Search Results (7)

Background/Objectives: Geographic inequity remains a persistent concern in liver transplantation, particularly for patients requiring liver transplantation for advanced chronic liver disease, in which transplantation remains the definitive therapy for advanced disease. We evaluated state-level differences in liver transplant waitlist burden using publicly available U.S. data. Methods: We performed a retrospective ecological panel study using publicly available United Network for Organ Sharing (UNOS)-derived annual state tables from 1995 to 2025. Six analyzable states were grouped as higher-rurality/substantial-rural-population states (Texas, North Carolina, Pennsylvania) and urban-dominant states (California, New Jersey, Massachusetts). Primary outcomes were annual liver transplants, death removals, and death-share (death removals divided by death removals plus transplants). Descriptive comparisons, era analyses, and heteroscedasticity-robust regression models were performed. Results: The final dataset contained 186 state-year observations. Across 1995–2025, higher-rurality states had more cumulative transplants than urban-dominant states (39,471 vs. 34,178) and fewer cumulative death removals (8642 vs. 10,625). Mean death-share was lower in higher-rurality states (18.7% vs. 22.6%), as was the death-to-transplant ratio (0.219 vs. 0.311). From 2020 to 2025, higher-rurality states again demonstrated lower mean death-share (9.5% vs. 14.3%). In regression modeling, higher-rurality group membership was associated with lower death-share (β = −0.0389, 95% CI −0.0604 to −0.0175, p < 0.001), while the post-2020 era was independently associated with lower death-share (β = −0.1091, 95% CI −0.1299 to −0.0882, p < 0.001). Highly rural low-volume states initially considered for analysis had sparse or suppressed counts and could not be reliably modeled. Conclusions: In this six-state ecological study, higher-rurality states with substantial rural populations exhibited lower waitlist death-removal burden than urban-dominant comparators. These discoveries probably indicate the varying transplant-system configurations instead of the individual rural access being better. The ecological data related to the public can be the basis for significant hypotheses concerning the transplant discrepancies, but the exhaustive consecutive tasks need to be supplemented by static national studies that are patient-level and relevant to rurality, travel distance, PSC-specific cohorts, and psychosocial determinants. Full article

To people living with Alzheimer’s Disease-Related Disorders (ADRD), timely and coordinated communication is essential between their informal caregivers and healthcare providers. In provider shortage areas, for example, the state of Nevada, telehealth can be an effective primary care delivery alternative to in-person visits. To evaluate the cost-effectiveness of telehealth visits for people living with ADRD in the state of Nevada, a decision-analytic Markov model was developed from healthcare system perspectives with a 10-year horizon/1-year cycle. To estimate the effects of demographic and geographic parameters on the Markov model, race parameters were divided into non-Hispanic White individuals vs. others and location parameters were divided into urban vs. rural. A 12-item short-version Zarit Burden Interview (ZBI-12) was applied to measure the informal caregiver burdens of non-institutionalized people living with ADRD. The values of mortality rate and healthcare utilization were obtained from healthcare systems’ publicly available payor administrative data and Nevada State Inpatient/Emergency Department datasets. Among urban-residing non-Hispanic White individuals, the Incremental Cost-Effectiveness Ratio (ICER) per modified ZBI-12 indicated a cost saving of USD 9.44 with telehealth visits; among urban-residing racial minorities, the ICER per modified ZBI-12 indicated a cost saving of USD 29.26 with in-person visits; and among rural residents, the ICER per modified ZBI-12 indicated a cost-saving of USD 320.93 with telehealth visits. Distributional differences in the cost-saving effects of telehealth primary care were noted in line with racial and geographic parameters. Workforce and caregiver training is necessary for reducing distributional differences, especially among urban-residing racial monitories living with ADRD in the provider shortage area of the state of Nevada. Full article

Open burning poses a significant threat to human health and the environment by releasing hazardous chemicals and exacerbating plastic pollution. Urgent action is required to address its pervasive impact and the substantial release of gaseous pollutants. Limited research has explored the demographic aspect of open burning behavior, with none specifically conducted in Kentucky. An analysis of open burning complaints reported to the Kentucky Division for Air Quality in 2015, 2019, and 2021 revealed no significant differences in reported incidents by month and county. Binary logistic regression analyses identified the urban vs rural divide as significant predictors of open burning incidents, while violations were influenced by both urban and rural factors and average household income. Unemployment rates and the percentage of individuals with less than a high school diploma did not significantly predict open burning violations. Targeted interventions at the state and local level, focusing on rural areas and economically disadvantaged communities, can effectively address and mitigate open burning issues. Full article

This study explores digital divide issues that influenced online learning activities during the COVID-19 lockdown in five developing countries in South Asia. A multi-layered and interpretive analytical lens guided by three interrelated perspectives—structure, cultural practices, and agency—revealed various nuanced aspects across location-based (i.e., rural vs. urban) and across gendered (i.e., male vs. female) student groups. A key message that emerged from our investigation was the subtle ways in which the digital divide is experienced, specifically by female students and by students from rural backgrounds. Female students face more structural and cultural impositions than male students, which restricts them from fully availing digital learning opportunities. Rich empirical evidence shows these impositions are further exacerbated at times of crisis, leading to a lack of learning (agency) for women. This research has provided a gendered and regional outlook on digital discriminations and other inequalities that came to the forefront during the COVID-19 lockdown. This study is especially relevant as online learning is being touted as the next step in digitization; therefore, it can inform educational policymaking and help build inclusive digital societies and bridge current gender and regional divisions. Full article

Background: Rural–urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (AF) differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010–2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural–urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99–1.03), AADs 1.11 (1.07–1.15), cardioversion 1.01 (0.98–1.03), catheter ablation 1.05 (0.98–1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03–1.08), AADs 1.18 (1.14–1.23), cardioversion 1.05 (1.02–1.08), catheter ablation 1.10 (1.02–1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural–urban inequity exists in Finland. Full article

Objectives: This study aims to explore how changes in external factors caused by migration impact antibiotic use behaviors among Chinese university students in comparison to their peers from host areas and origin areas. Migration status was determined by host universities and origin areas, which were broadly defined as eastern vs. western regions in China. Methods: This study analyzed secondary data from a cross-sectional study conducted in China about the antibiotic use behaviors of university students in 2015. Students were divided into four groups: eastern local students (E-Es), western local students (W-Ws), eastern–western migrant students (E-Ws), and western–eastern migrant students (W-Es). Results: After controlling for gender, grade, major, hometown (rural or urban), and parents’ education, E-Ws reported a significantly higher odds of asking for antibiotics (OR = 2.13; 95% CI = 1.54–3.03; p < 0.001) and taking antibiotics prophylactically (OR = 1.85; 95% CI = 1.32–2.56; p < 0.001) compared with E-Es; W-Es reported a significantly lower odds of asking for antibiotics (OR = 0.56; 95% CI = 0.37–0.83; p < 0.01) and taking antibiotics prophylactically (OR = 0.57; 95% CI = 0.41–0.81; p < 0.01) compared with W-Ws. Discussion: Regional differences likely interacted with students’ migration status in forming different antibiotic use behaviors. Factors including financial incentives and loose regulations of antibiotic over-prescription by health providers and peer influence may contribute to worsened antibiotic use behaviors among E-Ws. Full article

The purpose of this study was to investigate the effect of two-hour exposure to a forest environment on cytokine, anti-oxidant and stress levels among university students and to compare the results to those measured in urban environments. Forty-one subjects were recruited. For our crossover design, subjects were divided into two groups based on similar demographic characteristics. Group A remained in the urban environment and was asked to perform regular breathing for 2 h. Blood samples were collected and the serum levels of cytokines including interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), and glutathione peroxidase (GPx) were examined. Subjects were moved to a small town in a rural area for an equal amount of time to exclude carryover effects, and then remained for another 2 h in a forest environment. The second set of blood samples was collected to assess the effect of exposure to the forest environment. Using the same method, Group B was first exposed to the forest environment, followed by exposure to the urban environment. Blood samples collected after the subjects were exposed to the forest environment showed significantly lower levels of IL-8 and TNF-α compared to those in samples collected after urban environment exposure (10.76 vs. 9.21, t = 4.559, p < 0.001, and 0.97 vs. 0.87, t = 4.130, p < 0.001). The GPx concentration increased significantly after exposure to the forest environment (LnGPx = 5.09 vs. LnGPx = 5.21, t = −2.039, p < 0.05). Full article