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Objective: Rurality is associated with higher incidence and higher disease-specific mortality for most cancers. Outcomes for rural and ultrarural ("frontier") patients with thyroid cancer are poorly understood. This study aimed to identify actionable deficits in thyroid cancer outcomes for rural patients. Methods: We queried linked California Cancer Registry and California Office of Statewide Health Planning and Development databases for patients diagnosed with thyroid cancer (1999–2017). We analyzed time from disease stage at diagnosis, time from diagnosis to surgery, receipt of appropriate radioactive iodine ablation, surveillance status, and overall and disease-specific mortality for urban, rural, and frontier patients. Cox and logistic regression models controlled for clinical and demographic covariates a stepwise manner. All incidence figures are expressed as a proportion of newly diagnosed cases. Results: Our cohort comprised 92,794 subjects: (65,475 women [70.6%]; mean age 50.0 years). Compared to urban patients, rural and frontier patients were more likely to be American Indian, White, uninsured, and from lower quintiles of socioeconomic status (p < 0.01). Distant disease at diagnosis was more common in rural (56.0 vs. 50.4 cases per 1000 new cases, p < 0.01) and frontier patients (80.9 vs. 50.4 per 1000, p < 0.01) compared to urban patients. The incidence of medullary thyroid cancer was greater in rural patients (17.9 vs. 13.6 cases per 1000, p < 0.01) and frontier patients (31.0 vs. 13.6 per 1000, p < 0.01) compared to urban patients. The incidence of anaplastic thyroid cancer was higher in frontier versus urban patients (15.5 vs. 7.1 per 1000, p < 0.01). When compared to urban patients, rural and frontier patients were more often lost to follow-up (odds ratio [OR] 1.69 [confidence interval, CI 1.54–1.85], and OR 3.03 [CI 1.89–5.26], respectively) and had higher disease-specific mortality (OR 1.18 [CI 1.07–1.30], and OR 1.92 [CI 1.22–2.77], respectively). Rural and frontier residence was independently associated with being lost to follow-up, suggesting that it is a key driver of disparities. Conclusion: Compared to their urban counterparts, rural and frontier patients with thyroid cancer present with later-stage disease and experience higher disease-specific mortality. They also are more often lost to follow-up, which presents an opportunity for targeted outreach to reduce the observed disparities in outcomes. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) among CVDs is the largest killer in the developed world and is rapidly becoming one in the developing countries. CAD is a leading cause of mortality, morbidity and disability with high healthcare costs. CAD is caused by atherosclerosis of the coronary arteries that leads to a restriction of blood flow to the heart. Depending on the degree of stenosis (narrowing) and plaque characteristics, patients may experience stable angina (angina pectoris) or remain asymptomatic until a plaque ruptures and thrombosis occurs, causing acute Coronary syndrome. Materials and methods: It was hospital based cross sectional study, conducted at our Hospital over a period of 1 year. Study subjects consisted of old and newly diagnosed CAD cases attending Hospital. Information was collected on a pre-structured, well designed scheduled questionnaire. New and old cases of CAD attending Hospital were included in the study and patients who were unconscious and not giving consent were not included in the study. The subjects were explained with purpose of the study and assured for secrecy and confidentiality of the information which they provided us. It was decided to include 90 study subjects in the study. First case was selected randomly then further every case was selected till 90 study subjects were covered. If any patient did not agree, then the next case was included in the study. Result: The gender influence when studied separately, it was observed that the mean age of the study subjects among females 56.75 ± 2.008 was slightly lower than males 57.68 ± 2.188. Only 11 of the CAD subjects had post graduate education, while only 2 had professional degrees. The majority of smokers and Ex-smoker were males as compared to females. The overall 37 subjects of CAD had hypertension. There were 38 males and 18 females those who had both the comorbid disease (HTN + DM). On the other side 22 patients had no history of co-morbid disease. The majority 31 of study subjects of coronary artery disease were current smokers, followed by 21 Ex-smokers and 38 nonsmokers. The majority of smokers and Ex-smoker were males as compared to females. Conclusion: The findings corroborate existing literature, highlighting gender disparities and urban-rural differences in CAD prevalence and risk factors. This study contributes valuable insights into CAD epidemiology in India, particularly in the North Eastern Zone. [ABSTRACT FROM AUTHOR]

The police occupy a central role in the functioning of the state by being tasked with upholding security, law and order. Across the African continent, the public has little trust in the police, but such perceptions are subject to considerable subnational variation. In this study, we are interested in how the different contexts in which the police operate affect police-citizen relations. We ask: How does an urban versus rural environment shape citizens' trust in the police? We address this question within the context of Kenya, using geocoded survey data from Afrobarometer. We theorise that the rural versus urban environment will shape citizens' experience with the police in ways that affect their attitudes toward the police. Specifically, we argue that in a context where the police have frequently been employed to repress specific sociopolitical groups, urban residents, living in denser and more diverse environments compared to rural residents, are more prone to have first- or second-hand experiences of the police that result in diminished trust towards them. Our results support these propositions: We find a strong and robust relationship between urban residence and lower levels of trust in the police. The relationship holds when controlling for respondents' political alignment, which likely conditions people's perceptions of state institutions. Qualitative evidence from interviews provide additional understanding of the urban-rural divide we identify. Our results provide important insights into the contextual dynamics that shape individuals' trust in the police, and underline the importance of efforts to improve police-community relations in urbanising contexts. [ABSTRACT FROM AUTHOR]

Wild pollinators and their microbiota are sensitive to land use changes from anthropogenic activities that disrupt landscape and environmental features. As urbanization and agriculture affect bee habitats, human-led disturbances are driving changes in bee microbiomes, potentially leading to dysbiosis detrimental to bee fitness. This study examines the bacterial, fungal, and plant compositions of the small carpenter bee, Ceratina calcarata , and its pollen provisions across an urban–rural divide. We performed metabarcoding of C. calcarata and provisions in Toronto by targeting the 16S rRNA, ITS, and rbcL regions. Despite similar plant composition and diversity across bees and their provisions, there was a greater microbial diversity in pollen provisions than in bees. By characterizing the differences in land use, climate, and pesticide residues that differentiate urban and rural landscapes, we find that urban areas support elevated levels of microbial diversity and more complex networks between microbes and plants than rural areas. However, urban areas may lead to lower relative abundances of known beneficial symbionts and increased levels of pathogens, such as Ascosphaera and Alternaria fungi. Further, rural pollen provisions indicate elevated pesticide residues that may dysregulate symbiosis. As anthropogenic activities continue to alter land use, ever changing environments threaten microbiota crucial in maintaining bee health. [ABSTRACT FROM AUTHOR]

Previous meta-analyses have revealed that in adult and older adult populations of developed countries, depression is more prevalent in urban than rural areas. No meta-analyses have identified the effects of urbanicity on the general age demographic for developing countries. We conducted a meta-analysis of urban-rural differences in depression across all age demographics for developed and developing countries. PubMed and PsycINFO databases were searched for studies published between 1980 and 2020. Studies were included if they reported prevalences of urban and rural depression, or odds ratios comparing urban-rural depression prevalence. Studies were excluded for: nonrepresentative samples, non-standard measures of depression, and reporting continuous outcomes only. Meta-analytic models of urban-rural differences in the odds of depression were conducted across country development levels and age demographics. From 1597 records screened and 302 full texts assessed for eligibility, 80 studies (N = 539,557) were included for meta-analysis. Urban residence was significantly associated with a higher prevalence of depression in developed countries (OR = 1.30, 95 % CI [1.17, 1.46], z = 4.75, p <.001), which was primarily driven by urban-rural differences in the general population age demographic (OR = 1.37, 95 % CI [1.22, 1.54], z = 5.38, p <.001). Studies reporting urban-rural differences in depression in terms of continuous symptom severity scores were not included. Urbanicity appears to uniquely be associated with a higher prevalence of depression in developed countries, but not in developing countries. • In developed countries, depression is more prevalent in urban than rural areas. • This urbanicity effect is most observable in the general age demographic. • In developing countries, there is no effect of urbanicity on depression. • The impact of urbanicity on depression may be growing for developing countries. [ABSTRACT FROM AUTHOR]

Objective To analyze the urban and rural differences and influencing factors of the demand for community door-to-door medical services of the disabled elderly. Methods In total 3 865 disabled elderly were selected as research subjects from the 2018 Chinese Longitudinal Healthy Longevity Survey. The 於 test, rank sum test, and binary logistic regression were used to analyze the demand and influencing factors of community door-to -door medical services for the disabled elderly in urban and rural areas. Results In total 2 154 (83.39%) rural disabled elderly and 1 009 (78.71%) urban disabled elderly had demand for community door-to-door medical services, and the difference was statistically significant (护=6.113, P=0.013), Age over 80 years old: (OR=L529, 95%CI: 1.044-2.239; P<0.05), old-age security (old-age pension: OR=1.370, 95%CI: 1.070-1.755, P<0.05; retirement pension: OR=0,637, 95%CI: 0.424-0.959, P<0.05) and visual acuity (unclear: 0/2=1.272, 95%CI: L010-1.601, P < 0,05) were the influencing factors of the demand for community-based medical services of the disabled elderly in rural areas. Geographical division (northeast: 0R=0,603, 95%CI: 0413-0.881, P<0,01), health self-assessment (bad: 0=1.891, 95%CI: 1.151-2.893, P < 0.05) and loneliness self-assessment (having experienced loneliness: OR-1,467, 95%CI: 1.057-2.036, P < 0.05) were the influencing factors of the demand for community-to-home medical services of the urban disabled elderly. Conclusion The demand for community door-to-door medical service of the elderly in rural areas is higher than that in urban areas. In providing door-to-door medical services, we should focus on the rural disabled elderly with old age, pension, and visual impairment as well as the urban disabled elderly with poor self-evaluation and loneliness. [ABSTRACT FROM AUTHOR]

Existing studies on the contemporary U.S. urban-rural divide have neglected its potential role in non-voting political participation. Theoretically, there are mixed expectations: for example, higher social capital in rural areas, alongside a generally older population, suggest rural areas should have greater political participation. Conversely, lower socioeconomic indicators and more physical distance barriers suggest the opposite. Using nationally stratified survey data from the 2018 CCES (N = 61,000) and 2020 CES (N = 60,000), we find that specific participation behaviors do not consistently vary across the urban-rural spectrum, controlling for demographic variables. The few consistently significant differences relate to the nature of location-based access. For instance, using 2020 and 2021 ACLED data, we find that an activity where non-rural residents participate more—protesting—occurs less often in rural areas, thus stymieing participation opportunities for rural and small-town residents. Alternatively, rural and small-town residents are consistently more likely to put up a sign, which may reflect a greater incidence of living in houses with yards compared to urban residents. Social media political participation behaviors do not yield urban-rural differences, further suggesting that once geographic access-related barriers are removed, participation rates are essentially similar across the urban-rural spectrum. [ABSTRACT FROM AUTHOR]

Background In this study, we wanted to assess the menstrual awareness among urban and rural adolescent girls and compare the menstrual hygiene practices among them. Methods This was a hospital based cross-sectional study conducted among 170 adolescent girls attending the OPD of Gynaecology, Paediatrics and General Medicine at Government Medical College, Thrissur District, Kerala. It was carried for a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. They were provided with a validated questionnaire to assess menstrual awareness hygiene practice among them. Results Majority (89.4%) from the urban area of residence believed that it was physiological, while majority (54.1%) from the rural areas didn't know the actual cause for menstruation. This difference between the rural and urban areas on awareness about the cause of menstruation was found to be statistically significant. More than half of the subjects used sanitary pads during menstruation. The frequency of changing pads at school was less in both urban and rural groups. The reusage of pads was almost similar among rural and urban study subjects with around 23.5% and 22.4% of them reusing the pads respectively in both the groups. Awareness regarding menstrual cup was more in urban group compared to rural. But restrictions during menstruation was practised more in rural group that is 70% compared to urban group which was roughly 52%. Conclusion Menstrual health forms the most important stepping stone to women's sexual and reproductive health. One third of the study population was not at all aware of the cause of menstruation. There was significant difference in various menstrual hygiene practices among urban and rural girls. Many restrictions were practiced during menstruation more in rural group. A concerted effort from parents, educational institutions and existing healthcare institutions along with media may ensure safe and secure reproductive health prospects for adolescents in the region. [ABSTRACT FROM AUTHOR]

As the American political landscape becomes increasingly divided along urban–rural lines, it raises the prospect of deepening social identities that are tied to one's community-type. As community-type becomes an important social identity, it can lead to favoritism of one's community in-group, or denigration of one's community out-group. We explore the extent to which urban and rural identities exist above and beyond other factors like party and race, and whether they are consequential for the ways in which people evaluate the political and non-political world. Using national survey data, we demonstrate that people in both urban and rural locations hold beliefs that are consistent with a community-type social identity that is independent of other factors which are correlated with the urban–rural divide. We use two different experiments to assess the consequences of this identity, finding that there are distinct effects in the political arena when allocating government resources, and in the non-political world when judging hypothetical job applications. These effects are generally smaller in magnitude than other factors, such as partisanship, but suggest that community-type identities are important in politics. [ABSTRACT FROM AUTHOR]

Background: Suicidal ideation (SI) is severe comorbidity of depression that has been extensively studied in the past. Residence differences between SI have rarely been systematically studied, especially in parental rearing behavior. This large-scale explored the residence differences in the prevalence and correlation of SI adolescent patients with depression.Methods: A total of 1417 patients with depression were recruited, and their demographic data and clinical data were collected. The Children's Depression Inventory (CDI) and the Egna Minnen Beträffande Uppfostran (EMBU) scale were used to assess depression, and parental rearing behavior, respectively.Results: The prevalence of suicidal ideation was higher in urban patients than in rural patients (43.7 % vs.37.7 %, P < 0.05). Patients with SI scored higher on total CDI scores, parental punishment, parental rejection, and paternal overprotection compared to their respective patients without SI. In the urban group, patients with SI had lower parental emotional warmth scores and higher parental intervention scores compared to patients without SI. Logistic regression analysis showed that total CDI score, gender, alcohol consumption, father's emotional warmth, father's rejection, and mother's intervention were significantly associated with SI in urban patients (P < 0.05); total CDI score and mother's rejection were significantly associated with SI in rural patients (P < 0.05).Limitations: No causal relationship could be drawn due to the cross-sectional design.Conclusions: The results of this study showed significant residential differences in risk and associated factors for SI among adolescents with depression. Focusing on the parenting styles of adolescent patients can help with the early identification and intervention of SI. [ABSTRACT FROM AUTHOR]

Aim: The aim of this article is to estimate prevalence of menopausal symptoms among women in the menopausal age group and study the urban-rural differences. Methods and Design: Analytical cross-sectional study conducted in rural and urban field practice areas of a tertiary care center affiliated to Medical College, where 290 women (145 each from urban and rural areas) were interviewed to measure prevalence of menopausal symptoms. Forty-one symptoms were divided into 'Psycho-somatic' (17 symptoms), 'genito-urinary (9 symptoms)' and musculo-skeletal (5 symptoms) domains. The prevalence of each of these symptoms is reported as proportion and the differences in the median scores in the two groups were tested using Mann-Whitney U test. Results: From among 145 women each, in urban and rural settings, most common psychosomatic symptoms were physical exhaustion-fatigue (73.1%), difficulty climbing stairs (59.3%), sleep problems (45.2%), body ache (43.4%), and hot flushes (41.4%). Among the urban participants, most common was physical exhaustion (42.1%), difficulty climbing stairs (62.1%), anger (46.9%), sleep problems (45.5%), and irritability (42.1%), while among the rural participants they were physical exhaustion (66.2%), difficulty climbing stairs (56.6%), insomnia (54.5%), and body ache (46.2%). Most common genito-urinary symptoms overall and in rural areas were urinary urgency (35.9% and 38.6%), increased frequency of urine (31.7% and 37.2%) and incontinence (30% and 35.2% respectively). Among the urban women, common symptoms were urinary urgency (33.1%) followed by itching of private parts (30.3%) and increased frequency of urination (26.2%). Among musculo-skeletal symptoms, joint pain (74.1%, 74.5%, 73.8%) was the most common symptom followed by joint and muscular discomfort (71.7%, 73.8%, 69.7%) among the overall, urban and rural participants. There was a significant difference in the median psychosomatic score as per the symptoms experienced by the urban and rural participants (U = 36, Z statistic = 2.31, and P = 0.02). However, there was no significant difference in the scores for genito-urinary and musculo-skeletal symptoms; thereby, median scores under both these domains were almost similar in both urban and rural groups Conclusion: There was significant difference in the median psychosomatic score as per the symptoms experienced by the urban and rural participants however; there was no significant difference in genito-urinary and musculo-skeletal symptom scores. [ABSTRACT FROM AUTHOR]

This study uses three years of repeated cross-sectional data (N = 386,654) from the multinational Gallup World Poll (representing >90 % of world's population) to explore differences in the well-being of rural and urban inhabitants. We performed a series of descriptive analyses comparing rural and urban residents on 30 indicators of well-being, both in the overall sample and by regional, sex, educational, age, and income subgroups. In the overall sample and for most subgroups, urban residents tended to report higher levels of well-being compared to their rural counterparts (effect sizes were mostly very small). This trend did not apply to all well-being metrics, with rural residents occasionally reporting more favorable well-being for some indicators (both in the overall sample and for some subgroups). Our findings suggest that the magnitude and direction of urban-rural well-being disparities are nuanced and may vary across different individual and geographical capabilities (e.g., resources, opportunities, and freedoms available to individuals based on their location). The findings of this study offer a global snapshot of potential urban-rural disparities in well-being, and provide a stepping-stone toward more robust research that can unpack the causal dynamics between the rural-urban continuum and multidimensional well-being. We explore some possible implications of the findings for policy development and practice aimed at fostering well-being in rural and urban areas around the world. • Gallup data indicates urban dwellers enjoy a well-being advantage. • Well-being disparities vary by demographics. • A capabilities approach sheds light on the urban-rural well-being divide. • Urban vs rural well-being differs due to ecological, social, and cultural factors. • Findings suggest policies should be customized for urban and rural well-being. [ABSTRACT FROM AUTHOR]

Reducing crime is a fundamental goal of all policymakers, because its costs are both pecuniary and non-pecuniary. A number of studies have shown that individuals who are victims of crime report lower levels of life satisfaction or subjective well-being (SWB) as compared to nonvictims (Powdthavee, 2005; Cohen, 2008; Davies & Hinks, 2010). But, what is not as clear is how this nexus may differ based on household geo-type, or put differently, whether a household is located in an urban area versus a rural area. The rationale as to why geographical location is likely to play a role is as follows: (a) people migrate from rural to urban areas in hopes of finding a job or better standard of living. Given that urban migration is associated with "false expectations" (Mulcahy & Kollamparambil, 2016:1357), it may lead some to turn to crime as a means of coping. Therefore, one expects to see more crime in cities as opposed to farm areas. (b) In rural areas, people share a sense of community or 'Ubuntu'1. This means that should someone fall victim to crime, others will ensure that its effects on well-being are minimized, by assisting where they can. (c) Social disorganization theory explains differences in urban and rural crime rates, as it suggests that "a person's residential location is more significant than the person's characteristics when predicting criminal activity" (Bond, 2015: para 4). This paper investigates the impact of perceived crime on individual well-being in urban and rural areas of South Africa using a nationally representative panel dataset from 2008 to 2017. By making use of a fixed-effect model, a finding was that perceived crime negatively influences the SWB of individuals living in rural and urban areas in South Africa. Unlike the urban coefficient, the rural coefficient is not statistically significant. These results suggest two patterns: firstly, perceived crime plays a stronger role in predicting SWB in urban areas as compared to rural areas. This is likely because urbanization is linked to a higher rate of crime (Park, Burgess & McKenzie, 1925). Secondly, it provides empirical support that there exists a geographically differentiated relationship between perceived crime and the SWB nexus in South Africa. The estimates are robust to the inclusion of the inequality variable as well as alternative models (specifically random ordered probit model). [ABSTRACT FROM AUTHOR]

Scholars are increasingly rethinking the urban, the rural, and the urban–rural binary. This article advances understanding of rural and urban imaginaries through examining how young people in a village in north India develop practices that they regard as "urban" to protect rural futures. Young adults (aged eighteen to thirty) in the village of Bemni, Uttarakhand, develop urban-style educational facilities and agricultural practices as well as performances of gender empowerment imagined as urban with a view to improving the functioning of their village and preventing migration to cities. Through analyzing these practices of "selective urbanism," we point to the production of ideas of urbanism and rurality beyond the metropolitan and large city regions usually studied and the importance especially of the performance of urban fragments in people's conceptions of rural futures. We also examine how value is attached to ideas of the rural and urban and how people deploy as well as problematize the rural–urban binary. [ABSTRACT FROM AUTHOR]

Studies have shown that children in rural areas face excess risks of dying, but the little research on spatial inequalities in adult mortality has reached mixed conclusions. We examine rural–urban differences in mortality in 53 low- and middle-income countries. We consider how the rural–urban mortality gap evolves from birth to age 60 by estimating mortality based on birth and sibling histories from 138 Demographic and Health Surveys run between 1992 and 2018. We observe excess rural mortality until age 15, finding the largest differences between urban and rural sectors among 1–59-month-olds. While we cannot claim higher mortality among urban adults than those in rural areas, we find a reduced gap between the sectors over the life course and a diminishing urban advantage in adult mortality with age. This shift over the life course reflects a divergence in the epidemiologic transition between the rural and urban sectors. [ABSTRACT FROM AUTHOR]

• Across European countries consumers differ in intention to adopt alternative proteins. • Approval of insect-based proteins is higher in Northern than Southern Europeans. • Eastern European consumers are not ready to shift diet toward alternative proteins. • Similarities in adoption of alternative proteins were found for rural and urban areas. • Local production of alternative proteins increases a likelihood to try such proteins. This review synthesizes empirical evidence for the associations between alternative protein food (APF) choices and geographical context factors, including differences and similarities between consumers from various European countries, rural versus urban environments, and the "local" attribute of APF. The preregistered systematic review (PROSPERO repository, no. CRD42023388700) was conducted in 13 databases with 25 original studies being included. The risk of bias was evaluated using Joanna Briggs Institute quality evaluation tools. The findings indicate that across consumers from European countries, levels of intention to eat, try, and buy APF are low-to-moderate. Patterns of APF consumers' choices differed between Northern Europe (Denmark, Finland), Southern Europe (Italy, Spain), and Eastern Europe (Poland, Czech Republic). For example, Danish consumers have positive attitudes but relatively low intention to eat plant-based APF. In turn, Polish consumers have lower levels of knowledge and low readiness to shift dietary patterns toward APF intake compared to Western European consumers (e.g., Germany). Italian consumers have a lower acceptance of insect-based APF than consumers from Western or Northern European countries (e.g., Belgium, Denmark). Our findings do not support rural–urban differences. Finally, perceiving an APF product as local may increase the likelihood of APF choice by European consumers. Our review provides preliminary insights into differences among consumers inhabiting European countries, suggesting the use of different messages to promote APF intake across Europe. Systematic research comparing countries across Europe is needed to verify the consistency of geographical differences. [ABSTRACT FROM AUTHOR]

To examine associations between sun protection behaviors and physical activity (PA) by rural and urban residence in the United States. We analyzed data from the National Health and Nutrition Examination Survey (2013–2018), restricting to participants ages 20–59 with sun behavior data. Sunburns, sun exposure, and sun protection measures were dichotomized (yes/no): ≥1 sunburn in the past year, 2+ hour outside during workdays or non-workdays, and never/rarely/sometimes using sunscreen, wearing long sleeves, and staying in the shade. Meeting PA recommendations (yes/no) was defined as ≥150 min of vigorous/moderate or ≥ 75 min vigorous PA per week. Associations between sun behaviors and PA were analyzed using logistic regression models, which accounted for survey-weights and potential confounders, and stratified by rural-urban status. Rural and urban individuals meeting PA recommendations had greater odds of spending 2+ hour outside during workdays (OR: 2.26 [1.88, 2.74] and 3.95 [2.72, 5.73]) and non-workdays (OR: 2.06 [1.78, 2.38] and 3.33 [2.47, 4.46]). Among urban residents, odds of staying in the shade were lower among those who met PA recommendations (OR: 0.78 [0.66, 0.92]). We did not observe differences in sunburns or other sun behaviors by PA status, regardless of rurality. Meeting PA recommendations was associated with greater sun exposure in both rural and urban populations. Additional exercise location (indoors/outside) data is needed to inform PA and skin cancer prevention interventions to reduce unintended increases in sun exposure and reductions in PA, respectively, especially among rural populations. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effect of age and urban and rural living environments on children's actual and perceived motor competence. To that end, 320 female students aged 8–12 years were selected through random cluster sampling. The perceived motor competence of the participants was assessed using Marsh's Physical Self-Description Questionnaire, and their actual motor competence was measured by the Test of Gross Motor Development-3. The results showed significant differences between urban and rural girls in perceived and actual motor competence (p <.05). However, age did not make any significant difference in motor competence (p >.05). The most significant differences in actual and perceived motor competence between urban and rural girls were observed in girls aged 8 and 10 (p <.05). The findings also indicated that rural children performed better in actual motor skills, especially ball skills. Therefore, based on the findings, it was concluded that the rural environment could have a greater impact on actual motor competence. [ABSTRACT FROM AUTHOR]

Summary: In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross‐sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food‐frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR‐range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population‐based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children. [ABSTRACT FROM AUTHOR]

Purpose: Health-related quality of life (HRQOL) among older cancer survivors can be impaired by factors such as treatment, comorbidities, and social challenges. These HRQOL impairments may be especially pronounced in rural areas, where older adults have higher cancer burden and more comorbidities and risk factors for poor health. This study aimed to assess rural–urban differences in HRQOL for older cancer survivors and controls. Methods: Data came from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS), which links cancer incidence from 18 U.S. population-based cancer registries to survey data for Medicare Advantage Organization enrollees (1998–2014). HRQOL measures were 8 standardized subscales and 2 global summary measures. We matched (2:1) controls to breast, colorectal, lung, and prostate cancer survivors, creating an analytic dataset of 271,640 participants (ages 65+). HRQOL measures were analyzed with linear regression models including multiplicative interaction terms (rurality by cancer status), controlling for sociodemographics, cohort, and multimorbidities. Results: HRQOL scores were higher in urban than rural areas (e.g., global physical component summary score for breast cancer survivors: urban mean = 38.7, standard error [SE] = 0.08; rural mean = 37.9, SE = 0.32; p < 0.05), and were generally lower among cancer survivors compared to controls. Rural cancer survivors had particularly poor vitality (colorectal: p = 0.05), social functioning (lung: p = 0.05), role limitation-physical (prostate: p < 0.01), role limitation-emotional (prostate: p < 0.01), and global mental component summary (prostate: p = 0.02). Conclusion: Supportive interventions are needed to increase physical, social, and emotional HRQOL among older cancer survivors in rural areas. These interventions could target cancer-related stigma (particularly for lung and prostate cancers) and/or access to screening, treatment, and ancillary healthcare resources. [ABSTRACT FROM AUTHOR]

This article examines a tension at the heart of national leadership in Solomon Islands today: a conviction that national leaders need to spend more time in rural environments to better represent rural interests, needs and values, while having to be in town to access the individuals and organizations that, essentially, make them national leaders in the first place. Drawing on fourteen months of ethnographic fieldwork in urban Honiara and the rural Lau Lagoon, Malaita, we are especially interested in how this tension shapes rural perceptions of the legitimacy of chiefs as national leaders. Given that development projects can only be negotiated in Honiara, where the required state institutions, international (N)GOs and major businesses are based, rural residents feel compelled to send their most important village leaders, especially clan chiefs, to town. However, the longer these leaders are away from their homes, the more they seem distracted by urban 'luxuries' and the less they appear committed to their rural homes. In particular, villagers complain about their chiefs' contributions to exchange relations. Villages, thus, find themselves in a double‐bind that exaggerates a broader 'crisis of leadership' alongside an urban‐rural divide which challenges the promise of chiefly leadership as solution to antipolitical sentiments and a centralized state. [ABSTRACT FROM AUTHOR]

The 2021 German Federal Election saw an increasing variation in voting behavior between both age groups and geographic groups. This paper brings these developments together and argues that the urban-rural divide is much bigger among younger than among older voters. We combine data from the German Longitudinal Election Study with original survey data and introduce the number of freelance artists at the ZIP code level as a new measure of urbanity. Using this data, we show that the urban-rural age divide concerns cultural attitudes as well as the propensity to vote. While the Greens mainly attract young voters in cities, the AfD performed well among young rural voters, particularly in Eastern Germany. At the same time, the differences between the young and the old are larger in cities than in the countryside. These results suggest that the importance of the urban-rural divide is likely to increase in future elections. [ABSTRACT FROM AUTHOR]

Context: Family caregivers play a vital role in managing the pain of hospice patients with cancer; however, caregivers' knowledge of pain management principles and experiences as pain managers vary widely. Differences in cultural values and access to resources suggest that rural and urban hospice family caregivers may differ with regard to their pain knowledge and experience, but this has not been empirically investigated.Objectives: We sought to determine if rural and urban hospice family caregivers differed in terms of their knowledge of cancer pain management principles and their experiences managing cancer pain.Methods: Our study consisted of a secondary analysis of baseline, cross-sectional data from hospice family caregivers (N = 196) participating in an ongoing cluster randomized crossover pragmatic trial. We performed multivariable regression to model associations between caregivers' demographic characteristics and their scores on the Family Pain Questionnaire (FPQ), which included subscales measuring pain knowledge and experience.Results: When controlling for other demographic variables, rural caregivers' scores on the FPQ knowledge subscale were worse (P = 0.01) than their urban counterparts. FPQ experience subscale scores and FPQ total scores were not statistically significantly different between the two groups.Conclusion: Rural hospice family caregivers report greater pain knowledge deficits than urban hospice family caregivers, although the two groups report comparable pain management experiences. Additional research is needed to better explain observed differences. [ABSTRACT FROM AUTHOR]

Given the dearth of research exploring mental health differences between rural and urban men who have sex with men (MSM), we sought to examine differences in depressive symptomology and loneliness. Concurrently we examined the mediating effects of loneliness on the link between geographic locale and depressive symptoms via a mediation model. Data were collected from 156 MSM in Oklahoma. Results show urban MSM have significantly higher levels of both depressive symptomology and loneliness. Mediation analyses revealed that the link between urban/rural locale and depressive symptomology was mediated by loneliness. In other words, identifying as urban MSM may result in higher levels of depressive symptomology through feelings of loneliness. The rationale for this includes the possibility that rural MSM may have strong online social support 'networks' which act as a protective factor against loneliness and depressive symptomology, or that elements of urban environments increase stress in urban MSM. It is also possible that the urban landscape of Oklahoma does not provide the same level of acceptance as other urban areas in more liberal parts of the country. Interventions at the individual or community level should consider geographic location as a mesosystem factor that impacts the mental health of MSM. [ABSTRACT FROM AUTHOR]

Introduction: The problematic use of internet is associated with dysfunction life style. The emerging evidence do also suggest its impact on user's mood profile. There is need to establish the urban and rural difference in relation to internet use as well as its association with mood states and its implications for primary care setting. Methods: The present work explored the pattern of internet use in Urban and Rural area and its impact on mood states. 731 individuals (403 males and 328 females) in the age group of 18-25 years from urban and rural areas were approached for the study. The internet addiction test and Depression Anxiety Stress Scale were administered in group setting. Results indicated no significant difference in term of internet use as well as in term for gender. Significant difference was seen for internet use and mood states. Results: The results indicate no significant difference in terms of internet use pattern and gender in relation to urban and rural areas. However, a significant difference exists with respect to Internet use and its relation to depression, anxiety and stress. Conclusions: It implies the development of early brief intervention for Primary Physicians to enable them to screening psychological conditions along with internet use as well as help users to have healthy use of technology. [ABSTRACT FROM AUTHOR]

Over half of the world's human population currently lives in cities, and population density in urban areas is projected to increase over the coming decades. Past studies have shown cities to be hotspots for atmospheric deposition of nitrogen and researchers have found individual cities to have elevated rates of atmospheric phosphorus deposition. However, it remains unknown whether atmospheric phosphorus inputs are elevated in urban areas around the world and how temperature and precipitation affects these inputs. We conducted a meta-analysis to compare atmospheric deposition of phosphorus in urban and rural sites across the globe. We hypothesized that atmospheric phosphorus deposition behaves similarly to atmospheric nitrogen deposition, with increased concentrations and rates of atmospheric phosphorus inputs in urban compared to nearby rural areas. We also hypothesized that the urban enhancement of atmospheric phosphorus inputs is positively influenced by mean annual temperature and precipitation. Data were compiled from 38 cities across 11 countries (i.e. Brazil, China, India, Japan, Pakistan, Spain, Taiwan, Tunisia, Turkey, Ukraine, and United States) and five continents (i.e. Africa, Asia, Europe, North America, and South America). Across the 16 cities that had paired urban and rural sites, there was not a statistically significant difference in atmospheric concentrations nor fluxes of phosphorus deposition between urban and nearby rural sites. However, we found that the difference between rates of atmospheric phosphorus deposition in urban vs. rural sites is positively related to mean annual temperature, though not total annual precipitation. Together these results demonstrate that climatic factors like temperature enhance the urbanization effect, such that sites with warmer temperatures experience a greater difference in urban vs. rural phosphorus deposition rates. • Increasing interest in atmospheric phosphorus deposition over time. • No significant urban enhancement of phosphorus deposition across sites. • Higher temperatures increase deposition difference between urban and rural sites. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the knowledge, awareness and attitude towards the human papilloma virus (HPV) vaccine between urban and rural population groups. Materials and methods: A comparative and descriptive study was undertaken of 200 women attending gynaecological services in the Pietermaritzburg Hospitals Complex. A systematic random sampling and interview-administered questionnaire was conducted. The study analysed demographic data and compared the similarities/differences in terms of awareness, knowledge, attitude and uptake of HPV vaccine between the groups. Results: Some 29% of urban participants as compared with 27% of rural participants knew about HPV; 72% lacked knowledge and awareness of HPV (71.0% urban and 73% rural). Of the urban population, 12% knew that HPV vaccine existed and protected against HPV transmission, 54% did not know, whilst 34% wished to know more. Only 7% of the rural population knew that the HPV vaccine existed and protected against HPV transmission, 57% did not know and 36% expressed the wish to know more. Overall 25% of the participants agreed on HPV vaccine safety (urban, 28 vs. rural, 22), while among the rest of the participants 75% were unsure. In total 57% of participants were unsure as to whether the HPV vaccine could encourage sexual promiscuity (urban, 56 vs. rural, 59), 21 urban dwellers agreed that the HPV vaccine could encourage sexual promiscuity and 23 disagreed. In the rural populations, 24 agreed and 17 disagreed. Conclusion: The knowledge and awareness of the HPV vaccine was generally poor among both the urban and rural population groups. However, both rural and urban dwellers expressed the need for more information about the HPV vaccine before they could recommend the vaccine. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether country-level urban population growth is associated with the magnitude of the urban-rural disparity in under-five mortality (U5M) using ecologic and multilevel analyses.Methods: We used data from 2010 to 2015 Demographic and Health Surveys and World Bank data from 30 sub-Saharan African countries (n = 411,054 women). Country-level linear regressions determined associations between urban population growth and economic growth between 2005 and 2010 on U5M risk differences. Multilevel logistic regression models were used to determine the impact of urban population growth on the urban advantage in U5M, adjusting for child and maternal factors.Results: Countries with greater urban population growth and low economic growth had greater disparities in U5M between urban and rural areas. After adjusting for known U5M risk factors in multilevel analyses, interactions between country-level urban population growth and urbanicity were identified.Conclusions: Continued efforts to evaluate and address disparities in child mortality outcomes in sub-Saharan Africa should acknowledge urbanicity in context, as well as socioeconomic and geographic realities of families, mothers and children. Low-resource, demographically shifting environments require novel strategies to decrease child mortality. [ABSTRACT FROM AUTHOR]

This is prospective, cross-sectional, questionnaire-based study which was carried out among 300 literate subjects of both urban and rural population. The objective of our study was to compare the impact and pattern of self-medication between urban and rural literate population. Three hundred literates with one hundred and fifty each in urban and rural population were provided with a questionnaire containing various questions on the implications, pattern and reasons for selfmedication. Data was analyzed statistically using SPSS version 18 for counts and percentage. Respondents in the urban group fell ill more often than in the rural group (33% v/s 26%) but tendency to self-medicate was less (71% v/s 86%). Use of previous prescription was also less common (67% v/s 81%) among them. Incidence of adverse drug reactions was less (17% v/s 27%); however, emergencies were more (51% v/s 13%) among urban population. Self-medication was largely due to lack of time (66% v/s 47%) and antibiotics were more frequently used (26% v/s 7%). Though lack of time (47%) was the commonest reason for self-medication in rural population, cost was also an important factor (17%). In both the groups, analgesics were the most commonly used drugs for self-medication (U = 46%, R = 53%).The pattern of self-medication is different in urban and rural literate populations. Adverse reactions including emergencies can occur due to selfmedication. Hence, awareness about self-medication and its hazards has to be created among both urban and rural population. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare total ankle arthroplasty (TAA) utilization and outcomes by patient residence. We used the Nationwide Inpatient Sample (NIS) from 2003 to 2011 to compare utilization and outcomes (post-arthroplasty discharge disposition, length of hospitalization, and mortality) by rural vs. urban residence. Ten thousand eight hundred thirty-three patients in urban and 3,324 patients in rural area underwent TAA. Compared to rural residents, urban residents had: lower mean age, 62.4 vs. 61.8 years ( p < 0.0001); higher percent of women, 49 vs. 56 % ( p = 0.0008); and lower proportion of Whites, 93 vs. 86 % ( p = 0.0005). There were rural-urban disparities in TAA utilization in 2003 (0.32 vs. 0.39/100,000; p = 0.021), but not in 2011 (1.19 vs. 1.17/100,00; p = 0.80). TAA outcomes did not differ by rural vs. urban residence: (1) 11.3 % rural vs. 14.2 % urban residents were discharged to an inpatient facility ( p = 0.098); (2) length of hospital stay above the median stay, was 44.8 vs. 42.2 % ( p = 0.30); and (3) mortality was 0.2 vs. 0.1 %, respectively ( p = 0.81). Multivariable-adjusted logistic regression models did not show any significant differences in discharge to home, length of stay, or mortality, by residence. Our study demonstrated an absence of any evidence of rural-urban differences in TAA outcomes. The rural-urban differences in TAA utilization noted in 2003 were no longer significant in 2011. [ABSTRACT FROM AUTHOR]

Congenital toxoplasmosis involves Toxoplasma gondii type II strains in 95% of cases in France. We used spatial principal component analysis (sPCA) and 15 microsatellite markers to investigate the spatial genetic structure of type II strains involved in 240 cases of congenital toxoplasmosis in France from 2002 through 2009. Mailing addresses of patients were geo-referenced a posteriori in decimal degrees and categorized into urban or rural areas of residence. No spatial genetic structure was found for type II strains that infected mothers who were living in urban areas, but a global spatial genetic structure was found for those that infected mothers who were living in a rural environment. Our results suggest that sources of infection by T. gondii are different in rural and urban areas in France, and advocate for targeted messages in the prevention of toxoplasmosis according to the type of residence of susceptible people. [ABSTRACT FROM AUTHOR]

Background Studies have shown that the prevalence of mental illness can vary between urban and rural locations. This study extended research to the countries of the former Soviet Union (fSU) by assessing the association between settlement type and psychological distress and whether factors associated with psychological distress vary by settlement type. Methods Data on 18,000 adults aged ≥18 years from the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010/11 were analyzed. Settlement types were country capitals, regional capitals, cities/other urban settlements, and villages. Psychological distress was defined as the country-specific highest quintile of a composite score based on 11 questions. Logistic regression analysis with random effects was used to examine associations. Results In a pooled country analysis, living in a smaller urban settlement or village was associated with significantly higher odds for psychological distress compared to living in the country capital. Lower social support was a strong correlate of psychological distress in all locations except capital cities. Limitations The psychological distress measure has not been formally validated in the study countries. Conclusions Lower levels of urbanicity are associated with greater psychological distress in the fSU countries. As many Western studies have linked greater urbanization to poorer mental health, this highlights the need for caution in extrapolating findings from one part of the world to others and the importance of undertaking research on the geographical correlates of mental health in different world regions. [ABSTRACT FROM AUTHOR]

ABSTRACT In the Roman period, urban and rural ways of living were differentiated philosophically and legally, and this is the first regional study of these contrasting life-ways. Focusing on frailty and mortality risk, we investigated how these differed by age, sex, and status, using coffin type as a proxy for social status. We employed skeletal data from 344 individuals: 150 rural and 194 urban (1st-5th centuries A.D.) from Dorset, England. Frailty and mortality risk were examined using indicators of stress (cribra orbitalia, porotic hyperostosis, nonspecific periostitis, and enamel hypoplastic defects), specific metabolic and infectious diseases (rickets, scurvy, and tuberculosis), and dental health (carious lesions and calculus). These variables were studied using Chi-square, Siler model of mortality, Kaplan-Meier analysis, and the Gompertz model of adult mortality. Our study found that overall, mortality risk and survivorship did not differ between cemetery types but when the data were examined by age, mortality risk was only significantly higher for urban subadults. Demographic differences were found, with urban cemeteries having more 0-10 and >35 year olds, and for health, urban cemeteries had significantly higher frequencies of enamel hypoplastic defects, carious lesions, and rickets. Interestingly, no significant difference in status was observed between rural and urban cemeteries. The most significant finding was the influence of the skeletal and funerary data from the Poundbury sites, which had different demographic profiles, significantly higher frequencies of the indicators of stress and dental health variables. In conclusion, there are significant health, demographic, and mortality differences between rural and urban populations in Roman Britain. Am J Phys Anthropol 157:107-120, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify culinary practices associated with bean consumption in families from one rural population Jesus of Atenas) and one urban (La Union of Tres Rios) of Costa Rica. The study was developed in 2005, in a sample of 475 families that usually prepare and eat beans 223 rural and 252 urban). In this families, the person responsible for the preparation of food was interviewed. The study showed a per capita beans consumption of 37.5 g/person/day (g/p/d) of raw weight. This consumption differs by geographic condition, being higher in rural area 46.8 + 25 g/p/d) than in urban areas (37.5 + 23 g/p/d) (F= 18.031, p= 0.000). The factors that were associated with consumption are different by area; in the rural area the factors were some characteristics of the person preparing bean, some preparation practices and the reasons manifested for consumption, whereas in urban areas the associated factors were only related to preparation practices. [ABSTRACT FROM AUTHOR]

Preparation and conservation practices of beans in Costa Rican families. The objective of this work was to identify the culinary and preservation practices for beans in a population rural (Jesus of Atenas) and an urban (La Union of Tres Rios) of Costa Rica. The study was developed in 2005, in a sample 475 families that prepare and consume beans (223 rural and 252 urban). In each of these homes, the person responsible for food preparation was interviewed and it is the key informant. The soaking beans before cooking was used mostly in the rural area (x2=14.435, p<0,001) and cooking methods employed in this area differ significantly from those used in the urban area (x2=28.535, p<0,001). In the rural area the most used cooking methods were conventional cooking and pressure cooking, but in the urban area the most common method was pressure cooking. The beans preservation methods applied to cooked beans do not different by area, the most common method found was refrigeration (x2=3.722, p=0.293). [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed. [ABSTRACT FROM PUBLISHER]

The concepts of rural and urban are used to distinguish two different ways of spatial seizure and organization as well as the social relationships which take place therein. From the viewpoint of Sociology these concepts lead to classical themes such as modern and traditional dichotomy and to country-city relationships. This paper analyzes how these two spatial ways are delimited in Brazil and examines the criteria that should be used in order to classify a locality as either rural or urban. Starting from a critique of the statistical and administrative classifications, we seek to establish a typology that takes into consideration the social processes that determine the territorial dynamics of Brazilian municipalities. The paper therefore strives to establish a relationship between the theoretical definitions as well as empirical territorial construction. [ABSTRACT FROM AUTHOR]

Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is a need to better understand the contributors to these temporal changes; however, a general lack of temporal data on potential contributors prevents this investigation. However considering contributors to the rural-urban differences pooled across time, an overall a higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, with this higher incidence potentially associated with a higher prevalence of stroke risk factors in rural areas. Conversely, studies assessing rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity. [ABSTRACT FROM AUTHOR]

Political behaviour of citizens is traditionally formed by a wide range of factors that influence their voting decision in the election. Dichotomy of both the space and society into the town and the countryside generates different election results constantly. A key aim of this paper is to assess the extent of rurality concerning the electoral support of relevant political parties operating on the Slovak political scene after the groundbreaking elections held in 1998 until ballots of 2010 not only at national, but also at the regional level. Evaluation of level and dynamics in socio-political cleavage between rural and urban space is one of the most important research ambitions of this study. We shall note the position of particular regions in Slovakia in terms of size and acceleration of the conflict and try to categorize them according to the similarity in values of indicators characterizing this social discrepancy. On the basis of found facts, we shall appraise the electoral success of political parties in urban and rural environment and compose the regional typization of Slovakia concerning the party representatives of urban and rural environment. Finally, we shall evaluate the potential of the regions to be future outbreak sites of latent cleavage influencing their differential political inclination. [ABSTRACT FROM AUTHOR]

Abstract: There is a lack of validated and reliable instruments on perception of the food environment, in particular for rural environments. We estimated the test–retest reliability of a questionnaire assessing perceptions of the food environment. A total of 101 primary food shoppers in South Carolina were interviewed by phone to assess their perceptions of the food environment and presence of different food outlet types in their neighborhood. The survey was repeated approximately one month after the initial administration. The intra-class correlation (ICC) and Phi coefficient are reported as measures of reliability. The majority of questions on perceptions of the neighborhood food environment appear highly reliable (ICCs range from 0.55 to 0.71), including the 3-item scale on healthy food availability (ICC 0.71). Compared to participants in rural areas, those in urban areas demonstrated better reliability for questions on opportunities to purchase fast food and perceived presence of a supercenter. More research is needed to evaluate potential rural–urban differences in reliability. [Copyright &y& Elsevier]

Background: Exploration of urban-rural (UR) and regional differences is critical to developing effective healthcare delivery systems. Choledocholithiasis (CDL) remains a common problem with a range of therapeutic options and potentially severe complications. This study evaluated UR and regional differences of CDL presentation and treatment. We hypothesized that UR status contributes to differences in treatment of CDL. Methods: This study examined patients from the 2007 Healthcare Cost and Utilization Project dataset. Inpatient discharges and interventions for CDL patients were identified. UR and regional designations were determined from National Center for Health Statistics guidelines. Patients with pancreatitis or cholangitis were designated as complicated CDL (cCDL) patients. Interventions for CDL were classified as endoscopic, surgical, or percutaneous. Complex-sample proportion analyses were performed. Results: A total of 111,021 patients with CDL were identified; 81% of these patients lived in urban areas compared with 19% in rural areas; 61% had uncomplicated choledocholithiasis (uCDL) and 39% had cCDL. The overall distribution of uCDL and cCDL did not differ by UR status or region. A higher proportion of rural patients did not receive an intervention 45.1% (95%CI 41.8%–48.4%) versus urban patients 30.5% (28.8%–32.2%), P < 0.05. Interventions for urban patients were more likely endoscopic 87.7% (86.8%–88.6%) compared with rural 82.0% (79.3%–84.7%), P < 0.05. Rural patients were more likely to undergo surgery 10.5% (8.6%–12.4%) than urban patients 4.9% (4.4%–5.4%), P < 0.05. Regional variations did not impact the type of intervention received. Conclusion: Rural patients received CDL interventions less often and had a higher proportion of surgical interventions regardless of severity of presentation. [ABSTRACT FROM AUTHOR]

Physical activity (MVPA) levels during home-based cardiac rehabilitation (CR) remain problematic. Consequently, the present study examined the association between MVPA and urban vs. rural residential status and the perceived environment in patients attending home-based CR. A total of 280 patients completed a questionnaire assessing demographic, clinical, MVPA, and perceived environmental variables measured at baseline and 3 months later. Patient addresses were geocoded and linked to the 2006 Canadian census to establish the urban/rural distinction. Results showed that urban and rural patients had similar baseline MVPA and improvements in MVPA by 3 months. Several perceived environmental variables were significantly related to MVPA throughout home-based CR that were common and urban/rural-specific. Therefore, although there does not appear to be an urban vs. rural advantage in MVPA levels during home-based CR, there does appear to be environmental/MVPA-specific relationships specific to urban and rural patients that may warrant attention. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine if levels of personal stigma towards depression and agreement with health professionals about treatment differ between rural–urban populations. Methods: Data from a telephone survey conducted in Alberta (n=3047, response rate=75.2%) was analyzed. Participants responded to a case vignette describing a depressed individual and questionnaires assessing attitudes towards treatments, and personal stigma against depression. The relation between rural–urban status and agreement with health professionals about treatment was assessed using logistic regression. Stigma scores in relation to rural–urban status were analyzed using multivariate linear regression. Results: Urban respondents were more likely than rural participants to agree with health professionals about depression treatments. This was found overall, and in women. After adjustment for income and education, rural–urban status was no longer significant. Urban participants had lower stigma scores in overall analysis. After adjustment for income and education, stigma scores remained higher among rural men. Education was associated with lower stigma scores among both men and women in fully adjusted models. The ability to recognize depression was associated with lower stigma scores. Conclusions: Differences exist in rural–urban population about treatments for depression and stigma towards depression. The rural–urban differences in stigma and agreement with health professionals about treatment may be largely explained by educational levels. [Copyright &y& Elsevier]

This study aims to assess the airborne bioburden of rural and urban Portuguese Primary Health Care Centers (PHCC) using active and passive sampling methods and identify the potential differences in airborne microbiota between both environments. The highest total aerobic mesophilic bacterial load in indoor air were found in the Vaccination Room (448 CFU.m−3) in the Rural PHCC and in the Waiting Room (420 CFU.m−3) for Urban PHCC. The total coliforms contamination level in indoor air was detected only in the Cleaning Supplies Room (4 CFU.m−3) in the Urban PHCC. The most frequent bacteria genera identified was Micrococcus (21% Rural PHCC; 31% Urban PHCC). The surface samples showed a highest total aerobic mesophilic bacterial contamination in the Treatment Room (86 × 103 CFU.m−2) from the Rural PHCC and in the Front Office (200 × 103 CFU.m−2) from the Urban PHCC. The electrostatic dust cloth (EDC) samples showed a highest bacterial load in the Urban PHCC. Total aerobic mesophilic bacterial load in settled dust and in the Heating, Ventilating and Air Conditioning (HVAC) filter samples in the Urban PHCC (8 CFU.g−1 and 6 × 103 CFU.m−2) presented higher values compared with the Rural PHCC (1 CFU.g−1 and 2.5 × 103 CFU.m−2). Urban PHCC presented higher bacterial airborne contamination compared with the Rural PHCC for the majority of sampling sites, and when compared with the indoor air quality (IAQ) Portuguese legislation it was the Rural PHCC in two sampling places who did not comply with the established criteria. [ABSTRACT FROM AUTHOR]

• Cigarette and cannabis use in adults is changing across rural and urban America. • Rural geographic disparities in cigarette smoking are increasingly pronounced. • Cannabis use increased the most in rural non-cigarette smokers. • Cannabis users are no longer predominantly cigarette smokers. Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007–2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers. Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007. Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use. [ABSTRACT FROM AUTHOR]