BACKGROUND: Personalized therapeutic approaches for localized prostate cancer have evolved significantly, with tissue-based biomarker tests supplementing traditional risk stratification tools. However, national testing patterns and geographic variability remain limited a decade after coverage implementation. We aimed to assess current nationwide utilization and urban-rural differences in tissue-based biomarker testing. METHODS: Using full Medicare claims data, we retrospectively identified patients with newly diagnosed prostate cancer and tissue-based biomarker testing claims from 2019 to 2023. Patients' county of residence was categorized as metro, urban, or rural. Regional testing rates were further assessed across hospital referral regions. A multivariable logistic regression model was performed to assess the effect of residence on test receipt. RESULTS: Our final cohort included 749 202 patients, of whom 79.5% lived in metro, 11.4% in urban and 8.00% in rural counties. Overall, 86 908 (11.6%) patients underwent tissue-based biomarker tests. Hospital referral region-level testing rates ranged from 2.4% to 42.7%. Rural patients were 18% less likely to undergo testing compared to metro patients (odds ratio [OR] 0.82, 95% CI = 0.73 to 0.91). Independently, the odds of undergoing testing were lower among Black (OR 0.82, 95% CI = 0.77 to 0.88) and Hispanic patients (OR 0.80, 95% CI = 0.73 to 0.88) compared to White patients. CONCLUSION: This study reveals high geographic variability in tissue-based biomarker testing for prostate cancer. Further, Black and Hispanic patients were less likely to receive testing. Our findings highlight regional practice variation in the use of advanced, not routinely recommended tests and underscore the need to minimize disparities in diagnostic access.

• MeSH
• White MeSH
• Black or African American statistics & numerical data   MeSH
• Healthcare Disparities * statistics & numerical data   ethnology   MeSH
• Humans MeSH
• Medicare * statistics & numerical data   MeSH
• Urban Population statistics & numerical data   MeSH
• Biomarkers, Tumor * analysis   MeSH
• Prostatic Neoplasms * diagnosis   pathology   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Rural Population statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• United States MeSH
• Names of Substances
• Biomarkers, Tumor * MeSH

OBJECTIVE: Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. METHODS: The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. RESULTS: The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). CONCLUSIONS: In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.

• Keywords
• cardiovascular disease, risk factors, rural population, urban population,
• MeSH
• Adult MeSH
• Body Mass Index MeSH
• Cardiovascular Diseases * epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Urban Population * statistics & numerical data   MeSH
• Waist-Hip Ratio MeSH
• Prevalence MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Heart Disease Risk Factors MeSH
• Risk Factors MeSH
• Aged MeSH
• Rural Population * statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Croatia epidemiology   MeSH

Nutritional status, its assessment and its influence on numerous diseases is currently still being discussed. The aim of this study was to determine the current state of nutrition by various research methods in school children. Also, to verify the accuracy of body mass index (BMI) determination in school environment and to compare the nutritional status in two different types of school. We used a quantitative questionnaire method in 64 children from schools in the South Moravian Region. We have verified the weight and height measurement in the same group by sophisticated instruments. We have determined the basic parameters of the cardiovascular system (non-invasive continuously blood pressure recording; mutual spectral analysis for estimation of baroreflex sensitivity; applanation tonometry and cardiac polygraphy for arterial stiffness evaluation). The indicative questionnaire method encountered a problem with the weight of almost 40 % of the population approached - both obesity (14.3 %) and malnutrition (25.2 %). Cardiovascular parameters were in physiological range for the given age categories. We found increased values in BMI, % of body fat and heart rate in children from countryside type of school, respectively. We concluded that obesity/malnutrition are both common phenomena in the children population in the Czech Republic.

• MeSH
• Cardio Ankle Vascular Index MeSH
• Blood Pressure * MeSH
• Humans MeSH
• Urban Population statistics & numerical data   MeSH
• Adolescent MeSH
• Nutritional Status * MeSH
• Obesity epidemiology   physiopathology   MeSH
• Pilot Projects MeSH
• Malnutrition epidemiology   physiopathology   MeSH
• Vascular Stiffness * MeSH
• Rural Population statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

OBJECTIVE: To evaluate the dietary diversity and the nutrient contribution of traditional foods (locally cultivated and wild) by conducting a food intake study in rural Ecuador. DESIGN: Repeated 24 h recalls over a 14 d interval and frequency of consumption served to simulate the usual diet by the Multiple Source Method. Data on missing visits (n 11) were imputed using multivariate imputation by chained equations. The intakes of three macro- and six micronutrients were reported. Nutrient Adequacy Ratios, Mean Adequacy Ratio (MAR), Dietary Species Richness (DSR) and Minimum Dietary Diversity for Women were used as measures of dietary quality. A linear quantile mixed model was used to investigate the association between DSR, local species, MAR, age, education and occupation. SETTING: Guasaganda, Cotopaxi (Ecuador). PARTICIPANTS: Rural, indigenous adult women, non-pregnant and not breast-feeding. RESULTS: The studied diet had MAR of 0·78. Consumption of traditional foods contributed 38·6 % of total energy intake. Daily requirements for protein, carbohydrates, Fe and vitamin C were reached. An extra level of consumption of local species was associated with an increase in median MAR for macronutrients of 0·033 (P < 0·001). On the other hand, an extra level of consumption of local species was associated with an increase in median MAR for micronutrients of 0·052 (P < 0·001). CONCLUSIONS: We found statistical evidence that traditional foods contribute to adequate intakes of macro- and micronutrients and dietary diversification in the studied population. Future public health interventions should promote the cultivation and consumption of traditional foods to increase the quality of the local diet.

• Keywords
• Diet, Nutrients, Rural women, Traditional foods,
• MeSH
• Diet Surveys MeSH
• Diet * ethnology   statistics & numerical data   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Nutritional Status MeSH
• Fruit MeSH
• Aged MeSH
• Rural Population statistics & numerical data   MeSH
• Vegetables MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Ecuador MeSH

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues - particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals - 322 persons with disability and 451 comparisons (without disability) - covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. Implications for rehabilitation Persons with disabilities in rural South Africa have poorer reported health outcomes. Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. Better access to health care for persons with disabilities is needed in rural South Africa.

• Keywords
• Rural health, South Africa, disability,
• MeSH
• Adult MeSH
• Health Services Accessibility * standards   statistics & numerical data   MeSH
• Mental Health MeSH
• Humans MeSH
• Patient Preference * MeSH
• Persons with Disabilities * psychology   rehabilitation   statistics & numerical data   MeSH
• Attitude to Health MeSH
• Disability Evaluation MeSH
• Surveys and Questionnaires MeSH
• Rural Population statistics & numerical data   MeSH
• Treatment Outcome MeSH
• Health Services Needs and Demand * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• South Africa epidemiology   MeSH

OBJECTIVE: The aim of the study was to evaluate caries prevalence in a sample of schoolchildren aged 6 to 16 years from rural and urban areas in Croatia. METHODS: Using standardized World Health Organisation (WHO) criteria, the oral health status of 1,589 children (265 from rural and 1,324 from urban areas) was assessed by recording the following indices: DMFT (decayed, missing, filled permanent teeth), deft (decayed, extracted, filled primary teeth), DMFS (decayed, missing, filled surfaces - permanent teeth), defs (decayed, extracted, filled surfaces - primary teeth) and SiC (Significant Caries Index). Rural areas were Štitar and Babina Greda municipalities in Slavonia and urban areas were the cities of Županja (Slavonia), Zagreb and Dubrovnik. RESULTS: Half of the examined children (50.0%) had caries (D component in DMFT), with 46.0% of these being from urban and 70.2% from rural areas. The median DMFT among children was 2, 4 (rural) and 2 (urban) (p < 0.001). Among 12-year-olds, the median DMFT was 4 (rural) and 3 (urban), and mean DMFT was 3.4. The median DMFS for rural area was 5 and for urban area 3 (p < 0.001). The median deft was 1.00 for rural and 1.00 for urban, while the highest value was found among 6-year-olds at 9 in rural and 7 in urban areas. The median SiC was 4, 4 (urban) and 5 (rural). CONCLUSION: Schoolchildren from urban and rural areas in Croatia differ significantly in caries prevalence. They fall into the medium DMFT classification group according to the WHO, which indicates the need for a comprehensive oral health preservation programme.

• Keywords
• DMF index, cross-sectional studies, dental caries, epidemiology, paediatric dentistry, preventive dentistry,
• MeSH
• Child MeSH
• DMF Index MeSH
• Humans MeSH
• Adolescent MeSH
• Prevalence MeSH
• Rural Population statistics & numerical data   MeSH
• Dental Caries * epidemiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Croatia MeSH

OBJECTIVES: The health of the Roma population is relatively poor and indicators on municipal level are needed to inform authorities to improve it. The aim of this study was to compare the rate of low birthweights (LBW) and mean birthweight (BW) in municipalities with minor Roma population (MMR) and municipalities with large Roma population (MLR) in Slovakia. METHODS: A population-wide, ecological level, cross-sectional study was conducted using data from 2009-2013. Data on proportions of newborns with LBW, on mean birthweight of newborns and on mean ages of mothers at birth were obtained from the National Health Information Centre of Slovakia. Rates of LBW and mean BW were compared between the MMR and MLR groups. Mean age of mothers and rates of unemployment were considered possible confounders. RESULTS: The mean BW was by 183 g higher in the MMR group compared to MLR; the rates of LBW were 4.2% and 8.9%, respectively. Increasing proportions of Roma were significantly associated with increasing rates of LBW and decreasing mean BW, one percent increase in the proportion of Roma was associated with an increase in LBW rate of 0.15% and a decrease in mean LBW of -4.9 grams. CONCLUSIONS: Our findings could be used as a proxy for the purposes of policy making, replacing individual level studies with more resource-demanding design.

• Keywords
• Roma, birth weight, epidemiology, low birth weight, public health, reproductive health,
• MeSH
• Humans MeSH
• Infant, Low Birth Weight * MeSH
• Infant, Newborn MeSH
• Birth Weight * MeSH
• Cross-Sectional Studies MeSH
• Roma statistics & numerical data   MeSH
• Cities MeSH
• Rural Population statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH
• Geographicals
• Slovakia epidemiology   MeSH
• Cities MeSH

Human populations tend to grow steadily, because of the ability of people to make innovations, and thus overcome and extend the limits imposed by natural resources. It is therefore questionable whether traditional concepts of population ecology, including environmental carrying capacity, can be applied to human societies. The existence of carrying capacity cannot be simply inferred from population time-series, but it can be indicated by the tendency of populations to return to a previous state after a disturbance. So far only indirect evidence at a coarse-grained scale has indicated the historical existence of human carrying capacity. We analysed unique historical population data on 88 settlements before and after the Thirty Years War (1618-1648), one the longest and most destructive conflicts in European history, which reduced the population of Central Europe by 30-50%. The recovery rate of individual settlements after the war was positively correlated with the extent of the disturbance, so that the population size of the settlements after a period of regeneration was similar to the pre-war situation, indicating an equilibrium population size (i.e. carrying capacity). The carrying capacity of individual settlements was positively determined mostly by the fertility of the soil and the area of the cadastre, and negatively by the number of other settlements in the surroundings. Pre-industrial human population sizes were thus probably controlled by negative density dependence mediated by soil fertility, which could not increase due to limited agricultural technologies.

• Keywords
• Thirty Years War, disturbance, historical demography, human carrying capacity, population ecology, rural settlement,
• MeSH
• History, 17th Century MeSH
• History, 18th Century MeSH
• Humans MeSH
• Population Dynamics * MeSH
• Technology MeSH
• Rural Population statistics & numerical data   MeSH
• Conservation of Natural Resources * MeSH
• Agriculture instrumentation   MeSH
• Check Tag
• History, 17th Century MeSH
• History, 18th Century MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Historical Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: Despite high cardiovascular mortality in Central Asian republics of the former Soviet Union, there is limited information about major risk factors, including blood lipids. We investigated the prevalence of impaired concentrations of blood lipids, the awareness, treatment and control of hypercholesterolemia, and factors associated with these indicators in urban and rural populations in Kazakhstan. METHODS: We conducted a cross-sectional study of random urban and rural population samples (the state capital Astana and Akmol village). Men and women aged 50-74 years were examined; a total of 954 adults participated (response rate 59%). Serum concentrations of total, LDL and HDL cholesterol and triglycerides and a range of other cardiovascular risk factors were measured. RESULTS: The overall prevalence of hypercholesterolemia (total cholesterol ≥6.2 mmol/l) was 37%; among subjects with hypercholesterolemia, 57% were aware of their condition, 41% took medication and 23% had total cholesterol <6.2 mmol/l (4.5% <5 mmol/l). The prevalence, awareness, treatment, and control of hypercholesterolemia were all higher in the urban than the rural area. Similarly, the proportions of subjects with impaired concentrations of specific lipids fractions were also considerably higher in the urban population. Most associations with other covariates were in the expected direction. CONCLUSIONS: This study found relatively high prevalence of dyslipidemia in the Kazakh population, and the blood lipid profile was less favourable in the urban area. These pronounced urban-rural differences may be related to urbanization, the associated nutrition transition and to access to health care.

• Keywords
• Central Asian countries, Dyslipidemia, Hypercholesterolemia, Kazakhstan, Socioeconomic factors,
• MeSH
• Dyslipidemias diagnosis   epidemiology   therapy   MeSH
• Cardiovascular Diseases epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Urban Population statistics & numerical data   MeSH
• Prevalence MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Rural Population statistics & numerical data   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH
• Geographicals
• Kazakhstan epidemiology   MeSH
• USSR MeSH

BACKGROUND: Research into social root-causes of poor health within segregated Roma communities in Central and Eastern Europe, i.e. research into how, why and by whom high health-endangering settings and exposures are maintained here, is lacking. The aim of this study was to assess the local setup of health-endangering everyday settings and practices over the long-term in one such community. It is the initial part of a larger longitudinal study qualitatively exploring the social root-causes of poor Roma health status through the case of a particular settlement in Slovakia. METHODS: The study, spanning 10 years, comprised four methodologically distinct phases combining ethnography and applied medical-anthropological surveying. The acquired data consisted of field notes on participant observations and records of elicitations focusing on both the setup and the social root-causes of local everyday health-endangering settings and practices. To create the here-presented descriptive summary of the local setup, we performed a qualitative content analysis based on the latest World Health Organization classification of health exposures. RESULTS: Across all the examined dimensions - material circumstances, psychosocial factors, health-related behaviours, social cohesion and healthcare utilization - all the settlements' residents faced a wide range of health-endangering settings and practices. How the residents engaged in some of these exposures and how these exposures affected residents' health varied according to local social stratifications. Most of the patterns described prevailed over the 10-year period. Some local health-endangering settings and practices were praised by most inhabitants using racialized ethnic terms constructed in contrast or in direct opposition to alleged non-Roma norms and ways. CONCLUSIONS: Our summary provides a comprehensive and conveniently structured basis for grounded thinking about the intermediary social determinants of health within segregated Roma communities in Slovakia and beyond. It offers novel clues regarding how certain determinants might vary therein; how they might be contributing to health-deterioration; and how they might be causally inter-linked here. It also suggests racialized ethnically framed social counter-norms might be involved in the maintenance of analogous exposure setups.

• Keywords
• Ethnography, Health inequality, Public health, Roma health, Slovakia, Social determinants of health,
• MeSH
• Residence Characteristics MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Cross-Sectional Studies MeSH
• Roma statistics & numerical data   MeSH
• Social Segregation MeSH
• Social Class MeSH
• Rural Population statistics & numerical data   MeSH
• Health Behavior ethnology   MeSH
• Health Status * MeSH
• Life Style MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Slovakia MeSH