As core regions for energy production and consumption, coal-resource-based cities play a pivotal role in achieving national emission reduction targets. This study examines panel data from 49 coal-resource-based cities in China from 2002 to 2022. Building on an analysis of the factors influencing carbon emission in resource-based cities, an extended STIRPAT model is developed, and a data-driven nonparametric additive regression model is employed to investigate the relationships among resource dependence, green technology innovation, and carbon emission. The results reveal that: The inhibitory effect of green technology innovation on urban carbon emission exhibited a threshold, with marginal emission reduction effects dynamically varying across urban development stages. Resource dependence demonstrated a path-locking effect, where highly dependent cities exhibited slower declines in carbon emission compared to their resource dependence. The national low-carbon pilot policies have significantly reshaped the relationship patterns between resource dependence and carbon emission in coal-resource-based cities. Specifically, pilot cities exhibited an M-shaped relationship between resource dependence and carbon emission, along with an N-shaped relationship between green technology innovation and carbon emission. In contrast, non-pilot cities demonstrated a flattened inverted U-shaped curve and a saddle-shaped curve for these respective relationships. Furthermore, the driving mechanisms of carbon emission influencing factors displayed distinct regional and lifecycle heterogeneities: Mature cities needed to surpass technological thresholds; growing cities had yet to see emission reduction effects; declining cities experienced weakened effectiveness of technology investment; regenerative cities faced the dynamic balance dilemma between low-carbon development and economic recovery, with carbon emissions exhibiting volatile non-linear trend; while cities in eastern, central, western, and northeastern regions all showed mismatched patterns between carbon emission and resource dependence. These findings provide a theoretical foundation for formulating differentiated urban emission reduction policies and promoting the low-carbon transition of coal-resource-based cities.
Against the backdrop of comprehensively advancing the construction of a Beautiful China, the importance and demonstrative role of sustainable development in resource-based cities have become increasingly prominent for achieving the goals of Chinese-style modernization. Using panel data from 270 Chinese cities from 2007 to 2023 as the research sample, this study employs the national sustainable development policies for resource-based cities as a quasi-natural experiment and applies a difference-in-differences (DID) model to empirically analyze the impact of these policies on the synergistic effects of pollution reduction and carbon emission reduction. The study further investigates the underlying mechanisms and heterogeneity of these effects. The findings reveal three key insights: Sustainable development policies in resource-based cities significantly enhanced the synergistic effects of urban pollution reduction and carbon emission reduction; these policies primarily exerted their influence through three channels-reducing energy consumption intensity, optimizing industrial structure, and stimulating green technological innovation; and the effects were more pronounced in cities located southeast of the Hu Line, non-growth-stage cities, highly industrialized cities, and cities with lower consumption levels. Based on these findings, we recommend continuously optimizing and deepening the policy framework for sustainable development in resource-based cities, with particular emphasis on strengthening supporting measures aimed at reducing energy consumption intensity and fostering green technological innovation. Meanwhile, differentiated and precision-targeted synergistic governance strategies for pollution reduction and carbon emission reduction should be implemented according to local conditions, fully considering variations in urban development stages and resource endowments to maximize policy effectiveness.
Understanding how respiratory infectious diseases spread across cities of different socioeconomic tiers is crucial for regionally targeted interventions. However, most spatial prediction frameworks neglect the combined influence of urban hierarchy and human mobility in shaping transmission risk. We integrated large-scale intercity mobility data into an agent-based branching process model to simulate the spatial diffusion of respiratory pathogens across mainland China. Three COVID-19 outbreaks were used for validation: the Omicron outbreak in Shanghai, the Delta outbreak in Nanjing, and a multi-provincial Delta outbreak in northwestern China. We applied the framework to model the spread of SARS-CoV-2 (Omicron variant) and Influenza A to quantify tier-specific transmission risks. Tiers denote a hierarchical classification of Chinese cities based on concentration of commercial resources, transportation hub centrality, etc., ranging from super-tier metropolises to lower-tier cities. Predicted first arrival times showed strong agreement with observed data (r = 0.68 and 0.76), and mobility-based predictions more accurately identified outbreak origins than distance-based approaches. Markedly different tier-dependent diffusion patterns were observed across pathogens. Influenza A exhibited stable and stratified diffusion, with transmission confined mainly within the same or adjacent urban tiers and limited cross-tier seeding. In contrast, SARS-CoV-2 (Omicron) initially concentrated in super-tier and tier-1 cities but rapidly spread to lower-tier cities, producing a pronounced hierarchical pattern of spread that quickly diminished tier-level differences in transmission risk. Across pathogens, higher-tier cities consistently faced greater early importation risk; however, this disparity persisted for Influenza A but was rapidly attenuated for Omicron due to its high transmissibility and fast spatial expansion. A key limitation is that the model was validated against city-level first arrival times rather than full epidemic dynamics, and was parameterised using mobility data from China's "dynamic zero-COVID" period, which may limit direct quantitative generalisability to other settings. Spatial transmission risk reflects an interaction between pathogen-specific transmissibility and the hierarchical organisation of China's urban mobility system. These findings indicate that surveillance and response strategies effective for less transmissible pathogens may be insufficient for highly transmissible variants. Mobility-informed, tier-specific risk assessment may help inform early warning and support more adaptive public health responses. Because the framework relies on routinely available mobility data and minimal pathogen-specific inputs, it may provide a scalable approach for epidemic preparedness, including potential future emerging respiratory threats (Disease X).
Historic cities, as carriers of urban culture and history, have spatial organizations and usage patterns that directly impact district vitality and sustainability.Addressing the common problems in historic cities of disconnection between public space functions and resident needs, along with insufficient spatial flexibility, this study takes Meizhou Ancient City in Guangdong, China, as an empirical case. It introduces space syntax theory to explore sustainable design pathways. This theory can effectively reveal the strengths and weaknesses of spatial structures. Combined with field research, it constructs data models to quantitatively analyze indicators such as integration, spatial symbiosis, and intelligibility, diagnosing core problems: single-function spaces, weak road network connectivity, and chaotic spatial cognition. Based on this, it proposes a strategy of "Inventory Integration-Functional Reconstruction Interface Optimization". The results show that after the intervention, the spatial symbiosis and ecological resilience of the ancient city were simultaneously enhanced, contributing to the sustainable development of historic cities. The research validates the scientific supporting role of space syntax theory in the design of public spaces for historic cities. The proposed strategy can effectively buffer disturbances from evolving social demands during the development of historic cities, promoting their sustainable and positive development, and providing a reference paradigm for the renewal of similar commercial-residential mixed historic cities.
Urban ecological resilience is fundamental for an ability to withstand natural disasters and climate change impacts, maintain ecological functions, promote sustainable development, and ensure residents well-being, which is crucial for long-term urban stability. This study uses Chongqing, a mega-city in a mountainous region, as a case study. It constructs an ecological resilience evaluation framework based on scale-density-morphology and employs the entropy method and Geodetector to explore the spatial characteristics and influencing factors of ecological resilience in 38 administrative units. The findings reveal: ① The spatial distribution of scale, density, and morphological resilience showed higher values in the eastern regions and lower values in the western regions, closely related to Chongqing's spatial functional structure as a typical mountainous city. ② The ecological resilience level in Chongqing gradually increased from the central urban area outwards, exhibiting a polarization-diffusion phenomenon, with the lowest level in the central urban area and higher levels in the southeast and northeast regions, which was highly correlated with the spatial heterogeneity of the mountainous city's ecological foundation and economic level. ③ In terms of single-factor influence, topographic factors and population density had the greatest explanatory power for Chongqing's urban ecological resilience, while industrial structure had the least. In terms of interaction effects, the interaction between vegetation cover and consumption level had the most significant impact on urban ecological resilience. The study suggests that ecological protection measures should be strengthened, urban spatial structure should be optimized, and investment in scientific research and education should be increased, considering the ecological foundation and social-economic activities of mountainous cities to enhance ecological resilience. This research provides a scientific basis and decision-making reference for ecological protection and sustainable development in Chongqing and other mountainous cities.
This article describes a city-year dataset of residual-based tail physical climate risk for Chinese cities from 1973 to 2024. The released panel covers 368 prefecture-level cities and 19,136 city-year observations built from 6981,696 harmonized city-day records. The dataset is constructed from harmonized daily precipitation and temperature records and provides standardized annual indices of distributional tail risk for precipitation and temperature at the city level. For each city, the daily series are reduced to seasonal residuals by removing a low-order Fourier climatology in day of year, with no time trend or calendar fixed effects subtracted. Tail exposure is then accumulated from these residuals as annual exceedance intensities over a grid of city-specific quantile supports, standardized across city-years, and combined into composite precipitation, temperature, and overall city-level indices. The novelty of the dataset is that extremity is measured from city-specific seasonal residuals and defined relative to each city's own empirical distribution rather than by common national or absolute thresholds, which makes the tail measures comparable across the heterogeneous climate regimes of China. The released files include the standardized composite tail-risk indices for precipitation, temperature, and the overall city level, geographic identifiers, a harmonized city-day weather panel, a city identifier crosswalk, construction code, a variable dictionary, and a README file. The dataset can be reused in climate finance, urban vulnerability, regional adaptation, environmental policy, and location-based exposure mapping.
The development of new quality productive forces injects fresh impetus into achieving synergistic governance of pollution and carbon reduction. Based on panel data for 278 Chinese prefecture-level cities from 2012 to 2022, this study quantitatively measures city-level new quality productive forces and the degree of pollution-carbon synergistic effects and analyzes their spatiotemporal evolution. Employing a suite of econometric methods, we systematically explore the impact and mechanisms of new quality productive forces on synergistic effects. The main findings are as follows: ① New quality productive forces significantly enhanced synergistic effects of pollution and carbon mitigation, and this conclusion remained robust after a series of sensitivity tests. ② New quality productive forces improved synergistic effects primarily through three mediation pathways: independent mediation by advanced manufacturing agglomeration (contributing 73.47% of the total indirect effect), independent mediation by energy structure optimization (24.49%), and a sequential chain pathway: advanced manufacturing agglomeration→energy structure optimization (2.04%). ③ The impact of new quality productive forces was heterogeneous, being more pronounced in non-resource-based cities, environmentally prioritized cities, and cities with high factor allocation efficiency. ④ New quality productive forces exhibited pronounced spatial spillover effects, not only strengthening local synergistic effects but also enhancing those in neighboring regions. Overall, this research not only reveals the mechanism by which new quality productive forces promote synergistic pollution and carbon mitigation but also provides empirical insights for advancing new quality productive forces and enhancing coordinated low-carbon urban governance.
This study examines mass testing in three Chinese cities since 2020 as a 'stress test' for local governance. It analyses the governance performance of Shenzhen, Nanjing and Wuxi in terms of efficiency, equity and community resilience. Using Melbourne's pandemic lockdown as a reference case, it discusses the underlying mechanisms linking different governance approaches to health equity outcomes. The study adopts a nested governance framework to examine how governance capacities and policy logics operate across different local contexts. The results indicate that Chinese cities can efficiently complete mass testing within a few days, but face pressures related to health equity and community resilience. Melbourne's lockdown governance emphasised participation and institutional transparency, but advanced policies at a relatively slower pace. This study recommends building a dynamic governance mechanism that better balances efficiency and equity.
New quality productivity (NQP) has gradually emerged as a core driving force behind carbon emission reduction in the Yangtze River Economic Belt (YREB). Using balanced panel data covering 108 prefecture-level cities in the YREB between 2011 and 2023, this study employs a suite of econometric models, including benchmark regression, quantile regression, moderation effect, mediating effect, panel threshold, and spatial Durbin models, to empirically analyze the impact of NQP on carbon emission efficiency (CEE) and its spatial effects. The findings are as follows: ① Over the study period, the YREB's new quality productivity demonstrated a year-on-year increase, and its carbon emission efficiency followed an N-shaped evolutionary trend. Spatially, both of them exhibited a geographical pattern characterized by higher levels in the east and lower levels in the west. ② New quality productivity had a significant positive impact on the improvement of CEE in the YREB, while green finance played a positive moderating role in this process. Specifically, the positive moderating effect of green bonds and green investment was greater than that of green credit. ③ The mediating effect test showed that new productivity significantly improved carbon emission efficiency by enhancing the government's environmental governance capacity (EGC). ④ Threshold effect analysis indicated that when environmental regulation intensity was low, the impact of NQP on CEE was not significant. However, when environmental regulation intensity was high, NQP significantly promoted the enhancement of CEE. ⑤ Heterogeneity analysis revealed that the positive effect of NQP on improving CEE was more significant in the middle reaches of the Yangtze River, resource-based cities, and the middle reaches of the Yangtze River urban agglomeration. ⑥ The improvement in carbon emission efficiency driven by new quality productivity exhibited significant positive spatial spillover effects, most notably in cities within the middle reaches. Therefore, to enhance carbon emission efficiency in the YREB, it is necessary to accelerate the development of new quality productivity, actively cultivate strategic emerging industries and future industry clusters, steadily promote the innovation and application of green financial products, and implement differentiated green transition strategies.
Driven by the Fourth Technological Revolution and the "dual carbon" strategic goals, artificial intelligence has opened up new paths for the green and low-carbon development of cities. Exploring the causal relationship between the two is of great significance for the sustainable transformation of China's economy. Taking the urban panel data of the Yangtze River Economic Belt with a relatively high degree of artificial intelligence development from 2011 to 2021 as the research sample, multiple models such as bidirectional fixed effects, dual machine learning, and spatial Dubin were adopted to investigate the enabling role of artificial intelligence in the green and low-carbon development of cities. It was found that artificial intelligence had a significant resource-saving effect and environmental emission reduction effect on urban economy. This conclusion still held true after a series of robustness tests. Artificial intelligence mainly achieved resource conservation and environmental emission reduction through technological innovation and industrial structure upgrading. Moreover, the educational level and the degree of market integration had a positive moderating effect in the process of artificial intelligence empowering the green and low-carbon development of cities. Spatial analysis showed that in terms of environmental emission reduction, artificial intelligence had a promoting effect on both local and neighboring environmental emission reduction. In terms of resource conservation, artificial intelligence can promote local resource conservation but has no obvious impact on the resource consumption intensity of neighboring areas.
The widespread use of bisphenol S (BPS) as a substitute for bisphenol A has raised concerns about exposure to its derivatives, a topic largely unexplored in human populations. This study presents an investigation of multiple BPS derivatives in human urine in three cities from eastern and western China. Among the 317 urine samples, we revealed a landscape of widespread co-exposure. The geometric mean concentrations of BPS derivatives were 0.422 ng/mL, 0.548 ng/mL, and 0.376 ng/mL for Wuxi, Chengdu, and Shehong cities, respectively. Significant geographic differences were observed, with higher concentrations in Chengdu than in Wuxi (p < 0.05). Demographic factors such as age were remarkably associated with elevated urinary levels, with concentrations generally decreasing as age increased. A nationwide analysis revealed spatial variation across Chinese provinces, with concentrations negatively correlated with compound hydrophobicity. Additionally, estimated daily intakes of BPS derivatives (median: 9.50 ng/kg bw/day) suggest relatively low human exposure. These findings underscore the pervasive and varied exposure to BPS derivatives among the Chinese urban population, shifting the focus beyond BPS itself and highlighting the urgent need for comprehensive risk assessments of bisphenol-based substitutes.
Under the combined pressures of frequent extreme climate events and the spread of unilateral trade policies, global agricultural industry and supply chains are facing an unprecedented crisis. Digital technology (DT) is a key driver of the new technological revolution and is profoundly reshaping food production, distribution, and consumption. However, its comprehensive impact on food security and the underlying mechanisms remain unclear. This study systematically elaborates the theoretical logic through which digital technology enhances food security. Using panel data from 285 prefecture-level cities in China from 2011 to 2024, we construct an innovative urban DT composite index based on the number of artificial intelligence patents and the coverage rate of digital infrastructure. A dynamic spatial Durbin model and a mediation effects model are employed for empirical testing. The findings reveal three main results. First, DT has a significant direct positive effect on urban food security and a significant positive spatial spillover effect, meaning that local DT development improves food security in neighboring regions. These results remain robust after using instrumental variable methods, substituting core variables, and performing multiple robustness checks. Second, the mechanism analysis shows that DT indirectly enhances food security by improving agricultural socialized services, accelerating land transfer efficiency, and reducing climate-induced volatility in agricultural production. Among these channels, agricultural socialized services have the strongest mediating effect. Third, heterogeneity analysis indicates that the enabling effect of DT on food security is more pronounced in non-major grain-producing areas, regions with flat terrain, and cities with higher levels of financial development, suggesting that DT helps bridge the digital divide in agricultural development across regions. This study deepens the understanding of food security mechanisms in the digital economy era and provides a solid theoretical and empirical foundation for formulating precise, differentiated policies for digital villages and smart agriculture, thereby supporting the development of new-quality productivity in agriculture.
Bats, the second most diverse mammalian Order, have great ecological and economical importance. Globally, a large proportion of bat species are threatened and the trade in bats, either dead or alive, imperils several species, and may pose health risk for those people handling them. In southwestern Indonesia, bats are sold at wildlife markets for traditional Asian medicines, especially as a treatment for asthma. After purchase, bats are slaughtered at the market location where they were sold. Between 2012 and 2025 we conducted 362 surveys in 34 animal markets on the islands of Sumatra, Java, Bali and Lombok, and counted live bats offered for sale. We recorded 2245 Pteropus bats and 1080 Cynopterus bats during 249 (68%) of the surveys, and most markets displayed between 5 and 10 bats with a maximum of 50 bats at any given time. More bats were displayed on weekends than on weekdays, and over the 14 years covered by our survey trade was stable. There was no observed seasonality in the number of bats for sale. Average asking prices were US$22.25 ± 1.15 for Pteropus bats and US$12.75 ± 4.19 for Cynopterus bats. Cities with lower purchasing power per capita offered more bats per million people than their more affluent counterparts. Indonesia is the largest Muslim country globally by population, and bats are considered haram (unfit for consumption). Consequently, we observed more bats in cities with larger Christian populations. We found no evidence that the harvest or collecting of bats in Indonesia is sustainable, but sufficient support that it is not. Given the illegality of the trade in live bats in Indonesia, as there are no legal harvest quotas for the species we observed in trade, we urge local and national authorities to more effectively enforce existing regulations concerning the sale of wildlife in the animal markets.
Elucidating the coupling relationships and influencing factors between water resources carrying capacity, new-type urbanization, and the ecological environment is essential for improving urban water utilization, strengthening ecological protection, and promoting coordinated new-type urbanization development in river basins. Taking the nine cities and prefectures in the Gansu section of the Yellow River Basin as an example, we establish a comprehensive evaluation system targeting the overall development of water resources carrying capacity, new-type urbanization, and ecological environment. By employing the coupling coordination degree obstacle degree model and the geographically and temporally weighted regression models, the study explores the dynamic variations and spatial-temporal differences of the coupled coordination degree across the three aspects in the study area. The key findings are: ① The development indices of water resources carrying capacity, new-type urbanization, and ecological environment in the Gansu section of the Yellow River Basin showed a stable upward trend. ② The coupling coordination degree of the Yellow River Basin in Gansu Province showed an increasing trend, rising from 0.30 in 2012 to 0.45 in 2023. The coupling state had shifted from a mild imbalance to a stage of near imbalance. ③ Economic level, population size, expenditure on science and education, government capacity, social security capacity, and degree of openness to the outside world were the main external factors influencing the coupled coordination degree. Providing theoretical underpinnings and practical guidance for the formulation and implementation of coordinated development strategies integrating water resource conservation, ecological restoration, and new-type urbanization in river basin cities.
Resistance in pest species is no longer confined to classical genetic mechanisms or agricultural landscapes; instead, it emerges from a multilayered interplay of ecology, behavior, microbiomes, dispersal networks, and human-built environments. Across the manuscripts in this issue, a unifying picture emerges: urbanization and indoor environments act as powerful evolutionary arenas, shaping how pests invade, persist, and adapt to chemical, biological, and environmental pressures. Recent work on indoor pests, including cockroaches, bed bugs, and rodents, reveals how monitoring technologies, behavioral ecology, and microbe-mediated processes influence early detection and resistance management. Studies of long-distance dispersal in mosquitoes demonstrate how human transport networks accelerate the spread of adaptive alleles, including insecticide resistance, while creating spatial mosaics of selection within cities. Research on invasive termites, social wasps, and ants highlights how bridgehead effects, supercoloniality, and urban adaptation interact with microbial symbionts to shape invasion success and resistance trajectories. Meanwhile, emerging insights into microbiome-mediated detoxification show that resistance can arise not only from host genomes but also from microbial metabolism, epigenetic modulation, and environmentally structured microbial communities. Together, these contributions illustrate that pest resistance is an inherently cross-scale phenomenon, from genes and symbionts to cities and global trade routes. By integrating perspectives from molecular biology, invasion ecology, urban entomology, and microbial symbiosis, this issue reframes resistance as a dynamic, multi-dimensional process shaped by human behavior and built environments. Understanding these shared mechanisms is essential for predicting future resistance threats and designing sustainable, evolution-informed management strategies across indoor, urban, and global contexts.
Childhood obesity is a public health challenge, with 26.1% of Australian children aged between 2 and 17 years classified as overweight or obese in 2022. General practitioners (GPs) are the most frequently accessed healthcare providers for children. This project aims to provide a contemporary insight into current childhood obesity management practices among Australian GPs, including perceived barriers and enablers. A 20-question survey was developed by a multidisciplinary team including a paediatric endocrinologist, GP registrar, paediatric registrar and medical student. The HealthMap database distributed the survey to registered Australian GPs using a Quality Audit Reporting System. Free-text responses were thematically analysed using Braun and Clarke's qualitative descriptive methodology. Ethics approval was granted by the Nepean Blue Mountains Local Health District Human Research Ethics Committee. There were 199 responses, of which 92% (n = 183) were GP Fellows. Most respondents were from New South Wales (34.7%, n = 69) and Victoria (27.6%, n = 55). A majority (60.3%, n = 120) practised in major cities, with 18.1% (n = 36) based in outer regional areas. Thematic analysis identified key barriers to obesity management: difficulty engaging families, limited referral pathways for multidisciplinary care, inadequate public health interventions and underutilisation of national resources. Participating Australian GPs identified significant challenges in managing childhood obesity, particularly limited awareness of available resources and referral pathways. Improving the dissemination of existing services, strengthening clinical support and enhancing multidisciplinary care pathways may help support GPs in delivering effective, obesity-targeted care.
This qualitative study explores how women survivors of intimate partner violence (IPV) cope with abuse and reconstruct well-being and meaning in their lives. The study was conducted with 16 women aged between 27 and 51 living in three cities in the southeastern region of Türkiye. Participants were recruited through women's shelters and non-governmental organizations (NGOs) using purposive and snowball sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis. The findings indicate that women's experiences of violence were shaped by sociocultural gender norms and included physical, psychological, sexual, and economic abuse. Participants described multiple coping strategies, including seeking social support, emotional expression, religious coping, and resisting stigmatization. Women's pathways toward well-being involved gaining economic independence, developing healthier communication patterns, and investing in personal development. Meaning-making processes included redefining self-identity, motherhood, reconnecting with positive experiences, and interpreting survival as a source of strength. The findings highlight survivors' agency and resilience and underline the importance of social, psychological, and economic support mechanisms in facilitating recovery following IPV.
Neighborhood built environments may be associated with physical activity and sedentary behavior among older adults. However, evidence from rapidly urbanizing Chinese cities remains limited, particularly studies using objectively measured activity outcomes. This study aimed to examine the associations of perceived neighborhood built environment attributes with accelerometer-measured physical activity and sedentary behavior among older adults in urban China. Community-based cross-sectional study. A total of 499 older adults from 32 communities in Nanjing, China, were included. Physical activity and sedentary behavior were measured using ActiGraph GT3X + accelerometers. Perceived neighborhood built environment attributes were assessed using a questionnaire adapted from the Neighborhood Environment Walkability Scale. Multiple linear regression models were used to examine the associations of perceived built environment attributes with total physical activity, light-intensity physical activity, moderate-to-vigorous physical activity, and sedentary behavior, adjusting for sociodemographic and health-related covariates. Perceived access to service facilities was consistently associated with higher total physical activity, light-intensity physical activity, and moderate-to-vigorous physical activity, and with lower sedentary time. Access to fitness facilities was positively associated with total physical activity and light-intensity physical activity. Better neighborhood aesthetics was associated with higher moderate-to-vigorous physical activity. Traffic site accessibility and street connectivity were associated with lower sedentary time. In contrast, perceived access to commercial facilities was associated with lower total physical activity, light-intensity physical activity, and moderate-to-vigorous physical activity, and with higher sedentary time. Perceived neighborhood built environment attributes were associated with accelerometer-measured physical activity and sedentary behavior among older adults in urban China. Access to service and fitness facilities, neighborhood aesthetics, public transportation accessibility, and street connectivity may be relevant environmental correlates of active and sedentary lifestyles. The inverse association observed for commercial facility accessibility suggests that the role of destination accessibility may differ in high-density Chinese urban communities. These findings may inform age-friendly community planning and population-level public health strategies aimed at supporting active ageing and reducing sedentary behavior among older adults.
The rise of the gig economy has increased moonlighting among healthcare professionals. In China, nurse moonlighting and multi-site nursing practice remain emerging and context-dependent phenomena. Existing studies largely describe behaviors, with limited insight into subgroups and mechanisms underlying moonlighting intention among nurses. This study aimed to identify latent classes based on Chinese nurses' moonlighting intention and turnover intention, and to examine factors associated with membership in these classes. A multicenter cross-sectional survey with item-level latent class analysis was conducted. Nursing staff in medical institutions in seven geographic regions of China (northeast, north, central, east, south, northwest, southwest). Registered nurses (n = 1,879) from 21 hospitals in 7 cities across 7 provinces recruited via convenience sampling. Data were collected June-October 2024. Measures included demographics (gender, age, years employed, professional title, marital status, education, income, etc.), the Occupational Identity Scale, the Perceived Organizational Support Scale, and a Moonlighting Intention Scale. Latent class analysis identified joint classes of moonlighting and turnover intention. Univariate analyses and multinomial logistic regression were used to identify factors associated with class membership. A four-class solution was selected as the preferred model for the joint patterns of moonlighting intention and turnover intention (Entropy = 0.89; LMR/BLRT p < 0.001). The four classes were labelled as the Low MI-Low TI class (21.13%), High MI-Low TI class (23.36%), High MI-Moderate/High TI class (39.49%), and Uncertain MI-Low/Uncertain TI class (16.02%). Using the Low MI-Low TI class as the reference, nurses whose spouses did not have stable employment, those aged 25.1-30 years, those working in primary hospitals, and those with higher occupational identity had higher odds of belonging to the High MI-Low TI class, whereas higher perceived organizational support was associated with lower odds of membership in this class. For the High MI-Moderate/High TI class, spouse's unstable employment, unmarried/divorced/widowed status, male gender, age 25.1-30 years, and working in a primary hospital were associated with higher odds of membership, while no children, more than 15 years of practice, formal establishment, higher income, higher occupational identity, and higher perceived organizational support were associated with lower odds of membership. For the Uncertain MI-Low/Uncertain TI class, age 25.1-30 years was associated with higher odds of membership, whereas monthly income of 7,001-12,500 RMB was associated with lower odds. The relationship between moonlighting intention and turnover intention among Chinese nurses is heterogeneous rather than uniformly positive. Moonlighting intention should not be interpreted simply as a sign of withdrawal or impending turnover. Profile-specific retention strategies are needed, particularly for nurses with both high moonlighting intention and elevated turnover intention. Strengthening occupational identity, perceived organizational support, employment security, income protection, and career development pathways may help reduce turnover-related risk while addressing nurses' diverse work and career needs.
Carbapenemase-producing Klebsiella pneumoniae remains a major driver of multidrug resistance, traditionally linked to healthcare-associated infections but its detection in community-acquired infections represents a worrying shift. We aimed to characterize community-origin KPC- or NDM-producing K. pneumoniae isolates from two cities in São Paulo State, Brazil. A laboratory-based surveillance was conducted, including 111 non-duplicate K. pneumoniae isolates from urine of non-hospitalized patients. Polymyxin B MICs were determined by broth microdilution. All isolates underwent Illumina WGS. In silico analyses used Kleborate and Roary were used for bioinformatics analyses. 76% of the isolates were susceptible to polymyxin. The most frequent carbapenemase gene detected was KPC-2 (94.5%), but KPC-3, NDM-1 and NDM-5 were detected. MLST showed high clonal diversity (14 STs), dominated by ST11 (n = 34) and ST437 (n = 20), followed by ST16 (n = 12), ST6386 (n = 10), ST258 (n = 9), ST147 (n = 6), ST307 (n = 5), among others. Core-genome phylogeny revealed a polyclonal structure with multiple subclusters, consistent with community dissemination, grouped by ST. No classic hvKp plasmid markers were detected by Kleborate. Resistome were diverse. The predominance of CC11-related lineages (including ST11, ST437, and ST6386) indicates the persistence of the pandemic K. pneumoniae clone historically associated with blaKPC-2. The detection of secondary complexes such as CC16, CC147, and CC307, and the identification of NDM-producing isolates, highlight the polyclonal nature of dissemination and suggest ongoing genomic adaptation in community settings. The genomic diversity observed here reinforces the potential of environmental and community as non-obvious reservoirs contributing to KPC and NDM spread beyond hospital boundaries.