Colorectal cancer is a leading cause of oncologic morbidity and mortality in the United States, with rural populations facing greater barriers when accessing high-quality surgical care compared to their urban counterparts. We aim to highlight the extent and nature of such inequities, better informing policy and guiding future research. Our search was conducted in CINAHL Complete (EBSCOhost), Embase (Elsevier), MEDLINE (PubMed), and Scopus (Elsevier) using keywords specific to colorectal cancer, surgical access, and rural populations in the United States. Articles included were original and focused on access to surgical services for rural colorectal cancer populations in the United States. Two reviewers independently conducted title and abstract screening, full-text review, and data extraction. All final articles were reviewed by the full authorship team before extraction. We aimed to outline the domains contributing to disparities in surgical access among rural colorectal cancer populations. Our search yielded 5218 unique citations, with 245 full-text articles assessed for inclusion. A total of 20 studies were included in the final synthesis. The review revealed that disparities in access to colorectal surgical care are influenced by critical overarching domains, including geographic barriers, the health care workforce, underlying patient socioeconomics, and regional demographics. Rural populations are highly heterogenous and each specific domain identified may have differing levels of impact within a specific community. Rural colorectal cancer populations face significant barriers to accessing surgical care compared to their urban counterparts across key domains. Policymakers should focus on measures to support rural health care systems and address workforce shortages to improve access and outcomes for underserved populations.

Microplastic contamination has emerged as a growing environmental exposure concern in river-dependent rural populations, yet evidence on behavioral determinants remains limited. Health literacy is a key upstream determinant that may influence risk perception and preventive behavioral responses. This study examined the association between health literacy and preventive behaviors related to microplastic exposure among residents living along the Mun River in Buriram Province, Thailand. A community-based cross-sectional study was conducted among 268 adults selected using multistage sampling. Data were collected through structured interviewer-administered questionnaires. Health literacy was operationalized as a multidimensional construct covering six domains and categorized into sufficient and insufficient levels. Preventive behaviors were dichotomized as good or poor based on predefined scoring criteria. Multivariable logistic regression models were applied to estimate adjusted associations between health literacy and preventive behaviors while controlling for potential confounders, including sociodemographic and behavioral factors. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Insufficient health literacy was highly prevalent (70.9%) and was independently associated with poor preventive behaviors (AOR = 6.05, 95% CI: 3.08-11.90, p < 0.001) after adjustment for covariates. Domain-specific analysis identified action literacy (AOR = 2.67, 95% CI: 1.29-5.59, p = 0.008) and appraisal literacy (AOR = 3.19, 95% CI: 1.51-6.73, p = 0.002) as significant predictors. Frequent fish consumption was also independently associated with poor preventive behaviors (AOR = 3.25, 95% CI: 1.35-7.84, p = 0.009). Health literacy is a strong independent correlate of preventive behaviors related to microplastic exposure in rural riverine populations. Findings support targeted, domain-specific health literacy interventions-particularly action- and appraisal-oriented competencies-as a public health strategy to reduce environmental exposure risk.

Urban-rural and regional inequalities in PCDD/F exposure across China's urban agglomerations: Insights from a multimedia food-chain model with cooking bioaccessibility.

Urbanisation provides a unique framework for studying how organisms respond to human-modified environments. Although phenotypic differences between rural and urban populations are increasingly well documented, our knowledge of how natural selection operates in cities remains limited. In particular, few studies have quantified the direction and shape of natural selection acting on breeding phenology in urban environments. Using a 13-year dataset on great tits (Parus major), we investigated how first clutch laying date (FCLD) influences both fledgling output from first broods and total seasonal productivity (first and second clutches combined). We first tested whether FCLD differed between habitats and among urban plots. We then estimated natural selection on FCLD relating breeding phenology to fledgling number from (i) first broods only and (ii) total annual productivity including first and second broods. Finally, we evaluated how FCLD and habitat jointly affected the probability of multiple brooding. As in previous studies, FCLD occurred earlier in more urbanised areas. With first broods only, earlier breeding tended to be associated with higher fledging numbers in forest but not in urban habitats. In contrast, when including second clutches, a higher annual productivity was found for earlier breeders in both habitats. When controlling for clutch size, no direct selection on FCLD was detected. Earlier breeders were also more likely to initiate a second clutch, particularly in urban populations. Finally, structural equation models further showed that the effect of FCLD on annual fledgling production was largely indirect, mediated by the probability of multiple brooding and the resulting increase in annual egg number. Together, our analyses suggest that earlier laying females achieve higher annual fledgling productivity, mainly determined by a higher probability of double brooders and the resulting higher seasonal egg production in both forest and city. In general, these results highlight the importance of evaluating selection using annual reproductive output rather than single breeding attempts. We believe that the underlying proximate mechanism that may promote this advantage may be related to the dynamics of prey abundance throughout the birds' breeding season, and we encourage further studies that would compare these prey dynamics across habitats.

Healthcare access varies dramatically across the United States, with rural and underserved populations facing notable barriers to timely, specialized care. The proximity of physician training affects the overall workforce distribution; however, this trend has not been assessed within orthopaedic surgery. This study investigates the impact birthplace and training location have on future practice location among US orthopaedic surgeons and characterizes the per-capita workforce distribution. Eight thousand, six hundred seventy-six orthopaedic surgeons who completed residency training between 2004 and 2017 were identified from the American Medical Association Physician Masterfile. Demographic and practice data were extracted, including birthplace, medical school, residency and attending practice as of January 1, 2023. Locations were stratified by state and census division. The cohort represented 94.84% of orthopaedic surgeons trained nationally during the study period. Attendings returning to their state of birth, medical school, or residency to practice were 21.7%, 31.8%, and 33.9%, respectively, with pronounced state-level variability (birthplace: 2.50% to 47.95%; medical school: 3.94% to 61.8%; residency: 11.71% to 63.95%). Indiana (pop:6,880,131) trained the fewest residents per capita (1:1.15 million), whereas neighboring Ohio (pop:11,824,034) ranked fifth nationally (1:191,000). Univariate logistic regression revealed notable associations ( P < 0.01) between practice location by census division at all career stages. Attending distribution per capita showed strong correlations by state (R 2 = 0.98) and census division (R 2 = 0.99), whereas birthplace (R 2 = 0.71), medical school (R 2 = 0.53), and residency (R 2 = 0.63) showed moderate association. This study demonstrates that birthplace and training location are strongly associated with practice location for US orthopaedic surgeons. Despite variation in trainee numbers by state, the distribution of practicing surgeons normalizes relative to state population, likely driven by economic incentives, local workforce demands, and market conditions. Given the strong statistical association for surgeons to practice near their training location, aligning local programs with underserved or high-need areas may offer a potential solution to reduce regional disparities and improve access to orthopaedic care.

Recombinant human growth hormone (rhGH) treatment for idiopathic short stature (ISS) in China faces challenges including delayed initiation, poor persistence, limited adoption of advanced therapies, and conservative dosing. This study characterized real-world temporal and geographical patterns of rhGH therapy and identified associated socioeconomic factors. Data from two nationwide registries comprising 24,384 children with ISS initiating rhGH were analyzed. Predictors of treatment effectiveness were identified via linear regression. Provincial variations and temporal trends were assessed via descriptive analysis and seasonal-trend decomposition. Spearman correlation was used to examine associations between treatment patterns and socioeconomic indicators. The median rhGH initiation age was 8.45years. Most patients (81.3%) initiated short-acting GH (SAGH; median dose 0.15IU/kg/day), while 18.7% initiated long-acting GH (LAGH; median dose 0.20mg/kg/week). Younger age and treatment duration ≥ 9months predicted superior 1-year height standard deviation score gain (P < 0.001). Temporally, LAGH adoption and standard-dose regimens showed significant longitudinal increases (P < 0.05). Geographically, substantial variation existed in median initiation age (7.11-9.70years), LAGH adoption rates (11.8-31.1%), and duration of therapy (DOT; 10.3-28.1months). Higher per capita gross regional product correlated with younger initiation (ρ = - 0.530), higher LAGH adoption (ρ = 0.371), and longer DOT (ρ = 0.552). Conversely, higher rural population ratios correlated with delayed initiation, lower LAGH adoption, and shorter DOT (all P < 0.05). Geographic heterogeneity in rhGH therapy is observed and correlates with regional socioeconomic profiles. To enhance therapeutic outcomes and support the balanced development of pediatric endocrine care, adaptive clinical management considering regional socioeconomic contexts is recommended.

Multimorbidity affects most older adults in home health care (HHC), leading to inappropriate polypharmacy and increased risks for adverse outcomes. While deprescribing can mitigate these risks, fragmented communication during hospital-to-home transitions remains a major barrier. This study explored stakeholder perspectives on using telehealth to facilitate deprescribing for older adults with multimorbidity while receiving post-acute HHC. We conducted semi-structured interviews with 44 stakeholders across 12 U.S. states, including 14 HHC patients and 30 clinicians (physicians, nurse practitioners, pharmacists, and HHC nurses). Guided by the socioecological model of deprescribing, interviews explored factors across individual, interpersonal, organizational, and societal levels associated with telehealth use in deprescribing. Analysis followed a phased, iterative approach with independent double-coding and interprofessional team consensus to ensure credibility. Findings categorized telehealth as a promising tool to align medications with the "4Ms" (Medications, Mentation, Mobility, and What Matters) through goal-concordant deprescribing. At the individual level, stakeholders noted that telehealth readiness depended on patient cognition and digital literacy. At the interpersonal level, telehealth facilitated real-time multidisciplinary "virtual huddles" that reduced communication delays but could occasionally overwhelm patients and may be logistically challenging to schedule. Organizational barriers included reimbursement constraints and complex synchronous scheduling. Societal factors include equitable access for rural or low-income populations, populations who may benefit the most from telehealth-enabled deprescribing due to challenges in accessing care. Stakeholders emphasized a hybrid approach which pairs virtual prescriber consultation with in-home support of a clinician to provide context and assist with implementation for patient-centered deprescribing. Telehealth can support goal-concordant deprescribing during post-acute care transitions in HHC. A hybrid model, one that combines remote prescriber consultations with in-home clinician support, is the preferred approach to bridge coordination gaps. To maximize impact, future efforts are needed to improve reimbursement, infrastructure, and scheduling to integrate telehealth into routine deprescribing workflows.

This study examines the prevalence and characteristics of obstructive sleep apnea (OSA) in the general population of a rural-provincial region of Denmark. Additionally, it assesses associations between OSA and various demographic, socioeconomic, and health-related factors. This cross-sectional study linked data from the Lolland-Falster Health Study (LOFUS) with nationwide Danish health registries. LOFUS provided data on age, sex, body mass index (BMI), cardiac autonomic neuropathy (CAN), socioeconomic status, smoking, alcohol consumption, snoring, and irregular breathing during sleep from participants recruited between 2016 and 2020. Data on OSA and related chronic comorbidities were obtained from The Danish National Patient Registry and Danish National Prescription Registry. Among 16,138 LOFUS participants, we observed a prevalence of OSA of 2.9%, compared to 2.5% in Lolland-Falster and 2.2% in Denmark. Male sex was associated with OSA (OR = 3.42), as was higher age peaking in the age group 60-79years old (OR = 6.54) compared to 18-39-year-olds. Age and sex-adjusted estimates showed higher BMI (OR = 2.60 for overweight; OR = 7.67 for obesity), unemployment due to long-term sickness or rehabilitation (OR = 2.70), early retirement due to invalidity (OR = 2.64), divorced/separated/widowed status (OR = 1.89 cohabiting; OR = 1.35 not cohabiting), and former smoking (OR = 1.33) to be significantly associated with OSA. The risk of having OSA was significantly increased if diagnosed with atrial fibrillation and flutter (OR = 2.40), diabetes mellitus (OR = 3.15), essential hypertension (OR = 2.66), or ischemic stroke (OR = 1.82). OSA disproportionately affects specific population groups, warranting increased awareness, particularly in patients with OSA-related chronic comorbidities.

A body shape index is a better predictor of overall and cardiovascular mortality than body mass index: Results from the ENAH study.

The merger of Regional Rural Banks (RRBs) in India was initiated with the objective to improve efficiency and sustainability, as well as to include the rural population into this process. In Odisha, the merger of several regional rural banks has caused revolutionary changes in the scenario of rural banking through a combination of administration, branch network, and technology. This research paper discusses the problems arising post merger, the future of Regional Rural Banks in Odisha, as well as the impact of mergers of RRB on financial inclusion in Odisha. The research has been carried out on the basis of both primary and secondary data that have been gathered from 320 respondents including banks officers, rural customers, self-help groups, and small entrepreneurs in 12 districts of Odisha. The results show that after merging RRBs, there was a 28.4% growth in rural bank account penetration, a 31.7% increase in agricultural loan issuance, and a 24.6% increment in digital transactions from 2021 to 2025. Post-merger problems have also been recognized, such as resistance from employees (42.8%), technological integration problems (37.5%), increases in non-performing assets (18.3%), and difficulties in rationalizing branches in distant areas (26.9%). Moreover, a positive relationship is indicated by the regression analysis, which exhibits a correlation coefficient (r) of 0.71 between RRB mergers and banking sector expansion as well as financial inclusion measures like PMJDY bank account coverage, rural credit availability, and women's involvement in banking. Furthermore, regression analysis shows that technological modernization and optimization of branch networks have a significant impact on financial inclusion results with an adjusted R² of 0.68. Despite the existence of some operational problems after RRB mergers, the amalgamation of RRBs in Odisha has made significant contributions to improving rural banking efficiency and inclusive economic development. Some recommendations have been provided for future research to enhance the implementation of financial inclusion through technological advancements, capacity-building of employees, localized financial literacy activities, and risk management systems.

Stuttering affects approximately 1% of adults globally and carries a significant psychosocial burden shaped by public attitudes. Despite growing cross-national evidence using the Public Opinion Survey of Human Attributes–Stuttering (POSHA-S), age-related differences in public attitudes toward stuttering remain relatively underexplored in the Indian context. To address this gap, in the current study, ninety adults from a rural population of Delhi were divided equally into three age groups: young adults (18–35 years), middle-aged adults (36–55 years), and older adults (55+ years). Age group significantly predicted the Overall Stuttering Score and the Beliefs Score. Across both measures, young adults held comparatively least positive attitudes toward people who stutter, middle-aged adults showed demonstrated moderately positive attitudes, and older adults consistently showed the most positive attitudes overall. Bonferroni post-hoc comparisons confirmed that young adults scored significantly lower than older adults on both the Overall Stuttering Score and the Beliefs Score. Significant group differences were also observed for the Traits/Personality, Help From, and Potential components. Bonferroni-adjusted post-hoc comparisons indicated that older adults rated people who stutter more positively on Help From and Potential compared with younger adults, while middle-aged adults rated people who stutter more positively on Traits/Personality compared with younger adults, whereas no significant age-group differences were found for Self-Reactions. These component-level patterns suggest that beliefs about the character, potential, and available support for people who stutter accumulate more positively with age, while immediate behavioral reactions to stuttering remain uniformly negative across all age groups. These findings suggest that public attitudes toward stuttering in Delhi become more positive with increasing age, primarily through differences in the Beliefs domain. Speech-language pathologists (SLPs) have a central role to play in translating these findings into action. As both clinicians and community educators, SLPs are positioned to design and deliver targeted stuttering awareness and destigmatization programs, particularly for young adults who demonstrated the least positive attitudes in the present study. SLPs can advocate for the inclusion of stuttering education in school curriculum, workplace orientation programs, and public health campaigns, and can use instruments such as the POSHA-S to evaluate the effectiveness of such initiatives over time. The results indicate that young adults should be considered a priority target for future stuttering awareness, education, and destigmatization initiatives.

Hypertension is a leading cause of cardiovascular morbidity and mortality. Individuals living in rural areas have a higher prevalence of hypertension and a lower prevalence of blood pressure control. Factors contributing to the increased hypertension prevalence in rural populations include shortages of health care professionals, limited access to transportation and longer travel distances to care, lower health literacy, socioeconomic factors, and reduced access to pharmacies. Approaches to addressing barriers to effective hypertension management include expanding rural telehealth services, deploying mobile units, leveraging pharmacists, implementing remote blood pressure monitoring, and engaging community health workers. Health services need to be culturally tailored and address the unique challenges faced by rural communities. Further research is needed to identify effective methods for addressing health disparities experienced by rural populations related to hypertension management.

Land-use changes in tropical dry forests (TDF) have rapidly reduced native vegetation, disrupting gene flow dynamics of tree species. Bursera cuneata is a co-dominant TDF tree in central Mexico, which is threatened by habitat loss and overexploitation. We investigated landscape drivers of functional connectivity of B. cuneata across scales to inform species conservation efforts. We genotyped 227 B. cuneata individuals from 33 populations across five hydrological basins: covering western, central, and southern Mexico, at 10,499 single-nucleotide polymorphism (SNP) loci. We examined spatial patterns of genetic structure among hydrological basins and the landscape correlates of gene flow. We applied gravity models that incorporated within-site (i.e., local conditions within populations; slope and east aspect) and between-site (terrain roughness, habitat suitability, and habitat cover) factors associated with B. cuneata gene flow. Clustering analyses showed genetic structure among basins, with higher differentiation in more isolated regions. Gravity models revealed that functional connectivity is a scale-dependent process. Specifically, terrain roughness was the primary factor of connectivity at finer scales (1000-3000 m), while TDF cover became the main driver at regional scales (>4000 m). We recommend protecting and prioritizing crucial TDF remnants to maintain large-scale gene flow by integrating urban natural parks as important links to prevent genetic isolation between urban and rural populations.

Rural cancer research activity across Europe: A bibliometric analysis on patterns, gaps and policy implications.

In recent years, wildfires have shifted from a seasonal ecological disturbance to a persistent atmospheric crisis. Fire catalysts vary from agricultural encroachment in Brazil and Bolivia to stratospheric pyroconvection in Australia and conflict-induced ignitions in Ukraine, and from forest fragmentation in Amazon rainforests to Australia’s ‘Black Summer’ fires. Together, these events have a cumulative impact on the systemic destabilisation of the global carbon cycle. Future projections suggest a rapid shift of critical carbon sinks into net atmospheric sources. Projections for the late twenty-first century indicate that Forest Fire Danger Index (FFDI) and Fire Weather Index (FWI) values will continue to rise, extending burn windows into previously protected high-altitude refugia and carbon-dense peatlands. To mitigate this escalating threat, global management must move beyond reactive suppression towards an integrated framework that bridges the "science-management gap". This requires the implementation of high-resolution AI predictive models alongside proactive policies such as peatland re-wetting, adaptive silviculture and socioeconomic protection for vulnerable rural populations. Ultimately, ensuring resilience in an increasingly flammable world requires a transboundary approach that treats wildfire emissions as global, rather than only national, incidents. In this review, the authors discuss various risk factors associated with forest fires in different regions of the Earth, as well as their assessment and prediction using modern AI-ML technologies to reduce losses from such disasters.

Geriatric syndromes including polypharmacy and multimorbidity represent growing public health challenges in aging rural populations, yet their population-level burden remains poorly quantified in low- and middle-income countries. This study aimed to quantify gross disease burden, expressed as disability-adjusted life years (DALYs), across 25 conditions in a large rural Thai older adult population. Particular emphasis was placed on polypharmacy, multimorbidity, and potentially inappropriate medications, alongside the identification of disease clustering patterns to inform integrated care planning. Population-based cross-sectional study of 587,905 older adults (aged ≥ 60 years) from 46 secondary hospitals in the 8th Health Service Region of northeastern Thailand. DALYs were calculated using Global Burden of Disease 2017 methodology. Polypharmacy was defined as concurrent use of ≥ 5 unique active pharmaceutical ingredients (APIs) for ≥ 90 consecutive days, assessed over both 2-year and 3-year lookback windows. Multimorbidity was defined as ≥ 2 chronic conditions. Potentially inappropriate medications were assessed using 2019 American Geriatrics Society Beers Criteria and Thai Rational Drug Use (RDU) criteria. DALY estimates represent gross population-level burden attributable to each condition or syndrome, without adjustment for co-occurring conditions. Total disease burden was 48.4million DALYs (8,240,612 DALYs per 100,000 population). Diabetes mellitus accounted for the highest burden (16,511,859 DALYs; 2,910,112 per 100,000), followed by hypertension (8,331,200 DALYs; 1,417,720 per 100,000). Polypharmacy affected 59.5% (n = 349,803) contributing 4,035,612 DALYs (686,408 per 100,000), with YLL comprising 54.3% of this burden. Multimorbidity affected 48.6% (n = 285,721) contributing 3,301,572 DALYs. Potentially inappropriate medications were present in 32.1% (n = 188,718). The most common disease clusters were diabetes, hypertension, renal failure and respiratorycardiovascular combinations. Polypharmacy and multimorbidity represent substantial gross population-level burdens in rural Thai older adults. These findings apply specifically to older adults accessing outpatient services at secondary hospitals in the 8th Health Service Region and should not be generalized to the entire rural older adult population. High prevalence of potentially inappropriate medications indicates urgent need for medication optimization interventions. Diabetes emerges as the leading disease burden despite lower prevalence than hypertension, highlighting the importance of DALY-based priority setting. These gross DALY estimates should be interpreted as descriptive measures of population health loss associated with each condition, rather than causal or adjusted effect estimates.

BackgroundGallbladder cancer (GBC) is a highly lethal malignancy with particularly high incidence in Chile, especially among women. While gallstones are known to be a major risk factor, most individuals with gallstones never develop GBC. Diabetes mellitus has emerged as a risk modifying factor among those with gallstones, although it is unclear whether diabetes increases risk of stones or of neoplasia given the presence of stones. This study examined the association between diabetes and GBC risk among Chilean women with gallstones.MethodsThe Chile Biliary Longitudinal Study cohort enrolled 4,711 women aged 50-74 years with ultrasound-detected gallstones from south-central Chile (2016-2019). Diabetes status was self-reported at baseline. Incident gallbladder dysplasia and cancer were identified through pathology reports and death registry linkage. Outcomes were classified as: cholecystectomized GBC (diagnosed at cholecystectomy), clinical GBC (diagnosed during clinic visits), or high-grade dysplasia (HGD; diagnosed at cholecystectomy). Confounders were identified in logistic and Cox proportional hazards regression models. Multivariable-adjusted Cox proportional hazard models estimated hazard ratios (aHRs) and 95% confidence intervals (Cls), overall and stratified by urban/rural residence.ResultsOver a median of 4.8-year follow-up (range=2.0 to 7.7), 120 women (2.5%) were newly diagnosed with GBC. Median age at diagnosis was 59 years; 34% of cases identified as Mapuche (the major ethnic group in the region) and 28% had diabetes. After adjusting for confounders, the overall association with diabetes was aHR=l.2 (95%CI: 0.8-1.9). In stratified models, diabetes was associated with significantly higher GBC/HGD risk among urban women (aHR=2.5; 95%CI:1.4-4.3) but lower risk among rural women (aHR=0.43; 95%CI: 0.19-0.98). For clinical GBC specifically, diabetes was associated with elevated risk overall (aHR=3.4; 95%CI: 1.3-9.0) and among urban women (aHR=8.l; 95%CI: 2.3-28.3). No statistically significant associations were observed for cholecystectomized GBC or HGD either overall or in stratified analyses.ConclusionsAmong Chilean women with gallstones, diabetes was associated with increased GBC risk for those residing in urban settings but lower risk in rural areas. The reasons underlying this urban rural disparity remain unclear and warrant further investigation. Potential explanations may include differences in diabetes management, healthcare access, lifestyle factors, or environmental exposures between urban and rural populations. These preliminary findings suggest that diabetic women with gallstones in urban areas may represent a high-risk population that could benefit from enhanced surveillance, pending confirmation in additional studies.

Abstract Background Brain tumor(BT) in children and adolescent and Young adults(AYA) show age-related heterogeneity, yet data on age-stratified incidence and multidisciplinary team (MDT)–based care from LMICs remain scarce. Material and Methods Single centre retrospective review of electronic medical records for demographic, clinico-pathologic, MDT care (neurosurgery, radiation and paediatric/medical oncology team participation at any point in time) and overall-survival (OS) data of patients aged &amp;lt;40 years with primary BTs between January 2014 - December 2024 from a tertiary referral centre in India. Results Among 641 patients, infants(&amp;lt;3 years) constituted 3%, children(3-14 years) 23%, and AYA (15-39 years)74%; predominantly from urban regions(87.2%) and male gender(68%). Median symptom duration prior to presentation was 30 days (range, 10days–5years). Medulloblastoma(47%) in infants and, gliomas(64%) in AYA were the most frequent diagnosis; 66% of all gliomas were high- grade likely due to referral bias. Tumor location varied by age: posterior fossa(children) vs, supratentorial(infants and AYA)(p = 0.02). Only 37%(243/641) underwent definitive treatment that did not vary by age. MDT care delivery remained inconsistent across different age groups 14% (p-value-0.001) with 17 % vs 0.4% in those seeking definitive treatment vs opinion (pvalue-0.001). However , medulloblastoma patients demonstrated highest utilization(37%, p = 0.006). The treated cohort had 2- and 5-year actuarial OS of 62% and 55%, respectively. On univariate analysis, diagnosis and tumor site influenced OS; however, only diagnosis remained significant on multivariate analysis (p = 0.001). Conclusion Our study reveals distinct age-stratified patterns of paediatric and AYA BTs presentation, low treatment uptake, urban bias, and substantial gaps in MDTcare highlighting critical opportunities to strengthen referral pathways, expand outreach to underserved rural populations, and institutionalize MDT workflows. This analysis resulted in establishment of paediatric/AYA neuro-oncology tumor board at our centre, representing a scalable model to improve equitable care and BT outcomes in LMIC setting.

To investigate clinical outcomes, safety, and sustainability of humanitarian otolaryngology outreach programs in low- and middle-income countries (LMICs). PubMed, Scopus, and Cochrane databases. Following PRISMA-ScR guidelines, two investigators searched databases for published studies reporting clinical, safety, and sustainability outcomes of otolaryngology outreach programs. Bias analysis used Methodological Index for Nonrandomized Studies (MINORS). Twenty-six studies involving 9283 subjects met inclusion criteria, predominantly from Anglophone Africa and South America. Most programs were conducted by US multidisciplinary teams in teaching or referral hospitals, focusing on general otolaryngology, otology, airway, or head and neck surgeries. Targeted populations included surgical candidates (N = 15), deaf populations (N = 6), and community screening subjects. Surgical outcomes demonstrated excellent success rates with low complications. Other otolaryngological fields and disease prevalence in rural populations were poorly investigated. Sustainability outcomes were reported in 12 studies using surgical volumes and narrative evaluations rather than validated instruments; only three maintained follow-up beyond 2 years. Key barriers included supply constraints (N = 11), insufficient staff training (N = 7), and inadequate infrastructure (N = 4). Seven studies evaluated new technologies for hearing assessment, demonstrating high concordance between physicians and trained nonphysician providers. Mean MINORS score was 7.9 ± 2.3, indicating low-to-moderate methodological quality. Most humanitarian initiatives focused on specific disease outcomes with inadequate long-term sustainability investigation. Emerging literature on new technologies-including teleotology, digital otoscopy, and artificial intelligence-based assessments-supports future skill transfer to nonphysician providers in regions with substantial practitioner shortages. N/A.

BACKGROUNDKidney transplant recipients (KTR) have impaired immune responses to vaccination and remain at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection despite mRNA coronavirus disease 2019 (COVID-19) vaccination. Data from rural and medically underserved transplant populations remain limited.AIMTo evaluate serologic response to a two dose mRNA SARS-CoV-2 vaccination series and identify clinical factors associated with antibody response in KTR.METHODSThis single center retrospective observational study included adult KTR who completed a two dose mRNA COVID-19 vaccination series and had post vaccination anti spike IgG testing performed using stored serum samples. Multivariable logistic regression was used to identify predictors of seroconversion. Among responders, linear regression was used to evaluate factors associated with quantitative antibody titers.RESULTSA total of 108 KTR were included, of whom 63 (58.3%) achieved seroconversion. Higher estimated glomerular filtration rate showed independent association with seroconversion, while higher mycophenolic acid dose showed inverse association with response. Black race and basiliximab induction demonstrated association with seroconversion, though estimates were imprecise. Age, sex, body mass index, vaccine type, tacrolimus levels, and comorbidities were not independently associated with response. Among responders, no clinical or demographic variables were significantly associated with antibody titers.CONCLUSIONAfter two dose mRNA vaccination, fewer than two thirds of KTR developed detectable anti spike antibodies. Serologic response was associated with allograft function and antimetabolite exposure, while antibody magnitude was not explained by routine clinical factors in this cohort. These findings provide real world data from a rural transplant population and support consideration of augmented vaccination strategies in KTR.