EP.TH.359Improved Oesophagogastric Cancer Outcomes in Rural Patients

Introduction Despite advances in medical therapies and surgical techniques, oesophagogastric cancer survival remains low. Poorer cancer outcomes and survival for rural dwellers is well documented worldwide and has been an area of focus in Scotland since 2007, with changes to suspected cancer referral guidelines and a government report on delivering remote and rural healthcare. Methods A prospective, single-centre observation study was conducted utilising data from oesophago-gastric cancer MDT referrals and outcomes from January 2013 to December 2019. The Scottish Index of Multiple Deprivation 2020 tool provided a rurality code based on patient postcode at time of referral. Survival outcomes for urban and rural patients were compared across demographic factors, disease factors and stage at presentation. Results 1046 patients were included in this study. The median age of presentation for urban and rural patients was 73.7 and 72.4 respectively. There was no significant difference between oesophageal versus gastric cancer presentations nor was there any difference between T, N or M stage at presentation between the groups. No difference was identified between those commenced on a radical therapy with other treatment plans. On Kaplan-Meier analysis there was a difference in survival between the groups favouring rural dwellers (p = 0.012). Discussion The difference in survival demonstrated here between urban and rural groups is not easily explained but may represent improvements to rural access to healthcare delivered as a result of policy change. This is an interesting finding and this study should be expanded to include performance status at time of referral.

In pursuit of diverse energy futures: The political economy of electricity in Senegal

In recent years, Senegal has proactively pursued the expansion of renewable energy generation, particularly from solar and wind. In addition to starting exploration of offshore liquefied natural gas, the expansion in renewable energy is posited as a way to help the country move toward low(er) carbon development, reduce dependence on volatile oil markets, and improve reliable (and especially rural) access to electricity. To achieve these objectives, the electricity sector has continuously undergone structural reforms to improve its financial viability and to achieve objectives around universal access to electricity, particularly by increasing private sector participation in electricity generation. Through the lens of “electricity capital,” this paper examines the implications of reforms in the electricity sector for processes of accumulation, in a context of efforts to improve environmentally sustainable development. It asks how capital in the electricity sector is constituted and operates in the Senegalese context, who has power in shaping how it operates, and how this has influenced the potential for achieving a fair and equitable transition to a low(er) carbon energy system. This paper draws on recent work in political ecology on energy transitions and emerging literature on the political economy of electricity, as well as on analysis of policy and technical documents and semi-structured interviews carried out with those involved in the energy sector between 2018 and 2020. Findings suggest that even though the Senegalese government has set clear objectives for the electricity sector that are based on principles of equity, environmental sustainability, and justice, the current power relations and financing arrangements taken on by the state and other actors active in the sector has, paradoxically, led to an approach that risks undermining these very principles.

Visualising rural access index and not served rural population in Africa

The rural access index is beneficial to monitor accessibility in rural areas. However, the rural access index cannot indicate how many rural people have not been served (called not served rural population or NSRP), and it has only been mapped at a national and/or regional scale. This study visualises both the rural access index and not served rural population in Africa, and also visualises the not served rural population at a fine scale (i.e. 10 km × 10 km grid). The results show that: First, the spatial pattern of the not served rural population is quite different with that of the rural access index, and thus we suggest to use the not served rural population indicator as a supplement of the rural access index. Second, the not served rural population varies within a country, and the fine-scale mapping can be helpful for policy makers and planners to decide where there is a priority need to improve rural road accessibility.

The Health Impact of Water and Sanitation Utilities Privatization and Regulation in Sub-Saharan Africa

As of 2017, the urban access rate to safe water sources in 2017 stood at 84% while rural access was still around 45%. The rates for sanitation were 44% and 22%, respectively. Since the 1980s many high-profile reforms supported by international organizations have been implemented in the region in an attempt to close the access gaps in the water and sanitation sector (WSS). Two recommendations with high international exposure were an increased role for large-scale private sector participation in the management and financing of national or regional utilities and the creation of separate sector regulatory agencies to increase the independence of regulation. Both reforms seemed to contribute to improved water access rates, at least for the urban population, but not enough to catch up with the demands of a fast-growing population; and both failed to deliver on sanitation. The progress these initiatives allowed was correlated with improvements in the average health outcomes for some indicators (i.e., under-five mortality associated to diarrhea) but once again, it was not enough and was not fairly distributed. Indeed, improvements seem to have mostly benefited upper- and middle-income groups. Unfortunately, an evaluation of the health effects of these two reforms have not yet been fully established empirically, which is why it seems prudent to talk about correlations rather than causal effects. Most of the statistically robust evidence on the impact of utilities and regulatory reforms on health is incomplete because details of several dimensions of these reforms and their context are not measured consistently across countries or within countries. In addition, the small amount of econometric evidence available is based on pre-2010 data for SSA. The imperfect data is however solid enough to suggest that without further governance changes in the region, the health risks are likely to increase. This is because due to the high population growth rate of the region, closing the access gaps is likely to get tougher considering current investment levels and technological choices. The necessary changes require improving the match between policy and technological choices, including service delivery technologies that are consistent with the ability to pay and the tariff and subsidy levels adopted to ensure cost recovery without excluding any category of users.

Rural access to education through digital media

This paper is a summary of the research conducted during the development and design of Rural Access To Education Through Digital Media, a pilot education technology project in Tipling, Nepal. Beginning with an analysis of the relevant socioeconomic factors affecting school attainment nationally and those affecting Tipling in particular; the current challenges to formal and informal education are identified. The considerable potential of digital media and ICTs to address long-standing issues of access to both childhood and adult learning and thereby contribute to international development and education reform efforts are explored. Key project considerations and challenges are discussed along with project outcomes. Keywords: ICTs, Rural Education, Literacy, International Development, Education Technology

Rural access to education through digital media

This paper is a summary of the research conducted during the development and design of Rural Access To Education Through Digital Media, a pilot education technology project in Tipling, Nepal. Beginning with an analysis of the relevant socioeconomic factors affecting school attainment nationally and those affecting Tipling in particular; the current challenges to formal and informal education are identified. The considerable potential of digital media and ICTs to address long-standing issues of access to both childhood and adult learning and thereby contribute to international development and education reform efforts are explored. Key project considerations and challenges are discussed along with project outcomes. Keywords: ICTs, Rural Education, Literacy, International Development, Education Technology

Rural use of health service and telemedicine during COVID-19: The role of access and eHealth literacy

The COVID-19 pandemic has driven a greater reliance on telemedicine, yet rural access, use, and satisfaction with telemedicine and the role of eHealth literacy are unknown. Using a cross-sectional design, 279 (70.6% female) western rural Canadians completed an online survey. The majority of participants reported access to telemedicine, but nearly 1/5 lacked access to online or virtual mental health services. The majority of participants had used health care services following the declared COVID-19 pandemic in North America, and just under half had used telemedicine. Telemedicine satisfaction scores were higher among participants who had used video ( M = 4.18) compared to those who used phone alone ( M = 3.79) ( p = 0.031). Telemedicine satisfaction and eHealth literacy were correlated ( r = 0.26, p = 0.005). Participants did not want telemedicine to replace in-person consultations. Telemedicine practice requires that rural residents have the resources, ability and willingness to engage with remote care.

Pursuing pathways to care: dementia and aging in Indigenous communities

This chapter talks about pursuing pathways to care, which is critical in the movement towards addressing the health status and its relationship to dementia amongst Indigenous older adults in their communities. It refers to the proportion of Indigenous older adults who are above 65 years of age that continues to rise despite the numbers being lower than their non-Indigenous counterparts. It also mentions dementia, which can represent a concern for families and prevent individuals from aging in place, and causes distress to individuals and their caregivers. The chapter points out the lack of access to dementia services and specialists in rural communities that exacerbates families' ability to care for their loved ones at home. It presents an examination of dementia among Indigenous peoples, including dementia care and rural access to care.

Federally Qualified Health Centers Can Expand Rural Access to Buprenorphine for Opioid Use Disorder in Arizona

Medication for Opioid Use Disorder (MOUD) is recommended, but not always accessible to those who desire treatment. This study assessed the impact of expanding access to buprenorphine through federally qualified health centers (FQHCs) in Arizona. We calculated mean drive-times to Arizona opioid treatment (OTP) locations, office-based opioid treatment (OBOT) locations, and FQHCs clinics using January 2020 location data. FQHCs were designated as OBOT or non-OBOT clinics to explore opportunities to expand treatment access to non-OBOT clinics (potential OBOTs) to further reduce drive-times for rural and underserved populations. We found that OTPs had the largest mean drive times (16.4 minutes), followed by OBOTs (7.1 minutes) and potential OBOTs (6.1 minutes). Drive times were shortest in urban block groups for all treatment types and the largest differences existed between OTPs and OBOTs (50.6 minutes) in small rural and in isolated rural areas. OBOTs are essential points of care for opioid use disorder treatment. They reduce drive times by over 50% across all urban and rural areas. Expanding buprenorphine through rural potential OBOT sites may further reduce drive times to treatment and address a critical need among underserved populations.