Search Results (2,063)

Existing studies indicate that preventive conservation (PC) has become a key strategy in heritage risk management. For traditional villages with limited resources, community participation is necessary for the implementation of risk management. However, current research mostly focuses on case-based analyses and lacks a systematic synthesis of community participation in PC. To address this gap, this study conducts a systematic review of community participation in PC from historic rural areas and relevant heritage types. Following the PRISMA guidelines, 39 eligible studies were included in the final analysis. The findings show that effective participation depends on well-defined organizational and coordination networks. Internal organizational structures support coordinated efforts among community members, while external collaborative frameworks provide ongoing resources and support. Within this structure, capacity-building translates participatory arrangements into concrete risk-governance actions, thereby influencing how roles are assigned and adapted within the community across different risk scenarios. Based on these insights, this study presents an Organization–Capacity–Role framework that offers a way for risk governance of historical rural areas. Notably, the detailed arrangements in this framework are shaped by local institutional settings, specific risk types, and case contexts, demonstrating a strong contextual dependency. Full article

Background: Pediatric lymphadenopathy is a common reason for consultation, but information from secondary-level care in Latin American middle-income settings remains limited. Objective: The objective of this study is to describe the clinical profile, documentation quality, and use of complementary tests among pediatric patients with lymphadenopathy treated at a secondary-level hospital in Córdoba, Colombia. Materials and Methods: A retrospective descriptive study was conducted through a review of 246 medical records of children with lymphadenopathy evaluated between January 2020 and June 2024. Sociodemographic variables, lymph node characteristics, local inflammatory signs, associated clinical conditions, and complementary tests were extracted from the charts. An exploratory composite variable of predefined clinical assessment features recorded in the charts was analyzed descriptively. Results: The median age was 6 years, with 58.9% being male, and 79.7% lived in urban areas. Cervical involvement predominated (87.8%); most documented nodes were ≤1 cm (59.3%), and local inflammatory signs were uncommon (7.3%). Complementary testing was limited (complete blood count: 37.8%, serology: 17.9%, tuberculin skin test: 6.9%, ultrasound: 7.7%, and biopsy: 4.1%), without significant rural–urban differences. At least one predefined clinical assessment feature was recorded in 83.7% of charts, most often multiple nodes or bilateral involvement; these findings should be interpreted descriptively rather than as direct indicators of malignancy or infection. Conclusions: In this secondary-level, record-based series, pediatric lymphadenopathy was usually documented as small cervical node enlargement with limited complementary testing. The main contribution of this study is to describe documentation patterns and real-world initial work-up in a Colombian secondary-level hospital, which may inform standardized assessment and referral pathways. Full article

This study investigates the role of glamping within outdoor tourism as a potential tool for preserving and enhancing local landscape identity. Despite its rapid growth, glamping remains weakly defined within regulatory and design frameworks. The paper aims to explore whether a design-oriented approach can redefine glamping as a landscape-based practice rather than a purely market-driven phenomenon, with particular reference to the Italian context. The research adopts a qualitative research-by-design methodology, combining a critical literature review with the development of two pilot projects located in distinct settings: a natural hilly landscape and a rural agricultural context. These projects function as experimental tools to test spatial, ecological, and perceptual design strategies, focusing on settlement density, landscape integration, and experiential quality. The findings identify recurring principles that enable the codification of the glamping–landscape relationship, including low-density configurations, reversibility of structures, respect for existing morphology, and reinforcement of landscape identity. Landscape elements such as topography, vegetation, and visual relationships emerge as primary drivers of design. The study contributes to the discourse by reframing glamping as a landscape design practice, proposing a reversible and context-sensitive model of temporary inhabitation that supports sustainable tourism development. Full article

Background/Objectives: Emergency department (ED) overcrowding burdens rural and remote areas where geographic isolation limits timely care. The Compact Emergency Unit (CEU)—a 24 h facility with remote physician oversight—has been proposed but lacks an empirical foundation. We aimed to (1) quantify CEU-eligible (final KTAS 4–5) patients in a multicenter ED cohort; (2) compare their operational metrics with non-eligible patients; (3) characterize hourly demand for facility planning; and (4) develop machine-learning models for non-discharge prediction within this low-acuity stratum. Methods: Retrospective analysis of 12 months (January–December 2025) of NEDIS data from two Korean university-affiliated EDs. Effect sizes (Cliff’s δ, Cramér’s V) were reported alongside p-values. Three classifiers (logistic regression, random forest, and XGBoost) were developed with patient-level cross-validation, comparing a 16-feature baseline and a 22-feature set augmented with arrival vital signs. Calibration and decision curve analysis were performed. Results: Of 34,544 valid triage visits (27,743 unique patients), 9871 (28.6%) were CEU-eligible. They had shorter LOS (92 vs. 171 min; Cliff’s δ = −0.51), 98.8% symptomatic home discharge, and a median of 0 specialty consultations. Nighttime visits comprised 43.7% of CEU-eligible encounters, peaking at 20:00 (1.76 visits/h/day). The non-discharge rate was 1.20% (118/9871). The vital-augmented random forest reached AUROC 0.794 (95% CI 0.758–0.829); XGBoost calibration was near-perfect (ECE 0.020). A combined ML-or-vital-sign screening rule raised non-discharge sensitivity to 94.1%. Conclusions: Approximately 29% of ED visits could be CEU-suitable. Single-modality machine learning is insufficient for safety-critical triage, but a layered ML-plus-vitals screening approach achieves operationally relevant sensitivity. Prospective implementation studies are required before clinical deployment. Full article

Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira, primarily transmitted via direct or indirect contact with contaminated rodent urine. Human disease ranges from a mild, flu-like illness to severe, life-threatening Weil’s disease. Although the incidence of leptospirosis in Greece is not high, the Ionian Islands Region, including Corfu Island, presents the highest average frequency of cases in the country. A retrospective study of 11 confirmed cases in Corfu between 2015 and 2025 was conducted. The infections recorded during this period occurred from autumn to spring, exclusively affecting male patients in rural settings; notably, 90.9% of cases were attributed to occupational exposure. No association with urban or tourist areas was found. Although the incidence of the disease decreased by 42.1% compared to the previous decade (2005–2014), the case fatality ratio reached 27.3%, considerably above the average of 2.6% in Europe (during 2010–2022). The study underscores the need for enhanced clinical awareness and targeted preventive measures in Corfu, mainly among patients with at-risk occupations. Timely preparedness is needed especially in the face of ongoing climate change. Full article

School handwashing facilities in rural areas without piped water and drainage systems often discharge wastewater directly into the ground, leading to environmental contamination and loss of a valuable water resource, particularly in water-scarce regions. This study evaluates a decentralised three-stage handwashing wastewater treatment system combining biochar and sand filtration with chlorination. The integrated system effectively improved water quality by reducing turbidity, colour, suspended solids, nutrients, organic matter, and microbial contamination. While biochar and sand filtration provided substantial physicochemical treatment, chlorination was essential to ensure complete microbial inactivation. The treated water met several water quality standards for potable use (handwashing only) set by the World Health Organization (WHO) and the United States Environmental Protection Agency (USEPA) standards. Additionally, it complied with international guidelines for greywater reuse in toilet flushing, irrigation, and floor washing. This innovative water treatment strategy could help clean and reuse handwashing wastewater on-site. This could provide rural schools with clean water to support water needs in water shortage periods, such as hand hygiene, garden irrigation, toilet flushing, and floor washing. Overall, integrating biochar and sand filtration with disinfection could help remote rural schools recover water, advancing towards the achievement of the Sustainable Development Goals (SDG) for good health (SDG 3), clean water and sanitation (SDG 6), and sustainable communities (SDG 11). Full article

Background: Treatment adherence and outcomes for drug-resistant tuberculosis (DR-TB) continue to be subpar in rural South Africa, where structural health system limitations, comorbid conditions, and diverse resistance patterns make clinical management more challenging. This study aimed to assess how demographic, clinical, and programmatic factors, including a Community Engagement–Clinical Governance (CE–CG) implementation period, affect DR-TB treatment outcomes using explanatory predictive modeling. Methods: A retrospective cohort study was conducted using routine program data from 694 DR-TB patients. A complete-case analysis was performed for multivariable modeling (n = 282). Logistic regression and decision tree models were used to examine the relationships between treatment success and selected predictors, including age, sex, treatment regimen, resistance phenotype, comorbidities, and the CE–CG implementation period. Model discrimination and performance were evaluated using receiver operating characteristic (ROC) curves, pseudo-R² statistics, likelihood ratio tests, and multicollinearity diagnostics. Results: The cohort had a mean age of 40.7 years, and 58.8% of patients were male. Overall treatment success was 59.9%. Severe resistance phenotypes were rare (1.7%) but clinically significant. Comparative analysis showed no notable demographic or outcome differences between included and excluded patients, indicating minimal selection bias. In adjusted models, treatment initiation during the CE–CG implementation period was significantly linked to lower odds of treatment success (adjusted odds ratio [aOR] = 0.443; 95% CI: 0.240–0.818; p = 0.009). Severe resistance phenotypes were strongly negatively associated with treatment success (aOR = 0.303; p = 0.056). Logistic regression models had limited discriminatory ability (AUC: 0.523–0.548), while the decision tree model showed modest improvement (AUC: 0.626). Overall, the model’s explanatory power was limited (pseudo-R² = 0.029), although no evidence of multicollinearity was found. Conclusions: Programmatic implementation periods and resistance severity were important factors associated with treatment outcomes in this rural DR-TB cohort. Although model discrimination was modest and explanatory power was limited, the findings provide useful insights into structural and programmatic vulnerabilities that affect treatment success in real-world settings. Strengthening clinical governance, improving routine program documentation, and incorporating more granular adherence, social, and governance indicators into routine data systems may improve both program evaluation and future predictive modeling. Full article

Background: North Carolina faces persistent shortages of psychiatric professionals, particularly in rural and underserved regions, resulting in prolonged emergency department (ED) boarding, avoidable psychiatric hospitalizations, and inequitable access to behavioral health services. The North Carolina Statewide Telepsychiatry Program (NC-STeP), launched in 2013, is one of the nation’s longest-running statewide telepsychiatry programs. Objective: To summarize the development, implementation, outcomes, and lessons learned from NC-STeP across ED, community, maternal, pediatric, and university settings. Methods: Data were synthesized from NC-STeP operations, service data, and peer-reviewed publications (2013–2025). Results: NC-STeP completed 67,543 ED psychiatric assessments, prevented 11,802 hospitalizations, and generated $63.7 million in cost savings. Telepsychiatry increased safe discharges, reduced ED boarding, improved access, and revealed persistent equity gaps. Conclusions: NC-STeP demonstrates a scalable statewide telepsychiatry model improving throughput, reducing avoidable admissions, and expanding equitable behavioral health access. Full article

Background and Objectives: represents a major public health challenge in rapidly aging societies. While lifestyle behaviors are established modifiable risk factors for frailty, the longitudinal impact of composite lifestyle trajectories—particularly by sex—remains poorly understood. This study examined sex-stratified associations between Healthy Lifestyle Score Trajectories (HLSTs) and frailty among community-dwelling middle-aged and older adults in South Korea. Using 19 years of nationally representative panel data from the Korean Longitudinal Study of Aging (2006–2024), we analyzed 6603 participants (2684 males; 3919 females). Materials and Methods: Group-Based Trajectory Modeling was applied to Waves 1–6 to derive sex-specific HLSTs based on smoking, alcohol consumption, physical activity, and body mass index. Generalized Estimating Equations were used to assess longitudinal associations between HLSTs and Frailty Index (FI) scores across Waves 6–10, adjusting for sociodemographic covariates. Results: Five distinct HLSTs were identified in both sexes. In both males and females, persistently poor or deteriorating trajectories were independently associated with higher FI scores relative to the Favorable HLST reference group. The effect size for Poor HLST was more than twice as large in females (B = 0.039) than in males (B = 0.018), consistent with the sex-frailty paradox. Among females, the Improving HLST group did not demonstrate a statistically significant frailty benefit (B = 0.014, p = 0.091). Stratified analyses revealed that the lifestyle–frailty association among males was significant only in rural-dwelling participants, whereas in females the association was consistent across both urban and rural settings. Conclusions: Persistently unfavorable composite lifestyle trajectories were independently associated with higher frailty burden, with disproportionately greater impact in women. Late-life lifestyle improvement was not significantly associated with reduced frailty in women, reinforcing the importance of early and sustained behavioral maintenance. The rural-specific association in men highlights the role of structural disadvantage in amplifying lifestyle-related frailty risk. However, given the observational design of this study, the possibility of reverse causality cannot be excluded, and these findings should be interpreted as associative rather than causal. These findings support sex-sensitive, trajectory-based, and geographically tailored frailty prevention strategies. Full article

Rural heritage villages in China face compounding pressures from heritagisation policies, tourism marketisation, and digital platform logics, which together threaten the cultural integrity of lineage-based communities. While existing scholarship has shifted from treating authenticity as a fixed property to viewing it as a negotiated construct, a critical gap persists: the literature does not explain how local actors operationally manage the simultaneous demands of external governance compliance and internal cultural continuity. Drawing on multi-sited ethnography conducted across ritual spaces, tourism settings, and digital platforms in Huizhou lineage villages (March–August 2025)—including over 30 h of in-depth interviews with 18 cultural practitioners and two years of online community ethnography (2023–2025) within Huizhou traditional village cultural liaison groups—this study examines the micro-level strategies through which communities respond to Authorized Heritage Discourse (AHD). The study introduces the concept of Versioned Governance: a community-enacted mechanism through which cultural authenticity is strategically differentiated into ritual, performative, and pedagogical versions. Through spatial partitioning, temporal staggering, and linguistic encoding, lineage groups create cultural buffer zones that mediate between sacred practice and public display without compromising ethical coherence. This framework reframes authenticity not as an essential property nor as mere negotiated perception, but as a processual and political achievement—continuously produced through the interplay of structural discipline and local agency. The findings contribute to critical heritage studies and offer practical implications for cultural land-use and heritage governance policy in non-Western rural contexts. Full article

This paper presents an integrated and scalable methodology for assessing the feasibility of Renewable Energy Communities (RECs) in rural and agricultural settings, particularly in areas with limited technical and consumption data. By incorporating Geographic Information System (GIS) data, photovoltaic potential estimation, and energy consumption profiling, the study provides a decision-support framework suitable for various municipalities. A case study conducted in Caorso, a municipality in northern Italy, showcases the framework’s capability to model energy exchanges and estimate self-sufficiency levels for a predominantly rural area. The results highlight seasonal variations in energy production and consumption, identifying opportunities for improvement through energy storage and enhanced energy-sharing strategies. Overall, the proposed approach supports municipalities in the pre-feasibility assessment of RECs by enabling the evaluation of local renewable potential and minimum rooftop utilization thresholds under limited data availability. Full article

Children are among the most sensitive groups to air pollution. This study focuses on Chinese children aged 0–16 years, integrating six waves of tracking data from the China Family Panel Studies (CFPS, 2012–2022), the ChinaHighAirPollutants (CHAP) dataset, and MOD11A1 land surface temperature (LST) data, covering 20,241 samples across 25 provinces. Using the eXtreme Gradient Boosting–SHapley Additive exPlanations (XGBoost-SHAP) framework, we quantified the relative contributions of fine particulate matter (PM_2.5), ozone (O₃), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and climate factors to children’s respiratory disease risk. The overall area under curve (AUC) was 0.6765, with urban and rural sub-models achieving 0.6576 and 0.6864, respectively. SHAP analysis revealed that the temporal variable ranked first, reflecting population-level improvements from 2012 to 2022; age ranked second, with a 70.1% prevalence in the 0–6 age group. Rural PM_2.5 contribution was approximately 1.68 times that of urban areas; the O₃ effect showed opposite directions between urban (risk) and rural (protective association) settings; solid fuel contribution in rural areas was approximately 2.25 times the urban level. Regional clustering analysis identified differentiated environmental drivers across five geographic types. These findings provide a quantitative basis for differentiated regional prevention strategies. Full article

Background: Nursing student experiences in the clinical learning environment have been described in many countries but less is known about student nurses in rural settings. Aim: To explore undergraduate nursing students’ experience of clinical placement in a rural setting and identify factors that influence their experience. Methods: A cross-sectional observational study was conducted with a convenience sample of 170 undergraduate nursing students in regional Victoria, Australia, who completed professional experience placements between January and June 2020. Following their placements, participants completed the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale. Data were analysed using logistic regression models. Results: Completing clinical placements in medium to small rural towns or remote and very remote communities were associated with increased odds of high scores in the learning environment [odds ratio (OR) 2.90, 95% CI, 1.32 to 6.37; P = 0.01] and the supervisory relationship domains (OR 3.16, 95% CI, 1.40 to 7.14; P = 0.01). Female gender (OR 3.38, 95% CI, 1.12 to 10.19; P = 0.03), supervision by staff other than an educator (OR 2.71, 95% CI, 1.16 to 6.33; P = 0.02) and increased frequency of ad hoc (extra) supervision with a buddy nurse without the nurse educator (OR 2.55, 95% CI, 1.07 to 4.75; P = 0.03) were associated with increased odds of high scores in the role of nurse educator domain. Conclusions: In this study, nursing students reported valuing their exposure to smaller and more remote communities, the learning environments within rural and remote healthcare facilities, and the relationships they developed with supervising nurses. The findings also suggest that some students perceived greater value in supervision provided by clinical staff who were not in formal nurse educator or nurse facilitator roles. Given the limitations of the study, these observations should be interpreted cautiously and may warrant further investigation in broader contexts. Full article

While telemedicine has proliferated globally, its sustainable implementation in resource-constrained settings remains understudied. This study evaluates the efficacy, determinants of patient satisfaction, and systemic resilience of a “Home Ward” model at a rural Thai community hospital. Employing a convergent mixed-methods design, we surveyed 51 participants and conducted in-depth interviews with service users (n = 5) and a multidisciplinary team (n = 7). Multiple linear regression revealed high patient satisfaction ( = 3.70), explaining 67.3% of the variance (R² = 0.673). Notably, Perceived Usefulness (β = 0.589, p < 0.001) and the Effectiveness of Symptom Monitoring (β = 0.317, p < 0.05) significantly predicted satisfaction. Conversely, Overall System Quality was not a significant predictor (β = 0.142, p > 0.05), highlighting a ‘Low-Tech, High-Touch’ paradox. Qualitative analysis elucidated this through the “Human-in-the-Loop” mechanism, where Village Health Volunteers (VHVs) and healthcare providers bridge the digital divide. However, the study identifies an “invisible workload”—non-formalized discretionary effort—that sustains this resilience. Findings suggest that rural digital health governance should prioritize human intermediaries and pragmatic utility over purely technical upgrades. The study concludes that long-term sustainability requires institutionalizing human support networks while mitigating the exploitation of healthcare personnel’s goodwill. Full article

Background: Drug-resistant tuberculosis (DR-TB) continues to pose a major challenge in Limpopo Province, a predominantly rural region of South Africa with high prevalence of HIV and mobility of the cross-border population. Despite the scale-up of short all-oral bedaquiline-based regimens, there is limited recent provincial evidence describing DR-TB epidemiological characteristics and treatment outcomes in the post-COVID-19 period. This study aimed to assess resistance patterns, treatment outcomes, and factors associated with unfavorable outcomes among patients with DR-TB in Limpopo Province from 2020 to 2024. Methods: A retrospective cohort study was conducted using routinely collected data from the Electronic Drug Resistant Tuberculosis Register (EDRWeb). All laboratory-confirmed DR-TB cases diagnosed between January 2020 and December 2024 were included. Descriptive statistics were used to summarize demographic and clinical characteristics. Multivariable logistic regression was performed to identify predictors of unfavorable outcomes (treatment failure, death, and loss to follow-up). Kaplan–Meier survival analysis was used to estimate survival probability following treatment initiation. Results: A total of 1240 DR-TB cases were recorded, of which 1165 (94%) had documented treatment outcomes. Rifampicin-resistant TB (RR-TB) predominated throughout the study period, accounting for 76% (951/1240) of cases and remaining stable over time. Treatment success improved from 173/260 (67%) in 2020 to 130/166 (78%) in 2024, while loss to follow-up declined from 34/260 (13%) to 4/166 (2%). Kaplan–Meier survival analysis showed that mortality occurred predominantly during the early phase of treatment. Patients receiving bedaquiline-containing regimens demonstrated significantly higher survival probability compared with those not receiving bedaquiline (log-rank p = 0.024; HR 0.58, 95% CI: 0.35–0.94). In multivariable analysis, HIV infection was independently associated with unfavorable outcomes (aOR 1.36; 95% CI: 1.04–1.77; p = 0.025), while increasing age showed a modest association with poorer outcomes. Conclusions: Treatment outcomes for DR-TB improved over the study period, accompanied by declining loss to follow-up and improved survival. The survival advantage observed among patients receiving bedaquiline-containing regimens supports continued prioritization of bedaquiline-based treatment strategies in DR-TB management. Strengthening access to these regimens, alongside integrated HIV care, may further improve treatment outcomes in Limpopo Province and similar high-burden settings in South Africa. Full article