Rural Population Research Articles

Evaluating the Kuznets curve relationship between economic growth and child labor in an emerging economy

PurposeThis study aims to test the Kuznets curve between economic growth and child labor, along with the influence of exports, household size and rural population in the context of Pakistan.Design/methodology/approachTo achieve the research objective, this study applied the unit root test, bound co-integration test, and autoregressive distributive lags (ARDL) method for the period of 1972–2021.FindingsThe findings show an inverted U-shaped relationship between economic growth and child labor indicating that at the beginning stage of economic development, child labor increases due to lower per capita household and subsequently, in the long-run of economic development, child labor decreases due to the higher per capita households. Moreover, the results also show that exports, household size and rural population have a positive influence on increasing child labor.Research limitations/implicationsThe policymakers and government of Pakistan need to focus on long-term economic growth policies, ensure free quality education and cheap equipment which practices minimum manpower to reduce the threat of child labor.Social implicationsHaving long-run economic growth, the government of Pakistan need to equally benefit the households and the poor population to reduce child labor and enhance the social welfare of society.Originality/valueTo the best of the authors’ knowledge, this is the first study that investigates the Kuznets curve relationship between economic growth and child labor in the context of Pakistan. Moreover, this study contributes to the reduction in child labor through long-term economic growth in the context of Pakistan.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0387

Addressing food insecurity in rural primary care: a mixed-methods evaluation of barriers and facilitators

BackgroundFood insecurity (FI) is associated with negative health outcomes and increased healthcare utilization. Rural populations face increased rates of FI and encounter additional barriers to achieving food security. We sought to identify barriers and facilitators to screening and interventions for FI in rural primary care practices.MethodsWe conducted a mixed-methods study using surveys and semi-structured interviews of providers and staff members from rural primary care practices in northern New England. Survey data were analyzed descriptively, and thematic analysis was used to identify salient interview themes.ResultsParticipants from 24 rural practices completed the survey, and 13 subsequently completed an interview. Most survey respondents (54%) reported their practices systematically screen for FI and 71% reported food needs were “very important” for their patients and communities. Time and resource constraints were the most frequently cited barriers to screening for and addressing FI in practices based on survey results. Interview themes were categorized by screening and intervention procedures, community factors, patient factors, external factors, practice factors, process and implementation factors, and impact of FI screening and interventions. Time and resource constraints were a major theme in interviews, and factors attributed to rural practice settings included geographically large service areas, stigma from loss of privacy in small communities, and availability of food resources through farming.ConclusionsRural primary care practices placed a high value on addressing food needs but faced a variety of barriers to implementing and sustaining FI screening and interventions. Strategies that utilize practice strengths and address time and resource constraints, stigma, and large service areas could promote the adoption of novel interventions to address FI.

АНАЛИЗ ДЕЯТЕЛЬНОСТИ ВРАЧЕЙ-ДЕРМАТОВЕНЕРОЛОГОВ, ОКАЗЫВАЮЩИХ МЕДИЦИНСКУЮ ПОМОЩЬ СЕЛЬСКОМУ НАСЕЛЕНИЮ В РЕСПУБЛИКЕ БАШКОРТОСТАН

Relevance. Currently, there is a low staffing of medical organizations with local doctors and medical specialists, including dermatovenerologists. This determines the low availability of primary medical care for the rural population for diseases of the skin and subcutaneous tissue. Purpose of the study. To analyze the activities of dermatovenerologists in providing primary specialized medical care to the rural population for diseases of the skin and subcutaneous tissue in the Republic of Bashkortostan. Materials and methods. The calculation of indicators characterizing the activities of dermatovenerologists in the Republic of Bashkortostan for 2017-2021 was carried out: the provision of the population with dermatovenereologists, staffing of regular positions of dermatovenereologists, staffing with individuals, part-time ratio, share of visits per one rural resident and one patient with skin diseases, number of visits in connection with the disease, in connection with the preventive purpose. Results. Level of supply of dermatovenerologists in the Republic of Bashkortostan in 2021. amounted to 0.54 per 10 thousand population. In recent years, the provision of dermatovenerologists in the rural population remains low: in 11.1% of rural areas there are no dermatovenerologists, and in 31.5% the level of provision is insufficient. For the period 2017-2021 a decrease in the number of visits to a dermatovenerologist for skin diseases was established by 16.3% (per rural resident from 0.29 to 0.24 visits per resident), as well as a decrease in the number of visits to a dermatovenerologist by 22.0% . (from 4.63 to 3.61 visits per patient). An extremely low volume of telemedicine consultations was revealed, which is a significant factor in reducing the availability of medical care for the rural population. Conclusions. In the Republic of Bashkortostan in recent years, the provision of dermatovenerologists for the rural population remains insufficient. Thus, there is a need to develop measures aimed at improving primary specialized medical care provided by dermatovenerologists to the rural population of the Republic of Bashkortostan.

E-commerce development, poverty reduction and income growth in rural China

PurposeThis research examines the impact of the National Rural E-commerce Comprehensive Demonstration Project (NRECDP) on poverty reduction and income growth in rural China.Design/methodology/approachThe study develops a theoretical framework, which considers the role of geographical, technological, institutional and cultural factors for the e-commerce poverty alleviation (e-CPA) model. Empirically, this study applies the difference-in-differences (DID) model and the event study approach to evaluate the effectiveness of NRECDP on the basis of large-scale county-level and household-level panel data spanning 2010 to 2020.FindingsThe study found that the NRECDP, as a government-led, information and communication technology (ICT)-enabled, market-based program, has led to a significant increase in per capita output of primary industry employees, as well as in the disposable income of rural residents, especially those in national-level poverty-stricken (NP) counties. The interventions of the NRECDP achieved these positive outcomes through transportation and Internet infrastructure improvement, ICT adoption and human capital accumulation in impoverished towns and villages in remote rural areas. These effects are larger in the eastern region of China, followed by the central region, whereas the weakest effects were found in the western region. However, we found little evidence of the NRECDP increasing household developmental expenditure.Research limitations/implicationsThe study findings have important practical and policy implications for rural e-commerce development and self-sustained poverty alleviation solutions. The research revealed the significance of government NRECDP interventions for increasing rural income, reducing living costs, and empowering the rural population in its multiple social roles, namely, as consumers, producers, employees and microentrepreneurs. The local cultural context may also play a role in ICT adoption and entrepreneurship cultivation with a downstream effect on the effectiveness of e-CPA practices. Policymakers would need to ensure a supportive entrepreneur-friendly environment for rural e-commerce development and continue implementing progressive policies for poverty alleviation.Originality/valueThis study explores poverty alleviation issues in China by developing for the first time a multi-faceted framework that is subsequently tested by both county-level and household-level large-scale observations. Also, it is the first study to provide nationwide empirical evidence on the effectiveness of e-CPA in narrowing down the spatial and digital divides in China. In addition to the impact of geography, technology and governmental support, this study also sheds light on the role of culture in the adoption and diffusion of digital technologies and as a source of local entrepreneurial opportunities.

Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper

Background Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. Methods The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.

Current Status of Birth Registration Practice in Nepal

Birth registration is an essential element of civil registration and vital statistics which provide a legal identity and recognize the rights of an individual. In Nepal, birth registration has a long history starting from the Village Panchayat Act 1962 which was the first act with a provision for a birth certificate. Despite the over half-century experience of birth registration efforts, challenges to universal birth certificate coverage remain present, especially among the rural population. This research will investigate the current practices of birth registration in Nepal based on the findings of the National Population and Housing Census 2021. The analysis will show respective rates of birth certificate issuance across the regions, provinces, and development districts. Some areas show remarkable success in birth registration, while others struggle to reach significant coverage levels. The experience shows the critical role of government responsiveness to the development of birth registration which is especially important for rural areas and districts with significant rural populations. In this light, targeted efforts and outreach campaigns are necessary to eliminate barriers, thus guaranteeing equal access to birth registration for all children in Nepal.

Smart Tractor Reinvented for Safe Crops and Pesticides Control

This study addresses the challenges faced by rural Indian agriculture due to labor shortages and the migration of rural populations to urban areas. To mitigate these issues and enhance agricultural productivity, a novel solution is proposed: a GPS-guided autonomous robotic tractor equipped with advanced agricultural functionalities. The system incorporates features such as intruder detection, security measures, irrigation facilities, pesticide spraying, and environmental monitoring capabilities. With agriculture being the primary occupation in many Indian states, the significance of this innovation cannot be overstated. By harnessing autonomous technology, the project aims to optimize crop yields while minimizing labor requirements. The robotic tractor's design integrates basic components including DC motors, intruder sensors, a WIFI camera, and a solar panel for sustainable charging. The mechanical design prioritizes simplicity and functionality to ensure efficient operation in farm fields. Overall, this research contributes to the advancement of smart agriculture in rural India, offering a promising solution to the evolving challenges faced by the agricultural sector

The Great Persecution

The contribution sheds light on a mass witch trial that began in 1661 at the court in Hrastovec. It is related to proceedings initiated a decade later and taking place simultaneously in at least five courts. Those convicted were forced to list the names of many witchcraft meeting participants, which were described with all sorts of demonic imagery. The trials were thus interconnected and kept dragging on because of the confrontations between the accused. Despite the many mass trials, the number of the indicted even exceeded those that were actually put to trial. The proceedings were caused by weather storms, and many people were only tried when a new round of trials followed a storm. The trials were affected by the people’s understanding of the causes of the disasters, conspiracy theories, and various actors such as the rural population affected by the disasters, neighbourly disputes, superstitions, belief in magic, cruel, bloodthirsty judges and their personal motives, and the Inner Austrian government in charge of the criminal justice apparatus.

Deployment of a Phenotypic Characterization System for Effective Identification of the Onset of Asthma Disease

Background Essentially, machine learning techniques help with clinical decision-making by forecasting prediction results based on recent and historical data, which are frequently found in carefully chosen clinical data repositories. In order to uncover hidden patterns in the data, machine learning applies sophisticated analytical techniques that conduct an exploratory analysis while constructing prediction models to support clinical judgment. Objective To effectively identify asthmatics in two distinct cohorts representing India's rural and urban populations by adopting a phenotypic characterization approach. Methods Cross-sectional and categorical in design, the data represent the two populations, with clinical history information emphasizing clinical symptoms and patterns defining the condition. The method adopts a hybrid approach since it uniquely blends the unsupervised and supervised learning techniques to explore the advantages of both. The clustering data emphasizing the phenotypic characteristics of asthma is input to the classifier, and the performance of the classifier was continuously monitored for significant improvement in the results. Results Asthma disease outcome predictions made by the hybrid decision support system were quite accurate, with classification accuracy reaching up to 85.1% and 95.3% for the two datasets, respectively. Conclusion Since asthma is a heterogeneous disease with multiple subtypes, employing clustering information in the form of cluster evaluation scores as an input parameter to the classifiers can effectively predict disease outcomes.

The impact of food production on ecological footprint in Turkey: an analysis across agriculture, livestock, and aquaculture

AbstractThe ecological footprint (ECF), which has been frequently examined recently, offers a comprehensive analysis of the environment and has started to be used in Turkey. However, although it is a significant area of study in the world, food production, that raise the ECF the most, has not been the subject of much research in Turkey. In the present analysis, food production’s impacts on the ECF in Turkey are analyzed with yearly statistics for the period 1961–2018. Within the frame of this analysis, both food production as a whole and agriculture, livestock, and aquaculture production, which are the components of food, were analyzed individually. In this context, four different models were constructed, and the Autoregressive Distributed Lag method was used to analyze. According to the outcomes of the analysis, food, agriculture, and livestock production raise the ECF while aquaculture production diminishes. The largest coefficient among the three sub-sectors belongs to the agriculture sector. In addition, while the use of fertilizers, agricultural land, GDP, population, and life expectancy at birth increases the ECF, the age dependency ratio decreases, and the effect of rural population differs in the models.

Inclusion of Rurality and Social Determinants of Health in Documents for the Primary Prevention of Type 2 Diabetes: A Systematic Review.

Purpose: The type 2 diabetes (T2D) burden is disproportionately concentrated in low- and middle-income economies, particularly among rural populations. The purpose of the systematic review was to evaluate the inclusion of rurality and social determinants of health (SDOH) in documents for T2D primary prevention. Methods: This systematic review is reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched 19 databases, from 2017-2023, for documents on rurality and T2D primary prevention. Furthermore, we searched online for documents from the 216 World Bank economies, categorized by high, upper-middle, lower-middle, and low income status. We extracted data on rurality and the ten World Health Organization SDOH. Two authors independently screened documents and extracted data. Findings: Based on 3318 documents (19 databases and online search), we selected 15 documents for data extraction. The 15 documents applied to 32 economies; 12 of 15 documents were from nongovernment sources, none was from low-income economies, and 10 of 15 documents did not define or describe rurality. Among the SDOH, income and social protection (SDOH 1) and social inclusion and nondiscrimination (SDOH 8) were mentioned in documents for 25 of 29 high-income economies, while food insecurity (SDOH 5) and housing, basic amenities, and the environment (SDOH 6) were mentioned in documents for 1 of 2 lower-middle-income economies. For U.S. documents, none of the authors was from institutions in noncore (most rural) counties. Conclusions: Overall, documents on T2D primary prevention had sparse inclusion of rurality and SDOH, with additional disparity based on economic status. Inclusion of rurality and/or SDOH may improve T2D primary prevention in rural populations.

Feasibility of continuous glucose monitoring in patients with type 1 diabetes at two district hospitals in Neno, Malawi: a randomised controlled trial

ObjectivesTo assess the feasibility and change in clinical outcomes associated with continuous glucose monitoring (CGM) use among a rural population in Malawi living with type 1 diabetes.DesignA 2:1 open randomised...

Fostering digital equity: evaluating impact of digital literacy training on internet outcomes in rural marginalised communities in India

ABSTRACT Digital literacy (DL) training improves the participants’ digital skills and engagements and achieves desired online benefits and opportunities. However, there remains a gap in understanding whether the acquired skills effectively translate into tangible outcomes. This study explores how digital literacy training programs (DLTPs) serve as solutions to mitigate the impact of the digital divide, particularly among marginalised rural populations. Using the corresponding fields’ model, we explored the internet outcomes achieved post-training, as achieving meaningful outcomes is crucial in the digital age. In-depth interviews of 60 beneficiaries of the PMGDISHA programme, a DLTP run by the Government of India, were conducted, and thematic analysis was performed to identify the internet outcomes based on Helsper’s corresponding fields (2012). The findings demonstrate that training significantly impacts digital engagement and internet outcomes across online fields. However, discrepancies in internet outcomes persist among participants, and these disparities are closely linked to participants’ socio-demographic and economic characteristics. To create a more equitable digital landscape, digital inclusion initiatives must consider these elements and tailor their approaches accordingly. These findings significantly impact policymakers, managers, practitioners, trainers, and researchers in bridging the digital divide and creating a more inclusive digital society.

Climate Change Responses of High-Elevation Polylepis Forests

The high mountain forests on Earth are characterized by sharp environmental heterogeneity, high species endemism, and unique phenotypic adaptations. Yet, global warming is jeopardizing this ecosystem as no other as some forests may have nowhere to go beyond the mountain’s summits. One of the most human-endangered high-elevation ecosystems is the Polylepis forest. Despite its vulnerability, forecasting climate reactions in this distinctive high mountain forest type remains a formidable challenge. Therefore, in this study, we modeled climate change responses of high-elevation allopatric Polylepis sericea and P. quadrijuga (Rosaceae) in the northern Andes. The analysis took into account VIF-prioritized bioclimatic variables for near-to-present and future (2081–2100 MPI-ESM1-2-HR) conditions. Model selection was carried out following the AUC scores of 12 MaxEnt and six machine learning algorithms. Predictive power reached 0.97 for MaxEnt’s model fc.H_rm.1 (H-1). Results indicate a moderate vulnerability of P. sericea, with a 29% loss of area in the trailing edge, due to climate change for the period 2081–2100. On the other hand, P. quadrijuga is likely to experience even larger distribution losses, up to 99%, for the same period. The findings of this study suggest that P. quadrijuga, as compared to P. sericea, exhibits a restricted ability to maintain the corresponding habitat requirements in the face of climatic change. Higher niche specialization of P. quadrijuga in the environmentally heterogeneous Eastern Cordillera contrasts with the more generalist nature of P. sericea in the topographically less complex Central Cordillera. In addition to climate change, this trend may be exacerbated by the detrimental effects of agriculture, mining, and an expanding rural population, which represent significant human-driven pressures yet to be modeled in the northern Andean highlands. Yet, based on previous studies, the historical population dynamics during the past glacial cycles suggests that range shifts could play a more significant role at deeper time scales than previously forecasted in the species’ reaction to climate change. Additionally, Polylepis forests may be able to endure at the current locations via local adaptation and plasticity, major drivers of the phenotypic variation in long-lived trees, counteracting the vulnerability scenario under a niche conservatism hypothesis. Ultimately, the modeling procedure employed in this study provides insights into the potential effects of climate change on Polylepis forests 70 years from now. Oncoming studies may consider alternative responses inherent to the gene pool of the species and the interaction with edaphic and biotic agents. We advocate for the application of comparable estimations in other high-elevation tree communities found at the tree line.

Knowledge management for small-scale agricultural producers: a thematic proposal for strengthening rural economic units

Objective: To establish a thematic proposal for the management of knowledge of small-scale agricultural producers (peasants) and the strengthening of rural economic units in the state of Querétaro, to energize the social fabric and improve the quality of life of the rural population. Design/methodology/approach: A bibliometric study of the scientific production on peasant knowledge in Mexico was carried out, as well as an observational analysis focused on specific and general problems. According to the information obtained and the problems detected, three areas for knowledge management were established: technical-productive, managerial and entrepreneurial. Results: In the technical-productive area, training in good agricultural practices should be addressed, along with technological innovation and the generation of added value. In the management area, issues related with strategic management with a broad entrepreneurial vision that could help create strategies for agribusiness development. Concerning entrepreneurship, the internal and external factors of the environment stand out, which allow awakening their interest, encouraging leadership and direction for business development, in addition to promoting associativity in farming regions. The implementation of the topics proposed in the research will strengthen and boost small-scale agricultural production in the state of Querétaro. Limitations on study/implications: This study can serve as a reference for small-scale agricultural producers (peasant). Findings/conclusions: There is a great opportunity through knowledge management to increase the capacities, knowledge and skills of small-scale agricultural producers (peasants) in the state of Querétaro regarding technical-productive, managerial and entrepreneurial themes, which will generate economic, social and environmental impacts for the benefit of this rural sector.

Mapping socio-environmental vulnerability to assess rural migration in Ghana

Rural communities in Ghana, dependent on agriculture and lacking resources and infrastructure, are highly vulnerable to climate and environmental change. Internal migration is often considered as a strategy to mitigate local livelihood constraints. Understanding the challenges of rural communities requires knowledge of local conditions. As only few studies have mapped vulnerable areas in the context of migration in Ghana at a spatially explicit and nationwide level, this study provides a geodata-based examination of how rural areas in Ghana are vulnerable to multiple, co-occurring socio-economic and environmental factors influencing migration. A multifactorial and expert-based weighted overlay analysis was applied, integrating diverse data sources including climate, remote sensing, and recent census data from Ghana. Bivariate maps visualize vulnerable areas where a high impact of the factors coincides with a high rural population density. High levels of factor impact are observed in the northern regions and coastal areas of Ghana. Relatively low impact is found in more central parts of the country. The results align with current net migration rates, confirming the applicability of our method for assessing rural internal migration. This method enhances the understanding of migration dynamics in Ghana and emphasizes the role of spatial data in migration studies.

Abstract PO1-08-04: Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making

Abstract Background: Prior work from our group has shown a high rate of familial breast cancer (BC) among rural BC patients (pts), with 33% reporting > 1 first-degree family members with BC and 55% meeting NCCN germline genetic testing (GGT) criteria (Shelton CH et al. NC Med. J; 2022). In 2018, we increased GGT to include all BC pts and observed: 1) many pts were out-of-criteria per NCCN guidelines but had actionable pathogenic germline variants (PGVs) and 2) knowledge of GGT factored significantly into shared decision making by providers and patients, including for positive and negative results. Beginning in 2019, concurrent with the recommendation from the American Society of Breast Surgeons, we expanded this model of universal GGT to an IRB-approved study to measure the impact of prospective testing on shared decision-making. Herein we report the real-world implementation of universal GGT for patients with BC and genetics-informed treatment decision-making in a rural community practice. Methods: From 2019-2022 all BC pts at a small, rural community hospital were offered GGT. Demographics, clinical features, and GGT results were collected along with clinician-reported clinical recommendations for treatment based on GGT results. Descriptive statistics and two-tailed Fisher’s exact test were employed and significance was set at p< 0.05. Results: 210 BC pts were offered GGT and 192 (91%) underwent testing [97% female, 95% non-Hispanic White, mean age at diagnosis of 62, 75% Stage I], with all but 7 pts completing GGT before primary treatment decisions. 104 (54%) of patients were in-criteria (IC) and 88 (46%) out-of-criteria (OOC) with NCCN GGT guidelines. PGVs were identified in 25 pts (13%) and 15 genes, most commonly BRCA1/2 (5 pts), PALB2 (3), monoallelic MUTYH (3) and ATM, BARD1, CHEK2 (2 pts each). PGV frequencies were 15% in IC and 11% in OOC patients (p=0.495). 46 (24%) pts had only a variant of uncertain significance (VUS) results. 70% of patients had > 1 clinical management change based on their GGT results. Changes in breast surgery, uptake of risk-reducing bilateral salpingo-oophorectomy, surveillance and clinical follow-up were significantly higher in patients with PGV compared to those with VUS/negative results (p < 0.0001). Compared to those with negative results, patients with PGVs in BRCA1 and BRCA2 were significantly more likely to undergo bilateral mastectomy (BLM) while those with PGVs in other genes or with VUS were not significantly more likely to elect for BLM than those with negative results. Clinicians reported that return of GGT reinforced their recommendation for 73/138 (53%) of patients who underwent breast-conserving therapy. GGT results aided in radiation therapy strategy for 54% of pts, most often resulting in dose de-escalation (accelerated fractionation) for negative/VUS pts (Table). Conclusions: Universal GGT for patients with BC was successfully implemented in a rural community practice with >90% uptake. Treatment was enhanced in those with clinically actionable PGVs and de-escalated in those without PGVs. Universal GGT for patients with BC is feasible to implement as the standard of practice within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce unnecessary healthcare resource utilization. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making Changes in Radiation Therapy Strategy based on GGT Citation Format: Charles Shelton, Sarah Nielsen, Antonio Ruiz, Lauren Shelton, Karen Freas, Sarah Poll, Brandie Heald, Daniel Pineda-Alvarez, Edward Esplin, Rachel Ellsworth, Hannah Montgomery. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-08-04.

Menopause modified the association of blood pressure with osteoporosis among gender: a large-scale cross-sectional study

PurposeThis study aimed to assess the potential association between blood pressure and osteoporosis in a rural population with limited resources. Existing evidence on this association is limited, particularly in such settings.MethodsData from 7,689 participants in the Henan Rural Cohort study were analyzed. Four blood pressure indicators [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP)] were measured. The logistic regression model and restricted cubic spline plots were used to assess the relationship between blood pressure indicators and osteoporosis prevalence.ResultsPositive trends were noted between blood pressure indicators and osteoporosis prevalence in the entire group and women (Ptrend < 0.05 for SBP, MAP, and PP). Women with higher SBP and PP exhibited elevated odds of osteoporosis compared with those with the lowest SBP and PP (ORs ranging from 1.15 to 1.5 for SBP and 1.06 to 1.83 for PP). No such associations were found in men. These relationships were only evident in postmenopausal women. Dose–response analysis confirmed these findings. Excluding participants taking hypertension medication did not alter the results.ConclusionIn resource-limited settings, higher SBP and PP are associated with the increased prevalence of osteoporosis in women, potentially influenced by menopause-related factors. This indicates that potential gender-based differences and social inequalities may affect bone health.Clinical trial registrationThe Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.

Abstract PO1-09-07: Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility

Abstract Background The feasibility of the outpatient mastectomy in a rural setting is poorly characterized. Centers treating rural patient populations have unique challenges. Limited access to resources and distance to facilities that can care for post-surgical patients are two such challenges. The aim of this study is to analyze the efficacy and safety of an outpatient mastectomy program in our tertiary care facility treating rural Appalachian patients. Methods We performed a single-institution retrospective review of all patients with breast cancer over 18 years of age who underwent a mastectomy with or without immediate alloplastic breast reconstruction at JW Ruby Memorial Hospital from 2019-2022. Our primary objective was to determine the 30, 60, and 90-day readmission rates. Our secondary objective included an analysis of perioperative pain control variables to develop an enhanced recovery protocol. Data collected included age, ethnicity, prognostic factors, stage at diagnosis, surgical treatment, opioid and non-opioid based treatments pre- and postoperatively by milligram morphine equivalents (MMEs), comorbidities as analyzed by the Charlson comorbidity index (CCI) variables, and distance from the tertiary hospital. Results We identified thirty-two women between 2019-2022 who underwent same-day mastectomy at JW Ruby Memorial Hospital in Morgantown, West Virginia. The mean age was 55.4 years. The mean distance to the hospital was 22.1 miles with a maximum distance of 111 miles (SEM = 3.90). The mean CCI score was 2.9 (SEM = 0.51). Overall readmission rates at 30- 60- and 90-days were 6.3% (n = 2), 3.1% (n = 1) and 0%, respectively. One woman was readmitted eight days postoperatively from a unilateral mastectomy and sentinel lymph node biopsy without reconstruction for an expanding hematoma of the chest after resuming anticoagulation on postoperative day three. The other two patients were admitted for unrelated surgical reasons. Thus, readmission related to surgical complications alone was 3.1% (n = 1). Preoperatively, 90.6% (n = 29) of women received a local anesthetic block by the anesthesia provider. Neither a preoperative nor intraoperative block was given to the remaining three. Bilateral mastectomies occurred in 21.9% (n = 7) of women and 78.1% (n = 25) underwent unilateral mastectomy. Of these 32 women, 25.0% (n = 8) underwent immediate staged reconstruction with tissue expanders. There were no direct-to-implant reconstructions in this population. There were twenty-six sentinel lymph node biopsies and four axillary dissections performed. The mean MMEs received for the duration of the hospital encounter was 132 (SEM = 23.4). An enhanced recovery after surgery protocol was not used. Discussion Outpatient mastectomy is a safe and effective option for eligible patients living in rural settings. Factors such as the type of mastectomy, reconstruction, the patient's overall health status, and the availability of support at home can impact the feasibility of this approach. Careful patient selection and a multidisciplinary team including the patient, surgeon, and anesthesiologist should carefully assess the individual’s circumstances to determine if outpatient mastectomy is appropriate. Implementation of enhanced recovery after surgery protocols will be further investigated and guided by this study. Citation Format: Gregory Stimac, Kristin Lupinacci, Michael Cowher, Hannah Hazard-Jenkins. Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-07.

Assessment of Biomass Energy Potential for Biogas Technology Adoption and Its Determinant Factors in Rural District of Limmu Kossa, Jimma, Ethiopia

Increasing clean energy access for the rural population of developing countries is a priority to meet the United Nation’s Sustainable Development Goals-Zero hunger and affordable modern/clean energy for all. Similarly, to meet this goal, Ethiopia moved towards the development of renewable energy. However, there is a limited knowledge on the biomass energy potential for biogas technology adoption at the local/district level. Thus, this study aimed at assessing the biomass energy potential for biogas technology adoption and its determinant factors among rural households in Limmu Kossa district, Ethiopia. Data was collected from 411 households from 13–24 June 2021. The quantitative data was analyzed using Statistical software Package for Social Science (SPSS) version 23 and Microsoft Word-Excel. The qualitative data was analyzed using content analysis. The study showed that over 96% of households rely on the traditional use of biomass energy for cooking. Nevertheless, on average, about 1 m3 of biogas energy can be potentially available from livestock dung and human excreta per household per day. However, the huge potential of biomass energy did not contribute to improved energy technologies such as biogas. The adoption of biogas is hampered by the non-functionality of the installed biogas, a lack of awareness, the availability of firewood, and the socio-economic characteristics of the households. Thus, improving the awareness of the community, arranging financial access, and training biogas technicians, especially from the local community, would increase the adoption of the technology. However, meeting the digester water demand with the water collected from the walking distances of 15–20 min can be challenging. Community-based biogas digesters or biogas involving income generation with a water supply around the digester would be a better and more sustainable option for biogas energy adoption and use.