Search Results (564)

African, Caribbean, and Black (ACB) communities face increased COVID-19 morbidity and mortality, coupled with significant barriers to vaccine acceptance and uptake. Addressing these challenges requires innovative, multifaceted strategies. Peer-led interventions, grounded in critical health literacy (CHL) and critical racial literacy (CRL), and integrating collaborative equity learning processes, can enhance community capacity, empowerment, and health outcomes, contributing to long-term health equity. This paper describes and presents the evaluative outcomes of a peer-led intervention aimed at enhancing COVID-19 vaccine confidence and acceptance. The Peer-Equity Navigator (PEN) intervention consisted of a specialized training curriculum grounded in CHL and CRL. Following training, PENs undertook a 5-month practicum in community or health settings, engaging in diverse outreach and educational activities to promote vaccine literacy in ACB communities. The evaluation utilized a modified Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, using quantitative and qualitative methods to collect data. Sources of data included tracking records with community feedback, and a PEN focus group, to assess program feasibility, outreach, and effectiveness. From 16 September 2022, to 28 January 2023, eight trained PENs conducted 56+ community events, reaching over 1500 community members. Both PENs and community members reported high engagement, endorsing peer-led, community-based approaches and increased vaccine literacy. The PEN approach proves feasible, acceptable, and effective in promoting positive health behaviors among ACB communities. This intervention has clear implications for health promotion practice, policy, and research in equity-deserving communities, including immigrants and refugees, who also face multiple and intersecting barriers to health information and care. Full article

Urban metabolism frameworks offer insight into flows of energy, materials, and services in cities, yet tree species selection is seldom treated as a metabolic indicator. In Amman, Jordan, we integrate spatial metabolic metrics to critique monocultural greening policies and demonstrate how species choices forecast long-term urban metabolic performance. Using ENVI-met 5.61 simulations, we compare Melia azedarach, Olea europaea, and Ceratonia siliqua, mainly assessing urban flow related elements like air temperature reduction, CO₂ sequestration, and evapotranspiration alongside rooting depth, isoprene emissions, and biodiversity support. Melia delivers rapid cooling but shows other negatives like a low biodiversity value; Olea offers average cooling and sequestration but has allergenic pollen issues in people as a flow; Ceratonia provides scalable cooling, increased carbon uptake, and has a high ecological value. We propose a metabolic reframing of green infrastructure planning to choose urban species, guided by system feedback rather than aesthetics, to ensure long-term resilience in arid urban climates. Full article

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater recycling—under environmental, institutional, and reputational constraints. A comparative qualitative case study was conducted involving three hotel groups—Vila Vita Parc, Pestana Group, and Vila Galé—selected through purposive sampling based on organizational capacity and technology adoption stage. The analysis was supported by a supplementary mini-case from Mallorca, Spain. Publicly accessible documents, including sustainability reports, media coverage, and policy frameworks, were thematically coded using organizational environmental behavior theory and the OECD Principles on Water Governance. The results demonstrated that (1) higher organizational capacity was associated with greater maturity in water reuse implementation; (2) communication transparency increased alongside technological advancement; and (3) early-stage adopters encountered stronger financial, regulatory, and operational barriers. These findings culminated in the development of the Maturity–Communication–Governance (MCG) Framework, which elucidates how internal resources, stakeholder signaling, and institutional alignment influence sustainable infrastructure uptake. This research offered policy recommendations to scale water reuse in tourism through financial incentives, regulatory simplification, and public–private partnerships. The study contributed to the literature on sustainable tourism and decentralized climate adaptation, aligning with UN Sustainable Development Goals 6.4, 12.6, and 13. Full article

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake. Full article

AI-powered health assistants offer promising opportunities to enhance health management among older adults. However, real-world uptake remains limited, not only due to individual hesitation, but also because of complex interactions among users, platforms, and public policies. This study investigates the dynamic behavioral mechanisms behind adoption in aging populations using a tripartite evolutionary game model. Based on replicator dynamics, the model simulates the strategic behaviors of older adults, platforms, and government. It identifies evolutionarily stable strategies, examines convergence patterns, and evaluates parameter sensitivity through a Jacobian matrix analysis. Results show that when adoption costs are high, platform trust is low, and government support is limited, the system tends to converge to a low-adoption equilibrium with poor service quality. In contrast, sufficient policy incentives, platform investment, and user trust can shift the system toward a high-adoption state. Trust coefficients and incentive intensity are especially influential in shaping system dynamics. This study proposes a novel framework for understanding the co-evolution of trust, service optimization, and institutional support. It emphasizes the importance of coordinated trust-building strategies and layered policy incentives to promote sustainable engagement with AI health technologies in aging societies. Full article

Decentralized sanitation in rural areas urgently requires accessible and nature-based solutions to achieve Sustainable Development Goal 6 (clean water and sanitation for all). However, monitoring studies of such ecotechnologies in disperse communities remain limited. This study evaluated the performance of an evapotranspiration tank (TEvap), designed with community participation, for the treatment of domestic sewage in a rural Quilombola household in the Brazilian Cerrado. The system (total area of 8.1 m², with about 1.0 m² per inhabitant) was monitored for 218 days, covering the rainy season and the plants’ establishment phase. After 51 days, the TEvap reached operational equilibrium, maintaining a zero-discharge regime, and after 218 days, 92.3% of the total system inlet volumes (i.e., 37.47 in 40.58 m³) were removed through evapotranspiration and uptake by cultivated plants (Musa spp.). Statistical analyses revealed correlations that were moderate to strong, and weak between the blackwater level and relative humidity (Pearson correlation coefficient, r = 0.75), temperature (r = −0.66), and per capita blackwater contribution (r = 0.28), highlighting the influence of climatic conditions on system efficiency. These results confirm the TEvap as a promising, low-maintenance, and climate-resilient technology for decentralized domestic sewage treatment in vulnerable rural communities, with the potential to support sanitation policy goals and promote public health. Full article

Municipal solid waste (MSW) and refuse-derived fuel (RDF) incineration generate over 20 million tons of residues annually in the EU. These include bottom ash (IBA), fly ash (FA), and air pollution control residues (APCr), which pose significant environmental challenges due to their leaching potential and hazardous properties. While these residues contain valuable metals and reactive mineral phases suitable for carbonation or alkaline activation, chemical, techno-economic, and policy barriers have hindered the implementation of sustainable, full-scale management solutions. Accelerated carbonation technology (ACT) offers a promising approach to simultaneously sequester CO₂ and enhance residue stability. This review provides a comprehensive assessment of waste incineration residue carbonation, covering 227 documents ranging from laboratory studies to field applications. The analysis examines reactor designs and process layouts, with a detailed classification based on material characteristics, operating conditions, investigated parameters, and the resulting pollutant stabilization, CO₂ uptake, or product performance. In conclusion, carbonation-based approaches must be seamlessly integrated into broader waste management strategies, including metal recovery and material repurposing. Carbonation should be recognized not only as a CO₂ sequestration process, but also as a binding and stabilization strategy. The most critical barrier remains chemical: the persistent leaching of sulfates, chromium(VI), and antimony(V). We highlight what we refer to as the antimony problem, as this element can become mobilized by up to three orders of magnitude in leachate concentrations. The most pressing research gap hindering industrial deployment is the need to design stabilization approaches specifically tailored to critical anionic species, particularly Sb(V), Cr(VI), and SO₄²⁻. Full article

Classical epidemic models treat vaccine uptake as an exogenous parameter, yet real-world coverage emerges from strategic choices made by individuals facing uncertain risks. During the last two decades, vaccination games, which combine epidemic dynamics with game theory, behavioural economics, and network science, have become a very important tool for analysing this problem. Here, we synthesise more than 80 theoretical, computational, and empirical studies to clarify how population structure, psychological perception, pathogen complexity, and policy incentives interact to determine vaccination equilibria and epidemic outcomes. Papers are organised along five methodological axes: (i) population topology (well-mixed, static and evolving networks, multilayer systems); (ii) decision heuristics (risk assessment, imitation, prospect theory, memory); (iii) additional processes (information diffusion, non-pharmacological interventions, treatment, quarantine); (iv) policy levers (subsidies, penalties, mandates, communication); and (v) pathogen complexity (multi-strain, zoonotic reservoirs). Common findings across these studies are that voluntary vaccination is almost always sub-optimal; feedback between incidence and behaviour can generate oscillatory outbreaks; local network correlations amplify free-riding but enable cost-effective targeted mandates; psychological distortions such as probability weighting and omission bias materially shift equilibria; and mixed interventions (e.g., quarantine + vaccination) create dual dilemmas that may offset one another. Moreover, empirical work surveys, laboratory games, and field data confirm peer influence and prosocial motives, yet comprehensive model validation remains rare. Bridging the gap between stylised theory and operational policy will require data-driven calibration, scalable multilayer solvers, and explicit modelling of economic and psychological heterogeneity. This review offers a structured roadmap for future research on adaptive vaccination strategies in an increasingly connected and information-rich world. Full article

Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged ≥60 years or 18–64 years with at-risk medical conditions. Methods: We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. Searches in PubMed, EMBASE, and Scopus identified studies published in the last 10 years evaluating hospital-based interventions reporting vaccination uptake. The risk of bias was assessed using validated tools (NOS, RoB 2, ROBINS-I, QI-MQCS). A meta-analysis was conducted for categories with ≥3 eligible studies reporting pre- and post-intervention vaccination coverage in the same population. Results: We included 44 studies. Multi-component strategies (n = 21) showed the most consistent results (e.g., pneumococcal uptake from 2.2% to 43.4%, p < 0.001). Reminder-based interventions (n = 4) achieved influenza coverage increases from 31.0% to 68.0% and a COVID-19 booster uptake boost of +38% after SMS reminders. Educational strategies (n = 11) varied in effectiveness, with one study reporting influenza coverage rising from 1.6% to 12.2% (+662.5%, OR 8.86, p < 0.01). Standing order protocols increased pneumococcal vaccination from 10% to 60% in high-risk adults. Hospital-based catch-up programs improved DTaP-IPV uptake from 56.2% to 80.8% (p < 0.001). For patient education, the pooled OR was 2.11 (95% CI: 1.96–2.27; p < 0.001, I² = 97.2%) under a fixed-effects model, and 2.47 (95% CI: 1.53–3.98; p < 0.001) under a random-effects model. For multi-component strategies, the OR was 2.39 (95% CI: 2.33–2.44; p < 0.001, I² = 98.0%) with fixed effects, and 3.12 (95% CI: 2.49–3.92; p < 0.001) with random effects. No publication bias was detected. Conclusions: Hospital-based interventions, particularly those using multi-component approaches, effectively improve vaccine coverage in older and high-risk adults. Embedding vaccination into routine hospital care offers a scalable opportunity to reduce disparities and enhance population-level protection. Future policies should prioritize the institutional integration of such strategies to support healthy aging and vaccine equity. Full article

Micro, Small, and Medium Enterprises (MSMEs) are vital drivers of economic growth in Kenya, yet they face persistent barriers, including limited capacity, financial exclusion, and weak market integration. This study assessed the potential of universities as strategic hubs for MSME capacity building through a collaborative initiative between Egerton University and the KCB Foundation. Using the International Labour Organization’s Start and Improve Your Business (SIYB) methodology, 481 entrepreneurs from Egerton, Njoro, and Gilgil were trained in a business development bootcamp. This study evaluated the training effectiveness, participant demographics, confidence in skill application, networking outcomes, and satisfaction levels. The results showed high participant confidence (over 95% across all regions), strong financial management uptake (85%), and mobile banking adoption (70%). Gilgil led in inclusivity and peer engagement, while Njoro showed stronger gender representation. However, logistical challenges caused 25% absenteeism in rural areas, and only 23% accessed post-training mentorship. These findings underscore the transformative role of HEIs in fostering sustainable entrepreneurship through localized, inclusive, and industry-aligned training. Policy recommendations include hybrid delivery models, tiered curricula for diverse skill levels, and institutionalized mentorship through public–private partnerships. This case demonstrates the value of embedding entrepreneurship support within university mandates to advance national MSME development agendas. Full article

In the context of increasing demands for sustainable natural resource management, this study analyzes the demographic and structural characteristics of family farms in Croatia and their participation in three environmental measures under the 2014–2022 Rural Development Programme. Using national administrative data and spatial analysis, the results highlight key patterns linked to age, education, gender, and ownership, as well as regional disparities in measure uptake. The findings suggest the importance of tailoring rural development policy to small farms’ specific needs to improve future CAP implementation. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

This study investigates the influence of agricultural mechanization on maize productivity in Tanzania’s Ruvuma region, a major maize-producing area vital to national food security. It addresses gaps in understanding the cumulative effects of mechanization across the maize production cycle and identifies region-specific barriers to adoption among smallholder farmers. Focusing on five key stages—land preparation, planting, plant protection, harvesting, and drying—this research evaluated mechanization uptake at each stage and its relationship with yield disparities. Statistical analyses using Python libraries included regression modeling, ANOVA, and hypothesis testing to quantify mechanization–yield relationships, controlling for farm size and socioeconomic factors, revealing a strong positive correlation between mechanization and maize yields (r = 0.86; p < 0.01). Mechanized land preparation, planting, and plant protection significantly boosted productivity (β = 0.75–0.35; p < 0.001). However, harvesting and drying mechanization showed negligible impacts (p > 0.05), likely due to limited adoption by smallholders combined with statistical constraints arising from the small sample size of large-scale farms (n = 20). Large-scale farms achieved 45% higher yields than smallholders (2.9 vs. 2.0 tons/acre; p < 0.001), reflecting systemic inequities in access. These inequities are underscored by the barriers faced by smallholders, who constitute 70% of farmers yet encounter challenges, including high equipment costs, limited credit access, and insufficient technical knowledge. This study advances innovation diffusion theory by demonstrating how inequitable resource access perpetuates low mechanization uptake in smallholder systems. It underscores the need for context-specific, equity-focused interventions. These include cooperative mechanization models for high-impact stages (land preparation and planting); farmer training programs; and policy measures such as targeted subsidies for harvesting equipment and expanded rural credit systems. Public–private partnerships could democratize mechanization access, bridging yield gaps and enhancing food security. These findings advocate for strategies prioritizing smallholder inclusion to sustainably improve Tanzania’s maize productivity. Full article

Against the backdrop of global climate change, enhancing farmers’ adaptive capacity to reduce crop production risks has emerged as a critical concern for governments and researchers worldwide. Drawing on social capital theory, this study develops a four-dimensional measurement framework comprising social networks, social trust, social norms, and social participation, utilizing survey data from 1772 households in the Yellow River Basin. We employ factor analysis to construct comprehensive social capital scores and apply ordered Probit models to examine how social capital influences farmers’ climate adaptation behaviors, with particular attention to the moderating roles of agricultural extension interaction and digital literacy. Key findings include: (1) Adoption patterns: Climate adaptation behavior adoption remains low (60%), with technical adaptation measures showing particularly poor uptake (13%); (2) Direct effects: Social capital significantly promotes adaptation behaviors, with social trust (p < 0.01), networks (p < 0.01), and participation (p < 0.05) demonstrating positive effects, while social norms show no significant impact; (3) Heterogeneous effects: Impact mechanisms differ by crop type, with grain producers relying more heavily on social networks (+, p < 0.01) and cash crop producers depending more on social trust (+, p < 0.01); (4) Moderating mechanisms: Agricultural extension interaction exhibits scale-dependent effects, negatively moderating the relationship for large-scale farmers (p < 0.05) while showing no significant effects for smaller operations; digital literacy consistently demonstrates negative moderation, whereby higher literacy levels weaken social capital’s promotional effects (p < 0.01). Policy recommendations: Effective climate adaptation strategies should integrate strengthened rural social organization development, differentiated agricultural extension systems tailored to farm characteristics, and enhanced rural digital infrastructure investment. Full article