Search Results (701)

This study assessed whether COVID-19 pandemic experiences were associated with excessive alcohol use during the first year of the pandemic in Iowa, a heavy-drinking midwestern US state. We analyzed survey data from 4047 adult residents of Iowa collected in August 2020, focusing on three pandemic-related stressors (e.g., emotional reactions to the pandemic; disruption of daily activities; and financial hardship) and salient social support. Using multiple logistic regression, we tested correlates of increased drinking, heavy drinking, and binge drinking, controlling for demographic characteristics and health status. We found that nearly half (47.6%) of respondents did not change their drinking compared to before the pandemic; however, 12.4% of respondents reported increasing their drinking and 5.3% reported decreasing their drinking. Emotional reactions to the pandemic and disruption of daily activities were associated with higher odds of increased drinking, and rurality was associated with lower odds of increased drinking. No pandemic-related stressor was associated with heavy or binge drinking, but social support was associated with lower odds of binge drinking. Thus, we concluded that some pandemic-related stressors may explain increased drinking but not heavy or binge drinking. Understanding the nuances of alcohol use can inform preventive interventions, policy decisions, and preparations for future catastrophic events. Full article

Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated with VI in Duhknah, a rural area in Qassim Province, Saudi Arabia. Methods: This cross-sectional study, conducted in May 2024, included 929 participants aged 6–90 years from Duhknah, a rural area in Qassim Province, Saudi Arabia. Refractive errors (REs) were measured using a non-cycloplegic autorefractometer. Anterior and posterior eye examinations were performed using slit lamp biomicroscopy, direct ophthalmoscopy, and 90 D fundus biomicroscopy. VI was classified based on the International Classification of Diseases 11th revision (ICD-11), 2018. Results: The findings revealed that 671 (72.2%) participants had never undergone an eye examination. The overall prevalence of presenting VI was 370 (39.8%), comprising 21.6% with mild VI, 11.0% moderate, 4.1% severe, and 3.1% classified as blind. The prevalence of hyperopia, myopia, and astigmatism was 20.6%, 36.9%, and 13.2%, respectively. Uncorrected REs were the most common cause of VI (81.4%), followed by amblyopia (13.5%) and cataracts (3.2%). Regression analysis showed that women had 1.58 times higher odds of VI (p = 0.001). Participants with eye examinations for one year or more had 3.64 times higher odds (p < 0.001). Additionally, the risk of VI was significantly lower among older participants (ages 18–90) compared to younger ones (ages 6–17), (p < 0.001). Conclusions: This study found most participants had never had an eye exam, and VI was highly prevalent in the rural community. These findings underscore the need to strengthen primary eye care in rural Saudi Arabia. Regular vision screening, particularly for children, and better access to refractive services could significantly reduce VI and support the goals of Saudi Vision 2030. Full article

Background: Access to safe and reliable water and sanitation remains a critical public health and development challenge, with rural and low-income communities being disproportionately affected by inadequate services and heightened exposure to waterborne diseases. Despite global efforts and infrastructure-based progress indicators, significant disparities persist, and these often overlook users’ perceptions of water quality, reliability, and safety. This study explores the determinants of household satisfaction with drinking water in rural areas, comparing subjective user feedback with official access data to reveal gaps in current monitoring approaches and support more equitable, user-centered water governance. Methods: This study was conducted in Kazakhstan’s Atyrau Region, where 1361 residents from 86 rural villages participated in a structured survey assessing household access to drinking water and perceptions of its quality. Data were analyzed using descriptive statistics and multinomial logistic regression to identify key predictors of user satisfaction, with results compared against official records to evaluate discrepancies between reported experiences and administrative data. Results: The field survey results revealed substantial discrepancies between official statistics and residents’ reports, with only 58.1% of respondents having in-house tap water access despite claims of universal coverage. Multinomial logistic regression analysis identified key predictors of user satisfaction, showing that uninterrupted supply and the absence of complaints about turbidity, odor, or taste significantly increased the likelihood of higher satisfaction levels with drinking water quality. Conclusions: This study underscores the critical need to align official water access statistics with household-level experiences, revealing that user satisfaction—strongly influenced by supply reliability and sensory water quality—is essential for achieving equitable and effective rural water governance. Full article

This study presents the scientific and methodological foundation of Spain’s first national framework for the ethical management of community cat populations: the Action Plan for the Management of Community Cat Colonies (PACF), launched in 2025 under the mandate of Law 7/2023. This pioneering legislation introduces a standardized, nationwide obligation for trap–neuter–return (TNR)-based management of free-roaming cats, defined as animals living freely, territorially attached, and with limited socialization toward humans. The PACF aims to support municipalities in implementing this mandate through evidence-based strategies that integrate animal welfare, biodiversity protection, and public health objectives. Using standardized data submitted by 1128 municipalities (13.9% of Spain’s total), we estimated a baseline population of 1.81 million community cats distributed across 125,000 colonies. These data were stratified by municipal population size and applied to national census figures to generate a model-ready demographic structure. We then implemented a stochastic simulation using Vortex software to project long-term population dynamics over a 25-year horizon. The model integrated eight demographic–environmental scenarios defined by a combination of urban–rural classification and ecological reproductive potential based on photoperiod and winter temperature. Parameters included reproductive output, mortality, sterilization coverage, abandonment and adoption rates, stochastic catastrophic events, and territorial carrying capacity. Under current sterilization rates (~20%), our projections indicate that Spain’s community cat population could surpass 5 million individuals by 2050, saturating ecological and social thresholds within a decade. In contrast, a differentiated sterilization strategy aligned with territorial reproductive intensity (50% in most areas, 60–70% in high-pressure zones) achieves population stabilization by 2030 at approximately 1.5 million cats, followed by a gradual long-term decline. This scenario prioritizes feasibility while substantially reducing reproductive output, particularly in rural and high-intensity contexts. The PACF combines stratified demographic modeling with spatial sensitivity, offering a flexible framework adaptable to local conditions. It incorporates One Health principles and introduces tools for adaptive management, including digital monitoring platforms and standardized welfare protocols. While ecological impacts were not directly assessed, the proposed demographic stabilization is designed to mitigate population-driven risks to biodiversity and public health without relying on lethal control. By integrating legal mandates, stratified modeling, and realistic intervention goals, this study outlines a replicable and scalable framework for coordinated action across administrative levels. It exemplifies how national policy can be operationalized through data-driven, territorially sensitive planning tools. The findings support the strategic deployment of TNR-based programs across diverse municipal contexts, providing a model for other countries seeking to align animal welfare policy with ecological planning under a multi-level governance perspective. Full article

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article

Traditional Chinese villages, which have long supported villagers’ comfort level of daily activities, are increasingly affected by global climate change and rural reconstruction, prompting growing research interest in their outdoor microclimate design. This systematic review aims to synthesize and evaluate the outdoor microclimate spatial design mechanism studies in traditional Chinese villages noted for their uniqueness and complexity. Following the PRISMA method, this study was carried out on November 27, 2024, by retrieving studies from the Scopus and CNKI databases and applying predefined inclusion and exclusion criteria; 42 empirical studies were systematically reviewed. It identifies current research trends, summarizes concepts, frameworks, indicators, and methodologies with a focus on the design mechanisms considering scales, contexts, and user groups, and outlines directions for future research. The findings reveal a growing number of publications, with case studies predominantly concentrated on three concepts: physical microclimates, human comfort, and behavioral responses, characterized as distributed in south-east areas. Based on these concepts and their correlations, this study proposes a classification framework based on multiple scales, contexts, and user groups. Within this framework, the study found that relative humidity and PET (physiological equivalent temperature) emerge as the most commonly used indicators, while field measurements, simulations, surveys, and observations are identified as the primary methods. The review further reveals that unique outdoor spatial design characteristics shape physical microclimates, human comfort, and behavior indicators influenced by contexts and users from the macro to the micro scale. Future research should advance existing studies by enriching the current contextual framework and explore more microclimatic factors. This review offers a comprehensive overview and actionable insights for outdoor microclimate design, policymaking, and the promotion of climate adaptation and villagers’ public health in different traditional rural settings. Full article

Access to clean cooking remains a major challenge in rural and off-grid areas where traditional fuels are costly, harmful, or scarce. Solar cooking offers a sustainable solution, but many existing systems suffer from fixed positioning and low efficiency. This study presents a low-cost, dual-axis solar tracking parabolic dish cooker designed for such regions, featuring adjustable pot holder height and portability for ease of use. The system uses an Arduino UNO, LDR sensors, and a DC gear motor to automate sun tracking, ensuring optimal alignment throughout the day. A 0.61 m parabolic dish with ≥97% reflective silver-coated mirrors concentrates sunlight to temperatures exceeding 300 °C. Performance tests in April, June, and November showed boiling times as low as 3.37 min in high-irradiance conditions (7.66 kWh/m²/day) and 6.63 min under lower-irradiance conditions (3.86 kWh/m²/day). Compared to fixed or single-axis systems, this design achieved higher thermal efficiency and reliability, even under partially cloudy skies. Built with locally available materials, the system offers an affordable, clean, and effective cooking solution that supports energy access, health, and sustainability in underserved communities. Full article

Background: Telehealth is an essential component of modern healthcare, and it was especially relevant during the COVID-19 pandemic, but disparities in digital and technological literacy among health professionals may limit its equitable adoption and impact. Objective: This study seeks to validate an eight-item telehealth literacy survey among health professionals in Central–South Chile and to examine demographic and behavioral determinants of literacy levels, developing predictive models to identify key factors. Methods: In this cross-sectional study, 2182 health professionals from urban and rural centers in Central–South Chile completed the adapted survey along with questions on age, gender, nationality, and frequency of telehealth use. We assessed internal consistency (Cronbach’s α), explored factor structure via exploratory factor analysis (EFA), and tested associations using Pearson correlations, t-tests, one-way ANOVA, and both linear and multinomial logistic regressions. Results: The instrument demonstrated high reliability (Cronbach’s α = 0.92) and a two-factor structure explaining 65% of variance. Age negatively correlated with literacy (r = −0.26; p < 0.001), while the frequency of telehealth use showed a positive correlation (r = 0.26; p < 0.001). Female professionals and those in urban settings scored significantly higher on telehealth literacy (p = 0.005 and p < 0.001, respectively). The reduced multinomial model achieved moderate classification accuracy (51.65%) in distinguishing low, medium, and high literacy groups. Conclusions: The validated survey is a reliable tool for assessing telehealth literacy among health professionals in Chile. The findings highlight age, gender, and geographic disparities, and support targeted digital literacy interventions to promote equitable telehealth practice. Full article

Background: Gastrointestinal (GI) cancer patients face a four-fold higher suicide risk than the general US population. This study explores psychosocial aspects of GI cancer patient experiences, assessing suicidal ideation and behavior, mental distress during treatment phases, and psychosocial factors on mental health. Methods: A two-phase mixed-methods approach involved a web-based survey and follow-up interviews. Quantitative data analysis validated mental health and suicidal ideation constructs, and correlation analyses were performed. The patient journey was charted from diagnosis to treatment. Results: Two hundred and two individuals participated, with 76 from the rural Appalachian region and 78 undergoing treatments. Quantitative analysis showed a higher prevalence of passive suicidal ideation than active planning. The post-treatment recovery period was the most emotionally challenging. Qualitative data emphasized emotional support and vulnerability to isolation. Care quality concerns included individualized treatment plans and better communication. Patients also needed clear, comprehensive information about treatment and side effects. The in-depth interview with four GI cancer patients revealed a healthcare system prioritizing expedient treatment over comprehensive care, lacking formal psychological support. AI emerged as a promising avenue for enhancing patient understanding and treatment options. Conclusions: Our research advocates for a patient-centric model of care, enhanced by technology and empathetic communication. Full article

In low- and middle-income countries, notably in rural agricultural populations exposed to environmental and occupational dangers, respiratory impairment and noncommunicable diseases (NCDs) are major public health issues. This cross-sectional study examined the associations between lung function, functional capacity, and cardiovascular responses to the Six-Minute Walk Test (6MWT) in 137 adults from San Pa Tong District, Northern Thailand. Lung function was assessed using spirometry, and participants were classified accordingly. Hemodynamic parameters, including blood pressure, heart rate, rate-pressure product, and oxygen saturation, were measured before and after the 6MWT. Participants with impaired lung function walked significantly shorter distances (p = 0.004), and walking distance was positively correlated with forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁). Logistic regression confirmed that walking distance independently predicted lung function impairment after adjusting for age and sex. Cardiovascular responses to exercise also varied significantly across demographic subgroups. These findings support the use of the 6MWT as a practical, cost-effective, and scalable method for detecting lung function impairments in resource-limited rural settings. To our knowledge, this is among the first studies to demonstrate the predictive value of the 6MWT for lung function impairment in a Southeast Asian agricultural population. Full article

Grassland communities consist primarily of perennial herbaceous species, with grasses forming a dominant or significant component. These ecosystems have been utilised for economic purposes since the earliest periods of human history. In the natural environment, they fulfil numerous critical functions that, despite increasing awareness of climate change, often remain undervalued. Grasslands contribute directly to climate regulation, air purification, soil conservation, flood mitigation, and public health—all of which positively affect the well-being of nearby populations. Moreover, they satisfy higher-order human needs known as “cultural” services, providing aesthetic enjoyment and recreational opportunities. These services, in tangible terms, support the development of rural tourism. The objective of this study was to examine the perception of cultural ecosystem services provided by different types of grassland communities—meadows, pastures, and lawns. The study employed a structured questionnaire to evaluate the perceived significance and functions of these communities. Respondents assessed their aesthetic and recreational value based on land-use type. To quantify these dimensions, the study applies the Recreational and Leisure Attractiveness Index (RLAI), the Aesthetic Attractiveness Index (AAI), ranking methods, and contingent valuation techniques. Based on the respondents’ declared WTP (willingness to pay) and WTA (willingness to accept) values, statistically significant differences in the perceived value of land-use types were identified. Lawns were rated highest in terms of recreational attractiveness, meadows in terms of aesthetics, while pastures achieved the highest economic values. Significant differences were also observed depending on respondents’ place of residence and academic background. The results indicate that the valuation of cultural services encompasses both functional and psychological aspects and should be integrated into local land-use and landscape planning policies. Full article

Recently, solar energy technologies are a cornerstone of the global effort to transition towards cleaner and more sustainable energy systems. However, in many rural areas of developing countries, unreliable electricity severely impacts healthcare delivery, resulting in reduced medical efficiency and increased risks to patient safety. This review explores the transformative potential of solar energy as a sustainable solution for powering healthcare facilities, reducing dependence on fossil fuels, and improving health outcomes. Consequently, energy harvesting is a vital renewable energy source that captures abundant solar and thermal energy, which can sustain medical centers by ensuring the continuous operation of life-saving equipment, lighting, vaccine refrigeration, sanitation, and waste management. Beyond healthcare, it reduces greenhouse gas emissions, lowers operational costs, and enhances community resilience. To address this issue, the paper reviews critical solar energy technologies, energy storage systems, challenges of energy access, and successful solar energy implementations in rural healthcare systems, providing strategic recommendations to overcome adoption challenges. To fulfill the aims of this study, a focused literature review was conducted, covering publications from 2005 to 2025 in the Scopus, ScienceDirect, MDPI, and Google Scholar databases. With targeted investments, policy support, and community engagement, solar energy can significantly improve healthcare access in underserved regions and contribute to sustainable development. Full article

Background/Objectives: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare’s reforms remains unclear. This study aimed to evaluate the current status and barriers of task shifting in pediatric care in Japan. Methods: A questionnaire survey was conducted among pediatricians working in hospitals in Japan. The results were compared with those from 2020. Results: Questionnaires were sent to 835 hospitals, and valid responses were received from 815 pediatricians in 316 hospitals (response rate: 37.8%). The largest group (31.0%) was 40–49 years, and 34.4% of the participants were women. Among the items surveyed, most pediatricians indicated “shifted” in “Patient transfer (transporting between hospitals using an ambulance)” and “Intravenous injection of antibiotics.” Most physicians believed task shifting improved care quality; 10.3% felt it worsened. The most common estimate for daily working hour reduction due to task shifting was “1 to <2 h” (44.9%). Precisely 15.8% of pediatricians believed that task shifting had “not progressed at all,” with rural areas and non-university hospitals showing lower task-shifting implementation. National university hospitals had a higher likelihood of task shifting than public hospitals. No significant associations were observed for the total hospital bed count or the number of full-time pediatricians. Conclusions: Task shifting in pediatric care remains underdeveloped. While many pediatricians support the concept and report modest reductions in working hours, actual implementation remains limited. Future efforts must address systemic, institutional, and regulatory challenges to facilitate meaningful task redistribution and improve healthcare delivery. Full article

Background/Objectives: This study aimed to explore how stressors and facilitators within the work–family interface (WFI) influence mental health outcomes among farming women in rural Chile. The research sought to identify key relational patterns and contextual determinants shaping psychological well-being in this population. Methods: An exploratory mixed-methods design was employed, involving 41 semi-structured interviews analyzed using grounded theory. Qualitative themes were quantified by calculating the percentage of occurrence per interview, allowing for comparative analysis. Pearson correlation and principal component analysis (PCA) were used to examine associations among WFI dimensions and mental health-related variables. Results: Strong and statistically significant correlations emerged between institutional and community facilitators (r = 0.664, p < 0.01) and between gender facilitators and family workload stressors (r = 0.609, p < 0.01). PCA revealed two distinct patterns: women who rely on institutional support often resist traditional family roles, while others find balance through familial support systems. The gendered distribution of caregiving and productive tasks was a key factor in psychological well-being, with some women reporting physical discomfort linked to triple workloads. Conclusions: The dynamics of the WFI in rural contexts are shaped by both sociocultural and institutional factors. The findings highlight the need for culturally sensitive mental health policies that acknowledge and respond to the lived experiences of farming women. Full article

Ample evidence has recognized the importance of teacher support for children’s mental health. However, less is known about the factors that may play a role in the association between teacher support and children’s mental health. In the present study, we examined the mediating role of self-concept and the moderating role of area (i.e., rural vs. urban area) in the relationship between teacher support and children’s mental health (i.e., depression and anxiety). We used a sample of Chinese elementary students who enrolled in grades 3 to 6 (N = 525, aged 8–13, 44.54% girls). Results showed that children who perceived more teacher support tended to report better mental health. Moreover, the relationship between perceived teacher support and mental health was mediated by each domain of self-concept. Lastly, the association between teacher support and mental health was moderated by area, with a stronger effect found for urban children compared with rural children. These findings highlight the importance of considering both individual and contextual factors in the association between teacher support and children’s mental health. Practical strategies are proposed for school teachers, professionals, and policymakers to foster children’s psychological well-being. Full article