The mental health risk factors for primary healthcare workers (PHWs) following the Coronavirus Disease 2019 pandemic and the differences by urbanicity remain unclear. In this study, we aimed to identify key factors of anxiety and depression among PHWs in urban and rural settings in China.

This cross-sectional study was conducted in all 31 provinces in mainland China, between 1 May and 31 October 2022. A total of 3,769 PHWs, including family physicians, nurses, public health professionals, pharmacists, and other medical staff, were recruited from 44 urban community health service centers and 27 rural township hospitals. The Bayesian Additive Regression Tree model was employed to identify risk factors of anxiety and depression.

Among 3,769 PHWs, 1,006 (26.7%) worked in urban areas and 2,763 (73.3%) in rural areas. Occupational satisfaction significantly influenced anxiety in both urban and rural practitioners. For urban PHWs, living with family (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.28–0.62) and self-rated health (fair: OR: 0.31, 95% CI: 0.23–0.42; good: OR: 0.13, 95% CI: 0.09–0.20) were key factors of anxiety. For rural PHWs, after-work exercise (rarely: OR: 0.28, 95% CI: 0.11–0.76; frequently: OR: 0.15, 95% CI: 0.05–0.44) played a critical role. Depression was associated with after-work exercise, self-rated health, and occupational satisfaction for all PHWs. Additionally, living with family (OR: 0.51, 95% CI: 0.34–0.75) and organizational support satisfaction (satisfied: OR: 0.28, 95% CI: 0.19–0.42) were significant for urban practitioners.

Risk factors such as occupational satisfaction, health, and family relations significantly influence PHW mental health in China, with notable differences by urbanicity. Tailored mental health interventions are recommended to address urban–rural disparities.

Family caregivers (FCGs) may experience numerous psychosocial and practical challenges with interpersonal relationships, mental health, and finances both before and after their care recipient (CR) dies. The specific challenges affecting rural FCGs who often have limited access to palliative care services, transitional care, and other community resources are not well understood. The purpose of this paper is to quantify the challenges rural FCGs experienced immediately before the death of a CR and continuing into the bereavement period.

A secondary analysis of data from a randomized controlled trial was conducted. The 8-week intervention included video visits between a palliative care research nurse and FCGs caring for someone with a life-limiting illness. Data were from structured interviews during nurse visits with FCGs in the intervention arm whose CR died during the intervention period.

Ninety (41.8%) of the 215 FCGs experienced the death of their CR. The majority of FCGs were female (58.9%), White (97.5%), spouses or partners (55.6%) and lived with the CR (66.7%). Most FCGs (84%) continued with intervention visits by the study nurse after the CR’s death. Visits resumed on average 7.2 days post-death. The majority of FCGs experienced challenges with grief/coping skills (56%) and interpersonal relationships/support systems (52%) both pre- and post-death of the CR. FCGs also experienced practical challenges with income/finance, housing, and communication with community resources both pre-and post-death.

Bereavement support should extend beyond a focus on grief to include practical challenges experienced by FCGs. Because challenges experienced in the bereavement period often begin before a CR’s death, there is benefit in continuity of FCG support provided by a known clinician from pre- to post-death. When given an option, many rural FCGs are open to bereavement support as early as a week after the death of a CR.

Implantable haemodynamic monitors allow remote monitoring of Fontan circulation. We report unique opportunities and challenges related to device use in rural, high-altitude regions.

Assess the performance of implantable haemodynamic monitor in Fontan circulation and identify potential sources of measurement discrepancy defined as non-physiological, negative, or significantly lower reading than baseline.

We performed a retrospective review of patients who underwent implantable haemodynamic monitor implantation from September 2021 to April 2024 (n = 17) at our centre (∼1,000 feet above sea level; ASL) and identified those with sensor discrepancies.

During a mean follow-up duration of 26 months (range 13–44 months), there were no procedure-related complications, thromboembolism, or device displacement. Ten patients lived in rural, higher-altitude regions (average altitude 5100 feet above sea level, average distance from centre ∼160 miles, range = 100–400 miles). Challenges in remote monitoring included unreliable home-internet connection, non-compliance, and difficulty performing device recalibration at patient’s home altitude. Sensor discrepancies were noted in 7 patients (41%), of whom 6 (86%) lived remotely. Manual review of the waveforms identified sources of discrepancy, including misinterpretation of the non-pulsatile pressure waveform (n = 3), offset due to change in hospital-interrogation unit (n = 4), and sensor drift (n = 1). Altitude change did not directly affect sensor performance. We were able to apply corrective interventions in 4/7 sensors, including Fontan-specific settings (overriding pulsatility), and back-end recalibration, which were effective in improving device accuracy.

Implantable haemodynamic monitors are a promising tool for monitoring Fontan circulation but may require modified settings and careful attention to potential interpretation errors. Home monitoring remains challenging for rural, high-altitude residents with limited resources.

Subjective cognitive decline (SCD) is defined as self-reported increase in confusion or memory loss. There is limited research on the interplay between rural–urban residence and education on SCD.

Examine rural–urban differences in SCD, and whether education moderates this relationship.

Respondents aged ≥45 years were queried about SCD in the 2022 Behavioral Risk Factor Surveillance System data, creating a sample size of 63 890. A logistic regression analysed the association between rural–urban residence and SCD, and moderation was tested by an interaction with education.

SCD was more common among rural (12.0%) compared with urban (10.7%) residents. Rural residence was associated with 9% significantly higher odds of SCD compared with urban residence after adjusting for sociodemographic and health covariates (adjusted odds ratio (aOR) = 1.09, P = 0.01). There was a negative relationship between education level and SCD, including the association of college degree with 15% lower odds of SCD compared with less than high school degree (aOR = 0.85, P < 0.01). Education was a significant moderator, with higher education associated with lower odds of SCD for urban, but not rural, residents.

Rural setting and lower education were associated with higher odds of SCD, but higher education was protective for only urban residents. These results indicate that higher education may be a gateway for more opportunities and resources in urban settings, with cascading impacts on cognition. Future research should examine reasons for the diverging cognitive benefits from education depending on rural–urban residence.

The study examined the impact of the Diabetes Prevention and Management programme on dietary tracking, changes in dietary behaviour, glycosylated Hb (HbA1c) and weight loss over 6 months among rural adults with type 2 diabetes and prediabetes. The programme was a health coach (HC)-led, community-based lifestyle intervention.

The study used an explanatory sequential quantitative and qualitative design to gain insight on participant’s dietary behaviour and macronutrient consumption as well as experience with food tracking. Five of the twenty-two educational sessions focussed on dietary education. Participants were taught strategies for healthy eating and dietary modification. Trained HC delivered the sessions and provided weekly feedback to food journals.

Obese adults with type 2 diabetes or prediabetes (n 94) participated in the programme and 56 (66 %) completed dietary tracking (optional) for 6 months. Twenty-two participated in three focus groups.

Fifty-nine percent consistently completed food journals. At 6 months, average diet self-efficacy and dietary intake improved, and average weight loss was 4·58 (sd 9·14) lbs. Factors associated with weight loss included attendance, consistent dietary tracking, higher HbA1c, diabetes status and energy intake (adjusted R2 = 43·5 %; F = 0·003). Focus group participants reported that the programme improved eating habits. The consistency of dietary tracking was cumbersome yet beneficial for making better choices and was key to being honest.

Participants who consistently tracked their diet improved dietary self-efficacy and intake over 6 months. This model has the potential to be reproduced in other rural regions of the United States.

During the COVID-19 pandemic, virtual physician visits rapidly increased among community-dwelling older persons living with dementia (PLWD) in Ontario. Rural residents often have less access to medical care compared to their urban counterparts, and it is unclear whether access to virtual care was equitable between PLWD in urban versus rural locations.

Using population-based health administrative data and a repeated cross-sectional study design, we identified and described community-dwelling PLWD between March 2020 and August 2022 in Ontario, Canada. Poisson regression was used to calculate rate ratios (RR) and 95% confidence intervals comparing rates of virtual visits between rural and urban PLWD by key physician specialties: family physicians, neurologists and psychiatrists/geriatricians.

Of 122,751 PLWD in our cohort, 9.2% (n = 11,304) resided in rural areas. Rural PLWD were slightly younger compared to their urban counterparts (mean age = 81 vs. 82 years; standardized difference = 0.16). There were no differences across areas by sex or income quintile. In adjusted models, rates of virtual visits were significantly lower for rural compared to urban PLWD across all specialties: family physicians (RR = 0.71 [0.69–0.73]), neurologists (RR = 0.79 [0.75–0.83]) and psychiatrists/geriatricians (RR = 0.72 [0.68–0.76]).

PLWD in rural areas had significantly lower rates of virtual family physician, neurologist and psychiatrist/geriatrician visits compared to urban dwellers during the study period. This finding raises important issues regarding access to primary and specialist healthcare services for rural PLWD. Future work should explore barriers to care to improve health care access among PLWD in rural communities.

Limited access to multiple sclerosis (MS)-focused care in rural areas can decrease the quality of life in individuals living with MS while influencing both physical and mental health.

The objectives of this research were to compare demographic and clinical outcomes in participants with MS who reside within urban, semi-urban and rural settings within Newfoundland and Labrador. All participants were assessed by an MS neurologist, and data collection included participants’ clinical history, date of diagnosis, disease-modifying therapy (DMT) use, measures of disability, fatigue, pain, heat sensitivity, depression, anxiety and disease activity.

Overall, no demographic differences were observed between rural and urban areas. Furthermore, the categorization of primary residence did not demonstrate any differences in physical disability or indicators of disease activity. A significantly higher percentage of participants were prescribed platform or high-efficacy DMTs in semi-urban areas; a higher percentage of participants in urban and rural areas were prescribed moderate-efficacy DMTs. Compared to depression, anxiety was more prevalent within the entire cohort. Comparable levels of anxiety were measured across all areas, yet individuals in rural settings experienced greater levels of depression. Individuals living with MS in either an urban or rural setting demonstrated clinical similarities, which were relatively equally managed by DMTs.

Despite greater levels of depression in rural areas, the results of this study highlight that an overall comparable level and continuity of care is provided to individuals living with MS within rural and urban Newfoundland and Labrador.