Rural Residents Research Articles

Impact of rurality on health care utilization among Australian residents from 2009 to 2021.

In Australia, there is limited research regarding the effect of rurality on health care utilization using longitudinal data. We analyzed data from four annual waves (2009, 2013, 2017, and 2021) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to examine changes in the health care utilization over time among urban and rural residents. Poisson regression models estimated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CIs) for rural versus urban residents, accounting for a range of health-related and sociodemographic characteristics. Health care utilization was measured using four key indicators: visits to family doctor or another general practitioner(GP visits from hereon), hospital admissions, total nights' stay in the hospital, and prescribed medications taken on a regular basis. The aIRR for GP visits among rural versus urban Australian residents increased over time, from 0.89 (95% CI: 0.82 to 0.97) in 2009 to 0.96 (95% CI: 0.89 to 1.04) in 2021 although not consistently increased in a statistically significant manner. While there were no consistent temporal patterns, our analysis found that rural residents experienced higher number of hospital admissions (aIRR, 1.12 to 1.15) and number of nights in the hospital in the last 12 months (aIRR, 1.18 to 1.25) compared to urban residents. Moreover, rurality had little to no effect on the number of prescribed medications taken on a regualar basisin the 12 months preceding the HILDA Surveys in 2013, 2017, and 2021. This study found that GP visits were less frequent among rural residents compared to metropolitan residents in 2009, indicating health care access disparities between rural and urban areas in Australia. However, the differences in GP visits between rural and urban areas were less pronounced from 2013 to 2021.

Quality of neonatal health care in comprehensive specialized hospitals, Amhara Region, Ethiopia: a retrospective study with neonatal death audit

BackgroundNeonatal health is one of the targets for the sustainable development goals (SDGs) that aim to reduce neonatal mortality to at least as low as 12 per 1 000 live births in 2030. However, the world is not on track to achieve this target. The problem has worsened in many low-income countries, including Ethiopia, due to a fragile health system, as well as health crises such as the COVID-19 pandemic, conflict, food insecurity and climate change. According to the Mini Ethiopian Demographic Health Survey, neonatal mortality is unacceptably high in Ethiopia in general, and in Amhara region in particular. Despite these facts, there is a paucity of information on the quality of neonatal health service provision in comprehensive specialized hospitals in Amhara region. Therefore, this study is aimed at assessing the quality of neonatal health services in terms of outcome (neonatal mortality) and its causes in comprehensive specialized hospitals in Amhara region.MethodsA multi-center retrospective study was conducted (from September 1–30/2022) on 315 neonates in four comprehensive hospitals with chart review. Data were collected through death audit with standardized neonatal death audit tool. Data were entered into Epi-data 3.1 and exported to SPSS 20 for analysis. Descriptive analysis was used to describe and summarize the data in an informative manner.ResultsFrom 315 neonatal deaths, about two-thirds, 205 (65.1%), were from rural areas. Nearly half, 151 (48%), of the mothers had complications and delivered outside a health facility. About 36 (11.4%), 45 (14.3%), and 21 (6.7%) neonates’ mothers had 1st, 2nd, and 3rd delays, respectively. About 59 (19%) of mothers had membrane rupture before the onset of labor and 23 (7.3%) had meconium-stained liquor. Almost three-fourths, 226 (71.7%), of the deaths were low birth weight (< 2500 gram). About 25 (8%) of neonates had congenital anomalies, 65% of them had fast breathing and 54.6% were preterm.ConclusionHigher proportions of neonatal deaths were observed among neonates with rural residence, low birth weight, mothers’ complications and neonates admitted for fast breathing. Histories of abortion, complications, congenital anomalies, and the 3 delays contributed to neonatal deaths.

Association of rurality and health professional shortages with the clinicopathologic characteristics of melanoma in North Carolina.

To assess rural-urban and health professional shortage area (HPSA)-related influences on the characteristics of melanoma in North Carolina. We conducted a single-center retrospective cohort study of patients living in North Carolina with an available pathology report for invasive cutaneous melanoma seen in the Duke University Health System from 01/01/2014 to 12/31/2020. Multivariable logistic regression models were employed to compare patient and tumor characteristics between rural versus urban county residence as well between melanoma thicknesses dichotomized into thin (≤1.0mm) and thicker (>1.0mm) tumors. The cohort included 807 patients, and rural patients accounted for 177 (21.9%) of invasive cutaneous melanomas. Rural patients had significantly higher odds of having thicker tumors than urban patients (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.17-2.71; P =.008). Rural patients were significantly more likely to be female (OR = 1.59, 95% CI: 1.10-2.28; P =.013) and located in a population-based (OR = 2.66, 95% CI: 1.84-3.84; P<.001) or geographic-based (OR = 8.21, 95% CI: 3.33-20.22; P<.001) HPSA. Living in a medium- or high-shortage population-based HPSA was associated with higher odds of thicker tumors (OR = 2.65, 95% CI: 1.85-3.80; P<.001). Patients living in rural North Carolina counties were more likely than those in urban counties to be diagnosed with melanomas >1.0mm in thickness, a clinically significant difference with important prognostic implications. Interventions at the county- and state-level to address this disparity may include improving access to skin cancer screening and teledermatology programs, increasing partnerships with primary care providers, and targeting interventions to counties with health professional shortages.

Impact of urban-rural resident basic medical insurance on consumption quality of middle-aged and older adult residents: evidence from rural China.

In the context of the Chinese government's advocacy for "Internal Circulation", ongoing reforms in medical insurance policies raise critical questions about whether the basic medical insurance system can stimulate resident consumption and enhance its quality. Based on five waves of panel data from the China Health and Retirement Longitudinal Survey (CHARLS), this paper analyzes the impact of medical insurance on the consumption scale and structure of middle-aged and older adult rural residents by using the time-varying difference-in-differences (time-varying DID) method. The findings indicate that the Urban-Rural Resident Basic Medical Insurance (URRBMI) effectively stimulates the consumption scale of rural middle-aged and older adult individuals, particularly enhancing non-food consumption, development-oriented spending, and hedonic consumption. This, in turn, optimizes the consumption structure and improves overall consumption quality. Notably, URRBMI significantly enhances the consumption scale and structure among rural middle-aged and older adult women, unmarried individuals, and residents in western China. These results suggest that URRBMI plays a crucial role in alleviating consumption inequality within rural areas and across different regions, providing a theoretical foundation for policy-making.

National Experience of Technology-based Eye Care Services (TECS): A Comprehensive Ophthalmology Telemedicine Initiative

Technology-Based Eye Care Services (TECS) is a tele-ophthalmology program operating in the Veterans' Administration since 2015. This study explores characteristics of the national TECS population, evaluates implementation and sustainability of TECS, and analyzes possible associations and effects of demographic characteristics and social determinants of health (SDOH) on being diagnosed with a vision threatening (VT) disease. Implementation and sustainability of TECS from 2015-2022 was examined along with the sociodemographic characteristics of Veterans served through TECS in 2021. Veteran patients seen in TECS nationwide. Characteristics, disease prevalence and diagnoses, implementation success rate, sustainability rate, preliminary analysis of outcomes and disparity. Per quarter from 2015-2022, TECS sites were classified as implementing, active, or sustained. Standard Query Language (SQL) was used to determine sociodemographic data and logistic regression models were used to identify risk factors associated with VT eye diagnosis. 21,712 Veterans, 52.1% rural or highly rural, were served by TECS in 2021. The average age was 64.7 years, with females comprising 10.9% of the population served. From 2015-2022, of the 67 TECS sites initiated, 6 were implementing with 51 of 61 initiated sites still operational in the first quarter (Q1) of 2022 (83.6% success rate).Macular degeneration (AMD) and cataracts were more prevalent in rural and highly rural populations (7.6% and 11.3%, and 48.8% and 55.0%, respectively) vs. urban populations; glaucoma and diabetic retinopathy (DR) had the opposite association. The prevalence of any type of VT eye disease was lowest in the Mountains/Central region (0.54%) and highest in the Southeast region (3.2%) of the US. Rural and highly rural residents were 1.3 and 2.5 times as likely, respectively, to be diagnosed with a VT eye disease than urban residents. Implementation and sustainability of TECS has been promising. The data provides key information that can be utilized to improve the deployment of TECS and similar programs, along with the possible future direction of TECS services. Moreover, experience from one national ocular telehealth program clearly illustrates that telemedicine can address eye care disparities in the Veteran population and may be utilized for other vulnerable groups as well.

Digital technology and psychological happiness: the mediating roles of interpersonal relationships and employment situations.

Psychological happiness represents the ultimate pursuit of human beings, and the impact of digital technology on psychological happiness is becoming increasingly significant in the era of the digital economy. Based on data from 2020 China Family Panel Studies (CFPS), this study constructs an empirical model that examines the effect and mechanism of digital technology on happiness. Additionally, this study investigates the heterogeneity and robustness of the impact of digital technology on happiness. The research conclusions are as follows: Firstly, digital technology can promote psychological happiness. When controlling for other factors, the marginal effect coefficient of digital technology is 0.031. Secondly, the effect of digital technology on personal happiness varies among different groups, particularly among women, young individuals, primary and college graduates, and rural residents. Furthermore, as absolute income increases, the happiness effect of digital technology diminishes. Thirdly, in terms of the influencing mechanism, digital technology indirectly affects individual happiness by influencing health status, interpersonal relationships, employment situations and income levels. Specifically, digital technology negatively impacts personal health, interpersonal relationships, and agricultural work, while positively impacting family relationships, non-agricultural employment, absolute income and relative income. Digital technology affects happiness through these channels indirectly. Based on the study results, it is proposed that efforts should be made to enhance the development of digital technology infrastructure in remote rural areas, reduce the financial burden associated with digital technology, and promote the digital technology ecosystem. Moreover, providing online services, such as e-commerce, travel reservations, and digital financial management, can improve access to digital technology in rural areas and contribute to increased happiness levels. Simultaneously, there is a need to strengthen digital skills training, particularly among vulnerable populations such as the elderly and rural residents, to improve their proficiency in digital technologies. This can be achieved through the integration of additional educational resources, thereby facilitating cost-free digital technology training and guidance. Meanwhile, it is essential to vigorously develop the new economy and innovative employment models, create job opportunities, foster entrepreneurial prospects, and improve income levels to enhance individual well-being.

Resistance Exercise Participation in Community-Dwelling Older Adults in Korea: Associated Factors and Sex Differences.

Background/Objectives: Despite the importance of resistance exercise in older adults, factors associated with participation remain unclear, especially regarding sex differences. This study investigated sociodemographic, behavioral, and comorbidity factors associated with insufficient resistance exercise participation among community-dwelling older adults in Korea, with analyses stratified by sex. Methods: Nationally representative cross-sectional data from 8671 participants aged ≥65 years (3758 men and 4913 women; mean age 72.8) were analyzed using the 6th-8th Korea National Health and Nutrition Examination Surveys (2014-2019). Complex-sample multivariable logistic regression identified factors associated with insufficient resistance exercise overall and by sex. Results: Women had a higher prevalence of insufficient resistance exercise than men (91.27% vs. 71.04%, p < 0.001). Older age groups, particularly those aged ≥80 years (OR: 2.39; 95% CI: 1.86-3.07), and those with lower education (OR: 1.56; 95% CI: 1.33-1.82), rural residence (OR: 1.89; 95% CI: 1.49-2.38), low household income, (OR: 1.45; 95% CI: 1.13-1.88), insufficient aerobic exercise (OR: 1.68; 95% CI: 1.46-1.94), current smoking (OR: 1.70; 95% CI: 1.26-2.29), and diabetes (OR: 1.28; 95% CI: 1.09-1.51) were independently associated with a higher likelihood of insufficient resistance exercise. The association of household income, current smoking, hypertension, and diabetes with resistance exercise adherence showed differences in sex-stratified analyses. Conclusions: Multiple sociodemographic, behavioral, and comorbid factors are linked to resistance exercise adherence among older Koreans. Tailored, sex-specific interventions are needed to promote resistance exercise in this population, informing public health strategies and further research on effective approaches for diverse older adults.

Research on the Impact of Digital Inclusive Financial Development on the Income Gap between Urban and Rural Residents in Henan Province

This paper begins with an introduction of what digital inclusive finance is; it immediately describes and analyzes the development of digital inclusive finance in Henan, and analyzes the status of disposable incomes of urban and rural residents in Henan from 2011-2021; secondly, based on the digital inclusive finance index released by Peking University from 2011-2021, and based on the panel data of the corresponding years and prefectural cities of Henan Province, it applies the Stata software, through econometric regression and other methods, to empirically analyze the relationship between the development of digital inclusive finance and the income differences between urban and rural residents, to explore the intrinsic relationship between the development of digital inclusive finance and the income differences between urban and rural residents, and to meticulously examine the impact of the coverage, depth of use, and degree of digitalization of digital inclusive finance on the income differences between urban and rural residents. Through the empirical analysis, it is found that the index of digital inclusive finance development has a significant effect on the reduction of the income gap between urban and rural residents, in which the index of the degree of digital inclusive finance digitization has a greater impact on the reduction of the gap between urban and rural residents' incomes.

Free education policy and rural Residents' happiness: Financial perspective

Using data from the 2010–2015 China General Social Survey, we applied a propensity score matching difference-in-differences model to examine how a 12-year free-education policy reform affected the happiness of Chinese rural residents. We found that the 12-year free-education pilot will make rural residents happier if the local government's spending on education does not reduce spending on other public services. We also found that the policy has benefited the beneficiaries' grandparents, high-income rural families, and relatively well-educated groups mainly by improving family finances and health. We recommend expanding the pilot program to increase the number of beneficiaries. We suggest that China would be in a position to fully implement the 12-year compulsory education only when the central and local governments can support its implementation.

Health care contact days in older adults enrolled in SWOG cancer clinical trials.

64 Background: Health care contact days—days with health care contact outside the home—are a measure of how much of a patient’s life is consumed by health care. This number of contact days are especially relevant for older adults with advanced cancer facing limited survival. One concern is that patients with different sociodemographic and clinical backgrounds may be at particular risk of increased contact days. Thus, there is a critical need to understand factors associated with contact days. Methods: We linked data from 6 SWOG trials in advanced cancer to Medicare claims data. These trials encompassed a variety of primary cancer types [prostate (S9916, S0421), lung (S0003, S0124, S0819), and pancreas (S0205)]. Health care contact days (days with ambulatory, emergency department, inpatient, or facility-based care) in the first 12 months were calculated using Medicare database files. A day with &gt;1 source of contact counted as 1. We examined sociodemographic (age, race, ethnicity, sex, insurance status, rurality, area deprivation index) and clinical (prognostic risk, cancer type, performance status) predictors of contact days, using negative binomial regression, with a log link and clustering by study ID, including an offset variable for duration of observation. We examined predictors in univariate and multivariable analysis. We report relative risk (RRs) estimates and 95% CI. Results: We included 1,429 patients (median age, 71 years, 7.6% Black, 2.7% Hispanic, 21.4% female, and 23.5% rural residence). Of these, 741 (51.9%) patients died in the first year. The median number of contact days was 48, out of a median of 350 days of observation. At a trial level, median percentage of contact days ranged from 14% (prostate) to 27% (lung). The most common sources of contact days were ambulatory clinician visits (median=17), tests (median=12), and treatments (median=11). In multivariable regression, factors associated with increased contact days included increasing age (per year, RR=1.02 [1.01-1.02], p&lt;.001), insurance status (Medicare alone or with Private or Medicaid insurance, vs Military/VA, none, or other insurance, RR=2.47 [2.16-2.83], p&lt;.001), higher prognostic risk score (RR=1.14 [1.04-1.25], p=.004), and type of cancer (pancreas, RR=1.69 [1.51-1.89] and lung, RR=1.69 [1.54-1.85] vs prostate, p&lt;.001 for both). Conclusions: This novel linkage of trial and claims data to evaluate contact days and associated factors found that older trial participants spent up to one in four days with health care contact. Ambulatory appointments were the most common source of contact days. Encouragingly, rural residence and neighborhood deprivation were not associated with contact days, increasing confidence that participants from diverse geographic areas may receive equitable care in trials. These data highlight the frequency of contact days for trial participants, while identifying factors to consider when benchmarking contact days.

Exploring Rural-Urban Differences in the Receipt of Nonelective Cancer-specific Gastrointestinal Surgery Using a Multilevel Mixed-Effects Approach

BackgroundRural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents. MethodsThis retrospective study included adult patients captured in the SEER-Medicare data between January 2008 and December 2015 with an incident stage I-IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was nonelective cancer-directed surgery among rural versus urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering. ResultsThe sample included 10,136 patients who underwent a surgical intervention; 2,941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural compared tourban patients [351 (27%) and 2590(29%); p= 0.05]. There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents [OR 0.88, 95% CI (0.76-1.03); p= 0.11] and [aOR 0.86, 95% CI (0.72-1.02); p= 0.080]. Additionally, high social vulnerability index counties or Black race was significantly associated with increase odds of nonelective surgery [aOR 1.33, 95% CI (1.07-1.65); p=0.009] and [aOR 1.49, 95% CI (1.26-1.77); p<0.0001], respectively. ConclusionThis study found no difference in the odds of receiving nonelective surgery for GI foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore if disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.

Hypertension in India: a gender-based study of prevalence and associated risk factors

BackgroundHypertension, a major non-communicable disease, is responsible for a significant number of global deaths, including approximately 17.9 million yearly. The Global Burden of Disease 2019 (GBD 2019) estimates that 19% of global deaths are attributed to elevated blood pressure. India, with a population of over 1.4 billion, is facing a serious challenge in combating this silent killer. This study aims to analyze the gender-based prevalence of hypertension in India and explore its associated risk factors using data from the fifth National Family Health Survey (NFHS-5).MethodsNFHS-5 collected data from 636,699 households across all states and union territories. The study includes standardized blood pressure measurements for 17,08,241 individuals aged 15 and above. The data were analyzed using Stata, employing descriptive statistics for the assessment of the prevalence and binary logistic regression to identify predictors of hypertension.ResultsThe study found the overall prevalence of hypertension in India to be 22.6%, with men (24.1%) having a higher prevalence than women (21.2%). Prevalence increased with age, reaching 48.4% in individuals aged 60 and above. Urban residents had a slightly higher prevalence (25%) than rural residents (21.4%), indicating the rapid spread of hypertension across all populations. Regional variations were observed, with the highest prevalence in Sikkim (37.9%) and the lowest in Rajasthan (16.5%). Increasing age, urban residence, belonging to certain religions (Muslim and other than Hindu or Muslim), and being classified as Scheduled Tribes (ST) were associated with a higher likelihood of hypertension. Conversely, belonging to Scheduled Castes (SC) or Other Backward Classes (OBC), being currently unmarried, and having higher education were associated with a lower likelihood of hypertension. Wealth index analysis revealed that those in the richest quintile were more likely to have hypertension. Behavioural risk factors, such as alcohol consumption, overweight, obesity, increased waist circumference, and high blood glucose levels, are positively associated with hypertension.ConclusionHypertension is a significant health burden in India, affecting both men and women. Age is the strongest non-modifiable predictor for both men and women. However, ageing women have higher odds of hypertension than ageing men, and this distinction becomes much more evident in their older ages. Obese women, based on BMI, have higher odds of hypertension than men. However, hypertension prevalence is slightly higher among men who are overweight or obese compared to women. BMI, waist circumference, random glucose level, alcohol use, and education level emerged as major predictors. Health education and awareness campaigns are critical to control the growing burden of hypertension in India. Policymakers must focus on preventive measures, targeting lifestyle changes and improved healthcare access for both men and women. By addressing these risk factors, India can make significant progress in controlling hypertension and reducing its impact on public health.

Quantitative tracing of typical herbicides and their metabolites in sorghum agrosystems for fate tendency and cumulative risk

Elucidating the combined exposure of agrochemicals is essential for safeguarding human health and agroecosystem safety. A rapid and high-sensitivity UHPLC-MS/MS method was developed for simultaneous quantification of nine compounds in sorghum by an assembly-line optimization process with a limit of quantitation of 0.001 mg/kg. The concentration variation of atrazine, quinclorac, fluroxypyr-meptyl and metabolites was reflected by terminal magnitudes of ≤0.0665 mg/kg. Additionally, atrazine was dealkylated to deethyl atrazine and desethyl desisopropyl atrazine at concentrations of 0.0014–0.0058 mg/kg during the sorghum harvest. Acceptable health hazardous of atrazine and quinclorac for all life cycle populations were comparatively assessed via deterministic and probabilistic models, in which atrazine gained an 83.55 % share of cumulative dietary risks. Rural residents had significantly higher risks than urban residents, and children were the most sensitive group. Despite the low health risks, combined exposure to herbicides and their metabolites should be continuously stressed, given their cumulative amplification effects.

Prevalence and factors associated with sarcopenia among urban and rural Indian adults in middle age: A cross-sectional study from Western India.

Sarcopenia is the age-related loss of muscle mass and function. India has 8.6% of the global elderly (>60 years) population, and this is expected to increase to 20% by 2050. Around 70% of Indians live in rural areas where lifestyle factors like diet and physical activity differ from urban areas. Understanding age, sex and location-specific sarcopenia prevalence in India is crucial. Thus, our aim was to assess the prevalence and determinants of sarcopenia in urban and rural community-dwelling men and women aged 40 years and older, representing the next generation of older Indian adults. This cross-sectional study included 745 adults (400 women) from urban and rural areas near Pune, Western India. Assessments included socio-demography, diet by-24-hr recall, physical activity, anthropometry (height, weight), muscle mass measurement by dual-energy X-ray absorptiometry, muscle strength (hand grip) & muscle function by Short Physical Performance Battery (SPPB). Sarcopenia was defined by Asian Working Group on Sarcopenia-2019 guidelines Mean age of participants was 53±7.6yrs. Overall prevalence of sarcopenia was 10% and of severe sarcopenia was 4.2%. Sarcopenia prevalence was higher in rural (14.8%) than urban (6.8%) participants and in men (12.5%) than women (8%, all p<0.05). Muscle mass, grip strength and SPPB score were all higher in urban than rural participants (p<0.05). Older age, rural residence, inadequate protein intake, and lower socio-economic status were independently associated with sarcopenia. In this middle-aged group, sarcopenia prevalence was similar to that observed in older Western populations, over 100% higher among rural than urban participants, and higher amongst men than women. Age, location, protein intake and socioeconomic status were factors associated with sarcopenia. Given this rapidly increasing population of older adults in India there is an urgent need to plan strategies for early sarcopenia diagnosis and management, especially in rural populations.

Linking EDC-laden Food Consumption and Modern Lifestyle Habits with Preeclampsia: A Non-Animal Approach to Identifying Early Diagnostic Biomarkers Through Biochemical Alterations

Preeclampsia, a pregnancy complication characterized by new-onset hypertension with or without proteinuria and/or end-organ damage, may be influenced by exposure to endocrine-disrupting chemicals present in processed foods and associated with modern lifestyles. This study explores this potential link using a non-animal approach to identify early diagnostic biomarkers for preeclampsia. Seventy pregnant women aged 21-41 years participated, completing questionnaires assessing socio-demographic factors, Suboptimal Health Status Questionnaire scores for fatigue, digestive, cardiovascular, immune, and mental health issues, and exposure to endocrine-disrupting chemicals from processed food consumption and daily product use. Peripheral blood samples were analyzed for hormone profiles, complete blood count, and liver function tests. Statistical analysis revealed that mothers above 27 years old, with a Body Mass Index exceeding 32.25 Kg/m2, and a Mean Arterial Pressure of 108.4 ±1.1 mmHg exhibited a potential obesogenic effect on preeclampsia development. Socio-demographic factors like lower economic class, housewife status, primiparous pregnancy, non-graduate education, and rural residence were significantly associated. Analysis of biochemical parameters revealed that serum creatinine, blood urea, total protein, platelet count, blood urea nitrogen, bilirubin profile, LFT profile, and thyroid profile showed potential detrimental effects on kidney, liver, muscle, and thyroid function in preeclampsia patients. Notably, PC, serum urea, bilirubin, total protein, SGOT, ALP, and TSH levels were significantly associated with preeclampsia in individuals reporting higher exposure to EDCs. Minor biochemical alterations were also observed with dairy product consumption. SHS-25 analysis indicated a significant increase in fatigue, and digestive, cardiovascular, immune, and mental health-related issues in patients. Probably, biochemical alterations due to EDC exposure from processed foods and modern lifestyle habits contribute to organ dysfunction in preeclampsia. Identifying these potential biomarkers may pave the way for the development of non-invasive, early diagnostic tools for improved preeclampsia management. This research emphasizes the importance of non-animal testing methods for assessing EDC-related health risks in pregnancy and contributes to the advancement of early PE diagnosis strategies.

Climate change adaptation in China: Differences in electricity consumption between rural and urban residents

We use high-frequency electricity consumption data (17.58 million observations) at level of household to parameterize the relationship between household electricity consumption and temperature for southern China. We find that although urban households are more sensitive to extreme temperature than rural households, with climate warming, rural households would adopt climate change adaptive behavior (e.g. installing air-conditioning), and rural households' sensitivity to temperature would increase significantly. Considering the long-run response, we find that climate warming as predicted under the RCP8.5 scenario would lead to an increase of 23.42 % and 22.28 % in the summer peak electricity consumption of rural and urban households in 2061–2080. Compared with the results of short-run response, ignoring the long-run response would lead to the summer peak electricity consumption of rural and urban households being underestimated by 56.13 % and 20.11 %. Only for our research sample, the economic losses in rural and urban areas caused by climate warming are as high as 1.358 billion Chinese yuan and 0.617 billion Chinese yuan in 2061–2080 under the RCP 8.5 scenario. Climate change would bring serious losses to rural residents.

Bouillon fortification as a strategy to address inequities in micronutrient adequacy of diets in Nigeria.

Bouillon is a widely consumed condiment in many West African countries, including Nigeria. Although Nigeria has mandatory fortification standards for multiple food vehicles, bouillon fortification could help address remaining gaps in micronutrient intake. Using household food consumption data, we used the nutrient density method to model the additional contribution of bouillon fortified with vitamin A (40-250µg/g bouillon), folic acid (20-120µg/g), vitamin B12 (0.2-2µg/g), iron (0.6-5mg/g), and zinc (0.6-5mg/g) for meeting micronutrient requirements of women of reproductive age (WRA) and children aged 6-59 months. Accounting for existing fortification programs, our results showed that, except for iron, the prevalence of inadequacy was substantially higher among WRA and children living in poorer and rural households. Given the ubiquity of bouillon consumption, bouillon fortification has the potential to virtually eliminate vitamin A, folate, and vitamin B12 inadequacy, reduce the prevalence of zinc inadequacy by over 20 percentage points, and improve equity in the micronutrient adequacy of diets across socioeconomic strata and urban and rural residence. Our results also suggested that designing a bouillon fortification program would require careful planning to balance reductions in inadequacy with the risk of high intakes. This evidence provides important input into decisions around bouillon fortification in Nigeria.

S506 Disparities in Mortality Trends Among Rural Residents With Metastatic Gastrointestinal Cancers in the United States: A CDC WONDER Database Analysis

S506 Disparities in Mortality Trends Among Rural Residents With Metastatic Gastrointestinal Cancers in the United States: A CDC WONDER Database Analysis

Why are City Residents Less Happy than the Rest of the Population in Developed Countries? Studying the Urban-Rural Happiness Gap in Denmark Using Blinder-Oaxaca Decomposition

AbstractIn Denmark, and in developed countries in general, urban residents tend to report lower subjective well-being than rural residents. This difference has been referred to as a happiness paradox as cities historically have pulled in residents from the countryside in what has become known as the rural exodus. This paper explores the urban-rural happiness gap in Denmark. Using the Danish Rural-Urban Survey administered in 2011/2012 (n = 2000), the paper compares the respondents who live in the five largest cities in Denmark (Copenhagen, Aarhus, Odense, Aalborg, and Esbjerg) to the respondents who live in other parts of the country. The residents in the five largest cities report significantly lower life satisfaction than residents in the rest of the country. In contrast to evidence from other developed countries, this urban-rural happiness gap is found to be consistent across groups in the Danish society, e.g., across age, education, and employment groups. Further, the results show that the urban-rural happiness gap loses its statistical significance - and the two groups display similar satisfaction levels - when adjusting for several important factors. Decomposition analyses reveal that differences in urban-rural characteristics explain up to 94% of the urban-rural happiness gap. Of these urban-rural characteristics, lower access to nature amenities, lower bonding social capital, lower rates of retired people, and higher rates of non-native residents in the five largest cities in Denmark were found to account for up to 37%, 22%, 14%, and 9% of the urban-rural happiness gap, respectively.

Telehealth yoga program for older adults in rural Wisconsin: intervention development and process outcomes

Although yoga improves physical functioning, balance, and quality of life in older adults, rural residents are less likely to participate due to issues related to availability, access, and beliefs regarding yoga practice. To address these barriers, we worked with community partners to adapt a yoga program designed for older adults for telehealth delivery. In this report, intervention development and process outcomes are presented. Community collaborators identified strategies to recruit and retain older adults and suggested modifications required to maximize the adoption and maintenance of a telehealth exercise program by local community organizations. Four rural serving organizations evaluated the program, with participants assigned to a first or second offering. Process measures collected at post-intervention supplemented program evaluation measures collected pre- and post-intervention. The adapted 8-week program consisted of two weekly group sessions delivered over videoconferencing software. Of 48 enrolled participants, 83% completed the program. Participants were on average 72.6 (SD=6) years old, majority white (98%), female (85.7%), and attended some college (92%). Most were satisfied with the telehealth delivery, program content, and yoga instructor with mixed results regarding logistical issues such as program length and duration. Community organizations similar to those that will ultimately disseminate the program, yoga teachers, and older adults were engaged to maximize the feasibility of this telehealth exercise program. The program appeared to be safe and acceptable, indicating telehealth may be a strategy to increase access to yoga programs for rural-dwelling older adults. Lessons learned will inform future telehealth iterations of this and similar exercise programming.