Rural Dwelling Research Articles

Configurational Design of a Hybrid System Based on an Air–Water Heat Pump and Biomass Boiler for a Rural Dwelling

Hybrid energy systems combine multiple energy sources and storage technologies to enhance performance and meet diverse energy needs. Hybrid heat pump systems are particularly suitable for heating and cooling buildings in rural areas. Air-source heat pumps have two well-known disadvantages during the coldest period of the year, when the building’s heating load is at its peak: the heat pump’s capacity is reduced and it needs to perform defrost cycles. A potential solution is to size the heat pump to cover only a portion of the peak load and to use a second heat generator in a hybrid heat pump system. There is a gap in the literature regarding the configurational analysis of hybrid heat pump (HHP) systems, particularly in terms of combining heat pumps and biomass boilers, and evaluating their efficiency, economic aspects, and environmental impact. Thus, in this research, a dynamic model of a HHP system, consisting of an air-to-water heat pump paired with a biomass boiler as a backup, is presented. Various configurations of the HHP system have been developed to evaluate key performance indicators, such as efficiency, emissions, operational costs, and other relevant factors. The findings of this paper indicate that the energy performance of HHP systems is significantly affected by the system layout, heat pump size, cut-off temperature, and the control algorithm used to activate the heat generators. Moreover, series operation of HHP systems is not only more efficient than parallel operation but also results in lower emissions and reduced operation costs. As expected, the energy loss associated with defrost cycles significantly impacts the overall performance of a hybrid system based on an air-source heat pump. Finally, the impact of the cut-off temperature on the key parameters in the configuration analysis was examined, and the optimal performance of the HHP system, in terms of minimizing operational costs and emissions, was depicted using a heat map diagram.

The economic burden of visceral leishmaniasis and barriers to accessing healthcare in Tigray, North Ethiopia: A field based study.

Visceral leishmaniasis (VL) is an important public health problem, which mainly affects the poor rural dwelling communities in Low- and Middle-Income Countries. However, little is known about the health and economic burdens of this disease in East Africa, including Ethiopia. The aim of this study was to assess the household level economic burden of VL among affected communities in Tigray, Northern Ethiopia. Between April and August 2020, a cross-sectional household survey was conducted on 96 patients who had been treated for VL within 12 months prior to the survey, in six districts of Tigray. Data on households' health seeking behavior, direct and indirect costs and coping strategies were collected using a structured questionnaire and the responses were analyzed using SPSS software. Most (82%) of the patients surveyed were males and the majority (74%) of them were between 16 and 30 years of age. The education level of participants was very low: over 33% had not received any form of education; 48% of patients were farmers dependent on subsistence agriculture and about 32% were daily laborers. Just under half of household families (46%) resided in "poor houses" with structures made from entirely local materials. Forty-one percent of patients from the surveyed households had traveled 48 to 72 kilometers to reach VL treatment hospitals. The median total household cost for one VL episode was estimated to be US$ 214. This is equated to 18% of the mean total annual household income or 72.5% of annual per capita income of the study population. More than 80% of the households surveyed incurred catastrophic costs of VL, where this is defined as exceeding 10% of annual household income. The median delay between the onset of symptoms and arrival at a care provider hospital was 37 days; once the patient arrived at hospital, the median delay during diagnosis was 3 days. Direct and indirect costs represented 44% and 56% of the total costs incurred, respectively. To cope with VL treatment costs, 43% of the households used more than one coping strategy: 48% took out loans, 43% sold livestock and 31% of households mobilized cash savings. VL in Tigray is concentrated among young males with low educational background and mostly engaged in subsistence economic activities. Despite the free diagnostic and treatment provisions that were available at public hospitals at the time of the study, our work shows that the household economic burden of the disease had significant impact among VL-affected communities in Tigray. Initiating community awareness towards prevention, early treatment seeking and decentralization of VL treatment centers are strongly recommended. In addition, we recommend efforts to reduce household treatment costs through transport and food provisions for patients (and their accompanying carers where possible) or through cash reimbursement for patients who complete treatment at public hospitals, in order to reduce the barriers to seeking treatment for this life-threatening disease.

Targeting chronic pain care to rural women veterans: A feasibility pilot.

For rural women veterans, significant barriers exist in accessing high-quality, multicomponent behavioral pain self-management interventions. As such, a telehealth behavioral pain self-management intervention designed specifically for rural-dwelling women veterans with chronic pain was piloted for this study. This mixed methods, single-arm preliminary study examined the feasibility and acceptability of this intervention and completed a responder analysis. Participants completed surveys before and 1-month following the intervention, and they completed a qualitative interview following the intervention. About one quarter (24%) of potentially eligible participants who were sent a letter about the study consented to participate (N = 44). All participants identified as female and were rural dwelling, with mean age of 56 years (range = 34-80), and the majority of the sample (81%) self-identified as White and non-Hispanic or Latino. Average baseline scores on the Pain, Enjoyment of Life, and General Activity three-item scale (PEG-3) measure indicated severe pain and functional interference (MPEG-3 total = 6.88, SD = 1.62). Of the 44 participants who consented, 70% completed the intervention. About half of treatment completers (47%, 14/30) were deemed responders, reporting ≥ 30% reduction on their PEG-3 total scores. On the Global Impression of Change scale, 87% reported improvement. Study completers indicated that the telehealth platform facilitated their engagement and that they perceived the intervention to be beneficial and credible. Qualitative data emphasized themes of connection with other women veterans who experienced chronic pain while perceiving a retained sense of individual identity. These preliminary data support feasibly of this intervention for rural-dwelling women veterans with chronic pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Community-based Geriatric Assessments: Is There an Urban/Rural Divide?

Abstract Background There is a paucity of literature describing urban/rural differences in baseline demographic factors and patterns of referral for those undergoing community based comprehensive geriatric assessment (CGA) in Ireland. We analysed differences in baseline demographics, referral sources and referral reasons among older persons who underwent CGA with a community specialist team, which accepts referrals from one predominantly rural community health network (CHN) and one predominantly urban CHN. Methods Data including baseline demographic characteristics, reasons for referral, referral sources, clinical frailty score (CFS), prevalence of polypharmacy (more than 10 prescribed medicines) and location of CGA was prospectively collected on all persons referred to an older persons' integrated care service from February 2023 to March 2024 and who underwent CGA. Data was stored on a secure database. Persons were categorised as either urban dwelling or rural dwelling, based on their local CHN. Descriptive statistics were used to describe differences between the urban and rural cohorts. Results 235 persons characterised as urban underwent CGA and 191 persons characterised as rural underwent CGA. There was a higher median CFS score amongst rural persons (CFS = 5, IQR=2) compared to urban persons (CFS=4, IQR=2). Urban persons were more likely to be referred by their G.P. (81% of total referrals) compared with rural persons (67%). Rural persons were more likely to be male (48% vs 37%) and experience polypharmacy (33% vs 27%) than urban persons. A similar proportion of persons underwent initial CGA in their home (20% rural vs 19% urban). Conclusion Here we describe the characteristics of urban and rural users attending an integrated care service. Future research should examine how these differences might affect healthcare utilisation and outcomes and provide opportunity to inform regional health and social care planning.

Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?

Abstract Background Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation. Methods Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed. Results Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays. Conclusion Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.

A novel multi-objective generative design approach for sustainable building using multi-task learning (ANN) integration

Building Performance Optimization (BPO) plays a pivotal role in enhancing building performance, guaranteeing comfort while reducing resource consumption. Existing performance-driven generative design is computational demanding and difficult to be generalized to other similar buildings with difficult to be generalized to other building types or climate conditions. To fill this gap, this paper introduces a novel framework, which integrates multitask learning (MTL), code compliance check, and multi-objective optimization through NSGA-III algorithm. This framework is able to identify Paratoo Optimal design solutions, which comply with building codes, at low computation costs. The framework begins with selecting key design variables that are critical to building energy, comfort performance and life cycle cost. It then employs MTL to enhance the model's accuracy while reducing computational costs. Next, we designed a code compliance checking module followed by the NSGA-III optimization process, with the objective of identifying solutions that comply with existing building codes. The results indicate that the proposed MTL network achieved an R2 score of 0.983–0.993 on the test set. In the particular case study where equal weights are preferred, this approach yielded noteworthy reductions of 27.65%, 19.55%, and 31.13% in Building Energy Consumption (BEC), Life Cycle Cost (LCC), and Residue of continuous Daylight Autonomy (RcDA), respectively, for a rural dwelling, and exclude solutions that fail to satisfy regulatory standards. This framework allows designer to input the weights of each objective based on their preference and can be applied to other building types and climate regions. Last, we develop a solution selection tool based on the results output by the framework we proposed, which can be found at https://github.com/LiMingchen159/Village-House-Design-Strategy-in-Hebei-Province-China.

Association Between Bladder Cancer and Environmental Risk Factors in Guilan Province: A Case-Control Study

Background: Occupational settings expose workers to various substances linked to cancer risk, influenced by exposure intensity and duration. Considering the diverse work conditions across Iranian cities and the unexplored link between occupation and bladder cancer (BC) in Guilan Province, identifying high-risk occupations and industries is imperative for implementing preventive measures in the region. Objectives: To investigate the effect of people's occupations on bladder cancer in Guilan Province. Methods: The study encompassed 266 diagnosed BC patients in Guilan Province who received treatment at local healthcare centers, along with 191 control individuals aged 18 and over. Data for the cases were meticulously recorded in medical records at the Guilan Cancer Registry. The same checklists, including demographic characteristics, comorbidities, addiction status, water consumption habits, environmental exposures, current and previous occupation, previous history of cancer, and family history of cancer, were recorded for the controls. Odds ratios and their 95% confidence intervals were estimated using adjusted logistic regression (LR). Results: The study found that the odds ratio of bladder cancer (BC) was 2.80 (95% CI: 1.26 - 6.21) for the age group 60 - 70 years and 18.2 (95% CI: 7.31 - 45.6) for individuals above 70 years. Rural dwelling increased the risk by 5.06-fold, while well water consumption and regular opium use amplified it by 6.12-fold and 2.58-fold, respectively. Exposure to tar and carbon derivatives led to a 3.53-fold increase in risk, and exposure to combustion/greenhouse gases showed a 10.72-fold increase. Chemical-related occupations, tar, carbon derivatives, smoking, and opium consumption were significant risk factors. Conclusions: Occupations involving chemical substances such as greenhouse gases, tar, and carbon derivatives are associated with a higher risk of bladder cancer (BC). Furthermore, smoking, opium use, and well water consumption significantly elevate the risk of this cancer.

Thermal Performance Optimization of Building Envelopes in a Low-Cost and Energy-Saving Rural Dwelling in Severe Cold Region—Taking Central Area of Liaoning as an Example

The thermal performance of rural building envelopes is mostly non-standardized in Northern China, resulting in significant heat loss. In this study, we take, as an example, the central area of Liaoning province, with the objective of proposing some low-cost and energy-efficient solutions. Through our investigations, we found that heating energy consumption was reduced by 20% and construction costs increased by less than CNY 8000 (USD 1108), which can be accepted by rural residents. In order to achieve this target, the NSGA-II algorithm integrated with Rhino + Grasshopper and EnergyPlus simulation kernel was used to establish a thermal performance optimization model for the heat transfer of rural building envelopes in this severe cold region. Among the above-calculated Pareto optimal solutions, the recommended thickness of insulation layers for room floors, roofs, and external walls was about 70 mm, 50 mm, and 40 mm, respectively. Furthermore, we tried to reduce the window-to-wall ratio as much as possible. Finally, based on both the lower building renovation cost and energy-saving rate, three technical solutions from which rural residents could select, according to their specific needs, are put forward.

The Association Between Back Pain, Depression, and Quality of Life Among Older Adults Living with HIV in Rural Areas of the United States

ABSTRACT Introduction This study aimed to assess prevalence of back pain among older people living with HIV (PLH) in rural areas of the United States (US); compare the presence of comorbidities, socioeconomic factors, and sociodemographic factors among older PLH in rural areas of the US with and without back pain; and examine the associations between back pain, depression, and QOL among older PLH in rural areas of the US. Methods Cross-sectional data was collected among US rural dwelling PLH of at least 50 years of age. Multiple logistic regression was performed to examine the association between back pain and depression. Multiple linear regression was performed to assess the association between back pain and QOL. Results A total of 38.8% (n = 164) of participants self-reported back pain. PLH with back pain were more likely to have depression (60.87%, n = 98). PLH with back pain had lower mean QOL scores (53.01 ± 18.39). Back pain was associated with greater odds of having depression (OR 1.61 [CI 0.99–2.61], p = .054) and was significantly associated with lower QOL (p < .001). Conclusions Prevention strategies to reduce back pain and poor HIV outcomes among PLH living in rural areas of the US are needed.

Pulse wave velocity among urban and rural dwelling rwandans

Pulse wave velocity among urban and rural dwelling rwandans

The Intersection of Rurality, Unmet Treatment Need, and Cannabis Use for Adults with Chronic Pain

Objective: Rates of chronic pain are higher among rural versus urban individuals and rural individuals experience higher levels of socioeconomic disadvantage, poor or no health insurance coverage, and unmet treatment need. Medical cannabis is legal in Oklahoma. With 40% of Oklahoma’s population living in rural areas, and nearly 17% uninsured, the medical legalization of cannabis may present as an accessible and relatively low-cost alternative treatment, particularly for those with chronic pain. This study investigated differences in cannabis use by rural (vs. urban) status and unmet (vs. met) treatment need among adults with and without chronic pain living in Oklahoma. Method: To be eligible, participants had to be 18 years or older, reside in Oklahoma, and be able to read and write English-language surveys. Results: The sample (N = 3622) was primarily made up of non-Hispanic White (70.4%) females (53.8%) in their early middle age (M = 41.80, SD = 16.88), employed full-time or part-time (53.8%), with some college/technical school (37.2%) or a bachelor’s degree (28.5%). Nearly one-fifth of the sample (18.2%) endorsed chronic pain, and individuals with chronic pain were eight times more likely to report past 30-day cannabis use. No difference was detected when only rurality (vs. urban residence) was examined. Among adults with chronic pain, those who were rural dwelling and who reported unmet treatment need were almost two times more likely to report past 30-day cannabis use, compared to urban dwelling chronic pain adults with unmet treatment need. Conclusions: In Oklahoma, adults in rural areas with unmet treatment need and chronic pain may benefit from increasing access to chronic pain treatment, as well as education on cannabis use and harm reduction strategies to inform healthcare decision-making.

Working From Within: The Rural Community Participatory Design Framework.

This article describes the development of the rural community-based participatory design framework to guide healthcare design teams in their integration of rural community and clinical voice during the planning, design, and construction of a healthcare facility. Rural communities are facing an alarming rate of healthcare facility closures, provider shortages, and dwindling resources, which are negatively impacting population health outcomes. A prioritized focus on rural care access and delivery requires design teams to have a deeper understanding of the contextual considerations necessary for a successful healthcare facility project, made possible through engagement and partnership with rural dwelling community members and healthcare teams. The rural community participatory design framework is adapted from the rural participatory research model, selected due to its capture of key concepts and characteristics of rural communities. Underpinning theories included rural nursing theory and theory of the built environment. The framework encompasses healthcare facility project phases, key translational concepts, and common traits across rural communities and cultures. As a middle-range theoretical framework, it is being tested in a current healthcare project with a Critical Access Hospital in Montana to facilitate design team and stakeholder collaboration. The rural community participatory design framework may be utilized by design teams as a means of familiarization with rural cultures, norms, values, and critical needs, which relate to meaningful design. The framework further enables design teams to critically appraise best practices of stakeholder engagement throughout the project lifecycle.

Cardiovascular Disease Risk Factors Among Rural Dwelling Older African American Women

Cardiovascular Disease Risk Factors Among Rural Dwelling Older African American Women

Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial.

Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Rural living adults with overweight/obesity (n=187, age∼50years 82% female, body mass index ∼35kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly∼45min sessions with 7-14 participants (n=71), IP, which included weekly∼15min individual sessions (n=80), or EUC, which included one-45min in-person session at baseline. Weight loss at 6months was clinically relevant, that is, ≥5% in the GP (-11.4kg, 11.7%) and the IP arms (-9.1kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6month weight loss was significantly greater in the IP versus EUC arms (-6.5kg. p≤0.025) but did not differ between the GP and IP arms (-2.4kg, p>0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively. Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).

Opportunities and challenges facing LGBTQ+ people in employment in rural England post-pandemic: a thematic analysis

PurposeThe following study aimed to better understand rural dwelling LGBTQ+ adults’ experiences of the challenges and opportunities facing their working lives in England.Design/methodology/approachA qualitative, focus group design was utilized, using online recruitment and an online, one-off focus group. Data were analyzed using thematic analysis.FindingsThree themes were identified: stressors facing LGBTQ+ people in the workplace; opportunities in employment; and ideas to improve the workplace for LGBTQ+ people. Participants spoke to the ways in which both rural living and the pandemic had impacted their working lives, including elevated fears of being discriminated against; experiencing microaggressions in the workplace which they felt were partly elevated by a lack of visibility and affirmative policies; and a sense that specific workplaces inhabited by LGBTQ+ people had been decimated by the pandemic. Conversely, participants spoke of opportunities for affirmation of their gender and/or sexual orientation identities, feeling a sense of pride and connection with their communities through work.Originality/valueThis is the first study to the authors’ knowledge that specifically explores rural dwelling LGBTQ+ adults’ experiences of the workplace post-pandemic. It builds on previous empirical research by highlighting qualitative experiences of challenges and opportunity, which can inform organizations and policymakers’ efforts to promote inclusivity.

Branched hierarchization of indicators related to rural housing for environmental health evaluation

The Brazilian rural communities concentrate a significant fraction of the population exposed to deficient conditions in water supply, sanitary sewage, and solid waste management, which, combined with housing conditions, directly impact the quality of a healthy environment. Few studies have evaluated the salubrious conditions of a rural environment, and in the searches carried out, the use of branched hierarchical techniques was not verified. The objective of this work was to create a branched hierarchization of those variables that are the cause of unhealthy conditions of the housing environment. Initially, all the variables that affect the salubrity of the housing environment were listed, to later order them in a ramified form. Afterwards, and based on the technical literature, the parameters of adequacy and/or inadequacy of these variables were defined. This methodology was tested in a rural dwelling in order to exemplify its applicability. The application of the proposed tool has demonstrated a satisfactory practical use, with low time spent for its conclusion, besides providing a realistic characterization of the environment evaluated. This work provides an easily applicable methodology for obtaining a detailed report on the degree of adequacy of a wide range of variables that influence the healthiness of rural dwellings.

Healthcare providers' perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study.

There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses' and other healthcare providers' perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care. A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers. Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses' ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p's < .007; effect sizes .58 - .68, respectively). The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention's implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention. The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care.

An exploratory study of mothers engaging in physical activity in rural communities

ABSTRACT Gender gaps in physical activity (PA) exist with women being less active than men. Multiple cultural and psychosocial factors influence women’s ability to successfully negotiate barriers to PA and other health promoting behaviors. The goal of this exploratory descriptive study was to better understand the daily experiences of mothers in making health promoting decisions for themselves and their families. Semi-structured interviews (N = 17) were conducted with rural dwelling mothers who were the primary caregivers of children in the home. Participants were asked to share their experiences with PA and other health behaviors, focusing on their motivators, barriers, and facilitators. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Emerging themes focused on 1) feeling internal and external pressures to prioritize family’s needs over one’s health, 2) family exerting both positive and negative influences on health choices, and 3) living in a rural community often resulting in a lack of opportunities to engage in physical activity and feelings of being isolated from social networks. To close the gender gap in PA, interventions should support mothers in navigating their multiple roles and competing demands while engaging in health promoting behaviors such as physical activity.

Strengths and opportunities to clinical trial enrollment among BIPOC, rural dwelling patients in the northwest United States: a retrospective study.

Introduction: Clinical trials investigating the safety and efficacy of experimental drugs and devices are the cornerstone of medicinal advancement. Enrolling sufficient participants in these trials is vital to ensure adequate statistical power and generalizability. Clinical trial participation is particularly low among certain populations, including medically underserved communities (i.e., rural areas) and Black, Indigenous, and People of Color (BIPOC). Methods: A retrospective study design was used to understand patient outcomes and access/barriers to clinical trial participation in the rural northwest United States. A quantitatively focused retrospective chart review was conducted for adult participants enrolled in at least one clinical trial in a single northwest health system between 1999 and 2022. Descriptive and inferential statistical analyses were performed to assess trial outcomes at a significance level 0.05. Results: The retrospective chart review yielded 833 clinical trial records with 753 individual enrolled participants. The all-cause relative frequency of death at last known follow-up amongst clinical trial participants was 8.90% (n = 67). Based on logistic regression, the death was significantly associated with the participants' age at initial trial screening (β = 0.09, p-value <0.001), those that resided in non-metro areas (β = -0.86, p-value = 0.045), and those that lived in Northeastern Montana (β = 1.27, p-value = 0.025). Additionally, death at last known follow-up was significantly associated with enrollment in 2021-2022 (β = -1.52, p-value <0.001), enrolled in more than one study (β = 0.84, p-value = 0.023), in internationally sponsored trials (β = -2.08, p-value <0.001), in Phase I (β = 5.34, p-value <0.001), in Phase II trials (β = 1.37, p-value = 0.013), diabetes as a primary trial target (β = -2.04, p-value = 0.003). Conclusion: As decentralized trial design and remote or virtual elements of traditional trials become normative, representation of rural and frontier populations is imperative to support the generalizability of trial data encouraged by the FDA.

The impact of marginalization on diffuse large B-cell lymphoma overall survival: a retrospective cohort study

The aim of this study was to describe the impact of marginalization on DLBCL overall survival (OS) within the Canadian setting. We conducted a population-based retrospective cohort study of adult patients with newly diagnosed DLBCL in Ontario between 1 January 2005 and 31 December 2017 receiving a rituximab-containing chemotherapy regimen with curative intent followed until 1 March 2020. Our primary exposure of interest was the Ontario Marginalization Index (ON-Marg). The primary outcome was 2-year OS, accounting for patient age, sex, cancer characteristics, comorbidity burden, and rural dwelling status. While two-year overall survival was inferior for individuals in the most deprived marginalization quintile (70.4% Q5 vs. 76.0% Q1), after adjustment for relevant covariates neither the composite ON-Marg nor any of its dimensions had a significant effect. Within the Canadian context, among patients who receive chemotherapy, marginalization may not have a significant association with overall survival when accounting for key patient covariates, lending support for preserved outcomes.