Search Results (9,145)

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability. Full article

The predictors of urban trip mode choice and one of its important components, public transit ridership, have still not been thoroughly investigated using case studies in Central Europe. Therefore, this study attempts to clarify the correlates of mode choices for commute travel and shopping, and entertainment travel to distant places, as well as the frequencies of public transit use of university students, using a wide range of explanatory variables covering individual, household, and socio-economic attributes as well as their perceptions, mobility, and the nearby built environment. The correlation hypothesis of these factors, especially the role of the street network, was tested by collecting the data from 1288 university students in Krakow and developing Binary Logistic and Ordinal Probit models. The results show that gender, age, car ownership, main daily activity, possession of a driving license, gross monthly income, duration of living in the current home, daily shopping area, sense of belonging to the neighborhood, quality of social/recreational facilities of the neighborhood, and commuting distance can predict commute and non-commute mode choices, while gender, daily activity, financial dependence from the family, entertainment place, quality of social/recreational facilities, residential self-selection, number of commute trips, time living in the current home, and street connectivity around home are significantly correlated with public transit use. Some of these findings are somewhat different from those regarding university students in Western Europe or other high-income countries. These results can be used for policy making to reduce students’ personal and household car use and increase sustainable modal share in Poland and similar neighboring countries. Full article

In 2018, an outbreak of human rabies caused by the hematophagous bat Desmodus rotundus hit the Brazilian Amazon Basin community of Melgaço, Brazil, resulting in the death of 10 people, 9 of them children. The incidence of rabies has been on the rise among populations in conditions of vulnerability in this ecosystem due to human expansion into sylvatic environments and limited access to public health services. To address this issue, in September 2019, a collaborative effort from national, local, and international institutions promoted and executed a pilot for pre-exposure prophylaxis of a population in high-risk areas for hematophagous bat-mediated rabies. This measure is usually only implemented in response to outbreaks. The pilot was conducted in Portel, in a nearby location to the previous outbreak, with the use of fluvial transportation, and 2987 individuals in 411 dwellings were successfully vaccinated. It established a methodology for pre-exposure prophylaxis for populations in conditions of vulnerability, identifying logistics and costs, as well as characterizing the target riverine population regarding risk factors associated with bites by hematophagous bats. This approach offers a proactive measure to prevent future outbreaks and provides valuable insights into how to address the issue of rabies in remote and difficult-to-reach areas. Full article

Brazil is the second largest beef producer and a leading exporter, contributing to some 3000 t CWE in global markets (27.7% of market share). The sector has experienced substantial development, but yields remain far below potential, and there are growing concerns regarding land use change and greenhouse gas emissions. The need for sustainable technologies, such as sound pasture management and integrated farming systems, is evident, but adoption may be low amongst farmers unable to keep up with technological advances. This article describes the historical developments of Brazilian beef farming towards sustainability and discusses possible socioenvironmental outcomes. We combined an extensive literature review, public data, and our own insights as senior researchers to achieve that. The trajectory shown here evidenced the technological intensification of Brazilian beef farming, with strong support of public policies for decarbonizing agriculture. Nonetheless, the pace of this transition may affect small to medium farmers with limited access to information, technologies, and credit. Our recommendations involve a broad program of technical assistance and training on sustainable technologies, including financial and digital literacy. A novel approach to financing farmers is suggested to support a sustainable and inclusive transition in beef farming in Brazil. Full article

Lassa Fever is a deadly viral haemorrhagic disease, causing annually several hundreds of deaths in West Africa. This zoonotic disease is primarily transmitted to humans by rodents of the genus Mastomys, even though other rodents reportedly carry the Lassa virus, while secondary interhuman transmission accounts for approximately 20% of cases. Although this disease has been endemic in rural zones of Nigeria, Sierra Leone, Liberfia, and Guinea for hundreds of years, it is also characterised by epidemic outbreaks in the dry season, responsible for heavy death tolls. No licensed vaccine or satisfying treatment is currently available. Disease management is hindered by the incomplete knowledge of the epidemiology and distribution of the disease, resulting from an inadequate health and surveillance system. Additional scientific constraints such as the genetic diversity of the virus and the lack of understanding of the mechanisms of immune protection complexify the development of a vaccine. The intricate socio-economic context in the affected regions, and the lack of monetary incentive for drug development, allow the disease to persist in some of West Africa’s poorest communities. The increase in the number of reported cases and in the fatality rate, the expansion of the endemic area, as well as the threat Lassa Fever represents internationally should urge the global community to work on the disease control and prevention. The disease control requires collaborative research for medical countermeasures and tailored public health policies. Lassa Fever, created by the interconnection between animals, humans, and ecosystems, and embedded in an intricate social context, should be addressed with a ‘One Health’ approach. This article provides an overview of Lassa Fever, focusing on Nigeria, and discusses the perspectives for the control of disease. Full article

Suicidal behaviour is defined as taking actions with the intention of killing oneself and thinking of performing these actions. Suicide is a serious public health problem with complex biological, social and psychological risk factors and a multidimensional clinical appearance, occurring all over the world and ranking among the leading causes of death. In this study, psychological approaches explaining suicide were evaluated under the headings of first-generation and second-generation suicide theories, the different aspects of these theories were put forward, and previously published studies and recent evidence were reviewed. A literature review on the theoretical foundations of suicide is presented. First-generation suicide theories were developed before the 2000s and second-generation suicide theories were developed after the 2000s. While Psychodynamic Theory, Social Learning Theory, Hopelessness Theory, Shneidman’s Suicide Theory and Escape Theory are included under the title of first-generation suicide theories, Interpersonal Psychological Suicide Theory, Three Stage Suicide Theory, Complementary Motivational-Demotivational Theory and Variable Predisposition Theory are examined as second-generation suicide theories. The approaches of the theories provide important evidence in understanding suicidal behaviour and recognising various risk factors in the transition from suicidal ideation to suicidal action. Controlling the risk factors may contribute both in terms of preventive community mental health and in the development of health policies. Full article

Reducing under-five mortality is a crucial indicator of overall development in a country. However, in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in sub-Saharan Africa, Angola faces significant challenges such as malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, which are the leading causes of death among children. This study aimed to identify factors associated with hospital deaths among children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Using a hospital-based case-control design, the study included 1020 children, among whom 340 experienced hospital deaths. Distal and intermediate determinants emerged as primary predictors of hospital mortality, showing significant associations with: mother without schooling (OR [95%CI] 4.3 [1.2–15.7], p < 0.027); frequent alcohol consumption during pregnancy (OR [95%CI] 3.8 [2.5–5.9], p < 0.001); hospital stay ≤24 h (OR [95%CI] 13.8 [6.2–30.8], p < 0.001); poor nutritional status (OR [95%CI] 2.1 [1.4–3.2], p < 0.001); short interbirth interval (OR [95%CI] 1.7 [1.1–2.5], p < 0.014); maternal age ≤19 years (OR [95%CI] 5.6 [3.0–10.8], p < 0.001); and maternal age ≥35 years (OR [95%CI] 2.1 [1.2–3.7], p < 0.006). These findings highlight the preventable nature of most under-five hospital deaths and underscore the urgent need to address social inequities and improve the quality of primary healthcare services to effectively reduce child mortality in Angola. Full article

Promoting sustainable and equitable public transportation services is essential for addressing disparities and preventing social exclusion among diverse population groups for daily activities. This paper proposes a comprehensive approach to assess transport disadvantages and identify areas with limited access to public transport and services. By combining statistical and geographic techniques, we analyze demographic, socioeconomic, and travel data to spatially contextualize areas based on the social structure and understand the characteristics of population groups facing transportation challenges in the Porto Metropolitan Area. Cluster analysis results revealed four distinct clusters with homogeneous characteristics. In contrast, service area analysis assessed the public transport coverage to identify served zones, the population within these zones, and activities reached in the region. Our findings indicate that suburban and rural areas often lack access to public transport stops, aggravated by lower service frequencies, leading to high reliance on private cars for essential activities, such as work and education. Despite the good geographical coverage of rail and bus stops, urban and central–urban areas also suffer from inadequate service frequencies, impacting public transport usage. Improving service quality in high-demand areas could encourage greater public transport utilization and enhance accessibility. Identifying areas facing inequities facilitates targeted policy interventions and prioritized investments to improve accessibility and address mobility needs to access services effectively. Full article

In construction, risk is inherent in each project, and success involves meeting defined objectives beyond budget and schedule. Factors vary for infrastructure projects, and their correlation with performance must be studied. In the case of public–private partnership (PPP) transportation, the level of complexity is higher due to more involved parties. Risks and success factors in PPP projects affect each other, which may lead to project failure. Recognizing the critical risk factors (CRFs) and critical success factors (CSFs) is indispensable to ensure the success of PPP infrastructure project implementation. However, the existing research on the PPP risk and success relationship has not gone into sufficient detail, and more support to address the existing gaps in the body of knowledge and literature is necessary. Therefore, in response to the missing area in the public–private partnership transportation industry, this paper analyzed the correlation between PPP risks and success factors. It identified, explored, and categorized various risk and success factors by combining a literature review, expert panel interviews, and a questionnaire survey among both the public and private sectors, a win–win principle. The data collected were analyzed using the structural equation modeling (SEM) approach and relative significance. Results show the relationship between risk and success factors, their influence on PPPs, and the most important factors, known as CRFs and CSFs, with high loading factors (LF > 0.5) and high relative importance (NMS > 0.5). The top five CRFs include “Contract quality (incomplete, conflicting)”, “Staff expertise and experience”, “Financial market risk”, “Conflicting objectives and expectations”, and “Inefficient feasibility study”. The top five CSFs were found as “Appropriate risk allocation and risk-sharing”, “Strong financial capacity and capability of the private sector”, “Government providing guarantees”, “Employment of professional advisors”, and “Realistic assessment of the cost and benefits”. This study advances the understanding of risk and success factors in PPPs and contributes to the theoretical foundations, which will benefit not only public management, policy consultants, and investors but also academics interested in studying PPP transportation projects. Full article

The in-depth participation and application of new-generation information and communication technologies, such as big data, Internet of Things, artificial intelligence, etc., in the field of smart cities have promoted their abilities in urban fine governance, public services, ecological livability, scientific and technological innovation, etc. Smart cities are gradually becoming recognized as the best solution to “urban problems”. Smart city construction drives urban innovative development, accumulates kinetic energy for economic growth, strengthens social support functions, enhances the effectiveness of the ecological environment, and promotes the convergence and integration of urban green development and high-quality development. This paper constructs a difference-in-differences model based on propensity score matching. Additionally, fiscal science and technology investment is introduced as mediating variables to further explain the mechanism through which smart city pilot policy impacts urban green and high-quality development. This research uses panel data from 156 prefecture-level cities in China from 2006 to 2019 to empirically test that the construction of smart cities has a significant positive effect on urban green and high-quality development. The mediation effect model shows that an increase in the level of local government’s fiscal science and technology investment enhances the positive effect of smart city construction on urban green and high-quality development. This research concludes with policy recommendations: the government should seize the development opportunity presented by smart city pilot policy, providing necessary policy support and financial incentive for the construction of smart cities. This will optimize the local economic structure, transform the driving forces of urban development, and assist cities in achieving green and high-quality development. Full article

This study involves a material flow analysis (MFA) of single-use plastics (SUPs) and packaging materials in the Republic of Korea, focusing on their short lifespans and significant contributions to plastic waste. Based on the MFA results, recommended policies for managing packaging materials and SUPs were proposed. In 2021, 6.340 Mt of synthetic resin were produced, with 39.7% (2.518 Mt) utilized for packaging materials and SUPs. The per capita consumption of these materials was 48.7 kg/year, surpassing global averages. The separate collection rate was 54.6%, with films (26.2%) and manufacturing facilities (10.6%) exhibiting the lowest rates. The overall recycling rate was 52.7%, and 981 t of recycled waste was directly placed in soil. The reliability of the MFA results was estimated to be 83.1%, which is an improvement compared to previous studies. Recommendations include reducing plastic use, expanding recycling infrastructure, raising public awareness, and implementing stricter regulations to control soil contamination. Full article

We explored the outcomes and challenges encountered during a 12-year collaborative development endeavor in Tanzania, focused on enhancing the healthcare system. The Health Promotion and System Strengthening (HPSS) project, supported by the Swiss Government and implemented by the Swiss Tropical and Public Health Institute (Swiss TPH) from 2011 to 2023, aimed to strengthen various aspects of Tanzania’s healthcare landscape. This included reforms in health insurance through the improved Community Health Fund (iCHF), the establishment of a public–private partnership to optimize the health commodity supply chain via a Prime Vendor System (Jazia PVS), the implementation of health technology management innovations, and the facilitation of participatory community and school health promotion initiatives. Operating in a multisectoral, interdisciplinary, and systemic manner, the HPSS project employed a variety of interconnected strategies, focusing on key entry points within the Tanzanian health system, starting from district level to national policies. These efforts followed a three-stages approach to reach a sustainable adoption of the innovations, going through the process of service and product innovation, integration into service delivery systems, and finally their adoption in the respective institutional policies. Each stage presented distinct frameworks and challenges, detailed in this article. The development of innovative concepts was complemented by capacity building through on-the-job training, establishment of new accredited training programs for pre-service trainings, and the development of new IT systems integrated into the governmental IT environment, as well as efforts to improve transparency, accountability, and governance. Activities in these fields were guided by operational research, following the translational approach of Swiss TPH to go from innovation and validation to application. The example of the HPSS project highlights the cycle of developing and testing innovations at the community and district level, followed by endeavoring national-level integration and policy adjustments, consequently resulting in improved service delivery at the district and community level. Full article

This article documents and explores the history of the e-scooter ban in Toronto, Ontario, Canada as a pathway to examining broader issues concerning the eradication of accessibility barriers in public spaces for pedestrians with disabilities and respectful uses of consultation to develop disability-inclusive regulations. The use of e-scooters poses a particular dilemma to accessibility for persons with disabilities. On the one hand, the concept of disability contemplates attitudinal and environmental barriers, as noted, for example, in the Preamble of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). Attitudinal and environmental barriers have traditionally stemmed from interests that are inherently opposed to the collective interests of disabled persons. Examples include attitudes that project stigma against persons with disabilities or a focus on seeking to preserve historical features of the built environment for their aesthetics, without consideration for their accessibility or functionality for disabled persons. They have also generally originated in periods of historical marginalization or exclusion of persons with disabilities. By contrast, e-scooter debates and connected debates regarding the regulation of micromobility vehicles, contain at least one dimension that could very well be shared with persons with disabilities—that is, the preservation of the environment. E-scooters are also a phenomenon of contemporary disability exclusion: policies concerning environmental sustainability, including those promoting e-scooters, are being developed contemporaneously with growing international and national legal recognition of disability rights. These factors render arguments over appropriate regulation of the use of public spaces more complex as, within those arguments, one sees two competing positive policy directions that need to be addressed: the rights of pedestrians with disabilities and environmental sustainability. This article concludes with theoretical and practical suggestions for strengthening regulatory policymaking to address these and other complex intersectional issues of accessibility policy design. Full article

Rural ecological revitalization (RER) is one of the five goals of China’s rural revitalization strategy. However, there is a lack of an effective index system to evaluate RER levels, which hinders the implementation of this national policy and reduces the effectiveness and efficiency of public resource input. Using the driver-pressure-state-impact-response (DPSIR) framework, this study developed an evaluation framework consisting of 5 subsystems, 12 secondary indicators, and 33 tertiary indicators. Using the entropy-weighted TOPSIS method, we analyzed a set of 30 provinces’ data and empirically determined the weights of each indicator. We found that the response subsystem had the largest weight (0.338), followed by the state (0.271), impact (0.148), pressure (0.130), and driver (0.113). We then evaluated the RER level in each province and found that five provinces had high RER levels, 16 provinces had moderate RER levels, and nine provinces had low RER levels. Using Moran’s I, we examined spatial autocorrelation of provincial RER levels at global and local dimensions. We found significant positive global autocorrelations across all subsystems, indicating that geological aggregation exists in all RER subsystems. The local autocorrelation results showed that low–low and high–high patterns were the dominant local autocorrelation patterns. According to the findings, we discussed the possible implications of this RER evaluation index system and provided policy recommendations for strengthening RER in different regions across the country. Full article

Ecuador is one of the world’s leading banana exporters; however, low productivity resulting from inadequate agronomic management requires an analysis of banana production units. This study aimed to define the types of banana production units based on the different agronomic management practices adopted by producers in two Ecuadorian provinces. Data from the National Institute of Statistics and Censuses (INEC) for 2021 were used, with a sample of 319 production units. Principal component and cluster analyses were applied to identify the different types of production units, resulting in four types: high technology conventional (Cluster 1), balanced conventional (Cluster 2), intensive conventional (Cluster 3), and agroecological (Cluster 4). It is important to highlight that 58% of the production units are intensive conventional and use an average of 3.5 management practices, with 98% using fertilizers, 100% using fungicides and pesticides, and 45% using improved genotypes. In contrast, agroecological production is still incipient in Ecuador (4.7%). Regression analysis showed that waste is important in high-yield production units in the three clusters. In addition, Cluster 2 relied on regional factors, family labor, and irrigation efficiency, while in intensive conventional farms (Cluster 3), banana yield was related to fungicide application. Therefore, public policies should be customized according to cluster-specific characteristics to optimize agronomic management practices and facilitate their transfer among groups. Full article