Rural Research Articles

Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia.

Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61%), nurses (20/62, 32%), physicians assistants (3/62, 5%), and physicians (1/62, 2%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92%), increasing health worker attentiveness (39/62, 63%), and contributing to improved patient care (34/62, 55%). MORES was perceived as sustainable and scalable (62/62, 100%), particularly if technological barriers (21/62, 34%) and staff training (19/62, 31%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89%), feedback mechanisms for hospitals and RHFs (48/62, 77%), interprofessional teamwork (21/62, 34%), longitudinal follow-up care (20/62, 32%), creating a record of care delays (17/62, 27%), and electronic health record infrastructure (13/62, 21%). MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES.

Adaptation Strategies of Smallholder Farmers in Facing Climate Change and Its Impact on Livestock Productivity in Rural Areas

Adaptation Strategies of Smallholder Farmers in Facing Climate Change and Its Impact on Livestock Productivity in Rural Areas

The Urban Bias in Latin American Avoidable Mortality.

In 1977, Michael Lipton introduced the Urban Bias Thesis as a framework for understanding how most economic policy initiatives have contributed to the overdevelopment of urban areas and the underdevelopment of rural areas. In Latin America, there has historically been a positive correlation between urbanization and mortality decline, as the region's health transition generally began in the main cities and tended to proceed more rapidly in countries with higher levels of urbanization. This paper seeks evidence of a residual urban bias in the region's mortality patterns. Using a sample of Latin American countries over the 2000-2010 period, I analyse the disparities in mortality patterns and avoidable causes of death by looking closely at urban and rural areas using continuum categories. The results indicate that the urban advantage does persist and that rural-urban mortality differentials have consistently favoured the largest cities. The metropolitan advantage in mortality is an outcome of lower mortality in causes of death that are avoidable through primary interventions. Even in scenarios of high mortality at younger adult ages (15-44), the metropolitan advantage remains, due primarily to unsuccessful efforts to reduce mortality in populations aged 45years and over outside the main and large cities.

Inclusive engagement for equitable resilience: Community case study insights

Abstract Incorporating equity into climate resilience planning, especially through participatory processes, is important to adequately address social vulnerability and avoid reproducing inequities. Recent analyses of resilience and adaptation plans in the United States suggest that there is increasing attention on equity and justice, but a wide variation in how it is being incorporated and implemented. Available studies of resilience planning are limited by their focus on larger urban areas and on plan contents. This research contributes a qualitative analysis of engagement in resilience planning in smaller cities and rural areas. It presents findings from community case studies used as part of human-centered design research to develop an equitable resilience planning tool. Materials from the tool were used to conduct participatory engagement activities including storytelling, mapping, and brainstorming actions that elicited community members’ experiences with hazards and disasters and ideas for equitable resilience actions. Themes that emerged from the qualitative analysis of the workshop discussions were: community members’ include both environmental and social concerns in addressing resilience, challenges associated with social vulnerability framing, the underlying social systems that perpetuate inequities, recognizing different types of trauma, the power of convening, and challenges with sustaining engagement without dedicated resources. This article provides insights that inform efforts to better incorporate equity into resilience planning and advance the study of equitable resilience.

Abstract A067: lncTransformer: Identifying novel prognostic biomarkers for pancreatic cancer using deep learning models

Abstract Pancreatic cancer remains a formidable challenge due to high mortality rates and limited therapeutic options due to late detection of the cancer. Recent literature has focused on investigating the potential of long noncoding RNAs (lncRNAs) as biomarkers in several cancers. To identify significantly altered expression of lncRNA in pancreatic cancer, I collected information from the Cancer Genome Atlas (TCGA) and extracted RNA-sequencing (RNA-seq) transcriptomic profiles of pancreatic carcinomas. Out of 60,660 gene transcripts shared between 151 pancreatic cancer patients, 38 lncRNAs were identified to be significantly differentially expressed. To find the lncRNAs related to metastatic progression of pancreatic cancer, different machine learning algorithms, including logistic regression (LR), support vector machine (SVM), random forest classifier (RFC), and a custom autoencoder model were trained to identify potential prognostic biomarkers. The custom deep learning model predicted metastatic prognostic biomarkers with a 92% accuracy, with the second-best accuracies coming from the SVM and RFC models, having an accuracy of 76%. Using the deep learning model, the following novel lncRNA and gene biomarkers were identified: LINC01300, SERPINB13, AC010789.1, TMPRSS15, DUSP5-DT, AL513128.3, MIR205HG, LINC00486, RF00019, LINC01115, and AC133530.1. Further investigating these results, specifically the identified lncRNA, the LINC01300 was identified to be potentially circulating in the blood. If further analysis proves this hypothesis correct then LINC01300 along with other identified genes could serve as a biomarker panel for a liquid biopsy. The identified biomarkers would be especially helpful in rural areas with lower accessibility to healthcare as it would allow for an easier, more efficient, and cost-effective method of pancreatic cancer detection. Based on these findings, further investigations of this gene panel are being conducted, in vitro and in vivo, to create a novel liquid biopsy to assist in the prognostic diagnosis of metastatic progression of pancreatic cancer. Citation Format: Shivali Singh. lncTransformer: Identifying novel prognostic biomarkers for pancreatic cancer using deep learning models [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A067.

Ethical challenges of telepsychiatry

Telepsychiatry is shifting the focus of psychiatry and psychotherapy from personal interaction and relationship building to communication with technological mediators in the form of telecommunication, virtual reality (VR), social robots or artificial intelligence (AI). This article discusses the opportunities and risks of new technologies in psychiatric treatment, taking into account the principles of medical ethics. Telepsychiatric treatments can promote self-determination in the home environment as opposed to institutionalisation but carry the risk of uncontrolled data sharing. They harbour risks of potential harm such as social isolation, negative effects on the doctor-patient relationship and long-term changes in patient behaviour through, for example, VR. In terms of justice, demographic and psychopathological factors could result in unequal access to telepsychiatry, with questionable sustainability effects. The anonymity of telepsychiatry threatens alienation, while moral considerations cannot be replaced by AI for the time being. It is obligatory to carefully weigh up the benefits and risks of telepsychiatry, but especially in rural areas they could optimise care.Precisely because of ethical concerns, further intensive research is necessary to weigh up the risks and benefits. The development of telepsychiatric systems requires transdisciplinary co-operation. At a societal level, the significance of technologies as a supplement or replacement for the doctor-patient relationship needs to be discussed.

Perception of Farmers about Impact of Climate Change on Agriculture in Uttarakhand, India

The development process is being threatened by climate change, which is also negatively affecting the Indian economy in a number of areas, most notably the agriculture sector. Planting, transplanting, weeding, thinning, harvesting, processing, selling, winnowing, storing, kitchen gardening, and other methods are some of the crop production techniques that farmers use. Unpredictable, and chaotic climate change is threatening agricultural productivity and the stability of rural communities' livelihoods. Farmers that are aware of these disruptive variables may be able to lessen the detrimental effects of climate change on agriculture. This study aimed to evaluate farmers' perceptions regarding the impacts of climate change on agriculture within the Almora district of Uttarakhand, India. The study was carried out in the Almora district of Uttarakhand state. Purposive sampling technique and Random sampling was used to select the study area and samples. Total sample size was 120. Data on perception of farmers about impact of climate change reveals that 63 percent of respondents reported a decrease in overall food production. Results on change in availability of water for irrigation revealed that there was no change as reported by 43.33 percent of respondents in Almora district. Availability of drinking water decreased in Almora (54 %). The frequency of forest fire was reported to be increased as reported by respondents (65 %). When we talk about crop diversity and climate change, it was found that crop diversity decreases as reported by majority of respondents (82%) in Almora showing that crop rotation and other practices were not followed properly. The wild animal attack to the crop was increased in present time and causes serious damage to the crop. To effectively address these difficulties, policy measures and guidelines can be designed with more insight if location-specific farmers' perceptions and adaptive behaviors are understood.

Abstract A074: Early detection of breast implant associated anaplastic large cell lymphoma by multiplex lateral flow assay of CD30 and IL-10

Abstract Introduction: More than 1300 women have developed a unique breast implant associated anaplastic large cell lymphoma (BIA-ALCL) around breast implants. BIA-ALCL presents as an accumulation of fluid (seroma) a median of 9 years after implant placement. When detected early, survival with surgery alone is nearly 100%. Remaining patients present with masses and/or lymph node metastases requiring radiation, chemotherapy and/or immunotherapy and fatalities have occurred. Methods: Preliminary studies identified CD30 and IL-10 as the most sensitive and specific biomarkers for BIA-ALCL in seroma fluids. Therefore, we constructed a multiplex LFA to detect both CD30 and IL-10 in 30 mL seroma fluid within 20 minutes. LFA is a point of care immunoassay using capture and detection antibodies that detect separate epitopes of the target molecule. The detection antibody is linked to a colored particle; in this multiplex assay CD30 antibody was linked to blue and IL-10 to red particles. Separate positive test lines (blue and red) indicate presence of CD30 or IL-10. A control line confirms migration of the seroma fluid past the test lines. To determine the dynamic range of sensitivity we spiked recombinant CD30 and IL-10 into benign seromas. Test and control lines were quantitated with NIH Image J software and ratios of test line to control line calculate for each sample. Forty-eight hour supernatants of supernatants of BIA-ALCL lines TLBR1 and TLBR2 were tested for IL-10 and CD30. Fifteen patients, 8 with BIA-ALCL and 7 with benign seromas provided consent for testing of their seroma fluids. Results: Multiplex CD30/IL10 LFA produced positive test lines for neat and 1:10 dilutions of 48 hour supernatnats of BIA-ALCL lines TLBR1 and TLBR2. Both IL-10 and CD-30 could be detected on the multiplex LFA strip using a 1:3 dilution of seroma fluids. The multiplex LFA shows both IL-10 and CD30 are significantly higher in malignant samples (IL-10 TL/CL: malignant, 0.2±0.16 n=8 vs benign, 0.004±0.007 n=7, p<0.05; CD30 TL/CL: malignant, 0.38±0.2 vs benign, 0.02±0.02, p<0.001, two-way ANOVA). Importantly, when either IL-10 or CD30 yields a faint positive test line, the other is not detected reducing the possibility of false positives. Conclusions: The CD30/IL-10 multiplex LFA had 100% positive and negative predictive value in this pilot study. The assay was able to distinguish lymphoma from recurrent breast cancer and more common benign seromas. The use of this multiplex assay mitigates positive false positive results from more sensitive CD30 LFA which has been detected in some benign seromas. This LFA will potentially allow early pre-operative detection of ALCL allowing surgeons to plan their surgical approach. The LFA can replace more costly time-consuming flow cytometry, immunohistochemistry, cyto- and histopathologic studies which require at least 10 ml of fluid. The LFA can be performed outside of medical centers in rural and underserved areas. A larger prospective multicenter study including intra-operative sampling is planned to validate these results. Citation Format: Peng Xu, Katerina Kourentzi, Richard Willson, Marshall Kadin. Early detection of breast implant associated anaplastic large cell lymphoma by multiplex lateral flow assay of CD30 and IL-10 [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A074.

The World is the “Hometown” of the Camera: Interview with Jia Zhangke

Abstract In this interview, director Jia Zhangke shares the background and thought process behind his latest documentary Swimming Out Till the Sea Turns Blue (Yizhi Youdao Haishui Bianlan, 2021). Through the lens of rural literature, the film narrates 70 years of China’s social changes since 1949, featuring four writers – Jia Pingwa, Yu Hua, Liang Hong, and Duan Huifang, the daughter of Ma Feng – as the storytellers. The film explores the evolving relationship between urban and rural China and individual life experiences across different historical periods. Jia Zhangke emphasizes that the hometown is not only the starting point of creation but also a spiritual destination. He discusses the cultural value of dialects and traditional opera, highlighting that cinema should convey core Chinese stories through local narratives to preserve societal memory.

Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding: a cross-sectional study in rural China.

Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts. We introduced relevant items to Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0-6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification. Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: "Breast milk supply and quality," "Breastfeeding skills," and "Exclusive breastfeeding" subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach's alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF. Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs.

Co-designing with and for Small and Remote Communities: Reflections on Transformative Innovation, Servitisation, and Agonism.

Within the conceptual framework of design for social innovation and democracy, this paper reports on implementing participatory processes in regenerating public spaces in semi-rural contexts, questioning the meaning of transformative innovation, servitisation, and agonism in non-urban contexts. This inquiry argues for exploring a reassessment of how we enact participatory public space regeneration strategies through their application in a remote context. The latter has been untouched by all the bottom-up initiatives and movements that have swept through European urban centres over the last fifteen years; returning to the urban space with these reflections could provide an opportunity to explore new perspectives, even in a saturated context, questioning the models of metropolitan practices. By challenging the paradigm of innovation as the only direction associated with a valid process of improvement and change, this paper delves into the urgency of looking at co-design processes through the lenses of decoloniality, relationality and agonism, creating moments of reflexivity inside the research team and with the local community. Our reflections and learnings stem from “Human Cities / SMOTIES, Creative Works with Small and Remote Places”, a participatory design project that examines community engagement methods for co-designing public spaces and transformations in European rural areas, specifically Albugnano, a small town in northern Italy. Setting the Albugnano community as an experimental ground, the case study addresses the lack of valorisation of tangible and intangible heritage, depopulation and social fragmentation by unpacking narratives, nurturing social imagination, and collectively envisioning and designing potential regenerative transformations.

The Setting-Up Measure to Support Generational Renewal in Agriculture: The Italian Experience

Since the 1970s, the issue of ageing farmers and generational renewal in agriculture has consistently attracted the attention of policymakers. However, despite successive reforms of the European Union Structural Funds, efforts to encourage young people to enter the agricultural sector remain largely focused on agricultural and rural policies, specifically on the First Settlement scheme. This paper highlights the role of the European Union’s rural development policy in supporting and encouraging generational renewal in agriculture. A qualitative analysis of the Italian case examining some of the demographic changes that have occurred within the agricultural system at the regional level has been conducted. The analysis is based on the comparison of policy implementations in different programming periods. Using data from the General Censuses of Agriculture and the Italian Agricultural Payments Agency—supplemented by the Annual Implementation Reports of the Italian Rural Development Programmes—the research traces the evolution of initiatives supporting young farmers. The main findings reveal a notable decline in the number of young people in the primary sector over the last decade, together with an ageing population of agricultural farmers. Measures to support young farmers under the Common Agricultural Policy appear to be ineffective in countering the ageing trend. There is scope for integrated policies to enhance the attractiveness and profitability of rural areas and to ensure long-term sustainable generational renewal in the agricultural sector.

Decomposition and scenario analysis on carbon emissions of road transportation: case study of the rural areas of Tianjin, China

Decomposition and scenario analysis on carbon emissions of road transportation: case study of the rural areas of Tianjin, China

Spatiotemporal distribution in chemical composition of wet atmospheric deposition in Bandung Indonesia.

Bandung, Indonesia, represents the complex interactions between climate variability, basin topography, and deposition processes. This study conducted a long-term spatiotemporal analysis, including pH distribution and pollutant accumulation monitoring, to observe the chemical composition of wet deposition in Bandung as part of the Acid Deposition Monitoring Network in East Asia (EANET). The results revealed that and were the predominant ions, followed by , with their distribution varying across different sites due to local emissions and atmospheric processes. The interactions between these ions, particularly the formation of secondary inorganic aerosols such as ammonium sulfate and ammonium nitrate, were closely linked to the basin's localized sources and topographical features. Areas experiencing high traffic congestion were classified as acidic regions due to their low pH levels. In contrast, a rural site exhibited a basic pH due to the high concentration of ion . Variations in pH and conductivity, along with the impacts of climatic events such as El Niño and La Niña, emphasized the role of weather patterns in shaping wet deposition dynamics. Seasonal trends indicated elevated total ion concentrations during the dry season, driven by sea salt contributions, as supported by strong correlations between Na+ and and between Na+ and Mg2+. Additionally, geological materials and atmospheric reactions contributed to the strong correlations observed between soil-derived cations and acidic species. The increasing trend in and the contrasting decrease in concentrations in rural areas suggest evolving emission sources and environmental conditions.

AN EVALUATION OF THE EFFECTIVENESS OF THE PROVISION OF LAND USE POLICY FOR BUILDING HOUSES IN RURAL BANGLADESH

The paper provides a comprehensive evaluation of the national land use policy in Bangladesh, highlighting the gaps in implementation and the need for strategic improvements for building houses using minimum agricultural land in rural areas of Bangladesh. The main objectives of the policy evaluation research are to explore the extent of the intervention of the National Land Use Policy 2001 that has achieved the objective of minimum use of agricultural land, to determine whether the authority has made the rural people aware of building model houses, multistorey buildings, and planned residential areas in the village and finally to find out the critical factors for effective implementation of national land use policy. It has been used as a mixed evaluation research method with both qualitative and quantitative approaches. Data were collected online using a semistructured questionnaire and checklist for respondent interviews. The main results of the policy evaluation revealed that the objectives of the policy are not achieved and effectively implemented for numerous reasons as such, the implementers are reluctant to implement and make aware the villagers, responsible implementing agencies are not fully well-defined, people are unaware and do not know about the policy, lack of village development planning and design, overpopulation and segregation of families, poverty, lack of monitoring by the ministry, unorganized urbanization and industrialization, local political influence, absence of land zoning and union parishad are unwilling to enforce their laws, etc. To implement the policy effectively, a joint effort of the local government bodies, local communities, and all local administration departments would be required, and each organization’s role would be well classified, and payment or loan support would be transferred to the rural people of Bangladesh.

Abstract 4135525: Bridging the Gap: How a Specialized Heart Failure Program Improves Guideline-Directed Medical Therapy Optimization for Rural Patients

Background: Previous research has shown that patients with heart failure with reduced ejection fraction (HFrEF) living in rural areas have suboptimal utilization of guideline-directed medical therapy (GDMT). Considering the associated increased mortality risk, this highlights the need for novel approaches to improve GDMT optimization for rural patients. The aim of this study was to evaluate how rural residence influences outcomes in a multidisciplinary, telehealth-based HF-GDMT optimization program implemented at our institution. Methods: We studied 322 patients who participated in a HF-GDMT optimization program led by a HF nurse practitioner and clinical pharmacist at Penn State Hershey Medical Center. We categorized residence at the time of enrollment using the Rural-Urban Commuting Area (RUCA) classification system. Differences in patient characteristics and program outcomes between the two groups were analyzed. P < 0.05 indicated statistical significance. Results: Among the 322 patients enrolled, 56 (17.4%) resided in rural areas and 266 (82.6%) in urban areas. Rural patients were younger (mean age 61.1 vs. 65.1; p=0.04) and the two groups differed significantly in racial demographics (p=0.006). The rural group had a higher proportion of patients with chronic HF (55.4% vs. 39.8%; p=0.038) and fewer patients with a recent HF hospitalization (30.4% vs. 49.2%; p=0.012). As far as outcomes, program completion rates were similar between rural and urban patients (83.9% vs. 83.1%; p=1). Those who received target doses of the four GDMT drug classes versus the maximum tolerated dose were also similar between the rural and urban groups (21.4% vs. 15.8%; p=0.32). Conclusions: Patients from rural areas were more likely to present with chronic HF and less likely to have recent HF hospitalizations compared to their urban counterparts, suggesting potential disparities in access to HF care. Despite these differences, program outcomes, measured by completion rates and GDMT medication titration, were comparable between the two groups. Our findings emphasize the crucial role of specialized HF programs in advancing GDMT use for rural patients, which may ultimately improve HF outcomes and bridge the healthcare gap.

Addressing bias in national population density models: Focusing on rural Senegal.

Knowing where people are is crucial for policymakers, particularly for the efficient allocation of resources in their country and the development of effective, people-centred policies. However, rural population distribution maps suffer from biases related to the type of dataset used to predict population density, such as the use of nighttime lights datasets in areas without electricity. This renders widely used datasets irrelevant in rural areas and biases nationwide models towards urban areas. To compensate for such biases, we aim at understanding the importance and relationship between water-related covariates and population densities in a random forest model across the urban-rural gradient. By extending a recursive feature elimination framework, we show that commonly used covariates are only selected when modelling the whole country. However, once the highest density areas are removed, water-related characteristics (especially distance to boreholes) become important covariates of population density outside of densely populated areas. This has important implications for modelling population in rural areas, including for a better estimation of the size of remote communities. When seeking to produce country-level population maps, we encourage further studies to explicitly account for rural areas by considering the urban-rural gradient and encourage the use of water-related datasets.

FEATURES OF TRAINING A YOUNG DOCTOR IN MODERN CONDITIONS

Reforming the system of primary health care in healthcare in the Russian Federation over the past decade has been a priority task of the state. On instructions from the President, the Government continues to create conditions to increase the availability of medical care. A decision was made to expand the capabilities of the primary health care development program in rural areas, urban settlements and small towns of the country. This resolution was signed by Prime Minister Mikhail Mishustin (Resolution No. 2226 dated December 21, 2023). In the course of the conducted survey of 128 district therapists of the Stavropol Territory who started medical practice immediately after graduation, the main problems they faced when starting their work were identified: lack of practical training for independent professional activity, the assignment of a mentor to not every young specialist; insufficient equipment of the workplace with the necessary tools; incomplete computerization jobs (especially in rural areas); not all district doctors are assigned nurses; the number of attached population in 1 therapeutic area exceeds the norm. The difficulties of the professional activity of young specialists were associated with an insufficient number of hours of practical training in 5-6 years of study at the university and the cancellation of the internship. In order to revive the traditions of mentoring and increase the level of competence of young district therapists who received a diploma after 2017, the Ministry of Health of the Stavropol Territory, together with the Department of Polyclinic Therapy of Stavropol State Medical University, organized the work of the "School of a young therapist", which showed great effectiveness in the practical activities of young doctors in the region.

Gallbladder cancer incidence and mortality rate trends in China: analysis of data from the population-based cancer registry.

Gallbladder cancer is a major health concern in China, and awareness of the associated incidence and mortality rates is particularly important given the aging population. To determine trends in gallbladder cancer incidence and mortality rates over 12years and quantitatively analyze the influence of demographic factors on these rates in China. We performed a retrospective study of 98,860 Chinese citizens using the Chinese Cancer Registry, a national database. Gallbladder cancer incidence and mortality data pertaining to patients treated between 2005 and 2017 were collected. Joinpoint regression models were used to estimate the annual percentage change (APC) and average APC (AAPC). We used age-period-cohort analyses and decomposition methods to investigate differing trends in incidence and mortality. The age-standardized gallbladder cancer incidence and mortality rates in China trended downward between 2005 and 2017, with AAPCs of -2.023% and -1.603%, respectively. Coefficients of age effect for incidence rate increased with age up to 70years and peaked at 70-79years, while coefficients of age effect for the mortality rate showed a consistent increase with age. Both coefficients of period for incidence and mortality rates increased in more recent periods; in terms of the cohort effect, coefficients of cohort for rates generally decreased in later birth years but showed a partial rise between 1982 and 1996. The crude incidence rates of gallbladder cancer according to demographic and non-demographic factors were 626.09% and -526.09% respectively (366.23% and -266.23% among men, and 6068.93% and -5968.93% among women, respectively). The rates were 543.01% and -443.01%, respectively, in urban areas and were 68.22% and 31.78%, respectively, in rural areas. The mortality rates according to demographic and non-demographic factors were -495.93% and 595.93%, respectively (-1763.10% and -1863.10% for men and -270.56% and -370.56% for women, respectively). These rates were -930.33% and 1030.33%, respectively, in urban areas and were 101.48% and -1.48%, respectively, in rural areas. The overall standardized gallbladder cancer incidence and mortality rates in China are trending downward, but not sufficiently so. Proper living and eating habits should be encouraged while exploring the establishment of long-term, standardized gallbladder cancer screening programs.

Entrepreneurship and Rural Development in Morocco: A Comparative Analysis of Female and Male Entrepreneurs in the Fes-Meknes Region

Rural entrepreneurship is a growing field of research, with a focus on understanding and promoting entrepreneurial activities in rural areas. It is important to examine the differences between male and female entrepreneurs in these rural settings. This study explores the relationship between entrepreneurship and rural development in Morocco, focusing on the differences between male and female entrepreneurs. The Fes-Meknes region conducted the research, surveying 200 individuals, including 120 male and 80 female entrepreneurs, using econometric analysis. The study aimed to compare male and female entrepreneurs' socioeconomic characteristics, business attributes, technological factors, and entrepreneurial behaviors, as well as their impact on rural development. Key variables included education, household income, family situation, financial resources, investment grants, business sector, revenue, legal structure, target market, digital technology usage, and management style. The results of the analysis showed significant differences between male and female entrepreneurs in various aspects, such as education level, household income, family situation, access to financial resources, business sector involvement, legal structure, years in operation, and target market preferences. Additionally, the study found that male entrepreneurs tended to utilize digital technologies more extensively and benefit more from entrepreneurship training compared to their female counterparts. However, female entrepreneurs demonstrated a higher propensity for contributing to rural development initiatives through their businesses, particularly in agribusiness-related activities. The study emphasizes the need for tailored policy interventions to address gender-specific entrepreneurship dynamics in rural areas, thereby promoting sustainable development and economic growth.