Search Results (1,571)

Background: Population aging in Poland has led to rising healthcare needs, but comprehensive evidence on long-term utilization patterns is limited. This study aimed to analyze healthcare use and disease burden among older adults, with particular focus on the impact of the COVID-19 pandemic, including its effects on care pathways, continuity of services, and differences between urban and rural populations. Methods: We conducted a retrospective study using anonymized medical records from a primary healthcare network in Poland between January 2020 and December 2024. The sample included 42,844 patients aged 60 years or older patients aged ≥60 years, with a total of 738,300 consultations. Data on demographics, visit type, prescriptions, referrals, diagnostic tests, and follow up were analyzed using chi-square tests, logistic regression, and nonparametric comparisons. Results: The mean age of patients was 77.5 years (SD 9.4), and 63.7% were women. The mean number of visits in the preceding 12 months was 10.3 (range 0–460). Prescriptions were issued in 56.9% of visits, referrals in 33.5%, and diagnostic tests in 21.4%. Patients with chronic diseases were more likely to receive diagnostic tests than those without (32.4% vs. 21.1%, χ² = 1570.42, p < 0.0001), but less likely to return within 30 days (23.4% vs. 39.4%, χ² = 2243.76, p < 0.0001). First visits generated more referrals than follow ups (41.6% vs. 32.9%, χ² = 1620.51, p < 0.0001). Completed visits were strongly associated with prescription issuance (63.2% vs. 16.4%, χ² = 1048.76, p < 0.0001). Return analyses showed that patients with more prior visits were significantly more likely to re-engage at 30, 60, and 90 days (all p < 0.0001). Age correlated positively with total number of visits (ρ = 0.136, p < 0.05) with the oldest adults more likely to return at 60 and 90 days. Visit realization decreased during early pandemic phases but increased significantly post-COVID (OR = 1.76, p < 0.001). Psychiatric referrals increased the odds of return within 30 days (OR = 1.42) and 60 days (OR = 1.36). Conclusions: Older adults in Poland demonstrate high healthcare utilization, with patterns shaped by age, chronic disease status, and pandemic-related disruptions. While statistical associations were robust, effect sizes were small, highlighting the need to focus on clinically meaningful differences in planning geriatric care. The findings highlight that COVID-19 acted as a major modifying factor of healthcare engagement, revealing the vulnerability of geriatric care continuity to system-level disruptions. Full article

Under the background of urban–rural dual structure, integrating urban and rural resilience construction is inevitable to realize high-quality development. This study constructs a unified urban–rural resilience index system, evaluates county-level resilience of China, and reveals its spatial-temporal evolution and the characteristics of urban–rural differentiation. The results show that the development level of county resilience in China generally raised from 2010 to 2021, but regional differences are obvious. Development level of county resilience shows prominent urban–rural differences, with higher resilience in urban areas and lower in countryside, mainly due to the urban–rural differences in economic development and population. The urban–rural resilience difference in the southeast is significantly higher than that in the northwest China. These results suggest that there is a coexistence of regional and urban–rural divergence in the process of county-level resilience development, and attention needs to be paid to this complex feature when formulating development strategies. Full article

Background: Geographic Information Systems (GIS) have emerged as a critical tool in healthcare research, facilitating the assessment of healthcare accessibility through spatial analysis and data visualisation. This scoping review synthesises literature published between 2020 and 2024, a period marked by the COVID-19 pandemic and rapid methodological innovation, providing a timely overview of how GIS has been applied to evaluate healthcare access across European countries. Methods: The review underscores the role of GIS methodologies in identifying geographic disparities, optimising resource distribution, and informing policy decisions. Results: Key findings highlight significant urban-rural differences in healthcare access, shaped by factors such as transportation infrastructure, population density, and healthcare facility distribution. Additionally, GIS has proven valuable in examining the link between healthcare accessibility and utilisation, with better access generally correlating with higher service use. Conclusions: Despite its potential, challenges including data availability, methodological variability, and uneven adoption across regions limit its broader implementation. The review emphasises the need for integrating advanced technologies to foster more equitable healthcare access throughout Europe. Full article

Land economic density (LED) is vital for optimizing industrial structure and promoting intensive resource utilization. However, most existing studies have focused on city or county scales, with limited attention to township-level patterns. To address this research gap, we take 86 townships in Anyang City as research units and develop a four-dimensional evaluation system for LED. The study aims to reveal the spatial patterns and driving mechanisms of township-level LED evolution. This study is based on township-level land use, statistical, and socioeconomic data from 2005 to 2023. Using ArcGIS 10.5 for spatial analysis, spatial autocorrelation, standard deviation ellipse, and geographically weighted regression methods were applied to explore the spatiotemporal evolution and driving mechanisms of LED in Anyang City. The results indicate that (1) high-LED areas form a ring around the central city with dual cores in western Linzhou county and southeastern Huaxian county, while low-LED areas are concentrated at the northwestern and northeastern margins; (2) global spatial autocorrelation is weak, with low–low clusters shrinking from contiguous patches to only three townships by 2023, while high–high clusters expand from isolated points to multi-centered diffusion; (3) the ellipse consistently shows a northwest–southeast orientation, with the rotation angle increasing from 128.24° to 130.35°, the flatness ratio rising from 0.432 to 0.445, and the centroid shifting northwest then southeast; (4) The geographically weighted regression (GWR) results highlight economic foundation, industrial upgrading, and government support as the dominant drivers. Based on these findings, we propose a “One Core–Four Poles, Three Axes–Five Zones” spatial optimization framework to promote coordinated urban–rural development. This study provides a practical and multidimensional evaluation approach at the township level, offering methodological support for regional territorial spatial planning and sustainable development. Full article

Integrated urban–rural development is of great significance in promoting coordinated development in underdeveloped areas across provinces and advancing common prosperity. Previous studies have mostly focused on typical counties in single or developed areas, with insufficient exploration of integrated urban–rural development in underdeveloped areas. A total of 71 counties in Wuling Mountain area were taken as the research object, and a conceptual model of “element–structure–function” was constructed based on the theory of the urban–rural integration system. The entropy weight ideal point method, variation coefficient method, coupling coordination model, and obstacle model were employed to analyze the integrated urban–rural development in counties of the Wuling Mountain area during 2010 and 2023 from the five dimensions of population, economy, space, society, and ecology, and to explore their coupling coordination relationship and key obstacle factors. The research results indicate the following: (1) During the study period, the average annual growth rate of integrated urban–rural development was only 1.213%, showing a relatively low level. The spatial evolution exhibited a trend of “overall optimization–gap convergence–multipolar linkage–hot in the south and cold in the north”. (2) The comprehensive coupling coordination increased from 0.6380 in 2010 to 0.7016 in 2023, and the coupling coordination of “population–space” became the dominant mode. Nearly 60% of counties achieved a level upgrade from the transition stage to the coordination stage, and the multidimensional coordination relationship was mainly affected by the dual effects of spatial polarization and ecological constraints. (3) The obstacle of spatial integration ranked first and the mismatch of factors was severe. Land urbanization and population distribution imbalance were key obstacles, and their core contradictions were concentrated in the tripartite dilemma of “extensive land utilization–factor blockage–ecological antagonism”. It is urgent to achieve coordinated and sustainable development of urban and rural integration through market-oriented reforms of two-way factor flow. The conceptual model of “element–structure–function” constructed by the research results can provide a theoretical tool for analyzing the integrated development of urban and rural areas in counties, and can provide decision support for solving the dilemma of element mismatch. Full article

Background: In China, a paradox has emerged: while the digital access gap narrows, a pronounced digital gradient—a sequential decline in outcomes from urban to county to township students—persists in innovation and entrepreneurship. This study investigates the hidden, cognitive mechanisms behind this enduring gradient inequality. Methods: Analyzing a national survey of 31,779 students, we employed statistical models designed to trace sequential pathways and account for institutional influences. Results: We found a clear urban > county > township gradient in students’ digital literacy, information perception, and innovation capabilities. The disparity is primarily driven by a cognitive mediation chain: rural students’ lower digital literacy inhibits their ability to perceive and evaluate information effectively, which in turn suppresses their innovation and entrepreneurial potential. This “digital literacy → information perception” pathway explains over 80% of the gap in entrepreneurial intention and one-third of the gap in innovation capacity. Crucially, elite “Double First-Class” universities mitigate this gradient; their robust offline support systems compensate for deficits in students’ digital literacy, reducing its necessity for entrepreneurial success. Conclusions: The contemporary digital divide is fundamentally a cognitive gradient. Moving forward, policy must look beyond infrastructure to foster a cognitive capacity to transform digital access into innovation capability, rather than merely expanding digital access. Our findings affirm that universities can act as powerful institutional compensators. A dual strategy that combines cognitive empowerment with targeted institutional support is essential to bridge the digital gradient and close the innovation gap across urban, county, and township student populations. Full article

Background/Objectives: Despite its effectiveness, colorectal cancer (CRC) screening rates are suboptimal in the United States. Navigating patients towards complete CRC screening can be effective in addressing barriers. However, to date, much research on patient navigation has occurred in urban settings or large health systems, thereby missing some populations that could benefit the most. Methods: We report on a patient navigation program delivered by clinic staff during a large pragmatic study to improve CRC screening in rural Medicaid populations. We use qualitative and implementation data from interviews, contract logs, and tracking systems to explore the context, barriers, and facilitators of patient navigation, as well as feasibility and acceptability for rural primary care clinic partners. Results: A total of 35 patients were eligible for navigation following an abnormal FIT (n = 26, 74%) or due to higher CRC risk (n = 9, 24%); only 8 of the 14 intervention clinics (57%) had any eligible patients. Of the 26 patients who needed navigation following an abnormal FIT, 13 patients (50%) received navigation, and 3 (23%) completed a colonoscopy; all 9 of the higher-risk patients received navigation, but none completed colonoscopy. Several barriers impacted adherence to the navigation protocol, such as staffing disruptions, limited colonoscopy availability, patient mistrust, and data tracking limitations. Our findings also highlight implementation facilitators, including protocol adaptations and cross-team collaborations for low-volume settings. Conclusions: Future models to increase patient navigation in rural settings could include more centralized system-level interventions that build on relationships between clinics and colonoscopy providers or payers and leverage quality improvement best practices. Full article

Early childhood education (ECE) fundamentally shapes children’s developmental trajectories, significantly influencing lifelong cognitive, socio-emotional, and physical outcomes. Despite considerable policy efforts aimed at enhancing educational equity across the United States, marked disparities persist between rural and urban contexts, reflecting deep-rooted structural inequalities rather than mere geographic differences. This integrative review systematically examines disparities in ECE access, quality, workforce conditions, infrastructural resources, and developmental outcomes, specifically comparing rural and urban settings. Utilizing Ecological Systems Theory, Capital Theory, and an Intersectional framework, the study identifies critical systemic determinants reinforcing rural educational inequities, exacerbated further by the recent COVID-19 pandemic. The findings reveal chronic underfunding, fragmented governance, workforce instability, infrastructural inadequacies, and intersectional disadvantages disproportionately impacting rural communities. Based on these insights, this study proposes targeted, evidence-based policy recommendations, emphasizing the necessity for increased federal funding, mandated rural representation in policymaking, workforce stabilization incentives, infrastructural enhancements, and robust community partnerships. This research calls for immediate, systemic policy responses to ensure equitable early educational foundations for all children across diverse geographic contexts by bridging a significant research gap through a comprehensive rural–urban comparative lens. Full article

Enhancing shrinking county towns’ resilience (SCTR) is crucial for fostering high-quality development and supporting China’s new urbanization strategy. However, research on resilience in shrinking areas remains limited, particularly at the county level—characterized as an “urban-rural intermediary”. In this study, we develop an evaluation framework based on a coupled human–environment perspective. Using this framework, we assess SCTR across various regions and levels of shrinkage in China from 2013 to 2022, while analyzing the coupling coordination degree among subsystems. To address challenges such as nonlinearity, spatial heterogeneity, and interpretability in attribution analysis, we integrate the Geographically Weighted Random Forest (GWRF) model with the SHapley Additive exPlanation (SHAP) model. The results show a gradual increase in resilience throughout the study period. Spatially, a distinct East–West disparity emerges, with higher resilience in the East and lower resilience in the West, as delineated by the Hu Line. For extreme-shrinking counties, population decline has become a paramount constraint on their resilience. Key factors, including local fiscal revenue, GDP, the Gini coefficient, and urbanization levels, have a significant impact on SCTR. Notably, in counties undergoing severe or extreme shrinkage, population decline has become a critical barrier to resilience. This study provides scientific insights and policy recommendations for the development of a sustainable and resilient county-town system in China. Full article

Rural revitalization relies on both industrial upgrading and cultural reinvigoration. Tea-culture–tourism integration has been regarded as a potentially effective route for advancing rural revitalization, yet its interactive relationship and dynamic evolution remain insufficiently understood. Based on provincial-level panel data from 18 major tea-producing provinces in China between 2013 and 2022, this study constructs two comprehensive evaluation index systems for tea–culture–tourism integration and rural revitalization. It employs the entropy weight method, the coupling coordination degree model, the Dagum Gini coefficient decomposition, and spatial econometric models to measure their coupling coordination degree and analyze its spatiotemporal pattern, regional disparities, and driving factors. The main findings are as follows: (1) Both tea–culture–tourism integration and rural revitalization exhibited upward trends, with the latter being consistently higher. (2) The coupling coordination degree transitioned from dissonance to coordination, spatially forming a gradient progression pattern of “coastal-river-inland”. (3) Regional disparities were primarily dominated by transvariation density and inter-regional differences. (4) Results of spatial econometric models indicated that fiscal conditions exerted a significant positive direct effect, while urban–rural social development, employment structure, and human capital generated significant positive direct and indirect effects. Full article

This study investigates the regional drivers shaping the development of short food supply chains (SFSCs). SFSCs are increasingly recognized as sustainable alternatives to industrial food systems; however, their development dynamics at the regional level remain poorly understood. Drawing on structured interviews and surveys with regional agricultural institutions, combined with official statistical data, we applied Spearman’s rank correlation to test five hypotheses related to structural, institutional, historical, and demand-related factors across 16 provinces in Poland. The results revealed weak or statistically non-significant associations between most of the analyzed factors and the development of SFSCs, with the notable exception of a strong correlation with urban population size. These findings challenge conventional assumptions about the role of agrarian or policy conditions in supporting localized food systems and suggest that regional food policy should focus more on enhancing urban–rural linkages and consumer engagement to foster sustainable food supply models. Full article

In Korea, rural regions increasingly function as peri-urban zones integrated into urban systems. To assess vulnerabilities in these transitional areas characterized by mixed land use and uneven access to infrastructure, this study developed a three-tiered peri-urban livability vulnerability framework by integrating the analytic hierarchy process and the entropy weight method. The results indicated that medical facilities, childcare and education centers, and village communities consistently emerged as key indicators, linking peri-urban livability directly to the stability of settlement environments and the quality of life of residents. Contrastingly, expert evaluations and data-driven outcomes related to road networks and agricultural infrastructure displayed substantial discrepancies, revealing gaps between perceived importance and actual provision levels. Such differences highlight the risk of underestimating infrastructure-related vulnerabilities when subjective assessments are employed exclusively. By synthesizing subjective and objective weights, this study advances urban and environmental analysis and supports evidence-based decision-making for policy prioritization. The findings demonstrate that peri-urban vulnerability is shaped less by productive capacity than by social infrastructure and community stability. This conclusion offers crucial insights for enhancing livability and guiding urban planning strategies. Full article

Rural resilience building has gained increasing scholarly attention, yet existing literature overlooks the temporal dynamics of resilience evolution and lacks an integrative framework to explain cross-level mechanisms. This paper uses a longitudinal case study to explore how rural resilience transitions from a low-equilibrium to a high-equilibrium state and how neo-endogenous practices emerge in a weak institutional context. The study reveals three key findings. First, the village’s resilience evolved through three phases—institutional intervention, community capital activation, and resilience self-reinforcement—driven by co-evolutionary interactions between an enabling government and the rural community. This process is marked by chain effects of multidimensional community capital (e.g., cultural capital enhancing social capital) and overflow effects from resilience amplification (e.g., multi-scalar network). Second, exogenous resources and endogenous community capital are critical in the neo-endogenous model, but their synergy relies on vertical institutional interventions that foster horizontal networks and enhance communities’ resource absorption capacity. Third, the government enables resilience building by creating a support ecosystem that transitions from institutionally bundled resources to a higher-order composite space, facilitated by urban–rural interactions and community restructuring. The study makes three theoretical contributions: (1) it proposes an analytical framework integrating an enabling government, community capital, and ecosystem upgrading, thus advancing beyond the current community capital-centric paradigm; (2) it introduces a three-phase process model that unpacks spatiotemporal interactions across urban-rural interfaces, multi-scalar networks, and state-community relations, addressing the limitations of static factor-based analyses; (3) it reconceptualizes the role of government as an “enabling government” that mediates local and extra-local resource interfaces, challenging the neo-endogenous theories’ neglect of institutional agency. These insights contribute to rural resilience scholarship through a complex adaptive systems lens and offer policy implications for synergistic urban-rural revitalization. Full article

Zero-day attacks pose unprecedented challenges to modern cybersecurity frameworks, exploiting unknown vulnerabilities that evade traditional signature-based detection systems. This paper presents ZeroDay-LLM, a novel large language model framework specifically designed for real-time zero-day threat detection in IoT and cloud networks. The proposed system integrates lightweight edge encoders with centralized transformer-based reasoning engines, enabling contextual understanding of network traffic patterns and behavioral anomalies. Through comprehensive evaluation on benchmark cybersecurity datasets including CICIDS2017, NSL-KDD, and UNSW-NB15, ZeroDay-LLM demonstrates superior performance, with a 97.8% accuracy in detecting novel attack signatures, a 23% reduction in false positives compared to traditional intrusion detection systems, and enhanced resilience against adversarial evasion techniques. The framework achieves real-time processing capabilities with an average latency of 12.3 ms per packet analysis while maintaining scalability across heterogeneous network infrastructures. Experimental results across urban, rural, and mixed deployment scenarios validate the practical applicability and robustness of the proposed approach. Full article

Objectives: This study aimed to reveal the prevalence, geographic variations, and determinants of pain among the Chinese older adult population and provide empirical strategies for pain management in older adults in China. Methods: A total of 21,346 Chinese residents aged ≥ 60 years from 31 provinces in mainland China participated in our survey. Standardized questionnaires were used to collect data on socioeconomic characteristics, lifestyle factors, and self-reported pain experiences. Multivariate logistic regression models were used to estimate the associations between individual socioeconomic status, chronic diseases, and pain. Results: The national prevalence of pain was 56.5% (95% CI: 55.9–57.1%), representing approximately 140 million Chinese older adults. The prevalence increased with aging and peaked at 80 years and older (61.00%, 95% CI: 59.30–62.70%). Women (62.36%, 95% CI: 61.47–63.25%), rural residents (61.27%, 95% CI: 60.34–62.20%), and those with no formal education (65.08%, 63.90–66.26%) had a higher prevalence than men (50.27%, 95% CI: 49.32–51.22%), urban residents (52.19%, 95% CI: 51.28–53.10%), and those with higher education levels, respectively. Provincial prevalence ranged from 38.98% in Shanghai to 72.75% in Gansu Province. The presence of chronic diseases significantly increased the odds of pain, with multimorbidity (three or more chronic diseases) showing the strongest association (OR = 11.380, 95% CI: 10.257–12.627). Conclusions and Implications: Pain was highly prevalent among older adults in China and varied geographically. Socioeconomic status, chronic diseases, and multimorbidity were strongly associated with pain prevalence. Our findings support prioritizing the reduction in gender and geographic disparities in China’s pain management strategies. An integrated approach addressing both pain and chronic diseases should be urgently established in China’s healthcare system for older adults. Full article