Search Results (9,098)

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

Cultural ecosystem services (CESs) are the non-material benefits people derive from ecosystems and are important for human well-being. Most research has focused on individual CES supply–demand relationships, with little systematic study of the overall CES structure, interactions, and mechanisms in metropolitan areas. This study takes the Nanjing Metropolitan Area as a case study, integrating multi-source geospatial data and employing the MaxEnt model, self-organizing maps (SOMs), Spearman correlation analysis, and the Optimal Parameters-based Geographical Detector (OPGD). It analyzes supply–demand matching, trade-offs, synergies, and drivers for four CES categories: aesthetic (AE), recreational entertainment (RE), knowledge education (KE), and cultural diversity (CD). The main findings are as follows: (1) CES supply and demand are spatially zoned: the core area has surplus supply, secondary centers are balanced, and the periphery has both weak supply and demand. (2) Three supply–demand bundles have distinct synergy and trade-off patterns: Bundle 1 primarily exhibits strong synergy between AE and CD; Bundle 2 shows a weak trade-off relationship; and Bundle 3 forms a synergy centered on AE. (3) The explanatory power of driving factors exhibits pronounced spatial heterogeneity: Bundle 1 is dominated by non-quantifiable social factors; Bundle 2 features dual synergistic drivers of population and transportation; and Bundle 3 demonstrates synergistic effects driven by facilities and economic factors. Overall, this study contributes an integrated metropolitan-scale framework that connects CES supply–demand mismatch patterns with bundle typologies, interaction structures, and bundle-specific drivers. The results provide an operational basis for targeted planning and coordinated ecological–cultural governance in the Nanjing Metropolitan Area and offer a transferable reference for other metropolitan regions. Full article

This study aimed to screen candidate genes related to body size traits in Dongfeng sika deer bucks by genome-wide association analysis. A total of 266 adult Dongfeng sika deer underwent 20× whole-genome resequencing. Genome-wide association analysis (GWAS) was performed using a mixed linear model (MLM), and gene annotation was conducted on SNP loci. GO and KEGG enrichment analyses were subsequently conducted to identify biological functions and pathways associated with body size regulation. The GWAS results screened 774 SNP sites significantly associated with body size. Functional enrichment analysis further identified that four genes—CDH4, TSHR, SLC23A2, and RIMS1—were potentially associated with body size traits. This study provides a reference basis for subsequent functional exploration of candidate genes. Full article

Green space equity is increasingly recognized as a critical environmental condition for healthy aging, yet existing research often overlooks how different green space attributes—accessibility and diversity—are associated with distinct dimensions of older adults’ health. Limited attention has been paid to their nonlinear threshold effects or to the social pathways through which green spaces influence health outcomes. Using the United States county-level panel data from 2020 to 2023, this study integrates fixed-effects models, Extreme Gradient Boosting (XGBoost), and mediation analysis to examine the associations between green accessibility measured by the Two-Step Floating Catchment Area (2SFCA) method, and green diversity measured by the Shannon Index, on the general, physical, and mental health of older adults. Findings indicate that (1) higher green accessibility is associated with better general health, whereas green diversity shows a stronger association with physical health, reflecting its link to more heterogeneous ecosystem service environments. (2) Green accessibility demonstrates the threshold effect, in which the strength of association with health becomes steeper once accessibility approaches higher levels. (3) Green space equity is linked to health partly through social structures. Education clustering and marital stability mediate the associations with general health, while mental health appears to depend more on the social interaction opportunities embedded within green environments than on their physical attributes alone. The study proposes an integrated “physical environment–social structure–health outcome” framework and a threshold-oriented spatial intervention strategy, highlighting the need to prioritize improvements in green accessibility in underserved areas and prioritizing green diversity and age-friendly social functions where accessibility is already high. These findings offer evidence for designing inclusive, health-oriented urban environments for aging populations. Full article

Food security and income generation remain a critical issue for small-scale farming households in Sub-Saharan Africa (SSA) due to population growth, climate change, and market instability. Indigenous leafy vegetables (ILVs) offer high nutritional value and have the capability to mitigate food insecurity but are underutilized due to social stigma. This review aims to systematically analyze the food and income contribution of cultivation and utilization of ILVs by small-scale farming households in Sub-Saharan Africa. This review analyses the literature on the role of ILV cultivation in enhancing food security and household income over the past two decades. A systematic search across five databases was conducted and identified 53 relevant studies. Findings indicate that ILVs contribute significantly to household nutrition and income through consumption and surplus sales. However, ILV cultivation faces barriers such as climate change, pest infestations, land degradation, water scarcity, insecure land tenure, limited agricultural training, poor communication networks, and restricted market access. Policy interventions are necessary to support small-scale farmers in ILV cultivation by providing agricultural extension services, promoting sustainable farming practices, and integrating ILVs into food security strategies. Further research should examine policy frameworks and supply chain mechanisms to enhance farmer participation and economic benefits from ILV production. Full article

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

Background/Objectives: The growing number of older adults with complex healthcare needs increases demand for homecare services, while a shrinking workforce often lacks skills for advanced tasks. Digital health is seen as a promising tool to address these challenges. This study explored Swedish homecare professionals’ perceptions of the potential use of digital twins in daily work. Methods: Four focus group discussions were conducted with 31 homecare professionals; two groups each in one urban/rural and one rural municipality. Data were analyzed using inductive content analysis. Results: Three main themes emerged: (i) Perceptions of digital twins as support for older adults, including needs-based, individualized care and proactive support enabling preventive measures; (ii) Perceptions of digital twins as support for professionals, including a better work environment through streamlined tasks and flows and enhanced planning and assessment; and (iii) Concerns about digital twins, focusing on ethical and social issues and limited understanding, which were related to monitoring aspects, the importance of physical visits, and how the technology works. Conclusions: Digital twins are perceived by professionals to have the potential to improve homecare services by supporting both older adults and professionals; however, further research is needed to address concerns and practical implications. Full article

Adoption of electric vehicles (EVs) is widely considered as a crucial step in decarbonizing urban mobility. While access to private ownership of EVs is socially and spatially still highly unequal, shared electric mobility has been suggested as a more accessible alternative. However, access to shared electric mobility is still inequitable; hence, there is a need for practical insights and recommendations for urban policymakers on how to improve this. This study addressed this need with a ‘practice consultation’, comprising 15 in-depth interviews with practice experts from Belgium, Denmark, Finland and the Netherlands, on the current state of shared electric mobility, the associated policies and realistic policy options to promote and ensure equitable access. The study revealed not only a diverse offer of shared electric mobility but also the persistence of earlier-identified barriers to equitable access. Current policies focus more on the orderly and safe integration of shared mobility services and improving access to shared mobility more generally. Yet, various recent plans, experiments and pilots with policy options for more equitable access were mentioned. Some options are novel and open up new ways to equitable access, while other already-suggested ones were confirmed as relevant and feasible by practice experts. Full article

Rapid urban growth in many Global South cities strains waste systems and slows the shift to circular economy (CE) practice. Colombo, Sri Lanka, exemplifies this challenge, where overstretched state-led services coexist with neighborhood groups, NGOs, and informal collectors driving circular activities. This study adopts a layered social network diagnostic framework to examine how community-based waste management networks operate and how they might be reshaped to enable a city-wide CE. Using survey and interview data from 185 actors, information-sharing, collaboration, and resource-exchange networks are analyzed separately and in combination. The results reveal three principal findings: (i) Social-capital forms operate largely in parallel, with limited conversion between information, collaboration, and material exchange; (ii) the network exhibits “thin bridges and thick clusters,” in which a small number of NGO hubs mediate most cross-cluster connectivity; (iii) layers operate with mismatched coordination logics, producing gaps between awareness, collective action, and resource mobilization. As a result, ideas circulate widely but rarely translate into joint projects, local teams coordinate effectively yet remain isolated, and material flows depend on a narrow and fragile logistics spine. By diagnosing these structural misalignments, this study demonstrates a key novelty: scalable circular economy adoption depends not only on technology and policy but also on the design and alignment of underlying coordination networks. Full article

Family caregivers provide up to 90% of care in Alberta’s communities and play an essential role in sustaining the province’s health and social care systems, yet they remain under-recognized and insufficiently supported. To address this gap, we co-designed the Alberta Family Caregiver Strategy and Action Plan (2024–2025), a provincial framework developed through participatory research and collective impact methods. Guided by principles of co-production, equity, and lived experience, the project engaged over 500 stakeholders, including caregivers, healthcare providers, educators, employers, and policymakers, through Phase 1 interviews (health/community leaders, n = 44; Family and Community Support Services (FCSS), n = 47; navigation experts, n = 9), Phase 2 co-design team consultations, and Phase 3 sector roundtables (n = 52). Using reflexive thematic analysis, we identified four foundational caregiver strategies, Recognition, Partnership, Needs Assessment, and Navigation, and four enabling conditions: Education, Workplace Supports, Policy and Research and Data Infrastructure. These elements were synthesized into an eight-priority Alberta Caregiver Strategy and Action Plan Framework, a practical way to connect validated priorities with coordinated, measurable implementation across settings. Participants emphasized four key enablers essential to making caregiver inclusion more feasible and sustainable: education, workplace supports, policy infrastructure, and research and evaluation. Findings highlight strong cross-sector consensus that caregiver inclusion must be embedded into routine practice, supported by consistent policy, and reinforced through provincial coordination with local adaptation. The Alberta Family Caregiver Strategy provides a practical, evidence-informed plan for transforming fragmented supports into a coherent, caregiver-inclusive ecosystem that strengthens both caregiver well-being and system sustainability. Full article

Background: Spasticity, which occurs with certain neurological conditions, substantially affects quality of life, function, and social participation. Despite widespread botulinum toxin use, variability persists in patient information, access to specialized rehabilitation, and follow-up models. Methods: This two-phase Delphi-Dialogue Patients–Professionals study (DDPP), promoted by SERMEF, integrated perspectives from 77 patients and 141 rehabilitation professionals. Phase 1 used parallel surveys to assess satisfaction, perceived effectiveness of botulinum toxin, communication preferences, and rehabilitation follow-up. Phase 2 applied Real-Time Delphi with 38 experts to generate consensus recommendations to improve spasticity management. Results: Patients and professionals agreed on botulinum toxin benefits, the importance of ongoing rehabilitation, and the value of hybrid (in-person/remote) follow-up. Key gaps concerned access to Physical Medicine and Rehabilitation services, clarity and timing of information, and shared goal setting. Experts translated these misalignments into 10 prioritized recommendations, with highest feasibility for actions standardizing access pathways, optimizing botulinum toxin use, reinforcing structured education, and consolidating hybrid rehabilitation models. Conclusions: The DDPP approach offers a reproducible framework to align stakeholder perspectives by converting quantified divergence into consensus-based innovation priorities. Implementing the recommendations—particularly those strengthening communication, education, and hybrid pathways regarding botulinum toxin treatment—may support more accessible, personalized, patient-centered spasticity care. Full article

Objectives: This study aims to explore the facilitators and barriers in the process of using AI agents for disease management in older COPD patients. Methods: Based on the normalization process theory, a descriptive qualitative study was used to conduct semi-structured interviews with 28 older patients with COPD recruited from June to August 2025 in a Class A tertiary hospital in Wuxi, Jiangsu Province. Results: A total of 28 interviews were conducted. Four themes (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring), nine subthemes (recognition of intelligent technology;supported by policy discourse and the background of national-level projects; the creation of a family atmosphere; recommendations from HCPs; relief and social connection; new “doctor”–patient relationship and communication; eliminate the burden and return to life; benefit and value perception; right self-decision by AI) in facilitators and nine subthemes (privacy conflicts and trust deficiency; blurred boundaries of human–machine responsibility and authority; non-high-quality services are chosen reluctantly; technical anxiety; lack of motivation for continued engagement; extra burden; limitations of the physical environment; human–machine dialogue frustration; a sense of uncertainty about the future of AI) in barriers were extracted. Conclusions: This study identified key factors influencing the use of AI agents in chronic disease management in older patients with COPD. The results provide directions for improving the implementation and sustainable use of AI health technologies. Full article

The rapid adoption of generative artificial intelligence (AI) in higher education has intensified a pedagogical dilemma: while AI tools can increase immediate classroom engagement, they do not necessarily foster the self-regulated learning (SRL) capacities required for ethical and reflective professional practice, particularly in human-service fields. In this two-time-point, pre-post cohort-level (repeated cross-sectional) evaluation, we examined a six-week AI-integrated curriculum incorporating explicit SRL scaffolding among social work undergraduates at a Taiwanese university (pre-test N = 37; post-test N = 35). Because the surveys were administered anonymously and individual responses could not be linked across time, pre-post comparisons were conducted at the cohort level using independent samples. The participating students completed the AI-Enhanced Learning Attitude Scale (AILAS); this is a 30-item instrument grounded in the Technology Acceptance Model, Attitude Theory and SRL frameworks, assessing six dimensions of AI-related learning attitudes. Prior pilot evidence suggested an engagement regulation gap, characterized by relatively strong learning process engagement but weaker learning planning and learning habits. Accordingly, the curriculum incorporated weekly goal-setting activities, structured reflection tasks, peer accountability mechanisms, explicit instructor modeling of SRL strategies and simple progress tracking tools. The conducted psychometric analyses demonstrated excellent internal consistency for the total scale at the post-test stage (Cronbach’s α = 0.95). The independent-samples t-tests indicated that, at the post-test stage, the cohorts reported higher mean scores across most dimensions, with the largest cohort-level differences in Learning Habits (Cohen’s d = 0.75, p = 0.003) and Learning Process (Cohen’s d = 0.79, p = 0.002). After Bonferroni adjustment, improvements in the Learning Desire, Learning Habits and Learning Process dimensions and the Overall Attitude scores remained statistically robust. In contrast, the Learning Planning dimension demonstrated only marginal improvement (d = 0.46, p = 0.064), suggesting that higher-order planning skills may require longer or more sustained instructional support. No statistically significant gender differences were identified at the post-test stage. Taken together, the findings presented in this study offer preliminary, design-consistent evidence that SRL-oriented pedagogical scaffolding, rather than AI technology itself, may help narrow the engagement regulation gap, while the consolidation of autonomous planning capacities remains an ongoing instructional challenge. Full article

This article explores urban ‘societal resilience’ during the global pandemic of 2020–2021. This health crisis involved a complex interweaving of social, cultural, political, and economic processes which involved both top-down measures undertaken by nation-state governments and bottom-up actions by local residents. In a research study undertaken in two European cities—Stuttgart and London—we focussed on two migrant minorities and the involvement by ‘experts’ and ‘non-experts’ in the meso-level where these top-down measures and bottom-up actions met. Our study provided a grounded understanding of ‘layered resilience’ where resiliency develops through the disjunctive order of communication patterns, public service delivery, institutionalized dialogue, narratives, and values. Through distinguishing between resiliency and resilience, we seek to illustrate the ‘elastic’ character of urban modes of integration. Our study suggests the need for more empirically grounded investigations into the continuity and difference between adaptation and adjustment, normality and normalcy, and resilience and resiliency. It also highlights the importance of context-specific and path-dependent notions of resilience and resiliency. Full article

Extreme wildfires are becoming increasingly frequent and severe across many regions worldwide, driven by climate change, land-use transitions, and long-standing fire-suppression legacies. In this context, Nature-based Solutions (NbS)—defined as actions that work with ecological processes to address societal challenges while providing biodiversity and socio-economic benefits—offer a promising yet underdeveloped pathway for enhancing wildfire resilience. This Special Issue brings together eleven contributions spanning empirical ecology, landscape configuration, simulation modelling, spatial optimisation, ecosystem service analysis, governance assessment, and community-based innovation. Collectively, these studies demonstrate that restoring ecological fire regimes, promoting multifunctional landscapes, and integrating advanced decision support tools can substantially reduce wildfire hazard while sustaining ecosystem functions. They also reveal significant governance barriers, including fragmented policies, limited investment in prevention, and challenges in incorporating social demands into territorial planning. By synthesising these insights, this editorial identifies several strategic priorities for advancing NbS in fire-prone landscapes: mainstreaming prevention within governance frameworks, strengthening the science–practice interface, investing in long-term socio-ecological monitoring, managing trade-offs transparently, and empowering local communities. Together, the findings highlight that effective NbS emerge from the alignment of ecological, technological, institutional, and social dimensions, offering a coherent pathway toward more resilient, biodiverse, and fire-adaptive landscapes. Full article