Search Results (3,199)

In this review, I synthesize recent evidence showing how climate acceleration, biosphere disruption, food and freshwater insecurity, pollution, disease, and inequality are increasingly converging into a single, interconnected sustainability challenge. I show that the Anthropocene crisis extends far beyond climate warming and its impacts alone: current national commitments remain consistent with warming of approximately 2.3–2.5 °C under full implementation, while current policies could produce up to 2.8 °C; however, the remaining carbon budget for a 50% chance of limiting warming to 1.5 °C may be exhausted within only a few years, and the oil and gas industry has committed to a 14% increase in upstream production over the period 2024–2030. At the same time, pollution remains responsible for approximately nine million deaths annually; agriculture accounts for roughly 70% of global freshwater withdrawals; and groundwater depletion, continental drying, marine heatwaves, weakening carbon sinks, and intensifying precipitation extremes are destabilizing the ecological and hydrological systems that sustain human health and food security. This review’s incremental contribution is the integration of these trends within a justice-centered sustainability framework that links Earth-system feedback, public health burdens, water insecurity, and institutional failure rather than treating them as separate environmental problems. I argue that because vulnerability is produced not by exposure alone but by unequal access to infrastructure, wealth, governance capacity, and political power, a viable response therefore requires more than decarbonization: it demands ecological restoration, food and water-centered governance, pollution and disease mitigation, and justice-based institutional reform capable of sustaining human dignity, equity, and resilience within planetary boundaries. I encourage resilience and sustainability programs around the world to fold in these additional challenges to their missions and goals. Full article

Background/Objectives: Youth who experience bullying victimization often report lower mattering, the perception of being valued by others; yet this association remains underexplored across intersections of gender and sexual identities. Methods: Using Spring 2025 data from the Health and Peer Relations Study, we examined whether gender identity and sexual orientation moderated the association between bullying and mattering among Canadian youth in Grades 7–12 (N = 54,181; racially/ethnically diverse = 65.2%, sexually diverse = 14.8%, gender diverse = 3.5%), controlling for grade and race/ethnicity. Results: After controlling for covariates, the three-way interaction between bullying, gender identity, and sexual orientation was statistically significant (p = 0.042). Bullying was negatively associated with mattering across most groups, and the association was strongest among straight girls, while associations were largely similar across other groups. In contrast, average mattering followed a clear social gradient wherein straight girls and boys reported the highest levels, and sexually and/or gender diverse youth reported the lowest. Conclusions: Bullying is associated with lower mattering among most youth. However, socially advantaged youth reported stronger associations between bullying and mattering, while socially marginalized youth reported lower mattering regardless of bullying exposure. Findings highlight the importance of addressing youth bullying and underlying drivers of social inequities in mattering. Full article

Access to safe and effective contraception is central to reproductive autonomy and public health, yet numerous contraceptive products have been associated with recalls, safety warnings, litigation, and allegations of insufficient risk disclosure. This article examines the harms associated with defective and insufficiently disclosed contraceptive products through the lens of white-collar and corporate crime. Drawing on scholarship on corporate harm, consumer fraud victimization, and gendered inequality, the article argues that these harms are not simply isolated product failures but reflect broader patterns of organizational decision-making, information asymmetry, and regulatory limitation within pharmaceutical systems. Using documented case illustrations involving the Dalkon Shield, oral contraceptives, Mirena, and NuvaRing, the analysis identifies recurring patterns involving delayed recognition of harm, contested disclosure of risk, and reliance on civil litigation as a primary mechanism of accountability. The article further emphasizes the gendered distribution of these harms given women’s disproportionate reliance on contraceptive technologies. By conceptualizing faulty contraceptive products as a form of corporate harm and consumer victimization, this article extends criminological scholarship on white-collar harm into reproductive health contexts and highlights how institutional systems shape the production and distribution of consumer risk. Full article

Identifying parameters of dynamical systems from sparse measurements is a core task in structural health monitoring and vibration engineering. For second-order oscillators, standard physics-informed neural networks (PINNs) struggle because different parameter values can produce nearly identical displacement records, making the inverse problem ill-posed. We propose the derivative-observation-augmented PINN (D-PINN), which incorporates velocity measurements into the training loss to resolve this degeneracy. Three theoretical results support the method: a Sobolev-type inequality proves that constraining the velocity error automatically bounds the displacement error; a Fisher information analysis shows that velocity observations increase the information available for parameter estimation; and a residual-based estimate bounds the parameter error in terms of the solution accuracy and its derivatives. Experiments on linear, forced near-resonance, and Duffing oscillators (10 random seeds, 20,000 epochs) show that D-PINN reduces the damping coefficient relative error from 40% to 11.7% without any parameter prior. With a weak prior (${\mu }_0=3.2$, a 20% deviation from the true value 4.0), the error drops further to 2.1%, a 19-fold improvement over standard PINN. We also analyze sensitivity to prior quality, derivative observation source, and measurement noise, and identify scenarios where derivative observations do not improve displacement fitting. Full article

Background: Timely hepatitis B vaccine birth-dose (HepBV-BD) vaccination is a cornerstone strategy for preventing mother-to-child transmission of hepatitis B virus (HBV). Although hepatitis B vaccination coverage in China has improved substantially, evidence regarding long-term district-level spatiotemporal inequalities in timely birth-dose vaccination remains limited, particularly in western China. This study assessed spatiotemporal disparities in hepatitis B vaccination coverage across Chongqing, China, from 2016 to 2025. Methods: This ecological descriptive study used district- and county-level vaccination surveillance data from the Chongqing Immunization Information Management System. Temporal trends in HepBV-BD, timely birth-dose (TBD), HepBV2, and HepBV3 coverage were analyzed. Regional disparities, interregional inequalities, and spatial clustering were assessed using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: All vaccination indicators improved substantially during the study period. TBD coverage increased from 81.9% to 95.4%, whereas HepBV3 coverage increased from 83.7% to 98.7%. TBD coverage was strongly positively associated with HepBV3 coverage(r = 0.95, p < 0.001). Mountainous ethnic minority regions consistently exhibited the lowest TBD coverage despite marked improvement over time. Absolute interregional inequality decreased from 30.8 to 8.4 percentage points. Although Global Moran’s I was not statistically significant, LISA analysis identified persistent localized low-coverage clusters in southeastern mountainous regions and emerging high–high clusters in northern Chongqing. Conclusions: Hepatitis B vaccination coverage in Chongqing improved markedly between 2016 and 2025, accompanied by declining geographic inequality. Nevertheless, persistent spatial inequities in timely birth-dose vaccination remained in mountainous ethnic minority areas. Continued monitoring of spatial inequalities, together with strengthened primary healthcare capacity, culturally tailored health education, and equitable resource allocation, may help support geographically targeted immunization strategies and accelerate progress toward the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Full article

Introduction: Globally, disabled individuals experience persistent social inequalities and health inequities, yet the health and wellbeing of Deaf, DeafBlind, blind, and partially sighted (DDBBPS) people remain profoundly under-researched and excluded from social science and health policy agendas. Existing studies narrowly focus on narratives of hearing and vision impairments within a medical model of disability, which pathologizes difference and obscures the biomedical origins of social inequalities and health inequities experienced by these groups. Methods: Drawing on critical disability studies and community-based literature, this narrative review introduces and applies the concept of medical violence to examine how systemic ableism, audism, and ocularcentrism shape DDBBPS people’s healthcare experiences. Results: We identify six interrelated manifestations of medical violence: denied interpreting services, inaccessible health communication, harmful interpersonal practices, health inequities and medical avoidance, absence of DDBBPS practitioners, and gaps in community-based care. Conclusions: These conditions reinforce a cycle of exclusion and misrepresentation, wherein DDBBPS persons are denied equitable access to healthcare and are simultaneously constructed as objects of cure rather than as knowledge holders. We argue for a community-based participatory research agenda led by and for DDBBPS communities to challenge ableist research paradigms and advance health equity. Full article

Lymphomas are broadly categorized into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Despite treatment advances, they remain a major cause of cancer-related morbidity and mortality in Canada. This study examined temporal trends in socioeconomic inequalities in lymphoma mortality in Canada from 2000 to 2019. Using a unique census division level dataset (n = 280) constructed by pooling information from the Canadian Vital Statistics Death Database, the Canadian Census of Population and the National Household Survey, we measured mortality in HL and NHL in Canada. The age-standardized Concentration index (C) was used to quantify income and education inequalities in lymphoma. Time trend analyses were conducted to examine the changes in the observed socioeconomic inequalities. Crude HL mortality declined significantly over the study period. Crude NHL mortality remained largely unchanged in Canada overall, although modest declines were observed in the Prairies. The age-standardized C indicated persistent income and education inequalities for both lymphoma types. For NHL, mortality became increasingly concentrated among lower-income and lower-education populations over time. The persistent and widening socioeconomic inequalities observed in HL and NHL mortality, respectively, in Canada underscore the need for targeted public health interventions and more equitable distribution of resources to address systematic and avoidable differences in cancer outcomes associated with socioeconomic disadvantage. Full article

Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article

Long-term sickness absence is a growing public health issue, reducing workforce participation and widening health inequalities. Effective interventions must address both health and workplace factors to enable not only return-to-work but sustained employment. This study evaluated the feasibility of a multi-level workplace intervention to support sustainable RTW in large organizations. A two-arm cluster randomised feasibility trial was conducted in nine UK organizations (≥600 employees). Participants included senior leaders and HR professionals (n = 91), workers on long-term sick leave (n = 112), and line managers (n = 83). The IGLOo intervention combined e-learning for leaders/HR with structured toolkits for workers and managers to support RTW before and after return. Feasibility outcomes included recruitment, retention, engagement, acceptability, and usability. Secondary outcomes included RTW timing, sustained participation, mental health, and workplace factors. A mixed methods process evaluation explored implementation and context. Retention, acceptability, and usability met targets, but recruitment and engagement were lower than expected. Potential mechanisms included improved confidence, communication, and self-management. Organizational systems and pressures affected delivery. Exploratory analyses suggested different patterns of return-to-work trajectories across trial arms. Overall, the intervention was acceptable to participants who engaged with it, but recruitment barriers and organizational constraints require substantial modification before any future efficacy trial. Full article

Central and Eastern Europe (CEE) carries some of the widest immunisation gaps in Europe, and improving coverage there is often treated as a problem of access infrastructure. On 14 May 2026, a multi-stakeholder meeting hosted at the Romanian Parliament brought together around twenty-five speakers, among some fifty participants in all, from Romania, Poland, the Czech Republic, and Bulgaria, together with international contributors, to agree which barriers to vaccine confidence matter most in the region, which interventions are deliverable within 12 to 24 months, and how responsibility for them should be divided among stakeholders. This Perspective synthesises that discussion as a set of strategies for coverage. Meeting-derived priorities are set against published coverage and confidence data for the region and against the published intervention literature. We argue that the central problem across the region is eroded trust rather than missing information, because misinformation succeeds mainly where trust has already broken down, a process deepened by a historically conditioned, post-communist distrust of public institutions. The two recommendations carried most strongly, as both high in expected impact and achievable within 12 to 24 months, were continuing professional education for primary care on vaccine communication and the resourcing of locally trusted community figures, including health mediators working with marginalised populations. We then show how system-design reforms already demonstrated in the region, in particular pharmacy-based vaccination, direct reimbursement, and targeted outreach to under-vaccinated and marginalised groups, turn restored confidence into measurable coverage while narrowing inequities. We close with a 12-to-24-month agenda for CEE, organised around a clear multi-stakeholder division of labour. These are stakeholder-derived priorities that now require implementation and evaluation. Full article

Black women faced disproportionate social, emotional, and structural burdens during the dual pandemics of COVID-19 and racial injustice, yet their mental health experiences remain underexamined. This study explores how Black women understood, navigated, and coped with these intersecting crises. Seven Black women in North Carolina participated in a seven-session virtual photovoice study, including four photo discussion sessions. Participants generated four photo assignments, took photos, and discussed them using the SHOWeD framework. Recorded discussions were analyzed using Reflexive Thematic Analysis and Sort and Sift, Think and Shift, with participants supporting theme development. Narratives revealed multi-level mental health impacts: at the individual level, caregiving overload, compounded grief, and constant vigilance; at the interpersonal level, invisibility, racial misreading, and everyday racism that intensified distress and made help-seeking itself a labor of confronting providers’ biases; at the community level, trauma from witnessing racial violence and pandemic loss; and structural factors such as inequity, food insecurity, and policing as primary drivers of mental health strain. Participants employed healing as resistance through faith, nature, sister circles, and culturally concordant care. Black women’s mental health during the dual pandemics is inseparable from structural racism and gendered labor; healing is individual and collective, and crisis preparedness requires system-level change driven by Black communities. Full article

Countries face interconnected policy challenges: population aging, fertility change, migration, urbanization, labor transitions, food and water security, climate risk, health-system demand, school planning, housing pressure, consumption planning, and spatial inequality. Yet planning evidence is often fragmented across ministries, statistical offices, surveys, administrative systems, research projects, and dashboards. This paper proposes the Population-Based Systems Model, or PopSyM, as a country-owned analytical infrastructure that places population dynamics at the center of integrated policy planning. PopSyM begins with a demographic spine by age, sex, location, year, and scenario, then links that spine to modules for health, education, food, labor, housing, social protection, environment, and local infrastructure. Its purpose is not projection for its own sake, but the measurement and improvement of population well-being: longer and healthier lives, adequate material conditions, skills, meaningful work, security, dignity, and country-specific dimensions of a good life. Nepal is used as a motivating example, but the proposed architecture is general. The paper argues that the population should be treated not only as a denominator for indicators but also as the organizing framework through which countries understand future demand, vulnerability, consumption needs, policy trade-offs, and feedback between people and systems. Full article

(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety—the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions. Full article

This study investigates the long-run relationship between socio-economic inequality, public service provision, infrastructure development, structural transformation, and quality of life in Central Asia, focusing on Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan over the 2000–2024 period. Using panel data from the World Development Indicators, the analysis applies a comprehensive econometric strategy including panel unit root tests, Pedroni cointegration tests, FMOLS, DOLS, CCR estimators, and a Panel ARDL-PMG framework for robustness. The study examines how inequality, education and health expenditure, ICT development, electricity access, economic growth, and urbanization jointly shape quality-of-life outcomes measured by life expectancy. The empirical results confirm the existence of a stable long-run equilibrium relationship among the variables. Urbanization emerges as the most powerful determinant of quality of life, indicating a highly elastic welfare response to spatial structural transformation. ICT development and education expenditure consistently exert positive effects, highlighting the importance of digital connectivity and human capital accumulation in improving welfare outcomes. In contrast, health expenditure, electricity access, and economic growth display negative long-run relationships, suggesting that these variables often reflect structural inefficiencies, transitional dynamics, or non-inclusive growth patterns in the region. The Gini coefficient shows a positive association with quality of life, which is interpreted in the context of structural transformation and sectoral reallocation processes in transition economies. Robustness checks using Panel ARDL-PMG confirm both long-run equilibrium relationships and heterogeneous short-run dynamics, with evidence of adjustment processes toward equilibrium. The findings suggest that improvements in quality of life in Central Asia are driven primarily by structural transformation, digital development, and education investment rather than aggregate economic growth alone. The study contributes to the literature by providing a comprehensive multi-country panel analysis of Central Asia, integrating infrastructure, inequality, and structural change within a unified framework. The results offer important insights into the mechanisms through which development processes translate into welfare outcomes in transition economies. Full article

Depression, anxiety, and stress-related disorders continue to rise globally, with South Africa’s burden intensified by structural inequalities and a 91% mental health treatment gap, making accessible complementary interventions urgently needed. This exploratory mixed-methods pilot study examined the feasibility and acceptability of astronomy-based mental health support grounded in Attention Restoration Theory and awe research and sought a preliminary signal of change in psychological well-being. Two sequential retreat iterations combined guided naked-eye and telescope-based stargazing with nature immersion: a proof-of-concept peer camp (n = 19, Glencairn) and a family-focused retreat (n = 22 across nine family groups, Sutherland). The Depression Anxiety Stress Scale (DASS-21) was administered before (T1) and after (T2) the Glencairn retreat; qualitative data comprised the Most Significant Change focus groups (Glencairn) and asynchronous text-based interviews (Sutherland). Mean depression, anxiety and stress scores were lower at T2 than at T1. Because questionnaires were completed anonymously, individual T1 and T2 responses could not be linked. A valid paired analysis was therefore not possible, and inferential significance testing was not undertaken. These results represent descriptive cohort level patterns and should not be interpreted as evidence of within person change. Qualitative findings across both settings indicated calm, perspective shifts, and relational connection, while environmental novelty and family dynamics introduced competing cognitive demands at Sutherland. These preliminary findings suggest that astronomy-based interventions may support short-term psychological well-being and highlight three design considerations for implementation in African contexts, offered as provisional insights rather than established implementation principles with the design considerations being: cognitive spaciousness, contextual onboarding and relational anchoring. Full article