Search Results (1,525)

Across the literature, family involvement is recognized as a key factor for academic progress, inclusive education and personal development. However, family size is rarely examined in bibliometric analyses, despite growing attention to socioeconomic and family-related factors influencing educational participation and inequality. Although empirical evidence does not establish a direct relationship between family size and inclusive education, existing research suggests that inclusive practices are more effective when family-related challenges are acknowledged. This study maps the representation of large families within the literature addressing educational inequality, participation, and inclusion-related processes. A bibliometric and co-occurrence analysis of 395 Web of Science publications (retrieved March 2026) was conducted using VOSviewer and Microsoft Excel. Findings revealed that research emerged in the 1990s and expanded after 2016, with the United States, Ethiopia, and China as leading contributors. Six thematic clusters were identified: socioeconomic participation, child vulnerability, educational outcomes, fertility and gender dynamics, and household-level constraints. Results indicate that large families are unevenly addressed, appearing more frequently in research on educational inequality than in inclusive education. Based on these findings, the study proposes a conceptual framework describing the “lights and shadows” of large family contexts in inclusive education, capturing both constraining and enabling dimensions associated with family structure. Full article

Background: Sociodemographic and structural inequities shape the risk of alcohol-related harms among underage individuals. This study assessed disparities in alcohol-related emergency department (ED) visits, using the COVID-19 pandemic as a contextual backdrop to examine how these inequities shifted during a period of widespread disruption. Methods: This repeated cross-sectional study used pooled Nationwide Emergency Department Sample (NEDS) data (January 2019–December 2021) for individuals aged 12–20, comparing pre-COVID-19 (January 2019–March 2020) and during-COVID-19 (April 2020–December 2021) periods. Alcohol-related visits were identified via ICD-10-CM codes. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and geographic factors, with interaction terms assessing period-related changes in disparities. Results: Sociodemographic disparities were the primary drivers of alcohol-related ED visits. Native American youth had markedly higher odds than White youth (OR = 3.68, 95% CI: 3.52–3.86), while Black, Hispanic, and Asian youth had lower odds. Uninsured (OR = 1.43) and charity-care youth also showed elevated odds. COVID-19 itself was not significantly associated with overall visits (OR = 1.03, p = 0.053), but disparities widened for Native American youth (OR = 1.20) and narrowed modestly for Black (OR = 1.04) and Medicaid-insured (OR = 1.05) youth, while other disparities remained unchanged. Conclusions: Persistent structural disparities, particularly by race/ethnicity and insurance status, drive underage alcohol-related ED utilization far more than the pandemic itself, underscoring the need for equity-focused prevention strategies targeting systemic barriers to care. Full article

Lymphomas are broadly categorized into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Despite treatment advances, they remain a major cause of cancer-related morbidity and mortality in Canada. This study examined temporal trends in socioeconomic inequalities in lymphoma mortality in Canada from 2000 to 2019. Using a unique census division level dataset (n = 280) constructed by pooling information from the Canadian Vital Statistics Death Database, the Canadian Census of Population and the National Household Survey, we measured mortality in HL and NHL in Canada. The age-standardized Concentration index (C) was used to quantify income and education inequalities in lymphoma. Time trend analyses were conducted to examine the changes in the observed socioeconomic inequalities. Crude HL mortality declined significantly over the study period. Crude NHL mortality remained largely unchanged in Canada overall, although modest declines were observed in the Prairies. The age-standardized C indicated persistent income and education inequalities for both lymphoma types. For NHL, mortality became increasingly concentrated among lower-income and lower-education populations over time. The persistent and widening socioeconomic inequalities observed in HL and NHL mortality, respectively, in Canada underscore the need for targeted public health interventions and more equitable distribution of resources to address systematic and avoidable differences in cancer outcomes associated with socioeconomic disadvantage. Full article

Background: Ignatzschineria species are rare emerging human pathogens that are typically associated with myiasis. Methods: We report the first case of Ignatzschineria indica bacteraemia in Greece in a male patient presenting with maggot-infested wounds of the thorax, shoulders, and arms. The isolate was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and antimicrobial susceptibility testing was performed according to EUCAST guidance. A review of the published literature on I. indica bacteraemia was also conducted. Results: The patient was diagnosed with bacteraemia caused by a multisusceptible I. indica isolate and was successfully treated with antibiotic therapy, resulting in complete recovery. This represents the first reported case of I. indica infection in Greece. Review of the literature showed that most published I. indica isolates were susceptible to a broad range of antimicrobial agents, and all reported patients survived, although some required limb amputation because of severe underlying soft tissue disease. Conclusions: Ignatzschineria indica infection should be considered in patients with neglected, maggot-infested wounds. Increased awareness of this emerging pathogen, together with the use of modern microbiological identification methods, may improve recognition of these uncommon infections. Socio-economic inequalities and the changing distribution of insect vectors due to climate change may contribute to the occurrence of such infections. Full article

Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article

Biologic therapies have significantly improved outcomes for patients with moderate-to-severe atopic dermatitis (AD), yet access to these treatments remains uneven and frequently limited. This systematic review synthesizes evidence on insurance-related, financial, administrative, prescriber-level, and structural barriers that limit equitable access to biologic therapies for AD. In contrast to prior reviews that primarily focus on biologic efficacy, safety, or general disease management, this review evaluates access itself as the primary outcome. Across diverse study designs and populations, findings consistently demonstrate that high out-of-pocket costs, restrictive insurance policies, and administrative burdens disproportionately impact low-income, minority, and Medicaid-insured patients. However, racial and ethnic disparities should be interpreted cautiously, as factors like insurance type, Medicaid enrollment, socioeconomic status, geographic access, and other structural determinants may influence these associations. Pediatric patients and caregivers also face challenges such as insurance delays, financial burden, and long-term effects of poor disease control. These barriers contribute to delays in treatment initiation, reduced adherence, and poorer clinical outcomes. Persistent racial, socioeconomic, and geographic disparities further exacerbate inequities in care delivery. Variability in prescribing patterns and provider familiarity with biologics also influence treatment access. Collectively, these findings underscore the need for comprehensive policy reform, streamlined authorization processes, and targeted interventions to improve equitable access to biologic therapies in AD. Full article

The relationship between climate change and migration remains widely debated, particularly regarding the extent to which environmental factors directly drive mobility. While climate-related stressors such as droughts, floods, and environmental degradation can disrupt livelihoods, migration decisions are rarely shaped by environmental factors alone. This study argues that climate change is often overstated as a primary driver of migration and may function instead as a secondary explanatory frame for mobility shaped by deeper socioeconomic and institutional constraints. Focusing on environmentally vulnerable regions of the Global South, this study examines the interplay between ecological stressors, structural inequalities, governance frameworks, and development conditions in shaping migration outcomes. It adopts a sustainability-oriented perspective to highlight how migration is embedded within broader adaptive and developmental processes rather than operating as a direct response to environmental change. The analysis demonstrates that effective policy responses must move beyond climate-deterministic narratives and instead adopt integrated approaches that combine environmental management, socioeconomic development, and migration governance. Strengthening adaptive capacity, improving institutional resilience, and promoting inclusive urban and rural development are identified as key policy priorities. By linking climate-related migration to the Sustainable Development Goals (SDGs)—notably SDG 10 (Reduced Inequalities), SDG 11 (Sustainable Cities and Communities), and SDG 13 (Climate Action)—the study contributes to a more holistic understanding of mobility in the context of environmental change. Overall, it calls for a re-evaluation of climate–migration dynamics in the Global South, emphasizing sustainable and context-sensitive governance approaches that reflect the complexity of migration processes. Full article

Background and Objectives: Aspects of social relationships, like isolation and low social support, have been linked to type 2 diabetes onset, though evidence is inconsistent. We investigated whether social relationships mediate the association between socioeconomic status (SES) and diabetes or interact with SES in relation to diabetes. Materials and Methods: The study included 3642 participants (mean age 58.9 ± 7.6 years, 47.9% male) from the Heinz Nixdorf Recall Study, a population-based cohort in Germany. Baseline examinations took place in 2000–2003 with two 5-year follow-ups. Adjusted relative risks (RRs) were estimated for social relationships (isolation, partnership, instrumental, financial, emotional support) and incident diabetes using Poisson regression with robust variance. We performed causal mediation analyses and estimated relative excess risks due to interaction (RERI). Results: Associations between measures of social integration and diabetes incidence were weak (e.g., RR = 1.09 (95% CI: 0.86, 1.39) for lack of partnership). Limited financial support was associated with higher diabetes risk (RR = 1.33 (1.09, 1.62)), whereas instrumental or emotional support was not. Some evidence of mediation was found for limited financial support (14% (95% CI: −7%, 35%) for the income–diabetes association). There was hardly any excess risk of diabetes in persons with poor education, and poor income, respectively, and low social support (RERI = −0.33 to 0.27). Conclusions: In this prospective study, limited financial support emerged as a social risk factor for type 2 diabetes and explained a small proportion of socioeconomic inequalities in diabetes incidence. Other dimensions of social relationships showed little evidence of independent, mediating, or interaction effects. The findings regarding financial support require confirmation in further studies. Full article

This study investigates the long-run relationship between socio-economic inequality, public service provision, infrastructure development, structural transformation, and quality of life in Central Asia, focusing on Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan over the 2000–2024 period. Using panel data from the World Development Indicators, the analysis applies a comprehensive econometric strategy including panel unit root tests, Pedroni cointegration tests, FMOLS, DOLS, CCR estimators, and a Panel ARDL-PMG framework for robustness. The study examines how inequality, education and health expenditure, ICT development, electricity access, economic growth, and urbanization jointly shape quality-of-life outcomes measured by life expectancy. The empirical results confirm the existence of a stable long-run equilibrium relationship among the variables. Urbanization emerges as the most powerful determinant of quality of life, indicating a highly elastic welfare response to spatial structural transformation. ICT development and education expenditure consistently exert positive effects, highlighting the importance of digital connectivity and human capital accumulation in improving welfare outcomes. In contrast, health expenditure, electricity access, and economic growth display negative long-run relationships, suggesting that these variables often reflect structural inefficiencies, transitional dynamics, or non-inclusive growth patterns in the region. The Gini coefficient shows a positive association with quality of life, which is interpreted in the context of structural transformation and sectoral reallocation processes in transition economies. Robustness checks using Panel ARDL-PMG confirm both long-run equilibrium relationships and heterogeneous short-run dynamics, with evidence of adjustment processes toward equilibrium. The findings suggest that improvements in quality of life in Central Asia are driven primarily by structural transformation, digital development, and education investment rather than aggregate economic growth alone. The study contributes to the literature by providing a comprehensive multi-country panel analysis of Central Asia, integrating infrastructure, inequality, and structural change within a unified framework. The results offer important insights into the mechanisms through which development processes translate into welfare outcomes in transition economies. Full article

Background: Multimorbidity is a growing global health challenge in aging populations, yet its progression across physical, psychological, and cognitive domains and its contribution to health inequalities remain unclear. We compared longitudinal patterns of multimorbidity in China and the United States (US) and examined the socioeconomic and healthcare-related factors associated with these patterns and their functional consequences. Methods: This longitudinal cohort study included adults aged ≥45 years from China (2011–2020) and the US (2012–2020), matched 1:1 by baseline age and sex. Multimorbidity was classified into eight domains spanning physical, psychological, and cognitive conditions and their combinations. Longitudinal changes across five survey waves were assessed. Multinomial logistic mixed models examined socioeconomic and healthcare-related correlations, and Cox models estimated associations with subsequent limitations in activities of daily living (ADL) limitations and instrumental activities of daily living (IADL) limitations. Results: A total of 7064 participants from China (mean age 60.15 ± 7.93 years; 45.4% male) and 7064 matched participants from the US were included. Multimorbidity patterns were more complex in the US at baseline, but progression toward cross-domain multimorbidity occurred in both countries and was more pronounced in China. Psychological conditions occupied a central position in the development of more complex multimorbidity patterns. Higher educational and household wealth were consistently associated with lower odds of cognitive-related and cross-domain multimorbidity in both countries, whereas associations with healthcare-related factors varied across settings. Cross-domain multimorbidity was more strongly associated with functional limitations than within-domain multimorbidity. In particular, physical–psychological–cognitive multimorbidity was associated with substantially higher risks of ADL limitations (hazard ratio (HR)  =  5.70, 95% confidence interval (CI)  =  4.87–6.67 in China; HR  =  7.72, 95% CI  =  5.90–10.11 in the US) and IADL limitations (HR  =  4.14, 95% CI  =  3.64–4.71; HR  =  5.84, 95% CI  =  4.50–7.59, respectively). Conclusions: Multimorbidity increasingly spans physical, psychological, and cognitive domains in both China and the US. Psychological conditions appeared to bridge physical and cognitive conditions in more complex multimorbidity patterns. Integrated care models incorporating psychological health and strategies addressing socioeconomic inequalities may help reduce the burden of multimorbidity and related functional decline. Full article

Housing financialization has transformed residential property from a basic social necessity into a speculative asset, intensifying socio-spatial inequalities in the Global South. In Iran, a bank-dominated financial regime and high spatial inequality severely restrict access to housing finance, particularly for low-income households and climate-induced migrants in mid-sized cities. While the spatial consequences of financialization have been extensively studied in major metropolises, neighborhood-scale exclusion mechanisms in secondary cities remain significantly understudied. This study addresses this gap by employing a hybrid methodology that integrates the Bayesian Best–Worst Method (BWM) with Geographic Information Systems (GISs) and Fuzzy Overlay analysis to quantify and spatially visualize barriers to housing finance in Birjand, Iran. Eleven indicators were weighted through probabilistic expert elicitation (n = 10) using Markov Chain Monte Carlo (MCMC) sampling, with excellent convergence confirmed by Gelman–Rubin diagnostics (R-hat ≈ 1.00). Results identify land use as the dominant barrier (posterior mean = 0.256; 95% CrI [0.244, 0.270]), followed by homeownership rate and education level (≈0.132 each). Spatial modeling reveals a pronounced north–south monetary–spatial divide: southern districts concentrate financial services and formal tenure, while northern peripheries, predominantly inhabited by low-income and climate-migrant populations, constitute financial deserts. These findings demonstrate that spatial barriers to housing finance are structurally embedded in land-use classification and asset-based gatekeeping. The study offers a replicable probabilistic–spatial framework for diagnosing financial exclusion in Global South mid-sized cities and provides evidence-based guidance for spatially targeted policy interventions aligned with SDGs 1, 10, and 11. Full article

Against the backdrop of stock-space urban renewal, green-space governance in megacity cores increasingly requires a shift from expansion-oriented supply to the optimisation of existing spatial resources. This study examines the spatial equity of green-space provision in the central districts of seven Chinese megacities using high-resolution remote-sensing data from 2015, 2020, and 2025. We combined semantic segmentation, nested-buffer measurement, the Gini coefficient, Extreme Gradient Boosting (XGBoost), and Shapley Additive Explanations (SHAP) to evaluate the relationships between urban morphology and green-space provision. We first derived a pixel-level cumulative green-space provision index from nested-buffer measurements and calculated city-year Gini coefficients to quantify distributional inequality. XGBoost models were then used to predict the cumulative green-space provision index from urban morphology, and SHAP was applied to interpret the resulting nonlinear, model-derived associations. The results show that changes in the green-space provision index and its distributional inequality were not synchronous across cities. Beijing showed the largest increase in inequality, whereas Chengdu showed the strongest improvement; Tianjin recorded the fastest increase in the green-space provision index, while Beijing experienced a marked decline. Urban form showed nonlinear associations with the unit-level green-space provision index, helping to explain the spatial differentiation underlying the city-year Gini coefficients. Building density was the primary contributor in most city-year models, whereas compactness showed threshold-like associations, with positive effects at lower levels and inhibitory effects at higher levels. Statistical testing and clustering further indicated substantial heterogeneity among cities, which were categorised into three spatial patterns: centripetal agglomeration, peripheral expansion, and clustering/ring-shaped fluctuation. These findings provide morphology-based evidence for differentiated green-space governance in high-density megacity cores, though they should not be interpreted as a complete socioeconomic assessment of green-space equity. Full article

Background: Socioeconomic deprivation is a well-established determinant of participation in colorectal cancer (CRC) screening. However, less is known about the geographic clustering of screening adherence and whether spatial inequalities mirror regional patterns of socioeconomic disadvantage. This study investigated the association between socioeconomic deprivation and adherence to CRC screening across Italian regions and explored the presence of spatial autocorrelation using geographic analytical methods. Methods: We conducted a nationwide ecological cross-sectional study including 21 Italian regional units. Pearson correlation analysis was performed to explore associations between colorectal cancer (CRC) screening adherence, primary care physician (PCP) workload and socioeconomic deprivation. Multivariable linear regression was used after assessment of multicollinearity using variance inflation factors (VIFs). Sensitivity analyses included alternative deprivation indicators and leave-one-region-out analyses. Spatial dependence was evaluated using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: CRC screening adherence showed substantial geographic variability across Italy, with higher participation in northern regions and lower participation in southern areas. Screening adherence was inversely associated with socioeconomic deprivation. Sensitivity analyses confirmed the robustness of the association across alternative deprivation measures and sequential exclusion of each regional unit. Spatial analysis demonstrated significant positive spatial autocorrelation (Moran’s I = 0.275; p = 0.039), indicating that neighbouring regions tended to exhibit similar screening behaviours. LISA analysis identified significant High–High clusters in northern Italy, Low–Low clusters in southern and insular regions, and isolated spatial outliers, highlighting persistent territorial inequalities in preventive healthcare utilisation. Conclusions: Regional disparities in CRC screening participation were associated with socioeconomic deprivation and modest but significant spatial clustering. These findings provide a regional-level description of inequalities in screening participation and may help inform future public health strategies aimed at reducing disparities in organised colorectal cancer screening. Full article

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. Full article

Telehealth has the potential to improve access to healthcare, but teleassessment usability may be influenced by contextual factors beyond technology access alone. This study investigated factors associated with teleassessment usability among individuals with interstitial lung disease (ILD) in Brazil using a convergent mixed methods design with 31 adults from four Brazilian regions. Usability was assessed with the Telehealth Usability Questionnaire (TUQ-Brazil); associations with contextual variables were examined using Spearman’s correlation. Qualitative data were obtained through semi-structured interviews and analyzed using thematic analysis. Participants generally reported acceptable usability perceptions with predominance of agreement responses; greater dispersion was observed for items related to equivalence with in-person care and video quality. Usability was significantly associated with income (rho = 0.437; p = 0.014), perceived clinical feasibility (rho = −0.397; p = 0.027), and perceived intensity of access barriers (rho = −0.428; p = 0.016). Qualitative findings identified financial constraints, digital literacy, internet stability, third-party support dependence, and absence of physical examination as key experiential factors. Teleassessment was perceived as a complement for follow-up and triage rather than a substitute for face-to-face assessment. Usability in ILD is shaped by socioeconomic, clinical, and structural factors, underscoring the need to address digital inequalities in telehealth implementation. Full article