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

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

BMC Neurology ◽

10.1186/s12883-020-01999-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Matthias N. Ungerer ◽

Loraine Busetto ◽

Nima H. Begli ◽

Katharina Riehle ◽

Jens Regula ◽

...

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Emergency Services ◽

Time Window ◽

Patient Characteristics ◽

Stroke Care ◽

Rural Populations ◽

Prospective Survey ◽

Prehospital Delay ◽

Educational Campaigns

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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Opioid mortality in rural communities

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v7i31.601 ◽

2019 ◽

Vol 7 (31) ◽

pp. 59-62

Author(s):

Jonathan Kopel

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Significant Risk ◽

Opioid Therapy ◽

Mortality Data ◽

Opioid Overdose ◽

Opioid Use ◽

Policy Makers ◽

Evidenced Based ◽

Related Mortality

Opioid mortality has become a significant medical and economic burden in the UnitedStates, accounting for over 66.3% of drug-related overdoses and $78 billion dollars in healthcare costs. The current US “opioid crisis” has continued to grow with an estimated 2.5 millionpatients being diagnosed with opioid use disorders in 2016. In response, policy makers andgovernment agencies have initiated several programs to mitigate the adverse effects of opioidsthrough expanding access and delivery of evidenced-based treatment and rehabilitationprograms. Rural communities remain significant risk factors for opioid overdose and mortalityin areas lacking access to opioid therapy. Despite measures to provide access to rehabilitationand medical therapy, the opioid-related mortality rate in rural areas has increased significantlydue to greater opioid prescriptions in these areas, an out-migration of young adults, greaterrural social and kinship network connections, and economic stressors. However, limitedopioid-related mortality data in rural regions, such as West Texas, impede further analysisand investigation into effective programs for preventing and treating opioid overdoses in thesecommunities.

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The rural–urban gap: differences in injury characteristics

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.39.12.01 ◽

2019 ◽

Vol 39 (12) ◽

pp. 317-322

Author(s):

Felix Bang ◽

Steven McFaull ◽

James Cheesman ◽

Minh T. Do

Keyword(s):

Rural Areas ◽

Motor Vehicle ◽

Soft Tissue Injuries ◽

Eye Injuries ◽

Injury Rates ◽

Urban Settings ◽

Rural And Urban ◽

Rural Settings ◽

Severity Of Injury ◽

The Difference

Background Injuries are among the top 10 leading causes of death in Canada. However, the types and rates of injuries vary between rural versus urban settings. Injury rates increase with rurality, particularly those related to motor vehicle collisions. Factors such as type of work, hazardous environments and longer driving distances contribute to the difference in rural and urban injury rates. Further examination of injuries comparing rural and urban settings with increased granularity in the nature of injuries and severity is needed. Methods The study population consisted of records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from between 2011 and July 2017. Rural and urban status was determined based on postal codes as defined by Canada Post. Proportionate injury ratios (PIRs) were calculated to compare rural and urban injury rates by nature and severity of injury and sex, among other factors. Results Rural injuries were more likely to involve multiple injuries (PIR = 1.66 for 3 injuries) and crush injuries (PIR = 1.72). More modestly elevated PIRs for rural settings were found for animal bites (1.14), burns (1.22), eye injuries (1.32), fractures (1.20) and muscle or soft tissue injuries (1.11). Injuries in rural areas were more severe, with a higher likelihood of cases being admitted to hospital (1.97), and they were more likely to be due to a motor vehicle collision (2.12). Conclusion The nature of injuries in rural settings differ from those in urban settings. This suggests a need to evaluate current injury prevention efforts in rural settings with the aim to close the gap between rural and urban injury rates.

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A Model Rural Inclusive Postsecondary Program for Students With Intellectual Disability

Rural Special Education Quarterly ◽

10.1177/87568705211032380 ◽

2021 ◽

Vol 40 (4) ◽

pp. 191-202

Author(s):

Gerlinde Beckers ◽

Colleen Klein-Ezell

Keyword(s):

Intellectual Disability ◽

Rural Communities ◽

Rural Areas ◽

College Experience ◽

Full Potential ◽

Program Outcomes ◽

Federal Financial Aid ◽

Employment Skills ◽

Rural Settings ◽

Postsecondary Program

Lions Connected (LC) is an inclusive postsecondary program approved by the U.S. Department of Education; thus meeting rigorous program standards and accountability. Equally important is that it gives eligible students from rural areas the opportunity to receive federal financial aid to attend college. The purpose of developing LC was to meet the needs and desires of the surrounding rural communities by providing postsecondary opportunities for students with intellectual disability (ID) to enhance their social, academic, and employment skills alongside peers without disabilities. This article describes the program in detail as well as program outcomes, including employment in rural home communities. LC students receive a true college experience while preparing to become contributing members in society regardless of where they live. By following LC’s program structure, there are multiple opportunities for supporting students with ID in rural settings and helping them garner a college experience and become successfully employed in their community and reach their full potential.

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The Protection of the Person is Central in CIOMS International Ethical Guidelines

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v3i4.449 ◽

2014 ◽

Vol 3 (4) ◽

pp. 270-272

Author(s):

Michel Vallotton ◽

Sian Fluss ◽

Gian Sjolin Forsberg

Keyword(s):

Clinical Trials ◽

Selection Criteria ◽

Meta Analysis ◽

Epidemiological Studies ◽

Nongovernmental Organization ◽

Evidence Based ◽

Ethical Guidelines ◽

The Subject ◽

Based Medicine ◽

And Storage

In this brief article the authors report on the objectives of this nongovernmental organization and, most particularly, on the protection of the person in its International Ethical Guidelines for the fields of clinical trials and epidemiological studies. They emphasize the terminology used to describe the subjects or the populations involved in these studies. They discuss the possibility and nature of harm to persons involved in such studies, and justify the requirement for informed consent also for the persons involved in epidemiological studies. Finally, they consider the roles of such trials and studies as the basis for evidence-based medicine, including cases when their results are pooled in meta-analysis. This methodology is the subject of examination by a CIOMS Working Group of problems concerning identification and selection criteria, analysis and interpretation of results (including unpublished results), and storage of data.

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Prescription Opioid Misuse Among Rural Community Pharmacy Patients: Pilot Study for Screening and Implications for Future Practice and Research

Journal of Pharmacy Practice ◽

10.1177/0897190016656673 ◽

2016 ◽

Vol 30 (5) ◽

pp. 498-505 ◽

Cited By ~ 8

Author(s):

Gerald T. Cochran ◽

Rafael J. Engel ◽

Valerie J. Hruschak ◽

Ralph E. Tarter

Keyword(s):

Rural Communities ◽

Community Pharmacy ◽

Rural Areas ◽

Pilot Project ◽

Prescription Opioid ◽

Opioid Misuse ◽

Rural And Urban ◽

Increased Risk ◽

Rural Settings ◽

Prescription Opioid Misuse

Background: Opioid misuse imposes a disproportionately heavy burden on individuals living in rural areas. Community pharmacy has the potential to expand and coordinate with health professionals to identify and intervene with those who misuse opioids. Objective: Rural and urban community pharmacy patients were recruited in this pilot project to describe and compare patterns of opioid misuse. Methods: We administered a health screening survey in 4 community pharmacies among patients filling opioid medications. Univariate statistics were used to assess differences in health characteristics and opioid medication misuse behaviors between rural and urban respondents. Multivariable statistics were used to identify risk factors associated with rural and urban opioid misuse. Results: A total of 333 participants completed the survey. Participants in rural settings had poorer overall health, higher pain levels, lower education, and a higher rate of unemployment compared to patients in urban pharmacies. Rural respondents with illicit drug use (adjustable odds ratio [aOR]: 14.34, 95% confidence interval [CI] = 2.16-95.38), posttraumatic stress disorder (aOR: 5.44, 95% CI = 1.52-19.50), and ≤high school education (aOR: 6.68, 95% CI = 1.06-42.21) had increased risk for opioid misuse. Conclusions: Community pharmacy represents a promising resource for potential identification of opioid misuse, particularly in rural communities. Continued research must extend these findings and work to establish collaborative services in rural settings.

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Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Journal of Fungi ◽

10.3390/jof7110985 ◽

2021 ◽

Vol 7 (11) ◽

pp. 985

Author(s):

Salman Hussain ◽

Abanoub Riad ◽

Ambrish Singh ◽

Jitka Klugarová ◽

Benny Antony ◽

...

Keyword(s):

Mortality Rate ◽

Selection Criteria ◽

Primary Outcome ◽

Meta Analysis ◽

Epidemiological Studies ◽

Pooled Prevalence ◽

All Cause Mortality ◽

The Mean ◽

Pooled Sample ◽

Humanistic Burden

Mucormycosis, a secondary fungal infection, gained much attention in the ongoing COVID-19 pandemic. This deadly infection has a high all-cause mortality rate and imposes a significant economic, epidemiological, and humanistic burden on the patients and healthcare system. Evidence from the published epidemiological studies showed the varying prevalence of COVID-19-associated mucormycosis (CAM). This study aims to compute the pooled prevalence of CAM and other associated clinical outcomes. MEDLINE, Embase, Cochrane COVID-19 Study Register, and WHO COVID-19 databases were scanned to retrieve the relevant articles until August 2021. All studies reporting the prevalence of mucormycosis among COVID-19 patients were eligible for inclusion. Two investigators independently screened the articles against the selection criteria, extracted the data, and performed the quality assessment using the JBI tool. The pooled prevalence of CAM was the primary outcome, and the pooled prevalence of diabetes, steroid exposure, and the mortality rate were the secondary outcomes of interest. Comprehensive Meta-Analysis software version 2 was used for performing the meta-analysis. This meta-analysis comprised six studies with a pooled sample size of 52,916 COVID-19 patients with a mean age of 62.12 ± 9.69 years. The mean duration of mucormycosis onset was 14.59 ± 6.88 days after the COVID-19 diagnosis. The pooled prevalence of CAM (seven cases per 1000 patients) was 50 times higher than the highest recorded background of mucormycosis (0.14 cases per 1000 patients). A high mortality rate was found among CAM patients with a pooled prevalence rate of 29.6% (95% CI: 17.2–45.9%). Optimal glycemic control and the judicious use of steroids should be the approach for tackling rising CAM cases.

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Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives

Annual Review of Biomedical Engineering ◽

10.1146/annurev-bioeng-083120-023315 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Juan P. Wachs ◽

Andrew W. Kirkpatrick ◽

Samuel A. Tisherman

Keyword(s):

Rural Communities ◽

Rural Areas ◽

The United States ◽

Rural Practice ◽

Annual Review ◽

Publication Date ◽

Future Perspectives ◽

Medical Assistance ◽

Residency Programs ◽

Rural Settings

Telemedicine is perhaps the most rapidly growing area in health care. Approximately 15 million Americans receive medical assistance remotely every year. Yet rural communities face significant challenges in securing subspecialist care. In the United States, 25% of the population resides in rural areas, where less than 15% of physicians work. Current surgery residency programs do not adequately prepare surgeons for rural practice. Telementoring, wherein a remote expert guides a less experienced caregiver, has been proposed to address this challenge. Nonetheless, existing mentoring technologies are not widely available to rural communities, due to a lack of infrastructure and mentor availability. For this reason, some clinicians prefer simpler and more reliable technologies. This article presents past and current telementoring systems, with a focus on rural settings, and proposes a set of requirements for such systems. We conclude with a perspective on the future telementoring systems and the integration of artificial intelligence within those systems. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 23 is June 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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A Review of the Literature on Rural Suicide

Crisis ◽

10.1027/0227-5910.27.4.189 ◽

2006 ◽

Vol 27 (4) ◽

pp. 189-199 ◽

Cited By ~ 158

Author(s):

Jameson K. Hirsch

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Urban Areas ◽

Epidemiological Data ◽

Epidemiological Studies ◽

Health Concern ◽

Prevention And Intervention ◽

Rural And Urban ◽

Urban And Rural Areas ◽

Suicidal Thoughts And Behaviors

Abstract. Background. Suicide is a major cause of mortality worldwide. Differences in rates of suicide exist between urban and rural areas; however, little rigorous research has examined the phenomena of rural suicide. Objective. This review examines the current body of literature on rural suicide and investigates differences between rural and urban suicide, including socioeconomic, psychological, and cultural variables. Prevention and intervention strategies specific to rural communities are discussed. Description of studies. All empirical and epidemiological studies of rural suicide were included in the review regardless of study design or methodology. Results. Although findings are mixed, research and epidemiological data indicate that suicide is a public health concern in rural areas, with suicide rates often greater than in urban areas. Discussion. Rural locale may create geographic, psychological, and sociocultural barriers to treatment of suicide. A better understanding of the role of rurality in the development and maintenance of suicidal thoughts and behaviors is needed and may inform prevention and intervention efforts.

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