Flooding disasters in most parts of the world has become worrisome to the government and to the humanitarian emergency organisations. In this article, the authors proffer a mathematical solution to minimise the cost of rescue operations, using stochastic programming of a multicommodity and multimodel network flow. In the formulation, the authors considered four supply depots: national centre depot (NCD), three local distribution centres (LDCs) and six points of distribution (PODs). Two vehicle types were helicopters by air and trucks by land. Three basic types of emergency relief materials include food, water and medical items. Three basic scenarios were mild, medium and severe situations with associated probabilities of 0.25, 0.5 and 0.25, respectively. The formulated model was solved using the LINGO software. The results show that the formulated model effectively reduced the cost of distribution during emergency rescue operation, as there was a thin line between demand and met demand. For the scope of this model, a minimised cost of about $1016673.37 is sufficient to carry out successful rescue operations.The estimated amount of $1016673.37 becomes a benchmark for the government, research agencies and other developmental agencies for the purpose of planning. By using the air and road transport modes, and allowing direct and indirect transportation to the PODs, it saved time, resulting in many lives being saved. Most often emergencies result from serious, unexpected and dangerous situations such as accidents occasioned by man, major terrorist attacks and natural hazards, which require urgent action  defined it as:A]ny occurrence that causes damage, destruction, ecological disruption, loss to human life, human suffering, deteriorating of health as well as health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area. situation or event which overwhelms local capacity, necessitating a request to a national or international level for external assistance, an unforeseen and often such event that causes great damages, destructions and human suffering.  early estimates are that up to 210 million tonnes of rubble will need to be cleared in Türkiye alone  and Okereke  summarisT]he process of planning, implementing, and controlling the efficient, cost-effective flow and storage of goods, materials, as well as related information, from the point of origin to the point of consumption for the purpose of alleviating the suffering of vulnerable people. (pp. 12–13)[The primary desires therefore become utilising the available resources effectively to meet the urgent assignment of saving lives and properties. The authors therefore should agree with Thomas  when he L]ogistics plays a key role in disaster response operations, it serves as a link between procurement and distribution, and between headquarters and the field, and is crucial to the effectiveness and responsiveness to major humanitarian programs such as health, food, shelter, water, and sanitation.[Van Wassenhove  observedFurthermore, thousands of hectares of farmland were flooded from torrential rains. Dam bursts are a common cause of flooding in Nigeria. Edward-Adebiyi  reportedFurthermore, the authors also observe the impacts of the economic damages of flood that occurred during 1985–2011 in terms of monetary cost as shown in The need for vendors to cut costs was stressed in a study on robust optimisation using mixed-integer linear programming for the supply chain for liquefied natural gas (LNG) .The United Nations, development partners and relevant ministries and agencies put the estimated total value of infrastructure, physical and durable assets destroyed at $9.6billion. The economic activities lost was valued at $7.3bn. The combined value of damages and losses was estimated at $16.9bn  minimise the various cost associated with the entire process of transporting the relief materials from the preposition point to the final consumer at the point of distribution (POD), (2) estimate and guide the government on the yearly ecological budget and (3) prepare an estimate to government on the immediate rehabilitation of the people affected by flooding.The model is a stochastic programming that handles uncertainty. Before stating the working objectives, the authors made the following assumptions:An inventory may be stored at the national centre depots (NCDs), but when that happened, it is penalisedA local distribution centre (LDC) may be supplied by either NCD or other LDCs.Given that no LDC is open within the area of a POD, such POD may be served by multiple LDCs.When disaster occurs, roads or path and/or facility may be damaged or destroyed. This may likely affect the performance ability of suppliers and candidate NCDs.N should be taken as a set of possible disaster situation.At the POD, the cost parameters and the demand levels are stochastic and are likely to be associated with the scenarios of the disasters and the level of impact of the disaster. The relief commodity will be more than one type and each commodity will differ in volume, procurement cost, storage and cost of transportation. The commodities for this model are food, clothes and medical facilities.The probability distribution of the scenarios shall be assumed to have been derived by experts in this field of study.It is assumed that the transportation cost by air is twice that of by land.In some cases, where the supplies and demand parameter of relief commodities differ from the real conditions, estimated information may become useful because of damages, but it will be good estimation for planning.The chosen PODs must be away from the disaster zone.Furthermore, let us assume:Subject to:Here, the authors are considering an objective optimisation model design to solve emergency allocation network problem with:MultisupplierMultirelief itemsMultivehicleMultiaffected areasThe objective, which is i, cannot exceed the total usable amount of relief material 1, which is stored in NCDi. Constraint *Land (trucks)i.The maximum amount of supply of item l is treated in NCDThree types of emergency supply items shall be food, clothes and medical facilities. Three scenarios  should be considered with associated probabilities of 0.25, 0.5 and 0.25, respectively. These probabilities are assumed to be derived by experts. The transport cost is linear cost function of distance assuming the air transport to be twice expensive as the land transport. Therefore, the data about distance from the emergency facilities are provided in tables within the present prevailing circumstances with reflection on the rescue operation during the 2012 flood disaster in Nigeria. Some, however, may be estimated as near reality by experts.1, n2 and n3 represent mild, medium and severe scenarios, respectively. Let the weight function of the scenario n be P(n), satisfying 0 ≤ P(n) ≤ 1. It should however be observed that this probability usually depends on: (1) the type of disaster, (2) the intensity of the disaster and (3) the environmental factors. The travel trip is a function of the impact of the disaster in the region. For the land trucks, their travel time within the region is determined by the nature of the routes. Bozorgi-Amiri and Khorsi  has more effect on the small probability scenarios.However, this research has an interwoven effect as the probabilities vary. It must be observed that the authors did not subject their analysis on P-reliable criteria solution. It might be hard to capture all the changes for the different cases; however, the authors will attempt to summarise the effect on cost.From Considering this probability variations, with higher probability as the severe scenario, it is observed that cost is higher on the scenario with lower probabilities. The mild and the medium scenarios experiences higher cost of transportation and distribution of relief materials.1 and LDC3, a case of ‘reduce cost’ situation. This has been discussed in detail in the next section.This table and figure depicts higher probability at the mild scenario and lower probability at the medium and severe scenarios. This case showed some zero cost as the LDCThe focus of this study is on the effect of variation of probabilities on direct expected cost. The authors wish to introduce the concept of reduce cost. Reduce cost value for each decision variable tells us how much the objective function value will change for a one-unit increase in the decision variable. The reduce cost column gives, for each variable which is currently zero, an estimate of how much the objective function will change if variable is to be non-zero. It is the column referred to as the opportunity cost for the variable.1 to the PODs. At  and , the opportunity cost of investing on improved relief materials by 112909.3 units and 4878.049 units, respectively, is minimisation of the direct cost effect of transportation.From this work, it is evident that the impact of flood in Nigeria and in Delta State, in particular, transcends significantly in an alarming proportion. Flood affects wildlife habitats and crops production and reduces farm produce. The preparation for emergency rescue operations is generally inadequate.Floods are on a threatening proportion, resulting to loss of many lives and properties. Millions of dollars were spent to deal with flood response. Furthermore, it has been realised that the millions of dollars allocated yearly during budget presentation for ecological fund are not adequately accounted. There is thus an urgent need to effectively plan well to avert these flood threats facing the entire country.The model has proved to be efficient and effective as a solution to the flood situation in Nigeria. In emergency humanitarian logistics problems, the knowledge of various cost involved helps in making budget. This article considered the costs and the shortage costs and was able to present a minimum cost using mathematical models, which considered uncertainty situation.Based on this study, the authors however wish to recommend that:Humanitarian relief organisations should adopt more innovative ways of achieving internal control, to reduce cost wastage and massive corruption.Humanitarian logistics management should adopt a collaboration venture with international financial administration for proper execution of emergency situation.Shortages could be reduced to a minimal level if adequate funding is channelled to provision of warehouses stocked with relief materials that are not perishable for quick response emergencies.Government should compensate the people whose wildlife habitat and crops were destroyed.This model, using the air transport mode and road transport mode, together allowing direct and indirect transportation to the PODs saved time, resulting in many lives being saved. It enhances minimisation of cost. Further work can be carried out on minimisation of time in the humanitarian logistics planning.


This study protocol aims to describe the rationale and developmental strategy of the first study in the Italian context which aimed to define a Midwifery Interventions Classification, an evidence-based, standardized taxonomy and classification of midwifery interventions. Midwifery interventions require a specific definition, developed through a consensus-building process by stakeholders to develop the Italian taxonomy of the Midwifery Interventions Classification with the potential for international transferability, implementation, and scaling up. A multi-round Delphi study was designed between June and September 2022, and data collection is planned between February 2023 and February 2024. The developmental phase of the study is based on a literature review to select meaningful midwifery interventions from the international literature, aiming to identify an evidence-based list of midwifery interventions. This phase led to including 16 articles derived from a systematic search performed on PubMed, CINAHL, and Scopus; 164 midwifery interventions were selected from the data extraction performed on the 16 included articles. Healthcare professionals, researchers, and service users will be eligible panelists for the Delphi surveys. The protocol designed a dynamic number of consultation rounds based on the ratings and interim analysis. A nine-point Likert scoring system is designed to evaluate midwifery interventions. Attrition and attrition bias will be evaluated. The results from the study designed in this protocol will inform the development of the Italian taxonomy of the Midwifery Interventions Classification. A shared classification of midwifery interventions will support audit and quality improvement, education, and comparable data collections for research, sustaining public recognition of midwifery interventions to promote optimal maternal and newborn health. Maternal and neonatal care quality indicators usually relate to disease or adverse event prevention and seldom to health promotion ,2. HenceQuality of care is a core issue of maternal and newborn health ,4,5,6. TMost of the available quality indicators in maternal and neonatal care typically refer to illness or adverse event prevention, with less attention to health promotion ,11. TherMidwifery interventions are defined as elements of maternity care provided by midwives to improve and optimize the health outcomes of women, newborns, and the public health of society at large. The Lancet’s Series on Midwifery developed the Quality Maternal and Newborn Care framework  that desIn light of the above consideration, identification and consensus from key stakeholders on core interventions are pivotal to ensuring quality midwifery care. Each midwifery intervention will be listed with a label name and a definition and classified into a domain and a class. The scope of the MIC will cover healthy women with low-risk pregnancies and their newborns, from antenatal to birth and postnatal care. The reference frameworks will be the Donabedian framework , the salhttps://comet-initiative.org/Studies/Details/1723, accessed on 1 March 2023).This protocol was designed including a multi-method and multi-phase approach between June and September 2022, consistent with the recommendations of The COMET Handbook: version 1.0  and the The study will consist of two stages. The first stage  was recently completed and included conducting a literature review to develop a preliminary and evidence-based version of the MIC; the second stage (Consensus process) will validate the classification through a Delphi survey involving different stakeholders: healthcare professionals, healthcare researchers, and service users. Midwifery interventions resulting from Stage 2 will be taxonomized into domains and classes constituting the final version of the MIC. Stage 1 aimed to identify an evidence-based list of midwifery interventions and develop a preliminary version of the Midwifery Interventions Classification. A literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and flowchart . We updaStage 2 will aim to achieve consensus on MIC through a Delphi technique, an established method for reaching consensus among field experts and stakeholders . ExpressIn the midwifery and maternity context, different stakeholders’ opinions are expected. We will involve three diverse stakeholder groups, each forming a balanced skill-mixed panel: healthcare professionals, healthcare researchers, and service users. The healthcare professionals panel will comprise midwives with at least one year of experience in midwifery care. The panel of healthcare researchers will involve experts on the Delphi technique and its methodology. The third panel will include healthy women who experienced a physiological pregnancy and birth within the last five years. We will use diverse Participant Information Sheets using different terminology depending on the stakeholder’s group.Group size is a pragmatic choice in a Delphi process, not based on statistical power . OtherwiThe number of rounds in a Delphi can be dynamic, but there will be a point beyond which a greater degree of consensus is unnecessary or unlikely to be achieved . TherefoDesigning the Delphi questionnaire requires careful consideration. Different studies investigated the “consistency effect”, for which participants are influenced to answer items by the previous ones . Thus, wWe will use the 9-point Likert scoring system to evaluate midwifery interventions, as recommended by the Grading of Recommendations Assessment, Development and Evaluation Working Group . ExpressThere is no evidence of the impact on the final list of items of retaining or dropping items between rounds . On one To define consensus, we will follow the “70/15%” method  implemenAll input and involvement during the process will remain highly confidential. Based on the information given, each invited participant will either agree to participate in the study or exercise their right to withdraw at any time. Data will be managed following the General Data Protection Regulation (EU GDPR).The assessment of the validity and reliability of the results derived from this study will reflect the strategy to manage the attrition and attrition bias between rounds. Attrition is the degree of non-response after the first round of the Delphi that can vary widely between studies. It may depend on many factors, e.g., the timing of Delphi rounds, the length of the Delphi, and the method of recruitment of participants. Although there is no guidance on what constitutes an acceptable response rate, The COMET Handbook suggests that around 80% for each stakeholder group is deemed acceptable . AttentiFrom a previously published literature review, we identified two included studies out of eleven that were consistent with the need to identify midwifery interventions. We updated the literature review to develop the preliminary list of MIC for the future phases of this study. The search strategy is described in Stage 1 of this study outlines a preliminary classification of midwifery interventions across a range of categories and classes that are consistent with previous international classifications . The emeBy breaking down midwifery interventions into specific categories/domains and classes, this proposed classification also provides a more nuanced understanding of the various factors that contribute to maternal and newborn health. For example, the section on maternal outcomes identifies a range of physiological and behavioral interventions that may impact a woman’s physical and psychological well-being from antenatal to birth and postnatal periods. Similarly, the newborn care section outlines interventions for healthy and sick babies, recognizing that different newborns may require different levels of care and support. The emerging MIC also highlights the importance of interdisciplinary collaboration and coordination across different healthcare settings and providers. For example, the inclusion of birth center/primary care and hospital/physician care categories underscores the need for midwives to work closely with other healthcare providers to ensure seamless continuity of care for women and newborns.The proposed preliminary version of MIC derived from Stage 1  will serIn Italy, midwifery is an established, autonomous profession and self-regulated. A self-regulated profession is responsible for setting and enforcing its own standards of practice, conduct, and ethics . This meStandardized classifications provide a valuable tool for organizing and standardizing health information and practices, particularly in the context of global health initiatives and efforts to improve healthcare quality and outcomes . HoweverIn other words, a country-specific proposal will be developed as the result of the implementation of the next phases of the protocol to ensure that the MIC is relevant and applicable to the unique needs and contexts of midwifery practice in Italy. This tailored approach will enhance the classification’s effectiveness and ensure alignment with the priorities and perspectives of Italian midwives and maternal and newborn health stakeholders.Having an MIC is highly relevant to sustaining health promotion and salutogenic interventions in maternal and neonatal care in real-world settings . The curTaxonomies are also relevant for facilitating training, education programs, and assessments, because they provide a defined scheme of classification and precisely hierarchical classification of interventions within given domains for educators, students, and healthcare workers . Other aThe proposed Delphi approach enables researchers to gather expert opinions through a series of iterative questionnaires to reach a group consensus on defining the MIC. This approach mitigates issues often associated with traditional consensus meetings by anonymity. For instance, anonymity helps reduce the impact of dominant personalities in the debate and decreases peer pressure . In thisThe main limitations of the protocol are consistent with the employed methodology. In fact, the process might be perceived by participants to be time-consuming. In this regard, adopting a web-based system should help researchers in optimizing the response rate . Other implicit limitations of this approach stem from a restriction of the possibility of elaborating in-depth on the views of the experts as the method does not encompass open discussions. Finally, reaching a consensus does not necessarily imply achieving the best possible MIC. In this sense, future further validation studies  are needed to corroborate the MIC in relation to measurable patient-level outcomes and to the previously developed M-COS.The MIC is pivotal for highlighting salutogenic midwifery interventions in promoting and maintaining maternal and neonatal health. This protocol encompasses the methodological guidance for defining an evidence-based, standardized taxonomy and classification of midwifery interventions based on the Italian context and with possible international scaling up. The MIC has the potential to facilitate education, be used in clinical documentation, boost comparable gathering of data for research purposes, audit and quality improvement, and promote the understanding of the maternal and neonatal in the general public. Future research will be necessary to corroborate the validation of the results of the study designed in this protocol.


Emerging infectious diseases have inflicted a significant health and socioeconomic burden upon the global population and governments worldwide. West Nile virus, a zoonotic, mosquito-borne flavivirus, was originally isolated in 1937 from a febrile patient in the West Nile Province of Uganda. It remained confined mainly to Africa, the Middle East, and parts of Europe and Australia until 1999, circulating in an enzootic mosquito-bird transmission cycle. Since the beginning of the 21st century, a new, neurotropic, more virulent strain was isolated from human outbreaks initially occurring in North America and later expanding to South and South-eastern Europe. Since 2010, when the first epidemic was recorded in Greece, annual incidence has fluctuated significantly. A variety of environmental, biological and socioeconomic factors have been globally addressed as potential regulators of the anticipated intensity of the annual incidence rate; circulation within the zoonotic reservoirs, recruitment and adaptation of new potent arthropod vectors, average winter and summer temperatures, precipitation during the early summer months, and socioeconomic factors, such as the emergence and progression of urbanization and the development of densely populated areas in association with insufficient health policy measures. This paper presents a review of the biological and socioenvironmental factors influencing the dynamics of the epidemics of West Nile virus (WNV) cases in Greece, one of the highest-ranked European countries in terms of annual incidence. To date, WNV remains an unpredictable opponent as is also the case with other emerging infectious diseases, forcing the National Health systems to develop response strategies, control the number of infections, and shorten the duration of the epidemics, thus minimizing the impact on human and material resources. West Nile virus (WNV), is a positive-stranded ribonucleic acid (RNA) virus. It belongs to the family of Flaviviridae, in the Japanese encephalitis antigenic complex . Other mWNV was first isolated in 1937 from a woman in the West Nile district in Uganda .Eight phylogenetic lineages have been described, but only lineages 1 and 2 are associated with disease in humans. Lineage 1 and its multiple profiles are the source of the epidemic transmission in Africa and throughout the world. Lineage 2 was considered an African zoonosis and has historically been considered to be less pathogenic in humans than lineage 1. However, in 2004, lineage 2, previously only isolated from horses in sub-Saharan Africa and Madagascar, appeared in Hungary, where the first recorded outbreak affected 18 horses. Prior to the emergence of a lineage 2 strain in Hungary in 2004, sporadic cases and occasional outbreaks in animals and humans in Europe were linked to lineage 1 strains. Since 2008, the lineage 2 strain has spread over central Europe and the eastern Mediterranean region and has become more virulent in vertebrates . This stThe significant majority of WNV infections in humans are asymptomatic. About 20–25% of WNV infections may cause a mild disease, associated with a wide variety of symptoms . NeuroinInfection is initiated after the vector salivary components are introduced into keratinocytes and skin dendritic cells and/or macrophages. The inflammatory response that follows leads to the recruitment of neutrophils, which secrete attractants to summon monocytes. The monocytes are differentiated into dendritic cells and macrophages and become attacked by the virus, while in the meantime, the resident dermal dendritic cells migrate to draining lymph nodes to induce adaptive immunity . In the Culex, along with the Japanese encephalitis and Murray Valley encephalitis viruses . January, April, and July were chosen to represent winter, spring and summer, respectively. Temperature and precipitation anomalies, as well as relative humidity and soil moisture deviations, were compared to the intensity of the annual WNF epidemic waves . InteresWNV has been established in the area of South, South-eastern and, lately, Western and Central Europe, and is spreading towards its northern part with the aid of climate change, which in turn facilitates its potential to survive and spread in previously inhospitable regions . OutbreaGreece ranks among the countries with the highest annual notification rates with significant fluctuations, or rather, with an irregular wavy pattern in the intensity of its outbreaks. Annual reported symptomatic cases in the years from 2010 to 2022 varied from 0 to 311 with a notification rate for West Nile cases with neuroinvasive disease ranging from 0 to 2.2 per 100,000 population. The associated mortality rate ranged from 9% to 40%. Initiation of each year’s epidemic fluctuated and was recorded from as early as May 31st with the detection of the first annual case up to as late as August 5th. Years with a higher epidemiological burden were usually characterised by an early start of the epidemic .Predicting the severity of each year’s epidemic seems unrealistic as a variety of factors exert their effect and interrelate in a highly complex manner. An intense previous season justifies public health authorities’ alertness. Recording of WNF cases in a geographical area during the summer to early autumn of a specific year carries a risk of recurrence of WNV infections in the same region of up to 50% for the next month of the season and 20% for the subsequent year .Climate factors favouring potential outbreaks are more versatile and affect geographical regions relative to their native climatic conditions. In an epidemiological study from Spain, the combination of high precipitation rates, soil moisture, and a warmer spring provided more favourable environmental conditions for mosquitoes to breed and transmit WNV , in agreAs the virus has gained endemicity in the region and has already been steadily circulating for more than a decade, perhaps the most reliable tool to predict the next epidemic at this point is to monitor mosquito-borne viral activity prior to the initiation and throughout each year’s candidate season. Greece has one of the most organized WNV surveillance programs . IncreasWNV and other flaviviruses have expanded their distribution significantly and are expected to increasingly burden public health systems in the future. It therefore is of particular significance to develop reliable outbreak prediction tools adjusted to each particular pathogen’s ecology that will be implemented in order to limit the spread of the virus and lessen the impact of the forthcoming epidemic.


British Columbia (BC) has been facing a public health emergency of overdose since 2016, with rural regions of the province facing the highest rates of death. Peers  are known to be effective patient navigators in health systems and can play a role in connecting patients to care and reducing overdose risk.We outline a peer-led program focused on opioid agonist treatment and prescribed safe supply medication delivery that began in March 2020 at a clinic in rural BC. The peer takes an Indigenous harm reduction approach and is focused on meeting the needs of the whole person. The peer has regular contact with approximately 50 clients and navigates medication delivery and appointments for approximately 10–15 people each day. Clients have been retained on the medication, and experienced improvement in other outcomes, including securing housing, employment and managing acute and chronic health conditions. The peer has established contact with clients since March 2020 to support engagement with health care and continuity of medication access. This program highlights the importance and value of peer-led work and need for further investments in peer-led programs to respond to the unregulated drug poisoning crisis.This peer-led intervention is a promising approach to engaging people who remain disconnected from health services in care in a rural community. This model could be adapted to other settings to support patient contact with the health system and medication access and continuity, with the ultimate goal of reducing overdose risk. Unregulated drug poisoning (i.e. overdose) is a public health emergency, with overdose death rates continuing to rise in the context of COVID-19 across North America . BritishNevertheless, rates of overdose deaths have continued to rise in BC and have consistently disproportionately affected Indigenous peoples. For example, First Nations people are overrepresented in toxic drug poisoning deaths, making up just 3.2% of the province’s population, but 15.3% of toxic drug poisoning deaths in 2022 . This isNavigating services access and advocating for alternatives when first-line interventions are not appropriate requires time, energy, and knowledge. Peers  are effective patient navigators in health systems, not just for substance use, but for other conditions such as diabetes and heart disease. , 13In this case report, a peer-led approach being carried out in a rural community in BC is presented. While the language of “peer-led” can be used in the context of a range of programs, with diverse objectives, structures, and outcomes, in the context of this manuscript, the peer-led approach represents the work carried out by one peer (JM), to collaborate with health service providers , to ensure access to and continuity of medications for patients accessing services at a community clinic. We outline what the program offers, how services are delivered, and program outcomes. The report is written from the positionality of the First Author, who is an Indigenous  woman with more than a decade of experience working in harm reduction, who brings an Urban Indigenous worldview to the manuscript and has worked collaboratively with the Second Author (JM) to document the peer-led approach. The manuscript brings attention to the intersections of this program’s peer-led approach with an Indigenous harm reduction approach , 15.The case presentation is organized around three graphic illustrations which represent the experience of the peer who leads this intervention (JM), outlining what she does Fig. , how sheIn the present program, a peer with lived experience of entrenched homelessness, addiction, incarceration (JM) has been serving in her capacity as a peer since 2010, when she began attending the clinic in a town in rural British Columbia. Since then, she has worked as a community advocate for harm reduction, substance use services, with the Coalition of Substance Users of the North. Through this role, she began advocating for new clients to be taken into the OAT clinic, formally began engaging in the work outlined in the manuscript in March 2020, in the context of COVID-19, when a new policy was introduced in BC that provided guidance for physicians to prescribe a range of alternatives to the unregulated drug supply , to navigate patient service access. She facilitates the following series of contacts for patients: initial appointment booking, reminders, rides to and from and accompaniment to medical appointments, medication pickup and delivery (to housing). Medication discontinuation is avoided by check-ins, reminders, and by regular communication between the peer on behalf of the patient, and the physician’s office and pharmacist.Since March 2020, this program has connected patients with care, including people most vulnerable to overdose and related harms  who may have otherwise not been engaged in health services. The program is operated out of an OAT clinic. The only eligibility criteria for accessing care is current opioid use. Many clients self-identify as Indigenous however Indigenous ancestry is not a requirement to become a patient at the clinic. For patients who do not use opioids and who are Indigenous, the peer makes referrals to the FNHA virtual clinic, which serves Indigenous people in BC who are seeking substance use services.The peer has regular contact every 1–4 days) with approximately 50 people and navigates medication delivery and appointments for approximately 10–15 people each day. The peer supports contact with care for OAT medications and safe supply medications .The principle of knowledge and wisdom relies on acknowledgement of clients’ experiences of stigma and shame, as factors that shape their interactions or lack thereof with the health system. Indigenous peoples experience systemic and internalized stigma, which is compounded among people actively using illegal substances. These layers of stigma can be broken down by interacting with someone with shared lived experience, who understands these baseline experiences as a barrier that needs to be navigated in moving toward engaging with the health system. The principle of strength and protection is practiced by the Peer, in acknowledging the critical role of culture and tradition in wellness, and the connections the peer is able to facilitate to Indigenous health service providers .The principle of healing relies on supporting clients toward self-acceptance as part of the path to wellness and is established by approaching interactions with non-judgment, and unconditional care and support regardless of current positions .The peer described the broad range of outcomes she has witnessed in program clients including making plans for the future, safer pregnancies and deliveries, keeping homes and jobs, managing other health issues, parents being able to be around for their kids, and being more present in their lives. Despite these positive outcomes, there are several existing gaps in services that remain, including the need for a broader range of medications to meet a diversity of needs, and engage people who remain outside of the care system. Along with an expanded range of medications is the need for medication options that meet a diversity of patient preferences regarding routes of administration. Recent data demonstrate that smoking is now the most common and preferred version of opioid use in BC among people accessing harm reduction services , howeverThere is a need for continued training for staff in health systems around Indigenous harm reduction principles and approaches to decolonizing care , 15, incIn this case report, a peer-led medication delivery program has been outlined. Through an Indigenous harm reduction approach, the peer was able to establish regular and ongoing contact with clients since March 2020 to support engagement with health care and continuity of medication access, including OAT, and safe supply medications.This program was implemented in the context of an overdose crisis in BC, where the health and substance use needs of many people remain unmet by existing services. For example, oral opioid agonist treatment (first-line treatment for opioid use disorder in BC) retention has been declining over the past decade, and when people do attempt treatment with oral OAT, induction rates are low, and minimum effective doses are often not reached . There aFollowing an Indigenous harm reduction approach , 15, theIn terms of barriers and challenges faced, the peer outlined some resistance to her role as she first began, in particular in interactions with the pharmacy. She noted that after only a couple of months of regular communication about the program and rapport building, this resistance had disappeared. While the peer works consistently to navigate access to housing, lack of housing options means that many clients remain unhoused. This poses an ongoing challenge to medication access and engagement, for example with medications going missing or being stolen. Housing remains a critical foundation for supporting client wellness and connection to care. Accessibility of services and care for pregnant persons remains a challenge. The peer supports pregnant clients by driving them to their prenatal care appointments; however, these appointments are not available within the community. This takes significant resources from the peer  and reduces her capacity to support additional clients.This manuscript has highlighted the value of peer-led work and the need for further investments in peer-led programs to respond to the overdose crisis. Peers have the solutions and the passion for this work and can create bridges between patients and the health system by building trusting relationships . NeverthThis peer-led intervention is a promising approach to engaging people who remain disconnected from health services and to ensure continuity of medication to reduce overdose risk. This model could be adapted to other settings with willingness of funders and clinicians to partner with peers to support patient contact with the health system, with the goal of reducing overdose risk.


Juniperus communis in PAs and interface areas of Andean Patagonia, Argentina. We mapped its distribution and described both the invasion and the environments this species inhabits through field studies, a literature review, and a citizen science initiative. We also modeled the species’ potential distribution by comparing the climatic characteristics of its native range with those of the introduced ranges studied. The results show that J. communis is now widely distributed in the region, occurring naturally in diverse habitats, and frequently within and close to PAs. This species can be considered an incipient invader with a high potential for expansion in its regional distribution range, largely due to its high reproductive potential and the high habitat suitability of this environment. Early detection of a plant invasion affords a valuable opportunity to inform citizens of the potential risks to high conservation value ecosystems before the invader is perceived as a natural component of the landscape.The benefits of early detection of biological invasions are widely recognized, especially for protected areas (PAs). However, research on incipient invasive plant species is scarce compared to species with a recognized history of invasion. Here, we characterized the invasion status of the non-native conifer  Paradoxically, these areas are suffering increased degradation due to processes related to global change, biological invasions being one of the most important drivers associated with this phenomenon5. In particular, the biodiversity and integrity of several PAs around the world are being jeopardized by the invasion of introduced plants1, a process fostered especially by human activity7. Since PAs are not entirely excluded from the major threats to biodiversity, the unique biological reservoirs contained in these areas are being increasingly compromised.Protected areas (PAs) worldwide are recognized as a key component of the broad response to the environmental degradation caused by global change, mainly because of their crucial role in conserving biodiversity8. The spatial configuration of these landscapes can facilitate a network of potential pathways for introduced species9. Indeed, the abundance and composition of non-native plant species in PAs are strongly influenced by their surroundings, mainly due to the rapid colonization of these species from belt zones10. Non-native plant species are undesirable in PAs, and those which are invasive are considered a priority for research and management12. In this regard there is abundant research on plant species with a recognized history of invasion and conspicuous impacts on natural areas . This is despite the ecological knowledge that incipient plant invaders may respond to efficient management strategies before they advance in the invasion process16 and have a significant ecological impact, at which point their eradication becomes unlikely17.Most PAs are interspersed with or adjacent to a mosaic of landscapes altered by human influence20. Detection of early invasion foci is usually fortuitous16, and citizen collaboration is important in increasing the probability of registering these situations. Public engagement is being enhanced by collaborative projects, led by professional scientists, that seek to compile information on potentially invasive species21. In particular, citizen science has emerged as a powerful tool for detecting and mapping the distribution of recent invasive species and obtaining diverse bio-ecological information on them23. This knowledge can provide insights into the invasion stage, the mechanisms behind the invasion, and the invader’s potential ecological impact, which can be context-dependent25.Although the benefits of early detection of incipient invasion in natural habitats are well recognized, so are the difficulties associated with it27. Thus, a frequently used approach to predict where a species might invade is analysis of the climatic similarity between its native range and areas outside it29, even for plant species with no invasive history30. This approach has been used for invasion risk assessment of non-native conifer species in areas of their introduced ranges throughout the Southern Hemisphere30, where they pose a significant threat to the diversity and functioning of native ecosystems31 and even PAs33. In particular, climate matching can be a valuable tool for estimating suitable areas for potentially damaging non-native conifers with incipient invasion. By cross-referencing information, it is possible to prioritize the search for and control of new invasion foci in, for example, PAs with high invasion risk.Climate is recognized as the single most important factor determining the distribution of plant species at a large scale35. In this region, increasing anthropogenic pressure on PAs acts as a catalyst for new invasions of introduced plant species whose invasive status, ecology, impact, and distribution are mostly unknown. This is exemplified by the conifer Juniperus communis L. , which has been identified as a potential high-risk invader of climatically suitable areas in Africa30 and Oceania28. At the southernmost tip of South America, Argentina, J. communis has recently been officially cataloged as an invasive species (Ministerio de Ambiente y Desarrollo Sostenible 2021). Despite this, no studies have addressed its invasion status, distribution, or potential expansion range, especially in the areas of the country where it may represent a risk to biodiversity, such as the PAs. This species already has three validated records in PAs of Andean Patagonia, according to the Biodiversity Information System which provides biological information on the species, and PAs of Argentina (www.sib.gob.ar). However, J. communis can be frequently seen in PAs of Andean Patagonia, which suggests that it is under-recorded, probably because of its incipient invasion (i.e. the earliest stage of the invasion process). This assumption of an incipient invasion is supported by the lack of J. communis registers in key reference literature describing the regional flora36, including literature focusing on introduced plant species in the main PAs of the region37. In addition, this species is increasingly valued as the raw material for producing gin, an alcoholic beverage that is booming internationally. This encourages its cultivation in the area, which can increase the source of propagules for invasions in nearby PAs. It can also be seen in gardens; however, its incidence as an ornamental plant, and therefore the importance of this type of use as a source of propagules, is as yet unknown.The PAs of Andean Patagonia are no exception in terms of their high vulnerability to an increasing number of introduced plant speciesJ. communis in PAs and interface areas of Andean Patagonia, Argentina, by mapping its distribution and describing both the invasion and the environments this species inhabits. We registered the type of invaded habitats, species abundance, its spatial configuration pattern, the accompanying woody species, the species’ reproductive potential (i.e. presence of reproductive plants and seedlings), its importance as an ornamental plant, and its occurrence in PAs and associated areas. We also modeled the potential distribution of the species by comparing the climatic conditions in its introduced range in Patagonia with those of its native distribution range. We used different methodological approaches to acquire data on the species in the region: a literature search, field sampling, and citizen collaboration. To our knowledge, this is the first work to provide information on J. communis as an invader of a South American country. We address key descriptive aspects of the current J. communis invasion that provide clues to the ecological mechanisms involved in its spread. Knowledge of the potential distribution of J. communis could be useful in determining the invasion risk the species presents for high conservation value ecosystems of Patagonia.Here, we characterized the invasion status of the non-native conifer J. communis in the region ; > 90% of these records were from PAs , followed by shrublands (26%), with the lowest representation in steppe environments , followed by thickets (21%) and, to a lesser extent, both patterns in the same site , Maytenus boaria (Celastraceae), Nothofagus dombeyi (Nothofagaceae), and Lomatia hirsuta (Proteaceae). Among the non-native species the most frequently found were Pinus contorta (Pinaceae), Rosa rubiginosa (Rosaceae), and Cytisus scoparius (Fabaceae) , with the oldest record dating back to 2002 60, which consumes fleshy fruits of common shrub species62, including those of J. communis . Additionally, there are records of apparently viable seeds of this species in the feces of hares63 and red deer . It is interesting to note that T. falcklandii is the most important frugivore present during winter61. Unlike most functionally equivalent native woody species, during winter J. communis bears fruits, which may represent a reproductive advantage for the invader64. The preliminary evidence described for this incipient invader highlights the importance of studying aspects of its reproductive ecology (e.g. phenology) that may provide clues to mechanisms that facilitate its spread and its potential impact on the recipient communities.The wide distribution of J. communis in different areas of its native range, where the number of populations and their size have decreased drastically, mainly due to a lack of natural recruitment66. This is mainly associated with a low percentage of viable seeds67, which could be due in part to climate effects. For example, Garcia et al.65 demonstrated that rainy spring periods (short but heavy storms) in open shrublands of the Mediterranean mountains negatively affected the viability of J. communis seeds by impeding pollen dispersal. This effect is probably not as pronounced in the areas of incipient invasion in Patagonia, where rainfall is scarce during the period of pollen dispersal (i.e. the warmest quarter of the year) and is even lower than that registered in the species’ native range . Considering that forest habitats are suitable for J. communis invasion, and that disturbed areas represent expansion opportunities for this species, the increased degradation caused by new trails  produced by domestic animals and visitors to PAs78 is of great concern. On the other hand, although medium to high abundance invasion was observed in ca. one-fourth of the sampled sites, it was common to find individuals in small groups or alone (i.e. isolated from other conspecifics but not from other woody species). While individuals established far from parent plants may indicate an increase in the spatial occupancy of the species, it also reveals that conditions for its control in areas of conservation concern may be favorable . As pointed out for other conifer invasive species80, the relatively low growth rate of woody plants affords a time window during which on-the-ground action can be taken before the incipient invasion takes hold – even a single plant can constitute a significant propagule source to the surroundings15.Belt zones control the number of invaders in PAs, determining the entry and spread of these species into the natural vegetation matrix82, J. communis was infrequently found as an ornamental or a living fence plant. Therefore, the current use of this species does not represent a major threat in terms of invasion spread. However, attention should be paid to other human-induced propagule sources. In light of the increasing valuation of this species for gin production, it would be interesting to investigate the importance of emerging cropping areas as a source of propagules that could spread to natural areas, as well as the generation of protocols to minimize its potential dispersal and consequent invasion risk. On the other hand, while fruit harvesting by local people from natural populations can reduce propagule pressure, it also favors positive public perception of the species as being of value as an economic resource83. Thus, the control of incipient invaders could be a particularly difficult challenge in areas associated with PAs, due to the cultural importance and economic value certain invasive species can represent for residents and visitors85.Unlike other woody plants that became invaders of natural environments associated with urban areasJ. communis in PAs of Andean Patagonia, Argentina. Although the results indicate that the species has high spreading potential, they also show that this is an opportune moment for its control in areas that merit conservation.We present here the first documentation of the distribution and descriptive characteristics of an incipient invasion of 86. Scientists have an important role to play in achieving this goal; for example, by leading citizen science projects and promptly communicating their research results to the public, thus constructing a two-way process that should be strengthened over time. This process could be especially important in the case of incipient plant invasions since people can receive a timely warning about the potential risks of invasive species before they are perceived as a natural component of the landscape and become valued.Since belt areas are important in mediating introduced plant biodiversity in PAs, raising citizen awareness of environmental issues such as plant invasion is crucial. Citizen science is a powerful tool when used as a means of informing and raising awareness of the consequences of individual actions  when living beside or close to natural areas. Awareness of the potential impact of introduced non-native species in natural-urban interfaces can promote a greater demand for native species, which also has multiple advantages for both the user and the environment87. The study area is covered mainly by plants of the Subantarctic biogeographic province and, to a lesser extent, the High Andean and Patagonian biogeographic provinces88. The Subantarctic province is characterized by temperate and cold forests, both deciduous and evergreen, especially conifers and southern beeches of the genus Nothofagus; the High Andean province is characterized by a dominance of xerophytic grasses and creeping or cushion dicotyledons; and the Patagonian province is represented by ingressions of the Patagonian steppe with scattered low compact shrubs and abundant bare soil – the grasses found here are mainly low88.The abrupt longitudinal precipitation gradient, moisture availability and temperature of Andean Patagonian brings about a transition in vegetation from humid forests in the west to steppe environments in the eastIn Andean Patagonia there are at least 51 PAs  grows as a shrub or upright tree (up to 12 m high) but can also acquire a prostrate form, presumably in response to environmental conditions57. The species is usually dioecious and reproduces predominantly by sexual means89. Rooting of decumbent branches occurs in areas with an oceanic climate although it is not clear whether these branches survive when the original shrub dies57. Female individuals produce axillary green globose strobiles, which turn bluish-black when mature57. Cones present unusually fleshy and fused scales that give it a berry-like appearance and take two to three years to mature66 , drought , or high soil moisture (Eastern Alps)90. Its growth rate is strongly controlled by temperature and limited by soil moisture90. Moreover, high temperatures can decrease its seed viability, particularly by disrupting the growth of the pollen tube and female gametophyte, as well as fertilization91. Since ancient times this species has been widely used for culinary, medicinal, and ornamental purposes93. In Andean Patagonia, local people harvest the fruits from natural populations and sell them to gin production companies located in the region and other parts of the country. There is a record of the species entering this region in the 1930s, when it was introduced along with other non-native conifers to be cultivated for ornamental purposes on Isla Victoria (northwestern Andean Patagonia)55.ee up to 2 m high J. communis we compiled records of its location (latitude and longitude) in PAs and their interface areas in the Andean Patagonian region (Argentina). Data were obtained through field surveys, a literature review, and the contributions of citizens. For each data source, a set of additional variables to describe the invasion and the environment were also recorded. The number and type of variables depended on the data source.To describe the invasion of J. communis individuals (sampling point). At each sampling point (with at least 1 km between points) we registered: species location, habitat type , environment type , the abundance of individuals , the spatial configuration of the individuals , the main woody species, whether the species was occurring naturally or not , and if there were individuals with fruits and seedlings (< 0.25 m58). The presence of fruits and seedlings was considered a proxy for reproductive potential.In autumn 2022 we carried out field surveys in an area that encompassed protected areas and their urban-natural interface areas . As we traveled along main and secondary roads  and walking trails, we searched for J. communis. In May 2022 we searched the scientific literature on Scopus using the following terms: “Juniperus AND communis OR enebro OR juniper AND Patagonia AND Argentina”. The reference lists from the articles found were also searched for other relevant publications not found in the initial search. In addition, to know when and how many times the species has been registered as naturally occurring in the region, and how it was recognized in terms of invasive status, we looked for articles that reported J. communis as part of the natural vegetation; we registered: the publication year, whether the species was the focus of the article , its recognized status , the reason why it was included in the study, and if it was registered in a protected area.In addition, to compile a set of data we reviewed the scientific literature and literature specializing in the regional flora  that reported the occurrence (location) of J. communis, along with information on how to identify it. We enabled a number of WhatsApp accounts for citizens to send their records to, since this application was one of the preferred ways for people in Argentina to report species sightings23. We asked citizens to give the species’ location, provide a picture of the plant to verify its identity, and report whether any observed plant had fruits. The fruiting plants could be easily detected by citizens; it is unlikely they would be confused with the similar fruits of common woody natives  whose fructification period ended in midsummer, before the survey period64. From both the citizen contributions and the literature review methods we obtained extra information on, for example, species abundance and habitat type. We incorporated these data into the database and indicated in the results section the number of records for each variable presented.During autumn 2022 we also made a call to citizens through social networks, requesting data on the location of J. communis based on climatic parameters that define the habitat suitability of Andean Patagonia, Argentina, we constructed Species Distribution Models (SDMs) for each species using the Maxent software94, a maximum entropy modeling method that generates a continuous binomial probability distribution of habitat suitability. For this we used the records obtained through field sampling and citizen science 97 and on relevant bio-ecological knowledge of the species99. We used layers with a resolution of 2.5 min for these variables. The model was developed using 75% of the location data, while the remaining 25% was used to validate the model. The algorithm was run with 1000 iterations, through which MaxEnt increases the model gain by modifying the coefficient of a single feature as a function of the input environmental data. The accuracy of the model was tested using the area under the curve of the receiver operating characteristic (ROC)100. The contribution of each variable to the final model was determined by randomly permuting the values of that variable between training points (both presence and background) and measuring the resulting decrease in the area under the curve. Values were normalized to obtain percentages. The relative strength of each predictor variable was assessed using the Maxent Jackknife test of variable importance. This test shows the importance of the environmental variables by detecting (i) the variable with the greatest explanatory power, and (ii) the variable with the greatest amount of unique information (not contained in the other variables). Finally, to test whether the observed bioclimatic characteristics coincide between the PAs of the introduced area in Andean Patagonia (200 randomly selected sites) and records from the native range, we quantitatively compared the values of the 4 environmental variables included in the model. Values for the native range and the PAs of Andean Patagonia were extracted with the point sampling tool in Qgis and compared using the Anderson–Darling test. The QGIS version 2.18 spatial analysis software was applied to edit and process all the maps shown in this work. All the reported models, tests, and graphs were performed in R101.To estimate the potential distribution of ce Table , and alsThe use of plant parts in the study complies with international, national, and institutional guidelines.Supplementary Information.


The steady increase in China’s ageing population and an upswing in migration among the country’s population, on the whole, has caused a continuous expansion of the scale of older migrants. The migration of older adults not only directly affects the well-being of individual families but also significantly impacts the population structure and economic development of the places of origin and destination. Despite this, in China, the various relevant aspects concerning this age group and, in particular, its migration choices and the patterns thereof have only rarely been the subject of sound research. The study presented in this paper seeks to fill this gap; the present study makes use of the microdata obtained from the national population censuses of 2000 and 2010 and the 1% population sample surveys conducted nationally in 2005 and 2015. The findings of the present study were the following: ① During 1995–2015, the efficiency of older adults’ migration was significantly higher in the eastern region than in the central and western regions. ② Older individuals migrating to urban areas are increasingly choosing, for their relocation, economically developed, urban areas such as the Yangtze River Delta, Pearl River Delta and Beijing-Tianjin-Hebei region. ③ Relocation of older adults to urban areas was much more than to rural areas. The latter group has a more diverse choice of destination, and the larger migration flow is primarily from developed provinces to relatively underdeveloped provinces. ④ The results of binary logit regression indicated that the factors that significantly and consistently influence the migration decisions of older adults were found to be the following: age, education level, health status, the primary financial resource, children aged ≤ 6 years being members of the household that would receive the migrants, and the average wage of employees. As for the geographical characteristics of the province to which the older adults migrate, a substantial difference was observed between the preferences of older adults migrating to urban regions and those of older adults relocating to rural areas. The findings of the present study provide further insight into the decision-making of older adults regarding migration. Further, these findings constitute an empirical basis for the local governments concerned to devise and implement policies to better cope with an ageing population. Western nations began gradually transitioning into an ageing society from the late 19th century through the first half of the 20th century. The willingness to migrate becomes a trend, among individuals as they get older, growing diversity of locations to migrate to and an increased awareness of relocation options in old age account for this trend. Older adults’ migration has several interconnected implications. It directly alters the regional population’s age structure and changes how adults are spatially distributed in an area . On the A review of the extensive literature on this topic reveals that the spatial patterns of older adults’ migration can be simply divided into the following two basic types: ‘centripetal migration’ and ‘centrifugal migration’ –6. ‘CentThe spatial patterns of older adult migration vary significantly among countries. In developed countries such as the United States (US) and France, this pattern is primarily ‘centrifugal’, that is, the older adults tend to move from urban centres in colder regions to small coastal towns and villages with warmer weather, which has a ‘sunny’ characteristic. The colder weather in the Northern and Midwestern US has caused approximately 60% of the older adults there to migrate after their retirement to the Sun Belt, i.e. to places like Florida and California . SchaffaThe migration pattern of China’s older adults is similar to that of older adults in Poland; however, the underlying reasons for this similarity are quite different. Traditional Chinese society is influenced by Confucianism, wherein interpersonal networks are built based on what is referred to as ‘blood relations’ or a family dependency network centred on spouses and children , 20. TheCompared with studies in developed countries that have focused on older adults and have developed theories and models by drawing on many perspectives , 23, theTo expand the scope of research concerning migration among China’s older adults and identify the characteristics that are specific to urban and rural migrants, certain basic information must be available for exploring the impact that migrant older adults have on their families and societies in the areas of their origin and destination. The literature review carried out for this study is summarised in the initial sections of this paper, which also introduce the experience and background of migrant older adults. These sections also detail the basic demographic characteristics of this population in China and self-reported causes of their in-country migration by referring to microdata from the 2000 and 2010 national censuses and the 2005 and 2015 1% national population sample surveys. Subsequently, in the context of the unique urban–rural dichotomy in China, this paper analyses the differences in the spatial patterns of migration of older adults to urban and rural areas. It also discusses the factors that influence the choice to migrate and location-related decisions of older adults in China and how they manifest at three levels: individual, family, and regional. This paper then discusses the present study’s findings, expounds upon their significance, and touches upon the future prospects of older adult migration in China for further research on this topic.The population data used in this study were mainly obtained from the microdata sample of the fifth and sixth national censuses in 2000 and 2010 and the 1% national population sample surveys in 2005 and 2015. The actual older migrant data are derived from statistical data according to the corresponding sampling ratio each year. Due to the small sample size of the older adults’ migration the Tibet, as well as the lack of data from Hong Kong, Macau, and Taiwan, none of them were included in the study. Therefore, this study takes 30 provincial administrative units in China as the study area, including 22 provinces, 4 autonomous regions, and 4 municipalities directly under the central government.To prevent the role of the time factor, i.e., simultaneity bias, in influencing older migrants, all provincial variables in this study are year-end data for 1995, 2000, 2005, and 2010, taken mainly from the ‘China Statistical Yearbook’. Among them, Chongqing was established as a municipality directly under the Central Government in 1997, and the district includes the former Chongqing, Wanxian, Fuling, and Qianjiang areas of Sichuan Province. Therefore, the data of Chongqing in 1995 are combined according to the data of Chongqing, Wanxian, Fuling, and Qianjiang areas in the ‘Sichuan Statistical Yearbook 1996’. The distance data were obtained from the ‘National Railway Passenger Train Timetable’ using the minimum time of railroad transportation between provincial capitals. All variables are taken as natural logarithms in the operation to facilitate the elasticity interpretation of the effect estimates later.Finally, the National Bureau of Statistics’ statistical zoning and urban-rural categorization codes were used to classify the existing residences of older adults into urban and rural categories. The urban-rural categorization codes 111, 112, 121, 122, and 123 are situated in urban areas, whereas 210 or 220 are situated in rural regions.Migration is a type of population movement, which entails the physical transfer of people from geographical area to another. Such movement usually involves a long-term, if not a permanent, change in the residence of the individuals concerned from the place of departure to the place of entry. The present study defines older migrants as Chinese citizens whose residence changed across provincial administrative units at the time of the census  and the census that was carried out five years before that .Interim Measures of the State Council on the Resettlement of Old, Weak and Disabled Cadres and the Interim Measures of the State Council on the Retirement and Retirement of Workers in China.The term ‘older adults’ refers to those who have reached a certain age limit, which is typically 60 or 65 years or more. Since the migration behaviour of older adults usually occurs after their retirement , 28, thiThe decision of older adults to migrate is based on two options: ‘migration’ and ‘non-migration’, which can be transformed into a dummy variable of ‘1’ or ‘0’. An econometric approach, based on the binary choice theory is commonly employed to analyse this type of problem, namely the binary logit model, wherein the dependent variable of the model is a binary variable, expressed in the form of the following equation:Uij, F(Yij); this signifies the specific form of the utility function; Yij denotes the province characteristics; i signifies the number of older adults; and j denotes the number of provinces. When the older adults choose province j instead of province k, then Uij > Uik, and ∀j ≠ k stands true. At this point, the probability of choosing to move to province j can be expressed as follows:chosenij is the variable of the province selected and is taken as 1 when selected and 0 when not.Conditional logit models are widely employed in location-selection problems, and they can be constructed drawing on two perspectives. First, a conditional logit model is used to construct a decision model for the older adults’ choice of the province. Assuming that older adults will consider a series of alternative provinces in their decision-making, the choice concerning which province to move to can be expressed as follows:Wi j = Xi×Yij denotes the interaction between individual features and province-related features.Second, individual characteristics are included in the model to assess the older adults’ choice of provinces from the perspective of individual heterogeneity. In the conditional logit model, incorporating individual characteristics directly into the regression is not possible, as doing so would engender the problem of covariance. Therefore, the effect of individual characteristics is considered by establishing an interaction term with the province characteristics, and then the probability of province selection is as follows:Older adults’ selection process for a place of relocation can be broadly divided into two stages: the decision to relocate and the search for a home. In most cases, older adults tend to be less satisfied with their current residence because of environmental triggers, and after evaluating the feasibility of relocation, they choose to move if they feel that the benefits of relocation outweigh the costs and if they are convinced that relocation will bring greater satisfaction . The seqThe investigation of specific factors was among the initial steps taken during this research, which also referred to the population migratory mobility theory. A sound state of physical and mental health is a crucial catalyst of migration in later life. This health-driven theory asserts that older adults with poor health are constrained by their environment, and they choose, often passively, to age in one place. Hence, they are less likely to move than their counterparts who have the advantage of good health . AdditioInterpersonal networks in Chinese society comprise close and distant relationships that are based on what is referred to as blood ties, and these relationships may change relative to time, space, and personal characteristics . MoreoveThe geographical characteristics and appeal of the destination are critical factors that influence older adults’ migration-related choices. This encompasses both physical environmental variables, such as climate and ecology, and soft environmental factors, such as local finances, availability of public services at the local level, and opportunities for social interactions. Older migrants in developed regions/countries, such as Europe/the US, exhibit significant ‘heliotropism’. Retirees prefer to migrate over large distances to sunny, pleasant locations as their last destinations , 37. MigThe multicollinearity between variables in the binary logit model was evaluated, and it was found that the variance inflation factor values of the independent variables in each year were < 3, and no significant cointegration problem was observed.Overall, a study of the socioeconomic attributes of older migrants  revealedThe survey data on the reasons for the migration of older adults in each period  revealedUsing the migration efficiency proposed by Bell et al. , we analThe top 25 older migratory flows to urban areas in China from 1995 to 2015 are shown in Second, the spatial features of the provinces where senior migrants are migrating to rural regions and that of those where older migrants are migrating to urban areas are very different. Compared with those who migrated to urban areas, those who migrated to rural areas were more dispersed and diversified in their choice of destination, with the number of destination provinces in the top 25 migration streams of older adults to rural areas in the four periods reaching 11, 16, 18 and 15, respectively. Among the top 25 older migratory flows to rural areas between 1995 and 2015, those with larger older migrants were mainly from more developed provinces to provinces with lower levels of economic development. The more typical ones were migration from Shanghai to Jiangsu, Guangdong to Sichuan, and Sichuan to Xinjiang. Provinces with a strong economy also typically have superior natural features, more employment opportunities, and higher income levels. While preventing their own people from leaving, these provinces also draw a lot of employees from other provinces, and older adults frequently move to such locations when they are young and looking for job prospects. As workers age, their ties to their birthplace significantly impact their migration decisions. After leaving their hometowns for work at a young age, many people choose to return to their hometowns to live and retire; this has become a common migration pattern known as “return migration”. A small number of economically developed provinces retain most of the migrating population, while the outflow provinces are widely distributed; this is why the destination choice of the older adults migrating to rural areas is more dispersed than that of the older adults migrating to urban areas.In this study, whether migration occurred after the age of 60 years was the dependent variable , and individual, household, and regional characteristics were the independent variables for the binary logit regression model employed to explore what kind of older adults are more likely to migrate. The results of this analysis are presented in (1) Individual levelDuring the period 1995–2000, the migration decisions of older adults were not determined by the sex they belonged to. Between 2000 and 2005, older Females were more likely to migrate than older Males; however, this changed in the next two periods, with men increasingly becoming more likely to migrate than women. Regarding age, the probability of migration was consistently weaker for the population aged > 75 years than for the population aged ≤ 75 years. Considering the rising need for healthcare as individuals age and that social security and health insurance coverage are still primarily based on administrative borders in China, people choose to stay in the same place, which reduces their likelihood of migration . When co(2) Family levelAmong the family-level factors, the presence or absence of a spouse did not influence the decision to move in old age in any of the four periods. The presence or absence of adult children in the older migrant’s destination family was positively significant between 2000 and 2005, that is, the presence of adult children in the destination household promoted older migration. However, this factor was negatively significant during the other periods. This indicates that older adults are more reluctant to move when adult children are present in the household they are moving into. Compared with the presence of adult children, the presence of children aged < 6 years in the destination family had a more stable effect on the migration decisions of the older adults, consistently and positively contributing to their migration. Owing to the growth of the market economy in China, two-income families now struggle to find time to care for their kids. The Chinese, given their strong family orientation, are more at ease leaving their children in the care of their parents than in the hands of nannies (when childcare facilities are inadequate). Therefore, young couples frequently remain with their parents until the third generation of children reach adulthood or enrol in school, and the old population’s movement is strongly correlated with the necessity of the families to have the grandkids duly taken care of , 35, 36.(3) Regional levelRegarding region-level attributes, only the average wage of workers in the potential migration location consistently influenced the migration decisions of older adults, and the four periods of them were positively significant. That is, the higher the wage level of employees in the potential migration location, the more willing older adults were to relocate there. The average wage of employees can, to some extent, reflect the level of socioeconomic development of a province, and in this case, the cost of living is a critical indicator of the financial ability of adult children and the quality of regional-level healthcare services for older adults , 46. In Concerning migration among the Chinese population, academic attention has tended to primarily focus on the migration of the labour population, relatively neglecting older migrants. In recent years, in tandem with population ageing and increasing migration, the number of older migrants in China has gradually increased. To address the demand for practice, academics have gradually begun to study migration among older adults; however, most studies concerning them have worked with single-period data or only studied the migrants of a specific region. It is not possible to compare the basic characteristics of older migrants, including spatial patterns and selective mechanisms across time, and understanding the situation of this group at the national level is difficult. Further, considering older migrants as a whole enables the description of the broad patterns of older adults’ migration but masks significant differences within subgroups. Therefore, in this study, we utilised microdata pertaining to four periods from the 2000 and 2010 population censuses and the 2005 and 2015 national 1% population sample surveys to classify older migrants into two categories at the national level—migrants to urban areas and migrants to rural areas.—Further, we examined their cross-provincial migration patterns and what explains their choices.Previous research has demonstrated that population ageing is usually accompanied by the onset of chronic diseases. When health conditions are poor, ageing in the place where one is already based is the best option, and the likelihood of relocation is greatly reduced , 31. FroRegarding migration efficiency, the present study found that between 1995 and 2015, the number of provinces with positive migration efficiency for older adults was less than that of provinces with negative migration efficiency. The eastern provinces have attracted many older migrants, while the central region has seen a large outflow of older migrants. Further, by dividing older migrants into those migrating to urban areas and those to rural areas, it was observed that between 1995 and 2015, the number of older adults migrating to urban areas was much higher than that of those migrating to rural areas. For older migrants who chose to move to urban areas, economically developed provinces such as the Pearl River Delta, Yangtze River Delta, and Beijing-Tianjin-Hebei region  were the most attractive. Simultaneously, a growing trend was observed among older migrants of migration from colder regions at high latitudes to low-latitude regions with milder weather, even as older adults’ choices concerning retirement destinations became more diversified and responsive to their own needs. By contrast, those older migrants who chose to move to rural areas were more dispersed in their choice of destination in terms of spatial distribution, and they primarily moved from more developed provinces to relatively less developed ones.Thus, China’s older adults have a migratory pattern that is very different from that of older adults in Western industrialised nations who are quite eager to move from urban to rural regions , 6. A maAmong all of the factors that influence the migration decisions of older adults, the present study found that, at an individual level, older adults aged ≤ 75 years consistently had a higher probability of migration than those aged > 75 years. The higher their education level, the more the likelihood that they would migrate: older adults with an education level of primary school and below being the reference group in this case. Older adults who went to college and beyond had the highest probability of migration, followed by those who studied till junior high school and high school. Those with an education level of elementary school and below lagged on this front. Older adults in poor health were less likely to migrate than those in good health. Finally, the likelihood of migration was also higher when the main financial resource for older adults was the income(s) of other members of the household than when it was their income or a severance pension. At the household level, the older adults’ decision to migrate was positively and significantly influenced by the presence of children aged ≤ 6 years in the destination household. In other words, the older adults were more inclined to migrate if there were children aged ≤ 6 years in the destination household. Finally, at the regional level, older adults were more likely to migrate when the potential migration destination was a metropolitan region where employees’ wages were on the higher side. We also noted the differences in locational preference between older adults who chose to move to urban centres and those who chose to move to rural areas, with the same influencing factors exerting different effects in different years when the interaction terms of regional attributes and the type of urban and rural destination were included.Numerous studies have confirmed that women exhibit a higher propensity to migrate and that this propensity grows stronger with age . The preThis study has some limitations. First, is the absence of an indicator of household registration nature owing to the abolition of the distinction between agricultural and non-agricultural households in China in 2015 and the unified registration of all properties as resident households. In China, the urban–rural dichotomy of ageing is conspicuous, and a majority of the older adults with rural household registration are located in rural areas and engaged in agriculture as their lifelong occupation. Hence, they have meagre savings and do not enjoy the retirement system. By contrast, most of the older adults in urban areas are not employed in the agricultural sector, have held jobs, and, therefore, enjoy retirement benefits. The differences in the nature of the study subjects affect their migration behaviour differently, and our failure to distinguish them in this study resulted in some bias in the findings. Second, due to the unavailability of certain data, some indicators that may influence the migration decisions of older adults, such as the provinces where the older adults are born and their regional economic attributes, were not duly considered as drivers of migration as far as the present study was concerned. This prevented a more detailed exploration of the impact of early life experiences on the migration decisions of older adults. Finally, migration was defined based on whether the same province was the usual and current residence five years ago, and the older adults may have moved to different destinations several times during this five-year period (which could not be taken into account). We recommend that future research should divide the category of older adults into more precise sub-categories, and the selection of variables should be so that more accurate and insightful results can be obtained.S1 Data(XLSX)Click here for additional data file.