Search Results (5,587)

With the rapid development of the social economy, human activities have increasingly disrupted water environments, and the continuous input of pollutants poses significant challenges for water environment management. Taking the Xiaoxingkai Lake basin as the study area, this paper develops a social–economic–water environment model based on the system dynamics methodology, incorporating subsystems for population, agriculture, and water pollution. The model focuses on four key indicators of pollution severity, namely, total nitrogen (TN), total phosphorus (TP), chemical oxygen demand (COD), and ammonia nitrogen (NH₃-N), and simulates the changes in pollutant loads entering the river under five different scenarios from 2020 to 2030. The results show that agricultural non-point sources are the primary contributors to TN (79.5%) and TP (73.7%), while COD primarily originates from domestic sources (64.2%). NH₃-N is mainly influenced by urban domestic activities (44.7%) and agricultural cultivation (41.2%). Under the status quo development scenario, pollutant loads continue to rise, with more pronounced increases under the economic development scenario, thus posing significant sustainability risks. The pollution control enhancement scenario is most effective in controlling pollutants, but it does not promote socio-economic development and has high implementation costs, failing to achieve coordinated socio-economic and environmental development in the region. The dual-reinforcement scenario and moderate-reinforcement scenario achieve a balance between pollution control and economic development, with the moderate-reinforcement scenario being more suitable for long-term regional development. The findings can provide a scientific basis for water resource management and planning in the Xiaoxingkai Lake basin. Full article

CR is a cornerstone of secondary prevention for cardiovascular disease, offering well-established benefits across mortality, hospital readmission, functional capacity, and quality of life. Despite Class I guideline endorsements and decades of supporting evidence, CR remains vastly underutilized, particularly among women, racial and ethnic minorities, older adults, and individuals in low-resource settings. This review synthesizes the current evidence base for CR, with emphasis on disease-specific benefits across different cardiovascular diseases, and highlights recent data on its role in expanding populations, including patients with HFpEF, older adults, patients with advanced heart failure, and those undergoing transcatheter interventions. We also examine persistent barriers to CR access and participation, including system-level and referral limitations, as well as patient-level disparities by age, sex, race and ethnicity, and socioeconomic status. Building on this, we explore innovative delivery models and recent policy initiatives such as hybrid programs and reimbursement reform, all designed to expand access, promote equity, and modernize CR delivery. The findings underscore the need for continued investment, advocacy, and innovation to ensure equitable access to CR and its life-saving benefits across the full cardiovascular care continuum. Full article

Understanding the spatial dynamics and drivers of armed conflict is crucial for anticipating risk and informing targeted interventions. However, current research rarely considers the spatio-temporal clustering characteristics of armed conflicts. Here, we assess the distribution dynamics and driving factors of armed conflict from the perspective of armed conflict clusters, employing complex network dynamic community detection methods and interpretable machine learning approaches. The results show that conflict clusters vary in terms of regional distribution. Sub-Saharan Africa boasts the highest number of conflict clusters, accounting for 37.9% of the global total and covering 40.4% of the total cluster area. In contrast, South Asia and Afghanistan, despite having a smaller proportion of clusters at 12.1%, hold the second-largest cluster area, which is 18.1% of the total. The characteristics of different conflict networks are influenced by different factors. Historical exposure, socio-economic deprivation, and spatial structure are the primary determinants of conflict patterns, while climatic variables contribute less prominently as part of a broader system of environmental vulnerability. Moreover, the influence of driving factors shows spatial heterogeneity. By integrating cluster-level analysis with interpretable machine learning, this study offers a novel perspective for understanding the multidimensional characteristics of armed conflicts. Full article

Climate warming is anticipated to significantly alter the distribution and composition of plant species in the Arctic, thereby cascading through food webs and affecting both associated fauna and entire ecosystems. To elucidate the trend in plant distribution in response to climate change, we employed the MaxEnt model to project the future ranges of 25 representative Arctic and Circumpolar plant species (including grasses and shrubs). Species distribution data, in conjunction with bioclimatic variables derived from climate projections of three selected General Circulation Models (GCMs), ESM2, IPSl, and MPIE, were utilized to fit the MaxEnt models. Subsequently, we predicted the potential distributions of these species under three Shared Socioeconomic Pathways (SSPs)—SSP126, SSP245, and SSP585—across a timeline spanning 2010, 2050, 2100, 2200, 2250, and 2300 AD. Range shift indices were applied to quantify changes in plant distribution and range sizes. Our results show that the ranges of nearly all species are projected to diminish progressively over time, with a more pronounced rate of reduction under higher emission scenarios. The species are generally expected to shift northward, with the distances of these shifts positively correlated with both the time intervals from the current state and the intensity of thermal forcing associated with the SSPs. Arctic species (A_Spps) are anticipated to face higher extinction risks compared to Boreal–Arctic species (B_Spps). Additional indices, such as range gain, loss, and overlap, consistently corroborate these patterns. Notably, the peak range shift speeds differ markedly between SSP245 and SSP585, with the latter extending beyond 2100 AD. In conclusion, under all SSPs, A_Spps are generally expected to experience more significant range shifts than B_Spps. In the SSP585 scenario all species are projected to face substantial range reductions, with Arctic species being more severely affected and consequently facing the highest extinction risks. These findings provide valuable insights for developing conservation recommendations for polar plant species and have significant ecological and socioeconomic implications. Full article

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Although the strawberry tree (A. unedo L.) has been long considered a neglected species of the Mediterranean maquis, the valorization of its fruit production may enhance its socioeconomic value, especially in rural areas. In this study, strawberry trees from different Sicilian sites were investigated in terms of macronutrients, fatty acid (FA) composition, tocopherols, total phenols, carotenoids, and minerals. Sicilian berries were a good source of carbohydrates (mainly fructose, glucose and sucrose) and dietary fiber. They were low in fat; however, the FA composition revealed the abundance of unsaturated FAs over saturated FAs and an advantageous n-6/n-3 ratio. Additionally, Sicilian berries showed an inversed linoleic/α-linolenic acid ratio with respect to berries from other Mediterranean regions, that had previously investigated in literature. This evidence suggests that this ratio may have a chemotaxonomic relevance. Considering antioxidants, the fruits had levels of tocopherols, particularly α-tocopherol, total phenols and carotenoids similar to those of certain commercial fruits. Precious amounts of minerals, such as Ca, K, Zn and Fe were also determined. Interestingly, berries harvested near a Sicilian volcanic area had higher levels of minerals, as well as tocopherols, phenols and carotenoids, than fruits from other Sicilian sites, thereby advancing the hypothesis that fruits from volcanic areas may have a superior nutritional value. Overall, data from this study elaborated by a proper statistical analysis revealed that the geographical origin was a relevant variable to consider in the reliable study of this fruit species. Full article

Background/Objectives: The social importance of health literacy (HL) is widely understood, and its measurement is the subject of various studies. Due to the recent pandemic, several instruments for measuring HL about COVID-19 have been proposed in different countries, including the HLS-COVID-Q22 questionnaire. The diversity of cultures and languages necessitates the cross-cultural adaptation of this instrument. Thus, the present study translates, adapts, and validates the psychometric properties of the HLS-COVID-Q22 questionnaire to provide its cross-cultural adaptation from English to Spanish (Peru). Methods: As part of ensuring that the final questionnaire accommodates the cultural nuances and idiosyncrasies of the target language, the following activities were carried out: (a) a survey of 40 respondents; and (b) a focus group with 10 participants, followed by expert approval. In addition, the validity and reliability of the health instrument have been ascertained through a further pilot test administered to 490 people in the city of Tacna in southern Peru. Results: The resulting questionnaire helps measure HL in Peru, aiding better-informed decision-making for individual health choices. Conclusions: The presence of such a tool is advantageous in case of similar global health emergencies, when the questionnaire can be made readily available to support a promotion of strategies towards better self-care. Moreover, it encourages other Latin American stakeholders to adjust the instrument to their own cultural, language, and socio-economic contexts, thus invigorating the regional and global expansion of the HL study network. Full article

Background/Objectives: Dietary patterns have changed over time, characterising a process of nutritional transition that reflects socioeconomic and demographic inequalities among different populations. This study assessed changes in dietary consumption patterns and the associated social determinants, comparing two time periods in a sample of individuals from a state in the Northeast Region of Brazil. Methods: Data from the 2008–2009 and 2017–2018 Household Budget Survey for the state of Paraíba were analysed, totalling 951 and 1456 individuals, respectively. Foods were categorised according to the NOVA classification and compared based on sociodemographic and economic variables. To determine the factors that most strongly explain the contribution of each NOVA food group to the diet, beta regression analysis was conducted. Results: Differences were observed between the two periods regarding the dietary contribution of the NOVA food groups, with a decrease in consumption of unprocessed foods and an increase in ultra-processed foods. Living in urban areas, being an adolescent, and having an income above the minimum wage were associated with reduced intake of unprocessed foods in both periods. Additionally, being an adolescent and having more than eight years of schooling were associated with higher consumption of ultra-processed foods. Conclusions: The population under study showed changes in food consumption, reflecting a transition process that is occurring unevenly across socioeconomic and demographic groups, thereby reinforcing social inequalities. These findings can guide priorities in food and nutrition policies, highlighting the need for intervention studies to evaluate the effectiveness of such actions. Full article

Given the severe global traffic safety challenges—including threats to human lives and socioeconomic impacts—this study analyzes visual behavior to promote sustainable transportation, improve road safety, and reduce resource waste and pollution caused by accidents. Four typical road sections, namely, turning, straight ahead, uphill, and downhill, were selected, and the eye movement data of 23 drivers in different driving stages were collected by aSee Glasses eye-tracking device to analyze the visual gaze characteristics of the drivers and their transfer patterns in each road section. Using Markov chain theory, the probability of staying at each gaze point and the transfer probability distribution between gaze points were investigated. The results of the study showed that drivers’ visual behaviors in different road sections showed significant differences: drivers in the turning section had the largest percentage of fixation on the near front, with a fixation duration and frequency of 29.99% and 28.80%, respectively; the straight ahead section, on the other hand, mainly focused on the right side of the road, with 31.57% of fixation duration and 19.45% of frequency of fixation; on the uphill section, drivers’ fixation duration on the left and right roads was more balanced, with 24.36% of fixation duration on the left side of the road and 25.51% on the right side of the road; drivers on the downhill section looked more frequently at the distance ahead, with a total fixation frequency of 23.20%, while paying higher attention to the right side of the road environment, with a fixation duration of 27.09%. In terms of visual fixation, the fixation shift in the turning road section was mainly concentrated between the near and distant parts of the road ahead and frequently turned to the left and right sides; the straight road section mainly showed a shift between the distant parts of the road ahead and the dashboard; the uphill road section was concentrated on the shift between the near parts of the road ahead and the two sides of the road, while the downhill road section mainly occurred between the distant parts of the road ahead and the rearview mirror. Although drivers’ fixations on the front of the road were most concentrated under the four road sections, with an overall fixation stability probability exceeding 67%, there were significant differences in fixation smoothness between different road sections. Through this study, this paper not only reveals the laws of drivers’ visual behavior under different driving environments but also provides theoretical support for behavior-based traffic safety improvement strategies. Full article

In light of the increasing frequency and intensity of natural phenomena, whether climatic or telluric, the relevance of multi-risk assessment approaches has become an important issue for understanding and estimating the impacts of disasters on complex socioeconomic systems. Two aspects contribute to the worsening of this situation. First, climate change has heightened the incidence and, in conjunction, the seriousness of geohazards that often occur with each other. Second, the complexity of these impacts on societies is drastically exacerbated by the interconnections between urban areas, industrial sites, power or water networks, and vulnerable ecosystems. In front of the recent research on this problem, and the necessity to figure out the best scientific positioning to address it, we propose, through this review analysis, to revisit existing literature on multi-risk assessment methodologies. By this means, we emphasize the new recent research frameworks able to produce determinant advances. Our selection corpus identifies pertinent scientific publications from various sources, including personal bibliographic databases, but also OpenAlex outputs and Web of Science contents. We evaluated these works from different criteria and key findings, using indicators inspired by the PRISMA bibliometric method. Through this comprehensive analysis of recent advances in multi-risk assessment approaches, we highlight main issues that the scientific community should address in the coming years, we identify the different kinds of geohazards concerned, the way to integrate them in a multi-risk approach, and the characteristics of the presented case studies. The results underscore the urgency of developing robust, adaptable methodologies, effectively able to capture the complexities of multi-risk scenarios. This challenge should be at the basis of the keys and solutions contributing to more resilient socioeconomic systems. Full article

The right to development, an inherent human right for all, emphasizes that all individuals and communities have the right to participate in, contribute to, and benefit from development that ensures the full realization of human rights. In Kenya, where a significant portion of the population faces poverty and vulnerability to climate change, access to rights-based needs such as clean water, healthcare, and education still remains a critical challenge. This study explored the implementation of a Human Rights-Based approach to community development through a Public–Private Development Partnership model (PPDP), with a focus on alleviating poverty and improving access to rights-based services at the community level in Narok and Nakuru counties. The research aimed to identify critical success factors for scaling the PPDP model and explore its effects on socio-economic empowerment. The study employed a mixed-methods approach for data collection, using questionnaires to obtain quantitative data, focus group discussions, and key informant interviews with community members, local leaders, and stakeholders to gather qualitative data. We cleaned and analyzed all our data in R (version 4.4.3) and used the chi-square to establish the significance of differences between areas where the PPDP model was implemented and control areas where it was not. Results reveal that communities with the PPDP model experienced statistically significant improvements in employment, income levels, and access to rights-based services compared to control areas. The outcomes underscore the potential of the PPDP model to address inclusive and sustainable development. This study therefore proposes a scalable pathway beginning with access to rights-based needs, followed by improved service delivery, and culminating in economic empowerment. These findings offer valuable insights for governments, development practitioners, investment agencies, and researchers seeking community-driven developments in similar socio-economic contexts across Africa. For the first time, it can be adopted in the design and implementation of development projects in rural and local communities across Africa bringing into focus the need to integrate rights-based needs at the core of the project. Full article

Background/Objectives: Educational background is an aspect of socio-economic status, that may be associated with higher caries risk. This study aimed to investigate differences in caries prevalence between different school types for older adolescents in Greifswald, Germany. Methods: Cross-sectional data were collected as part of compulsory dental school examinations between 2020 and 2023. Oral health status was assessed according to WHO criteria by six calibrated examiners and reported as mean D₃MFT (D₃: dentin caries, M: missing, F: filled, SD/±: standard deviation). To compare educational backgrounds, the adolescents were divided into two groups according to their age and type of school (11–15 and 16–18 years old). Results: The study included 5816 adolescents (48.7% females) with a mean D₃MFT of 0.65 (Q1–Q3: 0–1); 73.8% were clinically caries-free, having D₃MFT = 0, confirming the polarization in caries experience with 2.5 ± 2.13 SaC index. The logistic regression model showed a significantly increased Odds Ratio for having caries in relation to age, being male, having plaque or gingivitis (p < 0.005). There were significant differences in caries experience and prevalence between school types, where high schools had the lowest D₃MFT values in both age groups (0.39 ± 1.17 and 0.64 ± 1.49, respectively). The highest D₃MFT values were in schools for special educational needs in younger adolescents (1.12 ± 1.9) and in vocational schools in older adolescents (1.63 ± 2.55). Conclusions: In a low-caries-risk population, there were significant differences in caries experience and prevalence among adolescents in different school types. Prevention strategies should aim to reduce the polarization in caries across different educational backgrounds in late adolescence. Full article

Against the backdrop of China’s fast-growing digital economy and its financial inclusion agenda, there is still little city-level evidence on whether the e-CNY pilot accelerates financial deepening at the grassroots. Using a balanced panel of 271 prefecture-and-above cities for 2016–2022, this study employs a staggered difference-in-differences (SDID) design augmented by the synthetic control method (SCM) to rigorously identify the policy effect of the e-CNY pilot. The results show that the pilot program significantly improves urban financial inclusion, contributing to more equitable access to financial services and supporting inclusive socio-economic development. Mechanism analysis suggests that the effect operates mainly through two channels, a merchant-coverage channel and a transaction-scale channel, with the former contributing the majority of the overall effect. Incorporating a migration-based mobility index shows that most studies’ focus on the merchant-coverage effect is amplified in cities under tight mobility restrictions but wanes where commercial networks are already saturated, whereas the transaction-scale channel is largely insensitive to mobility shocks. Heterogeneity tests further indicate stronger gains in non-provincial capital cities and in the eastern and central regions. Overall, the study uncovers a “penetration-inclusion” network logic and provides policy insights for advancing sustainable financial inclusion through optimized terminal deployment, merchant incentives, and diversified scenario design. Full article

Self-medication is a subject of global importance. If practiced responsibly, self-medication represents a part of self-care or positive care of an individual or a community in promoting their own health. However, today’s practices of self-medication are often inappropriate and irresponsible, and as such appear all over the world. Inappropriate self-medication can be connected with possible serious health risks and consequences. Therefore, it represents a global health issue. It can even generate additional health problems, which will eventually become a burden to healthcare systems and can induce significant costs, which also raises socioeconomic concerns. Hence, self-medication attracts the attention of researchers and practitioners globally in efforts to clarify the current status and define feasible measures that should be implemented to address this issue. This narrative review aims to give an overview of the situation in the field of self-medication globally, including current practices and attitudes, as well as implications for actions needed to improve this problem. A PubMed/MEDLINE search was conducted for articles published in the period from 1995 up to March 2025 using keywords “self-medication” or “selfmedication” alone or in combinations with terms related to specific subthemes related to self-medication, such as COVID-19, antimicrobials, healthcare professionals, and storing habits of medicines at home. Studies were included if self-medication was their main focus. Publications that only mentioned self-medication in different contexts, but not as their main focus, were excluded. Considering the outcomes of research on self-medication in various contexts, increasing awareness of responsible self-medication through education and informing, together with surveillance of particular medicines and populations, could lead to more appropriate and beneficial self-medication in the future. Full article

Background and Objectives: Anemia and stunting are major public health concerns for young Indonesian children. Limited information is available from studies on multi-micronutrient supplements in Indonesia. The objective of this study was to investigate the effect of 12-month multi-micronutrient powder (MNP) supplementation on serum hemoglobin levels, anemia, and growth. Methods: A randomized double-blinded placebo-controlled study was performed, including 232 eligible children aged 8–10 months old. Children with severe anemia or stunting/those classed as underweight were not included as subjects. The study was performed in a low-socioeconomic-status community in Jakarta. With an active-to-placebo ratio of 60:40, 139 subjects received MNP sachets twice/day, and 93 subjects received placebo sachets, mixed with complementary food. The outcome parameters were hemoglobin level, anemia, and growth indicators. Per-protocol analysis was performed for 179 (intervention: 110; control: 69) subjects. Results: There were no differences at baseline between the groups, except for the weight-for-length z-scores (WLZ). Upon intervention, the serum hemoglobin level and anemia proportion did not change significantly within the group, and no significant differences were found between the groups (p > 0.05). However, subgroup analysis of non-anemic children at baseline showed a significant increase in hemoglobin levels in the youngest age group (8.0–8.9 months old) receiving MNP compared to placebo (0.13 vs. −0.79, p = 0.031). Iron deficiency anemia proportion showed a similar upward trend upon intervention in both groups. No significant differences in growth were found between both groups. Conclusions: This study failed to find a significant effect of 12-month MNP supplementation on serum hemoglobin level, anemia, and growth. Full article