The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for opioid use disorder (OUD). The geographic variability in OODs drives the need for localized decision-making, where interventions are tailored to the unique needs of communities. This study aimed to develop and calibrate a simulation model that evaluates the impact of enhanced implementation of EBP on OODs at the community-level. We developed OPSiM (Opioid Policy Simulation Model), a community-level microsimulation model that simulates the course of opioid use, OUD, treatment, recovery and overdose-related events. The model was parameterized with data from the HEALing Communities Study and looked at six scenarios of EBPs implemented in 2025 with sustainment through 2030: (1) maintain 2024 EBP levels (status quo); (2) increase initiation of medications for opioid use disorder (MOUD); (3) increase MOUD retention; (4) increase MOUD initiation and retention; (5) increase distribution of naloxone; and (6) both scenarios 4 and 5. Twenty-nine communities in Massachusetts, New York, and Ohio, USA. Simulated community residents with non-prescribed opioid use or OUD. Estimated number of OODs per 100 000 individuals between 2025 and 2030 in each community, averaged across the 26 communities. Under the status quo, the model projected 158 OODs (range across communities: 39-468) per 100 000 individuals between 2025 and 2030. Increasing medications for the treatment of OUD (MOUD) retention alone reduced OODs by 6% (range: 3-15%), while increasing MOUD initiation alone reduced OODs by 9% (range: 8-12%). Increasing both MOUD initiation and retention had a synergistic effect, reducing OODs by 21% (range: 15-31%). Reduction in OODs in response to increased MOUD initiation and/or retention was similar across urban and rural communities. The effect of increasing naloxone distribution varied substantially across communities due to differing saturation levels; in some communities, additional naloxone kits provided only marginal benefits. Rural communities were further from saturation whereas most urban communities were at or close to saturation. A tailored, multi-pronged approach that scales up medications for opioid use disorder alongside widespread naloxone distribution, and that addresses community-specific needs and capacities, will be most effective at reducing opioid overdose deaths in the United States.

Investigating traditional ethnobotanical knowledge and the use of medicinal plants in rural communities in Assam's Bajali district: An examination of native medical practices and cultural legacy.

Left behind: forgone medical care due to transportation barriers among adults with physical impairments and disabilities that prevent physical activity in small and rural communities

Human papillomavirus (HPV) related cancer incidence is higher among American Indian/Alaska Native (AI/AN) women than among White women. Limited access to health care or preventive services in rural communities might increase cancer risk among AI/AN people. To understand disparities in Alaska, this study compares rural/urban HPV vaccination rates of AI/AN with non-AI/AN people. Immunization rate data were extracted for each year during 2018-2023. Immunization rates from the Alaska Immunization Information System (VacTrAK) were compared between AI/AN and non-AI/AN people. From 2018 to 2023, HPV vaccine series completion among Alaska adolescents aged 13-15 years ranged from 32% to 39%, with 32% up to date in 2023; 48% had initiated vaccination. AI/AN adolescents had significantly higher completion than non-AI/AN peers (48% vs. 29%, p < 0.01), with consistently higher coverage across years and in both rural and urban settings after stratification; rural coverage was higher overall. Regional disparities were substantial, with series completion ranging from 15% to 58%. HPV vaccination coverage among Alaska adolescents remained low from 2018 to 2023, with substantial decline between initiation and series completion. AI/AN adolescents had significantly higher coverage than non-AI/AN peers, challenging assumptions about access and highlighting the effectiveness of community-centered, Tribal-led vaccination efforts. Persistent regional and urban-rural disparities, along with recent declines in AI/AN coverage, underscore the need to strengthen equitable strategies and improve series completion.

Microbial networks and pathogen detection: Insights from ticks and patients with acute febrile illness.

Diabetic foot ulcers (DFUs) remain one of the most devastating complications of diabetes, accounting for over 80% of nontraumatic amputations and contributing to a 5-year mortality rate exceeding 30%. Despite significant clinical advances, profound disparities persist. Racial and ethnic minoritized populations, rural communities, and people with low socioeconomic resources experience disproportionate rates of severe ulceration, infection, delayed healing, and amputation. Traditional research approaches, often developed in academic settings without community input, have insufficiently addressed the contextual, cultural, and structural factors shaping DFU risk and outcomes. Community-engaged research (CEnR) offers a promising pathway to address these inequities; yet, DFU-specific evidence remains limited and heterogeneous. In response, the Diabetic Foot Consortium (DFC), a national research network funded by the National Institute of Diabetes and Digestive and Kidney Diseases, has initiated multisite efforts to embed community advisory boards, faith-based partnerships, mobile outreach, and culturally aligned engagement into DFU research. We propose the DFC-CEnR Model, a conceptual framework for integrating community-engaged approaches to DFU prevention, early detection, treatment, and research participation. The model distinguishes CEnR from related approaches (community-based participatory research, patient and public involvement, cultural humility, and equity-focused system interventions), outlining hypothesized mechanisms and evaluation domains. Illustrative consortium examples demonstrate how engagement domains may be operationalized and inform future testing of validated outcome measures. This article positions community engagement as a hypothesis-generating strategy that requires rigorous empirical testing to determine its impact on DFU outcomes and disparities.

Study protocol for weSIPsmarter: A cluster randomized-controlled trial to evaluate the efficacy of a digital health intervention aimed at reducing sugary drinks among rural Head Start preschoolers and their parents.

Increasing physical activity in rural Pennsylvanians: The PA moves trial study protocol for a cluster randomized controlled trial.

Local women's organisations assume essential roles during disasters in hazard-prone, rural poor communities, especially when government capacities are overwhelmed and non-government resources are required to meet affected people's needs. Yet, they are often deprioritised as international actors' partners of choice in the well-established humanitarian system of the Philippines. This paper illustrates how they navigate vertical social ties with international humanitarian organisations to enhance their resilience in disaster preparedness, response, and recovery. It examines whether strengthening the linking social capital of local women's organisations with international humanitarian non-governmental organisations can: improve women's ability to access resources in disasters; challenge the power dynamic in such a way that women are able to engage meaningfully in decision making and attain an equal footing in the partnership; and increase the capacity of women to build community resilience as an outcome of improved access and meaningful engagement. The study engaged 10 leaders of the National Rural Women's Coalition (PKKK) in semi-structured interviews and applied a social constructionist, feminist standpoint framework to the analysis. It found that rural women navigate asymmetrical power dynamics in creative ways and value partnership behaviours that demonstrate equitability and true accompaniment.

Mansonella streptocerca is a species of neglected skin-dwelling filarial nematode parasite with scarce epidemiologic data from Central Africa. We conducted a cross-sectional survey of 1,007 adults from 51 rural and semiurban communities in Gabon to update prevalence estimates and identify risk factors. Molecular analyses by quantitative PCR detected filarial DNA in 18.3% of skin snips; M. streptocerca predominated (14.2%), and Onchocerca volvulus (3.4%) occurred focally in a single rural area. Blood-dwelling parasite species such as Loa loa, M. perstans, and Mansonella sp. "DEUX" were rarely detected. M. streptocerca infection was 4 times more frequent in rural areas than in semiurban areas and independently associated with male sex, urticaria, and poor housing conditions. Wolbachia DNA occurred in 28% of M. streptocerca-positive samples, suggesting endosymbiosis. Our findings reveal a substantial but overlooked burden of M. streptocerca nematodes in Gabon and emphasize the need for integrated surveillance of skin-dwelling filarial infections in Central Africa.

Objectives. To examine (1) the strategies regional public behavioral health boards employ to align county-based public social service agencies with private substance use treatment organizations, (2) regional variations in strategies, and (3) factors that affect community-board relationships. Methods. We conducted a multiple case study of 17 Ohio county-based systems implementing a cross-sector model to support parental substance use disorder (Ohio START). We applied template analyses to 48 small group interviews conducted in 2020-2021 with 104 staff from child welfare and behavioral health organizations and community boards. Results. Participants described direct and indirect ways that boards supported system alignment, funding, brokering of information and relationships, and planning. Reasons for boards not being involved included perceived needlessness and a lack of connection between the board and the community. Rural and Appalachian communities reported various forms of close integration of boards and communities. Conclusions. Behavioral health boards can support cross-system integration by reducing barriers to collaboration and enhancing community capacity to address complex public health issues, especially in resource-limited regions. Public Health Implications. Incorporating a centralized organization could mitigate implementation barriers and promote effectiveness in community collaborations, especially under resource constraints. (Am J Public Health. 2026;116(S3): S202-S209. https://doi.org/10.2105/AJPH.2026.308579).

Using 15 years of hospital survey data (2008-2023), we examined rural-urban trends in electronic health records (EHR) adoption and advanced capabilities for data sharing, public health reporting, and care improvements. We conducted a repeated cross-sectional study using the American Hospital Association Annual Survey Information Technology Supplement (2008-2018, 2020-2023). We constructed hospital-year measures of basic and comprehensive EHR capability, certified EHR technology (CEHRT) adoption, and advanced functions in patient engagement, interoperability, public health reporting, and social determinants of health (SDOH). We compared rural and urban adoption using descriptive analyses, Cochran-Armitage trend tests, and logistic regression with clustered standard errors, adjusted for bed size, ownership, and census division. The cohort included 41838 hospital-years (45% rural). Comprehensive capability rose from 2% in 2008 to 75% in 2020, and CEHRT was nearly universal by 2023. Rural hospitals lagged urban hospitals in adopting basic and comprehensive EHRs, with the gap peaking at 25% in 2016. By 2021-2023, most hospitals reported patient portals, interoperability, public health reporting, and SDOH capabilities. Rural hospitals remained 4%-15% behind urban peers in advanced functions, particularly interoperability, public health reporting, and SDOH data collection and use. Persistent rural-urban gaps in advanced EHR use may limit interoperability, data-driven care, and public health reporting in rural settings. EHR adoption is widespread, but substantial rural-urban gaps persist in advanced EHR use. Support for advanced capabilities that enable data sharing, reporting, and data-driven improvement is needed to ensure that rural hospitals and communities benefit from digital transformation beyond adoption.

North Carolina's (NC) healthcare workforce shortages have been a major concern, as geographic health disparities become more pronounced and health outcomes decline in rural communities compared to those in urban areas. Rural residents face severe challenges accessing primary and specialized care and behavioral health services, especially in counties designated as Health Professionals Shortage Areas (HPSAs). NC will continue to experience these challenges as its overall population grows.Historically, NC had to pivot and reimagine policies and programs to improve its workforce crisis with federal assistance. Medicaid expansion and transformation, provider incentives, international labor recruitment, and innovative federal funding sources helped mitigate critical provider gaps and enhance access to care. However, in the wake of state budget challenges and fiscal restraints, persistent provider differentials remain.This article discusses how federal assistance has impacted the rural healthcare workforce crisis in North Carolina prior to the passage of the H.R.1 One Big Beautiful Bill Act (OBBBA) of 2025 (Congress.gov 2025). It also examines OBBBA's policy provisions and NC's plan for workforce improvements with the $213 million funding awarded through the Rural Health Transformation Program.

How to respond effectively to extreme flood events? Lessons from non-frequently flooded rural communities in northern China

Use of telehealth for behavioral health services has rapidly expanded with potential to reduce rural health disparities. Applying evidence-based treatments for problematic sexual behavior (PSB) among youth via telehealth can prevent further sexual harm of children. Successful implementation of telehealth in rural communities requires examining the acceptability, understanding, barriers, and facilitators of the approach. Using a qualitative approach, this study explores family and clinician perception of the utility of telehealth to enhance access to PSB cognitive behavioral group treatment (PSB-CBT) services. Results revealed telehealth provided opportunities to address internal (e.g., shame, stigma) and external barriers (e.g., time, transportation, childcare), as well as impact of unique rural communities' characteristics. Privacy, safety, reduced isolation and shame, and enhanced sense of community among members were noted as benefits of group telehealth, while technology literacy, device accessibility, and group appropriateness were reported obstacles. Strategies to enhance success included telehealth orientation, loaning secure devices, integrated therapeutic activities, focused efforts on building relationships among members, and augmenting with family sessions. Future research on implementation and treatment outcomes of group telehealth for PSB is recommended.

Vector-borne pathogens are expanding in northern Europe as climate and host-vector communities change, shifting vector distributions, yet baseline data from boreal systems and early-life wildlife hosts remain scarce. Moose (Alces alces) represent a useful sentinel species for monitoring pathogen circulation at the wildlife-vector interface because they occupy diverse habitats and are widely distributed across boreal ecosystems. In this study, we investigated the occurrence and phylogenetic location of Trypanosoma spp., Anaplasma phagocytophilum and Bartonella spp. in moose calves during their first season of life, providing insight into early exposure patterns relevant to integrated surveillance. Whole-blood samples from 23 calves (twenty-two hunted animals and one found dead) were screened by PCR and sequenced for 18S rRNA (Trypanosoma), 16S rRNA (A. phagocytophilum) and rpoB (Bartonella). At least one pathogen was detected in 44% (10/23) of calves. Trypanosoma DNA was found in 35% (8/23) and all isolates clustered within the TthII lineage of the Trypanosoma theileri complex, including three novel 18S rRNA haplotypes deposited in GenBank. Anaplasma phagocytophilum was detected in 17% (4/23), with sequences identical to reference haplotypes reported from Eurasia. Bartonella spp. were detected in 9% (2/23), with the rpoB haplotype identical to a lineage previously reported from North America and closely related to ruminant-associated Bartonella species. The detection of multiple vector-borne hemoparasites in moose calves indicates that exposure to diverse pathogens can occur early in life in boreal cervid communities. Phylogenetic relationships suggest that the detected lineages are part of widely distributed pathogen populations rather than locally confined variants. Although this study was not designed to quantify zoonotic risk, documenting pathogen circulation in free-ranging moose may support One Health-oriented surveillance integrating wildlife hosts, vectors, and environmental factors, particularly in regions where hunters and rural communities may be exposed to vector-borne pathogens. These findings establish the grounds for future monitoring efforts aimed at understanding pathogen dynamics, host condition, and emerging vector-borne risks in boreal ecosystems of northern Europe.

Access to adolescent mental healthcare in rural communities can be improved through community leadership, education and cooperation.

Intermittent closures of rural maternity units in northern Sweden disrupt access to essential sexual and reproductive health services, making intrapartum care unpredictable for local women. While long travel distances have been linked to adverse outcomes, less is known about how women view the closures and prepare for birth when local services are unavailable. Hence, the aim of this study is to analyse how women make sense of and negotiate the meaning of their pregnancy and childbirth in relation to intermittent maternity unit closures in rural contexts. Semi-structured interviews were conducted with 20 women who were pregnant or had given birth between May 2024 and August 2025 and lived in the catchment area of a rural maternity unit with repeated closures. Interviews were conducted in Swedish in September-November 2025, transcribed verbatim and analysed using discourse psychology to identify interpretative repertoires and subject positions. The closures created a discursive gap in which established expectations about where and how birth should take place no longer functioned as stable points of reference. Three interpretative repertoires were identified: equity and legitimacy, where women framed rural living as a chosen life yet treated secure maternity care as non-negotiable; moral responsibility, where risk management shifted from system-level preparedness to women's own planning, including preparing for both hospital and roadside birth; and bodily vulnerability and dignity, where distance, admission thresholds and travel reshaped bodily labour, dignity and help-seeking, sometimes leading women to delay or avoid contacting healthcare services despite their concerns. Intermittent closures disrupt access to maternity care and shift the responsibility for managing uncertainty and risk from the healthcare system to women themselves. Access to sexual and reproductive health services is more than a matter of geographical availability; it is shaped by how responsibility and legitimacy are negotiated in practice. Maternity services function as a clinical service and as a condition for whether family life feels possible and sustainable in rural communities.

A significant proliferation of boarding schools and boarding students has been observed in rural areas of China due to the challenges associated with "school consolidation" policies and parental migration from rural to urban areas for employment purposes. Hence, boarding has emerged as a prominent characteristic within the present-day rural student community. However, there remains a lack of consensus regarding the impact of boarding on noncognitive development among rural students. This study investigates the impact of boarding on students' noncognitive development using a two-period panel dataset collected during the research conducted on rural elementary schools in 2019 and 2020. Using a two-period panel dataset comprising 10,923 students from 195 rural elementary schools in 21 counties, we employ both the propensity score matching method and instrumental variable approach to establish a causal relationship between boarding arrangements and students' noncognitive development. This study finds that boarding has detrimental effects on students' noncognitive skills, negatively impacting certain aspects such as openness and grit, and affinity for schools. The study also reveals that the impact of boarding varies across different student subgroups, with girls, younger students, those from affluent families, and students with more educated mothers benefiting more from the boarding experience. The study also examines pathways through which boarding influences students' noncognitive development. This paper proposes the following policy recommendations: (1) At the familial level, parents should allocate additional time and effort towards nurturing their children's emotional well-being and academic performance. (2) Schools ought to incorporate curriculum training programs aimed at enhancing students' noncognitive skills, including self-care, resilience, and interpersonal abilities. (3) The government should ensure the cultivation of students' non-cognitive skills by implementing policies, allocating funds, as well as promoting and raising awareness about the significance of these skills.

Incidence of symptomatic Lassa virus infection in West African countries (Enable 1.0 Lassa Research Study): a prospective, multisite, cohort study.