Rural Population Research Articles

Using the Tasmanian Palliative and End of Life Care Policy Framework (2022) to assess service delivery in a rural general practice.

This commentary uses the Tasmanian Palliative and End of Life Care Policy Framework (2022; the TPE Framework) to reflect upon palliative care services delivered by a rural Tasmanian general practice. Rural populations have challenges in accessing many healthcare services, including palliative care. General practitioners (GPs) and other primary healthcare workers are frequently relied upon to deliver palliative care in rural Australia. Palliative care is often needed before the end-of-life phase and patients prefer this to be delivered in the community or at home. GPs face challenges and barriers in continuing to deliver home-based palliative care services. All Medical Benefit Scheme billings for after-hours or home-based palliative care provided by the practice, between September 2021 and August 2022, were identified and patient demographic and clinical details collated. To further understand this data, nine GPs were surveyed to explore their attitudes to provision of palliative care service to the local rural communities they serve. These data highlighted several priority areas of the TPE Framework. The TPE Framework is used here to add to the shared understanding of palliative care service delivery in a rural community, and to see if GP's responses align with the priorities of the TPE Framework. Of the 258 after-hours and home-visits delivered over a 12-month period, almost 58% (n = 150) were for palliative care. Patients receiving palliative care were generally older than non-palliative patients visited (79.9 years vs. 72.0 years respectively; p = 0.004). Patients not at imminent risk of death (64.0%) were more frequently recipients of home-visits. Of the nine GPs responding to the survey, most intended to continue home visits for palliative patients. Disincentives to providing palliative care during home visits included a lack of time during the day (or after hours), low levels of interdisciplinary coordination or role-definition, and inadequate remuneration. Existing frameworks can be used as an implementation and evaluation guide to help understand local palliative care services. Using a Framework, a rural general practice in Tasmania reflected on their provision of palliative care services. Providing holistic palliative care services from a rural general practice is desirable and achievable with a coordinated, team-based approach. Access to and integration with specialist services remains a key component of community-based palliative care pathways.

Prevalence and Associated Risk Factors of Hypertension Among Tribal Population Aged 15-49 in India: Evidence from National Family Health Survey, 2019-2021.

Approximately 10% of non-communicable diseases (NCDs) can be attributed to hypertension. The prevalence of hypertension is steadily increasing among urban, rural, and tribal populations alike. There has been a growing incidence of hypertension within underprivileged groups; however, there is a scarcity of research focusing on the risks of hypertension within Indian tribes. The current study aimed to estimate the pooled prevalence of hypertension among tribes and the risk factors of hypertension. This study uses data from the fifth phase of the National Family Health Survey (NFHS-5) in India, covering 2,843,917 individuals in 636,699 households. A total of 69,176 individuals belonging to tribal communities aged between 15 and 49, encompassing both males and females, have been incorporated into our study. The study utilized bivariate and multivariable binary logistic regression analyses, which were conducted using the R statistical software. Among 69,176 tribal populations between 15 and 49 years, the overall prevalence of hypertension was 12.54% (8676/69176; 95% CI, 12.29%, 12.79%). The prevalence of hypertension among males was 16.4% and 12.07% among females. Age, gender, education, marital status, smoking, and alcohol consumption were found to be the significant predictors of hypertension among tribes. The rising prevalence and potential dangers of hypertension within Indian tribes highlight their epidemiological transition burdened by significant cardiometabolic health concerns, necessitating prompt and ongoing monitoring and surveillance.

Assessment of prevalence and need for screening of diabetic retinopathy using non-mydriatic fundus camera in rural and tribal diabetic populations in Maharashtra.

To assess the prevalence of DR and the need for screening and management of DR with medical management of diabetes in rural and tribal population in Maharashtra. The known diabetics of rural area and tribal area were screened at corresponding primary health centers, subcenters, and village level with the help of local healthcare workers using a portable non-mydriatic fundus camera. The prevalence of blindness among known diabetics in rural area was 1.29%, and 0.84% in tribal area. In the rural area, the prevalence of diabetic retinopathy (DR) was 5.67% (n = 776), out of those 18.18% had sight threatening diabetic retinopathy (STDR). The prevalence of DR was 7.73% (n = 711) in tribal areas, out of those, 30.90% had STDR. The significant risk factors were identified to be the duration of diabetes and poor glycemic control. Implementation of targeted interventions for screening and management are required to reduce the risk of blindness among known diabetics in rural and tribal areas.

Identifying Determinants of Food Security Using Panel Data Analysis: Evidence from Maghreb Countries

Countries and international bodies are focusing on agriculture as a route to achieving sustainable food security. Hence, the aim of this study is to examine the determinants of food security. It investigates the effects of gross domestic product deflator (GDPD), rural population, arable area, agricultural workers, farmers, agricultural exports, and agricultural imports on agricultural performance, which is a metric of food security. This study uses time lapse data models of a sample from the group of Maghreb states, namely Libya, Tunisia, Algeria, Morocco, and Mauritania, for the 2003–2018 period. All these data were collected from the statistical reports of the Arab Organization for Agricultural Development. The results provide evidence of the significant positive impacts of gross domestic product, arable areas, and agricultural exports on the agricultural sector’s performance, which results in achieving food security. However, the results indicate that the rural population and the number of workers in the agricultural sector have a significantly negative relationship with agricultural sector performance. In terms of agricultural imports, the results do not show a relationship between agricultural imports and agricultural sector performance. To the best of the researchers’ knowledge, this is the first study conducted in the Maghreb states, including five countries. This study alerts policymakers to issues regarding the importance of having effective policies that could enhance the performance of agricultural production to achieve food security in the Maghreb states. Policymakers must improve the investment climate in North African countries to encourage investors to enter the agricultural sector.

Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study

BackgroundEarly access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care.ObjectiveWe sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access.MethodsIn this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis.ResultsWe identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many.ConclusionQuality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.

Study of association of leptin with leukocyte telomere length in a Chinese rural population

BackgroundPrevious studies have demonstrated the relationship between adipocyte factors, insulin resistance, and other indicators with telomere length. However, these studies did not consider the influence of changes in different indicators on telomere length over time. Therefore, the aim of this study is to elucidate the impact of changes in adipocyte factors, HOMA-IR, and other indicators on the dynamic variation of telomere length.MethodsThe data were from a cohort study conducted in Ningxia, China. A total of 1624 subjects were analyzed. Adipokines and relative leukocyte telomere length (RLTL) were measured, and changes in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Homeostatic Model Assessment for β-Cell Function (HOMA-β), and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated. Generalized linear models evaluated associations between changes in adipokines and RLTL changes. Furthermore, univariate analyses examined the effects of changes in adipokines and insulin resistance indicators on ΔRLTL.ResultsThe research findings indicate that females generally have shorter telomeres compared to males. In comparison to the low-level group of Δleptin (LEP), the high-level group of ΔLEP shows a negative correlation with ΔRLTL (B=-1.32, 95% CI (-2.38, -0.27)). Even after multivariable adjustments, this relationship persists (B=-1.31, 95% CI (-2.24, -0.23)). Further analysis reveals that after adjusting for ΔHOMA-IR, ΔHOMA-β, and ΔQUICKI, the high-level group of ΔLEP still exhibits a significant negative correlation with ΔRLTL (B=-1.37, 95% CI (-2.43, -0.31)). However, the interaction effects between ΔHOMA-IR, ΔHOMA-β, ΔQUICKI, and ΔLEP do not affect ΔRLTL.ConclusionsElevated levels of leptin were significantly correlated with shortened telomere length. This suggests that increased leptin levels may impact overall individual health by affecting telomere length, underscoring the importance of measures to reduce leptin levels to mitigate the onset and progression of related diseases.

First comprehensive assessment of dietary chlorinated paraffins intake and exposure risk for the rural population of the Tibetan Plateau, China

Knowledge regarding the occurrence of short-chain and medium-chain chlorinated paraffins (SCCPs and MCCPs) in foodstuffs and their dietary exposure risks for rural Tibetan residents remains largely unknown. Herein, we collected main foodstuffs (including highland barley, vegetables, Tibetan butter, mutton, and yak beef) across the rural Tibetan Plateau and characterized the CP profiles and concentrations. The highest SCCPs concentrations were detected in Tibetan butter (geometric mean (GM): 240.6 ng/g wet weight (ww)), followed by vegetables (59.4 ng/g ww), mutton (51.4 ng/g ww), highland barley (46.3 ng/g ww), and yak beef (31.7 ng/g ww). For MCCPs, the highest concentrations were also detected in Tibetan butter (319.5 ng/g ww), followed by mutton (181.9 ng/g ww), vegetables (127.0 ng/g ww), yak beef (71.2 ng/g ww), and highland barley (30.3 ng/g ww). The predominant congener profiles of SCCPs were C13Cl7–8 in mutton and yak beef, C10Cl7–8 in Tibetan butter, and C10–11Cl6–7 in highland barley and vegetables. The predominant congener profiles of MCCPs were C14Cl7–9 in all sample types. Combined with our previous results of free-range chicken eggs, the median estimated daily intakes (EDIs) of SCCPs and MCCPs via diet for Tibetan rural adults and children was estimated to be 728.8 and 1853.9 ng/kg bw/day and 2565.6 and 5952.8 ng/kg bw/day, respectively. In the worst scenario, MCCPs might induce potential health risks for rural Tibetan population. To our knowledge, this is the first systematic dietary exposure research of SCCPs and MCCPs in the remote rural areas.

Maternal Sleep Health, Social Support, and Distress: A Mixed–Methods Analysis of Mothers of Infants and Young Children in Rural US

ABSTRACT Objectives The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. Methods 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. Results Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. Conclusions Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Rural–urban inequalities in health care utilization in Bhutan: a decomposition analysis

Background and objectiveOn the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences.MethodsWe used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities. We employed two different decomposition analyses: decomposition of mean differences in utilization using the Oaxaca–Blinder decomposition framework and differences in the income-related distribution in utilization using recentered influence function regressions between rural and urban areas.ResultsSignificant differences exist in the type of outpatient services used by the rural and urban population groups, with those living in rural areas having 3.4 times higher odds of using primary health centers compared to outpatient hospital care. We find that the use of primary health care is pro-poor and that outpatient hospital resources is concentrated among the more affluent section of the population, with this observed inequality consistent across settings but more severe in rural areas. The rural–urban gap in utilization is primarily driven by income and residence in the eastern region, while income-related inequality in utilization is influenced, aside from income, by residence in the central region, household size, and marriage and employment status of the household head. We do not find evidence of significant mean differences in overall utilization or inequality in utilization of inpatient health care services.ConclusionsWhile the differences in average contacts with health services are insignificant, there are prominent differences in the level of services availed and the associated inequality among rural and urban settings in Bhutan. Besides, while there are obvious overlaps, factors influencing income-related inequality are not necessarily the same as those driving the utilization gaps. Cognizance of these differences may lead to better informed, targeted, and potentially more effective future research and policies for universal health coverage.

Socioeconomic determinants of COVID-19 vaccine acceptance.

The aim of the paper is to evaluate the relative importance of the set of socioeconomic characteristics of population on collective decision on COVID-19 vaccine acceptance. We apply cross-section OLS methods to the municipal-level non-survey data for 145 municipalities in Serbia, on the COVID-19 vaccination rate and socioeconomic characteristics of the population, to evaluate the determinants of cross-municipal variation in vaccine uptake decision. Using the estimated coefficients from the OLS regressions, we apply the standardized beta method to evaluate the relative importance of each factor. Vaccine acceptance in municipalities rises with the average level of education (especially in the female population), age and employment, while being negatively linked to religiosity of people and the proportion of rural population. We also find some evidence on the positive impact of the overall trust in government. Education level has the single largest impact, shaping around 37% of (explained) variation in the vaccination rate across municipalities, a rise in the proportion of people with higher degree by 1% being associated with increase in vaccination rate by 0.36%. Age of population explains 21%, urban-rural structure 13% and religiosity 11% of variation in vaccine acceptance, while employment status and trust in government each explain around 9% of variation in vaccine uptake across municipalities. Effective vaccination promotion strategy should be focused on younger, less-educated, unemployed cohorts, as well as on rural areas and should involve representatives of mainstream religions. Fostering education and strengthening trust in government are some of the key structural factors that may promote efficient collective behaviour in this respect.

Unveiling Health Inequalities: Exploring Metabolic Dysfunction in Rural Roma Communities

Background: Europe’s largest ethnic minority, the Roma, are often confronted with substantial obstacles that result in health disparities. Research indicates that there are elevated rates of both communicable and non-communicable diseases, such as metabolic syndrome (MetS), among Roma communities, often linked to living conditions, limited education, or poverty. This study centers on remote rural Roma settlements in Romania, evaluating the prevalence of metabolic dysfunction, obesity, and liver steatosis while considering socio-economic and lifestyle factors. Methods: Over a period of 36 months, local visits to a total of 25 rural Roma communities were conducted, where a medical team gathered information through a standardized questionnaire and conducted a physical exam on every participant. Liver steatosis was also recorded with the help of a portable wireless ultrasound device. Results: Our study included 343 participants, with a predominance of female subjects, representing 72.5% (n = 249) of the patients. The prevalence of obesity, defined by a body mass index (BMI) above 30 kg/m2, was 32.2% (n = 111). Arterial hypertension was found to have a prevalence of 54.1% (n = 185), with de novo hypertension being observed in 19.2% patients (n = 66). Type 2 diabetes mellitus was found in 28.9% patients (n = 99), with 19.5% being de novo cases. The prevalence of hepatic steatosis was 57.2% (n = 111/194). A positive association between metabolic features and at-risk behaviors was found. Conclusions: This study underscores the transition from infectious to metabolic diseases in vulnerable communities and highlights the urgency of targeted public health strategies tailored to the unique needs of rural Roma populations, aiming to mitigate health disparities and promote equitable healthcare access.

Satisfaction with Teleophthalmology Services: Insights from Remote Areas of Taiwan

During and after the COVID-19 pandemic, teleophthalmology provided access to eye care for rural populations. This study aimed to assess the efficacy of and satisfaction with an integrated real-time videoconferencing module. This project incorporated ophthalmic instruments and telecommunication devices and provided on-site consultations via videoconferencing. Both patients and healthcare providers completed satisfaction questionnaires. From May 2020 to May 2021, this project provided eye care services to 395 patients (aged 6–90 years). The most frequent eye condition was chronic conjunctivitis (n = 197), followed by senile cataract (n = 163), dry eye (n = 103), and refractive error (n = 95). Among them, 40 (10.1%) patients were referred to secondary or tertiary hospitals for further evaluation or treatment. In total, 181 recruited respondents provided good satisfaction scores in all dimensions, including quality of medical care (4.50 of 5.00), financial aspects of care (4.48), supportive attitude toward the project (4.47), quality of service (4.40), and quality of telecommunication (4.40). Women had a substantially more supportive attitude toward the project, and 25 healthcare providers provided low ratings in areas representing the quality of telecommunication (4.04) and user-friendliness of the instrument (4.00). This teleophthalmology system provided efficient and satisfactory eye care to participants in remote communities. However, better internet access and training in instrument use can reduce obstacles to the future implementation of the project.

Independent and joint associations of estimated cardiorespiratory fitness and its dynamic changes and obesity with the risk of hypertension: A prospective cohort.

Our aim was to examine the independent and joint associations of estimated cardiorespiratory fitness (CRF) and its changes and obesity with risk of hypertension in a rural Chinese population. A prospective cohort including 9848 adults without hypertension at baseline was enrolled. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression models. Restricted cubic splines were used to model the dose-response relationship. During 6 years follow-up, 2,019 individuals developed hypertension. A negative association between estimated CRF and hypertension incidence was observed, with the risk being 0.87 (0.84-0.90) per MET increment. For estimated CRF change, the risks of hypertension were 1.50 (1.27-1.77) and 0.75 (0.59-0.97) for decreasers and increasers, respectively, compared to maintainers. Joint analyses showed individuals in the overweight/obesity-fourth quartile of estimated CRF had a 2.08 times higher risk of hypertension than those in the normal weight-first quartile (Pinteraction < 0.05). Those overweight/obesity-decreasers had the highest risk (OR: 2.19, 95%CI: 1.71-2.81; Pinteraction < 0.05) compared to the normal-maintainers. Similar results for abdominal obesity were also observed. Estimated CRF and its dynamic changes showed a negative association with hypertension incidence in the rural Chinese population.

Utah Latina/o/x suicide decedents less likely to die by firearm, even in rural areas: examining population-wide data from the Utah Office of the Medical Examiner

IntroductionSuicide death remains a significantly rarer event among Latina/o/x populations compared to non-Latina/o/x populations. However, the reasons why Latina/o/x communities experience relatively lower suicide rates are not fully understood. Critical gaps exist in the examination of Latina/o/x suicide death, especially in rural settings, where suicide death by firearm is historically more common within non-Latina/o/x populations.MethodWe tested whether the prevalence of Latina/o/x firearm suicide was meaningfully different in urban and rural environments and from non-Latino/a/x decedents when controlling for age, sex, and a social deprivation metric, the Area Deprivation Index. Suicide death data used in this analysis encompasses 2,989 suicide decedents ascertained in Utah from 2016 to 2019. This included death certificate data from the Utah Office of the Medical Examiner on all Utah suicide deaths linked to information by staff at the Utah Population Database.ResultsCompared to non-Latina/o/x suicide decedents, Latina/o/x suicide decedents had 34.7% lower adjusted odds of dying by firearm. Additionally, among the firearm suicide decedents living only in rural counties, Latina/o/x decedents had 40.5% lower adjusted odds of dying by firearm compared to non-Latina/o/x suicide decedents.DiscussionThe likelihood of firearm suicide death in Utah differed by ethnicity, even in rural populations. Our findings may suggest underlying factors contributing to lower firearm suicide rates within Latina/o/x populations, e.g., aversion to firearms or less access to firearms, especially in rural areas, though additional research on these phenomena is needed.

Effects of ambient temperature, relative humidity and absolute humidity on risk of nasopharyngeal carcinoma in China.

Nasopharyngeal carcinoma (NPC) has a unique geographic distribution. It is unknown whether meteorological factors are related to the incidence of NPC. To investigate the effect of ambient temperature, relative humidity (RH), and absolute humidity (AH) on the incidence of NPC, we collected the incidence rate of NPC in 2016 and meteorological data from 2006 to 2016 from 484 cities and counties across 31 provinces in China. Generalized additive models with quasi-Poisson regression and generalized linear models with natural cubic splines were employed respectively to elucidate the nonlinear relationships and specify the partial linear relationships. Subgroup and interactive analysis were also conducted. Temperature (R2 = 0.68, p < .001), RH (R2 = 0.47, p < .001), and AH (R2 = 0.70, p < .001) exhibited nonlinear correlations with NPC incidence rate. The risk of NPC incidence increased by 20.3% (95% confidence intervals [CI]: [18.9%, 21.7%]) per 1°C increase in temperature, by 6.3% (95% CI: [5.3%, 7.2%]) per 1% increase in RH, and by 32.2% (95% CI: [30.7%, 33.7%]) per 1 g/m3 increase in AH, between their the 25th and the 99th percentiles. In addition, the combination of low temperature and low RH was also related to increased risk (relative risk: 1.60, 95% CI: [1.18, 2.17]). Males and eastern or rural populations tended to be more vulnerable. In summary, this study suggests that ambient temperature, RH, and particularly AH are associated with the risk of NPC incidence.

Effectiveness of a Health Belief Model-Based Education Program on Self-Efficacy and Preparedness for Infectious Disasters in Rural Populations.

Health education programs can enhance self-efficacy and disaster preparedness. However, research incorporating the Health Belief Model (HBM) in education for infectious disasters is lacking. Examine the effectiveness of an HBM-based education program on self-reported self-efficacy and self-reported preparedness for infectious disasters in rural populations. In total, 109 eligible participants were allocated to two groups: participants who received HBM-based education (n = 55) or regular education (n = 54), presented at in-person meetings, with individual follow-up conducted on WhatsApp. Self-reported self-efficacy and preparedness for infectious disasters in both groups were measured at 4 and 8 weeks. Participants showed a significant interaction between groups and in time to increase in self-reported self-efficacy and self-reported preparedness to deal with infectious disasters. After 4 and 8 weeks, the groups had statistically significant differences (p≤.001) in all outcome measures. HBM-based education was associated with increased self-reported self-efficacy and self-reported infectious disaster preparedness among the rural population. Follow-up by nurses is essential to implementing continuing health belief education programs to enhance rural populations' self-efficacy and infectious disaster preparedness.

Associations between digital literacy, health literacy, and digital health behaviors among rural residents: evidence from Zhejiang, China

ObjectiveWithin the digital society, the limited proficiency in digital health behaviors among rural residents has emerged as a significant factor intensifying health disparities between urban and rural areas. Addressing this issue, enhancing the digital literacy and health literacy of rural residents stands out as a crucial strategy. This study aims to investigate the relationship between digital literacy, health literacy, and the digital health behaviors of rural residents.MethodsInitially, we developed measurement instruments aimed at assessing the levels of digital literacy and health literacy among rural residents. Subsequently, leveraging micro survey data, we conducted assessments on the digital literacy and health literacy of 968 residents in five administrative villages in Zhejiang Province, China. Building upon this foundation, we employed Probit and Poisson models to empirically scrutinize the influence of digital literacy, health literacy, and their interaction on the manifestation of digital health behaviors within the rural population. This analysis was conducted from a dual perspective, evaluating the participation of digital health behaviors among rural residents and the diversity to which they participate in such behaviors.ResultsDigital literacy exhibited a notably positive influence on both the participation and diversity of digital health behaviors among rural residents. While health literacy did not emerge as a predictor for the occurrence of digital health behavior, it exerted a substantial positive impact on the diversity of digital health behaviors in the rural population. There were significant interaction effects between digital literacy and health literacy concerning the participation and diversity of digital health behaviors among rural residents. These findings remained robust even after implementing the instrumental variable method to address endogeneity issues. Furthermore, the outcomes of robust analysis and heterogeneity analysis further fortify the steadfastness of the aforementioned conclusions.ConclusionThe findings suggest that policymakers should implement targeted measures aimed at enhancing digital literacy and health literacy among rural residents. This approach is crucial for improving rural residents' access to digital health services, thereby mitigating urban–rural health inequality.

The Impact of Rural Population Aging on Agricultural Cropping Structure: Evidence from China’s Provinces

Agricultural cropping structure is related to the quality of the agricultural supply system and is a key element of the structural reform of the agricultural supply side. Based on China’s provincial panel data from 2000 to 2021, this paper empirically examines the impact and mechanism of rural population aging on the planting structure of food and cash crops by using a two-way fixed-effects model, which fills the gap in the research on the impact mechanism of the rural population aging on agricultural planting structure. The conclusions of the study show that: as the aging of the rural population deepens, the proportion of food crops planted will further increase, while the proportion of cash crops planted will decrease; agricultural mechanization will promote the further increase of the proportion of food crops planted while the proportion of cash crops planted will decrease in the deepening of the aging of rural population; the aging of the rural population has a more significant impact on the structure of agricultural planting in the eastern region and does not have a significant impact on the central and western provinces. The aging of the rural population has a significant impact on the agricultural planting structure in the eastern region, but not in the central and western provinces. This paper argues that we should fully respect the willingness of agricultural management subjects to choose planting varieties, increase the research, development, and promotion of agricultural machinery, continuously improve the level of farmers’ human capital, and further enhance the degree of organization, scale, and specialization of agricultural production.

Do WHO criteria for gestational diabetes fit a rural population in Tanzania? – A follow-up study assessing mother and child health six years after a pregnancy diagnosed with gestational diabetes

Aims and MethodsIn low- and middle- income countries (LMICs) consequences of gestational diabetes (GDM) is understudied. Using a prospective cohort of mothers (n = 197)and children (n = 251), from rural north-eastern Tanzania, we assessed prediabetes and type 2 diabetes (T2D) prevalence six years after a pregnancy with/without GDM. ResultsThe prevalence of prediabetes (49.4 % vs. 46.4 %) orT2D (20.0 % vs. 16.1 %), p ≥ 0.36, based on fasting plasma glucose (FPG) or HbA1clevels (prediabetes: 16.9 % vs. 13.8 % and T2D 1.2 % vs. 0 %, p = 0.47), andcardio-metabolic health parameters,weresimilar between women with/without previous GDM. These results were supported by similar perinatal outcomes and child health at follow-up.The overall prevalence ofprediabetes/T2D was high, but no differences in other cardio-metabolic risk markers were observed in women with prediabetes/T2D compared to women with normal glucose tolerance. ConclusionsDespite high prevalence of GDM amongTanzanian women, the diagnosis was not associated with adverse pregnancy outcomes, nor with increased risk of prediabetes or T2D at follow-up. FPG and HbA1c may be poor markers for diabetes in this population, and further follow-up studies with longer time intervals are warranted to evaluate which GDM diagnostic criteria are most optimal for women in rural Tanzania and similar LMIC settings.

Demographic Problems in the Northern Regions of the Republic of Kazakhstan

This article aims to analyse demographic and migration processes in Kazakhstan, focusing on identifying their impact on society’s economic, political and social aspects. The work methodology is based on comparisons and system-structural methods, such as control, generalization, systematization, logical analysis, and synthesis. The study used two main groups of indicators for 1990-2021. The first group included comparative indicators, such as the relative size of the population structure, the intensity and relative proportions of the structure, and the proportions of the urban and rural population. The second group included migration indicators, such as the number of arrivals to the settlement, the number of departures from the settlement, and absolute migration growth or balance. The study results reveal regional differences, especially in the context of migration processes. There is a negative balance of internal migration and high rates of population decline in the northern regions. In comparison, the southern regions are experiencing population growth, which poses new economic and social challenges. It is predicted that by 2050, the population of the south of regions will increase significantly. The authors emphasize the importance of an integrated approach to solving demographic problems, including improving well-being, providing affordable health care and developing effective demographic policies. In conclusion, it is noted that successfully overcoming demographic challenges requires balanced economic and social measures.