Telehealth May Reduce Rural-Urban Disparities in Accessing Pediatric Psychiatry Services: A Case Study of Trends in Central Ohio from 2020 to 2021 (Preprint)

2021 ◽  
Author(s):  
Ujjwal Ramtekkar ◽  
Jin Peng ◽  
Yungui Huang ◽  
Simon Linwood
Keyword(s):  
Behavioral Health ◽  
Rural Areas ◽  
Rural Families ◽  
Office Visit ◽  
Office Visits ◽  
Child Psychiatric ◽  
Rapid Transition ◽  
Pediatric Psychiatry ◽  
Urban And Rural Areas ◽  
Rural Patients

BACKGROUND The rural-urban disparities in access to child behavioral health services are well known and are further exacerbated by the COVID-19 pandemic related restrictions on travel and in person visits. Fortunately, regulatory flexibilities allowed rapid transition of telehealth to reduce contagion while maintaining continuity of care. However, there has been contradicting evidence on whether telehealth narrows the rural-urban gap. OBJECTIVE To examine the telehealth utilization trends and no-show rates between urban vs rural areas for pediatric psychiatry visits after the public health emergency was declared. METHODS Using 2020-2021 electronic health records (EHR) data from the psychiatry department at a large urban academic pediatric hospital, we calculated the telemedicine utilization rates by patient’s residence area (urban vs rural). We used two proportions z-tests to examine whether the observed differences in no-show rates among 4 types of visit (urban office visit, urban telemedicine visit, rural office visit, and rural telemedicine visit) were statistically significant. RESULTS Telemedicine utilization rates (~80%) are comparable in urban and rural areas. The average no-show rates for telemedicine visits were around 17% for both urban and rural patients, while the average no-show rates for office visits were around 20% for urban patients and fluctuated between 15% and 36% for rural patients. Two proportions z-tests indicated that, for rural patients, telemedicine visits had significantly lower no-show rates than office visits between Sept 2020 and Feb 2021, but such difference turned insignificant after March 2021. CONCLUSIONS Telehealth improved access to child psychiatric services for rural families when primary delivery of services was telehealth-based. Returning to in-person only options and limiting telehealth access would be detrimental to behavioral health outcomes of rural children that have been traditionally underserved. CLINICALTRIAL N/A

Family Expenditures and Human Capital Investment

2018 ◽  
Author(s):  
Qin Gao
Keyword(s):  
Rural Areas ◽  
Capital Investment ◽  
Social Insurance ◽  
Rural Families ◽  
Minimum Level ◽  
Or Education ◽  
High Expenditure ◽  
Education Needs ◽  
Urban And Rural Areas ◽  
Bare Minimum

Chapter 7 focuses on Dibao’s influence on family expenditures. The chapter documents the high expenditure demands on healthcare and education faced by most Dibao families across urban and rural areas. While Dibao has enabled urban recipient families to spend more on both of these items, it has helped rural families pay for healthcare but not education. Meeting survival needs is not found to be a priority in the use of Dibao money for either urban or rural recipients, suggesting that these families may be maintaining a bare-minimum level of livelihood while having to meet urgent health or education needs. In both urban and rural areas, Dibao receipt is associated with reduced spending on leisure. Rural Dibao receipt is also associated with reduced spending on alcohol, tobacco, gifts to others, and social insurance contributions, while the same effect is either not found or not examined in urban Dibao.

scholarly journals Rural-Urban Differences in Stroke Types, Risk Factors, Severity and Prognosis in Babol, Northern Iran

2018 ◽  
Author(s):  
Payam Saadat ◽  
Alijan Ahmadi Ahangar ◽  
Soraya Khafri ◽  
Mandana Kalantar ◽  
Azin Dariaie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Northern Iran ◽  
Cross Sectional ◽  
Chi Square Test ◽  
Urban And Rural Areas ◽  
Rural Patients

Introduction: Stroke recognized as the third most common cause of death. Stroke survivors often suffer a large amount of physical and mental disability. Due to assess difference between stroke types, progression and distribution of risk factors according to residential status, to get the correct information for prevention planning and management, this study was conducted. Methods: This descriptive cross-sectional study on stroke patient from 2016 to 2017 that admitted to Ayatollah Rohani Hospital of Babol was conducted. Type of stroke, their severity, risk factors, and urban or rural area of residence of patients were recorded in the checklist. The chi-square test was used to compare frequencies of gender, and stroke risk assessment between the urban and rural residents. Binary logistic regression modeling was used to estimate the association of risk factors with living in urban and rural areas. The results were expressed as multivariable-adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CIs). A two-sided p < 0.05 was considered statistically significant. All data analyses were performed, using SPSS statistical analysis software. Results: Of 241 stroke patients, 133 patients (55 %) were female and 213 patients (88.4 %) were  ischemic.  Also,  140 cases were (58  %)  rural.  Embolic strokes more in urban population and thrombotic strokes were more in rural populations. Hyperlipidemia was more in urban than rural p = 0.01. Severity of stroke in admission time (p = 0.03) and at discharge (p = 0.005) was more in rural than urban. The mortality was higher in rural 12 (8.6) vs. 2 (2) urban resident,( p = 0.03). Conclusion: Rural patients had more severity, thrombotic type and mortality than urban. Suitable policy regard to residential parameter is suggested.

Three hundred years of House Sparrow (Passer domesticus) persecution in Germany

2007 ◽  
Vol 34 (2) ◽  
pp. 307-317 ◽  
Author(s):  
J. SEITZ
Keyword(s):  
Rural Areas ◽  
House Sparrow ◽  
Bird Species ◽  
Passer Domesticus ◽  
Second World War ◽  
Population Increase ◽  
World War ◽  
Large Numbers ◽  
Urban And Rural Areas ◽  
Second World

Modernization of agriculture, economic development and population increase after the end of the Thirty Years' War caused authorities in many parts of Germany to decree the eradication of so-called pest animals, including the House Sparrow. Farmers were given targets, and had to deliver the heads of sparrows in proportion to the size of their farms or pay fines. At the end of the eighteenth century German ornithologists argued against the eradication of the sparrows. During the mid-nineteenth century, C. L. Gloger, the pioneer of bird protection in Germany, emphasized the value of the House Sparrow in controlling insect plagues. Many decrees were abolished because either they had not been obeyed, or had resulted in people protecting sparrows so that they always had enough for their “deliveries”. Surprisingly, various ornithologists, including Ernst Hartert and the most famous German bird conservationist Freiherr Berlepsch, joined in the war against sparrows at the beginning of the twentieth century, because sparrows were regarded as competitors of more useful bird species. After the Second World War, sparrows were poisoned in large numbers. Persecution of sparrows ended in Germany in the 1970s. The long period of persecution had a significant but not long-lasting impact on House Sparrow populations, and therefore cannot be regarded as a factor in the recent decline of this species in urban and rural areas of western and central Europe.

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