Retrospective evaluation of patients applied to internal diseases polyclinic from rural and urban regions: a sample of Cappadocia

The study takes a retrospective analysis of patients from rural and urban regions visiting an internal diseases polyclinic.

Depressive symptoms in adults in rural and urban regions of Canada: a cross-sectional analysis of the Canadian Longitudinal Study on Aging

ObjectivesPrevious studies on depression in rural areas have yielded conflicting results. Features of rural areas may be conducive or detrimental to mental health. Our objective for this study was to determine if there are rural–urban disparities in depressive symptoms between those living in rural and urban areas of Canada.DesignWe conducted a cross-sectional analysis of a prospective cohort study, which is as representative as possible of the Canadian population—the Tracking Cohort of the Canadian Longitudinal Study on Aging. For this cohort, data were collected from 2010 to 2014. Data were analysed and results were obtained in 2020.Participants21 241 adults aged 45–85.MeasuresRurality was grouped as urban (n=11 772); peri-urban (n=2637); mixed (n=2125; postal codes with both rural and urban areas); and rural (n=4707). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression. We considered age, sex, education, marital status and disease states as potential confounding factors.ResultsThe adjusted beta coefficient was −0.24 (95% CI −0.42 to −0.07; p=0.01) for rural participants, −0.17 (95% CI −0.40 to 0.05; p=0.14) for peri-urban participants and −0.30 (95% CI −0.54 to −0.05; p=0.02) for participants in mixed regions, relative to urban regions. Risk factors associated with depressive symptoms were similar in rural and urban regions.ConclusionsThe small differences in depressive symptoms among those living in rural and urban regions are unlikely to be relevant at a clinical or population level. The findings do suggest some possible approaches to reducing depressive symptoms in both rural and urban populations. Future research is needed in other settings and on change in depressive symptoms over time.

A Framework for Assessing Food System Governance in Six Urban and Peri-Urban Regions in Sub-saharan Africa

An important goal across Sub-Saharan Africa (SSA), and globally, is to foster a healthy nutrition. A strengthening of the diversity, sustainability, resilience and connectivity of food systems is increasingly seen as a key leverage point. Governance arrangements play a central role in connecting sustainable, resilient farming with healthy nutrition. In this article, we elaborate a framework for assessing, monitoring and improving the governance of food systems. Our focus is on food chains in six peri-urban and urban regions in SSA. A literature review on food chain governance and a mapping of current agri-food chains in the six regions provide the basis for the elaboration of an indicator-based assessment framework. The framework is adapted to the specific conditions of SSA and related goals. The assessment framework is then used to identify the challenges and opportunities in food chain governance in the six regions. The first testing of the framework indicates that the approach can help to identify disconnects, conflicting goals and tensions in food systems, and to formulate strategies for empowering agri-food chain actors in transitioning toward more efficient, equitable and sustainable agri-food systems. The article is concluded with a brief reflection on the strengths and weaknesses of the framework and suggests further testing and refinement.

Dynamic monitoring of urban built-up object expansion trajectories in Karachi, Pakistan with time series images and the LandTrendr algorithm

In the complex process of urbanization, retrieving its dynamic expansion trajectories with an efficient method is challenging, especially for urban regions that are not clearly distinguished from the surroundings in arid regions. In this study, we propose a framework for extracting spatiotemporal change information on urban disturbances. First, the urban built-up object areas in 2000 and 2020 were obtained using object-oriented segmentation method. Second, we applied LandTrendr (LT) algorithm and multiple bands/indices to extract annual spatiotemporal information. This process was implemented effectively with the support of the cloud computing platform of Earth Observation big data. The overall accuracy of time information extraction, the kappa coefficient, and average detection error were 83.76%, 0.79, and 0.57 a, respectively. These results show that Karachi expanded continuously during 2000–2020, with an average annual growth rate of 4.7%. However, this expansion was not spatiotemporally balanced. The coastal area developed quickly within a shorter duration, whereas the main newly added urban regions locate in the northern and eastern inland areas. This study demonstrated an effective framework for extract the dynamic spatiotemporal change information of urban built-up objects and substantially eliminate the salt-and-pepper effect based on pixel detection. Methods used in our study are of general promotion significance in the monitoring of other disturbances caused by natural or human activities.

The Hubei Memory and Aging Cohort Study: Study Design, Baseline Characteristics, and Prevalence of Cognitive Impairments

Background: Despite the improved access to health services in China, inadequate diagnosis and management of dementia are common issues, especially in rural regions. Objective: The Hubei Memory & Aging Cohort Study was designed as a prospective study in Central China to determine the prevalence, incidence, and risk factors for dementia and mild cognitive impairment (MCI) among urban and rural older adults. Methods: From 2018–2020, participants aged ≥65 years were screened, and data regarding their life behaviors, families, socio-economic status, physical and mental health, social and psychological factors, and cognition were collected. Diagnoses of MCI and dementia were made via consensus diagnosis using the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Results: Of 8,221 individuals who completed their baseline clinical evaluation, 4,449 (54.1%) were women and 3,164 (38.4%) were from remote rural areas (average age: 71.96 years; mean education period: 7.58 years). At baseline, 25.98%(95%confidence interval [CI]: 24.99–26.96) and 7.24%(95%CI: 6.68–7.80) of the participants were diagnosed with MCI and dementia, respectively. Prevalence showed a strong relationship with age. The substantial disparities between rural and urban regions in MCI and dementia prevalence and multiple dementia-related risk factors were revealed. Especially for dementia, the prevalence rate in rural areas was 2.65 times higher than that in urban regions. Conclusion: Our results suggested that public health interventions are urgently needed to achieve equitable diagnosis and management for people living with dementia in the communities across urban and rural areas.

Abstract 1122‐000062: Impact of COVID‐19 on Stroke Care in the United States and Potential Solutions

Introduction : The emergence of the COVID‐19 pandemic has negatively impacted medical care across the United States, especially so for rural communities. In this qualitative study, we investigated the barriers to the access of adequate treatment of ischemic stroke that have risen due to COVID‐19 in urban and rural regions of the United States of America. Methods : Using CDC data, we identified 16 regions, consisting of half urban and half rural regions, that had the highest stroke mortality rate and the highest incidence of COVID‐19 cases in the country. We compiled a list of neurointerventionalists practicing in these regions and designed a survey that was emailed to each neurointerventionalist. The survey investigated how stroke treatment in their hospital has been affected by the COVID‐19 pandemic; it additionally contained a request for a virtual interview to allow neurointerventionalists to discuss in greater detail the barriers to stroke treatment they are facing. Neurointerventionalists from hospitals across four urban regions and three rural regions filled out the survey and were then interviewed by Zoom or phone. Results : The survey and the interviews highlighted a number of barriers: hospitals in both urban and rural regions faced an unavailability of ICU beds during COVID surges. As COVID‐19 patients continued to occupy ICU beds, thrombectomy‐capable hospitals could not accept transfer stroke patients. These patients had to be diverted to other thrombectomy‐capable hospitals with vacant ICU beds, resulting in time lost before treatment. Stroke transfer posed more of a challenge in rural regions (as compared to urban communities) due to fewer rural‐area hospitals performing thrombectomy. Secondly, both urban and rural regions saw stroke patients delay their arrival to the hospital. In urban regions, stroke patients delayed their arrival by up to a week in some cases. Patients with milder stroke symptoms did not show up to the hospital for treatment at all, hoping the stroke would subside on its own. This pattern has been attributed to patients’ fear of contracting COVID‐19. In comparison, rural hospitals faced a smaller average delay of up to a few days, as many patients did not see the virus as a threat. The delay was attributed to some patients’ fear of the virus, fear of the procedure, or longstanding physician mistrust. Lastly, rural regions encountered an understaffing of nurses; a likely factor is the incidence of layoffs early in the pandemic, which lessened the time spent at a stroke patient’s bedside and impacted stroke outcome. Conclusions : Urban regions were quicker to adapt to the pandemic than rural regions. They had a greater number of available staff and vacant ICU beds to be able to treat patients with minimal interference. Urban regions could still consider having nearby hospitals communicate with each other so that they can share the burden of care and prevent a single hospital from becoming overwhelmed. Rural regions could especially focus on hiring travel nurses in cases of understaffing, increasing the number of thrombectomy performing centers, and pushing the education of stroke.