Search Results (177)

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

Differences exist between rural–urban migrants and urban–urban migrants in terms of human capital’s accumulation and pathways of social integration, yet few studies have systematically compared these distinctions. Based on the CMDS2017 survey data, this study constructed a comprehensive social integration index across four dimensions—economic integration, behavioral adaptation, identity recognition, and psychological assimilation—to analyze the influencing factors and decompose the disparities in social integration levels between the two groups from a human capital perspective. Using Oaxaca mean decomposition and Machado–Mata (MM) quantile decomposition, the results indicated that urban–urban migrants exhibited higher social integration levels than rural–urban migrants, with human capital significantly influencing integration outcomes. Better education, health status, longer migration duration, and more work experience positively enhanced migrants’ social integration. Human capital accounted for 38.35% of the social integration gap between the two groups, while coefficient differences were the primary driver of disparities. The returns to education diminish at higher integration levels, suggesting education played a stronger role for those with lower integration. The social integration gap between the two groups followed an inverted U-shaped trend, with smaller disparities at higher quantiles. As integration levels rose, characteristic differences declined continuously, indicating convergence toward homogeneity among high-integration migrants. These research findings indicated that the improvement in the social integration level of migrants still requires continuous investment in cultivating the human capital of migrants. Full article

This study aimed to longitudinally analyze changes in body mass index (BMI) among Korean middle and high school students before and after the COVID-19 pandemic. Data were obtained from the national-level Physical Activity Promotion System (PAPS), collected between 2018 and 2024. A total of 171,705 adolescents aged 13 to 18 were included in the analysis (86,542 males and 85,163 females), with a mean age of 15.2 years (SD = 1.68). Time-series analysis and two-way analysis of variance (ANOVA) were conducted to examine differences in BMI by year, sex, region (capital vs. non-capital), and urban–rural classification. The results indicated a significant increase in BMI during the pandemic period (2020–2022), peaking in 2022, followed by a gradual decline thereafter. Notably, male students and those living in rural or non-capital areas consistently exhibited higher BMI levels, suggesting structural disparities in access to physical activity opportunities and health resources. This study employed the Socio-Ecological Model and the Health Equity Framework as theoretical lenses to interpret BMI changes not merely as individual behavioral outcomes but as consequences shaped by environmental and policy-level determinants. The findings underscore the need for equity-based interventions in physical education and health policy to mitigate adolescent health inequalities during future public health crises. Full article

Background/Objectives: Healthy diets and proper nutrition are fundamental for human survival. With economic development and rising incomes, the food consumption structure of rural residents in China has noticeably changed. However, substantial disparities still exist in the quality of food consumption between urban and rural areas, and the dietary structure of rural populations remains imbalanced. Methods: This study uses 2020 China Rural Revitalization Survey (CRRS) samples of rural residents for analysis since it asked residents questions about their digital literacy and food consumption. A total of 2827 valid rural resident samples were finally obtained, and the participants had a mean age of 54.844 years. This study employs the ordinary least squares (OLS) model and the two-stage least squares (2SLS) method to examine the impact of digital literacy on the food consumption structure of rural households and its underlying mechanisms. Results: Based on the regression analyses, digital literacy significantly improves the food consumption structure of rural residents (p < 0.05). Heterogeneity analysis shows that at the regional level, digital literacy has a stronger impact on the food consumption structure of rural residents in southern China (β = −153.255, p < 0.05); at the individual level, its impact is more pronounced among rural residents with lower educational attainment (β = −427.506, p < 0.01) and among middle-aged and elderly populations (β = −212.705, p < 0.05). The mechanism analysis reveals that digital literacy can enhance the food consumption structure of rural residents by increasing their awareness of dietary health and food safety. Conclusions: These findings highlight the necessity of integrating the optimization of food consumption structures with enhancements in digital literacy into policy-making and provides valuable insights for developing policies aimed at improving the nutritional health of rural residents. Full article

This study examines the trends, impacts, and challenges of HIV in Bangladesh from 2000 to 2024, with a focus on its epidemiology, demographic distribution, and socioeconomic determinants. Despite maintaining one of the lowest HIV prevalence rates globally (<0.1%), Bangladesh faces a concentrated epidemic among high-risk populations, including people who inject drugs (PWID), men who have sex with men (MSM), sex workers, transgender individuals, and migrant workers. Analysis reveals a steady increase in reported infections, attributed to enhanced diagnostic capacities and public awareness. The 25–49 year age group remains the most affected, accounting for over 65% of cases, underscoring the vulnerability of the economically active population. Gender disparities persist, with males representing the majority of infections but lower ART coverage among females and transgender individuals. While interventions such as PMTCT programs, ART expansion, and targeted awareness campaigns have contributed to improved outcomes, barriers such as stigma, healthcare inequities, and limited rural access hinder progress. The study also evaluates Bangladesh’s progress toward the 95-95-95 targets, highlighting significant strides in treatment and viral suppression but gaps in diagnosis. Future research must address behavioral trends, stigma reduction, and integration of HIV services for marginalized populations. This paper emphasizes the need for evidence-based strategies to ensure equitable healthcare delivery and sustainable progress in combating HIV. Full article

Loneliness and social isolation are pressing public health concerns, prompting interest in how rural and urban environments shape social wellbeing. However, evidence remains mixed—perhaps because loneliness is a distal psychological outcome with complex, trait-like stability. To address this, we examined geographic variation in upstream patterns of social activity using data from the 2023 Canadian Social Connection Survey (N = 1556). The principal component analysis identified five domains of social behavior, which we analyzed using multivariable regression and supplemented with a series of sensitivity and stratified analyses. Our findings suggest that while broad differences across rural and urban geographies are modest, specific domains of behavior show some variation. For example, residents in rural areas reported lower casual social interaction (b = −0.19, p = 0.019) but similar or even greater engagement in intimate and supportive behaviors. Emotional loneliness was slightly lower in small towns (b = −0.17, p = 0.029), indicating possible protective effects of some smaller community contexts. While the overall structure of social behavior was not invariant across settings, general patterns of engagement appeared largely resilient to geographic differences. These findings underscore the importance of place-sensitive strategies that respond to specific forms of social behavior affected by geography while avoiding overgeneralized assumptions about rural–urban disparities. Full article

Background/Objectives: Cognitive deficiency associated with chronic alcohol consumption in older people remains an under-investigated public health issue in Romania, particularly concerning rural–urban disparities and the impact of reversible hepatic dysfunction on cognitive performance. To evaluate cognitive function at hospital admission and discharge using the Mini-Mental State Examination (MMSE); to identify rural–urban disparities; and to analyze the relationship between hepatic markers and MMSE scores in older people with chronic alcohol consumption. Methods: This retrospective, single-center observational study was conducted on 152 patients aged ≥55 years, hospitalized between January 2021 and December 2023 at the “Elisabeta Doamna” Psychiatric Hospital, Galați. Demographic variables, MMSE scores (at admission and discharge), and hepatic parameters (AST, ALT, GGT, total bilirubin, and ammonia) were collected. Statistical analysis included descriptive statistics, chi-square tests for categorical variables, paired t-tests or ANOVA for MMSE scores, and Pearson correlations between MMSE and hepatic markers (α = 0.05). Results: At admission, 94% of patients had an MMSE score < 24. The mean MMSE score increased from 23.4 ± 4.1 to 25.0 ± 3.7 at discharge (Δ = +1.6; p < 0.001). Patients from rural areas (63.8% of the sample) had significantly lower MMSE scores at admission compared to urban patients (22.6 ± 3.9 vs. 24.8 ± 4.2; p = 0.02). However, no statistically significant difference was observed between rural and urban patients regarding cognitive improvement during hospitalization (p = 0.88), indicating that the initial gap persisted at discharge. GGT levels were inversely correlated with MMSE scores (r = −0.41; p < 0.001), suggesting a contribution of hepatic dysfunction to cognitive decline. Conclusions: Alcohol-related cognitive impairment is highly prevalent among older patients hospitalized for withdrawal, with partial reversibility observed through inpatient management. The observed rural disparities and the association between hepatic dysfunction and cognitive performance highlight the need of concurrent MMSE and hepatic screening, with prioritized interventions in rural settings. Prospective, multicenter studies are warranted to validate these findings and to identify additional prognostic biomarkers. Full article

The Roma population is one of Europe’s largest ethnic minorities, often living in inadequate living conditions, worse than those of the majority population. They frequently lack access to essential services, even in high-income countries. This lack of basic services—particularly in combination with proximity to (stray) animals and human and solid waste—significantly increases environmental health risks, and leads to a higher rate of endoparasitic infections. Our study sheds light on the living conditions and health situation in Roma communities in Slovakia, focusing on the prevalence of intestinal endoparasitic infections across various settlement localisations. It highlights disparities and challenges in access to safe drinking water, sanitation, and hygiene (WASH) and other potentially disease-exposing factors among these marginalised populations. This study combines a comprehensive review of living conditions as per national data provided through the Atlas of Roma communities with an analysis of empirical data on parasitological infection rates in humans, animals, and the environment in settlements, applying descriptive statistical methods. It is the first study in Europe to provide detailed insights into how living conditions vary and cause health risks across Roma settlements, ranging from those integrated within villages (inside, urban), to those isolated on the outskirts (edge, sub-urban) or outside villages (natural/rural). Our study shows clear disparities in access to services, and in health outcomes, based on where people live. Our findings underscore the fact that (i) place—geographical centrality in particular—in an already challenged population group plays a major role in health inequalities and disease exposure, as well as (ii) the urgent need for more current and comprehensive data. Our study highlights persistent disparities in living conditions within high-income countries and stresses the need for greater attention and more sensitive targeted health-promoting approaches with marginalised communities in Europe that take into consideration any and all of the humans, ecology, and animals affected (=One Health). Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

Enhancing human well-being is a core priority of the Sustainable Development Goals. Understanding urban–rural well-being disparities is crucial for bridging gaps and improving social harmony. However, most existing studies focus on either urban or rural residents’ well-being, neglecting their disparities. This study quantified and compared the spatiotemporal patterns of the well-being of urban and rural residents in the Yangtze River Delta (YRD) urban agglomeration from 2000 to 2020 using the human development index (HDI). Results show the following: (1) Urban and rural well-being improved markedly from 2000 to 2020, with urban HDI increasing from 0.66 to 0.83 and rural HDI from 0.55 to 0.74. (2) Urban education and rural income inequalities were more pronounced, with the average Gini coefficients over 2000–2020 more than threefold and twofold those of urban and rural health, respectively. (3) Although disparities existed between urban and rural well-being, rural HDI had grown faster between 2000 and 2020, narrowing the urban–rural gap. From 2000 to 2020, the growth rate for rural HDI (34.55%) exceeded that for urban HDI (27.13%). To foster the shared urban and rural well-being, this study recommends diversifying rural industries, optimizing educational resources, and enhancing rural healthcare infrastructure in the YRD and beyond. Full article

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron supplementation remains limited, particularly in sub-Saharan Africa. This study examined these regional differences, stratified by income levels and national contexts. Method: This analysis utilised Demographic Health Survey (DHS) data conducted between 2015 and 2023 from 26 sub-Saharan African countries, including 287,642 women from urban (n = 91,566) and rural areas (n = 196,076). The outcome of this study was non-adherence to iron supplementation, defined as taking iron supplementation for less than 90 days during pregnancy. This study examines urban–rural differences in non-adherence stratified by country income levels based on World Bank 2022 income classifications and national context. A chi-square test was used to assess urban–rural differences, with a p-value of <0.05 considered statistically significant. Results: Non-adherence was significantly higher in rural areas (68.42%) than in urban areas (51.32%) (p < 0.001), with the disparity more pronounced in low-income countries (LICs). Ethiopia, Madagascar, Uganda, and Burundi were among the countries with the highest rural non-adherence, reflecting severe poverty and limited access to ANC. In contrast, Zimbabwe showed an inverse trend, where rural adherence was higher than urban. Conclusions: Rural sub-Saharan Africa has significantly higher non-adherence to iron supplementation, particularly in LICs, likely driven by systemic barriers such as poor infrastructure and limited access to healthcare. This non-adherence in rural areas undermines efforts to improve pregnancy and birth outcomes across the region. Targeted interventions, like those in Zimbabwe, can help address these inequities and improve maternal health outcomes. Full article

Background: Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban–rural resident basic medical insurance (URRBMI) participants. Methods: This study utilized data from the 2019 China Household Finance Survey (CHFS), and the concentration index (CI) was employed to estimate the effects of income-related health inequality on participants. Results: Our findings provide clear evidence that health inequality among participants has fluctuated—narrowing, widening, and then narrowing again—in the areas of the contribution, medical treatment, and reimbursement of URRBMI, respectively. Overall, the analysis indicates a widening of health inequality post-reimbursement, with results remaining consistent. A heterogeneity analysis shows that health inequality is most pronounced among women and those with less than a middle school education. Finally, our study reveals a pro-rich trend in the actual utilization of medical services among participants, with persistent disparities in outpatient and inpatient service usage even after standardization, further exacerbating income-related health inequality. Conclusions: We recommend that the URRBMI design take participants’ income levels into account, with policies favoring disadvantaged individuals to enhance their medical security, improve access to healthcare services, and ultimately reduce health inequality. Full article

Background: Breast cancer poses a significant health challenge in Bangladesh, where limited screening and unique reproductive patterns contribute to delayed diagnoses and subtype-specific disparities. While reproductive risk factors such as age at menarche, parity, and contraceptive use are well studied in high-income countries, their associations with hormone-receptor-positive (HR+) and triple-negative breast cancer (TNBC) remain underexplored in low-resource settings. Methods: A case-control study was conducted at the National Institute of Cancer Research and Hospital (NICRH) including 486 histopathologically confirmed breast cancer cases (246 HR+, 240 TNBC) and 443 cancer-free controls. Socio-demographic and reproductive data were collected through structured interviews. Machine learning models—including Logistic Regression, Lasso, Support Vector Machines, Random Forest, and XGBoost—were trained using stratified five-fold cross-validation. Model performance was evaluated using sensitivity, F1-score, and Area Under Receiver Operating Curve (AUROC). To interpret model predictions and quantify the contribution of individual features, we employed Shapley Additive exPlanation (SHAP) values. Results: XGBoost achieved the highest overall performance (F1-score = 0.750), and SHAP-based interpretability revealed key predictors for each subtype. Rural residence, low education (≤5 years), and undernutrition were significant predictors across subtypes. Cesarean delivery and multiple abortions were more predictive of TNBC, while urban residence, employment, and higher education were more predictive of HR+. Age at menarche and age at first childbirth showed decreasing predictive importance with increasing age for HR+, while larger gaps between marriage and childbirth were more predictive of TNBC. Conclusions: Our findings underscore the value of machine learning coupled with SHAP-based explainability in identifying context-specific risk factors for breast cancer subtypes in resource-limited settings. This approach enhances transparency and supports the development of targeted public health interventions to reduce breast cancer disparities in Bangladesh. Full article

Purpose: Socio-demographic inequities in mental health were magnified by COVID-19, with women experiencing greater household burden with less support in Canada and globally. While some health patterns during COVID-19 have been observed globally, there is a research gap in rural mental health during COVID-19 in Canada. We hypothesize there is a disparity in mental health decline during COVID-19 between men and women. Methods: In rural Ontario, mental health was measured through a survey of approximately 18,000 individuals living in seven counties. In 2021, survey respondents were asked to rate their mental health prior to and during COVID-19. Women reported poorer mental health during COVID-19 in comparison to men when tested via chi-squared tests, odds ratios, and percentage change. Responses to survey questions regarding social, financial, and mental health support were then evaluated. Findings: We found significant disparities in mental health ratings before and during COVID-19 between men and women. Women reported poorer mental health, increased substance use, and increased worry about social, financial, and community stressors. Respondents who self-identified as a woman were associated with poorer mental health outcomes. Conclusions: Interventions should be specific to geographic communities as well as individual needs (e.g., additional financial and childcare support). Rural communities need to be considered as independent geographies rather than as one geography (i.e., urban vs. rural). Full article

Background: This study examines disparities in HIV-related healthcare access, support, and treatment adherence between rural and urban Black/African American populations in Georgia, USA, emphasizing structural, socioeconomic, and stigma-related barriers affecting health outcomes. Methods: A cross-sectional quantitative study was conducted using structured surveys administered via RedCap from August to December 2023. Participants (n = 55) were recruited through community-based HIV organizations, healthcare providers, and advocacy networks. The survey assessed demographic factors, healthcare access, adherence to treatment, support systems, and experiences with stigma. Data were analyzed using IBM SPSS Statistics, version 28.0 (IBM Corp., Armonk, NY, USA), with chi-square tests examining associations between geographic location and HIV-related outcomes. Results: Findings indicate significant disparities in HIV care access and support. Urban participants were more likely to receive family and friend support (p < 0.01), financial assistance through the Ryan White Program (p = 0.01), and timely linkage to care within one week of diagnosis (p < 0.05). Rural participants reported lower educational attainment, income levels, and limited healthcare access, contributing to poorer health outcomes. No significant differences were observed in PrEP or condom use. Conclusions: The study underscores the need for targeted interventions. Expanding telehealth, enhancing community outreach, and reducing stigma through policy reforms are critical to improving HIV-related health outcomes in rural Georgia. Full article