Search Results (1,505)

São Paulo is the largest city in Brazil and the second in Latin America. Its domestic waste production reached 3,515,678.96 tons in 2024. Historically, the city has a low recycling rate, and several laws and policies have been implemented to reverse this situation. The objective of this study was to investigate whether there have been advances in the recycling of household solid waste in São Paulo 15 years after the National Solid Waste Policy, from municipal and intra-urban perspectives. The extended period studied and segregated data by regional administration represent the innovative approach of this manuscript. The methodology consisted of a case study with an analysis of the legislation, official data research and evaluation of goals, and socio-spatial distribution. The separate collection rate grew from 0.69% in 2006 to 2.85% in 2024, but this volume represents less than 10% of the target originally projected for the period. A socio-spatial inequality was found as well as a lack of dedicated collection for the organic fraction. It can be concluded that progress is incremental, but limited by structural barriers and urban inequities. Results indicate for São Paulo and for other large cities, mainly in low and middle-income countries, recycling success cannot depend on legislation as it is also correlated with demographic factors, such as educational level, and to the need of targeted policies for a progressive increase in source-separated recycling. Full article

Across the Global South, heightened contestation over rural land has placed land administration at the centre of policy debates, particularly where mismatches between official land records and lived realities generate disputes, exclusion, and limited access to welfare and compensation. In India, these challenges are shaped by colonial cadastral legacies, fragmented institutional arrangements, and rapidly changing rural and peri-urban landscapes. While digitization of land records is widely promoted as a solution to improve transparency and efficiency, reforms implemented without meaningful community participation risk reproducing existing inequalities in more rigid and legally entrenched forms. This article examines the limits of digitization-led land reforms in India and explores how decentralized and community-engaged governance approaches can strengthen land administration. Focusing on two case-study regions in Western India—Talasari and Chiplun in Maharashtra—the study draws on qualitative field research conducted between December 2024 and October 2025, including Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), institutional process-mapping, and analysis of land administration procedures across multiple departments. The combination of field-based evidence and process-mapping enables a grounded analysis of institutional coordination, governance bottlenecks, and the relationship between formal land records and customary tenure practices. The findings show that digitization without community-engaged implementation processes often reproduces inaccuracies and governance gaps rather than resolving longstanding structural problems. Outdated cadastral records, fragmented institutional arrangements, and weak coordination between departments continue to intensify exclusions, tenure insecurity, and administrative fragmentation. The article therefore argues that strengthening land governance requires hybrid and decentralized approaches that integrate statutory and customary systems through co-governance and community participation. These findings have important policy implications for ongoing reforms such as the Digital India Land Records Modernization Programme (DILRMP) and the Survey of Villages and Mapping with Improvised Technology in Village Areas (SVAMITVA), highlighting the need to align digitization initiatives with local tenure realities, participatory governance, and stronger institutional coordination. Full article

Banten Province, Indonesia, is a critical yet overlooked frontier of urbanisation. Despite being one of Southeast Asia’s fastest-urbanising regions, its secondary cities, towns and peri-urban hinterlands remain marginal in urban studies and sustainability science. This neglect is consequential. Future urban growth will increasingly concentrate in such settlements, yet debates on urbanisation in Indonesia and Southeast Asia remain focused on metropolitan regions such as Jakarta, one of the world’s largest urban areas. This paper addresses this gap by combining a cross-sector participatory horizon scan with a responsive development pathway for under-resourced territories. Thirty-four participants from academia, government and professional associations co-produced insights into Banten’s urban trajectories, triangulated with literature and secondary data. To our knowledge, this study draws on the first expert workshop on Banten’s urbanisation of this scale, cross-sectoral reach and disciplinary breadth, spanning six domains: economic development, physical infrastructure, social development, cultural heritage, environment and biodiversity, and disaster vulnerability. The deliberations also identified nine cross-cutting issues—including governance deficits, environmental injustice and climate risk—that underpin territorial inequality. From these findings, the paper synthesises a responsive development pathway that supports coordinated planning and governance across Banten’s urbanising settlements and offers a transferable model for negotiating extended urbanisation in rapidly urbanising Global South regions. Full article

Background: Socioeconomic deprivation is a well-established determinant of participation in colorectal cancer (CRC) screening. However, less is known about the geographic clustering of screening adherence and whether spatial inequalities mirror regional patterns of socioeconomic disadvantage. This study investigated the association between socioeconomic deprivation and adherence to CRC screening across Italian regions and explored the presence of spatial autocorrelation using geographic analytical methods. Methods: We conducted a nationwide ecological cross-sectional study including 21 Italian regional units. Pearson correlation analysis was performed to explore associations between colorectal cancer (CRC) screening adherence, primary care physician (PCP) workload and socioeconomic deprivation. Multivariable linear regression was used after assessment of multicollinearity using variance inflation factors (VIFs). Sensitivity analyses included alternative deprivation indicators and leave-one-region-out analyses. Spatial dependence was evaluated using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: CRC screening adherence showed substantial geographic variability across Italy, with higher participation in northern regions and lower participation in southern areas. Screening adherence was inversely associated with socioeconomic deprivation. Sensitivity analyses confirmed the robustness of the association across alternative deprivation measures and sequential exclusion of each regional unit. Spatial analysis demonstrated significant positive spatial autocorrelation (Moran’s I = 0.275; p = 0.039), indicating that neighbouring regions tended to exhibit similar screening behaviours. LISA analysis identified significant High–High clusters in northern Italy, Low–Low clusters in southern and insular regions, and isolated spatial outliers, highlighting persistent territorial inequalities in preventive healthcare utilisation. Conclusions: Regional disparities in CRC screening participation were associated with socioeconomic deprivation and modest but significant spatial clustering. These findings provide a regional-level description of inequalities in screening participation and may help inform future public health strategies aimed at reducing disparities in organised colorectal cancer screening. Full article

Background: Hearing health in Kazakhstan is documented through parallel administrative systems whose indicators are often conflated. We examined three administrative layers of hearing health during 2020–2025: dispensary registration of ear and hearing-loss diagnoses, disability certification as a severe administrative endpoint, and cochlear implantation (CI) as the specialised treatment response, with reference to Global Burden of Disease (GBD) 2021 estimates. Methods: We conducted a national ecological, region-year, multi-source administrative registry study across all 20 regions of Kazakhstan from 2020 to 2025. The dataset included 114 region-year observations and integrated Dispensary Report Form No. 12, the State Register of Persons with Disabilities, and the Electronic Register of Inpatient Patients. Dispensary indicators were interpreted as registered healthcare-utilisation measures, not population prevalence or incidence. Trends were assessed using Mann–Kendall tests with Benjamini–Hochberg false-discovery-rate correction. Regional patterns were examined using Spearman correlation, inequality metrics, and exploratory clustering. Results: Among adults, registered H60–H95 annual morbidity increased from 231,209 to 278,897 cases (CAGR +3.8%; FDR p = 0.016), and first-time registrations rose from 126,513 to 167,674 (CAGR +5.8%; FDR p = 0.016). Active dispensary observation declined modestly from 21,840 to 19,881. H65–H66 chronic otitis first-time registration remained stable, while active observation declined sharply. Paediatric H90–H91 registration was stable. In 2025, 31,560 persons were registered with hearing impairment-related disability, including 26,522 adults. CI procedures increased from 285 to 523. Adult CI activity was intermittent between 2012 and 2018 (peak 140 in 2013), ceased in 2019–2020, and was re-established from 2021 (14 → 129 procedures in 2025), reaching 24.7% of all CI. Most procedures were concentrated in Almaty and Astana. Compared with the GBD-2021 estimate of 17,212 per 100,000, administrative indicators captured much narrower service-utilisation and severe-certification layers. Conclusions: Kazakhstan’s administrative data describe distinct hearing-health layers rather than competing prevalence estimates. Adult screening, regional audiology capacity, post-CI rehabilitation, and longitudinal outcome registries are priority areas. Full article

This paper examines the geography of frail ageing in Italy by analysing how longevity, health conditions, non-self-sufficiency and assistance needs intersect across territories. Its distinctive contribution lies in moving beyond a purely demographic reading of population ageing, linking the extension of life to the quality of later-life survival and to the uneven territorial distribution of public assistance. Drawing on official data from Istat, Eurostat and INPS, this study adopts a regional comparative approach, with evidence disaggregated by sex, age group and macro-area. The analysis combines indicators of demographic structure, residual life expectancy at age 65, healthy life expectancy, severe limitations in daily activities, multimorbidity and assistance benefits. This framework makes it possible to distinguish between ageing as a numerical increase in the older population and ageing as a differentiated condition of vulnerability, dependency and welfare need. The findings show that Italy’s high longevity conceals marked territorial and gender inequalities. While the centre–north displays more favourable survival and health profiles, the south and the islands have higher levels of frailty, functional limitations and reliance on public assistance. Women appear to be particularly exposed to this imbalance, living longer but spending more years in conditions of disability and dependency. Full article

Telehealth has the potential to improve access to healthcare, but teleassessment usability may be influenced by contextual factors beyond technology access alone. This study investigated factors associated with teleassessment usability among individuals with interstitial lung disease (ILD) in Brazil using a convergent mixed methods design with 31 adults from four Brazilian regions. Usability was assessed with the Telehealth Usability Questionnaire (TUQ-Brazil); associations with contextual variables were examined using Spearman’s correlation. Qualitative data were obtained through semi-structured interviews and analyzed using thematic analysis. Participants generally reported acceptable usability perceptions with predominance of agreement responses; greater dispersion was observed for items related to equivalence with in-person care and video quality. Usability was significantly associated with income (rho = 0.437; p = 0.014), perceived clinical feasibility (rho = −0.397; p = 0.027), and perceived intensity of access barriers (rho = −0.428; p = 0.016). Qualitative findings identified financial constraints, digital literacy, internet stability, third-party support dependence, and absence of physical examination as key experiential factors. Teleassessment was perceived as a complement for follow-up and triage rather than a substitute for face-to-face assessment. Usability in ILD is shaped by socioeconomic, clinical, and structural factors, underscoring the need to address digital inequalities in telehealth implementation. Full article

While drone delivery has gained significant scholarly and industrial interest, rural residents’ acceptance of these systems remains underexplored, despite the region’s acute logistics challenges and service inequities. Using survey data from rural U.S. residents, this study first estimates an ordered logistic regression (OLR) model to identify factors associated with five-level drone delivery acceptance. The study then compares OLR, multinomial logistic regression (MNL), Random Forest (RF), XGBoost, and LightGBM under matched feature sets to evaluate whether nonlinear machine-learning models improve prediction beyond the interpretable statistical baseline. Open-ended responses are coded into LLM-derived sentiment labels and added as supplementary predictors to test whether unstructured feedback improves acceptance prediction. Results show that willingness to pay is the strongest predictor of acceptance, while equitable same-day delivery demand and post-pandemic attitude adjustment are also positively associated with higher acceptance. Household disability status and urban accessibility are not significant after adjustment. In the five-level analysis, OLR provides a strong ordinal baseline, while XGBoost and other tree-based models improve selected class-level prediction metrics. In the binary high-acceptance analysis, machine-learning models show stronger predictive performance, especially when structured predictors are combined with sentiment features. This study contributes to rural drone-delivery literature by linking service equity, perceived value, and LLM-derived sentiment within a comparable statistical and machine-learning framework for rural service design. Full article

Sickle Cell Disease (SCD) is a hereditary hemoglobinopathy arising from a single-nucleotide transversion (GAG → GTG) at codon six of the HBB gene on chromosome 11, substituting glutamic acid with valine in the β-globin chain and producing hemoglobin S (HbS). Under hypoxic conditions, HbS polymerizes and distorts erythrocytes into the characteristic sickle shape, initiating a cascade of vaso-occlusion, chronic hemolytic anemia, and progressive multi-organ damage that defines the clinical burden of this disease. Although SCD has ancient origins in sub-Saharan Africa, the Indian subcontinent, the Middle East, and the Mediterranean, regions where it conferred heterozygous resistance to malaria, the ease of human migration has long since made it a global health concern, affecting an estimated 300,000–400,000 newborns annually. Advances in molecular and genomic research have deepened our understanding of SCD pathophysiology, revealing the central contributions of hemoglobin polymerization, oxidative stress, endothelial inflammation, and nitric oxide depletion to disease progression. Current management rests on supportive pharmacological interventions, including hydroxyurea, chronic transfusion therapy, L-glutamine, and multimodal pain management, complemented by lifestyle modifications. Curative approaches have advanced substantially: hematopoietic stem cell transplantation (HSCT) remains the established standard of cure, while the regulatory approvals in late 2023 of the CRISPR/Cas9-based exagamglogene autotemcel (Casgevy) and the lentiviral vector-based lovotibeglogene autotemcel (Lyfgenia) represent the most transformative development in the history of SCD therapeutics. This review traces the disease from its ancient origins and molecular characterization through to its clinical manifestations, inheritance patterns, screening strategies, and the full spectrum of current and emerging therapies. Persistent challenges, prohibitive treatment costs, healthcare inequities, the ethical dimensions of genome editing, and the urgent need for long-term safety data, are examined critically, with a view to informing the research and policy agenda that must accompany these remarkable scientific advances. Full article

Urban waterlogging poses increasing threats to megacities; however, the spatial distribution of waterlogging risk inequality remains poorly understood. In this work, a comprehensive framework to evaluate urban waterlogging risk and its spatial inequality in Beijing is developed. The framework integrates machine learning-based waterlogging susceptibility, urban waterlogging resilience quantified using the entropy weight method, and population exposure data. The Gini index and Lorenz curves are employed to quantify risk inequality at both district and township scales. The central urban area is characterized by high- and very-high-susceptibility levels, while low-susceptibility areas are mainly concentrated in the outer suburbs. A distinct “core-periphery” pattern characterizes urban resilience: high resilience concentrates in the central urban area, while resilience drops significantly in the outer suburbs. The integration of susceptibility, resilience, and exposure reveals a profound spatial waterlogging risk disparity. The urban core has the highest waterlogging risk, but the burden is evenly spread across its dense population (Gini < 0.4). In contrast, outer suburbs and mountainous areas show severe inequality (Gini > 0.6), where a tiny fraction of the population bears most of the risk. This framework supports region-specific strategies to improve control efficiency and achieve environmental distributive justice. Full article

Background: Despite noteworthy progress in the Expanded Program on Immunization (EPI) for improving vaccination coverage worldwide, inequalities in vaccine uptake and accessibility persist in several middle- and low-income states. Pakistan’s routine vaccination uptake varies greatly between federal geographical regions and continues to fall below the standard threshold needed to attain optimal herd immunity. The Federal Directorate of Immunization (FDI) in collaboration with the provincial Expanded Program on Immunizations implemented Enhanced Outreach Activities (EOAs) to boost immunization delivery in selected districts in order to address immunization coverage gaps in marginalized and difficult-to-reach communities. The purpose of this secondary data research was to evaluate whether EOAs improved immunization coverage in the country. Methods: The Federal Directorate of Immunization’s longitudinal panel analysis of district–month administrative data for the years 2011–2021 have been analyzed. The research investigation reviewed 158 districts’ monthly vaccination records for multiple antigens, covering regions where EOAs were successfully carried out in particular months. National and subnational analyses were carried out to measure geographical variations in the impact of Enhanced Outreach Activities (EOAs). The average vaccination coverage during EOAs and non-EOAs months was compared using the paired t-test. Results: An aggregate of 2430 months with EOAs were included in the analysis of 19,068 monthly district observations. National level analysis revealed higher average vaccinations during the EOA months for all antigens, but a statistically significant increase was observed for IPV and measles second dose (p < 0.05) only. Provincial-level results indicate that the impact was more evident in underserved regions. Khyber Pakhtunkhwa, Balochistan, Punjab, and Sindh demonstrated statistically significant increases in vaccination counts for most antigens. Due to variations in baseline population coverage, as well as health care sector capability, the extent of improvements differed throughout regions. Conclusions: In Pakistan, routine immunization counts has been improved via enhanced outreach initiatives, especially in provinces with lower initial vaccination rates and restricted accessibility to services. Strengthening outreach strategies, together with consistent fixed-site immunization services, is likely to accelerate progress toward equitable immunization coverage and contribute to achieving the Immunization Agenda 2030 goals. Full article

Objective: This study aimed to identify priority areas, social vulnerability, and healthcare capacity and networks while considering hospitalization and mortality rates due to Severe Acute Respiratory Syndrome (SARS) caused by COVID-19 during the public health emergency period. Materials and Methods: A spatiotemporal analysis was performed to assess hospitalization, mortality, and case fatality rates among hospitalized patients due to severe COVID-19 across the municipalities of the Metropolitan Region of Belo Horizonte (MRBH), Brazil, between 2020 and 2022. The findings were contextualized by considering the social vulnerability of the population as well as the healthcare infrastructure and organizational characteristics of municipalities and health regions. Results: Municipalities located in the central area of the MRBH showed higher hospitalization rates, corresponding to areas with a greater concentration of healthcare infrastructure. However, mortality and case fatality rates among hospitalized patients were higher in municipalities with more limited healthcare infrastructure and greater social vulnerability. Conclusion: The spatiotemporal disparities in hospitalization and mortality risks suggest health inequities that seem to be influenced by social determinants and healthcare system vulnerabilities. These findings emphasize the imperative for public health emergency responses to prioritize the strengthening of health system organization and the establishment of effective care pathways to enhance access and service delivery, particularly in municipalities exhibiting higher levels of social vulnerability. Full article

Cross-border multimodal transportation systems are essential for regional connectivity, yet their structural concentration, modal imbalance, community organization, and accessibility differentiation remain insufficiently understood from an entropy perspective. Based on 2024 data, this study constructs railway, highway, aviation, and integrated transportation networks between Western China and the five Central Asian countries. It integrates complex network analysis, structural entropy, modal diversity entropy, Louvain community detection, and accessibility assessment within a structure–organization–function framework. The results reveal a core–periphery pattern, with Xi’an, Urumqi, Almaty, and Tashkent serving as hubs. Structural entropy shows that highway connections are balanced, aviation links are concentrated around core hubs, and the integrated network reflects the coexistence of core-hub agglomeration and multimodal coverage expansion. Modal diversity entropy indicates that high connectivity does not necessarily imply balanced modal configuration, and 41.8% of nodes remain dependent on a single mode. Community detection reveals local cohesion and global segmentation, while accessibility analysis identifies a Western China core and Central Asian periphery. Sensitivity analyses based on common-node normalization, travel-time weighting, and alternative modal weights confirm the robustness of the findings. These results provide an integrated diagnostic framework for identifying structural concentration, modal imbalance, and accessibility inequality in cross-border multimodal transportation networks. Full article

How SME development affects poverty reduction and income inequality remains a contested issue, particularly in transition economies characterized by structural and regional disparities. Existing studies often treat SMEs as a homogeneous phenomenon. As a result, evidence on the relationship between SME development, multidimensional poverty, and income inequality remains limited. This study examines the relationship between SME development, multidimensional poverty, and income inequality across 15 regions of Kazakhstan during 2005–2024 using panel data and Driscoll–Kraay estimators. Poverty is assessed using incidence, depth, and severity. SME development is measured using indicators capturing quantitative expansion and qualitative contribution. The findings identify unemployment and income inequality as the most robust drivers of poverty. Income growth reduces poverty depth and severity but is also associated with higher income inequality. SME development exhibits heterogeneous socioeconomic effects. Indicators reflecting SME value added are associated with lower poverty and inequality, whereas increases in the number of enterprises or SME output do not necessarily improve social outcomes and may be linked to higher poverty intensity. The results indicate that the developmental impact of SMEs depends on productivity, value creation, and structural transformation rather than enterprise quantity, highlighting the importance of quality-oriented SME policies for inclusive growth. Full article

Despite significant biomedical advances in the prevention of mother-to-child transmission (MTCT) of HIV, residual transmission and suboptimal maternal outcomes persist across Europe. The challenge is no longer primarily virological but structural: aggregated ART coverage indicators mask important discontinuities across the perinatal care pathway. This scoping review maps evidence on clinical and psychosocial dimensions of the perinatal HIV pathway among adult women living with HIV (WLHIV) in Europe, and identifies key gaps in their integration across the continuum of care. Following PRISMA-ScR guidelines, five databases were searched for studies published between 2010 and 2026. Of 1881 records identified, 109 met inclusion criteria. Findings were synthesized thematically using an inductively developed framework spanning preconception through long-term postpartum outcomes. MTCT rates declined from approximately 1–1.2% in the mid-2000s to below 0.5% in recent data, and vaginal delivery rates increased markedly with sustained viral suppression. However, persistent inequalities remain among younger women, migrants, and those with histories of injecting drug use. Stigma, migration-related vulnerability, mental health difficulties, constrained disclosure, and socioeconomic insecurity shape engagement with care, influencing treatment continuity, retention, and virological outcomes, particularly during the postpartum period. Equitable perinatal HIV outcomes require integrated care models that combine clinical HIV and obstetric services with mental health support, social needs screening, and migration-sensitive services to address the structural conditions shaping care trajectories. A substantial proportion of WLHIV in Europe originate from high-prevalence regions, making perinatal HIV in this context a direct interface between global infectious disease burden and migration health. Addressing care in European settings therefore contributes to broader global health equity goals in HIV elimination. The protocol was pre-registered on Open Science Framework with registration number: 10.17605/OSF.IO/9BZGY. Full article