Rural Island Research Articles

Techno-economic analysis of an off-grid hybrid system for a remote island in Malaysia: Malawali island, Sabah

As a developing country, Malaysia has always faced the problem of rural electrification in its islands. Rural islands cannot be connected to the grid as it is economically not feasible due to the low number of residents. The high greenhouse gas emission of the diesel generator is unfavorable to the residents. This study aims to assess hybrid system implementation in a remote community on Malawali island in Sabah, Malaysia, to provide the lowest price of electricity. Four scenarios, including diesel generator (DG) (A), PV/WT/Battery/DG (B), PV/Battery/DG (C), and PV/WT/Battery (D), are developed. A Techno-economic analysis is carried out to determine the most competitive system. Emissions are also observed to choose the optimum system. Results show that scenario B, with the net present cost (NPC) of 188,814$ and the cost of energy (COE) of 0.198$/kWh, is reliable in delivering the electricity required while having a reasonable cost relatively low emission. Sensitivity analysis is also carried out with different parameters to examine its effects on the system's sustainability throughout its lifetime.

Evaluating the social added value of LEADER: Evidence from a marginalised rural region

One of the most significant challenges in rebuilding Europe after COVID-19 is stimulating the marginalised, rural areas of the European Union (EU). Amid a social distancing environment, it is quite important to re-evaluate policy instruments that have recorded successes in rural development with an emphasis on the infrastructure of local dialogue; the Liaisons Entre Actions de Developpement de l'Economie Rurale (LEADER) has been such a programme. The current article introduces a qualitatively-integrated Social Return on Investment tool to evaluate the social added value of LEADER. The evaluation method was applied on the rural island of Lesvos in Greece. The evaluation results indicated that LEADER becomes a worthwhile investment when a wide range of its social outflows are taken into account. Additionally, in order to enhance its social value, a level of maturity and a solid economic basis must be first achieved. In this context, continuous monitoring and evaluation become crucial.

Exploring spatiotemporal patterns of COVID-19 infection in Nagasaki Prefecture in Japan using prospective space-time scan statistics from April 2020 to April 2022

BackgroundUp to April 2022, there were six waves of infection of coronavirus disease 2019 (COVID-19) in Japan. As the outbreaks continue to grow, it is critical to detect COVID-19’s clusters to allocate health resources and improve decision-making substantially. This study aimed to identify active clusters of COVID-19 in Nagasaki Prefecture and form the spatiotemporal pattern of high-risk areas in different infection periods.MethodsWe used the prospective space-time scan statistic to detect emerging COVID-19 clusters and examine the relative risk in five consecutive periods from April 1, 2020 to April 7, 2022, in Nagasaki Prefecture.ResultsThe densely inhabited districts (DIDs) in Nagasaki City have remained the most affected areas since December 2020. Most of the confirmed cases in the early period of each wave had a history of travelling to other prefectures. Community-level transmissions are suggested by the quick expansion of spatial clusters from urban areas to rural areas and remote islands. Moreover, outbreaks in welfare facilities and schools may lead to an emerging cluster in Nagasaki Prefecture’s rural areas.ConclusionsThis study gives an overall analysis of the transmission dynamics of the COVID-19 pandemic in Nagasaki Prefecture, based on the number of machi-level daily cases. Furthermore, the findings in different waves can serve as references for subsequent pandemic prevention and control. This method helps the health authorities track and investigate outbreaks of COVID-19 that are specific to these environments, especially in rural areas where healthcare resources are scarce.

Untangling the impact of socio-demographic factors on energy consumption: Why is energy access difficult to achieve in off-grid island communities?

The provision of electricity to rural off-grid island communities is considered a practical initial approach to achieving Just Energy Transition. Often, these communities are powered by diesel generators running on conventional fossil fuels that typically translate to higher electricity tariffs. The use of renewable energy technologies is deemed as the practical approach to electrify these islands. However, there is a need to define how these off-grid communities consume electricity to provide a more robust approach to load demand profiling. This study proposes an alternative path analysis approach to determine causality relationships between socio-demographic attributes of households and their ownership of electrical appliances, as an approach to ascertain electricity consumption. The approach is applied in three island communities in Palawan, Philippines where electricity is provided by diesel generators. A comprehensive survey considering age, gender, income, education, household size, and employment status was done in the three island communities. Path analysis using the R lavaan package was completed to determine causality and the results were compared with traditional correlation analysis. Results of both path analysis and correlation analysis show that income and education have the strongest significance in determining household ability to own appliances, and thus electricity consumption while age is not statistically significant at all. All other factors show weak to moderate significance. The results of the research provide a critical baseline approach to load demand profiling that can help stakeholders to conduct more efficient energy planning and develop more pragmatic strategies towards 100% household electrification and Just Energy Transition.

Seroprevalence of Severe Fever with Thrombocytopenia Syndrome Virus in Mui Island, Rural Area, Incheon, South Korea

The rural areas are the main outbreak sites of severe fever with thrombocytopenia syndrome (SFTS). To identify the seroprevelance of SFTS in rural island, we conducted a serosurveillance study of SFTS virus (SFTSV) of the general public in Mui Island, a representative rural island of Incheon, South Korea. A total of 203 participants (female 127, male 76, 30 to 97 years old, median 67) without symptoms or signs of SFTS were collected via a convenience sampling. Nested reverse transcription PCR was conducted for both the S and M segments of SFTSV gene. Indirect immunofluorescence assay was also performed for immunoglobulin G (IgG) and immunoglobulin M (IgM) against SFTSV. Only 1 participant (0.5%) was positive to SFTSV gene without IgM against SFTSV. In addition, 12 participants (5.9%) were positive to IgG against SFTSV. Seropositive rate of IgG against SFTSV was higher in age group >65 than ≤65 (9.6% vs. 1.1%, OR 9.202; 95% CI, 1.165–72.692; p=0.026) and was not statistically significant according to sex, occupation and duration of residence in Mui Island. This study suggests that SFTSV readily have infected humans in the rural island of Incheon, South Korea. Therefore, reinforced surveillance about SFTS is needed, focusing on medically vulnerable area such as an island.

Feasibility of telemedicine program using a hand-held nonmydriatic retinal camera in Panama.

To evaluate the image quality of a telemedicine screening program for retinal disease using a nonmydriatic camera among rural island communities in Bocas del Toro, Panama. In June 2018, a group of three medical students volunteered at clinics operated by the Floating Doctors in the province of Bocas del Toro, Panama. Non-mydriatic images of the retina were obtained using the Pictor Plus (Volk Optical, Mentor OH), randomized, and sent to two board-certified ophthalmologists at the University of California, Irvine for analysis using a modified version of the FOTO-ED scale. Inter-rater reliability was calculated using the kappa statistic. Seventy patients provided a total of 127 images. Average image quality was 3.31, and most frequent image quality was 4/5 on the FOTO-ED scale. Thirty patients had at least one eye image with ideal quality (42.86%), while only one patient had no adequate photos taken (1.43%). However, high quality images were obtained in both eyes in only 12 patients (17.14%). The inter-rater reliability between the two ophthalmologists was 0.614. Further improvements are necessary to acquire higher quality images more reliably. This may include further training and experience or mydriasis.

Sódó Reykjavík: How Homosexuality was Brought into Discourse in Early and Mid-Twentieth Century Iceland

ABSTRACT This article explores how homosexuality, as a concept and phenomenon, became in the early and mid-twentieth century a part of Icelanders’ vocabulary, public discourse, and conception of the world. To use Michel Foucault’s terms, the following discussion focuses on how homosexuality was brought into discourse in Iceland and asks if that process was concurrent with the neighbouring countries or unique for Iceland, a rural island on the periphery of Europe. Building on media discourse, memoirs and personal recollections it seeks to shed light on how Icelanders’ awareness of (predominantly male) homosexuality and the existence of homosexual men became more public and vocalized, and how this new public awareness and formulation of male homosexuality was an integral part of the modernization of Icelandic society. The findings show that while it was rarely addressed in the first half of the twentieth century, public discussion of homosexuality increased significantly around 1950 and included grave concerns regarding the existence of male homosexuals in Reykjavík. This suggests that (male) homosexuality was in this period becoming a more prominent part of Icelanders’ vocabulary and conception of the world.

Genetic sub-structuring of Croatian island populations in the Southeastern European context: a meta-analysis

AimTo use the method of meta-analysis to assess the influence of island population isolation on the sub-structuring of the Croatian population, as well as the influence of regional population groups on the sub-structuring of the Southeastern European population with regard to basic population genetic statistical parameters calculated by using STR locus analysis.MethodsBio-statistical analyses were performed for 2877 unrelated participants of both sexes from Southeastern Europe. Nine autosomal STR loci (D3S1358, vWA, FGA, TH01, TPOX, CSF1PO, D5S818, D13S317, and D7S82) were analyzed by using standard F-statistics and population structure analysis (Structure software).ResultsGenetic differentiation of Croatian subpopulations assessed with the FST method was higher at the level of the Croatian population (0.005) than at the level of Southeastern Europe (0.002). The island of Vis showed the most pronounced separation in the Croatian population, and Albanians from Kosovo in the population of Southeast Europe, followed by Croatia, Bosnia and Herzegovina, and Hungary.ConclusionThe higher structure of Croatian subpopulations in relation to Southeastern Europe suggest a certain degree of genetic isolation, most likely due to the influence of endogamy within rural island populations.

The impact of infrastructure investment on migration from rural islands

This paper explores the impact of infrastructure investment on migration from rural areas, where the population size in many cases is falling. To explore this, we examine eight rural islands where bridges and tunnels (fixed links) have replaced ferry connections. Fixed links offer a substantial reduction in travel time, as well as enabling the analysis to isolate and assess their impact. We estimate the effects on the population on the islands using a difference-in-difference approach, with islands without fixed links as control units. Using changes in accessibility to the nearest town as the explanatory variables, we estimate that a percentage change in accessibility to the nearest island increases the population size by 0.3 percent. The effects are close to zero immediately, while the rest builds up over a period of at least 15 years. On average, the estimated effect on the island population seems to be approximately what is needed to avoid a declining population.

Associations between physical frailty and living arrangements in Japanese older adults living in a rural remote island: The Shimane CoHRE study.

BackgroundLiving arrangements have been known to be associated with physical frailty. However, the prevalence of frailty and its risk factors in remote islands is not understood. We examined the association between living arrangements and objectively measured frailty among older adults living in a remote island of Japan.MethodsAmong older people living in Okinoshima, 656 older adults (75.6 ± 6.4 years) were analyzed. Physical frailty (robust, prefrailty, or frailty) was assessed using the 5‐item frailty phenotype (unintentional weight loss, self‐reported exhaustion, weakness, slow walking speed, and low physical activity). Physical functions (muscle mass, gait speed, and grip strength) were measured objectively.ResultsThe prevalence of frailty and prefrailty was 6.6% and 43.8%, respectively. Living with a spouse resulted in a significantly lower prevalence of frailty (p < 0.001) compared with other living arrangements. All objectively measured physical functions among those who lived with a spouse were significantly superior to those who lived with family or alone (p < 0.001). Multinomial logistic regression showed that living alone was significantly associated with frailty (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.07–5.24) and prefrailty (OR 1.75, 95% CI 1.14–2.69) after adjusting for all covariates.ConclusionThe prevalence of frailty on remote islands seemed similar to that in urban areas. Older people living in remote islands might be able to maintain their physical health. Furthermore, living alone may correlate with increased risks of frailty and prefrailty. Among elderly individuals on remote islands, living with a spouse might be desirable to prevent (pre)frailty.

Exploring the Relationship Between Arts Festivals And Economic Development in Rural Island Regions: A Case Study of Scotland's Orkney Isles

This article explores arts festivals in terms of their relationship to local economic development within the rural island region of Orkney in Scotland. Fourteen qualitative, semistructured interviews were conducted with arts festival organizers, tourism representatives, and local volunteers during the summer festival season. The findings offer new insights into the factors affecting how arts festivals impact the local economy, the areas of the local economy that are affected by arts festivals, and the implications of funding from awarding bodies on the endogenous development of arts festivals. For instance, it is concluded that supporting the cultural values of locals is vital to the economic success of rural arts festivals through a strategic design in the combined integration of minimized paid staff and maximized volunteers. Furthermore, it is revealed how in certain cases the initial retention of funding may benefit start-up arts festivals in terms of strategic development of their social approval and natural progression. Through the provision of an original theoretical framework for the relationship between arts festivals and economic development in a rural island context, the article also makes substantive contributions to theoretical development and knowledge advancement in this field, while offering future research directions for rural studies researchers. Ultimately, island community practitioners such as festival directors, local authorities, and merchants could benefit from using the findings to develop enhanced strategic operations, which could generate greater synergies and sustainability for the local arts festival sector and ultimately contribute towards greater economic prosperity.

Potensi Produk Unggulan Daerah dan Strategi Pengembangannya di Kabupaten Kepulauan Aru

This study aims to identify the potential of rural superior products in the Aru Islands Regency and strategies for developing these rural superior products. This study uses a combination method (mixed methods). A quantitative approach was used to: (1) determine the regional superior products in the Aru Islands Regency which were analyzed by MRP analysis, study area growth (RPS), shift share analysis, location quotient (LQ) analysis, overlay, and classification typology; (2) determining the strategy of developing superior products for the Aru Islands Regency using the SWOT analysis method. The results showed that the determination of regional superior products using a hierarchical assessment of various aspects were: skills, raw materials, capital, production facilities and infrastructure, technology, socio-culture, management, markets, prices, employment, and roles in the economy. Identification of the potential of regional superior products using the analytical hierarchy process shows that the superior products of rural Aru Islands Regency are corn, mackerel, grouper, white snapper, sweet potato, beef, goat, mangrove crab, and seaweed. The strategies for developing rural superior products include: 1) Increasing the attractiveness of the quality of regional superior products; 2) Improving the quality of infrastructure (production); 3) Improving the quality of infrastructure (general); 4) Improving the quality of promotion and investment; 5) Increased cooperation; 6) Increasing community participation; and 7) Increased protection of Regional Superior Products.

Clinical application of a 5G-based telerobotic ultrasound system for thyroid examination on a rural island: a prospective study.

PurposeTo evaluate the feasibility of a 5G-based telerobotic ultrasound (US) system for thyroid examination on a rural island.MethodsFrom September 2020 to March 2021, this prospectively study enrolled a total of 139 patients (average age, 58.6 ± 12.7 years) included 33 males and 106 females, who underwent 5G-based telerobotic thyroid US examination by a tele-doctor at Shanghai Tenth People’s Hospital and a conventional thyroid US examination at Chongming Second People’s Hospital 84 km away. The clinical feasibility of 5G-based telerobotic US for thyroid examination were evaluated in terms of safety, duration, US image quality, diagnostic results, and questionnaire survey.Results92.8% of patients had no examination-related complaints. The average duration of the 5G-based telerobotic US examination was similar as that of conventional US examination (5.57 ± 2.20 min vs. 5.23 ± 2.1 min, P = 0.164). The image quality of telerobotic US correlated well with that of conventional US (4.63 ± 0.60 vs. 4.65 ± 0.61, P = 0.102). There was no significant difference between two types of US examination methods for the diameter measurement of the thyroid, cervical lymph nodes, and thyroid nodules. Two lymphadenopathies and 20 diffuse thyroid diseases were detected in two types of US methods. 124 thyroid nodules were detected by telerobotic US and 127 thyroid nodules were detected by conventional US. Among them, 122 were the same thyroid nodules. In addition, there were good consistency in the US features (component, echogenicity, shape, and calcification) and ACR TI-RADS category of the same thyroid nodules between telerobotic and conventional US examinations (ICC = 0.788–0.863). 85.6% of patients accepted the telerobotic US, and 87.1% were willing to pay extra fee for the telerobotic US.ConclusionThe 5G-based telerobotic US system can be a routine diagnostic tool for thyroid examination for patients on a rural island.

Animal and Plant Protein Food Sources in Indonesia Differ Across Socio-Demographic Groups: Socio-Cultural Research in Protein Transition in Indonesia and Malaysia.

BackgroundPlant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes.ObjectiveTo examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia.DesignThe SCRiPT (Socio Cultural Research in Protein Transition) study was based on population-based samples recruited in Indonesia (N = 1665) and in Malaysia (N = 1604). Data from 24-h in-person dietary recalls in each country were used to construct the frequency counts of protein sources by food group. Protein sources were defined as fish, poultry, red meat (beef, pork, and mutton), eggs, dairy, and plants (cereals, pulses, and tubers). The percent reported frequencies for animal and plant proteins were compared across socio-demographic strata and by country. Analyses were based on one-way Anovas and general linear model regressions adjusting for covariates.ResultsAnimal protein frequency counts were 34% of total in Indonesia, but 50% in Malaysia's. Higher reported consumption frequencies for poultry and red meat in both countries were associated with urban living, greater modernization, and higher socioeconomic status, with stronger social gradients observed in Indonesia. Reported fish consumption was higher in Indonesia than in Malaysia. Fish was more likely to be listed by rural island populations in Indonesia and was associated with lower education and incomes. Consumption frequencies for plant-based proteins were associated with lower socio-economic status in Indonesia and in Malaysia.ConclusionsMore affluent groups in both countries reported higher frequencies for meat, eggs, and dairy as opposed to fish. Greater economic development in Southeast (SE) Asia is associated with more animal protein, particularly from poultry, which may displace fish, the traditional source of high quality protein for the region.

Many common presentations of obsessive-compulsive disorder unrecognized by medical providers in a Pacific Island community

PurposeObsessive-compulsive disorder (OCD) is a serious mental health condition that is frequently misdiagnosed and left untreated for extended periods. A contributing factor may be the lack of awareness regarding OCD’s heterogeneous symptom presentations in nonpsychiatric medical providers (MPs). Nonpsychiatric MPs are often consulted by those with OCD and are thus in a key position to first identify the symptoms in a person. Thus, the purpose of this study is to assess nonpsychiatric MPs’ ability to recognize varying symptom presentations of OCD.Design/methodology/approachThe current study examined OCD recognition rates in 105 nonpsychiatric MPs practicing on Guam – a rural island community with limited mental health resources. Participants were randomly assigned to read one of six vignettes describing a common obsessional theme within OCD (i.e. contamination, symmetry, religion, homosexuality, pedophilia or aggression) and asked to provide their diagnostic impressions.FindingsOver half of participating MPs (58.1%) did not recognize the condition in the vignettes as OCD. As groups, vignettes describing taboo obsessions were significantly less likely to be recognized as OCD than those describing contamination and symmetry obsessions. Overall, results reveal that MPs are largely unaware of the diversity of OCD symptoms.Originality/valueFew studies have examined nonpsychiatric MPs’ awareness of varying OCD symptom presentations, and to the best of the authors’ knowledge, no studies to date have been conducted on MPs practicing in rural settings. The findings of this study can inform training programs for MPs to help decrease OCD misdiagnoses in medical settings.

Crop Management Practices in Rural Riverine Islands of Bangladesh

This study focused on farmers’ crop management practices in selected rural riverine islands (Char lands) of Sariakandi Upazila, Bogura district, Bangladesh. Disproportionate stratified sampling was adopted to select the respondents. The data were elicited using an interview schedule and analyzed via Statistics 10 software. Results revealed that, on average, there was moderate knowledge on crop management practices, and the attitude towards the practices was favorable. But, in deviance from what is habitually obtained on mainland Bangladesh where rice cultivation dominates, jute (35.84%) and chili (28.4%) covered the majority in Char Ghagua and Char Shaluka, respectively. In Char Tengrakura, rice and chili covered a little above half (52.7%) of the crops cultivated by the respondents. In terms of the management practices, the lion’s share (81.7%, 74.7%, and 77.0%) of soil management practices was covered by chemical fertilizers in all the Char lands. Similarly, the use of chemicals dominated when handling pests and diseases. Triple cropping was foremost across the Char lands and had high mean coverage in Char Tengrakura (63.6%). The mean coverage of irrigation water management practices was virtually shallow tube well in the Char lands. Generally, there was moderate knowledge and a positive attitude towards crop management practices. That crop management practices (use synthetic materials and underground water) employed in the Char lands are unsustainable, tending to induce degradation of land and water resources.

Spatiotemporal trends in dementia‐associated deaths, what do the data reveal?

AbstractBackgroundData on dementia mortality are routinely collected by governments and used in health research. However, historical underrecording of dementia on death certificates has limited the utility of this widely available data source. Considerable effort has been invested in raising awareness of dementia, increasing diagnosis rates, and improving dementia recording on death certificates. Updated versions of the ICD‐10 rules for coding the underlying cause of death, implemented in Scotland in 2011 and 2017, have increasingly assigned deaths that mention both dementia and respiratory or urinary tract infections towards an underlying cause of dementia, if no other underlying medical condition is mentioned. Since previous cohort studies have shown geographical variation in dementia risk, this study utilises spatiotemporal modelling to investigate changes in dementia‐associated deaths in Scotland.MethodData on dementia and Alzheimer’s deaths and mid‐year population estimates available from the National Records of Scotland for the time period 2000‐2019 were used to build a Bayesian spatiotemporal disease mapping model. The data were grouped by the 32 Council areas and year, whilst stratification by age and gender were built into the model. The analyses were run in R using Integrated Nested Laplace Approximation methodology.ResultThe data show strong temporal and spatial trends in the relative risk of dementia‐associated death. The relative risk increases progressively over the time period studied, with a 2.3‐fold increase (95% Confidence Interval: 2.1‐2.5) between 2000 and 2019, reaching levels just below predicted dementia prevalence in recent years. The relative risk varies geographically and is highest in Scotland’s industrialised central belt region and lowest in the rural areas and islands, with a relative risk of 1.9 (95% CI: 1.6‐2.3) between the lowest and highest risk Council areas.ConclusionThere are factors, other than the step changes in underlying cause of death coding, driving the progressively increasing temporal trend in relative risk of dementia‐associated death. These factors could be a combination of increased dementia awareness, a larger proportion of people being diagnosed, greater recording on death certificates and, possibly, increasing prevalence. The strong spatial variation in relative risk in Scotland indicates that there are geographically‐varying factors affecting this risk.

Urban Regeneration-Is it possible for the environmental regeneration of Hong Kong to begin from Kau Yi Chau Island?

A Transitional Environment is a term recently used to describe a new form of hybrid space and habitat that has emerged within and around the contemporary city. During the last few decades in Hong Kong and China there has been an increased design focus on the distinct social, spatial, and economic characteristics and challenges that emerge in these spaces that sit both between the rural and the urban and the land and the sea. Now, a more holistic and regenerative perspective for urban design is under way, focusing on environments with an ecological mindset. Within the urban design and planning context of Hong Kong in particular, as an archipelago of islands attached to China’s mainland, these transitional environments include existing rural islands that are being adapted to and expanded as part of development proposals. These proposals tend to offer only a limited acknowledgement and engagement with their island or coastal locations and surrounding natural habitats, in favour of dense and environmentally unsustainable podium and tower schemes. With global challenges and specifically climate change and a growing number of threats to both the environment and our way of life there has been an increased focus on new approaches to problem solving that look to the natural world for solutions. This short paper includes case study projects from students at the Hong Kong Polytechnic University for the urban habitat island of Kau Yi Chau in Hong Kong. Supported by a review of relevant precedents and theories, this case study is used to discuss and reflect on the global and local issues and opportunities highlighted in the sustainable development goals (SDGs) established by the United Nations.

Abstract 12639: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). Hypothesis: Gender-based disparities in the modifiable and non-modifiable OHCA characteristics and outcomes are significant between rural and urban settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value&lt;.001). Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.

Abstract 12494: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). We sought to examine the association of the modifiable and non-modifiable OHCA characteristics and patient outcomes with rural settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% Female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value&lt;.001) . Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.