BURA Collection:

Climate change, artisanal and small-scale mining, and livelihood diversification: Whither the agrarian workforce?

2026-06-11T02:00:20Z

Title: Climate change, artisanal and small-scale mining, and livelihood diversification: Whither the agrarian workforce? Authors: Siaw, D; Ofosu, G; Sarpong, D Abstract: This article explores the dynamics of climate change and artisanal and small-scale mining (ASM), and its manifestations in livelihood diversification in the agriculture sector. Integrating the concept of ‘livelihood diversification’ with discussions on ‘cocoa-climate variations’ in Ghana, we empirically examine how climate effects have created a space and conditions for labour shifts from the agrarian to the ASM economy. The article offers explanatory power to explore how climate-related shocks can become key push factors of farmers’ diversification strategies, highlighting their consequences for the environment and farm yields, and, in turn, their implications for livelihoods. Description: Data availability: Data will be made available on request.

Socioeconomic inequity in extreme outcomes within very pre-term and/or very low birthweight infants: evidence from multi-national cohorts

2026-06-07T02:00:17Z

Title: Socioeconomic inequity in extreme outcomes within very pre-term and/or very low birthweight infants: evidence from multi-national cohorts Authors: Pilvar, H; Nicodemo, C; Petrou, S; Darlow, BA; van Dommelen, P; Evensen, KAI; Harris, S; Horwood, J; Johnson, S; Marlow, N; Mathewson, K; Saigal, S; Schmidt, LA; Wolke, D; Woodward, LJ; Kim, S Abstract: Background: Pre-term birth (<37 weeks’ gestation) is a major cause of neonatal mortality, with very pre-term (<32 weeks’ gestation) and extremely pre-term (<28 weeks’ gestation) infants facing the highest risks. While socioeconomic disparities in pre-term birth are well-documented, relatively little is known about inequities among the highest risk subgroups. Methods: Using data from the RECAP Pre-term Project across six high-income countries, we analyzed socioeconomic inequality in the incidence of extreme pre-term birth (EP) and extremely low birth weight (ELBW) among very pre-term/very low birth weight (VP/VLBW) infants. We measured inequality using concentration indices across cohorts and two adjusted measures of horizontal inequity (HI1 and HI2), to estimate the contributions of socioeconomic factors (e.g., parental education, ethnicity) to the outcomes. Results: Results showed that the incidence of EP in the Netherlands (HI2 = 0.171) and Norway (HI2 = 0.210) was higher among more socioeconomically advantaged infants born at VP/VLBW, but higher among more socioeconomically disadvantaged infants in New Zealand (HI2 = −0.020). Incidence of ELBW was higher among disadvantaged infants in Germany (HI2 = −0.046). Parental education was the strongest driver of these effects, though ethnicity and socioeconomic status moderated these effects. Conclusions: Counterintuitively, EP/ELBW were concentrated among advantaged groups in some countries, possibly reflecting survival bias or unequal access to neonatal care. The study highlights the need for targeted policies addressing inequities within high-risk pre-term populations and underscores methodological challenges in assessing disparities among vulnerable subgroups. Description: Data availability statement: The data analyzed in this study is subject to the following licenses/restrictions: the data supporting the results reported in this article are available upon request from the RECAP Pre-term Project and the individual data holders. Due to privacy restrictions, individual-level data cannot be shared publicly. For access to the data, researchers may contact the RECAP Pre-term Project at https://recap-pre-term.eu to request the minimal dataset necessary for replicating and building upon the findings reported in this study. Requests to access these datasets should be directed to https://recap-pre-term.eu.; Supplementary material: The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2026.1791450/full#supplementary-material .

Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs

2026-06-07T02:00:19Z

Title: Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs Authors: Tealdi, C; Madia, JE; Shah, A; Sheikh, A; Nicodemo, C Abstract: Objective: To identify and quantify key factors driving the decline in efficiency of NHS elective care, focusing on medical workforce dynamics, resource allocation and systemic inefficiencies. We hypothesised that medical workforce sickness absence and administrative turnover significantly affect productivity and backlog growth, instead medical workforce turnover has not effect. Design: This research is a national retrospective observational study using monthly panel data from NHS Digital (January 2018–December 2023). Ordinary Least Squares regression and Generalised Method of Moments models were applied to estimate the impact of workforce and resource factors on productivity and backlog indicators. These methods will account for the unobserved factors and potential reverse causality problem. Setting: The study follows secondary care across all NHS Trusts in England, with performance measured at the Trust level. Participants: All NHS Trusts delivering elective surgical services between January 2018 and December 2023. The unit of analysis was Trust-month observations, encompassing all elective surgical patients treated in each Trust. Main outcome measures: (1) Average per capita completed surgery elective cases (proxy for productivity). (2) Ratio of incomplete elective surgery to average completed elective surgery cases (proxy for additional resources needed to meet demand). Results: A one-percentage-point increase in NHS medical workforce sickness rates was associated with a 4.4% decrease in average completed elective cases (95% CI −0.0598 to −0.0272, p < 0.05). Gains in administrative staff reduced excess elective surgery incomplete cases by 14.4% (95% CI −0.155 to −0.133, p < 0.05). Findings were robust to controls for other workforce and resource-related variables. Conclusions: Workforce expansion alone will not resolve NHS elective surgery backlogs. Reducing medical sickness absence, enhancing staff wellbeing and ensuring adequate administrative capacity are critical to improving productivity and reducing waiting times. Description: Data availability statement: This research utilises routinely collected healthcare data available through NHS Digital and other publicly accessible sources. Please visit https://digital.nhs.uk/data~ .; Supplementary Material is available online at: https://journals.sagepub.com/doi/suppl/10.1177/01410768261442040/suppl_file/sj-pdf-1-jrs-10.1177_01410768261442040.pdf (326.29 KB).

Hospital resilience: public versus private sector dynamics

2026-06-06T02:00:24Z

Title: Hospital resilience: public versus private sector dynamics Authors: Fontana, S; Baglio, G; Guccio, C; Nicodemo, C; Pignataro, G; Romeo, D Abstract: This paper evaluates the recovery of elective admissions in Italian hospitals following the disruptions caused by the COVID-19 pandemic, with a particular focus on the dynamics between the public and private healthcare sectors. Employing a recovery metric that compares elective admission volumes in 2021 and 2022 to pre-pandemic levels, we observe significant regional variability in recovery rates, as well as disparities between public and private hospitals. Our analysis reveals that public hospitals experienced slower recovery rates, and suggests that the proximity of private healthcare providers further hindered their recovery capacity. Higher staffing intensity is positively associated with recovery, while hospitals serving older populations show weaker recovery performance. By quantifying recovery patterns and examining these influencing factors, this study enhances our understanding of healthcare system resilience. The findings highlight critical disparities in recovery across sectors and provide actionable insights for policymakers to improve coordination between public and private providers, thereby strengthening healthcare system preparedness for future crises.