[What importance does outpatient care have for mobility in rural areas? Results from a GPS study among persons aged 75 and older]. / Außerhäusliche Mobilität von Personen ab 75 Jahren im ländlichen Raum. Ergebnisse aus einer GPS-Studie.

BACKGROUND: Out-of-home mobility, defined as active and passive movement through external environments, is a resource for autonomy, quality of life, and self-realization in older age. Various factors influence out-of-home mobility, primarily studied in urban settings. The study aims to examine associated factors in a study population aged 75 and above in rural areas. METHODS: Baseline data from the MOBILE trial involving 212 participants aged 75 and above and collected between June 2021 and October 2022 were analyzed. Out-of-home mobility was measured temporally as time out of home (TOH) and spatially as convex hull (CHull) using GPS over seven days. Mixed models considered outpatient care parameters as well as personal, social, and environmental factors along with covariates such as age and gender. RESULTS: Participants in the MOBILE study (average age 81.5; SD: 4.1; 56.1% female) exhibited average out-of-home mobility of TOH: 319.3 min (SD: 196.3) and CHull: 41.3 (SD: 132.8). Significant associations were found for age (TOH: ß = -0.039, p < 0.001), social network (TOH: ß = 0.123, p < 0.001), living arrangement (CHull: ß = 0.689, p = 0.035), health literacy (CHull: ß = 0.077, p = 0.008), sidewalk quality (ß = 0.366, p = 0.003), green space ratio (TOH: ß = 0.005, p = 0.047), outpatient care utilization (TOH: ß = -0.637, p < 0.001, CHull: ß = 1.532; p = 0.025), and active driving (TOH: ß = -0.361, p = 0.004). DISCUSSION: Previously known multifactorial associations related to objectively measured out-of-home mobility in old age could be confirmed in rural areas. Novel and relevant for research and practice is the significant correlation between out-of-home mobility and outpatient care utilization.

Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study.

BACKGROUND: In 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover. METHODS: This study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data. RESULTS: Among the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059-0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714-43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090-0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion. CONCLUSIONS: This study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere.

Progress in Early Detection of HIV in Tajikistan.

HIV early detection (CD4 counts ≥350 cells/µL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors, including physical, cultural, structural, and financial barriers, may limit early detection of HIV. This is a first-of-its-kind study on population-level differences in early detection of HIV across time within Tajikistan and any country in the Central Asia region. Utilizing the Tajikistan Ministry of Health's national HIV data (N = 10,700) spanning 2010 to 2023, we developed median regression models with the median CD4 cell count as the outcome and with the following predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old were detected early for HIV, whereas those older than 39 years were detected late. Females were detected earlier compared to their male counterparts regardless of region of residence. Rural populations were detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. There were differences identified among different demographic and geographic groups which warrant further attention.

Community engagement for stakeholder and community trust in healthcare: Short-term evaluation findings from a nationwide initiative in Lao PDR.

BACKGROUND: Trust remains a critical concept in healthcare provision, but little is known about the ability of health policy and interventions to stimulate more trusting relationships between communities and the health system. The CONNECT (Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust) Initiative in Lao PDR provided an opportunity to assess the community-level impact of a trust-building community engagement approach. METHODS: A mixed-method process evaluation was implemented from 10/2022-12/2023 among 14 diverse case study communities in four provinces across Lao PDR. Data collection involved two rounds of census surveys (3161 observations incl. panel data from 618 individuals) including an 8-item trust scale, 50 semi-structured interviews with villagers, and 50 contextualizing key informant interviews. The two data collection rounds were implemented before and three months after village-based CONNECT activities and helped discern impacts among activity participants, indirectly exposed villagers, and unexposed villagers in a difference-in-difference analysis. RESULTS: Stakeholders attested strong support for the CONNECT Initiative although community-level retention of trust-related themes from the activities was limited. Quantitative data nevertheless showed that, at endline, the 8-item trust index (from [-8 to +8]) increased by 0.95 points from 4.44 to 5.39 and all trust indicators were universally higher. Difference-in-difference analysis showed that villagers exposed to the CONNECT activities had a 1.02-index-point higher trust index compared to unexposed villagers. Trust impacts improved gradually over time and were relatively more pronounced among men and ethnic minority groups. CONCLUSIONS: The CONNECT Initiative had considerable direct and systemic effects on community members' trust in their local health centers in the short term, which arose from strong stakeholder mobilization and gradual institutional learning. Relational community engagement approaches have the potential to create important synergies in health policy and broader cross-sectorial strategies, but also require contextual grounding to identify locally relevant dimensions of trust.

Does Medical Insurance Integration Reduce Frailty Risk? Evidence From Rural Older Adults in China.

OBJECTIVE: This study aimed to assess the impacts of China's health insurance integration reform on frailty among rural older adults. METHODS: Nationally representative longitudinal data with 2,751 adults aged ≥60 years were analyzed from the China Health and Retirement Longitudinal Study 2011-2015. The integration of the rural New Cooperative Medical Scheme and urban Resident Basic Medical Insurance into the unified Urban and Rural Resident Basic Medical Insurance (URRBMI). Frailty Index (FI) summarizes 32 health deficits, quantifying frailty severity with a range of 0-1. Frailty is defined as FI ≥0.25, prefrailty as FI 0.10-0.25, and robustness as FI <0.10. Frailty worsening, stability, and improvement from 2011-2015 were assessed. Difference-in-differences and propensity score matched difference-in-differences models assessed URRBMI integration effects on frailty severity and risk (FI ≥0.25) among rural older adults. RESULTS: URRBMI integration significantly reduced frailty severity by 15.16% and risk by 9.60 percentage points among rural older adults. Reductions were greatest among initially prefrail individuals, with 27.49% lower frailty severity and a 17.62 percentage point reduction in subsequent frailty onset risk after URRBMI integration. In contrast, no significant benefits were observed for initially robust or frail subgroups following integration. Analyses of frailty transitions corroborated selective benefits, with URRBMI integration lowering the risks of worsening frailty among prefrail but no significant reversal of frailty status among those initially frail or prefrail. DISCUSSION: China's URRBMI integration selectively ameliorated frailty progression among rural older adults with prefrail status. Targeting integrated medical insurance policies toward high-risk populations may optimize frailty prevention effects.

The impact of basic pension for urban and rural residents on the subjective well-being of the older adult in Chinese rural areas.

Introduction: As an important component of the social security system, basic pension insurance for urban and rural residents is expected to improve the quality of life of rural older adult people and make their lives better and happier. This article mainly studies the relationship between the basic pension for urban and rural residents and the subjective well-being of older adult people in rural China. Methods: This paper uses data from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2018 and 2020. It selected samples of rural older adult people aged 60 and above, ultimately obtaining 9,310 samples. The impact of the basic pension for urban and rural residents on the subjective well-being of rural older adult people was estimated by constructing Ordinary Least Squares (OLS) estimation methods and ordered logistic regression models. The robustness of the results was verified by changing the regression methods, and the samples were divided into different groups for heterogeneity analysis according to three different standards. Results: The results show that the basic pension for urban and rural residents significantly improves the life satisfaction of rural older adult, reduces their degrees of depression, and thereby enhances their subjective well-being. The impact of the basic pension for urban and rural residents is more significant for older adult individuals in areas with a higher gender ratio, those suffering from chronic diseases, and those in the eastern regions of the country. Further verification indicates that the basic pension for urban and rural residents enhances the subjective well-being of the rural older adult by improving their health status and reducing their labor supply. Discussion: Most of the existing research on basic pension insurance for urban and rural residents and subjective well-being has been conducted from the perspective of whether individuals are enrolled in the pension scheme or whether they received a pension. However, there are few studies analyzing from the perspective of the amount of pension benefits received by residents. The results of this study help to enrich the research perspective on the basic pension insurance system for urban and rural residents in China and expand the understanding of the impact and value of the basic pension for urban and rural residents.

Analysis of Food Security of Older Rural Indigenous People in Latin America and the Caribbean.

Food insecurity is a critical issue in the Americas, with severe impacts in the Caribbean, Mesoamerica, and South America, particularly affecting older adults in Indigenous and rural contexts where it intersects with poverty, gender, and ethnicity. This study aims to provide an in-depth understanding of the current research about food insecurity among older Indigenous adults in Latin America and the Caribbean. A comprehensive literature review was conducted, utilizing specific search queries and the population, intervention, comparison, and outcome (PICO) strategy across multiple databases to identify the pertinent studies. The findings indicate an increase in academic output on this topic since 2018, with significant emphasis on the interplay between climate change and food insecurity. The review highlights the importance of developing targeted food programs, reforming policies, and fostering collaboration between academia and local communities to implement practical interventions. Despite the growing body of literature, a notable research gap persists in rural areas of Latin America and the Caribbean. This study underscores the necessity of balancing the geographic distribution of research and emphasizes the preservation of cultural practices and the adaptation of public policies to support traditional food practices. It advocates for culturally sensitive interventions and interdisciplinary collaboration to formulate comprehensive strategies. The originality and value of this study lie in its focused analysis of older Indigenous adults, contributing crucial insights to the international literature on food security.

Acceptance and hesitancy towards COVID-19 vaccines in rural and tribal areas of Maharashtra (India).

INTRODUCTION: Hesitancy towards COVID-19 vaccines may be a major hindrance to a successful vaccination program. We assessed the vaccine uptake, facilitators, and barriers for the COVID-19 vaccine in tribal and rural populations in Maharashtra, India. METHODOLOGY: The present study is a cross-sectional analysis of data collected from 373 individuals from six villages (three tribal and three rural) from August 2022 to September 2022. Demographic information, COVID-19 history, details about vaccination, and reasons for taking/not taking the vaccine were collected. RESULTS: In these individuals, 236 (63.3%) had taken two doses, 85 (22.8%) had taken one dose, and 52 (13.9%) had not taken the vaccine. Tribal villagers were less likely to have completed vaccination (50.7% vs 79.3%; p < 0.001). Males were more likely to state 'compulsory at my workplace' (27.7% vs 7.7%; p < 0.001), whereas females were more likely to report 'could not get ration food without it' (52.7% vs 31.5%; p < 0.001) as the reason for vaccination. Common reasons for not taking the vaccine were: fear of side effects (56%); no need for vaccination (41.2%); do not trust the vaccines (40%); and 'there is no such thing as COVID-19'(16%). A majority (94.7%) had completed COVID-19 vaccination at government vaccination centers. CONCLUSIONS: Tribal villagers, women, and those from lower socioeconomic status were less likely to have taken the vaccine. Fear about side effects and mistrust about vaccines were the main reasons for not having taken the vaccine. Addressing these issues in mass information campaigns may help improve vaccination coverage.

The role of social capital in the impact of multiple shocks on households' coping strategies in underdeveloped rural areas.

Social capital has long been recognized as a facilitator of socio-economic development. However, the role of social capital in enhancing resilience to multiple shocks in rural China remains insufficiently explored. This study focus on the resilience of households that have recently get rid of poverty and reside in underdeveloped rural areas of China. Unlike previous studies, the article incorporates multiple shocks, social capital, and households' coping strategies into a research framework at the micro level. This study systematically analyses the multiple shocks experienced by households, their coping strategies, and further explores the mediating role of social capital. Utilizing two waves of a rural household panel survey data collected in six underdeveloped counties in 2015 and 2018 in China, we present four key findings. Currently, households primarily contend with drought, illness of family members, and the high costs of agricultural inputs as the main shocks. Their predominant coping strategy is reducing consumption. Importantly, social capital exhibits a mediating effect, accounting for 9.8% of the impact of multiple shocks on households' coping strategies. Notably, natural disasters significantly diminish the informal functions of social capital. While social capital exerts a full mediating effect in non-agricultural households, this effect is not observed among others. This study contributes to a better understanding of the dynamics and specificities of social capital in vulnerable rural areas. Additionally, the findings provide policymakers with practical insights regarding differentiated and preemptive risk governance approaches.

A multicriteria decision analysis for selecting rainwater harvesting systems in rural areas: a tool for developing countries.

Global water provision challenges have promoted decentralized water supply alternatives such as rainwater harvesting systems (RWHS). RWHS sustainability demands involve social, technical, and economic criteria in planning. Generally, in rural areas, water provision is more complex due to multiple uses of water, scattering of households, and low economies of scale. This research proposes a multicriteria tool for selecting RWHS in rural areas, considering social, technical, and economic criteria. The tool was developed by systematically identifying subcriteria and their hierarchization through the analytical hierarchy process (AHP), the technique for order of preference by similarity to ideal solution (TOPSIS), and a case study validation. Seven subcriteria were identified. The hierarchy of criteria was social (49.7%), technical (26.4%), and economic (23.9%). The tool involved: (i) users' consultation about the perceived ease of use and availability of water sources other than rainwater; (ii) system dimensioning to establish supply size, maintenance requirements, and required water quality; and (iii) costs and benefits estimation. Tool validation in a rural area included the evaluation of the alternatives proposed: (a) alternative 1: potable domestic uses (PD) and non-potable (NPD); (b) alternative 2: PD and NPD, irrigation of crops and chicken farming for self-consumption; and alternative 3: PD and NPD and chicken farming for profit sale. The sensitivity analysis showed the tool's consistency and robustness. Tool validation highlights the importance of integrating the three dimensions in selecting RWHS. The study provides a systematic methodology to assess and prioritize RWHS, appealing to policymakers, engineers, and practitioners facilitating water management and supply processes in rural areas.

[Spatiotemporal Simulation of Soil Pb Accumulation Process in Urban-Rural Areas: A Case Study of a Large City in Central China].

The high intensity of diverse human activities in urban-rural areas leads to complex soil Pb accumulation processes and high spatiotemporal heterogeneity, making it difficult to reveal the spatiotemporal characteristics of soil Pb accumulation in these areas. This study used a typical urban-rural area in a large city in Central China as the study area, constructed a soil Pb accumulation model, and established a spatiotemporal simulation method for soil Pb accumulation processes combining this model and land use classification and simulation results. Using this method, we simulated the soil Pb content in the study area from 2013 to 2040 and elucidated the future spatiotemporal variation characteristics of soil Pb content. The results showed that the average soil Pb content in the study area in 2013 was approximately 1.77 times the background value of the Pb content in the surface soil of the province where the city is located, indicating significant soil Pb pollution. The soil Pb content was predicted to continue increasing from 2013 to 2040, with relatively low increases (0.53-2.25 mg·kg-1) in the western, northern, and southern parts of the study area, accounting for 25.46 % of the total area, and relatively high increases (3.98-5.70 mg·kg-1) in the eastern part, accounting for 17.14 % of the total area. The increase in the area of forest land and the decrease in the area of water bodies and grassland in the eastern part of the study area led to a substantial rise in soil Pb content in this region; in addition, the spatial distribution of soil Pb content was highly correlated with the distribution of important factories and transportation facilities. This study overcomes the limitations of previous research that treated land use as unchanging and to a certain extent reflects the impact of regional land use changes on the heavy metal accumulation process. It provides a method for simulating the soil Pb accumulation process in urban-rural areas and a basis for controlling soil Pb pollution in the city's urban-rural areas.

Difficult-to-Engage Patients with Severe Mental Illness in Rural Community Settings: Results of the Greek Hybrid Assertive Community Treatment Model of Mental Healthcare.

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients' hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients' symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients' hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients' functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients' outcomes.

Investigation of caliciviruses and astroviruses in Gabonese rodents: A possible influence of national and international trade on the spread of enteric viruses.

Caliciviruses (Caliciviridae) and astroviruses (Astroviridae) are among the leading cause of non-bacterial foodborne disease and gastroenteritis in human. These non-enveloped RNA viruses infect a wide range of vertebrate species including rodents. Rodents are among the most important hosts of infectious diseases globally and are responsible for over 80 zoonotic pathogens that affect humans. Therefore, screening pathogens in rodents will be is necessary to prevent cross-species transmission to prevent zoonotic outbreaks. In the present study, we screened caliciviruses and astroviruses in order to describe their diversity and whether they harbor strains that can infect humans. RNA was then extracted from intestine samples of 245 rodents and retrotranscribed in cDNA to screen caliciviruses and astroviruses by PCRs. All the samples tested negative for caliciviruses and while astroviruses were detected in 18 (7.3%) samples of Rattus rattus species. Phylogenetic analyses based on the RdRp gene showed that all the sequences belonged to Mamastrovirus genus in which they were genetically related to R. rattus related AstVs previously detected in Gabon or in Rattus spp. AstV from Kenya and Asia. These findings suggested that transportation such as land and railway, as well national and international trade, are likely to facilitate spread of AstVs by the dissemination of rodents.

Service Provider Perspectives on Advance Care Planning Use in Rural Dementia Patients and Caregivers: A Qualitative Study.

Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants' recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings.

Burn injuries and acute burn management in the rural areas in northern Bangladesh - A household survey.

INTRODUCTION: Burn injuries pose a significant public health challenge, especially in low- and middle-income countries (LMICs). In Bangladesh, burn injuries are prevalent and often result in severe disability or death. However, knowledge regarding the causes of burn injuries, acute burn management, and barriers to seeking burn care in the riverine areas of northern Bangladesh is limited. METHODS: We conducted a questionnaire-based study in eight subunits and five selected districts in northern Bangladesh to determine the prevalence, causes, and management of burn injuries in these areas. A total of 210 individuals from different households were interviewed, which represented a population of 1020 persons. RESULTS: Among the respondents, 55% reported that at least one member of their household suffered from a burn injury in the past. The most common causes of burn injuries were open fire (41%) and hot fluids (30%). More than 40% of burns were not rinsed with water directly after sustaining the injury. Additionally, almost 30% of respondents did not seek medical care immediately after the injury, with financial constraints being the most commonly cited reason. DISCUSSION: We found a low rate of adequate cooling and seeking medical care. The need for basic knowledge on prevention and treatment of burn injuries and improved access to affordable health care services in the region is high.

A Case Report of Remitting Seronegative Symmetrical Synovitis With Pitting Edema Causing Severe Anemia, Acute Progressive Dementia, and Chronic Eczema in an Older Female.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a type of seronegative arthritis characterized by a favorable prognosis (Remitting), absence of rheumatoid factor (Seronegative), symmetry (Symmetrical), and synovitis with pitting edema on the backs of the hands and feet. The cause of RS3PE syndrome remains unknown, but involvement of the immune system is suspected, and steroids are highly effective. Here, we present a case of an 86-year-old woman with severe anemia and bilateral lower limb edema accompanied by chronic eczema, considered to be caused by RS3PE syndrome. The patient's symptoms included bilateral lower limb edema, allergic rash, cognitive decline, and difficulty in moving, all of which were attributed to RS3PE syndrome. Given the variety of systemic symptoms associated with RS3PE syndrome, which can significantly impair the activities of daily living (ADLs) in the elderly, early detection and treatment are crucial.

The relationship between health literacy and blood sugar control in rural areas among diabetes patients.

Background: Although the relationship between health literacy and glycemic control has been explored in patients with diabetes, little is known about the relationship between different categories of diabetes health literacy and glycemic control in rural areas. Therefore, this study focused on the relationship between different categories of health literacy and glycemic control among diabetic patients in rural areas of Guangxi, China. Objective: To explore the potential profiles of health literacy among rural diabetes patients in Guangxi and investigate their relationship with blood sugar control. Methods: A health literacy questionnaire was administered to 2280 rural diabetes patients in five cities in the Guangxi Zhuang Autonomous Region. Latent profile analysis was conducted to identify potential health literacy profiles. Results: Health literacy among rural diabetes patients in Guangxi could be categorized into high literacy-high functionality and low literacy-low criticality groups. The latent categories of health literacy were associated with blood sugar control, with diabetes patients in the high literacy-high functionality group demonstrating better blood sugar control than those in the low literacy-low criticality group (P < 0.05). Conclusion: Health literacy among rural diabetes patients in Guangxi exhibits heterogeneity. Healthcare professionals should pay attention to patients with low literacy and low criticality in rural areas and develop interventions to enhance their health literacy, thereby improving their blood sugar control.

Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State.

Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis. In 2018, the WV legislature passed a bill that placed prescribing limits on opioids. Our group set out to investigate the impacts of opioid prescribing restrictions through a sequential, mixed methods study evaluating prescription trends and stakeholder experiences. These stakeholder experiences generated emergent themes regarding the evolution of the opioid crisis up to and beyond the implementation of the bill, which is of relevance to neurosurgeons and back pain treatment. This study explores those findings for a neurosurgical audience. This study consisted of open-ended, semi-structured interviews with a purposive sample of 50 physicians, pharmacists, and patients in WV. Interviews were recorded and transcribed verbatim. Content analysis was utilized as the methodological orientation. Five theoretical domains relevant to the treatment of back pain emerged, describing the prevalence of opioid use, barriers to access care, the importance of opioids for function in resource-poor rural areas, disconnected and siloed care, and patient views on the impacts of pain care gaps and solutions. Spinal pain care in rural WV is complex due to identified challenges. Care siloing factors in suboptimal spinal pain care. Future work should define, implement, and assess the real-world effectiveness of treatment paradigms for the full spectrum of surgical and non-surgical back pain complaints. Neurosurgeons should be present in this arena.

Food insecurity is related to eating disorder psychopathology beyond psychological distress in rural Chinese adolescents.

OBJECTIVE: This study aimed to examine the relationship between food insecurity (FI) and eating disorder psychopathology in a large sample of rural Chinese adolescents. METHODS: Analyses included 1654 adolescents (55.4% girls; Mage = 16.54 years, SD = 1.45) from a rural high school in southwestern China. FI, eating disorder psychopathology, and psychological distress (i.e., symptoms of depression, anxiety, and stress) were assessed. Data were analyzed by sex. Pearson correlation analysis was performed to investigate the zero-order association between FI and eating disorder psychopathology. Hierarchical linear regressions were used to explore whether FI could explain meaningful variance in eating disorder psychopathology beyond psychological distress and demographic covariates (e.g., socioeconomic status). RESULTS: FI was significantly associated with higher eating disorder psychopathology for boys (r = 0.44, p < 0.001) and girls (r = 0.43, p < 0.001), with medium-to-large effect sizes. FI accounted for significant unique variance in eating disorder psychopathology beyond psychological distress and demographic covariates for boys (ΔR2 = 0.14, p < 0.001) and girls (ΔR2 = 0.10, p < 0.001). DISCUSSION: Using a large sample of rural Chinese adolescents, this study extends the connection between FI and eating disorder pathology in adolescents beyond the Western context. Future investigations on the mechanisms underlying FI and eating disorder psychopathology are warranted for developing prevention strategies for eating disorders among rural Chinese adolescents. PUBLIC SIGNIFICANCE: This is the first investigation that examined the link between FI and eating disorder psychopathology among rural Chinese adolescents. Our findings highlight the importance of incorporating FI as a potential risk factor to screen for the prevention and intervention of eating disorders among rural Chinese adolescents.

Working as a Healthcare Professional at Island Primary Care: An Exploratory Qualitative Study on the Cyclades Islands, Greece.

Improving the quality of and access to healthcare services in rural areas is fundamental to developing sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary-care units that lack direct hospital or hospital-health centre access. The research was conducted specifically in the rural islands of the Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction¼ thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors, and obligatoriness. The «recruitment¼ thematic was associated with understaffing, special care issues, an unstable working environment, educational and organisational aspects, and an insular lifestyle. The thematic of «retention¼ highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.