Factors affecting prehospital delay in rural and urban patients with stroke: a prospective survey-based study in Southwest Germany

Abstract Background Reducing prehospital delay plays an important role in increasing the thrombolysis rate in patients with stroke. Several studies have identified predictors for presentation ≤4.5 h, but few compared these predictors in urban and rural communities. We aimed to identify predictors of timely presentation to the hospital and identify possible differences between the urban and rural populations. Methods From January to June 2017, we conducted a prospective survey of patients with stroke admitted to an urban comprehensive stroke centre (CSC) and a rural primary care centre (PCC). Predictors were identified using binary logistical regression. Predictors and patient characteristics were then compared between the CSC and PCC. Results Overall, 459 patients were included in our study. We identified hesitation before seeking help, awareness of the existence of a time-window, type of admission and having talked about stroke symptoms with friends/relatives who had previously had a stroke as the strongest predictors for presentation to the emergency room ≤4.5 h. Patients admitted to the rural PCC were more hesitant to seek help and less likely to contact emergency services, even though patients had comparable knowledge pertaining to stroke care concepts. Conclusions Patients from rural areas were more likely to be hesitant to seek help and contacted the EMS less frequently, despite similar self-awareness of having a stroke. Educational campaigns should focus on addressing these disparities in rural populations. Affected patients should also be encouraged to talk about their symptoms and take part in educational campaigns.

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Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.9 ◽

2020 ◽

Vol 47 (3) ◽

pp. 301-308 ◽

Cited By ~ 1

Author(s):

Moira K. Kapral ◽

Ruth Hall ◽

Peter Gozdyra ◽

Amy Y.X. Yu ◽

Albert Y. Jin ◽

...

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Stroke Prevention ◽

Inpatient Rehabilitation ◽

Stroke Care ◽

Acute Stroke Care ◽

Geographic Access ◽

Prevention Services ◽

Care Services ◽

Driving Time

ABSTRACT:Background:Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.Methods:We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.Results:Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).Conclusions:Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.

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Impacts of the COVID-19 pandemic on rural America

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2019378118 ◽

2020 ◽

Vol 118 (1) ◽

pp. 2019378118

Author(s):

J. Tom Mueller ◽

Kathryn McConnell ◽

Paul Berne Burow ◽

Katie Pofahl ◽

Alexis A. Merdjanoff ◽

...

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Large Scale ◽

Research Effort ◽

Well Being ◽

The United States ◽

Rural Populations ◽

Exogenous Shock ◽

The North ◽

Scientific Attention

Despite considerable social scientific attention to the impacts of the COVID-19 pandemic on urbanized areas, very little research has examined its impact on rural populations. Yet rural communities—which make up tens of millions of people from diverse backgrounds in the United States—are among the nation’s most vulnerable populations and may be less resilient to the effects of such a large-scale exogenous shock. We address this critical knowledge gap with data from a new survey designed to assess the impacts of the pandemic on health-related and economic dimensions of rural well-being in the North American West. Notably, we find that the effects of the COVID-19 pandemic on rural populations have been severe, with significant negative impacts on unemployment, overall life satisfaction, mental health, and economic outlook. Further, we find that these impacts have been generally consistent across age, ethnicity, education, and sex. We discuss how these findings constitute the beginning of a much larger interdisciplinary COVID-19 research effort that integrates rural areas and pushes beyond the predominant focus on cities and nation-states.

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Assessing Heat-Related Mortality Risks among Rural Populations: A Systematic Review and Meta-Analysis of Epidemiological Evidence

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15081597 ◽

2018 ◽

Vol 15 (8) ◽

pp. 1597 ◽

Cited By ~ 3

Author(s):

Emmanuel Odame ◽

Ying Li ◽

Shimin Zheng ◽

Ambarish Vaidyanathan ◽

Ken Silver

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Selection Criteria ◽

Meta Analysis ◽

Epidemiological Studies ◽

Included Study ◽

Rural Populations ◽

Urban Settings ◽

Rural Settings ◽

Related Mortality

Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

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(A109) Health Workforce and Disaster Preparedness of Rural Hospitals

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001117 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s30-s31

Author(s):

L. Siegloff ◽

L. Cusack ◽

P. Arbon ◽

A. Hutton ◽

L. Mayner

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Disaster Preparedness ◽

Emergency Services ◽

South Australia ◽

Fire Risk ◽

Weather Conditions ◽

Rural Hospitals ◽

Hospital Staffing ◽

The Impact

Following the devastating March 2009 Victorian bushfire disaster in rural areas of Australia, authorities reviewed strategies designed to protect communities during periods of extreme fire risk. New policy and regulation were introduced and designed to ensure that small rural communities were protected and prepared to confront a wildfire emergency during days of extreme heat or bushfire risk weather. As a result on days of declared ‘catastrophic’ bushfire weather conditions government agencies in South Australia have implemented a policy for schools (including pre-schools) to be temporarily closed. On these days community members are advised to evacuate early to safe regional centres, and to limit travel on country roads. The WADEM Guidelines for Disaster Evaluation and Research demonstrate that Basic Societal Functions (BSFs), such as education, health, transport and others, are interconnected and interdependent. For example in small rural communities in South Australia people may have a number of important roles including being parents, volunteers of emergency services while also being employed as staff of local hospitals. This project reviewed the impact of school closures and other protective measures on the availability of the rural nursing workforce and on rural hospitals. Rural hospitals in Australia are staffed, on average, by 2–8 nurses, service very small communities and are separated by great distances. As a result, small changes in the absentee rate for nurses can have a significant impact on the operation of these hospitals. This paper will argue that policy changes in other sectors, such as education, can impact on societal activities such as childcare, volunteer emergency service work, and hospital staffing, in ways that may not be anticipated unless the impact on all Basic Societal Functions are considered by policymakers.

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Abstract TP236: Geographical Disparity of Acute Stroke Care Capabilities in Japan From a Nationwide Database: J-ASPECT Study

Stroke ◽

10.1161/str.48.suppl_1.tp236 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Koichi Arimura ◽

Kunihiro Nishimura ◽

Akiko Kada ◽

Satoru Kamitani ◽

Kuniaki Ogasawara ◽

...

Keyword(s):

Hospital Mortality ◽

Acute Stroke ◽

Rural Areas ◽

Patient Characteristics ◽

Stroke Care ◽

International Classification Of Diseases ◽

Stroke Severity ◽

Acute Stroke Care ◽

Nationwide Database ◽

Geographical Disparity

Objective: We previously demonstrated comprehensive stroke care (CSC) capabilities of the hospitals affect in-hospital mortality of patients with acute stroke. With the advent of unprecedented aging society, proper implementation of stroke centers requires understanding of geographical disparity of patient characteristics as well as stroke care capabilities. The aim of this study was to elucidate such geographical disparity regarding acute stroke care in Japan using a nationwide database. Materials and methods: We analyzed the data obtained from the Japanese Diagnosis Procedure Combination-based Payment System in 445 institutions between 2010 and 2012. Patients hospitalized emergently for ischemic stroke(IS), non-traumatic intracerebral hemorrhage(ICH) and non-traumatic subarachnoid hemorrhage(SAH) were identified using International Classification of Diseases-10 diagnosis codes. We classified the location of the hospitals into 4 areas, “Metropolitan Employment Area-Central (MEA-C)”, “ Metropolitan Employment Area-Outlying (MEA-O)”, “Micropolitan Employment Area-Central (McEA-C)”, and “ Micropolitan Employment Area-Outlying (McEA-O)”. We investigated patient characteristics, medical backgrounds, interventions and outcomes for each area. Results: Data obtained from a total of 214,910 patients with acute strokes (136,753 IS, 60,379 ICH and 17,778 SAH) were analyzed. As for patient characteristics, elderly patients and those with hypertension were more common in McEA-C and McEA-O, and stroke severity was more severe in McEA-C in all stroke types. As for hospital characteristics, proportion of admission by ambulance and CSC capabilities of the hospitals were smaller in all stroke types. Moreover, emergent interventions such as intravenous rt-PA infusion were performed at a lesser extent and in-hospital mortality was higher in McEA-C and McEA-O, and severe disability with mRS 3-6 was more often noted in McEA-C in all stroke types. Conclusion: We demonstrated geographical disparity of acute stroke care in Japan from a nationwide database. For proper implementation of stroke centers, centralization of acute stroke care capabilities should be considered in the rural areas to improve outcomes of acute stroke.

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Abstract 180: Stroke Mimics in Drip and Ship Thrombolytic Therapy

Stroke ◽

10.1161/str.47.suppl_1.180 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Gaurav P Dighe ◽

Arooshi Kumar ◽

Muhammad F Bilal ◽

Tapan Abrol ◽

Kari Moore ◽

...

Keyword(s):

Assisted Living ◽

Rural Areas ◽

Treatment Time ◽

Time Window ◽

Stroke Care ◽

Psychiatric Disease ◽

Stroke Treatment ◽

Discharge Disposition ◽

University Of Louisville ◽

Stroke Mimic

Introduction: Drip and ship (DS) thrombolysis provides immediate acute ischemic stroke treatment and follow-up tertiary stroke care at a certified Comprehensive Stroke Center (CSC) for one quarter of the US population living in rural areas. Studies reveal that patients with stroke mimic (SM) inadvertently receive treatment due to lack of immediate access to specialists and the limited treatment time window. Hypothesis: We hypothesized that a higher percentage of SM would receive thrombolysis via the DS paradigm than those directly presenting to the CSC. Methods: We reviewed consecutive DS tPA cases transferred to the University of Louisville Hospital (ULH) and tPA cases originating at ULH from January, 2013 to June, 2015. ULH is a CSC that provides rural Kentucky and Southern Indiana hospitals with 24-hour telephone access to stroke specialists. We compared the percentage of SMs via a DS paradigm to those originating at ULH. SM data collected included demographics, medical history, NIHSS, complications, discharge diagnosis, discharge disposition, and the length of hospitalization. Etiology of SM was evaluated in the Old (≥ 65 years old) and the Young (<65 years old) group, respectively. Comparative analyses with t-tests and Fisher Exact tests were performed. Results: Total numbers of tPA cases were similar between the DS (201) and the ULH (200) groups, but the percentage of SM in the DS group was double the ULH group (27.4% vs 13.5%). Clinical features, NIHSS on admission, and percentage of SM patients who were 65 years or older were similar in both groups. None of SM had intracranial hemorrhage or severe adverse events. One patient in the DS had minor hematemesis without transfusion. All except one patient returned home or to an assisted living facility. One patient who was from home was discharged to a nursing home due to Parkinson’s disease. Psychiatric disease was more common in the Young SM than the old (45.3% vs 7.4%, p < 0.05). Encephalopathy for various reasons (25.9%) and seizures (22.2%) were the two most common causes in the Old SM. Conclusions: SMs are treated with tPA more often in the DS paradigm than when presenting to a CSC. Although the thrombolysis caused no harm, adequate access to specialists (i.e telestroke) may decrease unnecessary treatment with tPA.

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Effect of COVID-19-related reductions in cancer screening in Native Hawaiians and across urban and rural communities in Hawaii.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.109 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 109-109

Author(s):

Randall F. Holcombe ◽

Jeff Tom ◽

Michael Morimoto ◽

Elizabeth Wright ◽

Izumi Okado ◽

...

Keyword(s):

Cancer Screening ◽

Rural Communities ◽

Health Systems ◽

Rural Areas ◽

Cancer Mortality ◽

Native Hawaiians ◽

Rural Populations ◽

Differential Impact ◽

Rural Residents ◽

Urban And Rural Areas

109 Background: The COVID-19 pandemic has disrupted medical care in all areas of the US and had a profound impact on cancer screening, with a concern that this may lead to excess cancer-related deaths over the next decade. There are existing disparities in cancer mortality among rural US residents and Native Hawaiians (NHs) due to access issues, lower socioeconomic status and lack of a sufficient provider workforce. A reduction in cancer screening may therefore have an oversized impact on these populations. In this study, we examine the effects of the COVID-19 pandemic on cancer screening frequency among NHs and in urban and rural populations in Hawaii. Methods: De-identified data on the frequencies of breast cancer (BCS), cervical cancer (CCS) and colorectal cancer (CRCS) screenings for 2019 and 2020 were obtained for Hawaii residents from several sources, including Hawaii Medical Services Association, the largest private and Medicaid provider in Hawaii, and the two largest state-wide health systems, Queen’s Health Systems and Hawaii Pacific Health. Data was analyzed using Rural-Urban Continuum Codes (RUCC) and Rural-Urban Commuting Area (RUCA) codes to define rurality and, along with health system facility location, to ascertain whether there was a differential impact on cancer screening rates for rural populations due to the pandemic. Cancer screening data for NHs in comparison to other groups was analyzed separately. Results: Overall, reductions in cancer screening during the pandemic were seen, with the degree of reduction varying widely across regions of the state and among different ethnic populations. Annual reductions in BCS, CCS and CRCS ranged from 4.0-30.2%, 2.7-3.0% and 9.4-13.2%, respectively, depending on the data source. BCS reductions were greatest in rural areas (p = 0.09) and among NHs (p = 0.0005). The island of Kauai, which is rural but was minimally affected by COVID-19, saw no reduction in BCS. CCS reductions had a reverse urban vs. rural pattern, with reductions of 4.5% urban and 0.8% rural (p = 0.02). CRCS reductions were most profound in rural residents (17.1%; p = 0.0001); reductions in CRCS among NHs were 1.5x greater than other groups. The differential impact across urban and rural areas was consistent for both RUCC and RUCA analysis. The extent of reduction was most significant for CRCS and was directly proportional to the degree of rurality. Conclusions: BCS and CRCS were impacted more significantly by the COVID-19 pandemic than CCS. For BCS and CRCS, greater reductions were seen in rural compaed to urban populations and in NHs. The lack of correlation with rurality for CCS may be because this population is generally younger and screening is often provided as a component of primary care. The greater pandemic-related reduction in screening among rural residents and Native Hawaiians may exacerbate existing cancer mortality disparities in these vulnerable populations.

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FRAMEWORK FOR ECONOMIC PERFORMANCE OF RURAL AREAS IN MALAYSIA: A TERRITORIAL APPROACH

International Journal of Built Environment and Sustainability ◽

10.11113/ijbes.v6.n1-2.374 ◽

2019 ◽

Vol 6 (1-2) ◽

pp. 1-6

Author(s):

Mohamad Fadhli Rashid ◽

Ibrahim Ngah ◽

Siti Hajar Misnan

Keyword(s):

Rural Communities ◽

Economic Performance ◽

Rural Areas ◽

Developing Economies ◽

Rural Populations ◽

Economic Stability ◽

Economic Equality ◽

Depth Interview ◽

Territorial Approach ◽

Direct Measures

Rural, poor and marginalized community often face many challenges in achieving economic equality and attaining socio-economic sustainability, especially among rural communities who have limited sources of income. Although it involves complex issues, it cannot be disregarded. Rural areas and its communities are important aspects of a country’s political and economic stability. In countries with emerging and developing economies such as Malaysia, rural populations constitute the majority of citizens. They are generally poorer and more disadvantaged than their urban counterparts. The study determines the factors for the differences in economic performance of the rural areas in Malaysia. The study also provides the framework to revitalize rural areas and the methods to use this framework that measure rural economic performance. Several methods were used to collect the information from rural communities using in-depth interview and structured survey. These two methods are important for this research in order to understand how the rural areas and its communities faced situation of growth or decline. By using this framework, the analysis of differentiation of economic performance provides understanding on how variation of factor influencing economic performance in rural areas and direct measures should be implemented in solving issues of rural decline.

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TURNING FARMERS INTO SOCIAL FARMER ENTREPRENEURS FOR DISADVANTAGED PEOPLE

NORDSCI Conference proceedings, Book 1 Volume 3 ◽

10.32008/nordsci2020/b1/v3/31 ◽

2020 ◽

Author(s):

Remus Runcan

Keyword(s):

Rural Communities ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Health And Safety ◽

Physical Work ◽

Healthy Environment ◽

Rural And Urban Areas ◽

Rural Development Programme ◽

Rural And Urban

According to Romania’s National Rural Development Programme, the socio-economic situation of the rural environment has a large number of weaknesses – among which low access to financial resources for small entrepreneurs and new business initiatives in rural areas and poorly developed entrepreneurial culture, characterized by a lack of basic managerial knowledge – but also a large number of opportunities – among which access of the rural population to lifelong learning and entrepreneurial skills development programmes and entrepreneurs’ access to financial instruments. The population in rural areas depends mainly on agricultural activities which give them subsistence living conditions. The gap between rural and urban areas is due to low income levels and employment rates, hence the need to obtain additional income for the population employed in subsistence and semi-subsistence farming, especially in the context of the depopulation trend. At the same time, the need to stimulate entrepreneurship in rural areas is high and is at a resonance with the need to increase the potential of rural communities from the perspective of landscape, culture, traditional activities and local resources. A solution could be to turn vegetal and / or animal farms into social farms – farms on which people with disabilities (but also adolescents and young people with anxiety, depression, self-harm, suicide, and alexithymia issues) might find a “foster” family, bed and meals in a natural, healthy environment, and share the farm’s activities with the farmer and the farmer’s family: “committing to a regular day / days and times for a mutually agreed period involves complying with any required health and safety practices (including use of protective clothing and equipment), engaging socially with the farm family members and other people working on and around the farm, and taking on tasks which would include working on the land, taking care of animals, or helping out with maintenance and other physical work”

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Tackling Rural Health, Energy, … and Technological Issues All at Once: A Call for a Global Interdisciplinary Platform for Strengthening Rural Setting Amid the COVID-19 Pandemic

Challenges ◽

10.3390/challe12020016 ◽

2021 ◽

Vol 12 (2) ◽

pp. 16

Author(s):

Farshad Amiraslani

Keyword(s):

Rural Communities ◽

Rural Health ◽

Rural Areas ◽

Rural Setting ◽

Global Challenges ◽

Rural Settings ◽

Research Studies

The recent COVID-19 pandemic has revealed flaws in rural settings where most people live without the necessary tools, income, and knowledge to tackle such unprecedented global challenges. Here, I argue that despite the research studies conducted on rural areas, these have not solved rising rural issues, notably poverty and illiteracy. I propound a global institute to be formed by governments that provides a platform for empowering rural communities through better training, skills, and competencies. Such global endeavour will ensure the remaining rural communities withstand future pandemics if they occur.

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