Search Results (5,499)

In sub-Saharan Africa, the sustainability of smallholder farming systems is threatened by climate change. Women farmers are often disproportionately affected. These disproportionate impacts are linked to gender-based inequities like limited decision-making power and resource constraints, which limit women’s adaptive capacity. Previous research has examined inequities in agriculture generally, as well as women farmers’ adaptation to climate change. However, relatively few studies have explicitly focused on the experiences of women who are the primary farmers. Intersectional research is also limited. This paper presents the results of a scoping review to identify how climate change affects women smallholder farmers and how they adapt. The review identified 41 studies between 2014 and 2024. The most frequently identified vulnerability factors were access to credit, social and cultural norms, and land issues (e.g., tenure issues). Few studies took an explicitly intersectional approach. The findings suggest the need for support that targets the challenges faced by women smallholders. More intersectional research is needed to examine how gendered impacts are shaped by other forms of inequality and inhibit sustainable livelihood options. The review revealed a pervasive patriarchal assumption in which dual-headed households are often described as “male-headed”. Revising such discourses can support women’s adaptive agency in the face of future climate challenges. These findings have direct implications for the sustainability of smallholder farming systems and rural livelihoods in the region, emphasizing the need for gender-responsive approaches to sustainable development in sub-Saharan Africa. Full article

Housing is a crucial determinant of population migration. However, the mechanisms through which urban housing influences floating-population re-migration, as well as its role in guiding the efficient spatial allocation of populations, remain underexplored. This study investigated the impact of urban housing status on population re-migration based on the spatial equilibrium theory, and empirically tested this relationship using nearly 370,477 individual migration intentions records from the China Migrants Dynamic Survey (CMDS). The key findings are as follows. First, urban housing status is related to shaping population re-migration intentions. In particular, owner-occupied housing and government-provided low-rent housing are associated with lower re-migration intentions. Second, institutional constraints on migrant populations can vary somewhat depending on household registration status. Rural-registered floating populations may sometimes face somewhat more restrictions in accessing urban housing and public services. By contrast, high-wage areas has less re-migration intentions primarily through labor income gains, leading to heterogeneous housing status effects on migration intentions. Further analysis reveals spatial and individual heterogeneity in how urban housing status shapes population re-mobility. Floating populations residing in first-tier, second-tier, and provincial capital cities prioritize employment opportunities. In comparison, first-generation floating populations, those with local spouses, and individuals engaged in low-risk occupations exhibit stronger demand for stable residence. Full article

Fine particulate matter with a diameter ≤2.5 μm (PM_2.5) pollution poses a global public health crisis, demonstrating significant threats to human health. This study focused on the strategically important Chengdu-Chongqing Economic Circle in western China, systematically comparing the toxic effects of urban and rural PM_2.5 across five levels. PMF and regression analysis were used to identify source contributions, dual-omics to pinpoint key molecules, and epidemiological data with a GAM model to assess health risks. Findings demonstrate that rural PM_2.5 possesses greater biotoxicity than its urban counterpart. Cytotoxicity in urban and rural PM_2.5 originated from road dust/vehicle emissions and biomass burning, respectively. Subsequently, integrated omics and molecular biology analyses identify kinesin family member 20A (KIF20A) as a shared key target, which mediates toxicity induced by both urban and rural PM_2.5. Finally, epidemiological analysis reveals that females and ≥65 years old exhibit relatively high sensitivity to urban PM_2.5 exposure trends, with rhinitis showing a comparatively higher impact among various related diseases. The novelty of this work lies in its pioneering application of a multi-tiered investigative approach. This approach spans “environmental samples-cellular mechanisms-population health” within the Chengdu-Chongqing economic circle context, systematically elucidating common and distinct respiratory health risk of urban and rural PM_2.5. This work offers a vital scientific foundation for advancing region-specific, precise air pollution prevention and control measures. Full article

Background/Objectives: Prostate biopsy is essential for diagnosing prostate cancer. Social determinants of health (SDOH), including socioeconomic status, race, occupation, education, and environment, affect access, outcomes, and quality of life. Recognizing disparities from technology access to complications is crucial for equitable care. A systematic review examined how SDOH impacts biopsy access, technology, and complications. Methods: A systematic search of PubMed, Web of Science, and Scopus was performed to identify eligible studies published through February 2026. We included studies that evaluated the association between one or more SDOHs and prostate biopsy. Relevant outcomes included biopsy utilization, use of specific biopsy technologies (e.g., magnetic resonance imaging (MRI)-guided, transperineal), and post-procedural complications. Results: Nine observational studies met the inclusion criteria. The findings revealed disparities across three key domains. First, access to advanced biopsy technology was uneven. Four studies showed that Black men were significantly less likely than White men to receive MRI-guided biopsies. Additionally, post-biopsy outcomes showed that Black and Hispanic men faced significantly higher rates of post-biopsy infection and hospitalization compared to White men. Lastly, patients in rural areas, those in public hospitals, and individuals with lower socioeconomic status demonstrated reduced access to modern techniques, including MRI-guided or transperineal biopsy. Conclusions: Social and economic factors influence who receives a prostate biopsy and who has access to advanced technologies. Minority and low-income patients face diagnosis barriers and higher complication rates, highlighting systemic inequities. The healthcare system often rewards access over need, and without bold policy changes, gaps in technology and resources will worsen, moving us further from truly equitable prostate cancer care. Full article

Objective: To evaluate the impact of urban–rural health insurance integration on the health outcomes and financial burden of rural older adults. Methods: Utilizing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 to 2018, we employed a staggered difference-in-differences model coupled with propensity score matching (PSM-DID) for rigorous causal identification. Results: The policy significantly reduced out-of-pocket medical expenditures for rural households by approximately 5.6% (p = 0.034). Concurrently, significant improvements were observed in both physical health (a 0.092-point reduction in ADL impairment scores) and mental health (a 0.725-point reduction in CES-D depression scores). Mechanism analyses revealed that the integration did not significantly increase the probability of outpatient or inpatient visits—thereby ruling out supplier-induced demand and moral hazard—while effectively reducing the incidence of catastrophic health expenditure by 1.9% (p = 0.004). Heterogeneity analyses indicated that while the financial relief was universally distributed across varying educational levels, the policy dividends were predominantly captured by the younger-old demographic. Notably, the reduction in financial burden was not statistically significant for the oldest-old cohort (aged 75 and older). Conclusions: The urban–rural health insurance integration has achieved a dual dividend of financial protection and health enhancement without triggering the overutilization of medical services. Nevertheless, the unmet care expenses for older adults with severe disabilities underscore the urgent necessity for a secondary safety net, such as long-term care insurance. Full article

Rural youth often face barriers to accessing mental health services, including workforce shortages, limited resources, and persistent stigma. Schools are well-positioned to address these gaps through comprehensive school mental health systems (CSMHSs) embedded within multi-tiered systems of support (MTSSs). This study evaluated the implementation and effectiveness of a CSMHS in a small Midwestern rural school district over seven years. A longitudinal case study design was used to describe implementation across seven years. Universal mental health screening data were analyzed to determine the proportion of students receiving tiered supports over time. Implementation fidelity was assessed annually using the School Health Assessment and Performance Evaluation (SHAPE) system. Across seven years, more than 80% of students consistently demonstrated mental wellness within Tier I supports, with Tier II and Tier III needs aligned with expected MTSS distributions. SHAPE data indicated steady implementation improvement, particularly in universal screening, teaming, and tiered support. Ongoing challenges included monitoring Tier II intervention fidelity and demonstrating system-level impact. Findings suggest that CSMHSs can be effectively implemented and sustained in rural school settings when aligned with existing MTSS frameworks, supported by strong partnerships, and adapted to local contexts. This study provides evidence supporting the feasibility of rural CSMHS implementation and offers implications for practice and sustainability. Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

This study investigates place-based barriers to initial teacher training (ITT) recruitment in rural-coastal regions of England, focusing on Cornwall as a case study. Utilizing semi-structured interviews with nine ITT provider leaders and nine trainee teachers, the research applies the concept of educational isolation to ITT providers in areas that are geographically remote, socioeconomic disadvantaged, and culturally isolated. The analysis is framed by the critical pedagogy of place and social capital theory, moving beyond deficit-based interpretations of rurality to critically examine how place-based inequities are produced through urban-normative policy and resource allocation. Primary data were analyzed using reflexive thematic analysis. Four substantive themes emerged: transport dependency and accessibility constraints that structurally exclude lower-income and disabled trainees; housing displacement driven by the tourist economy, which compounds financial insecurity; an “employment precarity problem” where localized primary school oversaturation coexists with secondary teacher shortages; and cultural and professional isolation that disproportionately impacts ethnically diverse trainees in demographically homogeneous communities. The research further identifies that community resilience, while enabling individuals to navigate structural barriers, can obscure infrastructural inadequacy and diminish impetus for systemic policy reform. This paper contributes to international scholarship on spatial justice and rural teacher education by presenting an integrated conceptual framework with transferable relevance to similar rural-coastal and peripheral contexts globally and by offering policy recommendations for place-weighted ITT funding, infrastructure investment in educationally isolated areas, and the development of collaborative provider models. Full article

Background/Objectives: Dengue prevention in rural Amazonian communities is shaped by knowledge, household feasibility, sociocultural dynamics, institutional continuity, and trusted communication. This study explored behavioral, sociocultural, and institutional barriers to dengue prevention and control in rural communities of the Peruvian Amazon. Methods: An exploratory qualitative study with an ethnographic orientation, informed by the Communication for Behavioural Impact (COMBI) framework, was conducted in three anonymized rural settlements in San Martín, Peru. The qualitative corpus included 120 adults, 84 in-depth interviews, six focus group discussions with 36 participants, 22 household and community observation records, 13 institutional communication materials, and seven local operational documents. Data were analyzed using an inductive thematic approach and triangulated across participant profiles, settlements, and sources. Results: Dengue was widely recognized as a mosquito-borne disease, but the central finding was a gap between general awareness and practical, routine application. Participants’ understanding of breeding sites, warning signs, and feasible source reduction was uneven. Prevention was mainly reactive, increasing after nearby cases, alerts, or fumigation, but weakening when risk was not visible. Irregular water supply, water storage, waste accumulation, gendered domestic labor, competing household priorities, reluctance to confront neighbors, and intermittent institutional action limited sustained prevention. Fumigation was perceived as the most visible institutional response, while communication was more credible when mediated by trusted local actors. Conclusions: Dengue prevention requires locally feasible household practices, safe water-storage guidance, trusted communicators, neighborhood coordination, continuous pre-outbreak engagement, and intersectoral support. Full article

Research on post-COVID tourism behaviour has expanded rapidly, yet inland UNESCO World Heritage cities remain underexamined, particularly in Mediterranean contexts. This study examines whether the pandemic produced durable changes in tourist behaviour and in willingness to pay for sustainable services in Cáceres, Spain. A structured face-to-face survey was administered to 421 visitors in March 2023, after public-health restrictions had been lifted. The analysis covered self-reported behavioural change, perceived impacts on different destination types, perceived effects on local sustainability objectives and changes in willingness to pay (WTP) for sustainable services. Descriptive statistics were complemented by an exploratory binary logistic regression predicting increased WTP. Because the model includes only sociodemographic predictors and shows modest fit, it is used to describe associations rather than to predict. Reported behavioural change was limited: mean scores for crowd avoidance, health–safety preferences, shorter stays and substitution towards rural and nature tourism ranged from 1.73 to 1.91 on a five-point scale. Respondents nevertheless perceived substantial spatial effects of the pandemic, particularly on natural parks (92.6%) and rural destinations (84.1%). Most believed that the pandemic had accelerated sustainability efforts mainly through greater institutional and business awareness (54.9%). WTP proved relatively stable, with 62.7% reporting no change and 26.1% an increase. Women and respondents with university education showed higher odds of reporting increased WTP. Because constructs such as institutional trust and pro-environmental values were not measured directly, these attitudes are interpreted—rather than demonstrated—as reflecting governance-related confidence and value orientations more than lingering health concerns. This governance-and-values reading is the study’s main interpretive contribution and requires confirmation with direct measures of the underlying constructs. Full article

Road traffic accidents represent a critical road safety issue, the severity of which depends on the complex interplay of multiple factors. This issue directly impacts Target 3.6 of Sustainable Development Goal (SDG) 3, which aims to halve global deaths and injuries by 2030, and SDG 11, which focuses on safe and sustainable transport systems. The study of these factors and their interrelationships is important in the scientific literature. The objective of this study is to analyze the factors that determine the severity of road traffic accidents, identifying the most important ones and their correlations. A dataset containing variables such as infrastructure, location, time, and vehicle type, among others, was used to predict severity, applying Association Rules to identify latent correlations and the Classification and Regression Tree for hierarchical risk classification. The results reveal that the type of collision is the primary predictor of severity; the highest severity is associated with heavy traffic and head-on or side-impact collisions, involving critical scenarios, in the early morning hours and in rural areas, linked to trucks. The combined use of both tools provides a scientific basis for designing interventions on highly vulnerable road segments, contributing to the fulfillment of the 2030 Agenda for safe mobility. Full article

As a core driver of high-quality urban–rural integration, digital inclusive finance plays a key role in the process of Chinese-style modernization. After measuring the level of high-quality urban–rural integration development using the TOPSIS entropy method, this study employs fixed-effects models and mediation models to empirically examine how digital inclusive finance influences high-quality urban–rural integration development over the period from 2012 to 2022. The main findings are as follows: (1) Digital inclusive finance has a significantly positive promoting effect on high-quality urban–rural integration. (2) The enabling effect of digital inclusive finance exhibits significant regional heterogeneity, following a gradient pattern of “strongest in the Eastern region, followed by the Central region, and weakest in the Western region.” (3) In terms of dimensional effects, the breadth of coverage contributes the most, followed by the depth of use, while the degree of digitalization has the smallest impact. (4) The mediation mechanism indicates that factor mobility indirectly promotes high-quality urban–rural integration. Based on the above findings, this paper proposes policy recommendations to foster high-quality urban–rural integration development in China. Full article

Ecologically fragile areas typically overlap with impoverished zones, rendering them susceptible to a vicious cycle of ecological degradation and poverty aggravation. Reasonable and diversified ecological compensation methods are closely associated with improved livelihood resilience among rural households in sandy areas. Building on this, we take three leagues and cities in Inner Mongolia with severe sandy desertification as the study area. OLS regression and mediating effect models are employed to examine the impact of diversified ecological compensation methods on the livelihood resilience of rural households in sandy areas, as well as the underlying mechanisms and heterogeneity. The results demonstrate that (1) diversified ecological compensation methods exert a significant positive effect on the livelihood resilience of rural households in sandy areas; (2) perceived fairness and livelihood diversity mediate the association between diversified ecological compensation methods and the livelihood resilience of rural households in sandy areas; (3) the effects of diversified ecological compensation methods on the livelihood resilience of rural households in sandy areas vary significantly across compensation modalities, beneficiary groups, and regions. Specifically, capacity-building compensation exerts a significantly stronger effect than direct-transfer compensation; poverty-alleviated households benefit more than general households; and the effects are significantly stronger in western Inner Mongolia than in eastern Inner Mongolia. Therefore, in optimizing ecological compensation policies in sandy areas, it is suggested to enhance the embedding depth of industrial and technical compensation, and to explore differentiated compensation pathways based on regional market capacity and household group characteristics, thereby promoting sustainable livelihood development for rural households in sandy areas. Full article

Population-based evidence on sleep quality in Kazakhstan remains limited. This study describes sleep quality as a multidimensional construct among adults in Kazakhstan using data collected during the first national survey wave after the adoption of a single national time zone. The survey was designed as a national post-transition baseline assessment and not as an evaluation of the causal impact of the time-zone reform. Associations with socio-demographic, behavioural, clinical, and regional factors were examined. We conducted a nationally representative cross-sectional survey of adults aged 18–69 years in Kazakhstan from May to October 2025 using a multistage stratified cluster design. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined as a global PSQI score > 5. Complete PSQI data were available for 5872 participants. Descriptive analyses examined the global PSQI score and the seven component scores. Survey-weighted multivariable logistic regression was used to identify factors independently associated with poor sleep quality. The weighted prevalence of poor sleep quality was 28.1%, and the weighted mean global PSQI score was 4.43. The greatest component burden was attributable to sleep latency (mean 0.87), subjective sleep quality (0.82), and sleep disturbances (0.80), whereas use of sleep medication contributed minimally (0.11). Poor sleep quality was more common among women, older adults, urban residents, and participants with diabetes, current smoking, heavy episodic drinking, and depressive symptoms. In the adjusted model, female sex (aOR 1.37, 95% CI 1.19–1.57), age 55 years or older versus 18–24 years (1.98, 1.53–2.55), diabetes (1.47, 1.22–1.78), current smoking (1.28, 1.10–1.50), heavy episodic drinking (1.43, 1.16–1.76), and depressive symptoms (4.26, 3.52–5.15) were independently associated with higher odds of poor sleep quality. Rural residence was inversely associated with the outcome (0.71, 0.61–0.84). Compared with the North, higher odds were observed in the Central region (2.00, 1.46–2.74), East (1.94, 1.48–2.53), West (1.48, 1.17–1.88), and Almaty city (2.18, 1.72–2.76). Poor sleep quality is common among adults in Kazakhstan and is characterized primarily by difficulties with sleep initiation, perceived sleep quality, and nocturnal disturbances. The findings provide national post-transition baseline evidence and suggest that sleep health surveillance in Kazakhstan should prioritize demographic, mental health, behavioural, and regional inequalities while avoiding causal interpretation of the time-zone reform itself. Full article

The escalating energy consumption in China’s rural residences necessitates the adoption of targeted energy-efficient design strategies. However, existing studies have mainly focused on urban buildings or cold-climate rural residences, and insufficient attention has been given to form-based energy optimization for rural housing in hot summer and cold winter regions. Hangzhou was selected because it is a representative city in this climate zone, where rural residences face both summer cooling and winter heating demands. This study systematically investigates passive design pathways for rural residential buildings by optimizing architectural forms. We conducted in-depth field surveys and data analysis on 76 diverse samples, including both self-built and unified construction types, to establish three representative typical residential models (rectangular, L-shaped, U-shaped) for the Hangzhou region. DesignBuilder was employed to simulate the impacts of eight morphological elements—Shape Coefficient, building area, aspect ratio, orientation, number of floors, floor height, floor height ratio, and roof slope—on building energy consumption. The Gradient Boosting Decision Tree (GBDT) method was then used to quantify the nonlinear effects and relative importance of these elements. The results indicate clear nonlinear relationships between elements and the energy-saving rate. Floor height is identified as the most critical factor affecting energy consumption, followed by roof slope, with building area and other elements also showing significant influence. Based on the quantitative analysis, this study proposes energy-efficient design optimization strategies for rural housing in Hangzhou, offering a validated methodological framework and practical design references for the sustainable development of rural residences in hot summer and cold winter regions. Full article