Search Results (193)

Background: The Canada Health Act (CHA), enacted in 1984, guarantees universal access to medically necessary care, yet inequities in hospital use persist. Acute length of stay (ALOS) is a key indicator of hospital efficiency, patient recovery, and healthcare system performance, with prolonged stays linked to higher costs, avoidable infections, and strain on acute care capacity. Understanding patterns in ALOS is critical not only for hospital management but also for public health, as extended stays can limit timely access to care and exacerbate population-level health inequities. Objective: This study examines social, geographic, and clinical gradients in ALOS and investigates whether the effects of admission urgency vary by sex, neighbourhood income, and rural–urban residence within a universal healthcare system. Methods: Using 2024–2025 hospital discharge data from the Canadian Institute for Health Information, this study examined ALOS as a function of comorbidity, sex, socioeconomic status, rural–urban residence (geography), and admission type (urgent versus elective). Interaction effects between admission urgency and key social and geographic variables were evaluated to assess subgroup differences in ALOS. Results: Disparities in ALOS were evident. Older age, male sex, urgent admission, and greater comorbidity were associated with longer stays, whereas higher neighbourhood income and urban residence were linked to shorter stays. Interaction analyses revealed substantial heterogeneity: compared with elective rural admissions, urgent urban admissions had 30.4% longer ALOS. Urgent admissions also amplified socioeconomic and sex-based differences, with male patients experiencing 27.9% longer stays than females. Conclusions: From a public health perspective, these findings highlight how system capacity constraints and social inequities jointly shape hospital use. Reducing avoidable variation in ALOS will require policies that strengthen acute care surge capacity, improve coordination for urgent admissions, and address upstream socioeconomic and geographic barriers to care, thereby promoting more equitable and efficient hospital services. Full article

Depopulation threatens livelihoods, services, and cultural landscapes. In the scientific literature, tourism is frequently discussed as a potential lever in depopulation contexts, yet reported demographic outcomes vary widely across settings. We conducted a PRISMA-informed systematic review of Web of Science and Scopus (1993–2025), identifying 268 articles that were coded using a hybrid bibliometric–narrative approach into thematic axes and reported effect directions (positive, neutral, negative). Reported outcomes are heterogeneous and conditional rather than uniform. Tourism is associated with positive demographic trajectories, primarily where it is embedded in diversified local economies, supported by strong social capital, and integrated into coordinated governance and planning frameworks; negative or neutral outcomes recur under tourism monoculture, strong seasonality, housing pressure, and weak territorial regulation. Keyword co-occurrence and narrative analyses identify three dominant thematic clusters (rural development, spatial–cultural transformation, and sustainability) structured around depopulation as the central conceptual node. The geography of knowledge production further indicates a strong European concentration, particularly in Southern Europe, where tourism is explicitly framed as a policy response to demographic decline, while non-European research adopts more analytical and sectoral perspectives. Overall, this review shows that tourism functions as a contingent territorial lever rather than a universal remedy: its demographic associations depend on institutional, spatial, and socio-economic configurations. By systematically organizing fragmented evidence, the study clarifies when tourism is reported to support demographic stabilization, and when it is reported to have no effect or to coincide with continued decline, providing a clearer analytical basis for future comparative research and context-sensitive territorial policy design. Full article

Background/Objectives: Lung cancer is one of the major causes of mortality worldwide despite breakthroughs in screening, diagnosis, and treatment. These advances have not been evenly spread, and discrepancies between populations remain concerning. This article examines lung cancer discrepancies in epidemiology, risk factors, screening, diagnosis, treatment access and quality, and survival outcomes, and identifies the main causes. Methods: An extensive narrative evaluation of peer-reviewed literature, national cancer surveillance reports, and large population-based research was searched. The evidence on lung cancer disparities by race, ethnicity, socioeconomic status, sex, geography, and healthcare access was synthesized. Disparities in prevention, early identification, treatment, and outcomes were organized into this paper. Results: Lung cancer incidence, stage, treatment, and survival showed persistent differences. Racial and ethnic minority groups, people on low-incomes, uninsured people, and rural or resource-limited people had higher disease burden and worse outcomes. Access to low-dose computed tomography screening, rapid diagnostic follow-up, surgical resection, molecular testing, targeted medicines, immunotherapy, palliative care, and clinical trials was unequal. When guidelines are followed, survival outcomes are similar across races and ethnicities. Conclusions: Lung cancer disparities are mostly caused by structural, social, and healthcare system factors, not biology. Coordinated measures to provide equitable screening, prompt and high-quality treatment, research inclusion, and culturally sensitive and policy-driven actions are needed to enhance lung cancer outcomes. Full article

In a time of rapidly rising home deliveries, the introduction of drones as part of a future logistics system could enhance the efficiency of some goods movements, but brings with it the prospect of a change to the environment and society. This study seeks to identify how varied the concerns are amongst both practitioners and citizens and also how different the concerns of the public are from those of practitioners. The research uses Q-Sort methods to understand the critical variables and clusters of opinions which reflect potential policy controversies. A Q-Sort was first conducted with 53 professional stakeholders before a common but reduced size Q-Sort was undertaken with a representative sample across three different local geographies (N = 610) in the UK. The findings suggest many common clusters of viewpoints across the expert and citizen samples, with the key interactions being between the degree of in principle support for drones for delivery and the degree of practical control over their introduction. However, the citizen group was dominated by drone sceptics worried about privacy, terrorism and environmental impacts in a way which was not manifested in the experts. Few differences occurred between places suggesting that simple urban–rural dichotomies do not define the key controversies. Full article

The scope of this research is to contribute, through qualitative bases and case studies, to the relevance of old and new materialities in the process of rural change and restructuring in remote rural areas. The research on rural materialities can be found in cultural studies of heritage, modern geographical history and postmodern rural geography, based on post-structural and Deleuzian geographies, mainly geographies of heterogeneous associations and experimental and vibrant materiality. Geographic materialities allow multiple approaches in rural geography. A first approximation allows us to distinguish between old and new materialities. In each old and new category, it is possible to use different approaches: qualities of place, more-than-human, rural change, assemblage theory, material design, emotional geographies and cultural heritage. The sustainability-related outcomes are the rural material styles reviewed. Styles of research on old materialism are based on (1) qualities on place, (2) heritage and its effects in place, and (3) rural restructuring. The new change in the conceptualization of the material world is based on reconstructed local materialism and dissolved traditional rural communities. The styles in new rural materialities in the rural geographical field are (1) rural restructuring processes and new materialities, (2) material values and sophisticated visions of the countryside, (3) ensembles and material lives, and (4) emotional negotiations and feelings. Full article

Rural spatial commodification serves as a vital pathway toward comprehensive rural revitalization. Its development is closely intertwined with land use transition, with each process exerting reciprocal influence on the other. Research on the coupling between these two systems has emerged as a cutting-edge interdisciplinary field bridging rural geography and land system science. Based on a systematic review of research advances in rural spatial commodification and land use transition, this paper summarizes the existing gaps in the literature and attempts to construct a coupling framework integrating rural spatial commodification and land use transition. The findings indicate that, although the academic community has amassed a substantial body of research on rural spatial commodification, land use transition, and their coupled relationship with rural transformation, several gaps persist. These encompass the absence of systematic indicator frameworks and quantitative validation methods for rural spatial commodification, insufficient exploration into the coupling mechanisms between rural spatial commodification and land use transition, and a notable scarcity of empirical studies examining land use optimization driven by rural spatial commodification. Future research on the coupling between rural spatial commodification and land use transition should follow the logical framework of “elucidating theoretical connotations, characterizing coupling relationships, analyzing coupling mechanisms, simulating coupling processes, and regulating coupling states”. It is essential to strengthen the interdisciplinary integration of rural geography and land system science, thereby providing scientific guidance for the allocation of resources in rural areas and the implementation of rural revitalization practices. Full article

Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births in Nevada from 2022 to 2024. Methods: A statewide, hospital-clustered, cross-sectional analysis was conducted using linked Medicaid billing and birth record data. Discordance was defined as GES identified in one source but not the other. Incidence per 1000 live births was stratified by demographic characteristics. Multilevel logistic regression assessed patient- and hospital-level predictors, with random hospital intercepts. Results: Among 50,394 live births, the discordance rate was 95.09 per 1000 (95% Confidence Interval: 92.5–97.7). Substantial disparities were observed by race/ethnicity, socioeconomic status, and geography, with higher discordance among White non-Hispanic mothers, those residing in rural or frontier counties, and individuals with lower educational attainment or living in lower-income areas. Modest but meaningful variation was also observed across hospitals, including differences by hospital size and teaching or research status. Conclusions: Findings highlight substantial discordance in GES reporting and underscore the limitations of single-source surveillance. Findings also have clear policy relevance, indicating that improved cross-system data integration would strengthen statewide surveillance, enhance early detection, and support more equitable resource allocation and intervention strategies. Full article

Background: Chronic diseases such as type 2 diabetes mellitus and cardiovascular disease and their cardiometabolic risk factors require management, which includes lifestyle interventions. Rural and remote residents are disproportionately affected by these conditions compared to their urban counterparts. Studies have examined barriers to chronic disease and cardiometabolic risk factor management in urban environments, but rural perspectives remain underexplored, especially in Western Australia (WA) with its vast geography. This study examined rural general practitioners’ (GPs) views on barriers and facilitators to chronic disease and cardiometabolic care in rural WA through lifestyle management. Methods: This qualitative study used semi-structured interviews with 15 rural WA GPs recruited via rural networks using convenience and snowball sampling. Braun and Clarke’s reflexive thematic analysis was used to identify patterns and themes within the qualitative data that addressed the study questions. Results: According to rural general practitioners, major barriers to chronic disease and cardiometabolic risk care included geographic isolation, socioeconomic disadvantage and an obesogenic food environment in rural areas, as well as severe time and financial constraints for GPs and workforce shortages with a high turnover and lack of accessible allied health professionals. Facilitators included co-located multidisciplinary teams, case management/health coaching, better remuneration for complex consultations involving preventive care and upstream policy measures, such as improving healthy food affordability and availability. Conclusion: Rural patients face systemic, geographic and socioeconomic barriers that are substantially greater than those in urban settings; these barriers impact GPs caring for their patients with chronic disease and cardiometabolic risk factors. Targeted solutions to these barriers such as attention to workforce issues, investment in lifestyle coaching approaches and having dedicated case managers, could reduce rural–urban inequities in chronic disease outcomes. Full article

Landfill contaminants pose significant risks to environmental and human health, particularly in rural Alaska. These communities are predominantly Alaska Native and face unique challenges in solid waste management due to geography, climate, and limited infrastructure. This scoping review assessed published research on the impacts of landfill contaminants in the Arctic (Aim 1) and Alaska specifically (Aim 2). Seventy-one studies met the inclusion criteria, all of which were used to develop a conceptual model of contaminant transport pathways. Thirty-nine studies included Alaska-specific research: thirty-three focused on environmental impacts, and six addressed human health (e.g., birth outcomes, cancer). Key topics included waste burning, heat generation, carbon release, leachate characterization, and water or sediment contamination. Evidence specific to Alaska suggested landfill leachate may contaminate surface water and groundwater, and that microbes can migrate beyond the landfill site boundaries in communities using honeybuckets (plastic bag-lined buckets that collect human waste). Landfill contaminants also impacted wildlife through consumption of garbage, which may have human health implications for subsistence-based communities. Major research gaps remain in understanding individual-level exposures, the effects of emerging contaminants, and the mechanisms of contaminant transport pathways. Further research designed for causal inference is needed to support improvements to public and environmental health. Full article

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were classified into four dimensions: cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), vulnerability factors (e.g., migrants, refugees, low-literacy groups), and geography (indigenous MENA populations versus diaspora and Mediterranean immigrant communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men’s engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality. Full article

Intangible cultural heritage (ICH) is deeply embedded in everyday social life, yet its officially recognized spatial distribution reflects both the independent influences of cultural traditions, development trajectories, and governance practices, and the complex interactions among them. Focusing on 494 national-level ICH items across ten categories in Jiangsu(J), Zhejiang(Z), and Shanghai(H), this study adopts a social-geographical perspective to examine both the spatio-temporal evolution and the driving mechanisms of ICH recognition in one of China’s most developed regions. After rigorous verification of point-based ICH locations, we combine kernel density estimation and the average nearest neighbor index to trace changes across five batches of national designation, and then employ the univariate and interaction detectors of the Geodetector model to assess the effects of 28 natural, socioeconomic, and cultural-institutional variables. The results show, first, that ICH exhibits significant clustering along river corridors and historical cultural belts, with a persistent high-density core in the Shanghai–southern Jiangsu–northern Zhejiang zone and a clear shift over time from highly concentrated to more dispersed and territorially balanced recognition. Second, human-environment factors—especially factors such as urban and rural income and consumption; residents’ education and cultural expenditures; and public education and cultural facilities—have far greater explanatory power than natural conditions, while different ICH categories embed distinctively in urban and rural socio-economic contexts. Third, bivariate interactions reveal that natural and macroeconomic “background” variables are strongly amplified when combined with demographic and cultural factors, whereas interactions among strong human variables show bivariate enhancement with diminishing marginal returns. In summary, these findings enrich international debates on the geography of ICH by clarifying how recognition processes align with regional development and social equity agendas, and they provide a quantitative basis for category-sensitive, place-based strategies that coordinate income policies, public cultural services, and the joint safeguarding of tangible and intangible heritage in both urban renewal and rural revitalization planning. Full article

Tourism is a key spatial process linking human mobility, resource consumption, and environmental change. Despite growing awareness of climate risks, sustainable travel behavior often remains inconsistent with pro-environmental attitudes, reflecting the persistent attitude–behavior gap. This study examines how psychological factors—sustainability motives, ecological identity, and climate attitudes—interact with artificial intelligence (AI) transparency to shape travel decisions with spatial and environmental consequences. Using survey data from 1795 leisure travelers and a discrete-choice experiment simulating hotel booking scenarios, the study shows that ecological identity and climate attitudes reinforce sustainability motives and intentions, while transparent AI recommendations enhance perceived clarity, data visibility, and reliability. These transparency effects amplify the influence of eco-scores on revealed spatial preferences, with trust mediating the relationship between transparency and sustainable choices. Conceptually, the study integrates psychological and technological perspectives within a geographical framework of human–environment interaction and extends this lens to rural destinations, where travel decisions directly affect cultural landscapes and climate-sensitive ecosystems. Practically, the findings demonstrate that transparent AI systems can guide spatial redistribution of tourist flows, mitigate destination-level climate pressures, and support equitable resource management in sustainable tourism planning. These mechanisms are particularly relevant for rural areas and traditional cultural landscapes facing heightened vulnerability to climate stress, depopulation, and uneven visitation patterns. Transparent and trustworthy AI can thus convert environmental awareness into spatially sustainable behavior, contributing to more resilient and balanced tourism geographies. Full article

Aging is associated with alterations in gut microbiota, yet the combined effects of geography and diet remain underexplored in elderly populations. This study investigated the gut microbiota of 227 healthy Vietnamese individuals aged ≥60 years, stratified by select urban and rural residence in both Hanoi and Thanh Hoa provinces, and across three age groups (60–69, 70–79, ≥80 years). Dietary patterns were collected and recorded for each participant. 16S rRNA gene sequencing revealed significant differences in microbial diversity and composition associated with geographical location (urban, rural) and age. Urban participants in Hanoi exhibited higher richness and greater abundance of health-associated genera, including Bifidobacterium, Fusicatenibacter, and Blautia, likely reflecting more diverse plant-based diets. In contrast, rural participants in Thanh Hoa showed enrichment of beneficial butyrate-producing genera such as Fusicatenibacter, Roseburia, Lachnospira and Blautia, possibly linked to traditional diets rich in freshwater fish and fermented foods. Participants aged 70–79 years displayed reduced microbial richness compared to other age groups. Age-related reductions in Roseburia, Veillonella, and Prevotella were also observed. These findings highlight how geography, diet, and aging shape the gut microbiota and may guide microbiota-targeted dietary strategies to promote healthy aging. Full article

This study evaluates South Africa’s progress toward achieving SDG 4.5 by examining disparities in educational access and outcomes for vulnerable groups, including girls, children with disabilities, rural populations, and low-income households. The study recognises multidimensional inequalities and develops strategies that promote inclusive and equitable education. The quantitative approach was employed by constructing a composite Educational Equity Index (EEI) using seven indicators: gender parity in primary and lower secondary completion, location-based attainment among adults, gender parity in adult lower secondary education, disability parity in primary completion, gender parity among the poorest quintile, and wealth parity in youth literacy. These indicators were standardised and aggregated to develop the EEI. The study developed a multivariate regression model to identify the most influential parity factors affecting youth literacy outcomes. Data from UNESCO, the World Bank, and national education statistics were sourced. The findings revealed persistent inequities across gender, disability, geography, and economic status, with particularly pronounced disparities in adult participation, rural attainment, and youth literacy among poorer households. While parity in youth literacy and primary education completion has been largely achieved, inequities persist in secondary education completion and adult education. The findings further revealed that upper secondary completion had a strong positive impact on equity outcomes, whereas disparities in adult participation significantly hindered progress. This study conducted a comprehensive, data-driven examination of educational equity in South Africa. By presenting a novel index approach customised to SDG 4.5, it provided fresh insights into multidimensional inequalities and offered actionable evidence for targeted policy interventions. The study contributes to scholarship on inclusive education while highlighting practical pathways for South Africa to accelerate progress toward equity in line with global education commitments. Full article

This paper examines the historical evolution and pathways of rural transformation (RT) at the regional level in four Asian countries—Bangladesh, China, Indonesia, and Pakistan. We conduct a comparative spatial analysis of regional level changes in high-value agricultural production (HVAP) and non-farm rural employment (NFRE). Using long-run data and bivariate mapping, we trace how rural economies have evolved over the past four decades and identify multiple transformation pathways. The results reveal both common upward trends and stark regional contrasts. China demonstrates the most rapid and synergic rise, integrating agricultural upgrading with widespread non-farm rural expansion. Bangladesh and Indonesia show more diverse trajectories, shaped by migration, urbanization, and agro-industrial linkages. Pakistan’s transformation is slower and more fragmented, marked by strong progress in some regions but persistent lags in others. The findings underscore that RT is not linear and can follow diverse pathways—synergic, HVAP-driven, NFRE-driven, remittance-based, or stagnant—depending on geography, natural endowments, policy, and local resource endowments. Our research highlights the need for regionally tailored strategies that link agricultural upgrading with rural labor diversification, strengthen rural–urban connectivity, and ensure that lagging regions are not left further behind. Full article