Search Results (1,395)

We systematically analyze the evolutionary characteristics of China’s public health policies, focusing on the dynamic changes in policy content, stage-specific differences, and inter-subject collaborative relationships. Based on 137 public health policy documents issued by the central government, the analysis is conducted from a dual perspective: first, the BERTopic model is employed to identify prominent policy themes and track their evolutionary paths; second, Social Network Analysis (SNA) is utilized to deconstruct the collaborative mechanisms and network structural characteristics among policy actors, goals, and tools. The findings indicate: (1) Collaboration among core policy actors is close, yet inter-departmental transparency and collaborative inclusivity remain limited for certain organizations. (2) Policy goals show a diversifying trend, with the strategic focus shifting from infectious disease prevention and control to comprehensive public health services. (3) There are significant preferences in the selection of policy tools for balancing rapid emergency response with sustainable long-term health governance. These findings reveal the evolutionary laws of the public health policy system and provide a theoretical basis for optimizing the policy framework and enhancing governance efficacy. Full article

This study examines the transformation of the Balaton region in Hungary from a traditional tourist destination into an international retirement migration destination for older adults from Western Europe. Migration theories and models are applied to illustrate the relationships between migration and development and to explore how tourism, lifestyle aspirations, and socio-economic factors influence the settlement decisions of older migrants. Empirical findings suggest that prior tourism experience can mitigate the uncertainty associated with migration and foster belonging. However, many retirees move to Hungary with limited knowledge of the country, relying on social networks and real estate agents for information. These retired migrants also utilize local services and infrastructure, including healthcare and community spaces, which shape their daily lives and help them integrate into the community. The migration of older adults stimulates the development of peripheral rural areas through real estate purchases, renovations, and small-scale entrepreneurial activities, particularly in the accommodation sector. This challenges the traditional perception of older-age migrants as inactive. Full article

Background: New psychoactive substances (NPS) represent an evolving component of global substance use patterns and may contribute to HIV transmission through both injection-related and sexual risk behaviors. In Kazakhstan, where HIV incidence has increasingly shifted toward sexual transmission, evidence on HIV testing among NPS users remains limited. This study examined behavioral, social, and structural factors associated with HIV testing in this population. Methods: A cross-sectional study was conducted among 1500 adults reporting NPS use across six regions of Kazakhstan. Data were collected using structured interviewer-administered questionnaires. The primary outcome was self-reported HIV testing (ever tested: yes/no). Independent variables included sociodemographic characteristics, substance use behaviors, sexual practices, peer communication about HIV, and structural access to prevention services. Univariable logistic regression with Bonferroni correction (p < 0.001) was used for variable screening. Multivariable logistic regression models estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: Overall, 86.7% of participants reported prior lifetime HIV testing. In the multivariable model (n = 1482), older age was associated with higher odds of testing (AOR 1.06 per year; 95% CI 1.04–1.08; p < 0.001). Compared with participants holding a bachelor’s degree or higher, those without a high school diploma had lower odds of testing (AOR 0.50; 95% CI 0.28–0.89). Injectable psychostimulant use was also associated with testing (AOR 1.40; 95% CI 1.21–2.01). Participants who never discussed HIV within peer networks were less likely to have been tested (AOR 0.69; 95% CI 0.49–0.97). Engagement with HIV prevention services (AOR 0.54; 95% CI 0.39–0.75) and use of prevention centers (AOR 0.63; 95% CI 0.45–0.87) were significantly associated with testing. The model demonstrated acceptable discrimination (AUC = 0.725). Conclusions: Lifetime HIV testing uptake among NPS users in Kazakhstan is high but influenced by educational attainment, peer communication, injection practices, and engagement with prevention services. Strengthening integration of prevention services and expanding peer-based outreach may improve equitable access to HIV testing in this population. Full article

This study examines how user-generated content (UGC) is incorporated and negotiated within platformized public service media (PSM) journalism, using the German content network funk as a case study. Based on a qualitative content analysis of selected formats and their social media posts, the study shows that participatory affordances offered by social media platforms (SMPs) are present but rarely foregrounded as central elements of storytelling. Instead, UGC is typically used as illustrative material or selectively embedded within editorial narratives. The analysis investigates how UGC is solicited, incorporated, and visually integrated into editorial storytelling across different formats. The findings identify three recurring patterns of UGC integration that illustrate how audience participation is negotiated within everyday editorial production: (1) illustrative UGC integration, (2) community-oriented UGC integration, and (3) minimalist UGC integration. Overall, the study highlights how platformized PSM journalism integrates UGC in ways that remain strongly editorially moderated rather than fully participatory, demonstrating how participation is enabled, constrained, and strategically applied within platform infrastructures. Full article

This study examines how the allocation of export expansion across sectors affects economy-wide outcomes in Bangladesh. Using a Social Accounting Matrix (SAM) framework, we combine linkage analysis with simulation to evaluate how sectoral export growth propagates through the production network. The results show that the impact of export diversification depends critically on sectoral allocation rather than export intensity alone. While aggregate differences between scenarios are modest, reallocating export growth toward sectors with stronger intersectoral linkages generates larger economy-wide gains in GDP and labor income. In particular, sectors with low initial export shares but high network connectivity—such as agriculture, hunting, forestry, and fishing; retail trade; other community, social and personal services; and inland transport—produce stronger multiplier effects than most export-intensive sectors. These findings highlight a key distinction between export intensity and network centrality, demonstrating that sectors with limited direct export participation can play a central role in transmitting economic gains. The results provide a network-based perspective on export diversification and offer policy-relevant insights for designing strategies that promote more inclusive and efficient economic growth. Full article

Hydrogen refueling stations (HRSs) are a critical enabling infrastructure for fuel cell electric vehicles (FCEVs), yet their deployment in dense metropolitan areas often faces a dual challenge: limited travel-time accessibility for users and low public acceptance driven by perceived safety risks. This study develops an integrated, city-scale framework to quantify HRS accessibility and resident acceptance and to identify expansion priorities for Seoul, South Korea. We combine (i) an online perception survey of 1000 adult residents (October 2024) capturing environmental awareness, perceived safety, siting preferences, and willingness-to-travel distance; (ii) spatial demand data on FCEV registrations by administrative dong (n = 2443 vehicles, 2022); and (iii) network-based travel-time analysis using the Seoul road network and the current HRS supply (n = 10, 2024). Accessibility is evaluated under three travel-time thresholds (10, 15, and 20 min), with service-area delineation and demand-weighted underserved-area diagnosis. Candidate expansion sites are generated and screened using operational and regulatory constraints (e.g., site area and proximity to protected facilities), followed by a p-median location-allocation optimization to select five additional sites that minimize demand-weighted travel impedance. Results indicate that, under the 20 min threshold (7.7 km at an average operating speed of 23.1 km/h), 50 of 425 dongs (11.8%) and 244 of 2443 FCEVs (10.0%) are outside the baseline service coverage. After adding five sites (total n = 15), underserved dongs decrease to 5 (1.2%) and underserved FCEVs to 26 (1.1%) for the 20 min threshold, with consistent improvements across shorter thresholds. Survey responses further reveal that only 12.5% of respondents perceive HRSs as safe, while 46.5% report a maximum willingness-to-travel distance of up to 5 km, underscoring the need for both accessibility enhancement and risk-aware communication. The proposed workflow offers a transparent, reproducible approach to support equitable and risk-informed HRS planning by jointly considering network accessibility, demand distribution, and social acceptance, thereby contributing to sustainable urban mobility, low-carbon transport transition, and socially acceptable hydrogen infrastructure deployment. Beyond local accessibility improvement, the study is framed in the broader context of sustainability, as equitable and socially acceptable hydrogen refueling infrastructure can support low-carbon urban transport transitions and more resilient metropolitan energy-mobility systems. Full article

Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers. Full article

Health and spa tourism is a rapidly growing sector that merges traditional healing with modern innovations to meet increasingly diverse client needs. Understanding professionals’ perspectives is crucial for developing sustainable strategies that enhance service quality, organizational performance, and long-term business viability. Drawing on qualitative narrative analysis and thematic network analysis, this study explores the key factors that spa tourism professionals in Băile Felix—the largest spa resort in Romania—associate with business success, competitive differentiation, and sustainable development. Data were collected through semi-structured interviews with 41 entrepreneurs and managers who provided detailed narratives on their strategic goals and market positioning. Rather than measuring customer psychological constructs directly, this study captures professionals’ expert attributions regarding service quality, staff professionalism, infrastructure investment, and economic objectives, and interprets these as managerial perceptions grounded in operational experience. Five research propositions guided the interpretive analysis: (P1) professionals narratively associate service quality and treatment diversity with perceived business performance and guest retention signals; (P2) staff professionalism and attitude are attributed as the primary drivers of competitive differentiation; (P3) infrastructure investment and innovation are framed as prerequisites for sustaining market positioning; (P4) the identified themes form a structurally interconnected network with key bridging nodes; and (P5) professional narratives reveal tensions between short-term economic objectives and longer-term commitments to service quality and sustainability. Thematic network analysis identified four central constructs—service quality and treatment diversity, staff professionalism and attitude, innovation and infrastructure investment, and economic and development objectives—and mapped 16 interconnected sub-themes, with modularity analysis (Q = 0.42) confirming a moderately cohesive structure. Sustainable innovation was operationalized across environmental efficiency, social value, and economic resilience dimensions, and found to be embedded systemically across multiple thematic clusters rather than treated as an isolated practice. The originality of this study lies in integrating narrative and thematic network analysis to reveal how these constructs co-evolve within a sustainability-oriented system, offering a novel methodological lens for spa tourism research in post-transitional Central and Eastern European contexts. Findings provide actionable insights for spa managers, policymakers, and investors seeking to balance modernization with tradition in resource-constrained destinations. Full article

Coastal cities are located at the critical interface of land–sea interaction, and scientifically assessing their ecological importance is essential for identifying conservation priority areas. Existing assessments focus primarily on static function while neglecting dynamic system processes and resilience characteristics. To address this limitation, this study developed an innovative “State-Interaction-Resilience” (SIR) assessment framework. It integrates ecosystem services (state), ecological connectivity and network supply-demand relationships (interaction), and social-ecological system adaptive capacity (resilience) and incorporates differentiated weighting based on the unique “sea–land gradient” pattern of coastal zones. Using Dongying City in the Yellow River Delta as a case study, the results show the following: (1) The SIR framework evaluation results demonstrate balanced and significant positive correlations with all dimensional indicators (r = 0.3~0.8), showing greater comprehensiveness and scientific validity than traditional evaluation methods, with 81% spatial agreement between identified extremely important areas and existing protected areas. (2) From 2000 to 2020, the overall ecological importance of Dongying City showed an upward trend, with the proportion of extremely important areas significantly increasing from 6.03% to 10.24%, while maintaining a stable spatial gradient pattern of “high along the coast, low inland”. (3) The improvement in ecological importance in coastal core areas mainly resulted from state improvement and resilience enhancement driven by restoration projects such as “aquaculture retreat and wetland restoration”, while inland areas were constrained by both habitat fragmentation and ecological supply-demand mismatch. This study confirms that the SIR framework can accurately capture the spatial heterogeneity of coastal zones. The proposed “core protection-corridor restoration-function enhancement” hierarchical and zonal spatial governance strategy provides scientific evidence and actionable spatial guidance for coastal territorial spatial planning, ecological protection redline optimization, and targeted ecological restoration. Full article

Slaughterhouse detection of lesions compatible with bovine tuberculosis represents a key passive surveillance component in Santa Catarina, Brazil, yet subsequent trace-back investigations often fail to identify infected farms. This study developed a quantitative framework to prioritize epidemiological investigations by estimating the probability of infection associated with each farm connected to PCR-confirmed cases. Using official movement records and historical diagnostic data, we reconstructed the lifetime contact networks of slaughtered cattle presenting confirmed Mycobacterium bovis lesions (n = 502). For each sentinel animal–farm interaction (n = 1452), infection probability was estimated through a non-homogeneous Poisson process incorporating exposure duration and the time-weighted average herd size as determinants of infectious pressure. After evaluating stochastic variability through Monte Carlo simulation, a deterministic model using the mean infectious-pressure parameter was applied to classify farms into high-, medium-, and low-risk categories. Model performance was assessed using validated field diagnostic outcomes within a three-year temporal window. High-risk farms represented most validated contacts (58%) and demonstrated a relative risk of 3.48 compared with lower-risk category. These findings indicate that a standardized risk-based classification can substantially improve the prioritization of trace-back investigations, offering a practical decision-support tool to enhance bovine tuberculosis surveillance and contribute to eradication strategies in Santa Catarina. Full article

Peru’s recent national mental health (MH) reforms aim to decentralise care and expand access to MH services for rural populations by integrating services into primary healthcare through the expansion of Community Mental Health Centres (CMHCs). Evidence on the implementation of these reforms at the local level remains limited. This qualitative study aimed to (i) describe the structure and implementation framework of MH services, (ii) analyse local understandings of MH; and (iii) examine pathways to care and identify barriers and facilitators to MH service implementation from both the supply (service providers) and demand (users and community members) perspectives. MH services were mapped across three provinces of northern Peru using a review of national MH policies, 2 focus group discussions, and 31 semi-structured interviews. Data were analysed thematically to explore local understandings of MH, pathways to care, and health system barriers. Local understandings of MH are shaped by cultural beliefs, social norms, and economic conditions, with many individuals experiencing distress initially relying on family networks or traditional healers. Stigma and expectations of a quick recovery hinder engagement with formal services. While the expansion of CMHCs has improved geographical access to specialised care in rural areas through proximity and being patient-centred, the implementation of respectful provider interactions remains uneven. Weak referral pathways and limited coordination between primary care centres and CMHCs frequently shift the responsibility for navigating care onto users and their families. Family involvement and culturally sensitive practices foster trust and support continued engagement. Persistent challenges include the limited capacity of service providers, high staff turnover, and the follow-up mechanisms, stigma, and tensions between cultural and biomedical understandings of MH. Peru’s expansion of CMHCs represents a significant health system reform to improve equitable access for rural populations. To sustain these gains, it will be necessary to strengthen workforce stability, clarify referral processes, and integrate culturally responsive approaches within primary care systems, offering lessons for similar resource-constrained contexts. Full article

Climate change poses a significant threat to the livelihoods of smallholder farmers in South Africa, particularly in rural areas where dependence on rain-fed agriculture and limited institutional support heighten vulnerability. This study investigates how different forms of social capital (bonding, bridging, and linking) influence climate change adaptation strategies among smallholder farmers in Bergville, KwaZulu-Natal. A mixed-methods design was employed, combining a household survey (n = 150), focus group discussions, and key informant interviews. Households engaged in smallholder farming were purposively identified and randomly selected within the study ward. To accommodate varying literacy levels, structured questionnaires were administered through interviewer-led surveys. Quantitative data were analysed using descriptive statistics, chi-square tests, and a probit regression model, while qualitative data were thematically analysed to contextualise adaptation decisions and social dynamics. The findings show that trust in peer information, farmer group membership, collective action, and access to extension services significantly increase the likelihood of adopting climate adaptation practices (p < 0.05). While bonding social capital supports short-term coping, limited bridging and linking social capital constrain access to institutional resources and climate information. By explicitly operationalising and empirically distinguishing these dimensions of social capital, the study provides context-specific evidence on how uneven social networks shape adaptation outcomes. Strengthening inclusive institutional linkages and extension services is essential for promoting long-term climate resilience among smallholder farmers in rural South Africa. This study contributes to the international literature by providing empirical evidence on the differentiated roles of social capital dimensions in shaping adaptation outcomes in resource-constrained rural contexts. The findings highlight the need for policy interventions that strengthen institutional linkages, improve extension service delivery, and promote inclusive access to adaptation resources to enhance long-term climate resilience. Full article

Urban neighborhood parks are essential infrastructure for sustainable cities, supporting physical and mental health, social cohesion, and climate adaptation. Equity-oriented park planning, however, requires accurate identification of residents who can access parks within network-constrained travel time thresholds. Many accessibility studies estimate served populations using coarse administrative zones and areal-weighting assumptions, which can bias results in heterogeneous, vertically developed districts. This study develops a building-based population allocation framework (implemented via a building centroid overlay) that integrates Statistics Korea’s census output areas (2023 Q4 release) with the Ministry of Land, Infrastructure and Transport (MOLIT)’s GIS Integrated Building Information database (2023 Q4 release) and applies it to Yongsan-gu (Yongsan District), Seoul. Park entrances were verified and digitized using street-view imagery available on multiple web map platforms, and walkable service areas (5 and 10 min) were delineated via network analysis. Potential service coverage and unserved population were then estimated under three spatial configurations—administrative dong (neighborhood-level administrative unit in Seoul; hereafter administrative unit), census output area, and building-based allocation—and compared. Under the 10 min scenario, the unserved share reached 24.6% at the administrative unit level but decreased to 5.9% and 4.3% when using census output areas and building-based allocation, respectively. The building-based approach additionally revealed micro-scale clusters of unserved residents near localized pedestrian constraints and boundary-crossing areas that are obscured by zone-based methods. These findings demonstrate the sensitivity of access-based potential service coverage diagnostics to spatial unit choice and population disaggregation and suggest that building-based population allocation can improve the targeting of park pro-vision policies and promote spatial equity in dense, vertically developed cities. Full article

Excessive fertilizer use not only harms agricultural sustainability but also leads to massive energy waste and carbon emissions. Under China’s carbon peaking and carbon neutrality goals, using social networks to spread better fertilization practices and reduce excessive application can deliver real wins for both energy savings and emission cuts. This paper examines whether farmers’ social network positions affect their fertilizer use. We analyze 14 years of data from 206 farm households in Gansu, China, using fixed effects models that incorporate degree, betweenness, and closeness centrality. Our results reveal that centrally positioned farmers substantially reduce fertilizer application: each 0.1 unit rise in standardized degree, betweenness, and closeness centrality corresponds to reductions of 1.26%, 0.84%, and 0.78%, which translate to actual reductions and carbon emission reduction of 1.06, 0.71, and 0.66 kg/mu; 9.52, 6.38, and 5.93 kg CO₂e/mu. The effects are stronger for farmers with more education, higher off-farm income, and tighter network connections. The effect of degree centrality on fertilizer reduction increased by 7.2 percentage points after 2018. Extension services should build on existing social networks and use key node farmers to drive other farmers in the village to reduce fertilizer use. It helps reduce carbon emissions from fertilizer production and promote sustainable agricultural development. Full article

This study investigates how social networking service (SNS) tourism information characteristics influence destination image and behavioral intentions in digital tourism communication. Drawing on the stimulus–organism–response (S-O-R) framework, SNS information characteristics are conceptualized as vividness, convenience, interactivity, and reliability, and their effects on affective image, cognitive image, and SNS behavioral intentions are examined. Data were collected from 273 Chinese tourists who used SNS platforms to obtain information about Jeju Island, and structural equation modeling (SEM) with bootstrapping was employed to test direct and mediating effects. Results indicate that convenience significantly influences cognitive image; vividness, convenience, and interactivity significantly affect affective image; and reliability shows no significant effect. Affective image positively influences behavioral intentions, whereas cognitive image does not. In addition, vividness, interactivity, and reliability directly influence behavioral intentions, while convenience has no direct effect. Mediation analysis shows that affective image partially mediates the effects of vividness and interactivity and fully mediates the effect of convenience, whereas cognitive image does not exhibit a significant mediating role. These findings highlight the importance of affective mechanisms in digital tourism communication and provide practical implications for sustainable destination marketing and digital tourism management. Full article