Rural Settings Research Articles

Schistosome and malaria exposure and urban–rural differences in vaccine responses in Uganda: a causal mediation analysis using data from three linked randomised controlled trials

Vaccine immunogenicity and effectiveness vary geographically. Chronic immunomodulating parasitic infections including schistosomes and malaria have been hypothesised to be mediators of geographical variations. We compared vaccine-specific immune responses between three Ugandan settings (schistosome-endemic rural, malaria-endemic rural, and urban) and did causal mediation analysis to assess the role of Schistosoma mansoni and malaria exposure in observed differences. We used data from the control groups of three linked randomised trials investigating the effects of intensive parasite treatment among schoolchildren. All participants received the BCG vaccine (week 0); yellow fever (YF-17D), oral typhoid (Ty21a), human papillomavirus (HPV; week 4); and HPV booster and tetanus-diphtheria (week 28). Primary outcomes were vaccine responses at week 8 and, for tetanus-diphtheria, week 52. We estimated the total effect (TE) of setting on vaccine responses and natural indirect effect (NIE) mediated through current or previous infection with S mansoni or malaria, and baseline vaccine-specific responses. We included 239 (43%) participants from the schistosomiasis-endemic setting, 171 (30%) from the malaria-endemic setting, and 151 (27%) from the urban setting. At week 8, vaccine responses were lower in rural settings: schistosomiasis-endemic versus urban settings (TE geometric mean ratio for YF-17D plaque reduction neutralisation at 50% (PRNT50) titres 0·58 [95% CI 0·37 to 0·91], for S Typhi O-lipopolysaccharide-specific IgG 0·61 [0·40 to 0·93], and for tetanus-specific IgG 0·33 [0·22 to 0·51]); malaria-endemic versus urban settings (YF-17D 0·70 [0·49 to 0·99], S Typhi O-lipopolysaccharide-specific IgG 0·29 [0·20 to 0·43], and tetanus-specific IgG 0·53 [-0·35 to 0·80]). However, we found higher BCG-specific IFNγ responses in the malaria-endemic versus urban setting (1·54 [1·20 to 1·98]). The estimated NIEs of setting on vaccine responses mediated through previous and current S mansoni and malaria were not statistically significant. For malaria-endemic versus urban settings, baseline vaccine-specific responses contributed to some but not all differences: S Typhi O-lipopolysaccharide-specific IgG at week 8 (57.9% mediated [38·6 to 77·2]) and week 52 (70·0% mediated [49·4 to 90·6]) and BCG at week 52 (46.4% mediated [-4·8 to 97·7]). We found significant variation in vaccine response between urban and rural settings but could not confirm a causal role for schistosome or malaria exposure. Other exposures require consideration. UK Medical Research Council.

Overcoming Barriers to Healthcare Reform: A Call to Action.

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing-the largest healthcare workforce with diverse roles-operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.

The effect of intensive praziquantel administration on vaccine-specific responses among schoolchildren in Ugandan schistosomiasis-endemic islands (POPVAC A): an open-label, randomised controlled trial

Vaccine responses differ between populations and are often impaired in rural and low-income settings. The reasons for this are not fully understood, but observational data suggest that the immunomodulating effects of parasitic helminths might contribute. We hypothesised that Schistosoma mansoni infection suppresses responses to unrelated vaccines, and that suppression could be reversed-at least in part-by intensive praziquantel administration. We conducted an open-label, randomised controlled trial of intensive versus standard intervention against S mansoni among schoolchildren aged 9-17 years from eight primary schools in Koome islands, Uganda. Children were randomly allocated to either an intensive group or a standard group with a computer-generated 1:1 randomisation using permuted blocks sizes 4, 6, 8, and 10. Participants in the intensive group received three praziquantel doses (approximately 40 mg/kg) 2 weeks apart before first vaccination at week 0, and every 3 months thereafter. Participants in the standard group were given one dose of approximately 40 mg/kg praziquantel after the week 8 primary endpoint. Participants in both groups received the BCG vaccine (Serum Institute of India, Pune, India) at week 0; the yellow fever (Sanofi Pasteur, Lyon, France), oral typhoid (PaxVax, London, UK), and first human papillomavirus (HPV) vaccination (Merck, Rahway, NJ, USA) at week 4; and the HPV booster and tetanus-diphtheria vaccine (Serum Institute of India) at week 28. The primary outcome was vaccine response at week 8 (except for tetanus and diphtheria, which was assessed at week 52). The primary analysis population was participants who were infected with S mansoni at baseline, determined retrospectively using either plasma circulating anodic antigen (CAA) or stool PCR. The safety population comprised all randomly allocated participants. The trial was registered at the ISRCTN Registry (ISRCTN60517191) and is complete. Between July 9 and Aug 14, 2019, we enrolled 478 participants, with 239 children per group. 276 (58%) participants were male and 202 (42%) participants were female. Among participants who were positive for S mansoni at baseline (171 [72%] in the intensive group and 164 [69%] in the standard group) intensive praziquantel administration significantly reduced pre-vaccination infection intensity (to median 30 CAA pg/mL [IQR 7-223] vs 1317 [243-8562], p<0·001) compared with standard treatment. Intensive praziquantel administration also reduced week 8 HPV-16-specific IgG response (geometric mean ratio 0·71 [95% CI 0·54-0·94], p=0·017), but had no effect on other primary outcomes. Among all participants (regardless of S mansoni status at baseline) intensive praziquantel administration significantly improved week 8 BCG-specific IFNγ ELISpot response (1·20 [1·01-1·43], p=0·038). Recognised adverse effects of praziquantel were reported more frequently in the intensive group. There were no recorded serious adverse events in either group. We show evidence suggesting that praziquantel administration improves the BCG-specific cellular response, but not humoral responses to other vaccines. Despite observational evidence that helminths impair vaccine response, these results show minimal immediate benefits of reducing helminth burden. The effect of longer-term helminth control should be investigated. UK Medical Research Council. For the Luganda translation of the abstract see Supplementary Materials section.

The effect of BCG revaccination on the response to unrelated vaccines in urban Ugandan adolescents (POPVAC C): an open-label, randomised controlled trial

Immune responses induced by several important vaccines differ between populations, with reduced responses in low-income and rural settings compared with high-income and urban settings. BCG immunisation boosts immune responses to some unrelated vaccines in high-income populations. We aimed to test the hypothesis that BCG revaccination can enhance responses to unrelated vaccines in Ugandan schoolchildren. We conducted an open-label, randomised controlled trial to compare the effects of BCG revaccination versus no BCG revaccination on the immunogenicity of subsequent unrelated vaccines among adolescents aged 13-17 years who are participants in an urban Ugandan birth cohort study, in which BCG vaccination was documented at birth. Participants were excluded if they had received any of the trial vaccines or related agents when aged 5 years or older. Computer-generated 1:1 randomisation was implemented in REDCap. Participants were excluded if they were concurrently enrolled in other trials; had a clinically significant history of immunodeficiency, or serious psychiatric conditions or moderate to severe acute illnesses; were taking immunosuppressive medications; had allergies to vaccine components, a predisposition towards developing keloid scarring; positive HIV tests or pregnancy tests; were female participants who were lactating; or if they planned to use investigational drugs, vaccines, blood products, or any combination thereof. Trial participants assigned to the BCG revaccination group received the live parenteral BCG-Russia vaccine (Serum Institute of India, Pune, India; 0·1 mL intradermally, right upper arm) at week 0. All participants received yellow fever vaccine (YF-17D; Sanofi Pasteur, Lyon, France; 0·5 mL intramuscularly, left upper arm), live oral typhoid vaccine (Ty21a; PaxVax, London, UK; one capsule per day taken for three alternate days), and quadrivalent virus-like particle human papillomavirus (HPV) vaccine (Merck, Rahway, NJ, USA; 0·5 mL intramuscularly, left upper arm) at week 4; and toxoid vaccines (tetanus-diphtheria; Serum Institute of India; 0·5 mL intramuscularly, left upper arm) and an HPV booster at week 28. An additional HPV vaccination at week 8 was provided to female participants older than 14 years who had not previously been vaccinated. The primary outcomes were yellow fever neutralising antibody titres at 4 weeks post-YF-17D vaccination, Salmonella enterica serovar Typhi (henceforth S Typhi) O-lipopolysaccharide (O:LPS)-specific IgG concentration at 4 weeks post-Ty21a vaccination, and HPV-16 and HPV-18 L1 protein-specific IgG concentration at 4 weeks post-HPV vaccination. Primary outcome assays were conducted at week 8, and at week 52 for tetanus-diphtheria. We conducted an intention-to-treat analysis comparing log-transformed outcomes between trial groups, with results back-transformed to geometric mean ratios (GMRs). The safety population comprised all randomly allocated participants. The trial was registered at the ISRCTN Registry (ISRCTN10482904) and is complete. Between Aug 31 and Oct 12, 2020, we screened 376 potential participants for eligibility. We enrolled and randomly allocated 300 participants to the two groups (151 [50%] to the BCG group and 149 [50%] to the no BCG group). 178 (59%) of 300 participants were male and 122 (41%) were female. 142 (91%) of 151 participants in the BCG group and 139 (93%) of 149 in the no BCG group completed follow-up. There was no effect of BCG revaccination, compared with no BCG revaccination, on the response observed for any vaccine. Yellow fever plaque reduction neutralising reference tests (PRNT50) titres (the reciprocal of the last plasma dilution that reduced by 50%) had a GMR of 0·95 (95% CI 0·75-1·19; p=0·62) and PRNT90 (reciprocal of the last plasma dilution that reduced by 90%) had a GMR of 0·94 (0·74-1·19; p=0·60); IgG to S Typhi O:LPS was 0·99 (0·80-1·23; p=0·94); IgG to HPV-16 was 0·97 (0·69-1·35; p=0·85) and to HPV-18 was 1·03 (0·76-1·40; p=0·83); and toxoid-specific IgG for tetanus was 1·13 (0·87-1·47; p=0·36) and was 1·00 (0·87-1·16; p=0·97) for diphtheria. There were no serious adverse events in either group. We found no evidence that BCG revaccination is an effective strategy to improve immunogenicity of other vaccines in this low-income, urban setting. UK Medical Research Council. For the Luganda translation of the abstract see Supplementary Materials section.

CASE REPORT: GIANT HYDATID CYST OF THE LIVER IN A YOUNG PATIENT: SURGICAL MANAGEMENT AND LONG-TERM FOLLOW-UP

Hydatid disease, caused by the parasite Echinococcus granulosus, remains a significant public health issue in endemic areas, especially in rural settings. This report presents the case of an 18-year-old female patient residing in a rural area, with no significant medical history, who developed a symptomatic hepatic hydatid cyst. The patient was treated surgically without preoperative antiparasitic therapy and was placed on postoperative albendazole. The case highlights the importance of timely surgical intervention and long-term follow-up to prevent recurrence.

Smart noise pollution monitoring system

Increasing pollution poses serious health risks, necessitating urgent control measures for a healthier future for all. Among various pollution types, sound pollution significantly impacts quality of life and well-being, especially in densely populated urban areas. This proposal describes the creation and deployment of an Internet of Things (IoT)-based noise pollution monitoring system intended to track sound levels in certain regions in real time. The core of this system comprises advanced sensors strategically placed to measure sound intensity accurately. These sensors can detect even minor variations in noise levels, providing precise and reliable data. After being gathered, the data is sent to a microcontroller, which effectively processes it. This microcontroller ensures the data is accurately captured and sent over the internet to an online server. Once the data reaches the online server, it becomes accessible for analysis and monitoring by authorities. The system's real-time data capability is crucial for timely intervention. Authorities can continuously monitor noise levels and identify trends or spikes in sound pollution, allowing them to address issues promptly. This feature is particularly beneficial for sensitive areas such as schools, hospitals, and residential zones, areas with heavy traffic, library, Where excessive noise can have severe health effects, including stress, sleep disturbances, and hearing loss. The system includes an alert mechanism that notifies relevant authorities when noise levels exceed predefined thresholds. These alerts enable quick responses to mitigate noise pollution. For instance, in a school, reducing noise levels can enhance the learning atmosphere and improve students' concentration. In hospitals, maintaining a quiet environment is crucial for patient recovery. The integration of IoT technology in this noise pollution monitoring system not only enhances efficiency but also provides a scalable solution adaptable to various urban and rural settings. This scalability ensures the system can be expanded to cover larger areas or multiple locations as needed.

Integration of renewable energy-powered cold storage solutions for reducing post-harvest food waste in rural agricultural areas

Post-harvest food loss remains a critical challenge in rural agricultural areas, exacerbated by inadequate storage facilities and unreliable energy access. This study develops and optimizes an advanced renewable energy-powered cold storage system tailored for rural settings, integrating solar and wind energy with phase change materials (PCMs) for efficient energy storage. The system incorporates Internet of Things (IoT)-based sensors and artificial intelligence (AI)-driven energy management to maintain optimal storage conditions and enhance energy efficiency. Field trials conducted in Lincolnshire, UK, and Appalachian regions of the US demonstrated significant reductions in post-harvest food loss by an average of 43.5%, extensions in produce shelf-life by up to 300%, and increased income for smallholder farmers by approximately 43%. The system also achieved an 80% reduction in greenhouse gas emissions compared to conventional diesel-powered systems. Economic analyses revealed a shorter payback period and higher return on investment, confirming the system's viability. High user satisfaction and adoption rates indicate the system's practicality and potential for widespread implementation. The findings suggest that integrating renewable energy with smart technologies in cold storage solutions offers a scalable and sustainable approach to enhancing food security, promoting economic growth in rural areas, and supporting environmental objectives globally.

An intersectional approach on menstrual inequity as lived by women in circumstances of socioeconomic vulnerability in an urban and rural setting in Spain: a qualitative study

Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women’s menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.

A Review of Wastewater-Based Epidemiology for the SARS-CoV-2 Virus in Rural, Remote, and Resource-Constrained Settings Internationally: Insights for Implementation, Research, and Policy for First Nations in Canada

Wastewater-based epidemiology (WBE) is regarded as a support tool for detecting and assessing the prevalence of infectious diseases at a population level. For rural, remote, and resource-constrained communities with little access to other public health monitoring tools, WBE can be a low-cost approach to filling gaps in population health knowledge to inform public health risk assessment and decision-making. This rapid review explores and discusses unique considerations of WBE in key settings, with a focus on the detection of the SARS-CoV-2 virus, which has rapidly expanded WBE infrastructure globally. To frame our understanding of possibilities for WBE with First Nations in Alberta, we address the following questions: What are the unique considerations and challenges for WBE under similar contexts in rural, remote, or resource-constrained settings? What are the resources and expertise required to support WBE? This review identifies several unique considerations for WBE in rural, remote, and resource-constrained communities, including costs, accessibility, operator capacity, wastewater infrastructure, and data mobilization—highlighting the need for equity in WBE. In summary, most resource-constrained communities require additional support from external research and/or governmental bodies to undertake WBE.

The impact of a rural school-based oral health intervention among primary schoolchildren in Armenia

Abstract Objectives Oral health (OH) interventions are shown to be effective in improving children’s OH status and behavior. This study evaluated the effectiveness of a school-based OH intervention combined with OH educational activities on rural schoolchildren’s OH status and behavior in a rural setting in Armenia. Methods The study population were primary schoolchildren of Mrgashat village, Armavir province, Armenia, and their parents. The intervention included sealant application to eligible permanent molars of children and fluoridization of their teeth twice a year over a two-year period. Educational activities included a training session for children and their parents, and distribution of educational materials among them. Baseline (BL) and follow-up (FU) assessments were conducted before and after the intervention (in 2022 and 2024) to evaluate its impact. Both assessments included clinical examination of children’s OH status by calculating their DMFT/dmft index, and telephone survey among parents on OH knowledge and behavior. The changes in DMFT/dmft index and OH knowledge and behavior scores were measured using paired t-test. Results Overall, 94 children and their parents participated in both BL and FU assessments. There was no significant change in the parental OH knowledge score: 77.4% (SD 14.0) at the BL and 78.7% (SD 13.2) at the FU. Yet, children’s OH behavior score increased significantly: from 44.9% (SD 18.2) at the BL to 60.0% (SD 15.4) at the FU (p &amp;lt; 0.001). Children’s DMFT/dmft index also improved significantly: from 7.31 at the BL to 5.09 at the FU assessment (p &amp;lt; 0.001). Conclusions The study demonstrated the effectiveness of the OH intervention in improving children’s OH status and behavior. Therefore, we recommend expansion of the intervention with inclusion of more rural sites in Armenia, and targeting primary schoolchildren, considering the importance of timely preventive interventions and early development of healthy habits for better OH later in life. Key messages • Oral health interventions among primary schoolchildren covering awareness raising and carries prevention activities result in positive changes in children’s oral health habits and teeth health. • Expansion of this type of interventions with inclusion of new rural sites and conduction of further assessments to explore the long-term effects of such interventions are recommended.

Thermal Performance of Novel Eco-Friendly Prefabricated Walls for Thermal Comfort in Temperate Climates

The global threat of climate change has become increasingly severe, with the efficiency of buildings and the environment being significantly impacted. It is necessary to develop bioclimatic architectural systems that can effectively reduce energy consumption while bringing thermal comfort, reducing the impact of external temperatures. This study presents the results of a real-scale experimental house prototype, MHTITCA, using a unique design composed of novel eco-friendly prefabricated channel walls filled with a blend of soil, sawdust, and cement for walls and roofs. The experimental analysis performed in this study was based on dynamic climatology. A solar orientation chart of the place was constructed to identify the solar radiation intensity acting on the house. Measurements of roof surface temperatures were conducted to determine temperature damping and temperature wave lag. Monthly average temperature and direct solar radiation data of the site were considered. Compared to other alternative house prototypes, the system maximizes thermal comfort in high-oscillation temperate climates. Temperature measurements were taken inside and outside to evaluate the thermal performance. A thermal insulating layer was added outside the wall and the envelope to improve the prototype’s thermal comfort and reduce the decrement factor even more. This MHTITCA house prototype had 85% thermal comfort, 0% overheating, and 15% low heating. This eco-friendly prototype design had the best thermal performance, achieving a thermal lag of twelve hours, a reduced decrement factor of 0.109, and preventing overheating in areas with high thermal fluctuations. Comparatively, the other prototypes examined provided inferior thermal comfort. The suggested MHTITCA system can be an energy-saving and passive cooling option for thermal comfort in low-cost houses in temperate climates with high thermal oscillations in urban or rural settings.

Assessing cyberchondria and eHealth literacy differences in urban and rural China

Abstract Background and Objectives This study aimed to explore the association between cyberchondria and eHealth literacy in the general Chinese population, and to assess how this relationship changes between urban and rural residents. Methods Data obtained from a web-based, cross-sectional survey that evaluate cyberchondria and its impact on health in February 2024. The Cyberchondria Severity Scale - 12 item was used to measure the cyberchondria, while the eHealth Literacy Scale was used to evaluate eHealth literacy. Descriptive analysis was used to describe the background characteristics of the participants. Then, a multivariable linear regression model was then performed for urban and rural subsample to examine the relationship between cyberchondria and eHealth literacy, respectively, providing a comparative analysis between the urban and rural populations. Results A total of 634 individuals completed the questionnaire. The average age was 33.2 years (SD = 7.4), with approximately 50.3% (n = 319) being female. Urban residents made up 71.4% (n = 451) of the participants. The mean eHEALS scores for urban and rural residents were 31.9 (SD = 4.3) and 30.4 (SD = 4.2), respectively. The CSS-12 scores for urban residents were 40.3 (SD = 7.58) and for rural residents were 39.1 (SD = 7.2). Linear regression analyses showed a significant association between eHealth literacy and cyberchondria for urban residents (Beta = 0.30, p &amp;lt; 0.001), but age and education level had no significant impact. For rural residents, a statistically significant association between eHealth literacy and cyberchondria was also observed (Beta = 0.40, p = 0.002). Conclusions Overall, eHealth literacy consistently predicts cyberchondria severity in both urban and rural samples. Higher eHealth literacy is linked to greater cyberchondria, especially in rural areas. Future research should explore other potential mediators, including psychological factors, internet usage patterns, and access to healthcare services. Key messages • eHealth literacy strongly predicts cyberchondria severity in both urban and rural populations, with a notably stronger impact observed in rural settings. • Urban and rural differences highlight the need for customized digital health literacy programs to effectively address region-specific challenges and behaviors.

Did the COVID-19 Pandemic Affect Suicide Rates Differently in Urban and Rural South Korea?

Abstract Background The influence of the COVID-19 pandemic on suicide rates remains a subject of debate. Despite increases in suicidal ideation and attempts reported during the pandemic, several recent meta-analyses have not demonstrated corresponding rises in suicide rates. Given the potential for substantial regional and demographic variability in the psychological consequences of COVID-19-related restrictions, this study explores differential suicide rates in urban versus rural contexts within South Korea subsequent to the pandemic outbreak. Methods This investigation employed age-standardized suicide rates from two periods, 2015-2019 and 2020-2022, across 234 administrative divisions (152 urban, 82 rural). A difference-in-differences approach was utilized to evaluate the pandemic’s impact on suicide rates, segmented by urban and rural classifications. A linear regression model was developed to examine the interaction between location (urban/rural) and time period, controlled for annual variations, perceived stress, and health status within each locale. Results Analysis revealed higher suicide rates in rural areas compared to urban counterparts (β = 1.247, p = 0.003), although no significant changes were observed during the pandemic period itself (β=-0.425, p = 0.682). Furthermore, the interaction between urban/rural status and the pandemic period did not reach statistical significance (p = 0.367). Conclusions The findings indicate no significant contribution of the COVID-19 pandemic to increased suicide rates, irrespective of the urban or rural setting. Further research is warranted to dissect the impact of more direct socioeconomic factors on this dynamic. Key messages • There in no evidence of increased suicide rates during the COVID-19 pandemic in South Korea. • The impact of the COVID-19 pandemic on suicide rates did not significantly different between urban and rural areas.

Exploring Type 2 Diabetes Self-Management Practices Among African Americans in Rural Counties: A Qualitative Study.

The purpose of the study was to understand diabetes self-management practices among African American individuals living with type 2 diabetes (T2D) in rural communities. This qualitative descriptive study, undergirded by the theory of integration, purposively sampled African Americans (N = 34) diagnosed with T2D living in rural communities. Thematic analysis employed both a priori and inductive coding to identify salient themes. Participants' mean age was 65.9 (SD 12.3) years, with an average T2D diagnosis duration of 14 (SE 11.2) years. Two major themes emerged: deciphering the cues and body sensing, which the participants used to monitor their glucose level using a personalized feedback loop. Those with longer diabetes duration demonstrated an ability to recognize hypoglycemic or hyperglycemic symptoms (deciphering the cues), informing their decision-making and self-management strategies (body sensing). The decision-making involved in glycemic level management emerges as a complex developmental process influenced by disease trajectory and cultural and environmental factors. These findings may inform a conceptual framework to guide future inquiries and provide insights for primary care clinicians and diabetes educators to better understand the complexities of T2D management among African American individuals in rural settings.

Creating opportunities for community voices to be heard

Abstract This presentation will showcase the importance of community based participatory research in developing health literacy in Ireland. Purposeful sampling (n = 105: 71% female) in two contrasting Sláintecare Healthy Community areas in Ireland (Finglas &amp; Cabra and Mayo), recruited participants to take part in semi-structured focus groups, or individual interviews. Using reflective thematic analysis, and a critical friend approach, five key themes were identified that demonstrated the strengths, needs and challenges in health literacy in urban and rural communities in Ireland. This included: i) Accessing and understanding health information; ii) Health literacy changing over time; iii) Perceiving health literacy as an individual responsibility; iv) Interpersonal and community influences on health literacy; and v) Health access through a rural or urban infrastructure. There were many similarities between rural and urban, young and old. Equally, there were unique challenges that required local solutions. As such, the next phase of this project utilised a co-design process to check, challenge, collaborate and create recommendations for health literacy solutions in each case study area. A specific method of experience-based co-design, the Double Diamond Design Approach (DDDA) was used. With DDDA, stakeholders progress through a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Two Co-design Workshops took place in March 2024 aiming to revise the strengths, barriers, needs, and propose potential recommendations for health literacy in each Sláintecare Healthy Community, using an adapted DDDA. Within the rural setting, solutions to promote health literacy spanned across transport, health access, and community based needs. Within an urban context specific suggestions around community engagement, information sharing, and earlier educational intervention were called for.

The profile and aberrant driving behavior of juvenile traffic law violators in Greece

Abstract The majority of juvenile offenses in Greece are related to road traffic violations. Juveniles in Crete region are required to attend an educational program offered by LaHeRS lab (HMU), in collaboration with the Prosecutor’s Office as part of reformative measures. The current presentation reports on the profile and aberrant driving behavior of juvenile offenders who attended the program between 2023-2024. The Driver Behavior Questionnaire (DBQ) was administered to 181 juvenile offenders. Participants were males (97.8), with a mean age 18.6 (SD = 1.2), resided in rural settings (51.8%) and secondary students 60.7%. The mean age of the first offence was 15.8 (SD = 1.1, min 13 - max 18). Participants scored low in all DBQ scales (covered violations mean=6.1, sd = 7.5; unintentional violations mean=0.9, sd = 1.6; lapses mean=8.9, sd = 10.5). No statistically significant difference was found in DBQ scores between those who had and did not have a driver’s license, as well as between those from urban or rural areas. The three DBQ subscales significant correlated (p &amp;lt; .001). Among other risky behaviors, 54.9% reported exceeding the legal speed limit, 66.3% reported aggression feelings when driving behind a slow vehicle, 34.5% used mobile phones while driving, 17.7% reported alcohol use while driving. Surprisingly, 85.5% stated high confidence addressing risks on the roads. Key messages • Early interventions on aberrant driving behavior among adolescents is crucial. • Educational programs should be tailored to address the unique needs of juvenile traffic law violators.

Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador

Abstract Background The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context. Methods Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals. Results Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia. Conclusions The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations. Key messages • The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities. • Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.

Development and validation of a training course on proton pump inhibitor deprescription for general practitioners in a rural continuing medical education program: a pilot study

BackgroundDespite being cornerstone medications for managing gastrointestinal disorders, proton pump inhibitors (PPI) have raised concerns due to inappropriate prescribing and overutilization, their potential side effects, and interactions with other medications. General practitioners (GPs) provide long-term patient follow-up and are targets to promote PPI deprescribing to reach the widest possible population. GPs practicing in rural settings encounter unique challenges as their numbers dwindle and their workload increases. Hence, targeted educational interventions are crucial to promote appropriate prescribing practices in such underserved areas.MethodsWe developed a continuing medical education (CME) program focused on PPI deprescribing for GPs in rural settings. The program comprised of an interactive training session featuring clinical cases, an open discussion, and distribution of educational materials. We assessed the program’s effectiveness using a two-level Kirkpatrick model, evaluating participant satisfaction and knowledge levels through pre- and post-course questionnaires.ResultsThirty-three GPs participated, with 61.9% working in semi-rural and 38.1% in rural areas (21 responded to the 1st questionnaire, 14 to the 2nd ). Median medical experience was 6 years, with 61.9% serving as internship supervisors. Despite 95.2% acknowledging PPI overprescription, none had previously participated in dedicated PPI CME programs. The open discussion session provided valuable insights into various topics related to PPI use and gastrointestinal health. Participants expressed high satisfaction with the program (average rating of 9.1/10) and 92.9% reported changes in practice, including increased awareness of inappropriate PPI prescriptions. Indeed, 92.9% of GPs identified inappropriate PPI use following the course. 57.1% of participants utilized the provided educational materials. The main practice changes observed included an increased reassessment rate of PPI indications (71.4% at each renewal after vs. 19% before, 28.6% non-systematically after vs. 66.8% before, 0% rarely after vs. 14.3% before; p = 0.006), the necessity for more than one consultation to deprescribe (64.3% after vs. 23.8% before; p = 0.021), systematic utilization of gradual cessation of PPI (100% vs. 61.9%; p = 0.039) and more frequent use of additional medication (92.9% vs. 57.1%; p = 0.022), primarily antiacids (92.3%).ConclusionsOur study underscores the effectiveness of targeted CME programs in promoting appropriate prescribing practices and enhancing knowledge among GPs in rural settings. Despite the challenges encountered in deprescribing PPI, the program facilitated proactive approaches in managing treatment discontinuation failures. Tailored educational interventions are essential for mitigating medication prescribing challenges and improving patient outcomes in rural primary care settings.Trial registrationsNot applicable.

The Impact of a Dialogic Intervention on a Chinese Rural Teacher and Students' Stances Towards Texts

ABSTRACTIn language arts classrooms, dialogic teaching encourages diverse text interpretations, fostering discussions that enhance students' literacy skills like reasoning. However, adopting a dialogic stance poses challenges for both teachers and students. The study investigated the impact of a tailor‐made dialogic intervention on a Chinese rural teacher and students' stances towards texts. Chinese rural students shifted from efferent and instrumental stances to a more critical‐analytical stance, indicating a profound change in how rural students interacted with texts through exploratory talk, highlighting the potential of dialogic teaching practices to foster deep engagement with reading materials. However, after the intervention ended, the teacher reverted to a monologic approach due to limited dialogic texts and time constraints. The findings underscore the potential of dialogic teaching for engaging rural students, yet highlight the need for sustained teacher training and suitable texts. Future research should focus on cultivating and maintaining students' growth mindset effectively in rural settings.

Anaerobic digestion of agricultural waste for biogas production and sustainable bioenergy recovery: a review

AbstractAnaerobic digestion constitutes a sustainable method for waste management and renewable energy generation, addressing significant environmental and societal challenges. The growing global waste crisis and the increasing momentum toward sustainable energy solutions emphasize the critical need to enhance anaerobic digestion technology for improved efficiency and environmental advantages. This process mitigates waste accumulation, enhances energy security, and reduces greenhouse gas emissions, providing a feasible solution within the framework of a circular bioeconomy. Here, we review the principles of anaerobic digestion and biogas production, focusing on agricultural waste and the utilization of biogas for energy within a sustainable framework. We specifically explore biogas applications in rural and industrial settings, assess the environmental impacts, and discuss the regulatory landscape with insights from China and Europe. This study reveals that the strategic implementation of anaerobic digestion can markedly improve energy yield and sustainability, demonstrating how focused policies and advanced technological practices can optimize biogas utilization. The review enhances comprehension of environmental impacts, emphasizing insights from China and Europe as key examples.