Rural Locations Research Articles

Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective

ObjectiveTo estimate inpatient care costs of childhood severe pneumonia and its urban–rural cost variation, and to predict cost drivers.DesignThe study was nested within a cluster randomised trial of childhood severe...

Trends in Patient Complexity, Practice Setting, and Surgeon Reimbursement for Urolithiasis: Do Rural Urologists Pay the Price?

ObjectivesTo evaluate the relationship between patient complexity, practice setting, and surgeon reimbursement for ureteroscopy and percutaneous nephrolithotomy (PCNL). MethodsThe “2021 Medicare Physician and Other Provider” file was used to collect Rural-Urban Commuting Area (RUCA) codes and hierarchical condition category (HCC) scores of urologists. Higher HCC score corresponds to higher medical complexity and higher RUCA code corresponds to a more rural area. Medicare reimbursement for ureteroscopy and PCNL were collected. Linear regressions were performed to predict change in reimbursement based on RUCA and HCC scores. ResultsIn 2021, 52,816 procedures under CPT code 52356 (ureteroscopy) and 1649 procedures under 50080 or 50081 (PCNL) were billed to Medicare. Mean reimbursement was $338.24 for ureteroscopy and $957.89 for PCNL. For ureteroscopy, higher HCC score predicted lower reimbursement (p<0.001). Higher HCC score predicted higher reimbursement for PCNL (p<0.01). Average RUCA for ureteroscopy was higher than for PCNL (p=0.02). Rural location predicted lower reimbursement for ureteroscopy (p<0.001), however there was no association for PCNL. ConclusionsFor ureteroscopy, higher-risk patients are associated with lower reimbursement while the opposite holds true for PCNL. Rural practices were associated with lower reimbursement for ureteroscopy, but there was no association between location and PCNL reimbursement. Together, these findings suggest practice pattern variation between ureteroscopy and PCNL and highlight gaps in reimbursement policy. Risk-adjusted reimbursement should be considered to incentivize urologists to treat complex patients within their practice scope.

OPTIMIZING INVENTORY MANAGEMENT: AMAZON’S STRATEGIES IN RURAL SUPPLY CHAINS

The world's largest online retailer, Amazon, has invested heavily in infrastructure and technology to save costs and improve operations. Amazon has the most efficient supply chain in the world due to cutting-edge robotics and artificial intelligence (AI) technology that can improve productivity and worker safety. Amazon's regional distribution centers use advanced algorithms, route optimization technology, and mapping tools to effectively handle deliveries in rural areas. Artificial intelligence (AI) technologies, machine learning, and Amazon Prime membership are some initiatives that personalize recommendations and enhance the purchasing experience. To get around logistical challenges in rural locations, Amazon also collaborates with regional businesses and delivery services. To save expenses and wait times for last-mile deliveries in remote places, Amazon has made investments in micro-fulfillment centers to reduce last-mile delivery time and costs in rural areas.

Bystander defibrillation for out-of-hospital cardiac arrest in Ireland

AimsTo describe and explore predictors of bystander defibrillation in Ireland during the period 2012 to 2020. To examine the relationship between bystander defibrillation and health system developments. MethodsNational level Out of Hospital Cardiac Arrest (OHCA) registry data were interrogated, focusing on patients who had defibrillation performed. Bystander defibrillation (as compared to EMS initiated defibrillation) was the key outcome of concern. Logistic regression models were built and refined by fitting predictors, performing stepwise variable selection and by adding pairwise interactions that improved fit. ResultsThe data included 5,751 cases of OHCA where defibrillation was performed. Increasing year over time (OR 1.17, 95% CI 1.13, 1.21) was associated with increased adjusted odds of bystander defibrillation. Non-cardiac aetiology was associated with reduced adjusted odds of bystander defibrillation (OR 0.30, 95% CI 0.21, 0.42), as were increasing age in years (OR 0.99, 95% CI 0.987, 0.996) and night-time occurrence of OHCA (OR 0.67, 95% CI 0.53, 0.83). Six further variables in the final model (sex, call response interval, incident location (home or other), who witnessed collapse (bystander or not witnessed), urban or rural location, and the COVID period) were involved in significant interactions. Bystander defibrillation was in general less likely in urban settings and at home locations. Whilst women were less likely to receive bystander defibrillation overall, in witnessed OHCAs, occurring outside the home, in urban areas and outside of the COVID-19 period women were more likely, to receive bystander defibrillation. ConclusionsDefibrillation by bystanders has increased incrementally over time in Ireland. Interventions to address sex and age-based disparities, alongside interventions to increase bystander defibrillation at night, in urban settings and at home locations are required.

Using Nighttime Light Data to Explore the Extent of Power Outages in the Florida Panhandle after 2018 Hurricane Michael

The destructive forces of tropical cyclones can have significant impacts on the land, contributing to degradation through various mechanisms such as erosion, debris, loss of vegetation, and widespread damage to infrastructure. Storm surge and flooding can wash away buildings and other structures, deposit debris and sediments, and contaminate freshwater resources, making them unsuitable for both human use and agriculture. High winds and flooding often damage electrical disubstations and transformers, leading to disruptions in electricity supply. Restoration can take days or even weeks, depending on the extent of the damage and the resources available. In the meantime, communities affected by power outages may experience difficulties accessing essential services and maintaining communication. In this study, we used a weighted maximum likelihood classification algorithm to reclassify NOAA’s National Geodetic Survey Emergency Response Imagery scenes into debris, sand, water, trees, and roofs to assess the extent of the damage around Mexico Beach, Florida, following the 2018 Hurricane Michael. NASA’s Visible Infrared Imaging Radiometer Suite (VIIRS) Day/Night Band (DNB) was processed to estimate power outage duration and rate of restoration in the Florida Panhandle based on the 7-day moving averages. Percent loss of electrical service at a neighborhood level was estimated using the 2013–2017 American Community Survey block group data. Spatial lag models were employed to examine the association between restoration rates and socioeconomic factors. The analysis revealed notable differences in power-restoration rates between urbanized and rural areas and between disadvantaged and more affluent communities. The findings indicated that block groups with higher proportions of minorities, multi-family housing units, rural locations, and households receiving public assistance experienced slower restoration of power compared to urban and more affluent neighborhoods. These results underscore the importance of integrating socioeconomic factors into disaster preparedness and recovery-planning efforts, emphasizing the need for targeted interventions to mitigate disparities in recovery times following natural disasters.

Prevalence and Correlates of Psychiatric Symptoms Among Medical Students in Punjab: A Comprehensive Cross-Sectional Study

Background: Pain is evident, pressure, hopelessness and anxiety-is equally well-known to students with each passing academic semester in medical school. To understand the frequency and reasons of mental symptoms in MBBS students, the current study aims at investigating the level of MBBS students at several medical colleges in Punjab, Pakistan. Objective: To compare the results of stress, depressive, and anxious symptoms of several numbers of medical students studying in different medical colleges in Punjab and secondly, to evaluate the role of several demographics on these mental health indicators. Methods: The cross-sectional survey was completed between September 2023 to May 2024 with 350 medical students from multiple private and government medical colleges in Punjab. A cross-sectional survey was carried out including the Depression Anxiety Stress Scale-21 (DASS-21) as the research tool and the data aspires to be statistically analyzed. Results: the results indicated that the percentage of the medical students who reported to be stressed, sad, or anxious was 47.3%, 55.7%, and 61.4%, respectively. Female students also claimed higher levels of depression compared to male students 58.3% vs. 50. 1%, (p ≤0.01) and higher levels of anxiety 65.2% vs. 55.1%, (p ≤0.03). Students in rural locations reported greater levels of stress (52.6% vs. 43.2%, p ≤0.04) than urban ones. Conclusion: The study linked high levels of mental symptoms among medical students in Punjab to characteristics such as being a female student or originating from a rural area. The current study emphasizes the necessity of targeted programs and activities in the areas of mental health promotion and preventive measures among medical college students.

Blastocystis colonization and associations with population parameters in Thai adults.

Blastocystis is a unicellular eukaryote commonly found in the intestinal tract of humans and other animals. The prevalence of Blastocystis has been investigated in both developed and developing countries, yet its occurrence and distribution in rural locations has been less studied. Herein, we aimed to examine the distribution of Blastocystis colonization in Thai adults representing background populations along a rural/peri-urban gradient, as well as associations between colonization and personal characteristics. A total of 238 participants were recruited from rural and peri-urban areas situated in three provinces. The presence of Blastocystis in feces was evaluated using PCR and qPCR. Information on gender, age, region (province), rural/peri-urban location, and body mass index (BMI) was collected. The overall rate of Blastocystis carriage was 67.2%. Univariate analysis revealed significant associations between Blastocystis carriage and region (p<0.05), location (p<0.001) and age group (p<0.05). Logistic regression analysis revealed that rural/peri-urban location and BMI were significantly associated with Blastocystis carriage. Nine subtypes (ST1-ST7, ST10 and ST23) were identified with ST3, ST7 and ST1 as the most abundant ones, in this order. The greatest diversity of subtypes, in terms of numbers, was found in the middle aged group (nine subtypes), while the least diversity was found in the young adult and obese (three subtypes each) groups. This study increases the understanding of the epidemiology of Blastocystis colonization and its association with population parameters and characteristics in middle-income countries.

Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador.

Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.

Insect catch at historic libraries in rural and urban settings

The historic libraries of Austria are often elegant classical spaces. The collections are sensitive to damage by insects, such as silverfish (Lepismatidae), biscuit beetles (Stegobium paniceum), spider beetle (Ptinus fur) and the furniture beetle (Anobium punctatum) and a range of other beetles e.g. Dermestidae, which attack carpets and museum objects. Warmer conditions and changes in humidity might encourage new species to appear at these locations. Historic libraries represent a useful group to study, because they have similar collections, with only limited addition of new material and sometimes very few visitors, thus representing a stable indoor ecosystem. The five monastic libraries in the study occupy a range of settings, from rural to urban. Additionally, there were three research libraries in Vienna. Insects were caught over several years (up to 10) from the eastern parts of Austria using sticky blunder and pheromone (webbing clothes moth) traps. Higher annual catch rates were found in more rural monastic settings and revealed a less even spread of species (a high Gini coefficient) than at urban sites. The Shannon diversity was higher in the urban research libraries. Species within the same family can show differences in preference: silverfish Lepisma saccharinum (rural), Ctenolepisma longicaudatum (urban) or C. calvum (urban), carpet beetles Anthrenus museorum (rural) and A. verbasci (urban). The differences may be a function of the land use, climate, air pollution or human activities. The work suggests that managing insects in these libraries need to account for differences between rural and urban locations.

The Performance of Critical Congenital Heart Disease Screening in Rural Versus Urban Locations in the Northwest United States

Pulse oximetry screening of newborns detects critical congenital heart disease (CCHD). Rural birth location is known to affect timing and management of when infants with CHD undergo surgery, but its association with CCHD screening is unknown. We assess the relationship between rural location and postnatal CCHD diagnosis and describe lesion-specific modes of diagnosis. Data were abstracted from medical records at 2 cardiac surgery centers in Washington state. Infants with CCHD, defined as CHD requiring either cardiac intervention or resulting in death at <1month of age, born between July 2015 and June 2020, were included and classified by method of identification. Patient home ZIP codes were used to determine rural location. We included 561 newborns with CCHD; 35% were diagnosed postnatally. Predominant postnatal mechanisms of identification (n=194) included symptomatic before CCHD screening period (56%), CCHD screening (22%), and symptomatic after false-negative screen (15%). Postnatal diagnosis rate increased with degree of ruralness (48% in small rural/isolated regions vs 32% in urban regions; P=.01) and incidence of undiagnosed CCHD at birth increased with lower nursery levels (5.5/10000 live births in nursery level 1 vs 2.1/10000 live births in level 4). CCHD screening identifies 22% of postnatally diagnosed CCHD and 7% of cases overall in our region. Postnatal diagnosis is more common in rural regions. The incidence of undiagnosed CCHD at birth increases with decreasing nursery levels. This study supports the value of CCHD screening in routine newborn care, especially in rural areas and hospitals with lower nursery levels.

Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study

BackgroundIn 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover.MethodsThis study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher’s exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data.ResultsAmong the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059–0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714–43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090–0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion.ConclusionsThis study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere.

Regional Disparities in Atrial Fibrillation Management: An IMPACT-AF Substudy

BackgroundIn rural regions, atrial fibrillation (AF) management is performed predominately by local primary care professionals (PCPs). Prior work has suggested that a disparity in outcomes in AF occurs for those patients living in a rural, vs urban, location. MethodsThis post hoc analysis of the cluster randomized trial Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) compared a clinical decision support system to standard of care. Patients were classified as living in a rural (population < 10,000) or urban location. The outcomes were as follows: AF-related emergency department (ED) visits, unplanned cardiovascular (CV) hospitalizations, AF-related referrals and guideline adherence for AF treatment. ResultsA total of 1133 patients were enrolled from 2016 to 2018; 54.1% (n = 613) were classified as living in a rural location. No differences were present in age (mean, 72 ± 9.63 vs 72.5 ± 10.42 years) or Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS2) score (mean, 2.1 ± 1.36 vs 2.16 ± 1.34). Referral rates to general internists were higher in the rural population (13.4% vs 3.9%, P < 0.001), whereas the rate of cardiology referrals was higher in the urban population (10% vs 15%, P = 0.0098). At 12 months, no difference in the composite outcome of AF-related ED visits and CV hospitalizations was seen. Fewer recurrent AF-related ED visits and CV hospitalizations occurred in the urban group (incidence rate ratio [IRR], 0.65 [95% confidence interval (0.44, 0.95), P = 0.0262). The incidence of guideline adherence was similar between the rural (IRR, 3.7 ± 1.2) and urban (IRR, 3.6 ± 1.2; P = 0.11) groups. ConclusionsAF patients living in rural locations had higher rates of recurrent AF-related ED visits and unplanned CV hospitalizations. Further research to optimize AF-related outcomes is needed to ensure equitable delivery of care to all Canadians, irrespective of geography. Clinical Trial RegistrationNCT01927367.

Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis.

Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. Retrospective data analysis from 2017-2021. Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261). While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.

Healthcare Disparities Among Older Adults: Exploring Social Determinants of Health and Cognition Levels.

The purpose was to investigate the impact of sociodemographic factors on healthcare utilization among adults with different cognition levels (normal and impairment/dementia). We used cross-sectional data from the Health and Retirement Study (N=17,698) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits. A cohort comparison between normal and dementia/impaired cognition groups revealed significant differences. The dementia/impaired group had lower education levels, higher single/widowed status, and more racial and ethnic minorities. They experienced longer hospital and nursing home stays, varied doctor visit frequencies, and had higher mean age, greater loneliness scores, and lower family social support scores. Differences in hospitalization, nursing home, hospice care, and doctor visits were influenced by factors such as race, age, marital status, education, and rurality. There were disparities in healthcare utilization based on participants' characteristics and cognition levels, especially in terms of race/ethnicity, education, and rural location.

The lived experiences of transgender and gender-diverse people in accessing publicly funded penile-inversion vaginoplasty in Canada.

Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.

“You are either sporty or you are not” a qualitative exploration of pre-teen girls of low-socioeconomic position experiences of being physically active

BackgroundEighty one percent of adolescents do not meet the recommended physical activity (PA) guidelines with levels of physical activity declining steadily with age and more pronounced in girls of low socioeconomic position (SEP). Furthermore, early adolescence is a time when the rate of decline in PA is most severe amongst girls, placing them at an increased likelihood of developing negative health outcomes associated with physical inactivity. In response, the aim of this study was to explore low-SEP pre-teen girls’ experiences of being physically active and to understand their perceptions of the individual, social and environmental factors that influence these experiences. MethodsFocus groups were conducted with 107 girls aged 10–12 years from four urban and three rural primary schools. Reflexive thematic analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework (TDF). ResultsThemes highlighted how skills and confidence underpin girls’ self-identity for PA. Girls described how their social network (i.e., peers, family, coaches and teachers) shaped their experiences of being active. Girls recognised how being active was impacted by the challenges and opportunities in their local community (e.g., lack of facilities and anti-social behaviour). ConclusionThis study provides insight into low-SEP pre-teen girls’ experiences of being physically active in both rural and urban locations, while highlighting the complex interplay of individual, social and environmental factors. Additionally, the use of the TDF presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote low-SEP pre-teen girls PA.

Measurements of Water-Soluble Ions in Particulate Matter 2.5 in Polish Rural Areas: Identifying Possible Sources

Limited data on rural Poland's atmospheric ion concentrations exists, with no publicly available monitoring data in urban areas. These knowledge gaps hinder the comparison of concentrations across environments and the identification of their sources. This study examines water-soluble ions across five rural locations in Poland over four years to investigate their concentrations and sources in the atmosphere. This study explores aerosol origins, performing a four-year correlation analysis across five locations to reveal ion relationships. Notably, sulfate (SO₄2⁻), nitrate (NO₃⁻), and ammonium (NH₄⁺) exhibit significant correlations ranging from 0.3 to 0.8, suggesting a common pollution source in all analyzed rural locations. Interestingly, magnesium (Mg2⁺) and sodium (Na⁺) in two locations demonstrated a strong correlation, ranging between 0.4 and 0.9, suggesting the influence of sea spray on these sites. Principal component analysis is used to investigate the factors influencing ion concentrations, revealing distinctive patterns for each location and explaining the total variances ranging from 74.9% to 84.8%. This underscores the significance of geographical and environmental factors. The study's novelty lies in its thorough and long-term analysis of water-soluble ion concentrations across rural Poland, providing an extensive dataset for the region. The study fills a data gap on rural pollution sources and reveals consistent ion patterns across different sites and seasons. The findings emphasize geographical and environmental impacts on aerosol composition and suggest common pollution sources for all areas. This research encourages further investigations into the stability and origins of ions in rural environments, providing valuable insights for local and broader atmospheric studies.

Understanding the landscape of domestic violence transitional housing: services and housing for rural and non-rural clientele

Housing support is one of the most powerful and in-demand remedies to address domestic violence (DV), with almost 40,000 survivors served daily in U.S. based DV housing programmes. DV transitional housing (DVTH) provides a critical safety net of longer-term housing for survivors beyond emergency shelters. Despite its wide use, little research has documented who is using DVTH, their needs, and how programme environment and location impact service provision. Using five years of data from U.S. government funded DVTH programmes, this study examines client and programme characteristics with attention to rurality. Findings indicate demographic, service engagement, and length of stay differences among DVTH clients within rural and non-rural locations. Programme environments and service provision significantly varied between rural and non-rural programmes. Results highlight substantial heterogeneity in programme structure, client demographics, and services engagement across non-rural and rural programmes. The wide range of DVTH types and service use indicate the need for dynamic and flexible support and funding to address survivor-defined needs.

The rising prevalence of type 2 diabetes among the youth in southern India-An ancillary analysis of the Secular TRends in DiabEtes in India (STRiDE-I) study.

We studied the prevalence and incidence of type 2 diabetes (T2DM) and its associated risk factors in younger (20 and 39 years) and older individuals (≥40 years) over a 10-year period. Epidemiological surveys in 2006 (n = 7066) and 2016 (n = 9848) were conducted in similar urban and rural locations of southern India among people aged ≥20 years. Diagnosis of T2DM was made using World Health Organization criteria. Self-reported diabetes was verified from medical records. Age and gender standardized prevalence and incidence rates, percentage change in obesity, hypertension, and dyslipidemia were calculated. Prevalence ratios (PR) were calculated using Poisson regression analyses. Primary study was registered on www. gov. Identifier: NCT03490136. In 10 years, the prevalence of T2DM increased in younger (7.8% vs. 4.5%, p < 0.0001) and older individuals (34% vs. 28.4%, p < 0.0001). After adjusting for age, family history of diabetes, and waist circumference, younger individuals showed a higher percentage increase in prevalence than the older group (PR = 1.36 [95% confidence interval [CI], 1.14-1.62], p = 0.001) versus (PR = 1.11 [95% CI, 1.02-1.20], p = 0.02). Increase in rates of obesity and dyslipidemia was also higher in the younger than in the older individuals. In 10 years, incidence of T2DM increased by 120% (1.1% vs. 0.5%, p < 0.0001) and 150% (5% vs. 2%, p < 0.0001) in the younger and older individuals, respectively. Higher percentage increase in prevalence of T2DM was seen among younger individuals over a 10-year period. Obesity and family history of diabetes were shown to be the primary contributing factors for the rise in prevalence.

The importance of 'place' and its influence on rural and remote health and well-being in Australia.

This article explores the crucial role of 'place' as an ecological, social and cultural determinant of health and well-being, with a focus on the benefits and challenges of living rurally and remotely in Australia. The health system, including health promotion, can contribute actively to creating supportive environments and places that foster health and well-being among individuals residing in rural and remote locations. For First Nations peoples, living on Country, and caring for Country and its people, are core to Indigenous worldviews, and the promotion of Aboriginal and Torres Strait Islander health and well-being. Their forced removal from ancestral lands has been catastrophic. For all people, living in rural and remote areas can deliver an abundance of the elements that contribute to a 'liveable' community, including access to fresh air, green and blue space, agricultural employment, tight-knit communities, a sense of belonging and identity, and social capital. However, living remotely also can limit access to employment opportunities, clean water, affordable food, reliable transport, social infrastructure, social networks and preventive health services. 'Place' is a critical enabler of maintaining a healthy life. However, current trends have led to a reduction in local services and resources, and increased exposure to the impacts of climate change. This commentary suggests ideas and strategies through which people in rural and remote locations can strengthen the liveability, resilience and identity of their communities, and regain access to essential health care and health promotion services and resources. Recommended strategies include online access to education, employment and telehealth; flexible provision of social infrastructure; and meaningful and responsive university-health service partnerships.