ABSTRACT Many municipalities are increasingly challenged by demographic decline, which threatens their ability to deliver equitable services, particularly in sparsely populated areas. This study investigates the forms, patterns, and motives of inter-municipal collaboration in Sweden, with a focus on how geographical and demographic conditions shape collaborative practices. Using a nationwide survey of Swedish municipalities, the research maps collaborations between municipalities, analysing their prevalence and municipal types. The findings reveal that collaboration is a crucial – often necessary – strategy for municipalities to maintain statutory and welfare services amid shrinking populations and limited resources. Densely populated municipalities exhibit higher levels of collaboration, driven by opportunity and efficiency, while sparsely populated municipalities are motivated primarily by necessity and the need to secure skilled labour. However, the study also highlights barriers to collaboration, such as long distances and limited administrative capacity in sparsely populated areas, which can exacerbate inequalities between municipalities. The study concludes that understanding the geographical and demographic determinants of municipal collaboration is essential for developing policies that support sustainable service delivery and reduce disparities between urban and rural areas.

The increasing global burden of obesity and its metabolic complications necessitates a detailed understanding of specific metabolic phenotypes. This study investigates the 25-year trends in the prevalence of eight metabolic phenotypes that are categorized by body mass index (BMI) and metabolic health status, among Iranian adults from 2000 to 2025. This retrospective analysis utilized data from four national and sub-national cross-sectional studies based on the World Health Organization (WHO) STEPwise approach to non-communicable disease (NCD) risk factors surveillance (STEPS), conducted in Iran from 2007, 2011, 2016, and 2021. Adults aged 25-65 were classified into eight phenotypes based on BMI categories (underweight, normal weight, overweight, obese) and metabolic health status (healthy/unhealthy), defined using the National Cholesterol Education Program's and Adult Treatment Panel III (NCEP-ATP III) criteria. A smoothing spline model was applied to estimate trends from 2000 to 2025. A total of 55,204 adults were included in this study. From 2000 to 2025, the prevalence of metabolically unhealthy overweight (MUOW) increased from 19.16% to 26.20%, and metabolically unhealthy obese (MUOb) from 15.07% to 21.67%, while metabolically healthy normal weight (MHNW) declined from 26.82% to 13.67%. For both genders, there was a constant increase in MUOW and MUOb, with the percentage of MUOb being nearly twice as high in females compared to males (In 2000: 19.37% vs. 10.30%, In 2025: 26.16% vs. 14.86% among females vs. males). The prevalence of MUOW (In 2000: 20.69% vs. 16.99%, among urban and rural areas, respectively, and In 2025: 26.72% vs. 23.14% among urban and rural areas, respectively) and MUOb (In 2000: 15.54% vs. 11.75%, among urban and rural areas, respectively, and In 2025: 23.26% vs. 18.76% among urban and rural areas, respectively) increased, with urban areas showing higher percentages than rural areas. Across age groups, MUOW and MUOb consistently rose over the years, peaking in the 45-54 and 55-64 age groups, while the 25-34 age group had the highest percentage of MHNW. Across provinces, MUOW and MUOb increased, while metabolically healthy underweight (MHUW), MHNW, metabolically healthy obese (MHOb), metabolically unhealthy underweight (MUUW), and metabolically unhealthy normal weight ( MUNW) decreased, with metabolically healthy overweight (MHOW) showing a slight rise. From 2000 to 2025, a significant increase in metabolically unhealthy phenotypes, particularly MUOW and MUOb, was observed among Iranian adults, driven by a decline in metabolically healthy phenotypes. This trend underscores the need for targeted public health interventions, especially for older adults, women, and urban populations. Regional differences reflect varying cultural and socioeconomic factors. The online version contains supplementary material available at 10.1007/s40200-025-01805-3.

Backgroun: SARS-CoV-2 infection was associated with inflammatory, metabolic, haematological, and immunological changes, which contributed to the increase in morbidity and mortality. Objective: To illustrate changes in some biomarkers (ESR, ferritin, CRP, D. dimer, ALT, AST, creatinine, and urea) during COVID-19 and their predictive value in the diagnosis of SARS-CoV-2 infection, especially in rural and urban areas in which sophisticated tests were not available. Materials and Methods: The study includes 154 COVID-19 patients with positive RT-PCR. Sixty age and sex-matched individuals were included as controls. The study was conducted during the period from 23rd July 2021 to the end of December 2021. The subjects with a history of liver diseases, pregnant women, an age of less than 18, and chronic renal failure were excluded. The informed consent was taken from each individual before their enrolment in the study. The study was performed in compliance with the World Medical Association Declaration of Helsinki. Venous blood samples were collected from both groups and tested for determination of creatinine, urea, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D dimer, ferritin, and C-reactive protein (CRP) using a Mindray BS 240 chemical auto-analyzer. Results: The mean serum values were significantly higher (P= 0.01 – 0.001) in COVID-19 patients as compared to matched controls for creatinine, blood urea, ALT, AST, ESR, LDH, D- dimer, ferritin, and CRP. In addition, the mean serum levels of ALT, AST, ESR, LDH, D-dimer, ferritin, and CRP were higher than the values of normal ranges. Although, creatinine and urea mean serum values were significantly higher in COVID-19 patients, their mean values were within the normal range values. ESR was highly significantly (p < 0.001) correlated with ALT, AST, LDH, urea, ferritin, and CRP. While LDH was highly significantly correlated with creatinine, urea, ESR, ferritin, and CRP. Also, D. dimer was significantly highly correlated with ferritin, and CRP. Serum ferritin was highly significantly correlated with creatinine, urea, ESR, LDH, D. dimer, and CRP. While CRP was highly significantly correlated with creatinine, urea, ESR, LDH, D. dimer, and ferritin. Conclusion: ESR, CRP, Ferritin, D. dimer, LDH, AST, ALT, urea, and Creatinine levels in venous blood were significantly elevated in COVID-19 patients compared with controls. Sex- influenced serum levels of C-reactive protein, creatinine, and urea in this study cohort. Serum levels of tested biomarkers may be useful in the diagnosis of COVID-19 in primary healthcare centres, especially in rural areas in developing countries.

Heterogeneity and trend of household energy structure variation between urban and rural residents

Rural regions, with lower population density, typically show higher car dependency leading to greater vehicle ownership, longer trips and higher travel frequencies. As a result, transport electrification of rural areas will strongly influence per-capita carbon reduction targets. This work considers capacity issues on low voltage distribution networks for uptake of large penetration level of electrified transport in rural areas. We use Ireland as a particular case study as 36% of the population live in rural areas, but account for ~55% of transport emissions. We synthesize EV charging load profiles for typical rural residential clusters under increasing EV penetration levels up to 100%. Results indicate that synchronized home charging during off-peak hours (02:00-04:00) is a key issue leading to voltage drops of up to 12% from 230 V and substantial transformer temperature rises and cycling. Smart charging including scheduling, queuing services, and flexible demand strategies offers significant potential to mitigate thermal stress, reducing peak temperatures by almost 80°C depending on the scenario and defer costly grid reinforcements. Urgent collaboration between policy makers, EV charger manufacturers and aggregators, and distribution system operators is required to implement smart charging and offset future costs. Typically considered in the context of dense urban areas, we demonstrate that smart charging can also be of practical benefit in rural regions. • EV uptake in Ireland is expected to be strong in commuter zones surrounding urban centres. • These regions have limited additional grid capacity due to population increases. • Nighttime incentivised charging windows drastically reduce load diversity factor. • Local smart queuing schemes delay the requirement for infrastructure upgrade.

Although cigarette butts (CBs) are known as a hazardous waste and an important litter in public environments, the density of littered cigarette butts in rural areas and the concentration of pollutants leaking from them remain a knowledge gap. This study aimed to investigate the difference in cigarette butt density in urban and rural areas of Iran and the environmental consequences caused by the leakage of various pollutants from them, by comparing the Cigarette Butt Pollution Index (CBPI). Visual surveys were conducted in seven locations in urban environments and sixteen locations in eight villages. The range of cigarette butt density in urban environments was 0.25/m2 to 0.81/m2 (0.46/m2 on average), while in rural environments, it was 0.8/m2 to 2.33/m2 (1.54/m2 on average). Additionally, the CBPI in rural areas was three times higher than in urban areas, resulting in an average CBPI of 31.24 in rural areas and 10.7 in urban areas. In addition, the higher durability of cigarette butts in rural environments resulted in the leakage of 1.09-2.38 µg/m2 of heavy metals, while the leakage of metals from littered cigarette butts in urban environments was estimated to be 0.065-0.406 µg/m2. Developing public services such as cleaning systems in rural environments is essential to reduce pollution caused by cigarette butts.

Plastic waste-derived fuel in diesel engine for 4 kW power generation supporting smart grid stabilization

This commentary proposes that paramedicine be repositioned within the national mental health workforce agenda to strengthen mental health service delivery, particularly in rural areas. Australia is experiencing a growing mental health crisis that is converging with a mental health workforce shortage, particularly in rural areas. While traditionally aligned with physical health emergencies, the paramedic role has expanded, with mental health crises now comprising a significant component of frontline practice. Despite Australia's mental health workforce being multidisciplinary, the capabilities and contribution of paramedicine to the mental health workforce are not recognised within the National Mental Health Workforce Strategy 2022-2032. The evolving role of paramedics highlights the need to strengthen mental health education, training and practice within the profession, enabling paramedics to contribute their distinctive capabilities to mental health care and enhance the capacity of the broader workforce. Furthermore, paramedicine graduate numbers now exceed available ambulance roles, creating a clinically skilled workforce that could be utilised through alternative models of care, particularly in mental health. This commentary draws on current evidence to highlight the evolving role of paramedics in mental health care and opportunities to integrate mental health competencies into paramedic education and training. Mental health competencies can be integrated into paramedic education to strengthen paramedics' capability to manage mental health presentations. Recognising paramedicine within the National Mental Health Workforce Strategy would enhance mental health system capacity, improve rural access to mental health care and provide meaningful employment pathways for new paramedicine graduates.

The role of product diversification in enhancing market vendor adaptability and food-system resilience in Senegal, West Africa

Rural women in developing countries often face significant barriers to employment, income generation, and access to productive resources. In Iran, medicinal plants (MPs) cultivation offers a sustainable pathway toward economic empowerment and livelihood resilience. This study develops and prioritizes strategies to enhance the livelihood sustainability of rural women through MPs cultivation using an integrated SWOT (Strengths – Weaknesses – Opportunities – Threats)–Fuzzy AHP (Analytic Hierarchy Process)–TOWS (Threats– Opportunities – Weaknesses– Strengths) model. Data collected from experts in agricultural and rural development sectors were analyzed to evaluate internal and external strategic factors. The strategic space analysis revealed that internal strengths (0.473) outweighed weaknesses (0.128), while external opportunities (0.325) surpassed threats (0.092), indicating that the favorable strategic space (O + S = 0.798) dominated the risky space (T + W = 0.220). Twelve strategies were formulated and prioritized, among which two emerged as most critical: (1) economic empowerment of rural women through home-based MPs processing enterprises and (2) promotion of greenhouse-based cultivation as a sustainable alternative to wild harvesting. The findings highlight the importance of leveraging indigenous knowledge, improving branding and packaging, and strengthening institutional support to achieve sustainable rural livelihoods. The proposed hybrid framework provides a replicable analytical tool for policymakers to design context-specific interventions linking women's empowerment, biodiversity conservation, and rural economic sustainability.

Unlocking circular economy potential in pig farming: Waste, impacts and pathways from Southeast Vietnam

Epidemiological investigation and risk factors of Peste des Petits Ruminants (PPR) in goats of Northeastern Bangladesh.

Can carbon insetting deliver credible sustainability outcomes in forest-risk supply chains? A critical perspective from soy and cattle production in Argentina’s Gran Chaco

Multilevel geographic determinants of smoking and smokeless tobacco use among young men in India: evidence for targeted addiction prevention policies.

Spatiotemporal characteristics and driving factors of coal-burning hotspots in Shandong Province revealed by multi-source data and machine learning.

Virologic failure (VF) in children living with HIV (CLHIV) remains challenging in sub-Saharan Africa, reaching alarming rates in Cameroon. We sought to evaluate predictors of virologic response and HIV drug resistance (HIVDR) among CLHIV in Cameroon during the introduction of pediatric dolutegravir (pDTG)-based antiretroviral therapy (ART). We conducted a facility-based longitudinal study from November 2022 through April 2023 among CLHIV (age 0-10 years) attending the Chantal BIYA Foundation's Mother and Child Centre in Yaoundé-Cameroon. Plasma viral load (PVL) and HIVDR were evaluated, with VF defined as 2 consecutive PVL ≥1000copies/mL under active adherence counseling/support. Overall, the 318 enrolled participants had a median (interquartile range) age of 8 (6-9) years and 162/318 (50.9%) girls. Most (299/318, 94.03%) received pDTG-based ART and mean ART duration was 5.6 ± 2.6 years. At enrollment, 37 (11.6%) children were virally unsuppressed (PVL≥1000copies/mL), with higher odds among children from rural areas ( P = 0.018) and among those reporting poor adherence ( P < 0.001). After active adherence counseling and support, 30/37 (81.1%) children were resampled after 1 month and 3 remained unsuppressed, indicating <1% (3/311) with VF overall. Among those experiencing VF, HIVDR mutations were found in <1% (2/311) children [L74V(1/3), K103N(1/3), M184V(2/3), P225H(1/3)]. Virologic response among children receiving pDTG-containing ART was strong in Cameroon. Combining robust ART regimens with active adherence support can advance sustained progress towards HIV elimination in children by 2030 in sub-Saharan Africa.

Trichinellosis knowledge and preventive practices in Mapuche communities of southern Chile: Evidence for targeted One Health implementation.

Dedication to the dwelling and neighbourhood? Rural-urban differences in determinants of mid-to-later-life homeowners to age@home

Pediatric skin conditions are a common reason for primary care visits, yet access to general dermatologists and pediatric dermatologists remains limited, particularly in rural areas. Primary care providers often manage these conditions with minimal formal dermatology training, which can result in diagnostic and treatment challenges. The Extension for Community Healthcare Outcomes (ECHO) model offers a telementoring framework that combines didactic learning with case-based discussions to improve provider knowledge and clinical decision-making. Seven peer-reviewed studies evaluating pediatric and general dermatology ECHO programs have been identified that include retrospective cohort studies, program evaluations using strengths, weaknesses, opportunities, and threats analysis, a prospective educational intervention, and a descriptive case report. While program structures varied, results consistently demonstrated improvements in provider confidence, diagnostic accuracy, and ability to develop more effective treatment plans. Diagnostic concordance between primary care providers and dermatology experts ranged from 40% to 54%, with the lowest agreement on treatment plans. Participants reported high satisfaction, and several programs demonstrated increased attendance over time. Pediatric dermatology ECHO programs represent a promising and scalable strategy to improve dermatologic care for children in underserved settings. Continued development of pediatric-focused curricula, sustainable delivery models, and strategies to better assess outcomes will be critical to realizing Project ECHO’s full potential.

This study examined nuanced preferences and unmet needs for bereavement care of mothers who experienced stillbirth or neonatal death. Cross-sectional survey. The Philippines. A total of 169 bereaved mothers aged 18 years or older who had experienced stillbirth or neonatal death on or after 30 January 2020 in the Philippines. Response patterns to nine self-administered questions about desired bereavement care and the care they received were analysed using latent class analysis. Measurement invariance was assessed across participant types and urbanicity. Multinomial logistic regression was used to examine the associations between latent classes, demographics and perinatal loss information. Desired type of bereavement care and unmet need for bereavement care. We identified three mutually exclusive stable latent classes related to desired care and unmet needs. For desired bereavement care, one class was characterised by a strong preference for seeing, holding, spending time with, and naming the baby, but low desire in memory making (25.1%). This preference was more common among mothers from urban areas (aOR = 3.04) and those who experienced stillbirth (aOR = 3.07), compared to those from rural areas and who experienced neonatal death, respectively. Regarding unmet need for bereavement care, one class reported unmet needs for memory making (28.3%), with preterm mothers (aOR = 3.11) three times more likely to belong to this class than those who delivered full-term. This study offers novel insights into the complex bereavement care preferences and needs of mothers who experienced perinatal loss. The findings can inform future frameworks and guide the development of culturally appropriate, context-specific interventions for mothers and families.