Search Results (4,769)

Most Sustainable Development Goals (SDGs) involve water, but integrated water resources management (IWRM) does not address them explicitly, especially the important health and sanitation goals. IWRM has structural problems and has been used mainly as a development tool rather than a way to manage water. There is no consensus among the professional communities about the methods and value of IWRM, and its inherent problems make assessment of its success difficult. It surveys national levels while most applications are at local levels. Efforts to improve and assess progress in the water, sanitation, and hygiene (WASH) sector faced similar obstacles, and a new approach based on household surveys was adopted. The mismatch between IWRM and WASH is caused by the polarization between communities of practice for public health and water management. Tools posted by the Global Water Partnership (GWP) do not address WASH explicitly, and the public health profession does not embrace IWRM. These problems can be mitigated by a new definition of IWRM that combines WASH with other water-related issues. To address its complexity, situational archetypes can be mapped to local levels and explained by case studies. To assess progress in IWRM implementation, a new approach should focus on results at local levels rather than methods at the national levels and address the polarization with WASH. SDG reporting relating to water should focus on local outcomes with WASH included, as well as key purposes that include water for food, flood control, drought resilience, and the sustainability of ecosystems. Progress could be assessed via outcome data collected by sector organizations. The GWP program could adopt a new definition of IWRM and new methods of assessment. Full article

Formally stipulating rental terms in farmland transfer contracts is essential to safeguarding transacting parties’ rights, anchoring market price signals, and underpinning the rule-based governance of rural land markets. Drawing on survey data from 1496 rural households across three Chinese provinces, this study empirically examines how connection strength between transacting parties shapes the decision to formally stipulate rental terms in farmland transfer contracts. Baseline estimates show that greater connection strength is significantly and negatively associated with the probability of formal rental term stipulation, a pattern robust to alternative model specifications and variable operationalizations. Mechanism analysis reveals that stronger connections inhibit formal stipulation by concurrently heightening reputational constraints among parties suppressing demand for formal enforcement mechanisms and attenuating perceived transactional risk, which erodes the perceived value of the risk-bounding function that written clauses provide. Heterogeneity analysis further shows that this inhibitory effect is concentrated among ordinary farm household transfers and disappears among new-type agricultural business entities, where institutional rationality crowds out connection-based governance logic. Beyond its direct effect on contract formalization, greater connection strength indirectly undermines the price-anchoring function of written agreements, exposing realized rents to systematic connection-based discounting. These findings carry direct implications for the demand-side redesign of contract formalization policy and the development of county-level rental price guidance systems in rural China. Full article

Food waste presents a significant challenge to sustainable development, resulting in annual economic losses of more than USD 1 trillion. It contributes to 8–10% of global human-caused greenhouse gas emissions and accounts for nearly 30% of agricultural land use. Households are responsible for over half of this waste, with fruits and vegetables being the most frequently discarded items. This highlights the urgent need to promote sustainable consumption habits. This 2024 study surveyed a sample of 923 individuals who consume at least one of four categories: fresh fruits, fresh vegetables, processed fruits, or processed vegetables. It used cluster analysis to segment consumers based on the amount of food waste and fruit and vegetable losses. Three distinct segments were identified. Cluster 1 (Proactive & aware, 56%): Characterised by high environmental awareness (approximately 75%) and efficient food management skills, such as frequent shopping list preparation (48%), resulting in the lowest wastage levels. Cluster 2 (Convenient & situational, 38%): Driven by “convenience waste” mechanisms, where lack of time, poor portioning (44%), and a lack of culinary ideas lead to moderate waste levels despite mid-range awareness. Cluster 3 (Disorganised & wasteful, 6%): Reveals a significant attitude–behaviour gap; despite declaring a desire to limit waste, this group reported the highest perceived levels of waste. This is partly explained by the reverse sunk cost fallacy, where produce from own cultivation is devalued due to the absence of a market price. The findings emphasise that food waste is not a monolithic phenomenon but results from diverse behavioural deficits. The results provide a foundation for tailored behavioural interventions (nudges) and educational strategies to enhance food management skills and contribute to the achievement of sustainable development goals (SDGs). Full article

Background: Diversity in academia promotes research that can reduces health disparities and addresses equity issues for marginalized populations. This study aims to examine the effect of visible minority status on academic achievements in cancer physicians and scientists. Methods: Faculty at the tertiary cancer center in Calgary, Alberta, Canada, completed a survey in 2023 to evaluate demographics, academic rank, leadership positions, number of trainees mentored, number of publications, and amount of grant funding. Chi-square tests and regression analyses examined the impact of race and ethnicity on these academic achievements. Results: The survey was completed by 74 faculty members (47% male, 43% female, 9% gender fluid or providing no answer) with a response rate of 26%. Seven percent were Black or Latin American, 18% East Asian or Southeast Asian, 19% West or South Asian, 39% Caucasian, 6% mixed race, and 11% not providing an answer. Visible minorities were underrepresented in the full professor rank (19%) compared to non-visible minorities (38%) and were overrepresented in assistant/associate professors (28% and 53%, respectively), with 41% of non-visible minorities having the title of assistant professor and 21% as associate professor (p = 0.02). Visible minorities were less likely to have both parents college-educated (OR 0.30, 95% CI 0.09–0.92, p = 0.042) and also less likely to have been raised in a home with household income above $100,000 (OR 0.26, 95% CI 0.07–0.90, p = 0.040). Discussion: Visible minorities are underrepresented in the full professor academic rank. Larger studies are needed to evaluate whether race and ethnicity significantly impact achievements in oncology academics. Full article

Background/Objectives: The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States providing income-eligible households with cash-like assistance to spend on food. In October 2021, a historic policy change permanently increased benefit amounts by 21 percent. This study assessed differences in diet quality and food security, supplemented by participant descriptions of using SNAP, among adults with low incomes residing in the state of Massachusetts from before (October 2020–January 2021) to after (December 2021–February 2022) the benefit increases. Methods: Derived from The Greater Boston Food Bank’s Annual Statewide Survey, our sample included adults with household incomes ≤300% of the federal poverty level who completed diet and food security measures. We calculated Prime Diet Quality Scores (PDQSs), with higher scores reflecting more nutritious diets on a scale of 0–70. Adjusted difference-in-difference regression models evaluated differences in PDQS and food security between SNAP participants and non-participants from before to after the benefit increases. Reflexive thematic analysis of write-in responses summarized experiences with SNAP. Results: Complete data were available for 1051 respondents before and 801 respondents after SNAP benefit increases. We found no significant differences in diet quality or household food security for SNAP participants, compared to non-participants, from before to after the benefit increases. In write-in comments, respondents expressed gratitude for increased benefits but also fear of them being rescinded. Increased benefits helped some better meet food needs, yet many noted rising costs of living prevented benefits from stretching as far. Conclusions: Increased SNAP benefits did not impact food security or diet quality among this sample. SNAP benefits may need to be further increased to meet the nutritional needs of families. Full article

This study examines patterns of digital inclusion in Ziguinchor, Senegal, using household survey data combined with spatial indicators of infrastructure and access. We construct a Digital Inclusion Index (DII) capturing realized digital practices and a Composite Digital Access Score (CDAS) reflecting enabling conditions across six domains, including technological equipment, electricity, affordability, and spatial access. The results reveal substantial variation in digital inclusion across quartiers, with strong associations between inclusion outcomes and infrastructural and socioeconomic conditions, particularly electricity reliability, device quality, and mobility constraints. A key finding is the coexistence of near-universal smartphone ownership with relatively low levels of internet use, indicating a pronounced gap between access and effective engagement. This divergence suggests that device ownership alone is insufficient to ensure meaningful digital participation. A typology combining DII and CDAS further highlights mismatches between realized use and enabling conditions, identifying groups of “under-utilizers” and “over-achievers.” The findings are consistent with multidimensional digital divide frameworks and point to the importance of both structural conditions and user capabilities. Given the cross-sectional design, results should be interpreted as conditional associations rather than causal effects. The study contributes a place-based analytical framework for diagnosing digital inclusion gaps in secondary cities and provides evidence to inform targeted, context-specific policy interventions. Full article

Grassland ecological governance is a systematic project integrating natural and social attributes, involving pastoral social structure adjustment and herders’ livelihood transformation. Pastoral households are the basic production units and direct ecological responsibility bearers in Inner Mongolia. Based on 2001–2023 statistical data and 2014–2023 field surveys, this study adopts an integrated mixed-methods approach: quantitative trend analysis is used to identify long-term changes in household number and size, while qualitative thematic coding of interviews and participatory observation is applied to interpret behavioral logic and governance mechanisms, so as to achieve mutual verification and complementarity between the two data types. We find that pastoral household numbers grew rapidly after 2010 and remained high. By 2023, the number reached 641,500, with average household size dropping to 2.89 people. Driven by ecological subsidy policies, grassland tenure confirmation, and livestock market returns, household scale shrank and grassland was fragmented. The three spontaneously formed ecological governance functions—population regulation, grass-livestock balance, and human-land adjustment—have weakened and shifted from “spontaneous governance” to “passive response.” Herder differentiation in this paper refers to the stratification of pastoral households into distinct groups in terms of livestock scale, grassland area, livelihood structure, and governance capacity, forming heterogeneous behavioral patterns and policy responses. Future governance should abandon the one-sided label of herders as “ecological destroyers,” improve differentiated subsidy policies, and support joint household governance to revitalize endogenous governance capacity. Full article

This study investigates associations between socioeconomic and travel variables among users of the São Paulo metro, focusing on travels made for work and study purposes, which are expected to reflect regular commuting patterns, and identifies the main variables associated with mobility characteristics within this group. Using data from the 2017 Origin–Destination Survey conducted by the São Paulo Metro Company, a set of 10,522 respondents was analyzed. The statistical analysis employed Pearson correlation, factor analysis of mixed data (FAMD), and multiple linear regression. The findings indicate that both socioeconomic and travel variables were significantly associated with mobility characteristics among metro system users in the Metropolitan Region of São Paulo (RMSP). The main variables associated with these mobility characteristics were the distance between origin and destination, the distances to the respective stations, travel duration, age, study status, employment status, education level, Brazilian Criteria score, and number of vehicles. Based on the FAMD, these variables were organized into multiple dimensions that could be descriptively grouped into three main groups of information: travel burden and spatial accessibility; life-stage and educational/occupational profile; and life-stage and socioeconomic position. The socioeconomic composition of consistent metro users predominantly includes middle and middle-lower economic classes, with lower economic class, lower household income, and lower education levels being associated with longer travel distances and durations. The study also revealed that most metro travels are within 20 km, with an average travel time of 74 min. These findings suggest that improved infrastructure and better-distributed metro networks throughout the RMSP may contribute to enhancing accessibility, promoting social inclusion, and improving transportation equity. Full article

Despite Mozambique’s substantial natural gas reserves, most households rely on solid biomass for cooking, with serious consequences for public health, livelihoods, and the environment. The domestic use of these resources could improve energy efficiency, security, and sustainable development. This mixed-methods study uses household interviews, descriptive statistics, multinomial, and conditional logit models, analyzing data from a random survey of 434 households in energy-rich peripheries of northern Inhambane and Maputo City to ascertain the determinants of household cooking energy choice. Results reveal that rising income increases the odds of choosing electricity, LPG, and biomass over natural gas. In energy-rich peripheries, the odds of selecting biomass over natural gas are reduced by 96.2% compared to non-energy-rich regions. Educational and urban habitation are positively correlated with the adoption of electricity and liquefied petroleum gas (LPG). Price serves as a significant negative predictor of fuel selection (OR ≈ 0.000001), whereby each unit increase in price per GJ substantially diminishes the likelihood of opting for alternatives over domestic gas. Monthly fuel expenditure positively predicts electricity, LPG, and biomass adoption (OR = 1.0042), with effects accumulating meaningfully across realistic spending ranges. Households that experienced energy system incidents were more than twice as likely to switch away from natural gas (OR = 2.072), reflecting the critical role of infrastructure reliability in fuel choice. Given natural gas’s potential as a clean cooking transition fuel, the government should prioritize investment in gas infrastructure, expand domestic supply, and promote public awareness of the health and environmental benefits of clean cooking energy. Full article

Background: Lifestyle factors such as diet and physical activity significantly impact on the risk of obesity in individuals with Down syndrome (DS). However, in the absence of national nutritional guidelines in individuals with DS, further work is needed to understand their dietary and physical activity patterns. In this work we retrieved caregivers’ responses on those aspects. Methods: We analyzed data from a cross-sectional online survey of caregivers of individuals with DS conducted as part of the GO-DS21 project and reported in the accompanying paper (nutrients-4216283) (n = 764). We explored physical activity patterns, dietary habits, beliefs around weight-loss interventions and caregiver confidence that family members with DS would engage in a healthier lifestyle. Associations were examined using correlation analysis, and cumulative and binary logistic regression models. Results: Caregivers reported that most individuals with DS exercised 1–3 times per week, with frequency declining with age. Males were more likely to exercise daily than females. Caregiver exercise frequency was positively correlated with that of their DS family member (ρ = 0.521, p < 0.001), suggesting clustering of shared health behaviors within households. In adjusted models, caregivers who exercised regularly had up to thirteen-fold higher odds of having a physically active family member with DS (aOR = 13.02, 95% CI: 7.40–24.06, p < 0.001). Fried food consumption and higher snack frequency were independently associated with perceived obesity status, while sugar-sweetened beverage consumption was not. Caregivers favored exercise as a weight-loss strategy, while anti-obesity drugs were endorsed by only 11% of caregivers primarily and were more likely to be endorsed when obesity was perceived (aOR = 4.21, 95% CI: 2.44–7.39, p < 0.001). Finally, caregiver confidence that their family member with DS would engage in healthier behaviors was associated with perceived obesity status and strongly associated with higher physical activity levels (aOR 14.68, 95% CI: 6.59–33.40, p < 0.001). Conclusions: In this large European caregiver survey, reported consumption of selected energy-dense foods was generally low, although fried food intake and higher snack frequency were associated with perceived obesity. Physical activity patterns were closely aligned between caregivers and individuals with DS, suggesting shared household health behaviors. These findings highlight the importance of involving caregivers and family environments in lifestyle interventions aimed at supporting physical activity and weight management in individuals with DS. Full article

In the context of revitalizing rural development, farmer entrepreneurship has emerged as a significant driver of rural economic growth. However, existing research has not sufficiently examined the specific mechanisms or heterogeneous effects through which digital skills influence farm household entrepreneurial behavior. This gap is the focus of the present study. Utilizing micro-level survey data collected from 936 farm households across Shandong, Shaanxi, and Henan provinces in 2021, we construct a digital skills index using factor analysis. We then employ a Probit model and an Interaction term model to examine the impact of digital skills on entrepreneurial behavior among Chinese rural households and its underlying mechanisms. Additionally, we explore heterogeneity across different household types. The results show that digital skills are positively associated with entrepreneurial decision-making. Further analysis provides suggestive evidence that this relationship may operate through three channels: shaping risk preferences, expanding relational networks, and improving access to credit. Heterogeneity tests reveal that the promoting effect of digital skills is stronger among disadvantaged households, households with a head younger than 45, and those engaged in opportunity-driven or online entrepreneurship. Theoretically, this study contributes by empirically validating a multi-pathway mechanism framework and identifying relevant boundary conditions. Practically, it offers targeted insights for policymakers to design skill-based interventions and foster inclusive entrepreneurial ecosystems in rural areas. Full article

Gastrointestinal nematodes (GIN) limit village chicken productivity, yet smallholder farmers often rely on indigenous knowledge (IK) to manage, and the factors influencing their adoption are poorly understood. A cross-sectional survey of 300 households was conducted to assess the use of IK for GIN management. Predictors of IK use were evaluated with binary logistic regression. Logistic regression model revealed that households with larger flocks (>24 birds) and households with chicken ownership were more likely to use IK (p < 0.05). Whereas age, education, religion, and access to herbalists were not significant predictors. Commonly used plants included Aloe ferox, Aloe marlothii, and Elephantorrhiza elephantina, with leaves, bark, and stems being the most frequently used plant parts. Females used leaves, roots, and stems, while males used bark and seeds. Farmers with more than 10 years of experience reported higher use of leaves and seeds, and very poor households used more leaves and soft stems compared to less poor households. The adoption of IK for GIN management in village chickens is influenced by specific socio-demographic factors, including flock size and chicken ownership. Full article

In Uganda, in 2019, 6.8 million people experienced health conditions that are amenable to rehabilitation. This is largely due to musculoskeletal disorders such as low back pain (LBP). Measuring effective coverage of rehabilitation means assessing whether a population that needs rehabilitation services receives the interventions with sufficient quality to produce the desired health gain. This study reports on the first measurement of effective coverage of rehabilitation in Uganda and globally using chronic primary LBP as the tracer health condition. A population survey was conducted to administer the WHO global tracer indicator questions. The survey questions were used to identify respondents with chronic primary LBP experiencing limitations in functioning and to determine utilization of rehabilitation services. The WHO Disability Assessment Schedule (WHODAS) 2.0 12-item was used for the measurement of an improvement in functioning that is meaningful to service users. The questions were nested in the Iganga–Mayuge Health and Demographic Surveillance Site (IMHDSS) update round 22 in seven sub-counties in rural Eastern Uganda between June and September 2023. Data collection followed a training session on survey administration and data capture for enumerators, field supervisors, research managers and lead scientists from the Makerere University Centre for Health and Population Research and a pilot testing of the data collection tool. Survey administration resulted in data collection for 8645 respondents aged 18 years and above. Specifically, 15.2% of the respondents had experienced chronic LBP in the last 12 months, of which 88.5% had experienced pain that was severe enough to affect their usual household, recreational or work activities. A total of 46% of this population in need of rehabilitation had been utilizing rehabilitation services (crude coverage), with no difference between women and men. Only 7.05% of the respondents with chronic primary low back pain experiencing limitations in functioning had been managed with sufficient quality to produce the desired health gain, defined by a minimal but meaningful improvement in functioning (effective coverage). Full article

How older adults psychologically appraise their health while managing multiple chronic conditions is a behavioral-science question as much as a clinical one. This study estimated the weighted prevalence of favorable mental-health self-appraisal, identified its behavioral, social, and functional correlates, and compared the relative salience of diagnosed-condition burden and functional limitation among U.S. adults aged ≥ 50 years with multimorbidity. This retrospective cross-sectional secondary analysis used the 2023 Medical Expenditure Panel Survey (MEPS) Full Year Consolidated Data File (HC-251). Multimorbidity was defined as at least two diagnosed chronic priority conditions. The primary outcome represents favorable mental-health self-appraisal, derived from MNHLTH53 (excellent/very good/good vs. fair/poor). Covariates were organized using Andersen’s Behavioral Model and health-psychology concepts of adaptation, resources, and lived functional burden. Weighted prevalence estimates and survey-weighted logistic regression models were fitted using PERWT23F, VARSTR, and VARPSU. Robustness checks examined a stricter outcome threshold, proxy adjustment/non-proxy restriction, and a physical-health extension model. The analytic sample included 5523 respondents, representing approximately 77.9 million U.S. adults aged ≥ 50 years with multimorbidity. The weighted prevalence of favorable perceived mental-health self-appraisal was 86.6% (95% CI 85.4–87.7). In the fully adjusted core model (complete-case n = 5330), age 65–74 years (aOR 1.52, 95% CI 1.17–1.98) and age ≥ 75 years (aOR 1.79, 95% CI 1.36–2.36) were associated with higher odds of favorable appraisal. Lower odds were observed for Hispanic respondents, non-Hispanic Asian respondents, lower educational attainment, lower income, non-employment, ≥4 diagnosed conditions, and any functional limitation. The strongest inverse association was limitation status (aOR 0.32, 95% CI 0.27–0.39). Sensitivity analyses were directionally consistent. Favorable mental-health self-appraisal remained common in this medically complex older population, but it was socially and functionally patterned. Functional limitation appeared more behaviorally salient than diagnosis count alone. Because the analysis was cross-sectional and based on household-interview reported measures, these results should be interpreted as associations rather than causal effects. Full article

Background: PPPs are central to Saudi Arabia’s Vision 2030 healthcare transformation, yet evidence on their impact on accessibility, quality, and sustainability remains limited. The purpose of this study was to evaluate the perceived associations between PPP implementation under Vision 2030 and three healthcare system outcomes—service accessibility (geographical, financial, technological), care quality (clinical outcomes, patient satisfaction, efficiency), and reform sustainability (economic, operational, adaptive)—from the perspectives of healthcare professionals and patients in Saudi Arabia. Methods: A cross-sectional, mixed-methods design was employed. Surveys were administered to 150 healthcare professionals and 210 patients at PPP-operated facilities (response rates of 61.2% and 65.6%, respectively). Descriptive and inferential statistics—including t-tests, ANOVA, chi-square tests, and multiple regression analysis adjusted for age, sex, education, household income, comorbidities, and facility type were used to assess associations between PPP initiatives and outcomes. Instrument reliability was confirmed (Cronbach’s α ≥ 0.7), and content validity was supported by an expert-panel content validity index of 0.91. Thematic analysis of open-ended responses captured stakeholder perceptions and challenges (inter-coder κ = 0.83). Results: Among professionals, 56.6% reported improved accessibility following the implementation of PPP, with 60.6% endorsing telemedicine as a key facilitator. However, 64.6% indicated financial access remained unchanged or worsened due to persistent out-of-pocket expenditures, and a statistically significant urban–rural gap was observed (p = 0.008). Quality indicators showed positive trends, including improved patient outcomes (52%), reduced waiting times (60.6%), and high satisfaction with hygiene and safety (74%). Sustainability assessments were cautiously favorable (mean financial viability = 3.4/5), though subsidy dependence remained a concern. Adjusted regression analysis identified financial accessibility (β = 0.31, p < 0.001) and reduced waiting times (β = 0.23, p = 0.005) as variables significantly associated with patient-reported outcomes. Conclusions: PPPs were associated with measurable improvements in healthcare accessibility, quality, and efficiency in Saudi Arabia. However, achieving the Vision 2030 objectives requires reforms that address financial equity, service distribution, workforce nationalization, and governance. Full article