Search Results (1,273)

Background/Objectives: Despite growing interest in oral frailty as a public health issue, no nationwide study has assessed regional differences in oral frailty awareness, and the factors associated with such differences remain unclear. This study investigated regional differences in oral frailty awareness among older adults in Japan and identified the associated individual- and municipal-level factors, focusing on local policy measures and community-based oral health programs. Methods: A cross-sectional analysis was conducted using data from the 2022 wave of the Japan Gerontological Evaluation Study. The analytical sample comprised 20,330 community-dwelling adults aged ≥65 years from 66 municipalities. Awareness of oral frailty was assessed via self-administered questionnaires. Individual- and municipal-level variables were analyzed using multilevel Poisson regression models to calculate prevalence ratios (PRs). Results: Awareness of oral frailty varied widely across municipalities, ranging from 15.3% to 47.1%. Multilevel analysis showed that being male (PR: 1.10), having ≤9 years (PR: 1.10) or 10 to 12 years of education (PR: 1.04), having oral frailty (PR: 1.04), and lacking civic participation (PR: 1.06) were significantly associated with lack of awareness. No significant associations were found with municipal-level variables such as dental health ordinances, volunteer training programs, or population density. Conclusions: The study found substantial regional variation in oral frailty awareness. However, this variation was explained primarily by individual-level characteristics. Public health strategies should focus on enhancing awareness among socially vulnerable groups—especially men, individuals with low educational attainment, and those not engaged in civic activities—through targeted interventions and community-based initiatives. Full article

Purpose: Following George Floyd’s death, the push for law enforcement accountability policies has intensified. Despite robust legislative action, challenges in enacting and implementing meaningful reforms persist. This study analyzes police accountability policies (PAP) in the U.S. from 2020 to 2022, identifying barriers and facilitators through expert perspectives in enforcement oversight, policy advocacy, and community engagement. Methods: The study used a dual approach: analyzing 226 police accountability bills from all 50 U.S. states, D.C., and Puerto Rico via the National Conference of State Legislatures database, and categorizing them into six key areas such as training, technology use, and certification. Additionally, a survey was conducted among experts to identify the challenges and drivers in passing police accountability legislation. Findings: A legislative analysis showed that although 48 states passed police accountability laws, California, New Jersey, Oklahoma, and Colorado have made significant strides by passing multiple pieces of legislation aimed at enhancing law enforcement accountability and ensuring better policing practices. The most common policies focused on training and technology, enacted by 16 and 12 states, respectively. However, crucial certification and decertification policies were adopted in just 13 states, highlighting the inconsistent implementation of measures critical for police accountability and transparency. The survey identified several barriers to passing PAP, including inadequate support from local governments (72.7%). Structural exclusion of poor and minority communities from policing resources was also a significant barrier (54.5%). Facilitators included community support (81.8%) and a cultural shift in policing towards viewing officers as “guardians” rather than “warriors” (63.6%). Conclusions: While some progress has been made in passing PAP, considerable gaps remain, particularly in enforcement and comprehensive reform. Resistance from law enforcement institutions, lack of community support, and structural inequalities continue to impede the adoption of effective PAP. Full article

This paper investigates how governance frameworks shape sustainable tourism outcomes in protected areas by comparing Tara National Park (Serbia) and Triglav National Park (Slovenia). Both parks, established in 1981 and classified under IUCN Category II, exhibit rich biodiversity and mountainous terrain but differ markedly in governance structures, institutional integration, and local community engagement. Using a qualitative, indicator-based methodology, this research evaluates ecological, economic, and social dimensions of sustainability. The findings reveal that Triglav NP demonstrates higher levels of participatory governance, tourism integration, and educational outreach, while Tara NP maintains stricter ecological protection with less inclusive management. Triglav’s zoning model, community council, and economic alignment with regional development policies contribute to stronger sustainability outcomes. Conversely, Tara NP’s centralized governance and infrastructural gaps constrain its potential despite its significant conservation value. This study highlights the importance of adaptive, inclusive governance in achieving the Sustainable Development Goals (SDGs) within protected areas. It concludes that hybrid approaches, combining legal rigor with participatory flexibility, can foster resilience and sustainability in ecologically sensitive regions. Full article

Thailand’s southern border provinces need youth-focused multicultural leadership programs integrating local religious–cultural elements, community involvement, and long-term evaluation to enhance social cohesion and sustainable development. This study aimed to develop and evaluate a program to foster multicultural leadership among youth in Thailand’s three southern border provinces. The research was conducted in two phases. The first phase involved synthesizing key multicultural leadership characteristics, designing a structured program and assessing its relevance and coherence through expert evaluation. The second phase focused on empirical validation by implementing the program with 22 selected youth participants, employing repeated-measures analysis of variance to assess its effectiveness. Additionally, experts evaluated the program’s validity, appropriateness, cost-effectiveness, utility, and feasibility. The resulting program, “EARCA”, comprises five core components: Experiential Exposure, Active Exploration & Engagement, Reflective Thinking & Analysis, Concept Integration & Synthesis, and Application & Extension. Expert assessments confirmed its appropriateness at the highest level, with a consistency index ranging from 0.8 to 1.0. Statistical analyses demonstrated significant improvements in all dimensions of multicultural leadership among participants. Furthermore, the program was rated highly accurate, appropriate, cost-effective, practical, and feasible for real-world implementation. These findings offer valuable insights for policymakers and practitioners seeking to enhance multicultural leadership development through structured, evidence-based interventions. Full article

This study documents Black Wisconsinites’ birthing experiences and their proposed solutions to improve Black birthing people’s trust in healthcare. Between 2019 and 2022, we conducted semi-structured, longitudinal interviews (both individual and focus group interviews) with those enrolled in a local perinatal support group program for Black birthing people (N = 25), asking about their pregnancy, birthing, and postpartum experiences and their ideas for building trust in healthcare. Using the Daughtering Method and Braun and Clarke’s method of reflexive thematic analysis, we coded the interview data and then iteratively collated the codes into themes and subthemes. Participants described experiencing medical racism, including healthcare trauma and provider bias, during pregnancy and delivery. They drew connections between those experiences and the distrust they felt toward healthcare providers and the healthcare system. They provided actionable strategies that individual providers and the healthcare system can take to build the trust of Black birthing people: employ more Black providers, listen to Black birthing people, exhibit cultural humility, engage in shared decision-making, build personal connections with patients, and spend more time with patients. This study connects Black birthing people’s experiences of medical racism to feelings of medical distrust and provides community-identified actionable suggestions to build trust and shape how we combat racial disparities in healthcare provision and health outcomes. Full article

Consumer-accessible and user-friendly smart products such as unmanned aerial vehicles (UAVs), or drones, have become widely used, adaptable, and acceptable devices to observe, assess, measure, and explore urban and natural environments. A drone’s relatively low cost and flexibility in the level of expertise required to operate it has enabled users from novice to industry professionals to adapt a malleable technology to various disciplines. This review examines the academic literature and maps how drones are currently being used in 93 rural and regional city councils in New South Wales, Australia. Through a systematic review of the academic literature and scrutiny of current drone use in these councils using publicly available information found on council websites, findings reveal potential uses of drone technology for local governments who want to engage with smart technology devices. We looked at how drones were being used in the management of the council’s environment; health and safety initiatives; infrastructure; planning; social and community programmes; and waste and recycling. These findings suggest that drone technology is increasingly being utilised in rural and regional areas. While the focus is on rural and regional New South Wales, a review of the academic literature and local council websites provides a snapshot of drone use examples that holds global relevance for local councils in urban and remote areas seeking to incorporate drone technology into their daily practice of city, town, or region governance. Full article

As sustainable cultural heritage tourism increasingly demonstrates its unique value and appeal, effectively stimulating tourists’ emotional experiences and value co-creation behaviors has become a focal issue. This study investigates how multiple tourist motivations (self-enhancement, escapism, and social interaction) shape value co-creation through emotional mediators—namely aesthetic, nostalgic, and flow experiences. Data were collected from 470 valid responses from visitors to the UNESCO-listed Suzhou Classical Gardens in China and analyzed using partial least squares structural equation modeling (PLS-SEM). The results show that these emotional experiences significantly drive value co-creation behavior: self-enhancement motivation enhances all three experiences, escapism mainly promotes nostalgic and flow experiences, and social interaction primarily affects aesthetic experience. These findings clarify the psychological mechanisms through which tourists’ motivations and emotional experiences influence value co-creation behavior in cultural heritage tourism. This research advances our understanding of the motivation–experience–behavior framework and emphasizes that enhancing emotional engagement is key to fostering sustainable cultural heritage tourism practices. The study provides practical implications for designing experiences and strategies that balance visitor satisfaction with the long-term vitality of cultural heritage sites and local communities, thereby contributing to broader sustainable development goals. Full article

Coyaima is a town in the department of Tolima, Colombia, that was prioritized in a pilot program under Colombia’s National Plan for the Control of the Taeniasis/Cysticercosis Complex, focusing on this neglected health issue. The project engaged local indigenous communities, promoting education and outreach within the One Health framework. The study included 444 randomly selected volunteers, who filled a Knowledge, Attitudes, and Practices (KAP) survey on the taeniasis/cysticercosis complex. The baseline study found no Taenia spp. eggs via microscopy on 383 stool samples examined, and no T. solium DNA was detected on human stool and soil samples by Copro-qPCR. However, seroprevalence was 8.5% for human cysticercosis and 14% for porcine cysticercosis, as detected by in-house ELISA testing for T. solium. Moreover, 57.9% of participants who provided a stool sample were positive for at least one parasite. Following the sampling and characterization activities, local health workers implemented mass treatment with Niclosamide, based on evidence of ongoing transmission, high porcine seroprevalence, poor basic sanitation, and the presence of free-roaming pigs reported in the KAP survey. These findings provide scientific evidence to apply national public health policies for controlling taeniasis/cysticercosis complex in Coyaima. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

The aim of this research is to identify policy and practice interventions that support a just transition towards resilient practices for resource-dependent communities. We focus on Thai Nguyen and Phu Tho, two provinces in the Northern Midlands and Mountains of Vietnam. The region is reliant on agriculture but is assessed as highly vulnerable to climate change. We surveyed 105 farming households. A Likert-type questionnaire asked respondents to self-assess their experiences of weather extremes and of changes they had made to their farming practices. Our results show that for both Thai Nguyen and Phu Tho, farmers see the effects of climate change on their crops. Respondents in Thai Nguyen were more likely to report technically driven adaptation and engagement with extension services. Respondents in Pho Tho were more likely to continue traditional practices. For both, use of traditional knowledge and practices was related to taking measures to adapt to climate change. Our main conclusion is that at least three actions could support a just transition to resilient livelihoods. First is incorporating natural science and traditional knowledge into decision-making for just transitions. Second is considering long-term implications of interventions that appear to support livelihoods in the short term. Third is tailoring messaging and engagement strategies to the requirements of the most vulnerable people. The main message of this study is that a just transition for resource-dependent communities will inevitably be context-specific. Even in centralized and authoritarian contexts, flexibility to adapt top-down policies to locals’ own experiences of changing climates is needed. Full article

Urban areas are at the forefront in addressing global challenges such as climate change and biodiversity loss. Among the key responses are nature-based solutions, which are increasingly being integrated into policy frameworks but which require strong community engagement for their effective implementation. This paper presents the findings of surveys conducted within the Place Lab in Katowice, Poland, an initiative developed as part of an international project and used as a participatory tool for co-creating and implementing green infrastructure. The project applies both place-based and people-centred approaches to support European cities in their transition towards regenerative urbanism. Place Lab activities encourage collaboration between local authorities and residents, enhancing awareness and fostering participation in environmental initiatives. The survey data collected during the project allowed for the evaluation of changes in public attitudes and levels of engagement and for the identification of broader societal phenomena that may influence the implementation of nature-based solutions. The findings revealed, for instance, that more women were interested in supporting the project, that residents tended to be sceptical of governmental actions on climate change, and that views were divided on the trade-off between urban infrastructure such as parking and roads and the presence of green areas. Furthermore, questions of responsibility, awareness, and long-term commitment were frequently raised. Building on the survey results and the existing literature, the study proposes a set of indicators to assess the contribution of citizen participation to the adoption of nature-based solutions. While the effectiveness of nature-based solutions in mitigating climate change impacts can be assessed relatively directly, evaluating civic engagement is more complex. Nevertheless, when conducted transparently and interpreted by experts, indicator-based assessment can offer valuable insights. This study introduces a novel perspective by considering not only drivers of engagement but also the obstacles. The proposed indicators provide a foundation for evaluating community readiness and commitment to nature-based approaches and may be adapted for application in other urban settings and in future research on climate resilience strategies. Full article

Commitments to carbon neutrality at both international and national levels have spurred the development of market-based mechanisms that incentivize low-carbon technologies while penalizing emissions-intensive activities. These policies have wide ranging impacts for the Australian agricultural sector, and associated rural communities, where the majority of carbon credits and biodiversity credits are sourced in Australia. Undeniably, the introduction of carbon and environmental markets has created the opportunity for an expansion and diversification of local, rural economies beyond a traditional agricultural base. However, there is much complexity for the agricultural sector to navigate as environmental markets intersect and compete with food and fiber livelihoods, and entrenched ideologies of rural identity and purpose. As carbon and environmental markets focused on primary producers have expanded rapidly, there is little understanding of the associated situated and relational impacts for farming households and rural communities. Nor has there been much work to identify the barriers to engagement. This study explores these tensions through qualitative research in Stanthorpe and Roma, Queensland, offering insights into the barriers and benefits of market engagement. The findings inform policy development aimed at balancing climate goals with agricultural sustainability and rural community resilience. Full article

Background/Objectives: BRIGHTLIGHT was the national evaluation of adolescent and young adult (AYA) cancer services in England. BRIGHTLIGHT results were not available when the most recent healthcare policy (NHSE service specifications for AYA Cancer) for AYA was drafted and therefore did not consider BRIGHTLIGHT findings and recommendations. We describe the co-development and delivery of a Policy Lab to expedite the implementation of the new service specification in the context of BRIGHTLIGHT results, examining the roles of multi-stakeholders to ensure service delivery is optimised to benefit AYA patients. We address the key question, “What is the roadmap for empowering different stakeholders to shape how the AYA service specifications are implemented?”. Methods: A 1-day face-to-face policy lab was facilitated, utilising a unique, user-centric engagement approach by bringing diverse AYA stakeholders together to co-design strategies to translate BRIGHTLIGHT evidence into policy and impact. This was accompanied by an online workshop and prioritisation survey, individual interviews, and an AYA patient workshop. Workshop outputs were analysed thematically and survey data quantitatively. Results: Eighteen professionals and five AYAs attended the face-to-face Policy Lab, 16 surveys were completed, 13 attended the online workshop, three professionals were interviewed, and three AYAs attended the patient workshop. The Policy Lab generated eight national and six local recommendations, which were prioritised into three national priorities: 1. Launching the service specification supported by compelling communication; 2. Harnessing the ideas of young people; and 3. Evaluation of AYA patient outcomes/experiences and establishing a national dashboard of AYA cancer network performance. An animation was created by AYAs to inform local hospitals what matters to them most in the service specification. Conclusions: Policy and research evidence are not always aligned, so when emerging evidence does not support current guidance, further exploration is required. We have shown through multi-stakeholder involvement including young people that it was possible to gain a different interpretation based on current knowledge and context. This additional insight enabled practical recommendations to be identified to support the implementation of the service specification. Full article

This study examines the regional disparities in public perceptions of decarbonization and the acceptance of the bioeconomy within Western Macedonia, a Greek region undergoing structural economic change. While the environmental benefits of decarbonization, such as reduced carbon emissions and improved air quality, are widely acknowledged, perceptions of economic and social outcomes, including investments, new business development, and policy support, vary significantly across sub-regions. To this end, a structured survey was conducted among 765 residents, utilizing Likert-scale items to assess attitudes, with demographic data providing a contextual framework. Statistical analyses, incorporating techniques such as one-way analysis of variance (ANOVA), Kruskal–Wallis, and multiple regression, were employed to explore spatial variations and identify the primary drivers of bioeconomy acceptance. The results indicate that perceived government action, visible investment, new enterprises, and a positive view of public sentiment are all significant predictors of acceptance, with institutional support showing the strongest influence. The findings reveal that certain areas feel less engaged in the transition, expressing skepticism about its benefits, while others report more optimism. This disparity in perception underscores the necessity for targeted policy interventions to ensure inclusive and equitable participation. The study emphasizes the necessity for regionally responsive governance, enhanced communication strategies, and tangible local development initiatives to cultivate public trust and support. The study makes a significant contribution to the broader discourse on just transitions by emphasizing the role of place-based perceptions in shaping sustainable change. Full article

This study explores the role of community-centered farm-based hospitality in promoting sustainable rural development, with a focus on South Tyrol, Italy. A survey of 461 local residents assessed perceptions of agritourism’s impact on agricultural heritage, environmental sustainability, and community well-being. Factor analysis identified two main constructs—Agroheritage Sustainability and Empowered Eco-Tourism—which together capture the multifaceted benefits of agritourism. Agroheritage Sustainability reflects the preservation of traditional farming practices, cultural landscapes, and intergenerational knowledge, emphasizing the role of tourism in maintaining cultural identity and preventing land abandonment. Empowered Eco-Tourism highlights the socio-economic benefits of sustainable tourism, including community empowerment, environmental stewardship, and the creation of new economic opportunities. The study’s findings indicate that local residents view agritourism as a holistic approach that supports rural livelihoods while preserving cultural heritage and promoting ecological resilience. The analysis further supports the potential of farm-based hospitality as a model for sustainable rural development, aligning closely with EU policies and global best practices. The Roter Hahn initiative in South Tyrol serves as a practical example of this approach, demonstrating the value of certification programs in enhancing transparency, quality, and sustainability. These insights provide valuable guidance for policymakers and tourism developers seeking to promote sustainable rural tourism globally. The contribution of this research lies in its empirical validation of a dual-construct model that links community engagement with agroecological and cultural sustainability, offering a transferable framework for evaluating agritourism as a lever for sustainable rural development in diverse regional contexts. Full article