Search Results (1,155)

While digitalization is expected to increase the demand for continuing workforce training in European economies, large-scale, cross-country panel data on macro-level relationships between participation in adult learning and digitalization remain insufficient. This study examines how digital diffusion, employment in the information and communication technologies sector, research and development intensity, and institutional quality are associated with adult learning participation across EU-27 member states. An unbalanced panel dataset covering the 27 EU member states for the period 2015–2023 was created from Eurostat and Sustainable Development Goals monitoring indicators. The empirical strategy includes cross-sectional dependence diagnostics, unit root and cointegration tests, fixed-effects estimation with Driscoll–Kraay standard errors, moderation analysis, and robustness checks based on alternative covariance specifications and first differences. The level-fixed-effects results show positive associations between individual internet use, as a proxy for economy-wide digital diffusion, and research and development intensity with adult learning participation (β = 0.110, p < 0.01; β = 2.451, p < 0.01, respectively). Employment in the information and communication technologies sector is not statistically significant, and institutional quality does not significantly moderate the association between individual internet use and adult learning participation. In hypothesis terms, H1 (digital diffusion) and H3 (research and development intensity) are supported in the level specification, whereas H2 (information and communication technologies employment) and H4 (institutional quality moderation) are not supported. When standard errors are clustered at the country level, the key coefficients lose significance, so these level estimates are descriptive structural associations rather than causal effects. The first-difference estimator does not reproduce the level relationships, indicating that the findings primarily reflect cross-country structural associations rather than within-country dynamic effects. Country-group analysis reveals a fourfold difference in mean adult learning participation between the lowest and highest digital diffusion quartiles (5.3% vs. 20.3%). The findings inform EU digital and skills policy by suggesting that the expansion of digital infrastructure should be coordinated with adult learning targets within the 2030 Digital Compass framework. Full article

The paper explores the nexus between indicators of development (the Human Development Index, Social Progress Index, happiness, employment in agriculture, industry, and services), indicators of habitat and species protection (Terrestrial Biome Protection based on national weights, TBN; Species Protection Index, SPI; Protected Area Representativeness Index, PAR; and Species Habitat Index, SHI) and indicators of governance (World Governance Indicators, WGI) and population density. The question at the heart of the research was whether various approaches to assessing development could be related to habitat and species protection, but this necessitated the inclusion of the quality of governance, as this has been established as being an important element for both. The analysis was based on data collected from 180 countries over the years 2018, 2020, 2022 and 2024, and was analyzed using OLS regression. The results suggest that the relationships between these factors are complex. Indicators of development having an element of perception (happiness and the Social Progress Index) had a statistically significant (p < 0.001) yet negative association with the SHI, but had no apparent association (p > 0.05) with the indicators based on protected areas (TBN, SPI and PAR). While the adjusted R² was low (<22%), results suggested that population density had a significant and negative association with the SHI indicator. The paper provides recommendations for future research to explore this important nexus between governance, development, population density and habitat and species protection. Full article

Background/Objectives: Depression is a mood disorder characterized by persistent sadness and loss of interest. Pharmacy students exhibit a relatively high prevalence of depressive symptoms, which may negatively impact quality of life, academic performance, and, in severe cases, lead to suicidal ideation. Given the increasing trend of medication use among young adults, we hypothesized that this behavior may be associated with depressive symptoms, potentially reflecting attempts to manage concurrent physical symptoms or reduced psychological well-being. Therefore, the objective of this study was to assess the association between depressive symptoms and medication use among pharmacy students. Methods: A cross-sectional study was conducted among students enrolled in pharmacy-related programs from University Center for Exact Sciences and Engineering (CUCEI), University of Guadalajara. Participants completed a personalized questionnaire assessing sociodemographic variables, medication use, comorbid conditions, and depressive symptoms using the Patient Health Questionnaire-9. Descriptive statistics were used to summarize participant characteristics. Categorical variables were reported as frequencies and percentages and compared using the chi-square test. Continuous variables were summarized as means and standard deviations and compared using Student t-test. To evaluate factors associated with moderate-to-severe depressive symptoms, logistic regression and multivariable linear regression analyses were performed. Results: A total of 365 students completed our personalized questionnaire; nearly half of the sample (47.3%) presented moderate-to-severe depressive symptoms. Multivariable analyses showed that insufficient sleep, academic stress, psychological support, and the number of medications used simultaneously were significantly associated with depressive symptoms. Logistic regression identified being in a relationship and receiving psychological support for at least one year as protective factors, while employment, insufficient sleep, academic stress, and a greater number of concomitant medications were associated with increased odds of moderate-to-severe depressive symptoms. Conclusions: A modest association was observed between self-reported medication use and moderate-to-severe depressive symptoms among pharmacy students. These findings suggest that medication use patterns may warrant further investigation as a potential marker of depressive symptoms in pharmacy students. Future longitudinal studies are needed to clarify the nature and direction of this association and to determine whether medication use could contribute to the identification of students at increased risk of depression. Full article

This study investigates the complex and nonlinear interaction between the dual circulation paradigm and high-quality full employment. Moving beyond the limitations of conventional static partial equilibrium frameworks, the analysis conceptualizes this relationship as a system of three interrelated feedback loops. Drawing on system dynamics (SD) theory, a set of nonlinear differential equations is developed, with model parameters calibrated using macroeconomic data from 2010 to 2025. The simulation results yield three main findings. First, international trade, cross-border investment, and technological exchange jointly form a core reinforcing feedback loop that underpins the mutually beneficial interaction between domestic and international circulations. Second, the integrated development of education, technology, and human capital emerges as a critical state variable for overcoming the persistent trade-off between employment quantity and quality. Third, the interplay between horizontal market expansion and vertical technological advancement constitutes a dual driving mechanism that facilitates the system’s transition toward a higher-level equilibrium, with multi-factor interactions generating pronounced nonlinear multiplier effects. Overall, the study provides a quantitative basis for designing adaptive and targeted employment policies within the dual circulation framework. Full article

Understanding the impact of neighborhood-level factors on stroke prevalence is crucial for addressing existing disparities. However, there is a distinct lack of ecological studies at the census tract level that investigate the social determinants of health (SDOH) influencing stroke prevalence within the U.S. Health and Human Services Region 3 (HHS Region 3: Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia). This study adopted a multivariate modeling approach to investigate the association between the 13 indicators of the Health Opportunity Index (HOI) and stroke prevalence at the census tract level in HHS Region 3 using four HOI indicator profiles and to highlight the specific SDOHs that are most associated with stroke prevalence. The four HOI indicator profiles include: (a) neighborhood and built environment profile, (b) social and community context profile, (c) resource profile, and (d) economic profile. The methodological approach was quantitative, using secondary data. The sample size was 8021 census tracts. The HOI was estimated for each census tract in the study area. Ordinary least squares regression (OLS) analysis and spatial lag model (SLM) were run to examine whether the 13 indicators of the HOI (categorized into four profiles) reliably predict stroke prevalence and to determine the most appropriate model that best identifies the strongest predictors of stroke prevalence. The results show that affordability, education, spatial segregation, and income inequality indicators were the strongest predictors of stroke prevalence in HHS Region 3. This granular research identifies the neighborhood-level SDOH most strongly linked to stroke prevalence, which can be leveraged to guide the development of targeted public health programs, quality improvement initiatives, resource allocation, and policy creation to combat stroke-related morbidity and mortality across census tracts in HHS Region 3. For example, the built environment, encompassing factors like employment access, affordable housing, and walkability, profoundly influences stroke prevalence and provides urban planners with practical insights for developing healthier, more equitable communities, such as creating neighborhood parks to encourage physical activity, a key factor in stroke prevention. This study also provides neighborhood organizations with the evidence needed to pursue grant funding and raise awareness about the socio-structural influences on stroke outcomes in their respective neighborhoods. Lastly, the insights generated from our study can facilitate collaborative decision-making processes with communities in HHS Region 3 regarding the prioritization of neighborhood-level SDOH for targeted public health interventions. This prioritization should focus on addressing predictors of stroke prevalence that are congruent with the community’s established priorities, thereby maximizing cost savings. Full article

Background and Objectives: Quality of life (QoL) is an important issue for breast cancer (BC) survivors. The objective of this study was to assess health-related QoL (HRQoL) of BC patients and investigate the impact of different demographic and clinical factors on physical and social functioning and BC-related symptoms. Materials and Methods: In this cross-sectional study, 107 BC patients undergoing chemotherapy in Greece completed a questionnaire collecting sociodemographic and clinical information and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (EORTC QLQ-C30) in order to assess HRQoL. Descriptive statistics and multiple linear regression analyses were used to identify factors linked to HRQoL outcomes. Results: Overall, participants reported moderate HRQoL, with high physical and social functioning and moderate emotional, cognitive, and role functioning. Fatigue was the most common symptom, whereas other symptoms were generally uncommon. Multiple regression analyses showed that marital status, place of residence, time since diagnosis, and type of surgery were significantly associated with the global QLQ-C30 score (R² = 0.337, p < 0.001). Physical functioning was associated with comorbidity burden, time since diagnosis, and employment status (R² = 0.155, p = 0.035), and social functioning with marital status and type of surgery (R² = 0.171, p = 0.011). Emotional functioning showed exploratory associations with place of residence and type of surgery; however, the overall regression model for emotional functioning did not reach statistical significance. No symptom model reached overall significance, but time since diagnosis, treatment type, and surgery were linked to distinct symptoms. Conclusions: BC patients undergoing chemotherapy in Greece report an overall moderate level of HRQoL, which is significantly influenced by a combination of demographic and clinical factors; physical and social functioning were high, with moderate emotional, cognitive, and role functioning. These findings highlight the importance of individualized supportive care strategies in order to improve QoL of BC patients. Full article

In the context of urban regeneration, identifying the nonlinear and interactive effects of the built environment on commercial vitality is essential for targeted spatial improvement. Using Xi’an’s central urban area as a case study, this study integrated multi-source data, including POI, AOI, street-view imagery, and mobile phone signaling data, to delineate commercial spaces via kernel density analysis. With actual service population density as the vitality indicator, a built-environment framework was constructed using 14 indicators across four dimensions: transport accessibility, functional diversity, street quality, and environmental capacity. Random forest regression and SHAP-based interpretable machine learning were employed to examine factor importance, nonlinear thresholds, and interactions. Results show that environmental capacity and transport accessibility are the dominant dimensions, with building density, road network density, and employment density contributing most. Built-environment variables generally exhibit nonlinear threshold effects; key thresholds include road network density > 8 km/km², building density > 40%, functional mix > 4.5, and sky view factor around 40%. Interactions involving building density are most pronounced, and its positive effect is significantly amplified under higher accessibility or employment density. These findings suggest prioritizing road network optimization and building coverage, while balancing functional mix and spatial scale in commercial space regeneration. Full article

During the stage of high-quality economic development, the synergy between advancing county industrial structure and employment growth has become a key issue in county governance. Although existing studies confirm that industrial structure has both creation and substitution effects on employment, few have adopted a configurational perspective to reveal how combinations of multiple factors can jointly promote both advanced county industrial structure and employment growth, thereby achieving industry-employment synergy. From the perspective of inclusive growth, this study incorporates six factors-economic level, financial level, innovation level, human capital, fiscal expenditure, and agricultural resources-into a unified analytical framework under the dimensions of efficiency and equity. Using a mixed method that combines dynamic QCA and regression analysis, and taking 1128 Chinese counties as the sample, this study explores configurational pathways that can simultaneously achieve advanced county industrial structure and inclusive employment growth. The findings are as follows: (1) Four configurational pathways lead to advanced county industrial structure: market-driven with efficiency priority (C1), endowment-substituted with factor concentration (C2), endowment-dependent with efficiency-equity coordination (C3), and talent–innovation dual-driven with government assistance (C4). (2) These four pathways differ in their effectiveness in promoting industry–employment synergy. Configurations C1, C2, and C3 achieve coordinated development of county industry and employment, whereas configuration C4 promotes advanced county industrial structure but inhibits employment growth. The conclusions reveal multiple equivalent pathways for synergistically enhancing county industry and employment, providing a basis for local governments to formulate context-specific industry–employment coordination policies. Full article

Background: Quality of life (QoL) after spinal cord injury (SCI) is influenced by psychosocial factors, yet less is known about how these factors are examined across national contexts. Objective: This scoping review mapped studies examining depression, employment, and social participation in relation to QoL or health-related QoL (HRQoL) among individuals with SCI in the United States and South Korea. Methods: Following PRISMA-ScR guidelines, five databases were searched for peer-reviewed English- and Korean-language studies published between 2007 and 2025. Results: Sixteen studies were included: nine from South Korea and seven from the United States. Depression and psychological distress were associated with lower QoL/HRQoL in both countries, although South Korean studies more often examined depression with stress and functional concerns, whereas U.S. studies situated depression within participation, spirituality, and youth psychosocial functioning. Employment was linked to QoL/HRQoL in both contexts, with South Korean studies emphasizing economic activity, vocational rehabilitation, and financial strain, and U.S. studies emphasizing employment status and vocational outcomes. Social participation was important in both countries, but South Korean studies focused more on community transition, functional independence, and social attitudes, whereas U.S. studies emphasized participation contexts, accessibility, and social relationships. Conclusions: Across the three domains, depression, employment, and social participation emerged as recurring psychosocial domains associated with QoL/HRQoL after SCI in both countries. These differences suggest that psychosocial adaptation after SCI should be understood within cultural and rehabilitation contexts. Full article

While land development opportunities stemming from planning regulations demonstrably influence rural household income, quantitative evidence quantifying these effects remains limited. Measuring and decomposing these effects can empirically support territorial spatial planning policies aimed at alleviating associated regional development imbalances and advancing sustainable rural development. This study selects Wuhan’s Sino-French Eco-City (urban development zone) and Xiaosi Township (wetland conservation zone) as typical zones. Based on 573 randomly sampled rural households, we explore the effects of land development opportunities on rural household incomes and find that: (1) Land development opportunities for non-agricultural conversion in the urban development zone significantly increase rural households’ total income, wage income, though their corresponding contribution rates are limited. Endogenously accumulated endowments such as human capital and economic status dominate the formation of such income gaps. (2) Planning-induced land development opportunities yield coefficients of 1.0442 for local employment income and −0.4567 for agricultural business income, with both statistically significant at the 1% significance level. Decomposition results show their respective contribution rates of 70.68% and 86.77%, demonstrating that such opportunities primarily account for cross-regional rural household income gaps. (3) Whereas non-agricultural land development opportunities narrow disparities in households’ local employment income, they raise inequality in rural households’ migrant employment, business, property and transfer income. These growth and equality-enhancing effects on local wage income are particularly pronounced for households possessing high-quantity but low-quality human capital. This study recommends supporting protected zones via farmer vocational training, expanded rural public service expenditure, and a benefit-sharing mechanism that channels land development gains to ecological and agricultural regions to strengthen households’ endogenous development capacity. Full article

Deaf people experience significant barriers to education, healthcare, employment, and information access, resulting in inequities across a myriad of contexts. To better understand these disparities, our all-deaf research team conducted semi-structured interviews with deaf and hearing (parents, caregivers, and educators) adults across Ecuador, exploring how structural, institutional, and social factors influence daily life and well-being. Participants (n = 36) described systemic exclusion from education and employment, limited access to interpreters and assistive technologies, and constrained autonomy due to insufficient family support and institutional resources. These barriers compound health risks by restricting access to care, information, and social participation. Participants’ narratives highlighted how political and economic instability, institutional neglect, and discrimination create structural vulnerabilities that extend beyond individual-level factors. Findings underscore the importance of public health interventions that address structural and communicative inequities, including inclusive education, accessible health services, and community-based support, to improve health equity and quality of life for deaf populations in Ecuador. Full article

Climate change has increased the frequency of extreme weather events, posing a major threat to the sustainable development of agriculture and farmers’ welfare. Based on provincial meteorological data and China Family Panel Studies (CFPS) data from 2014 to 2022, this study systematically investigates the impact of climate shocks on farmers’ welfare, heterogeneity characteristics, and the buffering role of off-farm employment, using a two-way fixed-effect model. The results show that climate shocks significantly reduce farmers’ welfare, with greater welfare losses in northern regions, major grain-producing areas, and plain areas. Extreme low temperatures, extreme high temperatures, and drought are the three dominant climate hazards. In response to climate shocks, off-farm employment effectively buffers welfare losses. This study clarifies the logic of changes in farmers’ welfare and livelihood adaptation mechanisms under climate change, providing micro-empirical support for improving differentiated climate adaptation policies, strengthening agricultural risk management systems, enhancing agricultural system resilience, and promoting high-quality and sustainable agricultural development. However, constrained by the matching precision between micro-level data and meteorological indicators, future research should further refine the measurement of climate shock exposure at the individual farmer level. Full article

Objective: This study aimed to assess health-related quality of life (HRQoL) among postpartum women in Jordan and identify the factors that may influence it. Methodology: This study employed a cross-sectional design and was conducted among women who had given birth within the last year, selected through cluster randomization from four primary healthcare centers in Amman. Household resource quality of life was measured on the validated 36-Item Short Form Survey (SF-36), which covers eight domains of health. Descriptive statistics were calculated. Independent t-tests and one-way ANOVA were used to compare mean HRQoL scores across categories of socio-demographic variables (e.g., marital status, income, employment, feeding type). Pearson correlation was used to examine the relationship between age (the only continuous variable) and HRQoL domains. Statistical significance was set at p < 0.05. Results: The physical functioning had the highest HRQoL (62.48 ± 25.19), and the lowest HRQoL (34.59 ± 37.46) was found in role limitations due to physical health and emotional problems (36.37 ± 40.90). Key socio-demographic factors were highly related to HRQoL. Better general health perceptions (p = 0.003) and emotional well-being (p = 0.005) were found to be correlated with higher income. The married women scored much higher in physical functioning (p = 0.015) and emotional well-being (p = 0.013) than divorced women. Infant feeding methods and employment status were also significantly associated with certain domains of HRQoL. Conclusions: Postpartum women in Jordan experience low HRQoL, particularly in the domains related to role limitations. Socio-demographic factors were found to be crucial, wherein marital status and income are specific aspects. This study strongly recommends immediate integration of an appropriate multidimensional support program in postpartum care as an intervention toward improving maternal well-being. Full article

Intergenerational educational mobility constitutes a cornerstone of sustainable social development—particularly in China’s ethnic minority regions, where socioeconomic development lags behind the national average. Digital inclusive finance—with its broad geographic reach and low entry barriers—offers a promising lever for breaking the cycle of low intergenerational mobility in these regions. This study systematically examines how the development of digital inclusive finance in China affects intergenerational educational mobility in ethnic minority regions and identifies the underlying mechanisms, thereby addressing SDG 4 (Quality Education) and SDG 10 (Reduced Inequalities). Using six waves of longitudinal data (2012–2022) from the China Family Panel Studies (CFPS), we examine the impact of digital inclusive finance on intergenerational educational mobility. To mitigate endogeneity, we construct an instrumental variable based on historical telecom infrastructure and employ two-stage least squares (2SLS) estimation. The findings indicate that digital inclusive finance significantly enhances intergenerational educational mobility in ethnic minority regions. Further mechanism analysis indicates that the effect operates primarily through increased household net income and, more tentatively, through improved access to education-related information—proxied here by traditional media usage. Accordingly, we recommend upgrading digital infrastructure in ethnic minority regions, improving residents’ digital literacy, and aligning digital inclusive finance with education subsidies and employment guidance. This helps households convert financial access into sustained investments in offspring’s education—boosting intergenerational educational mobility and advancing social sustainability. Full article

Objectives: This study aimed to identify the oral health conditions of homeless individuals in Rome, the most frequently required dental treatments, and to describe a standardized, replicable clinical protocol tailored to the specific needs and access barriers of this vulnerable population. Methods: Five hundred homeless individuals received comprehensive dental examinations at the Primary Care Services of the Dicastery for the Charity Services (Vatican City) between September 2023 and January 2026. Clinical assessments included oral hygiene status, periodontal health, caries prevalence, and degree of edentulism. Treatment interventions were programmed by scheduling subsequent appointments. For patients requiring prosthetic rehabilitation, treatment was sequenced into distinct steps: preparatory treatments (hygiene, extractions, conservative procedures), impression taking, prosthesis try-in, and delivery. Results: Oral health assessment revealed poor or absent hygiene (85.4%), high DMFT scores (63.0%), and root residues (22.4%). Periodontal disease affected 94.0% of participants (gingivitis 73.0%, periodontitis 21.0%). Tooth loss patterns included partial edentulism (12.0%) and complete edentulism (24.0%). A total of 440 appointments were scheduled, with an attendance rate of 78.4%. Prosthetic rehabilitation was completed in 150 patients: 50 received partial dentures (33.3%) and 100 complete dentures (66.7%). Conclusions: The examined homeless individuals experienced severe oral health deterioration characterized by extensive tooth loss and advanced periodontal disease. A substantial prosthetic rehabilitation was needed in this sample. The proposed sequential treatment protocol demonstrated high feasibility and patient adherence in this vulnerable population. Comprehensive dental services that address both immediate emergency needs and long-term rehabilitative care are crucial for improving oral health-related quality of life and facilitating social reintegration. Patient-reported outcomes indicated meaningful improvements in digestive function, aesthetic satisfaction, and employment opportunities following prosthetic rehabilitation. Full article