UNASSIGNED: Recent disease resurgence in China indicates that corona virus infectious disease is still a pertinent public health problem. We stand at a juncture where we are still unsure about the initial dilemmas regarding its birth, therapies, and the emerging novel strains. Medical literature has focused on the clinical, laboratory, radiological, and therapeutic aspects of disease management. There is paucity of literature on the association between socio-demographic variables on disease severity and clinical outcome.
UNASSIGNED: This retrospective observational study analyzing the socio-demographic variables was performed at a dedicated COVID care center in western Maharashtra, India. Electronic records of all individuals who were admitted to this hospital from July 29 2020, to June 14, 2021, and diagnosed COVID-19 positive by reverse transcriptase polymerase chain reaction (RT-PCR) were identified after due institutional ethical clearance. Patients admitted from July 29, 2020, to February 27, 2021, were categorized as patients presenting during the \'first wave of viral pandemic\'. Those admitted from March 01, 2021, to June 14, 2021, have been included as patients admitted during \'second wave of viral pandemic\'. The following outcome parameters were collected (presenting symptoms, duration of symptoms before the individual presented for diagnostic RT-PCR, total duration of symptoms, severity of disease at onset, duration of hospital stay, the final outcome (discharge/death) and Charlson\'s comorbidity index). The linear regression model was used to establish association between socio-demographic factors and disease severity at onset (mild/moderate/severe/critical).
UNASSIGNED: A total of 37033 patients were screened, and the positivity rate with RT-PCR was 16.99% (n = 6275) during the study period. Out of which 45% (n = 2824) of the patients had mild disease requiring home isolation and the remaining 55% of patients required admission. 1590 patients from the first wave and 910 from the second wave of COVID-19 were hospitalized and included in the study after exclusion. The mean age of patients in first wave was 49 years and that in second wave was 54 years with 77.6% and 70.6% males in two waves, respectively. The burden of critical cases was higher in second wave as computed to first wave (10% vs 8%). The second wave had more outreach in the rural population as compared to second one (17.8% vs 12.2%). The mean duration from the onset of symptoms to hospitalization was 03 and 04 days, respectively, in two waves. Mortality associated in two waves was 11.9% and 24%, respectively (P < 0.05). Higher Charlson\'s comorbidity index was associated with higher mortality, and the cumulative survival from urban area was more as compared to the rural population (log rank - 9.148, P = 0.0002).
UNASSIGNED: The second COVID-19 wave had significantly higher case mortality. It affected elderly patients and those with rural background. The factors associated with higher mortality during COVID-19 pandemic were rural background, higher Charlson\'s comorbidity index and late presentation to the hospital. Ongoing vaccine campaigns, thus, should focus on rural areas and individuals with comorbidities especially in developing and least developed countries.

BACKGROUND: Maldistribution of podiatrists limits capacity to address the footcare needs of the population. Understanding factors that impact recruitment and retention of Australian podiatrists is a key solution. The primary aim of this study was to describe factors related to rural podiatry work, and overall professional retention amongst Australian podiatrists.
METHODS: We used data collected from the most recent relevant response of a cohort of Australian podiatrists between 2017 and 2020 of four online surveys. Person and job role variables known to impact current work and retention were collected. Logistic regression models were used to determine factors associated with rural work and intent to leave direct patient care or the profession entirely.
RESULTS: There were 1129 podiatrists (21% of 5429) who participated in at least one of the survey waves. Podiatrists who had a rural background (30%) were less likely to work in a metropolitan location (OR = 0.20, 95%CI = 0.11,0.37). Podiatrists who undertook a regional/rural placement during their undergraduate education (43%) were more likely to work in a metropolitan location (OR = 1.86, 95%CI = 1.38,2.51). Podiatrists who indicated they were planning to leave direct patient care within 5 years (n = 282, 26%), were less satisfied with working conditions (OR = 0.77, 95% CI = 0.66, 0.92), less satisfied with opportunities to use their abilities (OR = 0.83, 95% CI = 0.69, 0.99), perceived less personal accomplishment (OR = 0.94, 95% CI 0.86, 0.94) and less job satisfaction (OR = 0.92, 95% CI = 0.91, 0.98). Podiatrists who indicated that they were planning to leave podiatry work entirely within 5 years (n = 223, 21%), were less satisfied with opportunities to use their abilities (OR = 0.74, 95% CI = 0.62, 0.88), agreed they had a poor support network from other podiatrists (OR = 1.35, 95% CI = 1.13, 1.61), had less job satisfaction (OR = 0.89, 95% CI = 0.86, 0.94), and did not have access to paid annual leave (OR = 0.62, 95% CI = 0.38, 0.99).
CONCLUSIONS: Findings suggest ways to promote rural work, including selecting university students with rural backgrounds, and optimising the experience of rural placements which currently predict metropolitan practice. To retain podiatrists, it is important to ensure access to leave, professional support, and appropriate physical working conditions. Further research is required to understand why intention to leave is so high.

Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province.
An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression.
A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03-11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24-31.1), and have no additional practice (OR 2.78, CI 1.34-5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42-17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09-8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10-0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05-3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06-4.09), currently practising in RR Maluku (OR 8.23, CI 3.27-20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13-0.70).
This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.

This study concerns the concentrations of gaseous and particle-bound mercury present in ambient air of two Polish sites, differing in terms of emission structure, and the estimation of inhalation risks related to those Hg species. The measurements of total gaseous mercury (TGM) and PM2.5-bound mercury (PBM) were performed at an urban station in Zabrze and a rural station in Złoty Potok, in 2014-2015. Both sites are located in Silesia, considered one of the European air pollution hot-spots. TGM was measured on-line (Tekran 2537). PM2.5 samples were taken with the use of low volume samplers. Hg contents in PM were determined by the CVAAS method following thermal decomposition. The median concentrations of TGM and PBM in Zabrze were 2.48 ng m-3 and 37.87 pg m-3, respectively; meanwhile in Zloty Potok, these were 1.69 ng m-3 and 27.82 pg m-3, respectively. Clearly, seasonal variability of TGM and PBM concentrations were observed, reflecting the importance of Hg and PM emissions from coal combustion for power and heating purposes. Health risk assessment was performed using a deterministic approach by the most conservative exposure scenario. The obtained HQ ratios and the cumulative HI indexes were below the limit value (<1). This means an unlikely health hazard due mercury inhalation.

On rural background areas atmospheric formaldehyde (HCHO) is important for its abundance and chemical reactivity, directly linked to the tropospheric ozone formation processes. HCHO is also toxic and carcinogenic to humans. Atmospheric HCHO was continuously measured in summer 2016 during 81 days (N = 6722, average: 1.42 ppbv) in a rural background area in Northern Spain, Valderejo Natural Park (VNP) using a Hantzsch fluorimetric system. To better characterize the photochemical processes the database was completed with hourly measurements of 63 Non-Methane Hydrocarbons (NMHC) performed by gas chromatography and other common atmospheric pollutants and meteorological parameters. HCHO mixing ratios were highly correlated with ozone and isoprene. Cloudy and rainy days, with low temperature and radiation, led to low HCHO mixing ratios, with maxima (<2 ppbv) registered around 14 UTC. On days with increased radiation and temperature HCHO maxima occurred slightly later (<6 ppbv, ≈16:00 UTC). During clear summer days with high temperature and radiation, two HCHO peaks were registered daily, one synchronized with the radiation maximum (≈3-4 ppbv, ≈13:00 UTC) and an absolute maximum (<10 ppbv, ≈18:00 UTC), associated with the addition of HCHO coming into VNP due to inbound transport of old polluted air masses. In the ozone episode studied, the processes of accumulation and recharge of ozone and of HCHO ran in parallel, leading to similar daily patterns of variation. Finally, HCHO mixing ratios measured in VNP were compared with other measurements at rural, forested, and remote sites all over the world, obtaining similar values.

OBJECTIVE: The objective of this study was to assess the impact of strategies on the intention of dental students/graduates to practice in rural areas. The strategies included the recruitment of dental students from rural backgrounds and clinical rotations in rural areas during the training of dental students.
METHODS: The study undertook a systematic review and utilized meta-analysis to assess these strategies. International literature published between 2000 and 2015 was retrieved from three main search engines: Medline, Embase, and Scopus. The selected articles were scanned to extract the main content. The impact of the strategies was quantitatively assessed by meta-analysis, using the random-effect model. The pooled effect was reported in terms of odds ratios (ORs) with 95% confidence intervals. Sensitivity and subgroup analyses were performed. Publication bias was assessed by the Funnel plot and Egger\'s test.
RESULTS: Seven of the initially selected 897 articles were included for the full review. The majority of the selected articles had been published in developed countries. The meta-analysis results revealed that the pooled OR of rural exposure on the intention to practice in rural areas was approximately 4.1, statistically significant. Subgroup analysis showed that clinical rotations in rural areas tended to have a slightly greater influence on rural dental practice than recruiting students from rural backgrounds (OR 4.3 versus 4.2). There was weaker evidence of publication bias, which was derived from small-study effects.
CONCLUSIONS: Enrolling students with rural backgrounds and imposing compulsory clinical rotation in rural areas during their study appeared to be effective strategies in tackling the shortage and maldistribution of dentists in rural areas.

Rural medical educators have devised strategies based on research evidence to help shape a medical workforce that will choose to serve in rural and other under-served communities, where the health care needs are often high. Based on evidence that students from rural communities are more likely to work later in rural practice, many medical programmes now have targets for rural background students in addition to rural curriculum and placement initiatives. However, just how strong is the evidence that this is effective? Australian medical schools now have data for up to 20 years since the rural medical education initiatives were first introduced. Rural background still appears to be a strong predictor or rural practice outcomes, although combining multiple strategies appears strongest. There remain some methodological issues, such as defining both \'rural\' and \'background\', and determining how intention relates to ultimate location of practice. We may yet have to await longer follow-up periods before we can be confident about what works best in rural medical education.

BACKGROUND: People residing outside the capital cities have poorer oral health than their city counterparts. Health workforce shortages and stability issues can have negative health effects on rural populations. There has been an increasing proportion of women entering the dental practitioner workforce in Australia. This study investigated whether dental practitioners who have a rural background are more likely to work in a rural area than those who do not have a rural background; and whether the gender of dental practitioners plays a role.
METHODS: A self-administered questionnaire was sent to a sample of dental practitioners via their professional dental associations. Practice location was assigned as either \'urban\' or \'rural\' using the Australian Standard Geographical Classification - Remoteness Area categories and measured with demographic characteristics of the respondents. Prevalence ratios (PR) were estimated using Poisson regression with robust standard errors.
RESULTS: Participants with a rural background were more than twice as likely (male PR = 2.23, 95% confidence interval (CI) = 0.79-6.26; female PR = 2.82, 95% CI = 1.35-5.87) to practise in a rural area than those with an urban background.
CONCLUSIONS: Dental practitioners with rural backgrounds were more than twice as likely to work in a rural practice as their urban counterparts.

OBJECTIVE: To investigate the factors eligible applicants consider in electing for a rural pathway into specialty training.
METHODS: Cohort study.
METHODS: Australia.
METHODS: Applicants to the Australian General Practice Training program.
METHODS: Applicants\' initial preference of either a general or rural pathway to undertake specialty training.
RESULTS: Of the 2,221 applicants, 45% were Australian Medical Graduates (AMGs), 27% Foreign Graduates of Accredited Medical Schools (FGAMS) and 29% International Medical Graduates (IMGs). Through government regulation, two thirds (70%) were eligible to train on both general and rural pathways and a third (30%) were required to train rurally. For applicants eligible for general pathway (n = 1552), those with rural background [Odds Ratio (OR) = 3.7, 95% CI 2.7-5.2] and rural clinical school experience (OR = 2.0, 95% CI 1.5-2.8) were more likely to choose the rural pathway. In addition, FGAMS who were eligible for the general pathway were less likely to choose a rural pathway when compared with IMGs (OR = 0.33, 95%CI 0.1 = 0.7). In applicants who changed their training pathway from their initial to revised preference, lower Multiple-Mini-Interview (OR = 0.54, 95% CI 0.43-0.66) and Situational Judgement Test z-scores (OR = 0.68, 95% CI 0.56-0.83) were associated with a higher probability of changing from a general to rural pathway preference.
CONCLUSIONS: For those eligible for a general or rural pathway, rural background and rural clinical school experience are associated with the decision to elect for rural training. Targeted support for international and foreign graduates of Australia/New Zealand schools may influence them to train rurally.

This study provides an analysis of the spatial distribution and trends of NO, NO2 and O3 concentrations in Portugal between 1995 and 2010. Furthermore, an estimation model for daily ozone concentrations was developed for an urban and a rural site. NO concentration showed a significant decreasing trend in most urban stations. A decreasing trend in NO2 is only observed in the stations with less influence from emissions of primary NO2. Several stations showed a significant upward trend in O3 as a result of the decrease in the NO/NO2 ratio. In the northern rural region, ozone showed a strong correlation with wind direction, highlighting the importance of long-range transport. In the urban site, most of the variance is explained by the NO2/NOX ratio. The results obtained by the ozone estimation model in the urban site fit 2013 observed data. In the rural site, the estimated ozone during extreme events agrees with observed concentration.