Challenges confronting rural hospitals accentuated during COVID-19

The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding decade.Twenty-five years later,1350 CAHs serve approximately 18% of the US population and a systematic policy evaluation has yet to be performed.This policy analysis serves to define challenges faced by CAHs through a literature review addressing the four major categories of payment,quality,access to capital,and workforce.Additionally,this analysis describes how current challenges to maintain sustainability of CAHs over time are accentuated by gaps in public health infrastructure and variability in individual health care plans exhibited during the COVID-19 pandemic.

Perception of Caesarean Section among Pregnant Women in a Rural Missionary Hospital

Introduction: Caesarean section is the delivery of a foetus through an incision made on the uterus. It is useful in situations where vaginal delivery is not feasible. Women in our setting usually see it as a reproductive failure and a sign of weakness. Our aim was to evaluate the perception of caesarean section among pregnant women attending antenatal clinic in a rural missionary hospital. Methodology: This was a cross-sectional study conducted at Mile 4 missionary hospital, Abakaliki among women attending routine antenatal clinic. Information was obtained from respondents with the aid of a questionnaire. Ethical clearance was obtained for the study. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 209 pregnant women participated in this study. Their age ranged from 14 to 43 with a mean age of 27 ± 5 years. One hundred and seventy two women (82.3%) have heard of caesarean section in the past. Eighteen (8.6%) have had caesarean section in the past while 5 were not willing to undergo the procedure again. Sixty (28.7%) are not willing to undergo caesarean section even when it is indicated. Conclusion: Despite awareness of caesarean section, women do not appear to have a positive attitude towards the procedure.

Control of Postpartum Haemorrhage with Uterine Balloon Tamponade Using Foley Catheter in a Rural Mission Hospital in Ebonyi State, Southeast Nigeria

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Socio-Demographic and Maternal Determinants of Birth Preparedness among Pregnant Women Seeking Skilled Birth Services at a Rural General Hospital, Mid Western Uganda

Background: Although the practice of preparing for childbirth among pregnant women is associated with 24.0% and 53.0% reduction in neonatal and maternal mortality respectively in low income countries, it remains inadequately practiced in Uganda. This study sought to assess socio-demographic and maternal determinants of birth preparedness among pregnant women at one of the rural hospitals in Uganda. Methods: This was a descriptive cross sectional study conducted among 332 pregnant women in first stage of normal labour between April and May 2017 at Kagadi hospital, mid western Uganda. In order to understand socio-demographic and maternal determinants of birth preparedness, we considered overall level of birth preparedness as our dependent variable and determined it using five elements. Data were collected using a researcher administered questionnaire. We used descriptive statistics to understand characteristics of respondents and multivariable logistic regression model to determine factors associated with birth preparedness. Results: Only 94 (28.3%) of the 332 pregnant women who were included in the study were prepared for childbirth. We found that male partners having secondary level of education (aOR 1.86, CI 1.107 - 3.243, p 0.02), discussing birth plan with spouse (aOR 1.97, CI 1.06 - 3.490, p 0.03), monthly income of at least eighty three dollars (aOR 2.98, CI 1.847 - 5.981, p 0.002), being escorted by the spouse during ANC visit (aOR 1.73, CI 1.010 - 2.964, p 0.04), intention to conceive (aOR 1.99, CI 1.087 - 3.65, p 0.026) and being health educated about birth preparedness during antenatal visit (aOR 1.90, CI 1.006 - 3.59, p 0.048) were associated with birth preparedness. Conclusion and Recommendations: We observed that the level of birth preparedness among respondents was associated with many socio-demographic and maternal factors. To scale up birth preparedness in rural settings, we recommend improving household financial income, reducing contraceptive unmet needs, male involvement and health education services to couples during antenatal visits.

Epidemiology of Cancer in Rural Congo: Case of IME Kimpese Hospital, Democratic Republic of Congo

Background and Aim: Cancer is a public health problem in developing countries. It is aggravated by diagnostic confirmation difficulties. The aim of this study was to determine the epidemiological profile of cancers in Congolese rural areas. Methods: A historical cohort study was conducted with 914 histopathological protocols at the IME/Kimpese hospital from January 2008 to December 2013. Results: The mean age of patients was 55.2 ± 14.5 years, and 61.9% were women with a sex ratio of 2W/M. Ductal carcinoma (23.6%), squamous cell carcinoma (23.5%) and adenocarcinoma (23.1%) were the most common cancers. The most affected organs were breast (26.3%) and prostate (14.3%). 41.5% of cancers had an undifferentiated character and more than half (51.1%) a differentiated character. The majority of this cancer infiltrated other organs (57.9%). Among cancers where grade was found, 16% and 10.8% were respectively grades 1 and 4, and the presence of metastases was observed in 10.9% of cancers. Conclusion: Cancer is more frequent in elderly women with a predominance of squamous and ductal carcinoma. The presence of a national cancer registry is necessary in the country for a good follow-up of cancer cases.

Reducing Extended Hospital Lengths of Stay

In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.

The impact of the Rural Minimum Living Standard Guarantee(Rural Dibao)Program on child nutrition outcomes

The Rural Minimum Living Standard Guarantee(Rural Dibao)is an important unconditional cash transfer program to alleviate poverty in rural China.Despite the importance of children’s nutrition in breaking poverty cycles,little is known about the impact of Rural Dibao on child nutrition outcomes.Using China Family Panel Studies(CFPS),this paper examines the effects of Rural Dibao on child nutrition outcomes and investigates potential pathways and heterogeneous effects.We exploit propensity score matching and difference-in-differences techniques to evaluate the effects of the Rural Dibao program on child nutrition outcomes.Our results suggest that Rural Dibao significantly impacts the nutrition outcomes of children up to 15 years of age.Specifically,our results suggest that Rural Dibao improves child height-to-age z-scores by 1.05 standard deviations and lowers the probability of stunting by 11.9 percentage points.Additional analyses suggest that increased protein intake is the main pathway through which Rural Dibao participation contributes to better nutrition outcomes.We also find that the effect of the program is more pronounced among girls,children who are non-left-behind or live with highly educated mothers,and those from low-income families and poor areas.Our findings suggest that Rural Dibao participation helps improve child nutrition outcomes through improving diet quality.

Ethnic Customs and Rural Tourism Development in Xinbin Manchu Autonomous County of Fushun City

The development of ethnic minority tourism is currently a hot topic in domestic tourism development.As an important component of Chinese civilization,the Manchu people have created brilliant culture in the long river of historical development.As the hometown of the Manchu people,Fushun has unique folk cultural tourism resources and a strong ethnic flavor.Nowadays,under the promotion of the rural revitalization strategy,the construction of new rural areas is constantly developing,and rural tourism is gradually becoming a new industry.Therefore,in the context of the increasingly prosperous rural tourism industry,it has become increasingly important to combine the ethnic customs of Manchu culture with rural tourism.Taking the ethnic customs and integrated development of rural tourism in Xinbin Manchu Autonomous County of Fushun City,Liaoning Province as the research object,this paper mainly sorts out the current situation and characteristics of rural tourism development in the region,systematically explores the problems in development and how to further optimize development,and proposes new models suitable for the development of folk tourism in Xinbin of Fushun,in order to achieve maximum economic and social benefits and provide a reference for promoting the development of tourism in the region.

Theoretical Research and Practical Application of the Rural Cultural Enhancement by Creative Designs Under Rural Vitalization-A Case Study of Shanxi Province

To revive the nation,the rural area must be revitalized.Every regional cultural and creative industry has its own development path and practical mode.From the perspective of rural revitalization,this paper conducts research on the development model of cultural and creative design,and analyzes the significance of the integration of creative design with rural regional culture.Based on the current situation of rural cultural and creative development in Shanxi Province,this study proposes to form a brand communication chain through the integration between cultural design and rural culture,and the establishment of cultural and creative brands,furthermore,to establish trending topics through multiple channels.Finally,the important practical significance of cultural and creative design in promoting rural economic development and enhancing rural culture value is discussed in this design strategy,so as to actively help the new journey of rural revitalization.

Research on Evaluation of Spatial Vitality and Influencing Factors of Guesthouses Public Areas Based on Rural Tourism Development

In recent years,China has continued to promote the strategy of rural revitalization.The rural tourism industry has developed rapidly in the context of rural revitalization.Now the rural B&B industry has become an important pillar in solving the problem of rural tourism accommodation.Most of the villages in China have begun to carry out the construction of rural lodging,for example,there are residents who use idle houses to carry out construction on their own initiative and projects developed by village collectives,so the rural lodging industry has been vigorously developed.The vitality of supporting industries and landscape resources around the distribution of rural lodging has become a hot spot of rural issues research in recent years.Therefore,we can use the method of data analysis to analyze the industry and function of the public area around the distribution of rural B&B.Through the comparison of data and the interpretation of related cases,the core elements affecting the spatial vitality of B&B public areas can be identified.We will analyze and improve the related elements to find a reasonable way to enhance the spatial vitality value.Finally,the article will put forward suggestions to improve the related spatial vitality as a way to promote the development of rural B&B industry and the progress of rural tourism.

The effect of"rural cultural auditorium"on the revitalization of rural culture:A case study of villages A and B in Zhejiang Province

The construction of rural cultural auditorium is conducive to gathering local popularity,excavating history and continuing civilization,and it has become a powerful driving force for cultural revitalization in rural revitalization.However,the development of"Rural Cultural Auditorium"encountered many problems so far.From the perspective of rural cultural revitalization,and under the background of the new socialist rural cultural construction in China,this paper takes the rural cultural auditorium as the topic.The field questionnaire survey and semi-structured interview were constructed in Village A and Village B of Zhejiang Province,.SPSS software is used to analyze the collected questionnaire data.On the basis of combing related concepts and theories,it summs up the problems of"rural cultural auditorium",such as the existence of cultural auditorium,low participation rate of cultural auditorium activities,poor information communication,etc.Through visiting and investigating,going deep into the local area,according solutions are put forward such as increasing content diversity,paying attention to publicity and increasing interaction,so as to promote the healthy and sustainable development of rural cultural auditorium.It is hoped that this paper will explore the significance of the construction of rural cultural auditorium to the revitalization of rural culture in China,and put forward ideas on how to further build rural cultural auditorium,so as to provide reference for rural cultural construction services.

Monitoring Changes in Hospital Utilization

This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstrated that hospital lengths of stay in the metropolitan area of Syracuse, New York increased by 25.0 percent between 2019 and 2023. This has been a notable increase in the movement of patients with this indicator. The analysis also demonstrated that numbers of inpatient discharges for these hospital services declined substantially during the same periods. Review of the data suggested that this information has been related. The increase in hospital lengths of stay has been related to a rise in numbers of patients at high severity of illness. They have also been associated with a decline in numbers of patients at low severity.

Analysis of Hospital Budget Management Control Based on Smart Hospital

Hospitals are crucial healthcare facilities where patients seek treatment,and effective budget management within hospitals significantly impacts their operational efficiency and financial performance.In the age of information technology and advanced healthcare solutions,the emergence of smart hospitals represents a new trend in the medical industry’s evolution.Leveraging modern information technology can enhance the development of hospital IT systems and drive budget management toward greater intelligence.This paper begins by analyzing the influence of smart hospitals on hospital budget control.It then examines the current state of budget management control within smart hospitals.Finally,it proposes several strategies for budget management control in smart hospitals,aiming to provide guidance for relevant stakeholders.

Spatial-temporal differentiation and influencing factors of rural settlements in mountainous areas: an example of Liangshan Yi Autonomous Prefecture, Southwestern China

Rural settlement is the basic spatial unit for compact communities in rural area. Scientific exploration of spatial-temporal differentiation and its influencing factors is the premise of spatial layout rationalization. Based on land use data of Liangshan Yi Autonomous Prefecture(hereinafter referred to as Liangshan Prefecture) in Sichuan Province, China from 1980 to 2020, compactness index, fractal dimension, imbalance index, location entropy and the optimal parameters-based geographical detector(OPGD) model are used to analyze the spatial-temporal evolution of the morphological characteristics of rural settlements, and to explore the influence of natural geographical factors, socioeconomic factors, and policy factors on the spatial differentiation of rural settlements. The results show that:(1) From 1980 to 2020, the rural settlements area in Liangshan Prefecture increased by 15.96 km^(2). In space, the rural settlements are generally distributed in a local aggregation, dense in the middle and sparse around the periphery. In 2015, the spatial density and expansion index of rural settlements reached the peak.(2) From 1980 to 2020, the compactness index decreased from 0.7636 to 0.7496, the fractal dimension increased from 1.0283 to 1.0314, and the fragmentation index decreased from 0.1183 to 0.1047. The spatial morphological structure of rural settlements tended to be loose, the shape contour tended to be complex, the degree of fragmentation decreased, and the spatial distribution was significantly imbalanced.(3) The results of OPGD detection in 2015 show that the influence of each factor is slope(0.2371) > traffic accessibility(0.2098) > population(0.1403) > regional GDP(0.1325) > elevation(0.0987) > poverty alleviation(0). The results of OPGD detection in 2020 show that the influence of each factor is slope(0.2339) > traffic accessibility(0.2198) > population(0.1432) > regional GDP(0.1219) > poverty alleviation(0.0992) > elevation(0.093). Natural geographical factors(slope and elevation) are the basic factors affecting the spatial distribution of rural settlements, and rural settlements are widely distributed in the river valley plain and the second half mountain area. Socioeconomic factors(traffic accessibility, population, and regional GDP) have a greater impact on the spatial distribution of rural settlements, which is an important factor affecting the spatial distribution of rural settlements. Policy factors such as poverty alleviation relocation have an indispensable impact on the spatial distribution of rural settlements. The research results can provide decisionmaking basis for the spatial arrangement of rural settlements in Liangshan Prefecture, and optimize the implementation of rural revitalization policies.

The impact of Internet access on household dietary quality:Evidence from rural China

Over the past few decades,the Internet has rapidly diffused across China.The spread of the Internet has had a profound economic and social impact on Chinese rural areas.Existing research shows that Internet access significantly impacts agricultural production and improves smallholder farmers’income.Beyond these,the Internet can affect other dimensions of social welfare.However,research about the impact of Internet access on dietary quality in rural China remains scarce.This study utilizes multi-period panel data from Fixed Observation Point in rural China from 2009 to 2015 to estimate the impact of Internet access on dietary quality and food consumption of rural households and conducts a causal analysis.Regression models with time and household fixed effects allow robust estimation while reducing potential issues of unobserved heterogeneity.The estimates show that Internet access has significantly increased rural household dietary quality(measured by the Chinese Diet Balance Index).Further research finds that Internet access has increased the consumption of animal products,such as aquatic and dairy products.We also examine the underlying mechanisms.Internet access improves dietary quality and food consumption mainly through increasing household income and food expenditure.These results encourage the promotion of Internet access as a valuable tool for nutritional improvements,especially in rural areas.

Echocardiographic Aspects of Type 2 Diabetics Patients Hospitalized in the Medicine and Endocrinology Department of the Mali Hospital

Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive and cross-sectional study of 12 months from June 2020 to June 2021. We included hospitalized type 2 diabetics who underwent transthoracic cardiac ultrasound in the Department of Medicine and Endocrinology at the Mali Hospital. Results: We collected 128 type 2 diabetics. The predominance was male with a sex ratio of 1.2. The mean age of patients was 60.06 ± 11.54 years with extremes of 28 and 84 years. Echocardiographic abnormalities were dominated by abnormal relaxation of left ventricle in 62.5%, increased of left ventricle mass in 54.7% and left atrium dilation in 28.1%. Patients with type 2 diabetes mellitus and hypertension had more left atrium dilation with a p of 0.02. Disorders of global kinetics and systolic dysfunction were more prevalent in smoking patients with statistically significant associations, respectively, p = 0.02;p = 0.03. Dyslipidemia had a statistically significant association with segmental kinetic disorders with a p of 0.008. Duration of diabetes greater than 5 years was associated with left atrium dilation and p-value was 0.04. Conclusion: Diabetes is responsible for cardiovascular manifestations that can be identified with transthoracic echocardiography. Its performance in diabetic patients makes it possible to refine the patient’s management.

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Heart Failure in the Medical Department at Gao Regional Hospital

Introduction: Heart failure is a major public health pandemic, particularly in Africa, where its prevalence continues to increase. In northern Mali, few data exist, hence the interest of this study with the objective of studying the epidemiological, clinical and therapeutic and evolutionary aspects of Heart failure at the regional hospital of Gao. Patients and Methods: This was a cross-sectional, descriptive study that took place from July 2022 to June 2023 in the medical department at Gao Hospital. Results: The hospital prevalence of heart failure was 44.1%. The mean age was 47.30 ± 20 years (range: 16-88). Hypertension was the most common with 46.1%, followed by a sedentary lifestyle, and diabetes with 18.2% and 8.3% respectively;NYHA stage III-IV dyspnea was found in 83.9%. Reduced EF heart failure was present in 110 patients (76.9%), seventeen cases with moderately reduced EF (11.9%) and sixteen patients had preserved EF (11.2%). Global heart failure was the dominant (91.6%). The main etiologies of heart failure were dominated by hypertensive heart disease in 46 patients (32.2%), followed by postpartum cardiomyopathy with 43 cases (30.1%), primary dilated cardiomyopathy in 18 patients (12.6%), ischemic heart disease in 16 patients with 11.2%. Seven cases of valvular heart disease, or 4.9%. The evolution was favorable under treatment in 104 patients or 72.7%. In-hospital mortality was 14.7%. Conclusion: Heart failure is a common condition in sub-Saharan Africa, particularly in our country.

Understanding livelihood vulnerability:a perspective from Western Sichuan’s ethnic rural settings

To explore the livelihood status and key influencing factors of rural households in the minority areas,we collected flat data from 284 rural households in 32 villages across 12 counties of Western Sichuan from 2021 to 2022.We conducted participatory household survey on the livelihood status of the rural households and try to identify the key factors to influence their livelihood vulnerability using multiple linear regression.The results showed that:the livelihood situation of the rural households is relatively vulnerable.The vulnerability varies significantly with the income levels,education levels,and income sources.The vulnerability of farm households,categorized from low to high livelihood types,follows the sequence:non-agricultural dominant households,non-agricultural households,agricultural dominant households,and pure agricultural households.The degree of damage to the natural environment,education costs,loan opportunities,the proportion of agricultural income to annual household income,and the presence of sick people in the household have significant positive effects on the livelihood vulnerability index(LVI)of rural households;while help from relatives and friends,net income per capita,household size,household education,agricultural land area,participation in industrial organizations,number of livestock,purchase of commercial houses,drinking water source,and self-supply of food have significant negative effects.Based on the findings,we believe that local rural households operate in a complex livelihood system and recommend continuous interventions targeting key influences to provide empirical research support for areas facing similar situations.

The Burden of Undiagnosed Hypertension and Associated Risk Factors among Adults in a Rural Community in Imo Sate, South-East Nigeria

Background: Cardiovascular diseases are the leading cause of death globally and hypertension is a major contributor to this burden. Many people with hypertension have poorly controlled blood pressure and up to half of the adults with hypertension are unaware of their hypertensive status due to factors that bother on poor management and poor screening approaches. The implication is that people who have poor access to healthcare especially those in the rural communities are at increased risk of cardiovascular complications and all-cause mortality. Unfortunately, not much has been done to ascertain the burden of undiagnosed hypertension and associated risk factors in rural communities in Nigeria. Methods: We conducted a community-based cross-sectional study in a rural community in Imo State, Nigeria, on burden of undiagnosed hypertension with participants recruited via a multi-stage sampling method. An interviewer-administered questionnaire was used, and standardized instruments were applied to obtain, process and analyze the data. Tests of association between the independent variables and outcome were conducted using logistic regression. P-value of Results: A total of 380 adults participated in the study. The mean age was 44.2 years. The prevalence of undiagnosed hypertension was 35.8%. Logistic regression revealed that age, with the respondents in the age groups 26 - 35 years (OR = 10.647, 1.910 - 59.345, p-value = 0.007), 36 - 45 (OR = 3.680, 1.263 - 10.723, p-value = 0.017), 46 - 55 years (OR = 2.737, 1.114 - 6.727, p-value = 0.039), 56 - 65 years old (OR = 3.384, 1.610 - 7.115, p-value = 0.001);and being married (OR = 3.846, 1.118 - 13.233, p-value = 0.033), were independent risk factors for undiagnosed hypertension. Conclusion: The prevalence of undiagnosed hypertension in the rural population of South-East Nigeria is high. Younger age (26 - 35 years) had the highest odds of risk for occurrence of hypertension. Also being married was identified as a risk factor for undiagnosed hypertension.

Therapeutic Compliance of Hypertensive Patients Followed in Ambulatory in the Cardiology Department of Kati University Hospital

Introduction: High blood pressure is a major public health problem worldwide due to its frequency and cardiovascular complications. Adherence to treatment for chronic diseases is a global problem. The aim was to study therapeutic adherence in hypertensive patients followed in ambulatory. Materials and Methods: This was a cross-sectional, descriptive study with prospective recruitment that took place from July 1 to December 31, 2022 (6 months) in the cardiology department of the university hospital of Kati. The variables studied were sociodemographic data, cardiovascular risk factors, comorbidities, the possession of insurance and compliance (the Girerd questionnaire was used to assess adherence). Results: A total of 1182 patients were consulted, including 887 for hypertension, a frequency of 75%. Fifty-six patients were included in the study. The average age was 58.18 ± 13.25 years with extremes of 30 and 80 years. There was a female predominance (75%) with a sex ratio of 0.3. The majority of patients lived in urban areas (89.3%). Out-of-school patients accounted for 44.6%, more than half of patients or 55.4% had no income, patients with medical coverage accounted for 67.9% of cases. The main risk factors were physical inactivity (25%) followed by smoking 14.3%. More than 71% of patients had a compliance problem and the main reasons were forgetting to take the drug with 73.2%, followed by delayed treatment of 50% and drug discontinuation of 28.6%. Conclusion: Compliance is a real challenge and a major public health issue. This study allowed us to find a real problem of compliance in our hypertensive patients. There was a statistically significant relationship between drug adherence and forgetting to take the drug and drug discontinuation.