Search Results (1,185)

There is a paucity of evidence informing our understanding of how the COVID-19 pandemic affected pediatric trauma in Manitoba, Canada. The aim of this retrospective cohort study was to analyze the effect of the pandemic on pediatric trauma and its association with patients’ demographic characteristics. Pre-pandemic and pandemic patient cohorts were created, and the rates of these injuries were compared by patients’ sex, age, and area of residence. During the pre-pandemic period, ED presentations with an MSK or head injury were lower in patients from rural communities compared to urban communities (RR: 0.68, p < 0.001, RR: 0.51, p < 0.001). Hospitalizations with an MSK or head injury were higher in patients from rural communities (RR: 1.78, p < 0.001, RR: 1.14, p = 0.62). During the pandemic, MSK injury ED presentations (RR: 1.14, p = 0.037) and hospitalizations (RR: 1.78, p < 0.001) were higher in patients from rural communities. Patients from rural communities had a lower rate of head injury ED presentations (RR: 0.81, p < 0.001), but higher hospitalization rate (RR:1.96, p = 0.001). Differences in the rates of pediatric MSK and head injuries could be attributed to the limited healthcare resources in underserved rural communities. Efforts should be made to rectify these inequities to ensure fair access to healthcare for these patients. Full article

This study examines how territorial peripherality and regional entrepreneurial ecosystem quality shape the growth trajectories of Italian university spin-offs, with a specific focus on internal areas. Combining firm-level data from NETVAL and AIDA with territorial indicators from the Italian Strategy for Inner Areas (SNAI) and ISTAT, we construct a panel of 655 university spin-offs observed between 2018 and 2022. Two composite indicators capture provincial peripherality and regional ecosystem quality. Using mixed-effects models, we analyse their effects on revenue and employment growth. Results show that stronger regional ecosystems support employment growth overall and significantly amplify revenue growth for spin-offs located in internal areas, partially compensating for structural territorial disadvantages. The findings highlight the importance of place-based ecosystem policies and the strategic role of universities in fostering knowledge-based development and proxy indicators of territorial resilience in peripheral regions. Full article

Urban street greening structure plays a crucial role in promoting environmental justice and enhancing residents’ daily well-being, yet existing studies have primarily focused on vegetation quantity while neglecting how perception and governance interact to shape fairness. This study develops an integrated analytical framework that combines deep learning, machine learning, and spatial analysis to examine the impact of perceptual experience and socio-economic indicators on the equity of greening structure distribution in urban streets, and to reveal the underlying mechanisms driving this equity. Using DeepLabV3+ semantic segmentation, perception indices derived from street-view imagery, and population-weighted Gini coefficients, the study quantifies both the structural and perceptual dimensions of greening equity. XGBoost regression, SHAP interpretation, and Partial Dependence Plot analysis were applied to reveal the influence mechanism of the “Matthew effect” of perception and the Site governance responsiveness on the fairness of the green structure. The results identify two key findings: (1) perception has a positive driving effect and a negative vicious cycle effect on the formation of fairness, where positive perceptions such as beauty and safety gradually enhance fairness, while negative perceptions such as depression and boredom rapidly intensify inequality; (2) Site management with environmental sensitivity and dynamic mutual feedback to a certain extent determines whether the fairness of urban green structure can persist under pressure, as diverse Tree–Bush–Grass configurations reflect coordinated management and lead to more balanced outcomes. Policy strategies should therefore emphasize perceptual monitoring, flexible maintenance systems, and transparent public participation to achieve resilient and equitable urban street greening structures. Full article

Urban resilience has emerged as a critical paradigm for addressing the intertwined challenges of climate change, rapid urbanization, and social inequality, positioning green public spaces as catalysts for social, ecological, and institutional transformation. This article presents a systematic review conducted under the PRISMA 2020 guidelines, examining how collaborative and community participation influenced transformative urban resilience in green public spaces between 2021 and 2025. A total of 6179 records were initially identified across ScienceDirect and MDPI (last search: July 2025), of which 26 empirical studies met the inclusion criteria (peer-reviewed, empirical, published 2021–2025). Methodological rigor was strengthened through the application of the Mixed Methods Appraisal Tool (MMAT, 2018) and confidence in qualitative evidence was assessed using the GRADE-CERQual approach, enhancing transparency and reliability. Data extraction and synthesis followed a theoretical-methodological coding framework, allowing for the comparison of participatory strategies, typologies of green spaces, resilience dimensions, and applied instruments. The results show that multi-actor co-management, co-design, and community self-organization are the most frequent participatory strategies, while urban green infrastructure, pocket parks, and urban gardens constitute the predominant spatial contexts. Socio-ecological and social-participatory resilience emerged as dominant theoretical perspectives, with qualitative and mixed-methods designs prevailing across studies. Evidence synthesis through GRADE-CERQual identified seven key pathways—multi-actor co-management, Nature-based Solutions, community-based actions, social equity, cultural identity, institutional innovation, and planned densification—each contributing differently to resilience dimensions. Overall, the findings highlight that transformative resilience depends on deep, inclusive participatory processes, multi-level governance, and the integration of social, ecological, and cultural dimensions. Despite the heterogeneity of designs and unequal data adequacy, this review confirms that transformative urban resilience is a co-produced process grounded in community action, ecological sustainability, and collaborative governance. Strengthening underexplored areas—technological innovation, cultural resilience, and standardized methodological instruments—is essential for advancing comparative research and practice. Full article

Spatial equity of healthcare services is a critical concern in social equity and spatial justice research. Despite the availability of various methods to measure this equity, few studies have integrated the supply–demand coupling perspective with the analysis of impacts of residents’ travel behaviors’ on equity. This study develops and applies a Travel Behavior-based Coupling Coordination Degree (TB-CCD) method to assess the spatial equity of healthcare services in the Xi’an region. The results show the following: (1) Traditional single-mode models may fail to accurately assess this equity, whereas the TB-CCD model provides a more realistic evaluation. (2) Public transportation and driving provide a more equitable distribution of healthcare services compared to walking and cycling modes. The spatial equity of healthcare services exhibits a distinct core–periphery pattern, where accessibility and equity levels are significantly higher in city centers than in suburban areas. (3) The distribution of inequity ‘deserts’ and ‘oases’ in healthcare services is found to be travel-mode dependent, with the walking and public transportation modes exhibiting the highest incidence of these classifications. These findings provide valuable insights for urban planners and policymakers to formulate strategies and spatial plans aimed at enhancing equity in healthcare services. Full article

The walking accessibility of primary healthcare institutions (PHCIs) is a pivotal determinant of health equity. However, prior studies often lack a comprehensive assessment that integrates the spatiotemporal dynamics of both multi-faceted supply and multi-scenario demand. To bridge this gap, this study develops an enhanced two-step floating catchment area method (2SFCA-MSD) that concurrently incorporates multiple types of service supply and multiple temporal demand scenarios to quantify PHCI walking accessibility, with equity evaluated using the Gini coefficient and Lorenz curve. The results indicate that: (1) Both supply and demand exhibit pronounced spatiotemporal inequalities. (2) Walking accessibility varies substantially across scenarios; Health services for vulnerable groups (Service B) exhibit the highest walking accessibility across all three supply scenarios, while the morning work scenario demonstrates the best walking accessibility among the four demand scenarios. (3) Gini coefficients exceeding 0.5 across all scenarios reveal severe resource allocation inequity. By establishing a dynamic supply–demand integration framework, this research advances methodological precision in accessibility evaluation, uncovers critical spatiotemporal mismatch patterns, and provides actionable insights for optimizing PHCI planning to promote spatial justice in urban health. Full article

Urban heat islands pose intensifying threats to public health, equity, and urban livability as climate change amplifies temperature extremes. This systematic review synthesizes evidence from 33 primary studies (2021–2025) examining health impacts, mitigation strategies, and policy integration. The analysis focuses on interaction mechanisms, specifically how mitigation strategies differentially reduce health burdens across vulnerable populations, to advance systems-level understanding of urban heat dynamics. Following PRISMA guidelines, the review examined these mechanisms across three interconnected domains: health burdens, physical mitigation effectiveness, and post-pandemic policy synergies. Findings reveal profound inequities in heat exposure and associated health outcomes, with disadvantaged populations experiencing 26–45% higher heat-related mortality risk and 3–4 °C greater exposure than affluent communities, even after controlling for income. Physical mitigation strategies show measurable effectiveness, providing 1–6 °C cooling from green infrastructure and 2–22 °C from cool surfaces. Optimal interventions vary by socioeconomic context, with urban trees being more effective in disadvantaged areas, while cool roofs are better suited to affluent zones. COVID-19 natural experiments demonstrated 30–50% anthropogenic heat reductions, revealing strategic opportunities for integrating heat mitigation with 15-Minute City planning and work-from-home normalization. Effective implementation requires moving beyond isolated interventions toward spatially differentiated, equity-centered strategies aligned across planning, transportation, and governance domains. The post-pandemic period presents a critical window for embedding heat mitigation into broader urban transformation agendas. Full article

This study investigates the spatial patterns and drivers of carbon emissions across China’s three major urban agglomerations—Beijing–Tianjin–Hebei (BTH), the Yangtze River Delta (YRD), and the Pearl River Delta (PRD)—from 2011 to 2020. A sequential analytical framework was employed to examine emission inequality, spatial dependence, dynamic transitions, and multi-scale drivers. Specifically, the Gini and Theil indices were used to quantify and decompose regional disparities. Spatial clustering patterns and heterogeneity were then identified through global and local Moran’s I analysis. Following this, spatial Markov chains modeled state transitions and neighborhood spillover effects. Finally, the Spatial Durbin Model (SDM) was applied to distinguish between the direct and indirect effects of key socioeconomic drivers. The findings reveal that disparities in emissions are largely driven by factors within each region. In BTH, heavy industrial lock-in accounts for 47.1% of the within-group inequality. By contrast, the YRD and PRD show noticeable convergence, achieved through industrial synergy and technological restructuring, respectively. The mechanisms of spatial spillover also differ across regions. In the YRD, emissions exhibit strong clustering tied to geographic proximity, with Moran’s I consistently above 0.6. In BTH, policy linkages play a more central role in shaping emission patterns. Meanwhile, in the PRD, widespread technological diffusion weakens the conventional distance-decay effect. The influence of key drivers varies notably among the urban agglomerations. Economic growth has the strongest scale effect in the PRD, reflected by a coefficient of 0.556. Industrial transformation significantly lowers emissions in the YRD, with a coefficient of −0.115. Technology investment reduces emissions in BTH (−0.124) and the PRD (−0.076), but is associated with a slight rebound in the YRD (0.037). Overall, these results highlight the persistent path dependence and distinct spatial interdependencies of carbon emissions in each region. This underscores the need for tailored mitigation strategies that are coordinated across administrative boundaries. Full article

Accurate monitoring of income inequality is critical for sustainable socioeconomic development and realizing the United Nations Sustainable Development Goals (SDGs). However, assessing inequality for counties continues to be challenging because of the high cost of household surveys and the limited accuracy of traditional nighttime light (NTL) proxies. To address this gap, we develop the Distribution Matching-based Individual Income Inequality Estimation Model (DM-I3EM), which integrates NTL data with household surveys. The model employs a three-stage workflow: logarithmic transformation of NTL data, estimation of Gini coefficients through Weibull distribution fitting, and selection of region-specific regression models, enabling high-resolution mapping and spatiotemporal analysis of county-level income inequality across China. Results show that DM-I3EM achieves superior performance, with an R² of 0.76 in China’s Eastern region (outperforming conventional NTL-based methods, R ≈ 0.5). By overcoming the spatiotemporal gaps of survey data, the model enables full-coverage estimation, revealing a regional divergence in income inequality across China from 2013 to 2022: inequality is intensifying in northern and western counties while stabilizing in the developed southern coastal regions. Furthermore, spatial agglomeration of inequality has strengthened, particularly in coastal urban clusters. These findings highlight emerging risks to socioeconomic sustainability. This study provides a robust, replicable framework for estimating inequality in data-scarce regions, offering policymakers actionable evidence to identify high-risk areas and design targeted strategies for advancing SDG 10 (Reduced Inequalities). Full article

Reducing urban–rural income inequality is a central objective of sustainable development and a critical challenge for inclusive growth in emerging economies. This study examines the impact of the digital economy on urban–rural income inequality in China. Using panel data across 279 cities in China and Chinese Household Income Project (CHIP) data, we find that the digital economy significantly widens urban–rural income inequality. Specifically, digital industries and innovations are the main drivers, contrasting with inclusive infrastructure. Although we observe a positive association between the digital economy and educational attainment among rural residents, such improvements do not appear to be fully translated into higher income. One possible explanation is that the digital economy is more effective in alleviating skill mismatch among urban residents than among their rural counterparts. Finally, our results suggest that Public Employment Services may help mitigate this negative effect through channels such as fiscal subsidies and improving skills training accessibility. Our findings highlight the need for caution regarding the inequality implications of digital economy development in emerging economies and underscore the crucial role of institutional arrangements in promoting socially sustainable and inclusive development. Full article

Background and Objectives: The COVID-19 pandemic had a significant impact on physical activity among various populations. Due to a lack of country-representative studies on the prevailing trends in leisure-time physical activity since the COVID-19 pandemic, the aim of this study was to assess the temporal, social, and demographic inequalities in the prevalence of engagement in exercise and sports among working-age citizens of Lithuania from 2021 to 2024. Materials and Methods: This study included four samples of working-age citizens (1600 per year, 6400 in total). Four surveys were conducted, and the distribution of respondents among the groups was compared. Results: In general, the prevalence of engagement in exercise and sports did not change over a four-year period (48.8%, p = 0.256). The prevalence of regular exercise and sports increased, while engagement in irregular exercise and sports decreased (p = 0.014). Binary logistic regression analysis showed that younger age, male sex, being single, having no children under 18 years of age, selecting foods for health strengthening, positive self-assessment of nutrition and health status, use of dietary supplements, attention to purchasing healthy products, and university education attainment were associated with engagement in exercise and sports (regular or irregular) (p < 0.05). Analysis focused specifically on regular exercise and sports revealed associations with a longer time since the onset of the COVID-19 pandemic, younger age, urban residence, selection of foods for health strengthening, positive assessment of nutrition and health status, and university education attainment (p < 0.05), while no significant associations were observed with sex, marital status, presence of children under 18 years of age, use of dietary supplements, or attention to purchasing healthy products (p > 0.05). Conclusions: The overall prevalence of physical activity engagement among working-aged Lithuanian citizens did not change from 2021 to 2024, engagement in regular and irregular exercise and sports has changed. Engagement in regular and irregular exercise and sports is associated with different social profiles. Full article

Land-use allocations—such as housing density, parcel size, housing typologies, parks, and other green areas—constitute key spatial planning (zoning) parameters that significantly shape how resources and opportunities are distributed within cities. As such, they play a central role in producing or constraining social justice across urban areas and communities, functioning as mechanisms through which planning and development processes deliver—or withhold—critical resources. Yet the literature remains limited in explaining how the allocation of specific zoning parameters contributes to social justice outcomes, which parameters matter most, and which dimensions of social justice they affect. This paper addresses this gap by examining and conceptualizing how spatial planning (zoning) parameters shape social justice in cities. A conceptual review approach, guided by Jabareen’s methodology, is employed to analyze and categorize planning parameters according to their specific contributions to social justice in cities. Accordingly, the study identifies three dimensions of social justice shaped by these parameters—inclusion, accessibility, and recognition—each addressing a key aspect of urban justice. Building on these concepts, we develop a new conceptual framework, referred to as the Conceptual Framework for Just Urbanism. At its core is the logic of difference, which explains how planning parameters are allocated unevenly across geographies, demographic groups, and socioeconomic conditions, producing spatially differentiated inequalities. The study concludes that planning parameters and zoning are powerful carriers of urban justice through their distribution of resources and opportunities. Full article

Urban tree canopy is increasingly recognized as a health-protective form of green infrastructure, yet its distribution remains uneven across socioeconomically stratified neighborhoods. This study quantifies fine-scale tree-canopy inequity across Census Block Groups (CBGs) in Baltimore and examines associations with socioeconomic deprivation and modeled pollution-related cancer risk. We integrated (i) 2023 US Forest Service canopy estimates aggregated to CBGs, (ii) Area Deprivation Index (ADI) national and state ranks, (iii) American Community Survey 5-year population counts, and (iv) EPA NATA/HAPs cancer-risk estimates aggregated to CBGs using population-weighted means. Associations were assessed using Spearman correlations and visualized with LOESS smoothers. Canopy was negatively associated with ADI national and state ranks (ρ = −0.509 and −0.503), explaining 29–31% of canopy variation. Population-weighted canopy declined from 47–51% in the least deprived decile to 13–15% in the most deprived (3.4–4.1× disparity). Beyond socioeconomic gradients, overall distributional inequity was quantified using a population-weighted Tree Canopy Inequality Index (TCI; weighted Gini), yielding TCI = 0.312, indicating substantial inequality. The population-weighted Atkinson index rose sharply under increasing inequality aversion (A_0.5 = 0.084; A₂ = 0.402), revealing extreme canopy deficits concentrated among the most disadvantaged neighborhoods. Canopy was also negatively associated with modeled cancer risk (ρ = −0.363). We constructed a Triple Burden Index integrating canopy deficit, deprivation, and cancer risk, identifying spatially clustered high-burden neighborhoods that collectively house over 86,000 residents. These findings demonstrate that canopy inequity in Baltimore is structurally concentrated and support equity-targeted greening and sustained maintenance strategies guided by distributional justice metrics. Full article

Background: Driven by rapid urbanization, infrastructural development, socio-economic growth, and population increase, noise pollution has become a major public health and environmental policy challenge in Moroccan cities. However, current legislation and enforcement mechanisms remain insufficient to address rising exposure levels and associated health risks. Methods: This systematic review followed PRISMA guidelines to examine urban noise levels, health implications, the regulatory frameworks, and policy actions related to noise pollution in Morocco. Various databases were systematically searched (Scopus, Web of Science, Google Scholar), along with reports from international organizations and government bodies for studies published between 2003 and 2025. Eligible documents included peer-reviewed publications and official reports directly addressing Moroccan noise pollution, legislation, urban impacts, or health outcomes. Results: Twenty-three Moroccan studies and additional regional, European, and legislative sources were included. Findings show that average noise levels in Moroccan urban centers generally exceed international safety thresholds and are associated with cardiovascular risks, sleep disturbances, and psychological stress. The regulatory framework suffers from weak enforcement, limited monitoring protocols, and an absence of noise mapping. Tangier, Béni Mellal, Témara, Marrakech, and Casablanca exhibit significant environmental inequalities, particularly in low-income districts. Conclusions: Morocco’s current noise-management system is inadequate to address the growing health and environmental impacts of urban noise. Urgent actions are needed, including a dedicated noise-control law, systematic monitoring, noise mapping, and integration of public-health considerations into environmental governance. Policy reforms must prioritize vulnerable populations and align with international best practices. Full article

This study proposes a novel framework for allocating CO₂ emission rights within the Yangtze River Delta (YRD) urban agglomeration, tackling the inter-city CO₂ transmission dynamics frequently neglected in conventional allocation models. Current emission allocation methods fail to capture the spatial spillover effects of CO₂ emissions driven by atmospheric transport, resulting in potential inequities. Leveraging the WRF model to simulate carbon emissions across 27 cities, we develop a two-stage network Data Envelopment Analysis (DEA) model that integrates both emission generation and governance capacities. Our findings highlight significant inter-city CO₂ transmission, with the wind direction and speed playing a pivotal role in emissions spread. In contrast to traditional models, our approach considers the regional interdependence of emissions, enhancing both fairness and efficiency in the allocation process. The results indicate that cities with stronger governance systems, including green technology investments and effective air quality management, are rewarded with higher carbon allowances. Moreover, our model demonstrates that policies prioritizing environmental governance over raw emission levels can foster long-term sustainability. This work provides a comprehensive methodology for achieving a balanced allocation of emission rights that integrates economic growth, environmental management, and equity considerations within complex urban agglomerations. Full article