Spatial Dimensions of Vulnerability: Meatpacking, Socioeconomics, and the Outbreak of COVID-19 in the High Plains of Texas

In May 2020, 2 months after COVID-19 arrived in the High Plains of Texas, meatpacking plant workers were discovered to be contracting the virus in large numbers. Working conditions in the plants-close spacing on the disassembly lines, cold temperatures, noise (shouting to be heard), etc.;along with congregant settings among the immigrant workers before and after work-were all implicated in the infections. Although much has been written on the vulnerabilities of meatpacking workers, little research has investigated the spatial spread of the virus. In this study we analyze COVID-19 case rates for May 15 (the first spike in daily case numbers), for the 41 counties of the region in relation to meat-packing influence, ethnicity, and socioeconomic structure of the counties. We find that meatpacking influence had the strongest relationship to COVID-19 rates across the counties;that the presence of Asian and African immigrants was also significant;and that rurality and isolation insulated more than half the counties from high virus rates. Further analysis, for later spikes in cases (July 1 and November 25), revealed a decline in meatpacking influence, a surge in COVID-19‘s infection of counties with large domestic minorities, and an amplification of low COVID-19 cases for rural, older, Anglo counties. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Rural-Urban Disparities in Hospital Admissions and Mortality Among Patients with COVID-19: Evidence from South Carolina from 2021 to 2022.

Although rural communities have been hard-hit by the COVID-19 pandemic, there is limited evidence on COVID-19 outcomes in rural America using up-to-date data. This study aimed to estimate the associations between hospital admissions and mortality and rurality among COVID-19 positive patients who sought hospital care in South Carolina. We used all-payer hospital claims, COVID-19 testing, and vaccination history data from January 2021 to January 2022 in South Carolina. We included 75,545 hospital encounters within 14 days after positive and confirmatory COVID-19 testing. Associations between hospital admissions and mortality and rurality were estimated using multivariable logistic regressions. About 42% of all encounters resulted in an inpatient hospital admission, while hospital-level mortality was 6.3%. Rural residents accounted for 31.0% of all encounters for COVID-19. After controlling for patient-level, hospital, and regional characteristics, rural residents had higher odds of overall hospital mortality (Adjusted Odds Ratio - AOR = 1.19, 95% Confidence Intervals - CI = 1.04-1.37), both as inpatients (AOR = 1.18, 95% CI = 1.05-1.34) and as outpatients (AOR = 1.63, 95% CI = 1.03-2.59). Sensitivity analyses using encounters with COVID-like illness as the primary diagnosis only and encounters from September 2021 and beyond - a period when the Delta variant was dominant and booster vaccination was available - yielded similar estimates. No significant differences were observed in inpatient hospitalizations (AOR = 1.00, 95% CI = 0.75-1.33) between rural and urban residents. Policymakers should consider community-based public health approaches to mitigate geographic disparities in health outcomes among disadvantaged population subgroups.

Racial disparities at rural and urban juvenile detention centers: Unanticipated findings since COVID-19's reduction in juvenile assessments

Studies on racial disparity within the juvenile justice system have demonstrated continued disproportionate minority contact (DMC) and racial and ethnic disparity (RED) issues throughout each decision point, especially at earlier stages. Yet, most research has centered on urban areas, with minimal attention given to youth-of-color in rural jurisdictions. As such, the current study utilized juvenile intake and assessment data from a rural Midwestern state, focused on racial and ethnic disparities prior to and per-COVID-19. Using data from a rural state, we examine the monthly counts of juveniles assessed at juvenile intake centers with an interrupted time-series design to explore whether the pandemic's impact differed by race or ethnicity. Our findings do not support the claim that the pandemic has exacerbated racial or ethnic disparity. Yet, trends suggest white and non-Hispanic youth, as well as youth in rural jurisdictions, are presenting at juvenile intake centers at less reduced rates than their youth-of-color and urban counterparts, per-COVID-19. The results show the pandemic has radically reduced assessments to the juvenile justice system, though this impact is not equally distributed. While intersectional comparisons are not possible at this time, policy implications and future directions are provided. [ABSTRACT FROM AUTHOR] Copyright of Journal of Crime & Justice is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Equal Opportunities, Fair Work and Social Protection: Impacts of COVID-19 on Young People in Portuguese Rural Territories

Several international organizations, as well as worldwide scholarship, have abundantly shown that young people under 34 are among the groups struggling the most with COVID-19 economic and social impacts. Seldom, however, does scholarship focus on the uneven effects of the pandemic on younger generations across different types of territories. Overall, young people in rural territories tend to face much greater adversities. These territories concentrate less population, show strong ageing trends trend and depict a lower settlement rate. Rural younger generations struggle to strive, because rural areas depend heavily on declining economic activities, such as farming, are plagued by precarious jobs, and display limited institutional support compared to (sub)urban areas. In Portugal, the country's population is unevenly distributed between affluent, high-density coastal areas and inlands and archipelagos with a considerable rural predominance. The COVID-19 crisis has the potential to further stretch the existing inequalities among young people due to spatial distribution. Therefore, in this chapter, we discuss the impact of the recent pandemic crisis on rural Portuguese young people. We will do so by characterizing headline indicators in the three domains of the European Pillar of Social Rights, namely equal opportunities (e.g. Early School Leavers from Education and Training), fair working conditions (e.g. Youth Unemployment), and social protection and inclusion (e.g. at risk of poverty and social exclusion). We expect to reach an initial comprehension of the challenges faced by rural Portuguese young people in the aftermath of the COVID-19 crisis in three domains: education, employment and social inclusion. We also discuss how more nuanced territorial conceptualizations (e.g. low-density areas) and policymaking can add alternative views about young people's living conditions due to subnational disparities. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Emergent rural-urban relations in Covid-19 disturbances: Multi-locality affecting sustainability of rural change

The recent Covid-19 pandemic highlighted rural-urban interactions, in particular the fact that cities are dependent on the accessibility of non-metropolitan and rural spaces and vice versa. This article seeks to understand how these interactions contributed to emergent relational spaces of rurality during the Covid-19 crisis. The article analyses politicised mobilities between localities and rural-urban linkages that are tied to the sustainability of rural change. The study focuses on two countries: Estonia and Finland, exploring thematic narratives on second-home practices and related politics during the outbreak of the Covid-19 crisis. The explored regions were the South Savo region in Finland and the island of Saaremaa and northern coastal villages in Estonia. The analysis indicates ways in which the mobility restrictions and disturbances triggered by the Covid-19 pandemic attributed certain demands and hopes to rural areas and led the shift in rural-urban interactions. The article contributes to the understanding of co-existences between im/mobilities and multi-local living and sustainability in rural change.

Emergent rural–urban relations in Covid‐19 disturbances: Multi‐locality affecting sustainability of rural change

The recent Covid‐19 pandemic highlighted rural–urban interactions, in particular the fact that cities are dependent on the accessibility of non‐metropolitan and rural spaces and vice versa. This article seeks to understand how these interactions contributed to emergent relational spaces of rurality during the Covid‐19 crisis. The article analyses politicised mobilities between localities and rural–urban linkages that are tied to the sustainability of rural change. The study focuses on two countries: Estonia and Finland, exploring thematic narratives on second‐home practices and related politics during the outbreak of the Covid‐19 crisis. The explored regions were the South Savo region in Finland and the island of Saaremaa and northern coastal villages in Estonia. The analysis indicates ways in which the mobility restrictions and disturbances triggered by the Covid‐19 pandemic attributed certain demands and hopes to rural areas and led the shift in rural–urban interactions. The article contributes to the understanding of co‐existences between im/mobilities and multi‐local living and sustainability in rural change. [ FROM AUTHOR]

Rural disparities in head and neck cancer from 2017 to 2021: a single institution analysis

Introduction:This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care.Materials and Methods:A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural–urban continuum codes were used to determine rurality.Results:A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20–30% of our patients live in rural areas and about 30% have a commute > 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively.Conclusions:Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.

Rural-Urban Disparities in Vaccine Hesitancy among Adults in South Tyrol, Italy.

BACKGROUND: The demographic determinants of hesitancy in Coronavirus Disease-2019 (COVID-19) vaccination include rurality, particularly in low- and middle-income countries. In the second year of the pandemic, in South Tyrol, Italy, 15.6 percent of a representative adult sample reported hesitancy. Individual factors responsible for greater vaccination hesitancy in rural areas of central Europe are poorly understood. METHODS: A cross-sectional survey on a probability-based sample of South Tyrol residents in March 2021 was analyzed. The questionnaire collected information on sociodemographic characteristics, comorbidities, COVID-19-related experiences, conspiracy thinking, and the likelihood of accepting the national vaccination plan. A logistic regression analysis was performed. RESULTS: Among 1426 survey participants, 17.6% of the rural sample (n = 145/824) reported hesitancy with COVID-19 vaccination versus 12.8% (n = 77/602) in urban residents (p = 0.013). Rural residents were less likely to have post-secondary education, lived more frequently in households with children under six years of age, and their economic situation was worse than before the pandemic. Chronic diseases and deaths due to COVID-19 among close relatives were less frequently reported, and trust in pandemic management by national public health institutions was lower, as was trust in local authorities, civil protection, and local health services. Logistic regression models confirmed the most well-known predictors of hesitancy in both urban and rural populations; overall, residency was not an independent predictor. CONCLUSION: Several predictors of COVID-19 vaccine hesitancy were more prevalent in rural areas than in urban areas, which may explain the lower vaccine uptake in rural areas. Rurality is not a determinant of vaccine hesitancy in the economically well-developed North of Italy.

Spatial Risk Factors for Pillar 1 COVID-19 Excess Cases and Mortality in Rural Eastern England, UK.

Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag-York-Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors.

Methodological proposal for the identification of priority areas for depopulation applied to the province of Badajoz (Extremadura)

In a world where the transformations that are taking place are increasingly rapid and difficult to predict –the recent global crisis associated with the COVID-19 pandemic is a case in point–there are also problems of a structural nature that affect specific territorial areas. In Europe and especially in Spain, the basic principles aimed at achieving economic, social, and territorial cohesion are hampered by the impact of phenomena such as depopulation and progressive ageing, which are very much entrenched in the most rural areas. It is therefore necessary to implement analysis tools aimed at complementing the Demographic Challenge Strategy and optimizing its results. This work provides a methodological proposal that provides a classification of the municipalities of the province of Badajoz (Spain), based on the preparation of a map to identify the most vulnerable areas to depopulation and its associated problems, according to the most significant socio-economic deficiencies. Seventy-three variables have been compiled, grouped into five thematic blocks (accessibility, demography, economy, territory and tourism), a multivariate analysis has been carried out and, finally, a map is obtained where the municipalities are classified according to their positive or negative characteristics with respect to the original variables. © 2022 Asociacion de Geografos Espanoles. All rights reserved.

Tecnologias em tempos de (pós) pandemia: um ensaio focalizado ao mundo rural brasileiro

No contexto atual, no qual vivencia-se a propagação do novo coronavírus (Covid-19), a tecnologia ganha roupagem diferenciada, mormente, interpretada como produto ou combinação inusitada de processos, baseada nos pressupostos da ciência, com vistas à superação dos desafios que foram criados ou avultados à vida humana. No espaço rural brasileiro, se por um lado, a incidência viral em nível global afeta negativamente distintos sujeitos do campo, por outro lado, ela destaca a importância, para toda a sociedade, de uma categoria social produtora de alimentos, em geral, mais saudáveis, mas, sobretudo tecnologicamente inovadora. À luz dessa problemática, este ensaio se propõe a refletir sobre as formas de concepção tecnológica desenvolvidas pela agricultura familiar que podem vir a configurar estratégias de desenvolvimento rural mais sustentáveis e contextualizadas em tempos de (pós) pandemia. Para tanto, é metodologicamente pautado em pesquisas bibliográficas e documentais realizadas no segundo semestre de 2020 e tem como cerne teórico as perspectivas de sistemas tecnológicos e de construção social da tecnologia. Como principais alcances, contribui na composição de uma agenda de pesquisa e mobilização sociotécnica voltada a iniciativas contra-hegemônicas de desenvolvimento rural a serem constituídas no contexto de (pós) pandemia.Alternate :En el contexto actual de pandemia, la tecnología adquiere una forma diferente, interpretada principalmente como un producto o una combinación inusual de procesos y basada en los supuestos de la ciencia con miras a superar los desafíos que fueron creados o añadidos a la vida humana. En el espacio rural brasileño, más allá de la incidencia negativa del coronavirus a nivel global, resalta la importancia que tiene el campo en su categoría social como productor de alimentos más saludables, en general, y sobre todo tecnológicamente innovadores. Ante esta problemática, este artículo se propone reflexionar sobre las formas de concepción tecnológica desarrolladas por la agricultura familiar que pueden llegar a configurar estrategias de desarrollo rural más sustentables y contextualizadas en tiempos pospandémicos. Para ello se basa metodológicamente en una investigación bibliográfica y documental realizada durante el segundo semestre de 2020, tiene como eje teórico las perspectivas de los sistemas tecnológicos y la construcción social de la tecnología, y contribuye a la generación de una agenda de investigación y movilización sociotécnica orientada a iniciativas contrahegemónicas de desarrollo rural.Alternate :In the present context, dominated by the Covid-19 pandemic, technology gains a new shape as a product or an unusual combination of processes oriented to overcome the challenges that were created or added to human life. In the Brazilian rural space, notwithstanding the global negative incidence of the pandemic, the importance of a social category that produces healthier and technologically innovative food for everyone is highlighted. This article proposes to reflect on the forms of technological conception developed by family farming that may come to configure more sustainable and contextualized strategies for rural development in these (post) pandemic times. The article is methodologically based on a bibliographic research carried out during the second half of 2020 and its theoretical core resides in the concepts of technological systems and the social construction of technology. It contributes to a research and socio-technical mobilization agenda aimed at constituting counter-hegemonic rural development initiatives.

Contextualising the association of socioeconomic deprivation with hospitalisation rates of myocardial infarction in a rural area in eastern Germany.

INTRODUCTION: Evidence on the association of socioeconomic deprivation with occurrence of acute myocardial infarction (AMI) is available from international studies and urban settings in western Germany. This study aimed to assess this association based on small geographical areas in a rural setting in eastern Germany. METHODS: This study used routine data of all patients with AMI who were treated in the Hospital Brandenburg in the city of Brandenburg, Germany, between May 2019 and May 2020. Hospitalisation rates of AMI were calculated for postal code regions that were located within the catchment area of the Hospital Brandenburg. Poisson regression was used to compare hospitalisation rates in areas with medium socioeconomic deprivation to areas with high deprivation, controlling for age group, sex and period (before or during COVID-19 pandemic). Publicly available social, infrastructure and healthcare-related features were mapped to characterise the study region. RESULTS: In total, 265 cases of AMI were registered in the study area, which comprised 116,126 inhabitants. The city of Brandenburg was characterised by the highest level of socioeconomic deprivation, while neighbouring areas showed a rural settlement structure and medium levels of deprivation. The number of general practitioners per 10 000 inhabitants did not differ between both areas. The adjusted rate ratio comparing hospitalisations due to AMI in areas with medium socioeconomic deprivation to areas with high socioeconomic deprivation was 0.71 (95%CI 0.56-0.91, p=0.01). CONCLUSION: This study adds evidence about the association of socioeconomic deprivation and AMI occurrence from a rural area in eastern Germany. Further research about the relationship of socioeconomic deprivation and cardiovascular health is needed from heterogeneous contexts.

[Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area]. / Características sociodemográficas y factores de riesgo asociados a las bacteriurias significativas en un área de salud del sudeste español.

OBJECTIVE: To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients. METHODS: Cross-sectional descriptive study carried out on urine culture samples received between 2016-2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set. RESULTS: A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19. CONCLUSIONS: The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas.

Rural disparities in head and neck cancer from 2017 to 2021: a single institution analysis

Introduction: This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care. Materials and Methods: A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural-urban continuum codes were used to determine rurality. Results: A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20-30% of our patients live in rural areas and about 30% have a commute > 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively. Conclusions: Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.

Rural Population and COVID-19: A Model for Assessing the Economic Effects of Drop-Out in Higher Education

Higher education is one of the ways to overcome social inequalities in rural areas in developing countries. This has led states to develop public policies aimed at access, retention and timely graduation of students in those sectors, yet the high drop-out rates among the rural student population, which were catalysed by COVID-19, prevent the intrinsic and extrinsic benefits of obtaining a higher education degree from materialising. Thus, the study of the phenomenon of dropout before and after the pandemic has not sufficiently addressed the economic issues raised by this phenomenon for the different actors at the educational level. The purpose of this paper is to model the economic effects of rural student dropout at the higher education level for students and families, Higher Education Institutions (HEIs) and the State, based on public policies for access to higher education, in the pandemic and post-pandemic scenario. In order to delimit the operationalisation of the proposed model, a set of undergraduate training programmes in Colombia was taken as a reference. System dynamics was used as the main modelling technique. The model was based on data from the 20 training programmes with the highest number of students enrolled in rural areas for the year 2019, by running three computational simulations. The results showed the description of the dynamic model and the financial effects of dropout for the actors of the educational level with the current policies of access to higher education, the scenario in which COVID-19 would not have occurred and the consolidation of the public policy of tuition fee exemption in public HEIs as a result of the pandemic. It was concluded that the model developed is very useful for the valuation of these economic effects and for decision-making on policies to be implemented, given that the costs of dropout are characterised by high costs for students and their families as well as for HEIs, and where it was determined that current policies are inefficient in preventing and mitigating dropout. Copyright © 2021 Guzmán Rincón, Barragán Moreno and Cala-Vitery.

The impact and implications of COVID-19: Reflections on the Zimbabwean society.

The article is an attempt to provide a kaleidoscopic interpretation of how social science scholarship views the socio-cultural terrain of Zimbabwe during and after the global health crisis, and the societal and business haemorrhage induced by the coronavirus (COVID-19). Built through a multi-perspective and triangulation involving a modified Delphic approach that engages archival methods involving document and literature review, content analysis and expert interpretation; the article unveils the various effects of COVID-19 on Zimbabwe. It is concluded that COVID-19 by its nature is disruptive to everyday life, restrictive to human-social relations and is an instigator to tradition, spirituality and intellectuality in the country. The challenge of the virus brings to society a deliberate consciousness that global processes and events are converging (borders are porous) while local embeddedness is being entrenched through practices like lockdowns and confinement.

Rurality and atrial fibrillation: a pathway to virtual engagement and clinical trial recruitment in response to COVID-19.

Study Objective: To summarize trial adaptation from in-clinic to virtual design in response to the SARS-2 coronavirus-2 (COVID-19). Design: A clinical trial of a mobile health intervention to improve chronic disease self-management for rural individuals with atrial fibrillation (AF). The trial has a 4-month intervention - accessible regardless of health or digital literacy - to enhance AF medication adherence and patient experience with 8- and 12-month assessments of sustainability. Setting: Rural, western Pennsylvania. Participants: Rural individuals with AF receiving oral anticoagulation for stroke prevention. Interventions: Enrolled participants underwent a telephone-based orientation, provided verbal consent, and were randomized using a digital platform. They received a smartphone with intervention or control applications and a curriculum on usage tailored for study arm. Participants received study assessments by mail with telephone-based administration and contact for the 12-month trial. Main Outcome Measures: Successful adaptation to virtual engagement and recruitment. Results: The study enrolled 18 participants during in-clinic recruitment (January-March 2020). From 5/1/2020 to 5/6/2021 the study team enrolled 130 individuals (median age 72.4 years, range 40.8-92.2; 49.2% women, 63.1% without college degree, and 45.4% with limited health literacy. Retention of participants enrolled using virtual methods during the 4-month intervention phase is 92%. Conclusions: We report a virtual trial of a mobile health intervention for rural individuals with AF. Our successful implementation suggests promise for engaging geographically isolated rural individuals, potential to enhance digital health access, and advance rural health equity.

Education in emergencies: Lessons from COVID-19 in South Africa.

On 11 March 2020, the World Health Organization upgraded the outbreak of COVID-19 to pandemic status. On 15 March 2020, the South African president declared a national state of disaster under the Disaster Management Act of 2002. On 26 March 2020, national lockdown, which included measures stipulated in guidelines for education in emergencies, was implemented in South Africa. The presidential declaration and subsequent lockdown came at a time when some of the universities in South Africa were already struggling either to commence the academic year, or to make up for time lost due to persistent student protests relating to several student demands. However, disaster management now entailed that all schools and institutions of higher education were forced to close immediately for extended periods, necessitating alternative ways of ensuring access to education. The qualitative case study presented in this article sought to document the intervention strategies developed by two universities located in remote parts of Eastern Cape Province to deliver education during the COVID-19 restrictions. A second aim was an examination of the challenges experienced by the two institutions' largely rural student population. The authors collected data using a questionnaire completed by 15 educators and 30 students from the two universities. They also analysed official communications documents from the universities addressed to lecturers and students. The results indicate that access to online teaching and learning platforms and resources for students from poor rural communities in South Africa is challenging, and that there are gross inequalities in educational outcomes for learners from different socio-economic backgrounds. This affects the future plans of higher education institutions to provide teaching and learning through online-based platforms. The authors conclude their article by providing recommendations to support online learning in rural areas, which has the potential to expand higher education access post-COVID-19.

L'éducation dans les situations d'urgence : les leçons de la COVID-19 en Afrique du Sud ­ Le 11 mars 2020, l'Organisation mondiale de la santé a fait passer la COVID-19 du statut d'épidémie à celui de pandémie. Le 15 mars 2020, le président sud-africain a déclaré l'état de catastrophe nationale conformément à la Loi de gestion des catastrophes de 2002. Le 26 mars 2020, un confinement national est entré en vigueur en Afrique du Sud. Il comportait des mesures conformes aux directives concernant l'éducation dans les situations d'urgence. La déclaration du président et le confinement qui a suivi sont arrivés à un moment où un certain nombre d'universités sud-africaines se battaient déjà soit pour entamer l'année universitaire, soit pour rattraper le temps perdu en raison des manifestations estudiantines persistantes liées à différentes revendications. Toutefois, la gestion de catastrophe a obligé toutes les écoles et tous les établissements d'enseignement supérieur à fermer immédiatement pour des périodes prolongées, une situation qui nécessitait de proposer d'autres solutions pour garantir l'accès à l'éducation. L'étude de cas qualitative présentée dans cet article avait pour vocation de documenter les stratégies d'intervention mises en œuvre par deux universités situées dans des régions reculées de la province d'Eastern Cape pour poursuivre leur mission d'enseignement pendant la période de restrictions imposées par la COVID-19. Elle se proposait également d'examiner les défis qui s'étaient posés aux étudiants de ces deux établissements, essentiellement issus de zones rurales. Les auteurs ont recueilli des données grâce à un questionnaire auquel ont répondu 15 enseignants et 30 étudiants de deux universités. Ils ont aussi analysé les documents de communication officiels des universités adressés aux maîtres de conférences et aux étudiants. Les résultats indiquent que l'accès à l'enseignement en ligne et aux plateformes et ressources d'apprentissage pour les étudiants de communes rurales pauvres d'Afrique du Sud est difficile, et que les résultats des apprenants sont très inégaux en fonction de leur milieu socio-économique. Ceci influera sur les plans à venir que les établissements d'enseignement supérieur développeront en matière d'enseignement et d'apprentissage pour les plateformes en ligne. Les auteurs concluent leur article en recommandant de soutenir un apprentissage en ligne susceptible d'élargir l'accès à l'enseignement supérieur après la crise de la COVID-19 dans les zones rurales.

What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action?

A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.