Rural Dwelling Research Articles

The life of people with dementia who have multiple children in rural China: A phenomenological case study.

The aim of this study was to explore the lived experiences of a rural dwelling person living with dementia and his children. Using a phenomenological case study methodology, it aims to explore the health-related and personal dilemmas faced by multiple family members who provide care to a person living with dementia in a rural area in Henan, China. The study also investigates the barriers to quality dementia care in this kind of setting in order to inform the relevant stakeholders. A phenomenological case study was designed for this study. The case that formed the focus of the research included a person living with dementia and multiple family members. Semi-structured in-depth interviews were undertaken with the five family members of the person living with dementia. Smith's interpretative phenomenological analysis was used for data analysis. Three major themes were identified: (1) Dementia as a normal ageing process or a bad disease; (2) Commitment to and challenges of family caring and (3) Life in rural areas. With the development of China's economy and its social-cultural changes, traditional home-based care provision in rural areas of China is being challenged for people with dementia who have multiple children. It suggests that there needs to be an exploration into providing more appropriate care for people with dementia living in rural settings. It also suggests that more support is required to increase dementia awareness and to improve the quality of life of people with dementia and their families in rural China.

Cognitive impairment and associated factors among mature and older adults living in the community of Gondar town, Ethiopia, 2020

Cognitive impairment and dementia are age-related major public health concerns in the elderly population. It is a major cause of disability, dependency, and poor quality of life. However, in Ethiopia, the magnitude of this cognitive impairment among the elderly community was not investigated. Hence, this study sought to determine the prevalence of cognitive impairment and associated factors among mature and older adults living in the community of Gondar town, Ethiopia, in 2020. A community-based cross-sectional study was conducted at Gondar town, from February 20 to April 30, 2020. Using a single-stage cluster sampling technique, 403 study participants were recruited. Data was collected by a pretested interviewer-administered structured questionnaire which consisting of sociodemographic variables, the Oslo Social Support Scale, and a Standardized Mini-mental State Examination (SMMSE) tool. Epi data version 3.0 was used to enter coded data and then exported into STATA 14 for analysis. Variables with a p-value < 0.25 in the bi-variable logistic regression were included in the multivariable regression. From multivariable logistic regression, variables having a p-value ≤ 0.05 were declared as statistically significant variables. In this study, a total of 403 study participants were involved, and 393 (97.5%) of them completed the survey. Among older participants screened for cognitive impairment, 43.8% was positive for cognitive impairment with a 95% CI (38.8–48.7%). The majority of the participants were (57.5%) male and (44.8%) aged over 60 years. After adjustment, the variables associated with cognitive impairment were age ≥ 75 years [odds ratio (OR) = 7.03, 95% CI 2.78–17.77] and between 61 and 74 years [OR = 3.18, 95% CI 1.81–5.59], and unable to read and write [OR = 5.05, 95% CI 2.04–12.50], low income level [OR = 2.60, 95% CI 1.26–5.20], being female [OR = 2.52, 95% CI 1.50–4.26], poor social support [OR = 2.50, 95% CI 1.30–4.81], and rural residence [OR = 2.39, 95% CI 1.26–4.51]. The prevalence of older participants who screened positively for cognitive impairment was high at Gondar town. The independent predictors of cognitive impairment among older individuals were older age, being unable to read and write, being female, low income, poor social support, and rural dwelling. Therefore, routine screening and social support, as well as free healthcare services for the mature and older community, are needed. Moreover, we strongly recommend the next researcher to use a diagnosis tool to estimate the actual prevalence of the problems among older people.

Selecting a theoretical framework for chronic cardiovascular disease self-management among rural dwelling adults

A paucity of research has examined the factors and perceptions of self-management among individuals living rurally with chronic cardiovascular disease (CCVD). Exploration of this population is prudent as CCVD continues to be the leading cause of mortality within the United States (US). As the US population ages, increased rates of CCVD and the process of managing the disease will continue to challenge patients and the health care system. Rural dwelling adults are faced with additional complexities to manage a chronic disease, resulting in higher rates of chronic disease as compared to urban dwellers. It is essential for nurses working with adults living with CCVD in rural areas to promote self-management strategies derived from a theoretical perspective. The purpose of this paper is to examine theories and models that facilitate self-management of CCVD among rural dwelling adults. Three established self-management theories and models from psychology and public health were evaluated using Walker and Avant's framework for theory analysis. Social cognitive theory was selected as a best fit for self-management of CCVD among rural dwelling adults, due to the symbiosis of chronic disease, and applicability of ruralness within the triadic reciprocal causation of person-behavior-environment of the model.

Public awareness, knowledge of availability, and willingness to use neurosurgical care services in Sub-Saharan Africa: A cross-sectional study.

IntroductionLow- and middle-income countries bear the majority of neurosurgical disease burden and patients face significant barriers to seeking, reaching, and receiving care. We aimed to understand barriers to seeking care among adult Africans by evaluating the public perception, knowledge of availability, and readiness to use neurosurgical care services.MethodsAn e-survey was distributed among African adults who are not in the health sector or pursuing a health-related degree. Chi-square test and ANOVA were used for bivariate analysis and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.ResultsSix hundred and sixty-two adults from 16 African countries aged 25.4 (95% CI: 25.0, 25.9) responded. The majority lived in urban settings (90.6%) and were English-speaking (76.4%) men (54.8%). Most respondents (76.3%) could define neurosurgery adequately. The most popular neurosurgical diseases were traumatic brain injury (76.3%), congenital brain and spine diseases (67.7%), and stroke (60.4%). Unwillingness to use or recommend in-country neurosurgical services was associated with rural dwelling (β = -0.69, SE = 0.31, P = 0.03), lack of awareness about the availability of neurosurgeons in-country (β = 1.02, SE = 0.20, P<0.001), and believing neurosurgery is expensive (β = -1.49, SE = 0.36, P<0.001).ConclusionKnowledge levels about neurosurgery are satisfactory; however, healthcare-seeking is negatively impacted by multiple factors.

Describing the linkage between administrative social assistance and health care databases in Ontario, Canada

BackgroundThe linkage of records across administrative databases has become a powerful tool to increase information available to undertake research and analytics in a privacy protective manner. ObjectiveThe objective of this paper was to describe the data integration strategy used to link the Ontario Ministry of Children, Community and Social Services (MCCSS)-Social Assistance (SA) database with administrative health care data. MethodsDeterministic and probabilistic linkage methods were used to link the MCCSS-SA database (2003-2016) to the Registered Persons Database, a population registry containing data on all individuals issued a health card number in Ontario, Canada. Linkage rates were estimated, and the degree of record linkage and representativeness of the dataset were evaluated by comparing socio-demographic characteristics of linked and unlinked records. ResultsThere were a total of 2,736,353 unique member IDs in the MCCSS-SA database from the 1st January 2003 to 31st December 2016; 331,238 (12.1%) were unlinked (linkage rate = 87.9%). Despite 16 passes, most record linkages were obtained after 2 deterministic (76.2%) and 14 probabilistic passes (11.7%). Linked and unlinked samples were similar for most socio-demographic characteristics (i.e., sex, age, rural dwelling), except migrant status (non-migrant versus migrant) (standardized difference of 0.52). Linked and unlinked records were also different for SA program-specific characteristics, such as social assistance program, Ontario Works and Ontario Disability Support Program (standardized difference of 0.20 for each), data entry system, Service Delivery Model Technology only and both Service Delivery Model Technology and Social Assistance Management System (standardized difference of 0.53 and 0.52, respectively), and months on social assistance (standardized difference of 0.43). ConclusionsAdditional techniques to account for sub-optimal linkage rates may be required to address potential biases resulting from this data linkage. Nonetheless, the linkage between administrative social assistance and health care data will provide important findings on the social determinants of health.

Abstract P107: Trends In Oral Anticoagulation Therapy In Non-valvular Atrial Fibrillation Patients At High-risk Of Stroke After The 2019 AHA/ACC/HRS Update For The Management Of Patients With Atrial Fibrillation Guidelines

Background: Oral anticoagulation (OAC) reduces the risk of ischemic stroke in patients with atrial fibrillation (AF) but is underutilized in high-risk patients. We aimed to assess the impact of the 2019 guideline-recommended use of non-vitamin K OAC (NOACs) as first line therapy over warfarin for high-risk patients with non-valvular AF. Methods: Adult patients at Essentia Health with AF or atrial flutter on their problem list, seen in an ambulatory clinic between 7/1/2020-7/12/2021, were included in the baseline cohort. Patients were excluded if they had moderate to severe rheumatic mitral stenosis or mechanical heart valves, or were deceased or missing 1-year follow-up data. High-risk AF was defined as males with a CHA2DS2-VASc score ≥2 and females with a score ≥3. ATRIA bleed score was calculated using electronic health record data and divided into 3 groups: low-risk (0-3), intermediate (4) or high-risk (5-10). Patients were separated into three groups: warfarin, NOAC, or no OAC therapy. Results: Of the 12,014 patients in the baseline non-valvular AF registry, 8,032 were high-risk (mean age 75.9 ± 9.8 years, 57.5% male). Over half (57.1%, n=4619) were age ≥ 75 years and 63.4% (n=5095) were rural dwelling. Compared to baseline, at 1-year follow up, high-risk AF patients had similar use of any OAC (75.6%; n=6069 at baseline vs. 75.7%; n=6083 at 1-year follow-up). The use of warfarin decreased 2.3% [from 39.3% (n=3160) to 37.0% (n=2973), p &lt;0.001] while NOAC use increased 2.4% [from 36.2% (n=2909) to 38.7% (n=3110; p &lt;0.001]. Eliquis was the most prevalent NOAC prescribed (57.9%; n=1802). At 1-year follow-up, patients with high-risk AF and low-risk ATRIA bleed score, the use of any OAC therapy increased by 0.9% while those at high-risk AF and high-risk ATRIA bleed score, the use of any OAC therapy decreased 1%. In the multivariate logistical model, age, male sex, CHA2DS2-VASc score 4-6, hypertension, stroke/transient ischemic attack/thromboembolism, and cardiology visit within the last 3 years showed an increased association with prescription of any OAC (p&lt;0.05). Vascular disease, high risk ATRIA bleed score, severe renal risk, prior hemorrhage, and left atrial appendage occlusion device (WATCHMAN) had a decreased odds of any OAC use (p&lt;0.05). Conclusion: Implementation of the 2019 ACC/AHA/HRS guidelines that established NOACs as first line therapy over warfarin for non-valvular AF resulted in a slight increase in NOAC use and decrease in warfarin use in a large high-risk non-valvular AF population. Approximately one in four high risk patients with AF are not on any OAC therapy and may benefit from treatment to reduce thromboembolic risk.

Photovoice exploration of physical activity norms and values among rural and remote pulmonary rehabilitation participants in British Columbia, Canada

Purpose Individuals with chronic obstructive pulmonary disease (COPD) engage in less physical activity compared to the general population, which can lead to worsened symptoms. In pulmonary rehabilitation (PR) programs, participants learn strategies to complete activities more easily. For such strategies to be effective, however, PR clinicians must understand their clients’ activity values and practices within their geocultural contexts. In this qualitative study, our aim was to explore physical activity norms and values among people with COPD living in remote and rural locations, using Photovoice methodology. Materials and methods We recruited 12 participants from rural PR sites in British Columbia, Canada. During two distinct seasons (winter and summer), participants photographed meaningful activities then completed semi-structured interviews. We analyzed transcripts using a three-step hermeneutic method, which revealed three themes. Results Participants discussed feeling conflicted regarding their COPD symptoms and physical activity, as difficulties in activity engagement cause stress, but remaining active also fosters a sense of purpose and well-being. Meanwhile, participants’ activities are inextricably linked to their rural, remote, and seasonal environment. Conclusions Our study provides insight into how people with COPD resiliently engage in activities in a rural environment with distinct weather variations. Findings highlight the importance of considering individual factors when recommending activities in PR programs. Implications for rehabilitation Although people with chronic lung disease often encounter difficulty and stress in completing their daily activities, they both recognize the importance of and derive great personal meaning from remaining active. The unique social, geographical, physical, and climatic environments of rural and remote dwelling people with chronic lung disease can both enable and challenge their activity engagement. Pulmonary rehabilitation (PR) programs and clinicians must situate their activity recommendations within the geographic contexts of their clients – which can vary across the seasons. Support for participants’ mental health is a vital aspect of PR.

Addressing rural health disparity with a novel hospital sleep apnea screening: Precision of a high-resolution pulse oximeter in screening for sleep-disordered breathing.

High-resolution pulse oximetry (HRPO) may offer a low-cost and simple screening option for sleep-disordered breathing (SDB) that could be vitally important in rural areas with limited healthcare resources and specialty care. Our team hypothesized that application of this technology to a broad cohort of rural dwelling hospitalized individuals would demonstrate congruence similar to previous urban studies comparing HRPO to portable sleep monitors. This retrospective study was conducted at West Virginia University Hospital and compared indices obtained from HRPO with those obtained from a type III portable sleep monitor (PM) on the same night. A total of 365 individuals underwent evaluation. The mean oxygen desaturation index (18.8 ± 19.3 events/h) from the HRPO was slightly higher than the mean respiratory event index (16.0 ± 18.1 events/h, p ≤ 0.001) from the PM. ROC curves were developed for thresholds of apnea severity predicted by the screening program. The AUC values for all three thresholds exceeded 0.92 and for a respiratory event index (REI) of ≥ 30 was 0.965. Indices from the PM and HRPO demonstrated agreement in those individuals with screening suggestive of moderatetosevere disease. This study demonstrates that use of HRPO in screening for SDB in hospitalized patients from rural communities is as accurate as PM and may serve as a simple cost-effective tool to address sleep health disparities in these regions with significant health inequity. Our data extend previous findings by applying HRPO to a larger hospitalized cohort with highly prevalent cardiopulmonary disease.

Indoor thermal environment in a rural dwelling heated by air-source heat pump air-conditioner

Air-source heat pumps (ASHP) are increasingly used to improve space heating. However, few relevant studies have focused on the rural residential buildings that use ASHP air-conditioners for heating conditions. Therefore, this paper presents experiments and numerical simulations to analyse the impact of ASHP air-conditioners on the indoor thermal environment of a rural dwelling during heating seasons. In this study, the influences of different air-supply parameters (temperature, angle and velocity of air supply) and the position of the ASHP air-conditioner on the local thermal comfort were evaluated. The influence weights of both the above factors and their interaction were obtained. The simulation results showed that the temperature differences between the head and foot region (ΔTh-f) in most cases exceeded 3.0℃, demonstrating the thermal comfort in the rural dwelling was more unacceptable than the urban buildings. Moreover, the results of orthogonal design indicated that air-supply velocity had the most significant impact on the ΔTh-f values, followed by the air-supply temperature, air-supply angle and installation height. Reducing any air-supply parameter or enhancing the installation height might improve the thermal comfort performance. This research can provide practical strategies for improving the indoor thermal environment of rural dwellings, and guide the design of ASHP air-conditioning systems.

Group B Streptococcal Colonisation among Antenatal Women from a Tertiary Care Centre, Northern Kerala: A Cross-sectional Study

Introduction: Group B Streptococcus (GBS) is the leading cause of neonatal sepsis all over the world. Maternal colonisation of GBS in vaginal and anorectal area poses risk for subsequent invasive disease. The prevalence of maternal colonisation varies with geographical, biological and socio-economical factors. Current recommendations consider maternal screening and antibiotic therapy to prevent GBS neonatal disease with a potential of alteration of infant gut flora. Aim: To find out the prevalence, outcome and antimicrobial susceptibility pattern of the GBS colonisation in antenatal women. Materials and Methods: A hospital-based descriptive crosssectional study was conducted in Government Medical College, Kozhikode, Kerala, India, during December 2017 to May 2019 including 300 antenatal women of 35-37 weeks gestational age. Vaginal and rectal swabs were taken and were subjected to microbiological examination and culture. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 16.0. The Chi-square test and Fisher’s exact test were used wherever applicable and p-value &lt;0.05 is considered significant. Results: Among the 300 antenatal women, 8 (2.7%) were colonised with GBS. Higher rate of colonisation was observed in women of 21-25 years, higher parity, rural dwelling and in women with poor glycaemic control. All the colonised women received antibiotic prophylaxis with intravenous ampicillin. None of the colonised women or the neonates born to them developed any invasive GBS infection. Antibiotic susceptibility testing showed that all the isolates were sensitive to penicillin, ampicillin and vancomycin but only 62.5% of the isolates were susceptible to clindamycin and 37.5% of the isolates were susceptible to erythromycin. Conclusion: The prevalence of GBS colonisation is low in Asian countries, compared to the data from western countries. Evidence based usage of narrow spectrum antibiotics should be considered. Further studies regarding prevalence, antibiotic susceptibility pattern, cost benefit analysis of the antibiotic usage and its effect on neonatal gut flora etc, including a wider population, is a need of the hour in the setting of emergence of resistance.

Describing the linkage between administrative social assistance and health care databases in Ontario, Canada.

BackgroundThe linkage of records across administrative databases has become a powerful tool to increase information available to undertake research and analytics in a privacy protective manner.ObjectiveThe objective of this paper was to describe the data integration strategy used to link the Ontario Ministry of Children, Community and Social Services (MCCSS)-Social Assistance (SA) database with administrative health care data.MethodsDeterministic and probabilistic linkage methods were used to link the MCCSS-SA database (2003-2016) to the Registered Persons Database, a population registry containing data on all individuals issued a health card number in Ontario, Canada. Linkage rates were estimated, and the degree of record linkage and representativeness of the dataset were evaluated by comparing socio-demographic characteristics of linked and unlinked records.ResultsThere were a total of 2,736,353 unique member IDs in the MCCSS-SA database from the 1st January 2003 to 31st December 2016; 331,238 (12.1%) were unlinked (linkage rate = 87.9%). Despite 16 passes, most record linkages were obtained after 2 deterministic (76.2%) and 14 probabilistic passes (11.7%). Linked and unlinked samples were similar for most socio-demographic characteristics (i.e., sex, age, rural dwelling), except migrant status (non-migrant versus migrant) (standardized difference of 0.52). Linked and unlinked records were also different for SA program-specific characteristics, such as social assistance program, Ontario Works and Ontario Disability Support Program (standardized difference of 0.20 for each), data entry system, Service Delivery Model Technology only and both Service Delivery Model Technology and Social Assistance Management System (standardized difference of 0.53 and 0.52, respectively), and months on social assistance (standardized difference of 0.43).ConclusionsAdditional techniques to account for sub-optimal linkage rates may be required to address potential biases resulting from this data linkage. Nonetheless, the linkage between administrative social assistance and health care data will provide important findings on the social determinants of health.

Abstract 10308: Rural-Urban Differences in Health Characteristics and Health Behaviors in 14,955 US Stroke Survivors

Introduction: Rural residence is associated with increased CVD risk, including incident stroke. Less is known about the association of rurality on health characteristics and health behaviors among stroke survivors. The purpose of this study was to determine the presence and magnitude of rural/urban differences in health characteristics and health behaviors among stroke survivors. Methods: Data from 14,599 stroke survivors were available from the 2017 &amp; 2019 Behavioral Risk Factor Surveillance System, an annual health survey of non-institutionalized US adults. Inclusion criteria included history of self-reported stroke and age ≥65 years. Respondents with missing data regarding rural vs. urban dwelling status were excluded from analysis. Respondents provided self-reported data on sociodemographics (sex, race, marital status, education, and income), health characteristics, and health behaviors (see table for characteristics and behaviors). Logistic regression was used to compute odds ratios and 95% CI’s to examine the association among rural/urban status and health characteristics and health behaviors. Results: Prevalence of health characteristics and health behaviors, and computed adjusted odds ratios, are presented in the table. Although the prevalence of disability, poor general health, and insufficient physical activity were higher among rural-dwelling stroke survivors, odds ratios adjusted for sociodemographic and health characteristics demonstrated no association among rurality, health characteristics, and health behaviors. Conclusions: Although no differences in health characteristics and behaviors were found between rural and urban-dwelling stroke survivors, prevalences of many CVD risk factors were high, which increase risk for recurrent stroke, secondary conditions, and chronic disease. Interventions for improving risk factors and health behaviors in this health disparate population are needed.

Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic.

IntroductionSeveral studies have shown that COVID-19 pandemic has a negative impact on type 2 diabetic mellitus (T2DM) patients’ quality of life (QoL). However, very few studies were performed in Middle Eastern countries.AimThe aim of the current study was to assess, the QoL and diabetes-specific QoL, treatment satisfaction and psychological distress of Lebanese patients with T2DMs using: the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and Kessler 10 (K10) questionnaires and to compare results to those obtained during the pre-COVID-19 period.Results461 patients with T2DM participated in the study; 52.6% men, 47.4% women; median age 59 years old. The respective median ADDQoL and DTSQs scores were − 2.2 (interval interquartile range (IQR) − 3.9, − 0.8) (range from − 9 maximum negative impact to + 3 maximum positive impact) and 30(IQR22-36) (range from 0 maximum dissatisfaction to 36 maximum satisfaction). K10 median score was 26(IQR18-35) (range from minimum score of 10 indicating no distress to maximum score of 50 indicating severe distress). Rural dwelling, lack of exercise, current smoking, diabetic complications, injectable diabetes treatment, and previous COVID-19 infection were all associated with significantly worse ADDQoL, DTSQs, and K10 score indicating greater distress. A significant worsening of ADDQoL scores followed onset of the pandemic with no significant change in DTSQs scores.ConclusionDuring the COVID-19 pandemic, T2DM Lebanese patients experienced more negative impact of diabetes on QoL and mental health. Those infected with COVID-19 also reported worse QoL, treatment satisfaction and mental health. This highlights the need for community and individual support.

Distance to Care, Rural Dwelling Status, and Patterns of Care Utilization in Adult Congenital Heart Disease.

Many patients with adult congenital heart disease (ACHD) do not receive guideline-directed care. While distance to an ACHD center has been identified as a potential barrier to care, the impact of distance on care location is not well understood. The Oregon All Payer All Claims database was queried to identify subjects 18-65years who had a health encounter from 2010 to 2015 with an International Classification of Diseases-9 code consistent with ACHD. Residence area was classified using metropolitan statistical areas and driving distance was queried from Google Maps. Utilization rates and percentages were calculated and odds ratios were estimated using negative binomial and logistic regression. Of 10,199 identified individuals, 52.4% lived < 1h from the ACHD center, 37.5% 1-4h, and 10.1% > 4h. Increased distance from the ACHD center was associated with a lower rate of ACHD-specific follow-up [< 1h: 13.0% vs. > 4h: 5.0%, adjusted OR 0.32 (0.22, 0.48)], but with more inpatient, emergency room, and outpatient visits overall. Those who more lived more than 4h from the ACHD center had less inpatient visits at urban hospitals (55.5% vs. 93.9% in those < 1h) and the ACHD center (6.2% vs. 18.2%) and more inpatient admissions at rural or critical access hospitals (25.5% vs. 1.9%). Distance from the ACHD center was associated with a decreased probability of ACHD follow-up but higher health service use overall. Further work is needed to identify strategies to improve access to specialized ACHD care for all individuals with ACHD.

Impact of whey protein supplementation in a weight-loss intervention in rural dwelling adults: A feasibility study

Weight loss in older adults enhances physical function, but may lead to sarcopenia and osteoporosis. Whey protein is a low cost rich source of essential amino acids, may improve physical function. We evaluated the feasibility and acceptability of consuming whey protein in the context of a weight-loss intervention in older adults with obesity. A 12-week pilot feasibility, non-randomized weight loss study of 28 older adults was conducted, consisting of individualized, weekly dietitian visits with twice weekly physical therapist-led group strengthening classes. Half consumed whey protein, three times weekly, following exercise. Preliminary efficacy measures of body composition, sit-to-stand, 6-min walk and grip strength and subjective measures of self-reported health and function were also evaluated. Of the 37 enrolled, 28 completed the study (50% in the protein group). Attendance rates for protein vs. non-protein groups were 89.9±11.1% vs. 95.6±3.4% (p=0.08). Protein consumption was high in those attending classes (90.3%) as was compliance at home (82.6%). Whey was pleasant (67.3±22.1, range 30-100, above average), had little aftertaste, and was neither salty or sticky. All were compliant (0.64±0.84, range 0-5, low=higher compliance). Both groups lost significant weight (protein vs. no protein,-3.45±2.86 vs.-5.79±3.08, p=0.47); Sit-to-stand, 6-min walk, and gait speed were no different, grip strength was improved in the protein compared to the non-protein group (-2.63kg vs. 4.29kg; p<0.001). Our results suggest that whey protein is a low-cost and readily available nutritional supplement that can be integrated into a weight loss intervention.

Impact of COVID‐19 on Prescriptions for Controlled Substances for Veterans with Opioid Use Disorder

Research ObjectiveVeterans with opioid use disorder (OUD) are at significant risk of overdose, unintentional death, and a wide range of negative health‐related consequences. While evidenced‐based treatments for OUD exist, including medications for opioid use disorder (MOUD) like buprenorphine (suboxone), there are a number of barriers preventing veterans from accessing this care. A potential avenue to increase the numbers of veterans who can access high quality mental healthcare such as MOUD is through telemental healthcare using VA Video Connect (VVC). While telehealth can mitigate this access to care issue, the opioid crisis led to the Ryan Haight Act of 2008, which mandates that the first visit with a prescriber of schedule II‐IV controlled substances be conducted in person. However, due to the public health emergency caused by COVID‐19, the in person requirement for controlled substances is temporarily waived.Study DesignThe aims of this project were to examine temporal changes in controlled substances from September 2019 – August 2020 (6 months before and after the requirement was waived), to understand the impacts of this waiver for veterans with OUD.Population StudiedWe examined prescription information from the VA Corporate Data Warehouse for 42,579 Veterans diagnosed with OUD (91.6% male, 71% white, 16.8% black, 27% rural dwelling).Principal FindingsDuring this 12‐month window, 56.6% of the sample were prescribed suboxone, 53.6% were prescribed sedatives, and 13.8% were prescribed anxiolytics. Monthly an average of 33,323 (SD = 3190) prescriptions were filled, with an average of 1.45 (SD = 0.08) medications prescribed per visit. As expected, the largest dip was seen in April 2020, with only 28,376 prescriptions filled, with an 1.33 prescriptions written per visit. As of August 2020, the rates for prescriptions for controlled substances had not returned to pre‐COVID levels.ConclusionsThese data suggest that while telehealth is a legal option to appropriately prescribe controlled substances, it was not utilized in a way that replicated in person care. Future projects that focus on understanding and addressing barriers providers face when attempting to provide care via telehealth are an important next step. Additionally, there was no dramatic increase in prescriptions for controlled substances as a result of the Ryan Haight waiver.Implications for Policy or PracticeThese data support keeping the wavier of in person appointments in the Ryan Haight Act is one useful avenue to help providers to provide access to life saving MOUDs.Primary Funding SourceDepartment of Veterans Affairs.

Pregnancy Associated Osteoporosis: Knowledge Attitude and Practice of Exercise among Pregnant Women in a Selected Nigerian Community

Pregnancy induced decrease in bone mineral density (BMD) often occurs at the femoral necks, lumbar spine and other sites during the second or third trimester of pregnancy leading to pain in the hips, pelvis, low back etc and sometimes fractures even with mild trauma/falls. Exercising during pregnancy has been known to offer several benefits including improving bone health. However, there is paucity of studies investigating the knowledge, attitude and practice of pregnant women towards exercising to minimize the risk for osteoporosis. The aim of this study was to investigate the knowledge, attitude and practice (KAP) of exercise for the prevention of pregnancy associated osteoporosis among urban and rural dwelling pregnant women in a selected Nigerian community. A total of 258 (168 urban dwelling and 90 rural dwelling) pregnant women were recruited and subjected to interview using a pre-validated questionnaire on KAP of exercise in the prevention of Pregnancy associated osteoporosis. The urban and rural dwelling women had moderate and poor knowledge of exercising for osteoporosis prevention respectively. Both groups of women had moderately positive attitude towards exercising for osteoporosis prevention. Also both groups of women had poor practice towards exercising for osteoporosis prevention. A significant association was only found between having another source of income in the family and the women’s attitude towards exercise.

Barriers to care in urban and rural dwelling adults with congenital heart disease

Adults with congenital heart disease (CHD) face a unique set of medical, psychological, and social challenges, and access to specialised adult congenital heart disease care has been associated with improved outcomes. Rural adults with CHD may represent a uniquely disadvantaged group given additional challenges when accessing specialised care. The aim of this study was to investigate the challenges faced by adults with CHD in accessing outpatient cardiac care, with a specific focus on understanding differences between urban- and rural-dwelling patients. This cross-sectional, survey-based study took place in the adult congenital heart disease clinic at an urban academic medical center. Additional medical information was abstracted in a retrospective manner from the electronic health record. In addition to descriptive statistics, t-tests and Chi-square tests were performed to investigate differences between urban and rural dwelling patients. A total of 100 patients participated in the study (mean age 40±13 years, 60% female, 18% rural dwelling). Across the total sample, the median driving distance to clinic was 20 miles (interquartile range 12-77); it was 15 miles for urban dwellers and 77 miles for rural dwelling patients (p < 0.001). The most commonly identified barriers to cardiac clinic visits were financial losses related to taking time off from work (39%), distance of clinic from home (33%), and weather (33%). Compared to urban dwelling patients, on average those who were rural dwelling had a lower level of education (p = 0.04), more difficulty paying insurance premiums (p < 0.001) and copays (p = 0.005), and were more likely to identify the distance from clinic (p = 0.05) and having to go into the city (p = 0.02) as barriers to clinic appointments. The financial impact and distance to clinic were the most commonly identified barriers to outpatient cardiac care in this cohort of adults with CHD. These barriers, along with difficulty paying insurance premiums, are more common in rural dwelling patients. Initiatives such as telemedicine visits or providing financial subsidies for travel and treatment could help to expand specialty adult congenital heart disease care and better serve this growing patient population.

Neighborhood-Level Influences and Adolescent Health Risk Behaviors in Rural and Urban Sub-Saharan Africa: A Systematic Review.

The impact of neighborhoods on adolescent engagement in health-risk behaviors (HRBs), such as substance use and sexual activity, has been well documented in high-income countries; however, evidence from low and middle-income country settings is limited, particularly in sub-Saharan African (SSA) countries. Neighborhoods and communities in SSA continue to experience urbanization, epidemiologic transition, and the simultaneous presence of large populations living in rurality and urbanicity. This is a dynamic context for exploring adolescent health challenges. This review seeks to identify and summarize existing literature that investigates adolescent engagement in HRBs when compared across rural and urban neighborhoods across SSA. We performed searches using three electronic databases, targeted grey literature searches and scanned reference lists of included studies. Following dual-screening, our search yielded 23 relevant studies that met all inclusion criteria. These were categorized into six broad themes including studies on: (1) sexual risk taking, (2) injury-related, (3) violence, (4) eating and/or exercise-related, (5) substance use, and (6) personal hygiene. We found that neighborhood factors relating to accessibility and availability of health information and care impacted adolescent engagement in HRBs in rural and urban areas. Urbanization of areas of SSA plays a role in differences in engagement in HRBs between rural and urban dwelling adolescents.

Analysis of Non-Marital Fertility in Nigeria and Implications for Intervention and Future Research

Fertility and marriage are inextricably linked in sub-Saharan Africa, but recent changes, such as the rise in non-marital fertility, signals a weakening link, and the second demographic transition offers some explanations. Non-marital fertility comes with disadvantages, but it has not been adequately studied in Nigeria. Hence, this study examined the levels, patterns, and correlates of non-marital fertility, and offers implications for interventions and future research. Using data from the Nigeria Demographic and Survey 2008–2018, with a pooled weighted sample size of 11,925 unmarried women, percentage distribution was employed and a two-part model for count data was fitted, with the result showing that the level of non-marital fertility is 29%, and it is common among younger, rural dwelling, and uneducated unmarried women. The correlates of non-marital fertility include age, region of residence, level of education, religion, household wealth index, relationship status, ethnicity, work status, and age at sexual debut. Interventions to arrest rise of non-martial fertility due to its obvious disadvantages, should strengthen sexual and reproductive health programs for unmarried rural-dwelling young women, and revitalize welfare efforts for children born outside wedlock, for poor women, while future research should explore an in-depth understanding of non-marital births.