Small Rural Communities Research Articles

Implementing a Multidisciplinary Post-COVID Clinic in a Small Community Environment

The emergence of Post-Acute Sequelae of Sars Cov-2 (PASC), also known as long-COVID, has prompted response from the medical community with research in how to treat patient's symptoms, and in some places, development of post-COVID clinics. Publications about PASC clinics thus far have been in large academic research centers, which have access to many specialists, yet only treat a small amount of the US population. Our hospital system was able to develop a multidisciplinary post-COVID clinic in a small rural community using a PM&R (Physical Medicine and Rehabilitation) physician lead, and the ancillary services we had available in our town of 13,508 people. Funding for this was internal with no grant sources. As part of the patient rehabilitation team, the roles of PM&R providers, physical therapy, speech therapy, respiratory therapy, and psychology are portrayed. This developed clinical model is accessible to small communities across the United States.

(050) Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives

Abstract Introduction Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live. Objectives We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions. Methods For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia. The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment. Results Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients’ inadequate knowledge of sexual functioning and sociocultural messages regarding “normal” sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments. Conclusions While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education. Disclosure No.

SARS-CoV-2 wastewater monitoring in rural and small metropolitan communities in Central Michigan

Central Michigan University (CMU) participated in a state-wide SARS-CoV-2 wastewater monitoring program throughout the 2021–2022 academic year. Wastewater samples were collected weekly from ten on-campus sites and nine off-campus wastewater treatment plants servicing small metropolitan and rural communities. SARS-CoV-2 genome copies were quantified using droplet digital PCR. Case data reported by Central Michigan District Health Department and CMU were collected and compared with wastewater data. During the delta wave, wastewater detection and on-campus case reports increased rapidly with the start of the academic semester and peaked quickly, compared with a more gradual and prolonged increase in detection and case reports off-campus. During the omicron wave, transmission dynamics were similar on-campus and off-campus. Normalization of on-campus and off-campus wastewater data with pepper mild mottle virus gene expression suggested lower SARS-CoV-2 shedding per person in on-campus compared to off-campus samples during the delta wave, but no difference in virus shedding during the omicron wave. We discuss the possibility that a higher on-campus vaccination rate may have reduced virus shedding per person during the delta wave, but that this effect was lost with the omicron variant. This study suggests that wastewater monitoring is effective in rural and small metropolitan communities when used in conjunction with case reports to understand regional transmission dynamics and the impact of public health policies at a public university on virus shedding in the community.

Summarizing Standpipe Water Data for Meknes Small Rural Communities (Morocco): An Extended Table for Testing for the Uniform Distribution

Summarizing Standpipe Water Data for Meknes Small Rural Communities (Morocco): An Extended Table for Testing for the Uniform Distribution

Spaces of Decoupling in the Netherlands and Poland: Emerging Local Governance Networks for Hosting Non-EU Migrants in Peripheral and Shrinking Areas

A significant share of migration studies is dedicated to understanding how large cities in Europe deal with the influx of international migrants, forced and by choice. Rural and peripheral regions, however, are hardly identified as receiving areas for migrant newcomers. Here, economic degradation, population decline and liveability are at the centre of academic debate. Nevertheless, peripheral—and shrinking—areas are increasingly regarded as favourable locations for hosting non-EU migrants, in particular asylum seekers, refugees and recognised refugees. In our study, we combined the two debates by examining how declining small peripheral cities and rural communities in the Netherlands and Poland deal with the arrival and settlement of non-EU migrants. We identified different spaces of decoupling to better understand how local policy discourses on migration governance relate to national ones. From our study, it appears that in these spaces of decoupling, alternative, cross-regional governance networks are formed to host migrant newcomers, and in some cases, migration is framed as a panacea for the decline. Within these networks, the leading efforts of non-governmental organisations and volunteers stand out and are more prominent than in urban contexts.

Teen Clinic - An integrated primary healthcare model that improves access for young people in rural communities.

Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase access to health care for young people, particularly school-aged young people (12-18 years) living in small rural towns (<5000 people). To determine the extent the Teen Clinic model meets its accessibility objective and to determine the barriers and enablers to sustainable delivery of the Teen Clinic service. A multimethod case study approach was used to assess access (multidimensional framework for patient-centred access) and determine the barriers and enablers to sustainable delivery. Data collection included a survey of young people in the included rural communities and key stakeholder interviews. The survey of young people indicated Teen Clinic model was accessible across multiple dimensions. From a practice perspective, accessibility was achieved by varying from usual care to a nurse-led, young person-centred drop-in model. This required skilled nurses working at the top of their scope; however, unpredictable demand and patient complexity made accounting for the time and therefore funding somewhat complex. The Teen Clinic model meets its objective of increasing healthcare access for young rural people. Relational and cultural factors were more important facilitators of practice integration than organisational processes. A key challenge to the ongoing provision of Teen Clinic was dedicated sustainable funding. Teen Clinic is an integrated primary healthcare model that increases access for young people in small rural communities. Sustainable implementation would benefit from dedicated funding.

Rurality and latent precarity: Growing older in a small rural New Zealand town

Behind rural lives lurk several forms of latent precarity that are unique to rural dwellers and rural contexts. Latent precarities may never become actualised or experienced, and the expression of latent precarity can be mitigated by both individual and community resources. For older rural dwellers, the latent precarities associated with rural life intersect with those associated with ageing and when experienced or actualised, can impact on an individual's ability to successfully ‘age in place’ within their rural community. We interviewed adults across the lifespan who lived in a small rural southern New Zealand community, and this article explores the latent precarities of rurality and ageing that they identified. If community assets dwindle or become unavailable, and health capabilities decline, latent precarities may multiply, or become actual/experienced precarities. The experience of ageing well in rural places can be improved and older adults better supported through the identification of, and attention to, forms of latent precarity within these rural places.

Optimising the Optic Fibre Deployment in Small Rural Communities: The Case of Mexico

Over the years, connection or access to the Internet has shown a positive impact on users in their everyday activities, such as entertainment, online education, online business, and productivity increments in their communities. Unfortunately, rural communities, which usually are far away from cities, cannot enjoy these benefits due to inefficient or inexistent Internet access. We propose an algorithm to select which communities to connect to maximise the number of people connected to the Internet while minimising the length of the network, or while maximising the number of connected communities, or while maximising the linked people per kilometre of fibre. The algorithm estimates the shortest driving distance and the minimum spanning tree. Then, the algorithm creates a subset of linked communities to select the next one to connect based on one of the three criteria described above. To test the algorithm, we used data from a set of rural communities in Mexico. The results showed that the minimum length of the network to connect the 597 rural communities (with 454,514 people) in our test case was 949.09 km. Moreover, there was a difference of 204.1 km in the network length to connect 90% of the total population depending on the selected criterion to connect the communities. If the decision-maker wants to connect 90% of the population, the maximum number of connected communities was 507 using the PC criterion.

Reiterative Code-Switching: Argument-Marking in Cena

Situations of language contact are often the norm for sign languages. This article investigates a case of unimodal contact between Cena, a young sign language in its third generation that is used in a small rural community in Brazil, and Libras, the national sign language of Brazil. Our analysis concerns one by-product of this contact: reiterative code-switches, wherein signers produce a sequence of two signs—one from each language—with the same meaning to label a single referent. We consider several motivations detailed in existing literature on code-switching, before proposing an explanation motivated by the disambiguation of reversible (therefore potentially ambiguous) verb events, primarily by using reiteration to focus agents. We suggest that with this phenomenon, we see signers employ a previously unattested strategy to mark arguments and thereby aid syntactic disambiguation.

Reducing energy poverty in small rural communities through in situ electricity generation

Energy is key in achieving sustainable societies. There have been great efforts towards improving energy access worldwide. Despite the advances in energy access, energy poverty remains a major problem in many parts of the world, particularly in rural communities. Modern energy, in particular electricity, can help rural communities develop through improving education and health. During the last two decades, there have been improvements on bioenergy technological innovations, e.g. electricity generation from bioenergy from residual biomass from several agricultural crops in biorefineries. Most research has focussed on large biorefineries, with limited research on small-scale gasifiers’ location and contribution to energy poverty. This paper is aimed at assessing technological options to generate electricity in situ from biomass to reduce energy poverty of rural communities. This is done using four analysis methods: (1) crops availability data; (2) poverty and marginalisation data; (3) electricity provision/distribution; and, (4) GIS/Geographical latitude and longitude to locate municipalities in Mexico. The results shows that the generating potential for electricity using residual biomass with gasifiers could improve the welfare of almost 10 million people communities using residual biomass from crops harvested in such communities. This research provides location solutions on the best places to locate small-scale biorefineries. The research also provides systemic analysis to reduce energy poverty through in situ electricity generation using cheap accessible small plant technologies and biomass as raw material, as well as their location. Generating electricity in a decentralised way through agricultural residual biomass can help lift rural communities from poverty and improve their well-being, and, thus, make societies more sustainable.

Techno-Economic Assessment of PV Power Systems to Power a Drinking Water Treatment Plant for an On-Grid Small Rural Community

This paper shows the technical–economic assessment of two power systems based on renewable electricity to cover the energy consumption requirements of a drinking water treatment plant in the town of Pile, Ecuador, with a planning horizon of 15 years. A stand-alone and a grid-connected solar PV system were proposed to power this plant, which was designed considering the maximum daily potable water supply condition. This plant operated under two scenarios: (1) 12 h during daylight hours and (2) 24 h. Both schedules were proposed to assess the impact of PV power systems on plant operation. We modeled and optimized a total of four scenarios, where each scenario consisted of one of the proposed PV power systems and the plant with one of its operating schedules. Homer Pro software was used to size and find an optimal solution in each scenario, considering the net present cost (NPC) as the main criterion for optimization. The results showed that the change in the plant operation schedule significantly influenced the parameters of each scenario, such as component sizing, electricity production, initial capital, NPC, and electricity purchase/sale capacity from the plant as a grid power service user to the electric utility company.

Turbidity removal and pH of raw water treated with natural coagulants

Concerns regarding water pollution and scarcity have led researchers to investigate new sustainable water treatment technologies, such as the use of natural coagulants, that can be used for water treatment in decentralized locations at small rural communities, as these materials can be used in compact water treatment plants. Thus, the present study evaluated the use of natural coagulants, drumstick tree seeds and tannins extracted from black acacia, in water treatment to remove turbidity. To determine the ideal coagulant dosage, jar tests were performed, followed by filtration to remove the formed sludge. pH and turbidity were analyzed to compare the coagulants efficiency. The natural coagulants achieved satisfactory removal of suspended solids, completely removed turbidity, and causing no significant changes in pH, unlike aluminum sulfate, hence, these natural materials can be used as an alternative to chemical coagulants.

Saberes y leyendas: El etnoconocimiento como herramienta para mejorar la convivencia entre serpientes y pobladores del sur de la Región Chaqueña (Córdoba, Argentina)

In the northwest of Córdoba, snakes accidents constitute a significant problem to the inhabitants of small rural communities because they live and work in the environments where snakes live. Therefore, it is relevant to study and know the perception and ancestral knowledge of the inhabitants of this area in relation to the snake fauna, as to properly diagnose this problem in a regional framework, and thus be able to carry out activities to prevent ophidian accidents. We performed interviews related to the knowledge of the snakes in the area, the popular nomenclature, the use, the beliefs or myths that exist about these animals and the actions taken against their bites and prevention. We used pictures of the most common species in the area to verify the vernacular names mentioned by the interviewees. Results show that the inhabitants of this region know a total of 15 species of the 20 known for the region. We were able to register ecological knowledge, vernacular names, and myths associated with snake species, among which, the 4 considered dangerous are well identified. 62% of the people surveyed kill the animal or would kill it before an encounter. We also registered the use of domestic practices to treat snake’s bites. The results of this study provide elements to generate useful tools to develop community management plans that will allow the use and conservation of snake species, focused on improving the coexistence between people and snakes.

Protocol for a parallel group, two-arm, superiority cluster randomised trial to evaluate a community-level complementary-food safety and hygiene and nutrition intervention in Mali: the MaaCiwara study (version 1.3; 10 November 2022)

BackgroundDiarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We describe a protocol for a cluster randomised trial to evaluate the effectiveness of a multi-faceted community-based educational intervention that aims to improve food safety and hygiene behaviours and enhance child nutrition.MethodsWe describe a mixed-methods, parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures. One hundred twenty clusters comprising small urban and rural communities will be recruited in equal numbers and randomly allocated in a 1:1 ratio to either treatment or control arms. The community intervention will be focussed around an ideal mother concept involving all community members during campaign days with dramatic arts and pledging, and follow-up home visits. Participants will be mother–child dyads (27 per cluster period) with children aged 6 to 36 months. Data collection will comprise a day of observation and interviews with each participating mother–child pair and will take place at baseline and 4 and 15 months post-intervention. The primary analysis will estimate the effectiveness of the intervention on changes to complementary-food safety and preparation behaviours, food and water contamination, and diarrhoea. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. A additional structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Qualitative and health economic analyses including process evaluation will be done.ConclusionsThe trial will provide evidence on the effectiveness of community-based behavioural change interventions designed to reduce the burden of diarrhoeal disease in the under-fives and how effectiveness varies across different contexts.Trial registrationISRCTN14390796. Registration date December 13, 2021

Photography and the Art of Memory Creation: Portraits of a Provincial Jewish Community in the Late 1930s

Using visual-historical methods, this article seeks to offer insights into the experiences of two historiographically underrepresented – but in this specific case overlapping – groups during the National Socialist era: elderly and provincial Jews. The article centres on a fascinating set of images: namely, a selection of portraits of individuals and photos of the Jewish community inside and outside of the local synagogue on a Saturday morning. The photographer, a young man by the name of Heinz Bähr, was preparing for his imminent immigration to the United States when he returned to his hometown of Breisach am Rhein in 1937 and photographed his extended family and members of the small rural Jewish community. As the article shows, photography was not simply a means to represent the elderly through the eyes of younger Jews but was an intergenerational practice of constituting communal memory. The photos reveal the self-perceptions of those who stood in front of and behind the camera and how these actors chose to represent historical processes on film.

Evaluating the impact of broadband access and internet use in a small underserved rural community

Having adequate access to the internet at home enhances quality-of-life for households and facilitates economic and social opportunities. Despite increased investment in response to the COVID-19 pandemic, millions of households in the rural United States still lack adequate access to high-speed internet. In this study, we evaluate a wireless broadband network deployed in Turney, a small, underserved rural community in northwest Missouri. In addition to collecting survey data before and after this internet intervention, we collected pre-treatment and post-treatment survey data from comparison communities to serve as a control group. Due to technical constraints, some of Turney's interested participants could not connect to the network, creating an additional comparison group. These comparisons suggest two primary findings, (1) changes in using the internet for employment, education, and health could not be directly attributed to the internet intervention, and (2) the internet intervention was associated with benefits stemming from the ability to use multiple devices at once. This study has implications for the design of future broadband evaluation studies, particularly those examining underserved rather than unserved communities. Recommendations for identifying appropriate outcome variables, executing recruitment strategies, and selecting the timing of surveys are made.

Practitioner perceptions of interprofessional practice (IPP) in small rural communities: An exploratory, qualitative study

The quality of life and the economic viability of rural communities are dependent on high-quality healthcare, which can result from interprofessional practice (IPP) that employs the IPEC Core Competencies. Health profession students can acquire these competencies during supervised clinical education experiences. Since little is known about IPP in rural areas, researchers conducted focus groups in four small communities to gain perceptions of health care providers and administrators about how IPP is operationalized in rural healthcare systems. Data were coded and analyzed using a complex dynamic systems model for team effectiveness. Respondents identified the presence of several requisite components of IPP. Absent was evidence of explicit strategies for continuous quality improvement of team processes and team responsibility for improving population health. Using a complex dynamic system model to evaluate rural IPP could identify and promote the acquisition of knowledge and skills associated with IPP and assist academic and clinical educators in developing curricular content to prepare students to learn the competencies to effectively promote the delivery of IPP in underserved rural communities.

Collaborative Care - empowering community in the development of rural primary health workforce and service delivery models.

Across Australia, providing sustainable primary care services in small rural communities (<1000 population) has been increasingly challenging. It is acknowledged that health system planners must take coordinated action to strengthen systems to enable a community-empowered response to such challenges. In partnership with the Australian Government, Collaborative Care is a whole-of-system approach used in five Australian rural sub-regions to align communities, organisations, policy and funding levers with a common purpose in health workforce and service planning (article here). A synthesis of field observations and experiences of community and jurisdictional partners in planning and implementing a Collaborative Care model. In this presentation, we report on the success factors and challenges in developing models for improved rural primary health care access. Successes include sustained community participation, improved community health workforce literacy, coordination of stakeholders and resources across health and community systems combined with health service planning expertise. Challenges include the time and investment to build a coordinated partnership approach and in identifying mechanisms for ongoing financial sustainability. Including community as a partner in design and implementation is a key enabler for achieving a tailored primary health workforce and service delivery model that is acceptable and trusted by communities. The Collaborative Care approach strengthens community through capacity building and integrating existing resources across both primary and acute care services to achieve an innovative and quality rural health workforce model built around the concept of rural generalism. Identifying mechanisms for sustainability will enhance the usefulness of the Collaborative Care Framework.

Mid-career graduate practice outcomes of the James Cook University medical school: key insights from the first 20 years.

Previous studies demonstrate early-career James Cook University (JCU) medical graduates are more likely to practise in regional, rural and remote areas than other Australian doctors. This study investigates whether these practice patterns continue into mid-career, identifying key demographic, selection, curriculum and postgraduate training factors associated with rural practice. The medical school's graduate tracking database identified 2019 Australian practice location data for 931 graduates across postgraduate years (PGY) 5-14, which were categorised into Modified Monash Model (MMM) rurality classifications. Multinominal logistic regression was undertaken to identify specific demographic, selection process, undergraduate training and postgraduate career variables associated with practice in a regional city (MMM2), large to small rural town (MMM3-5) or remote community (MMM6-7). One-third of mid-career (PGY5-14) graduates were working in regional cities, mostly in North Queensland, with 14% in rural towns and 3% in remote communities. These first 10 cohorts were undertaking careers in general practice (n=300, 33%), as subspecialists (n=217, 24%), rural generalists (n=96, 11%), generalist specialists (n=87, 10%) or hospital non-specialists (n=200, 22%). The findings show positive outcomes from the first 10 JCU cohorts for regional Queensland cities, with a significantly higher proportion of mid-career graduates practising regionally compared with the overall Queensland population. The proportion of JCU graduates practising in smaller rural or remote towns is similar to the overall Queensland population. The establishment of the postgraduate JCUGP Training program and the Northern Queensland Regional Training Hubs for building local specialist training pathways should further strengthen medical recruitment and retention across northern Australia.

Incidence and Bayesian Mapping of Myeloid Hematologic Malignancies in Sardinia, Italy.

The epidemiology of myeloid hematologic malignancies in Italy has been poorly investigated. We used a validated database of 1974-2003 incident cases of hematologic malignancies among the resident population (all ages) of Sardinia, Italy, to describe the incidence of myeloid malignancies overall (N = 4389 cases) and by subtype. We investigated the time trend of acute myeloid leukemia (N = 1227 cases), chronic myeloid leukemia (N = 613 cases), and myelodysplastic syndrome (N = 1296 cases), and used Bayesian methods to explore their geographic spread, and Poisson regression analysis to estimate their association with environmental and socio-economic factors. The annual standardized (world population) incidence rate (IR) of myeloid malignancies over the study period was 6.5 per 100,000 (95% CI 6.2-6.7). Myelodysplastic syndromes were the most prevalent subgroup (IR = 1.7, 95% CI 1.5-1.8). Incidence of all myeloid malignancies combined increased sharply during the study period with an annual percent change (APC) of 10.06% (95% CI 9.51-10.61), 19.77% for myelodysplastic syndromes (95% CI 19.63-19.91), and 3.18% (95% CI 2.99-3.37) for acute myeloid leukemia. Chronic myeloid leukemia did not show an upward trend. Apart from sporadic excesses in small rural communities and the major urban area, there was no evidence of spatial clustering. The risk of myeloid malignancies increased with increasing prevalence of sheep breeding. Our results might prompt further research on the local genetic and environmental determinants of myeloid hematologic malignancies.