavior. (2) Methods: A cross-sectional study was conducted in a community trial involving 227 Colombian university students. Participants self-reported their daily food waste (grams per person per day), as categorized by food type, which was collected through an online-based questionnaire under prior training. The data were analyzed using a binomial regression model to calculate adjusted prevalence ratios (PRaj) and identify associations between food waste and demographic variables. (3) Results: Of the participants, 63% were women, with a mean age of 20.4 ± 3.8 years. Overall, 65% (n = 148) reported food wastage. The average food waste per person per day was 22.6 ± 15.5 g, increasing to 94.0 ± 5.0 g among those who reported wastage. Significant associations were found between food waste and several factors: Among those with a higher prevalence of food waste were women (PRaj = 1.49; 95% CI: 1.19, 1.89); students from rural areas (PRaj = 1.39; 95% CI: 1.15, 1.67); and those with higher income levels, with adjusted prevalence ratios of 1.38 (95% CI: 1.14, 1.68) for those earning 1–2 Minimum Legal Monthly Wages (LMMW) and 1.49 (95% CI: 1.15, 1.93) for those earning 3+ LMMW. Household size and socioeconomic status were not significantly associated with food waste (p > 0.05). (4) Conclusions: On average, the population generates 8.25 kg of food waste per person per year, rising to 34.31 kg among those who report wasting food. Gender, geographic location, and income were key predictors of daily food waste.

Spatiotemporal Dynamics of Water Quality: Long-Term Assessment Using Water Quality Indices and GIS

The severe contamination of groundwater supplies in rural areas is a global problem that requires strict environmental measures. Related to this, one of the most important challenges at present is the elimination of local sources of pollution. Therefore, this research examined the local water quality changes following the construction of the sewerage network, under the framework of long-term monitoring (2011–2022) in Báránd, Hungary, using water quality indices and GIS (Geographic Information System) techniques. In order to understand the purification processes and spatial and temporal changes, three periods were determined: the pre-sewerage period (2011–2014), the transitional period (2015–2018), and the post-sewerage period (2019–2022). Forty monitoring wells were included in the study, ensuring complete coverage of the municipality. The results revealed a high level of pollution in the area in the pre-sewerage period. Based on the calculated indices, an average of 80% of the wells were ranked in categories 4–5, indicating poor water quality, while less than 8% were classified in categories 1–2, indicating good water quality. No significant purification process was detected in the transitional period. However, marked changes were observed in the post-sewerage period as a result of the elimination of local sources of pollution. In the post-sewerage period, the number of monitoring wells ranked as excellent and good increased significantly. Additionally, the number of wells assigned to category 5 decreased markedly, compared to the reference period. The significant difference between the three periods was confirmed by the Wilcoxon test as well (p < 0.05). Based on interpolated maps, it was found that, in the post-sewerage period, an increasing section of the settlement had good or excellent water quality. In addition to an assessment of long-term tendencies, the annual fluctuations in the water quality of the wells were also examined. This showed that the purification processes do not occur in a linear pattern but are influenced by various factors (e.g., precipitation). Our results highlight the importance of protecting and improving groundwater resources in municipal areas and the relevance of long-term monitoring of water adequate management policy.

Abstract 4127417: Trends in Atherosclerotic Cardiovascular Disease Related Mortality Among Older Adults in the United States From 1999-2021

Background: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established. Aims: This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7). Figure 1. Conclusion: Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Abstract 4122048: Disparities in Heart Failure-Related Mortality Among Reproductive-Aged Women in the United States from 1999 to 2019

Introduction: Heart failure (HF) majorly affects the elderly, but can also affect the younger population. This study aims to examine the trends of HF-related deaths among reproductive-aged women in the United States (US). Method: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 codes I11, I13.0, I13.2, and I50 to find HF-related deaths among women aged 15-44 from 1999 to 2019. We examined demographic disparities in HF mortality rates over time, considering age, ethnicity, and geographic areas. Results were reported as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). Joinpoint regression assessed trend changes and annual percentage change (APC). Results: Between 1999 and 2019, a total of 43,683 women aged 15-44 died from HF in the US, with an AAMR of 3.5 per 100,000 (95% CI: 3.5-3.5). The AAMR increased from 2.6 in 1999 to 4.8 in 2019. Non-Hispanic Black women had the highest AAMR at 10.2, while Hispanics had the lowest at 1.8. Geographically, the South was the most affected region with an AAMR of 4.6, contributing to nearly half (48.9%) of all deaths. States including Massachusetts, Oregon, New Hampshire, and Minnesota had the lowest AAMRs. Rural areas showed a higher AAMR compared to urban areas (4.4 Vs. 3.3). The age group (35-44) accounted for the majority of deaths (73.7%). Conclusion: HF-related mortality among reproductive-aged women increased from 1999 to 2019, with the highest burden among non-Hispanic Black women and those in the Southern region. Enhancing access to care, particularly in rural areas, and implementing targeted prevention programs are vital to reducing mortality rates.

Abstract 4128457: Trends in Hypertension-Related Mortality Among Younger Adults in the United States From 1999-2021

Background: The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated. Aim: We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S. Methods: Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region. Results: Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0). Figure 1. Conclusion: Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

FOSTERING ESL STUDENTS’ MOTIVATION IN WRITING THROUGH THE INTEGRATION OF ICT: A FOCUS ON TEACHERS AND STUDENTS

This study investigated the motivation in English writing by using the ICT in secondary school. The objectives of this study are to examine the impact of using ICT on ESL students’ motivation to engage in writing skills, and to explore how teachers incorporate ICT into ESL writing instruction to enhance motivation among students. This study used qualitative approach as the main approach by implemented semi-structured interview and open-ended questionnaire as the instruments. The total eight respondents including two secondary school English teachers age 31 and 46 years old meanwhile 6 secondary school students age 13 to 16 years old were participated in this research. The result reveal that ICT significantly enhances student motivation and engagement, making the learning more enjoyable and less monotonous, helping students clarify doubts and develop ideas more quickly especially in writing lesson. Implications of the study are where it enhanced student engagement and motivation, and improve learning and understanding in English writing lesson. Future research for this study is recommended due to the fact that majority of secondary schools in Malaysia such as rural area might need a better ICT implementation especially in English writing lesson. Addressing these issues could involve exploring how to improve ICT infrastructure, provide targeted professional development for teachers, and develop strategies to incorporate technology into curricula more effectively.

Abstract 4115684: Outcomes Associated with Remote Monitoring without In-person Evaluations for Patients with Cardiovascular Implantable Electronic Devices

Introduction: Traditionally, patients with cardiovascular implantable electronic devices (CIEDs: pacemakers and implantable cardioverter-defibrillators) attend in-person visits at least annually, paired with remote monitoring (RM). Because similar data are obtained through RM and in-person visits, it is unclear whether routine in-person visits are necessary. Two small trials conducted outside the U.S. found no difference in clinical outcomes without routine in-person visits for patients engaged in RM, but their generalizability is uncertain. Research Aim: To determine whether routine visits for CIED care are associated with major adverse cardiac events (MACE) among patients in the U.S.’ largest public integrated health system, the Veterans Health Administration (VHA). Methods: We classified Veterans who received their CIED care within VHA and sent ≥1 RM transmission between 7/1/20-6/30/21 into one of three groups based on type of clinical encounters for CIED care: (1) any in-person, (2) virtual-only (telephone and/or videoconference), or (3) no in-person or virtual visits. Data were obtained from the VHA National Cardiac Device Surveillance Program and Corporate Data Warehouse. The primary outcome was MACE, a composite of all-cause mortality, stroke, and cardiac hospitalization, between 7/1/21-6/30/22. We performed multivariable logistic regression, adjusting for patient and device characteristics. Results: Of 40,366 patients, 27,298 (68%) had at least one in-person visit, 9,268 (23%) had only virtual visits, and 3,800 (9%) had neither. Mean age was 73 years, 97% were male, and 37% lived in rural areas. There were 6522 (23.9%) MACE events among patients who had in-person visits, 2116 (22.8%) among those who had only virtual visits, and 947 (24.9%) among those who had no visits. After multivariable adjustment, there was no significant association between encounter type and MACE [odds ratio 0.93 (95% CI: 0.85-1.01) for patients who had any in-person or virtual visits compared to those without]. Conclusion: Among patients engaged in RM, the odds of MACE was similar regardless of whether patients had in-person or virtual visits versus no visits. Although there could be unmeasured confounding, these results suggest routine in-person or virtual visits may no longer be necessary for CIED care with RM. Patients, clinicians, and healthcare systems could benefit by reducing low-value visits and re-focusing resources on visits that yield actionable interventions.

Effects of Social Determinants of Health on Acute Stroke Care Among Patients With Acute Ischemic Stroke: A Retrospective Cohort Study.

Social determinants of health (SDOH) are important contributors to poor stroke-related outcomes. While some have suggested that this association is driven by the increased incidence of stroke observed with poor SDOH, others have raised concerns regarding disparities in acute stroke care. This study aimed to determine the association between SDOH and the administration of thrombolytic therapy and mechanical thrombectomy among patients with acute ischemic stroke. A retrospective cohort analysis was conducted using Texas Emergency Department Public Use Data (2016-2019), including adult patients diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (Social Vulnerability Index [SVI]) were computed using mixed-effects Poisson regression models accounting for the nested nature of patients in hospitals and neighborhoods. The Charlson comorbidity score was considered as a covariate. Of the 139,852 patients with ischemic stroke (female, 51.7%; White, 67.2%; Black, 16.6%; Hispanic, 25.1%), 16,831 (12.3%) received thrombolytic therapy and 5,951 (4.3%) received mechanical thrombectomy. Age older than 65 years (RR 0.578 [0.537-0.621]) vs 18-45 years, Black (RR 0.801 [0.761-0.844]) vs White, Hispanic (RR 0.936 [0.895-0.98]) vs non-Hispanic, Medicare/Medicaid/Veterans Affairs (VA) (RR 0.917 [0.882-0.954]) or uninsured (RR 0.883 [0.833-0.935]) vs private insurance, and rural (RR 0.782 [0.723-0.845]) vs urban dwelling were less likely to be associated with thrombolysis. Patients in the highest quintile based on the SVI were less likely to receive thrombolysis than those in the lowest quintile (RR 0.926 [0.867-0.989]). Patients were less likely to receive thrombectomy if they were 65 years and older (RR 0.787 [0.691-0.895]), belonged to the Black race (RR 0.745 [0.679-0.818]) or Hispanic ethnicity (RR 0.919 [0.851-0.992]), had Medicare/Medicaid/VA insurance (RR 0.909 [0.851-0.971]), or were from a rural area (RR 0.909 [0.851-0.971]). Similarly, SVI decreased the likelihood of undergoing mechanical thrombectomy (RR 0.842 [0.747-0.95]). Despite many improvements in stroke management, SDOH continue to be a significant driver of treatment access for acute ischemic stroke. While our findings are limited to Texas, our results should raise awareness and promote more studies regarding the effects of these SDOH at the national and international levels.

Spatial heterogeneity analysis on distribution patterns and underlying determinants of historical rural settlements: a case study in Taihang Baxing

AbstractAs vital carriers of cultural heritage, rural areas are facing the threats of degradation and urbanization during rapid urbanization processes. In recent years, China has formulated and implemented a series of national policies, regulations, and heritage protection lists to safeguard and perpetuate the traditional patterns and historical features of rural heritage. However, these rural heritage listings exhibit significant macro-level distributional imbalances and generally lack consideration of regional characteristics. This study uses the Taihang Baxing (THBX) in China as a case study, initially employing historical local documents and maps as base data. It utilizes the stability in the evolution of Chinese characters to compare historical and contemporary village names, filtering out existing historical rural settlements (HRS) to construct a dataset. Further, a multi-scale geographically weighted regression (MGWR) model is applied to analysis the impacts of natural, economic, and social factors on the concentration of HRS (CHRS). The study reveals that the CHRS in the region is markedly characterized by clustering, with evident spatial heterogeneity in the impacts of various factors. Slope (SLP), total annual precipitation (TP), and potential crop yield (PCY) significantly influence the CHRS globally, while elevation (ELV), distance to ancient path (DAP) and surface runoff (DSR), gross domestic product (GDP), and road density (RD) have significant local impacts. This research offers a methodological framework for HRS data compilation and provides theoretical and methodological references for national and local levels of rural heritage protection, optimization of rural spatial patterns, prediction of rural evolution pathways, and implementation of China’s rural revitalization strategy.

Abstract 4128261: Heart Failure-Associated Sudden Cardiac Death: Trends and Demographic Differences in the United States Adults, 1999 to 2020

Background: The US population has seen a dramatic increase in the burden of heart failure (HF) and sudden cardiac death (SCD) mortality. SCD is one of the prominent causes of mortality in HF patients. However, HF-associated SCD-related mortality trends have not been established yet. Aims: This study aims to highlight the annual trends and demographic differences in HF-associated SCD mortality among adults in the U.S from 1999-2020. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2020 for HF-associated SCD mortality in adults over the age of 25. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons was calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2020, 39,660 HF-associated SCD-related deaths occurred among US populations. Following a reduction from 10.9 in 1999 to 6.8 in 2018 (APC, -2.5 [-2.8 to -2.3]), AAMR increased to 8.2 in 2020 (APC, 10.3 [3.6 to 13.7]) in the overall population. Men had consistently higher AAMRs than women from 1999 (AAMR men: 15.1 vs women: 7.9) to 2020 (AAMR men: 11.3 vs women: 5.6). Non-Hispanic (NH) Black or African Americans had the highest AAMR (14.0), followed by NH Whites (8.3), and Hispanics or Latinos (3.4). Southern region had the highest AAMR (10.4), followed by Midwest (9.6), West (5.8), and Northeast (5.8). Moreover, rural areas had consistently higher AAMR (14.6) than urban areas (6.9). Conclusion: Following a steady decline until 2018, HF-associated SCD mortality in adults increased between 2018 and 2020. The highest AAMRs were observed among Black or African American adults and men, and patients living in the Southern and non-metropolitan areas. Tailored strategies focusing specifically on arrhythmic events and related mortality in HF patients are needed to address the recent surge in mortality rates among these demographics.