UNASSIGNED: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship.
UNASSIGNED: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas.
UNASSIGNED: Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences.
UNASSIGNED: There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82-1.63), less evaluation (AOR 1.29, 95% CI 0.92-1.81), and less decision ability (AOR 1.20, 95% CI 0.86-1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56-2.13), less evaluation (AOR 1.05, 95% CI 0.61-1.79), and less decision ability (AOR 1.10, 95% CI 0.64-1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48-1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47-1.54), evaluation (AOR 0.89, 95% CI 0.50-1.57), and decision ability (AOR 0.99, 95% CI 0.55-1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48-1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62-2.44), evaluation (AOR 0.98, 95% CI 0.53-1.82), and decision ability (AOR 0.90, 95% CI 0.49-1.67), were associated with medication adherence in rural areas.
UNASSIGNED: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.

This article analyzed the dynamics of regionalization in municipalities within hinterlands and the possible implications of gaps in care for the marketing of health. This is a multiple case study with a qualitative approach, involving 76 semi-structured interviews with municipal, regional, and state managers. The results show that, particularly in the Northern states, the regional scheme did not reflect the social dynamics of the populations and created inadequate flows and unwanted routes. The municipal political agenda often prioritized interests other than that of regionalization, and rural problems did not mobilize managers to build specific regional planning. Parliamentary amendments were essential for investment in healthcare and the managers pointed to clientelistic relationships to obtain such resources, often conditioned by political-ideological alignment. The scarcity of public services favored dependence on the private sector and the commercialization of health in different situations. The great distances and the lack of public services in municipalities in the hinterland made the local public health system offer eminently dependent on contracts with private providers who negotiated on a retail basis or via service packages. Lastly, in the wake of unmet needs and gaps in care in remote rural municipalities, players in the healthcare market ₋ companies supplying inputs, consultants, healthcare professionals, and transportation services ₋ filled the gaps in public provision, sometimes controlling prices, supply and availability of services.
Analisam-se a dinâmica da regionalização em municípios rurais remotos e as possíveis implicações dos vazios assistenciais na comercialização da saúde. Trata-se de um estudo de casos múltiplos, com abordagem qualitativa, por meio de 76 entrevistas semiestruturadas com gestores municipais, regionais e estaduais. Os resultados revelam que, particularmente nos estados da Região Norte, o desenho regional não repercutia a dinâmica social das populações e criava fluxos inadequados e rotas indesejadas. A agenda política municipal priorizava, muitas vezes, interesses díspares à regionalização e as questões da ruralidade não mobilizavam os gestores para a construção de um planejamento regional específico. Emendas parlamentares ocupavam um lugar imprescindível para o investimento em saúde e os gestores apontaram relações clientelistas para obter tais recursos, condicionada e corriqueiramente, pelo alinhamento político-ideológico. A escassez de serviços públicos favorecia a dependência do setor privado e a comercialização da saúde em diferentes situações. As grandes distâncias e a ausência de serviços públicos nas proximidades dos municípios rurais remotos tornavam a oferta do Sistema Único de Saúde (SUS) local eminentemente dependente do contrato com prestadores privados que negociavam no varejo ou por meio de pacotes de serviços. Por fim, na esteira das necessidades não atendidas e dos vazios assistenciais, nos municípios rurais remotos, agentes do mercado da saúde - empresas de fornecimento de insumos, consultorias, profissionais de saúde e serviços de transporte - ocupavam as brechas da provisão pública, algumas vezes controlando preços, oferta e disponibilidade dos serviços.
Se analizan las dinámicas de la regionalización en municipios rurales remotos y las posibles implicaciones de las brechas de la atención en la comercialización de la salud. Se trata de un estudio de caso múltiple, con enfoque cualitativo, que realizó 76 entrevistas semiestructuradas a los gestores del municipio, de la región y del estado. Los resultados mostraron que, principalmente en los estados de la Región Norte, el diseño regional no reflejó la dinámica social de las poblaciones y creó flujos inadecuados y rutas indeseables. La agenda política municipal frecuentemente priorizó intereses dispares a la regionalización y los temas de ruralidad no movilizaron a los gestores para construir una planificación regional específica. Las enmiendas parlamentarias fueron esenciales para invertir en sanidad, y los gestores señalaron las relaciones clientelares para obtener estos recursos, muchas veces condicionadas por el alineamiento político-ideológico. La escasez de servicios públicos favoreció la dependencia del sector privado y la comercialización de la salud en diferentes situaciones. Las grandes distancias y la falta de servicios públicos en las cercanías de municipios rurales remotos hicieron que la oferta del Sistema Único de Salud local dependiera eminentemente del contrato con proveedores privados que negociaban al por menor o mediante paquetes de servicios. Finalmente, ante las necesidades no cumplidas y las brechas de atención, en los municipios rurales remotos, los agentes del mercado de la salud (empresas proveedoras de insumos, consultorías, profesionales de la salud y servicios de transporte) ocuparon las brechas en la prestación pública mediante muchas veces el control de los precios, de la oferta y de la disponibilidad de los servicios.

UNASSIGNED: The digital divide is the difference between individuals who use the Internet and those who do not. Under the triple social environment of urban-rural dichotomy, population aging, and the digital era in China, the existence of digital divide among rural older adults has seriously affected their access to health information through the Internet, so it is urgent to bridge the digital divide problem they face.
UNASSIGNED: Based on Maslow\'s Hierarchy of Needs Theory and Stress Coping Theory, the impact of cultural capital on the digital divide among rural older adults was systematically analyzed using hierarchical regression and Chained Mediation Effect Tests using data from the Chinese Family Panel Studies (CFPS).
UNASSIGNED: Cultural capital has a significant positive effect on the digital divide among rural older adults (β = 0.178, p < 0.01). Cognitive ability and economic capacity both play independent intermediary effects between cultural capital and digital divide among rural older adults, and the intermediary chain formed by the two plays a chain intermediary effect. The increase in the cultural capital of rural older adults has led to an increase in their cognitive ability and economic capacity, which ultimately has a favorable effect on the bridging of the digital divide. Heterogeneity results suggest that cultural capital is more effective in bridging the digital divide among male rural older adults aged 60-69.
UNASSIGNED: Cultural capital is able to bridge the digital divide faced by rural older adults and is age and gender heterogeneous. At the same time, improved cognitive ability and economic capacity can also help rural older adults bridge the digital divide. Therefore, it is proposed that we increase the construction of public cultural service infrastructure in rural areas, liaise with community neighborhood committees and village committees to do a good job of publicity, improve training measures for key groups, and maintain the enthusiasm of rural older adults for learning, so as to provide references for the rural older adults in China and developing countries in general to bridge the digital divide.

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BACKGROUND: The care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians\' Health Program\'s objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia.
METHODS: Yarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia.
RESULTS: Two themes were developed through rigorous data analysis of yarning information and responses: participants\' experiences of managing wounds and barriers and enablers to effective wound care.
CONCLUSIONS: This study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers.

OBJECTIVE: Survival rates of breast cancer (BC) patients are particularly low in rural regions in sub-Saharan Africa (SSA) which is due to limited access to therapy. In recent years, gene expression profiling (GEP) of BC showed a strong prognostic value in patients with local tumour surgery and (neo)adjuvant treatment. The aim of this study was to evaluate the impact of intrinsic subtypes on survival of patients in rural Ethiopia without any (neo)adjuvant therapy.
METHODS: In total, 113 female patients from Aira Hospital with histologically proven BC and treated only with surgery were included in this study. All samples were analysed by immunohistochemistry (IHC) for estrogen receptor, progesterone receptor, HER2 and Ki67, as well as RNA-expression analysis for PAM50 subtyping.
RESULTS: A positive hormone receptor status was found in 69.0% of the tumours and intrinsic subtyping demonstrated Luminal B to be the most common subtype (34.5%). Follow-up data was available for 79 of 113 patients. Two-year overall survival (OS) was 57.3% and a considerably worse OS was observed in patients with Basal-like BC compared to Luminal A BC. Moreover, advanced tumours showed an increased risk of mortality.
CONCLUSIONS: The OS was very low in the patient cohort that received no (neo)adjuvant treatment. Immunohistochemistry and GEP confirmed endocrine-sensitive tumours in more than half of the patients, with a large proportion of Luminal B, HER2-enriched and Basal-like tumours so that adjuvant chemotherapy should be recommended.

BACKGROUND: Exposure to indoor air pollution from solid cooking fuel use may increase mental disorders risk through pathways such as oroxidative stress, neuroinflammation, or cerebrovascular damage. However, few studies have explored the underlying mechanism between solid cooking fuel use and psychological distress. The present study aims to investigate the mediating role of sleep quality on the relationship between solid cooking fuel use and psychological distress among older adults in rural Shandong, China.
METHODS: This study used the cross-sectional data from the second follow-up survey of the Shandong Rural Elderly Health Cohort (SREHC). A total of 3,240 rural older adults were included in the analysis. Logistic regression and the Karlson, Holm, and Breen (KHB) mediation analyses were performed to investigate the relationship between solid cooking fuel use and psychological distress, as well as the mediating role of sleep quality in this association.
RESULTS: This study found that solid cooking fuel use was significantly and positively associated with psychological distress among older adults in rural Shandong, China (OR = 1.38, 95% CI: 1.12,1.70). Mediation analysis revealed that sleep quality mediated the association between solid cooking fuel use and psychological distress among older adults (β = 0.06, P = 0.011). The mediation effect accounted for 16.18% of the total effect.
CONCLUSIONS: Our study showed that solid cooking fuel use was associated with psychological distress among rural older adults, and sleep quality mediated this association. Interventions should focus on addressing cooking fuel types and poor sleep quality to reduce psychological distress. In the future, more aggressive environmental protection policies would be needed to lessen the adverse effects of indoor air pollution on the health of older adults in rural China.

BACKGROUND: In 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients\' health seeking behavior from tertiary hospitals to primary health facilities.
METHODS: This study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study.
RESULTS: Participants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities (P = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not.
CONCLUSIONS: The study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

BACKGROUND: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited.
OBJECTIVE: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health.
METHODS: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided.
RESULTS: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website.
CONCLUSIONS: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants.

BACKGROUND: The North-eastern region of India has a relatively higher prevalence of substance use, which together with poor dietary practices and a lack of physical activity is one of the key risk factors for NCDs among older adults in the region. Understanding the prevalence of NCDs and their relationship to substance use can help develop preventive strategies and sensitization in North-eastern India.
OBJECTIVE: To assess the prevalence of NCDs and the strength of the association of substance abuse among the geriatric population of North-eastern states in India, for the development of preventive strategies.
METHODS: Data from the Longitudinal Ageing Study in India (LASI Wave-I, 2017-18) were drawn to develop this paper. The bi-variate and binary logistic regression analyses were carried out to predict the association between non-communicable diseases and substance use adjusting select socio-demographic characteristics.
RESULTS: The paper revealed the prevalence of NCDs among urban people (61.45%) is higher than among rural people (42.45%). Hypertension (37.29%) can be seen as the most prevalent disease among the following given NCDs followed by Diabetes (8.94%). The chances of having Cancer are nineteen times higher (OR = 19.8; C.I. = 18.82-20.83) if an individual has past smoking behaviour after controlling for socio-demographic and physical activity variables.
CONCLUSIONS: Since, the high prevalence of hypertension correlated with the high level of substance abuse, require immediate attention to develop appropriate intervention strategies for its control (substance abuse) and prevention of hypertension. In a lower middle-income country like India, preventive measures, rather than curative measures will be cost-effective and helpful.