Rural Settings Research Articles

A place to call our home: innovative rural physical therapy training in Canada

BackgroundTo promote rural practice and increase enrollment in the entry-level Master of Science Physical Therapy program at the University of Alberta, the Department of Physical Therapy developed a rural physical therapy satellite campus located in a farming region in central Alberta. A distributed learning format was used to connect the rural cohort to the main urban campus. Real time video conferencing was used to connect the two campuses for all lectures, seminars and clinical skills classes. This evaluation aimed to describe a unique rural training program for physical therapy students and its effectiveness in promoting work in rural communities after graduation.MethodsPhysical Therapy students in the first three years (2012–2015) of commencing the rural satellite program (n = 280) were surveyed, and six focus groups were held to capture student experiences, satisfaction and engagement. Data were collected on employment locations of the 2012–2019 graduates’ first physical therapy position and current employment.ResultsSurvey results suggested comparable levels of satisfaction and engagement for all physical therapy students regardless of campus. Focus group data revealed that students quickly accepted the distributed learning technological interface, enjoyed their local campuses, and felt connected to instructors and student colleagues. Compared to the overall physical therapy workforce, a higher percentage of physical therapists graduating from the rural campus reported working in rural centers for both their first and current jobs.ConclusionRegardless of campus, students were satisfied and equally engaged in the physical therapy program. Students who completed the physical therapy program in a rural setting tended to work rurally after graduation. A distributed learning model may be useful for other healthcare training programs to promote engagement in rural health.

Insights Of Cardiac Changes In Sudden Deaths In Kalaburagi District- An Autopsy Study.

Introduction: Sudden and unexpected death often arises as a complication of diverse cardiac ailments. The occurrence of sudden cardiac-related deaths is increasingly prevalent in both urban and rural settings. This surge presents a formidable challenge for forensic physicians tasked with conducting autopsies to ascertain the precise cause and manner of death, particularly in individuals previously considered healthy. Consequently, this study aims to shed light on infrequent lesions that may go unnoticed during the individual's lifetime, offering valuable insights into this phenomenon. Aims and Objectives of the study: 1) To study the demographic distribution of cardiac specimens of sudden death. 2) To study the histomorphology features in cardiac specimens in sudden death. 3) To grade the atherosclerotic lesions as per Modified American Heart Association Classification of Atherosclerotic Lesion. Materials and method: This is a retrospective study of 3 years from December 2020 to November 2023.The data of medicolegal autopsies was retrieved from the records of department of Pathology, Gulbarga Institute of Medical Sciences, Kalaburagi. A total of 371 medicolegal autopsy specimens were received in the department. Out of which 114 cardiac specimens (sent with other organs) of sudden death were studied. Results: Out of 114 cases of sudden death, 57% of the deaths occurred in outdoor location and remaining 43% occurred in hospitalized patients and homes. The commonest age group of sudden cardiac death was 31 to 40 years of age (27%). We found males were affected more commonly (84%) than females. The most common cause of sudden cardiac death is coronary artery disease (74.6%) followed by myocardial infarction (7.6%). Conclusion: The most common cause of sudden cardiac death is coronary artery disease, which is common in young males (age group 31-40 years).

Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study

Hypertension poses a critical threat to health in India, being the predominant risk factor for mortality and disability. With over 70% of outpatient care being provided by the private sector, our study investigated the practices and incentives of private health providers in screening, diagnosing, treating, monitoring, and counseling hypertension patients in rural and peri-urban India. Conducted from April 2020 to February 2021, the qualitative study involved 46 participants, including various healthcare professionals and patients in three Telangana state districts. Analysis revealed a lack of recognition of hypertension’s gravity among private providers in these areas, leading to inconsistent screening practices and varied diagnostic thresholds, particularly among rural medical practitioners. Both formal and informal providers lacked standardized protocols and follow-up mechanisms, with limited technical knowledge about hypertension observed, especially among rural practitioners who were often the first point of contact. Drug effectiveness, and incentives from pharmaceutical sales representatives influenced prescribing practices. Diagnostic labs also offered financial incentives for patient referrals. Thus, aligning providers’ objectives with patient preferences and public health goals is crucial. To encourage evidence-based hypertension care, the government and NGOs could implement strategies such as tailored incentives, financial rewards, tax benefits, accreditation, and recognition for private healthcare providers. Professional bodies in the private sector should establish programs emphasizing quality assurance and certifications. Future research should focus on designing and testing new models for private sector hypertension service delivery, coupled with targeted interventions to enhance care in rural and peri-urban settings.

A Cross-Sectional Analysis of ALS/ BLS Care in Low Acuity 9-1-1 Response by Geography and Insurance Status Utilizing the 2019 NEMSIS Dataset

Purpose. The objective of this study was to examine the relationship between patient acuity and level of EMS care adjusting for rurality and insurance. Methods. Data were obtained from the National Emergency Services Information System (NEMSIS) database for 2019. EMS responses (n = 4,375,568) were analyzed comparing patient acuity and CMS Service level, Advanced Life Support (ALS) vs Basic Life Support (BLS), to assess for associations in acuity and CMS Service level using logistic regression. Results. Overall, there was a decreased odds of advanced life service use at low acuity EMS responses (OR=0.443, 95% CI=0.440-0.445). Sub analysis exploring the interaction between CMS Service Level, Rurality demonstrates an overall trend of decreasing odds of low acuity EMS responses among rural areas and BLS care (OR=0.492, 95% CI=0.486,0.498) and ALS care (OR=0.198, 95% CI=0.197,0.200). When analyzing trends among public vs all other insurance and rural vs urban settings, there were decreases in low acuity ALS care in the rural setting; ALS and Pub Insurance (OR 0.447, 0.444-0.450, p<0.001), ALS and Rural (OR 0.198, CI 0.197-0.914, p<0.001) among low acuity responses. The results indicate that acuity and service level vary according to insurance and rurality. In the low acuity call type, we see decreased odds of ALS use compared BLS use in those with public insurances compared to other insurance. There is also a geographic component to these results where the use of Advance Life Support services declined with decreases in urbanicity. Discussion. These results potentially highlight that rural areas utilize less emergency medical response resources in low acuity responses. As such, EMS programs like community paramedicine, could be potentially effective interventions to close gaps in access to care for rural residents.

Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings.

Understand perceived barriers to and facilitators of using clinical informatics applications for pharmacogenomic (PGx) implementation in resource-limited settings. We conducted a qualitative research study using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview questions assessed CFIR contextual determinants related to: electronic health record (EHR) infrastructure; clinical informatics personnel and resources; EHR integration of PGx test results; PGx clinical decision support (CDS) tools; institutional resources; and partner receptivity. Transcripts were coded and analyzed to identify themes. We interviewed 24 clinical informaticists and executive leaders working in rural or underserved health care settings in Montana (n = 15) and Colorado (n = 9) and identified three major themes: (1) EHR infrastructure limitations, (2) insufficient supporting resources, and (3) unique contextual considerations for resource-limited settings. EHR infrastructure limitations included limited agency related to EHR build and interoperability concerns. Theme 1 highlighted challenges associated with integrating structured data into the EHR and inadequate vendor support. Theme 2 included limited familiarity with PGx across the care team, cost concerns, and allocation of non-financial resources. Theme 3 highlighted perceptions about the clinical utility of PGx within rural and underrepresented populations. Potential facilitators, such as being able to act nimbly, were found to coexist among the reported barriers. Our results provide insight into the clinical informatics infrastructure in resource-limited settings and identify unique considerations for clinical informatics-facilitated PGx implementation. Future efforts in these settings should consider innovative partnerships and strategies to leverage facilitators and minimize barriers associated with integrating PGx CDS applications.

Depressive and Anxiety Symptoms in Community-Dwelling Women in Rural Areas of Greece in the Post-COVID-19 Pandemic Era

Background/Objectives: Depressive and anxiety syndromes are associated with elevated disability and are more prevalent in women. Data on the prevalence of depressive and anxiety disorders in the rural context are limited and contradictory. It is relevant to study common mental disorders in rural areas in the most vulnerable population of women, particularly in the post-COVID-19 pandemic era. Methods: This is a cross-sectional study that was conducted in two primary healthcare sites in the rural region of Farsala, Central Greece after the obviation of all restrictive measures that had been posed due to the COVID-19 pandemic. All consecutive female patients that attended the study sites for any non-emergent reason were asked to participate in the study. For the recording of symptoms of depression and anxiety, the self-reported Depression, Anxiety, Stress Scale-21 (DASS-21) was used. Results: The study sample consisted of 129 women. The majority of participants were >50 years, with 27.9% being older adults. A small percentage (13.2%) suffered a chronic physical disease. A large proportion of the sample, slightly exceeding 40%, reported clinically relevant symptoms of anxiety, whereas a lower percentage of women with depressive symptoms was detected (17.1%). Symptoms of anxiety and depression were found to be interrelated, while a number of sociodemographic variables were associated with both, such as older age, education (primary), living status (alone, OR 123.5; 95% CI: 7.3–2098.8 for anxiety; OR 3.5; 95% CI: 1.3–9.8 for depression), employment (not working, (OR 0.157; 95% CI: 0.06–0.41 for anxiety; OR 0.08; 95% CI: 0.01–0.62 for depression) and the history of a chronic disease (OR 33.8; 95% CI: 4.3–264.7 for anxiety; OR 37.2; 95% CI: 10–138.1 for depression). Self-rated financial status was not related to symptoms of anxiety or depression. Conclusions: The study highlights the importance of inquiring for symptoms of depression and anxiety in women attending the rural primary care setting. The use of valid and reliable self-reported instruments that are easy to administrate may be helpful in this regard.

Exploring the Role of Social Norms in Buprenorphine Prescribing among Providers in a Rural Health System

Background: The opioid epidemic in the United States continues to accelerate, with opioid-related deaths increasing 30% from 2019 to 2021. Though medication assisted therapy (MAT) is an effective strategy for the treatment of opioid use disorder (OUD), utilization of this tool remains low, particularly in rural health settings. The aims of this study were (a) to examine perceived barriers to using MAT in a sample of rural health providers, (b) to examine the accuracy of medical providers’ perceptions of descriptive (eg, frequency) and injunctive (ie, approval of) norms related to the use of buprenorphine, and (c) to determine whether greater self-other differences predict greater likelihood of prescribing buprenorphine. Methods: An anonymous electronic survey was sent to 775 rural medical providers (response rate = 9.7%). Results: Results indicated that most providers do not prescribe buprenorphine or do so infrequently. Providers inaccurately believed that they were more accepting than their peers with regards to providing addiction care. Providers who assumed that peers were prescribing buprenorphine more often and were more accepting of it were more likely to engage in this practice themselves. Conclusions: These findings lay the groundwork for testing norms interventions that might enhance the uptake of the use of evidence-based substance use treatment by rural medical providers.

Evaluating Age-Friendly Health Care Approaches in Rural Primary Care Settings: A Multi-Case, Mixed-Methods Hybrid Type 2 Effectiveness-Implementation Study.

Maintaining and improving the health and well-being of older people in rural communities through integrated care is essential to address this cohort's frailty risk. The Indigo 4Ms Tool for health workers is a rural-specific approach to providing care that addresses the common conditions of ageing. With Australian government funding, five small rural health services are implementing the tool. This paper describes the protocol for a hybrid type 2 implementation-effectiveness study to evaluate the tool's impact on multidisciplinary comprehensive care planning and the implementation strategies that enhance the adoption and sustainability of the tool across diverse rural health settings.

Effectiveness of Antileishmanial Treatments in Three Endemic Areas of Colombia: A Community-Based Cohort Study.

The effectiveness of treatment of cutaneous leishmaniasis (CL) in rural settings remains underexplored. This study assessed the effectiveness of standard antileishmanial treatments using a community-based approach supported by mobile health (mHealth) in three rural areas of Colombia. From January 2018 to September 2021, we assessed treatment outcomes, adherence, and adverse drug reactions in CL patients, with the support of the Guaral+ST app. Treatment decisions were made by providers at health facilities at each site in accordance with national guidelines, whereas treatment follow-up and presumptive case identification were made by trained community leaders and health agents at the community level. In total, 231 participants received antileishmanial treatment (63 received miltefosine, 110 meglumine antimoniate, and 58 pentamidine). Disease presentation was mild (median number of lesions = 1, interquartile range [IQR]: 1-2) and of short duration (1.5 months, IQR: 1-3). The strategy yielded information on the therapeutic outcomes in 81% of study participants. Effectiveness, measured as the proportion of cure at 90 to 180 days, was 86.3% (95% CI: 73.3-93.48) for miltefosine; 77.6% (67.5-85.3) for meglumine antimoniate, and 73.1% (59.0-83.6) for pentamidine. The effectiveness of pentamidine in children ≤10 years old was 79.4% (61.6-90.3). This is one of the few reports of effectiveness of pentamidine in children with prospective data collection in the Americas. Adverse drug reactions occurred in 32% of patients, most frequently with meglumine antimoniate. Our findings demonstrate that standard antileishmanial treatments are effective in rural areas where the disease is endemic and that mHealth has a pivotal role in improving patient follow-up and data collection on therapeutic outcomes.

A process evaluation of a home garden intervention

BackgroundMost reviews of nutrition-sensitive programs assess the evidence base for nutrition outcomes without considering how programs were delivered. Process evaluations can fill this void by exploring how or why impacts were or were not achieved. This mid-term process evaluation examines a home garden intervention implemented in a large-scale, livelihoods improvement program in Odisha, India. The objectives are to understand whether the intervention was operating as planned (fidelity), investigate potential pathways to achieve greater impact, and provide insights to help design future home garden programs.MethodologyData collection and analysis for this theory-driven process evaluation are based on a program impact pathway that shows the flow of inputs, processes, outputs, outcomes, and impacts. Quantitative and qualitative data from focus group discussions, semi-structured interviews, and a Process Net-Mapping exercise with beneficiaries, frontline workers, and program management staff.ResultsDespite a mismatch between the design and implementation (low fidelity), the process evaluation identified positive outputs, outcomes, and impacts on home garden production, consumption, income, health and nutritional outcomes, and women’s empowerment. Flexibility led to greater positive outcomes on nutrition, the adoption of sustainable agricultural practices and easy-to-understand nutrition models, and the likelihood of the intervention being sustained after the program ends.ConclusionsTo help food systems in rural settings reduce food insecurity by utilizing more sustainable agricultural practices, we recommend that home garden interventions include instruction on easy-to-understand nutrition models and on how to make natural fertilizer. Finding local solutions like home gardens to help address critical supply issues and food insecurity is paramount.

Rates of Viral Non-Suppression and Acquired HIV-1 Drug Resistance Emergence among Children during the Sociopolitical Crisis in the Northwest Region of Cameroon: A Call for Improved Monitoring Strategies.

Virological failure (VF) among children remains concerning, with high risks of HIV drug resistance (HIVDR) emergence and increased disease progression. Therefore, monitoring of viral non-suppression and emerging HIVDR is crucial, especially in the frame of sociopolitical unrest. The study sought to determine the prevalence of VF and evaluate the acquired HIVDR and viral genetic diversity among children in the northwest region of Cameroon during the ongoing sociopolitical crisis. A cross-sectional facility-based study was conducted among HIV-infected children aged ≤18 years, receiving antiretroviral therapy (ART) in urban and rural settings of Northwest Cameroon, from November 2017 through May 2018. Viral load (VL) was done using the Abbott m2000RealTime. Unsuppressed VL was defined as viral load ≥1,000 copies/ml. HIVDR testing was performed by sequencing of HIV-1 protease-reverse transcriptase at the Chantal Biya International Reference Center (CIRCB) using an in-house protocol. Drug resistance mutations (DRM) were interpreted using Stanford HIVdbv8.5 and phylogeny using MEGAv.6. Data were compared between urban and rural areas with p<0.05 considered statistically significant. A total of 363 children were recruited, average age of 12 years (urban) and 8 years (rural). VL coverage was 100% in the urban setting and 77% in the rural setting. Overall, VF was 40.5% (39% [130/332] in the urban setting and 41% (13/31) in the rural setting; p=0.45). Overall, viral undetectability (defined as VL<40 copies/ml) was 45.5% (46% (urban) and 45% (rural); p=0.47). Among those experiencing confirmed virological failure and who were successfully sequenced (n=35), the overall rate of HIVDR was 100% (35/35). By drug class, HIVDR rates were 97.1% (34/35) for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 97.1% (34/35) for NRTIs and 17.1% (6/35) for protease inhibitors (22.7% (5/22) in the urban setting and 7.7% [1/13] in the rural setting). CRF02_AG was the most prevalent viral clade (75%), followed by other recombinants (09_cpx, 11_cpx, 13_cpx, 22_01A1, 37_cpx) and pure subtypes (A1, F2, G, H). In this population of children and adolescents living with HIV in a context of socio-political instability in the North-West region of Cameroon, rates of viral non-suppression are high, and accompanied by HIVDR selection. Our suggests the need for a more differentiated care of these CAHIV, especially those in these regions faced with significant socio-economic and health impacts due to the ongoing crisis.

Boosting Career Success: Innovative Behavioral Measures for Guiding Saudi Secondary School Graduates

This study developed and validated a comprehensive behavioral measure for career guidance among secondary school graduates in Saudi Arabia, aiming to integrate soft skills, personality traits, attitudes, and cognitive factors to fill gaps in existing career guidance frameworks. Using a cross-sectional design, data were collected from 814 secondary school students (M_age = 16.47) from diverse urban (n = 407) and rural (n = 407) settings in Saudi Arabia. Multigroup latent profile analyses (LPA) were employed to identify distinct career decision-making profiles among students. The study explored whether urban and rural students exhibited different patterns of engagement in career guidance behaviors. Three distinct engagement profiles were identified: high, moderate, and low engagement, consistent across both settings. High engagement profiles were characterized by high self-efficacy, proactive career exploration, and low anxiety, linked to better career decision outcomes and greater satisfaction with career guidance. Variance analysis using the Games-Howell post hoc test was conducted to compare the profiles based on key behavioral measures such as self-efficacy, career exploration behavior, and anxiety. To further understand the contextual factors influencing these profiles, a multinomial regression analysis examined the impact of teacher support and resilience on career guidance engagement levels. Results indicated that higher levels of teacher support and resilience significantly predicted membership in high engagement profiles. These findings highlight the importance of incorporating behavioral components into career guidance programs, particularly those tailored to address the specific needs of urban and rural students in Saudi Arabia, ultimately supporting the broader educational and workforce development goals of Vision 2030.

The Use of Remote Presence Robotic Tele-Presentation in Rural and Remote Canada: A Systematic Review.

Objective: One potential solution to limited health care in rural and remote regions is remote presence robotic tele-presentation to allow health care providers to care for patients in their home community via a robotic interface. We synthesized evidence regarding the use of remote presence robotic tele-presentation in rural and/or remote Canadian health settings. Methods: Medline, PubMed, and Embase were searched up to August 2023. Remote presence robotic tele-presentation refers to any robotic device used for the purpose of presenting and/or collecting patient information. Primary research was included if the patient was located in remote and/or rural Canada, featured remote presence robotic tele-presentation, and assessed patient, family, or clinician satisfaction, patient transport to nearby regional or urban center, health care costs, clinical outcomes, infrastructure outcomes, adverse events, or telementoring. Results: Six studies were included. Patients, nurses, and physicians all reported high levels of satisfaction when using the remote presence robotic tele-presentation. Fifty to sixty-three percent of patients were managed in their home community and did not require transfer to another center. Remote presence robotic sonography resulted in adequate imaging in 81% of first trimester ultrasound limited exams but was less useful for second trimester complete obstetric ultrasounds (20% adequate imaging). Two of eight laparoscopic colorectal surgeries had to be converted to open surgeries. Telerobotic ultrasound clinics resulted in a diagnosis in 70% of cases. Conclusions: Evidence suggests remote presence robotic tele-presentation is a safe and cost-effective approach to providing care in distant communities and can prevent some transfers and evacuations to tertiary hospitals.

The LAB school project: a socio-ecological investigation into the intersection between literacy, the arts and wellbeing in a rural early years classroom setting

AbstractThis study examined the piloting of a literacy, arts and wellbeing (LAB) project in a rural school in Queensland, Australia. The research involved a Year 1 class (n = 24) participating in co-designed lessons with their classroom teacher and two visiting researchers from a regional university. These lessons were developed with literacy learning outcomes, arts-based approaches and positive education components in mind. Lesson observations and artefacts were collected to understand the children’s participation and development of the learning objectives. In addition, teacher interviews and researcher reflections provided feedback about the approach’s effectiveness. Data were analysed using an arts-based social engagement model to improve health. Evidence from this case study showed that language and literacy learning outcomes and wellbeing were strongly developed through the LAB approaches. More research is needed to know if a whole school LAB approach would benefit children across other settings.

Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index.

Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.

Assessment of Knowledge and Practices Related to Non-Surgical Management of Osteoarthritis Among Patients in the Rural Community of Sri Ganganagar, Rajasthan.

Introduction: Osteoarthritis (OA) is a degenerative joint disease that represents a major public health challenge, especially in rural communities where access to advanced healthcare is limited. This study aims to assess the knowledge, attitudes, and practices (KAP) related to the non-surgical management of osteoarthritis among patients in the rural district of Sri Ganganagar, Rajasthan, India. Method: A cross-sectional descriptive study was conducted among 234 adult OA patients aged 45 and above, residing in selected rural areas of Sri Ganganagar. Participants were recruited using convenience sampling from local health centers and community clinics. The data were analyzed using descriptive statistics, Chi-square tests, and correlation analyses to explore associations between demographic variables and KAP levels. Results: The study revealed that 29.9% of participants had adequate knowledge about OA, while 18.8% had inadequate knowledge. Regarding practices, 21.4% of participants demonstrated good practices in managing their OA symptoms, whereas 20.9% exhibited poor practices. Significant associations were found between age and education level with both knowledge and practice levels (p &lt; 0.05). A moderate positive correlation was observed between age and knowledge score (r = 0.45, p = 0.002), and a strong positive correlation was found between knowledge and practice scores (ρ = 0.60, p &lt; 0.001). Conclusion: The findings underscore the need for targeted health education programs in rural communities like Sri Ganganagar to bridge knowledge gaps and improve adherence to non-surgical OA management practices. Enhancing patient education and integrating healthcare providers in the patient education process could significantly improve OA management and patient outcomes in rural settings.

12242 Enhancing Continuous Glucose Monitor Utilization In Lower Economic Community Hospital Outpatient Clinics: A Quality Improvement Initiative

Abstract Disclosure: V. Mehta: None. S. Deshpande: None. M. Nieman: None. K. Pereira: None. B. Agrawal: None. S.R. Russell: None. Continuous glucose monitors (CGM) measure the blood glucose level (BGL) and have been used for better glucose control, especially in patients requiring insulin. Primary care physicians (PCP) manage diabetic patients on a large scale in the US, especially in rural settings, and data shows that CGMs are prescribed less in PCP settings than in endocrine clinics. Our study aimed to understand internal medicine (IM) residents' knowledge about CGMs and their application in a community hospital outpatient clinic serving lower-economic populations and demonstrates how a clinical pharmacist (PharmD) led educational intervention successfully increased the adoption of CGMs. A survey was done using a form with multiple-choice questions. 50 residents participated and responded anonymously. Data was analyzed by calculating percentages based on answers, providing understanding of their perspectives on CGMs. 78% knew about and correctly identified CGM. When asked to name indications of CGM, answers varied and included uncontrolled diabetes (34%), insulin-dependent diabetes (34%), elderly and non-compliant patients (14%), any diabetic (12%), and others. Only 14% reported to have had formal training in use and interpretation of CGMs, 70% had prescribed, 34% knew how to apply the device, and 42% knew how to interpret the BGL. More than 95% self-reported having either poor/beginner or fair knowledge about the usage, application, and interpretation, whereas more than 80% professed to need more training to be more confident about prescribing the device. After the survey, our PharmD conducted session demonstrating the indications, types, usage, application, and interpretation of CGM. Following this, an impactful increase in patients who were appropriately prescribed and received CGM was observed. Technologies used in medicine have increased, CGM, being one of them. More than 100 million Americans have prediabetes or diabetes, with more than 10 million using insulin. Hence, access to CGM is crucial for patients for better management. Despite the benefits, many factors play a role in limiting their use, including prescription, cost, insurance coverage, social factors, willingness of the patients, discomfort, and decreased knowledge. Non-compliance, difficulty in application and picking the device from pharmacy was also observed in our clinic. A study by Sherrill et al. on use of CGMs (2014-2020) showed that use of CGM increased almost ten times in 2020 (v/s2014); most patients were younger, employed, and had better insurance coverage.With advances in technology, easier and more efficient devices are available to assess patients' glycemic control. Pharmacists play key role in ensuring continued education among practitioners and trainees. Continued efforts to increase awareness is required to ensure that latest advances are adequately incorporated into graduate medical education. Presentation: 6/3/2024

A first insight into seropositivity and risk factors for Brucella spp. and Coxiella burnetii in free-roaming dogs in Ecuador

Brucellosis and Q fever are two bacterial zoonoses caused by Brucella spp. and Coxiella burnetii, respectively. Dogs are reservoirs of these pathogens and play an important role in their spread. In this research, we determined the seroprevalence of antibodies against Brucella spp. and C. burnetii in free-roaming dogs from Ecuador and conducted a statistical analysis based on geographical variables. Serum samples were collected from 397 free-roaming dogs between November 2018 and May 2019 and analyzed with commercial ELISA tests for Brucella spp. and Q fever. An overall seroprevalence of 2.8 % (CI: 95 %, 0.0–6.2 %) and 1.8 % (CI: 95 %, 0.0–5.6 %) was found for Brucella spp. and C. burnetii, respectively. No statistical differences in seroprevalence values were found between geographical regions in Ecuador or between dogs from rural or urban settings, except for the association of C. burnetii infection with the Coastal Region. This is the first study of this kind in Ecuador and points out the need for a One Health approach for control and surveillance of zoonotic diseases like brucellosis and Q fever including feral and stray dogs as reservoirs to spread those pathogens to cattle, humans, or wildlife.

Strategies for Household Waste Management in Winong Village Waste Bank

Background: Legal frameworks are vital for guiding village autonomy and waste management practices. Specific Background: In Indonesia, laws such as Law No. 6/2014 and Law No. 18/2008 regulate these areas but face implementation challenges. Knowledge Gap: There is a lack of integration between community perspectives and local governance practices. Aims: This study analyzes the legal foundations of waste management in rural settings and assesses practical implementation through stakeholder input. Results: Using a normative legal approach alongside Focus Group Discussions with various stakeholders, the research identifies gaps in the application of waste management laws and emphasizes the need for tailored legal recommendations. Novelty: By merging legal analysis with empirical insights, the study provides a comprehensive view of waste management in rural contexts. Implications: Findings highlight the necessity for adapting legal frameworks to local systems and engaging communities, offering practical solutions for rural waste management that contribute to environmental governance. Highlights : Legal Foundations: Examines laws governing waste management and village autonomy. Stakeholder Input: Utilizes Focus Group Discussions to gather community perspectives. Contextual Adaptation: Emphasizes the need for tailored legal solutions for effective implementation. Keywords: legal frameworks, waste management, village governance, community engagement, empirical analysis

Empowering rural communities for effective larval source management: A small-scale field evaluation of a community-led larviciding approach to control malaria in south-eastern Tanzania

IntroductionLarval source management, particularly larviciding, is mainly implemented in urban settings to control malaria and other mosquito-borne diseases. In Tanzania, the government has recently expanded larviciding to rural settings across the country, but implementation faces multiple challenges, notably inadequate resources and limited know-how by technical staff. This study evaluated the potential of training community members to identify, characterize and target larval habitats of Anopheles funestus mosquitoes, the dominant vector of malaria transmission in south-eastern Tanzania. MethodsA mixed-methods study was used. First, interviewer-administered questionnaires were employed to assess knowledge, awareness, and perceptions of community members towards larviciding (N = 300). Secondly community-based volunteers were trained to identify and characterize aquatic habitats of dominant malaria vector species, after which they treated the most productive habitats with a locally-manufactured formulation of the biolarvicide, Bacillus thuringiensis var. israelensis. Longitudinal surveys of mosquito adults and larvae were used to assess impacts of the community-led larviciding programme in two villages in rural south-eastern Tanzania. ResultsAt the beginning of the program, the majority of village residents were unaware of larviciding as a potential malaria prevention method, and about 20 % thought that larvicides could be harmful to the environment and other insects. The trained community volunteers identified and characterized 360 aquatic habitats, of which 45.6 % had Anopheles funestus, the dominant malaria vector in the area. The preferred larval habitats for An. funestus were deep and had either slow- or fast-moving waters. Application of biolarvicides reduced the abundance of adult An. funestus and Culex spp. species inside human houses in the same villages, by 46.3 % and 35.4 % respectively. Abundance of late-stage instar larvae of the same taxa was also reduced by 74 % and 42 %, respectively. ConclusionThis study demonstrates that training community members to identify, characterize, and target larval habitats of the dominant malaria vectors can be effective for larval source management in rural Tanzania. Community-led larviciding reduced the densities of adult and late-stage instar larvae of An. funestus and Culex spp. inside houses, suggesting that this approach may have potential for malaria control in rural settings. However, efforts are still needed to increase awareness of larviciding in the relevant communities.