Search Results (3,096)

Background and Objectives: To provide, for the first time, statistical data on risk factors for proliferative diabetic retinopathy (PDR) in young-onset type 1 diabetes (T1D) in Croatia, and to develop a predictive health economic model to evaluate the clinical and financial impact of implementing a national diabetic retinopathy (DR) screening. Materials and Methods: A cross-sectional study at University Hospital Split (June 2020–June 2022) analyzed 58 suitable T1D patients out of 562 screened. Patients were classified based on detailed fundus exams and photos into PDR and non-PDR groups. Clinical, demographic, and laboratory data were collected and analyzed using logistic regression. A health economic model was established to project the number of preventable PDR cases and the potential cost savings under various screening scenarios. Results: PDR was found in 47% of patients. Its presence was statistically significantly linked to longer diabetes duration, poor glycemic control, onset before 18 years of age, and irregular eye exams. Irregular ophthalmologic examinations increased the odds of PDR by nearly 30-fold. Health-economic modeling for 10,000 young-onset T1D patients showed that annual screening with 60% uptake could prevent about 1973 PDR cases and save €14.2 million annually. Screening remained cost-effective even with moderate uptake or less frequent intervals. Conclusions: Strict glycemic control and regular eye examinations are critical for preventing PDR in young T1D, and establishing a national screening program would be cost-effective, especially in resource-limited settings like Croatia, where providing appropriate, timely treatment may be challenging. Full article

Background: Recent economic instability and social isolation have increased mental health vulnerabilities among young adults, highlighting the need to clarify how multiple contextual factors shape their subjective well-being. This study explored the relationship between depressive symptoms and subjective well-being among Korean young adults. It also investigated the mediating effects of housing satisfaction, social capital, occupational hazards, and future achievement readiness on this relationship. Methods: A parallel mediation model was used to analyze the mediating effects of housing satisfaction, social capital, future achievement readiness, and occupational hazards on the relationship between depressive symptoms and subjective well-being. The model examined direct and indirect pathways to determine the extent to which these factors influence subjective well-being in young adults. Results: Depressive symptoms were associated with reduced housing satisfaction, social capital, and future achievement readiness, as well as increased exposure to occupational hazards. All four variable associations between depressive symptoms and subjective well-being, suggesting that multiple structural and psychosocial conditions jointly shape young adults’ subjective well-being. Conclusions: The findings suggest that conventional mental health services alone may be insufficient. A multifaceted approach—including housing welfare policies, social connection support, employment and adjustment programs, and initiatives that enhance future preparedness—may help mitigate the negative effects of depressive symptoms and improve subjective well-being among young adults. Full article

It is well known that elevated phosphate concentrations in water bodies trigger the eutrophication process, posing adverse environmental, health, and economic consequences that necessitate effective removal solutions. Phosphate removal has therefore been widely studied using various methods, including chemical precipitation, membrane filtration, and crystallisation. However, most of these methods are often expensive or inefficient for low phosphate concentrations. Therefore, in this study, an eco-friendly, sustainable and biodegradable adsorbent was manufactured by extracting calcium ions from an industrial by-product, ground granulated blast furnace slag (GGBS) and magnesium ions from magnesium dross (MgD), then immobilising them on sodium alginate to form Ca-Mg-SA beads. The new adsorbent was applied to remove phosphate from water under different flow patterns (batch and continuous flow), initial pH levels, contact times, agitation speeds and adsorbent doses. Additionally, the degradation time of the new adsorbent, recycling potential, its morphology, formation of functional groups and chemical composition were investigated. The results obtained from batch experiments demonstrated that the new adsorbent achieved 90.2% phosphate removal efficiency from a 10 mg/L initial concentration, with a maximum adsorption capacity of 1.75 mg P/g at an initial pH of 7, a contact time of 120 min, an agitation speed of 200 rpm and an adsorbent dose of 1.25 g/50 mL. The column experiments demonstrated a 0.82 mg P/g removal capacity under the same optimal conditions as the batch experiments. The findings also showed that the adsorption process fitted well to the Freundlich and Langmuir isotherm models and followed a pseudo-second-order kinetic model. Characterisation of Ca-Mg-SA beads using EDX, SEM and FTIR confirmed successful ion immobilisation and phosphate adsorption. Furthermore, the beads fully biodegraded in soil within 75 days and demonstrated potential recycling as a fertiliser. Full article

Background: Despite evidence of potential benefits, variability in exercise types, psychological outcomes, and methods hinders comprehensive cost-effectiveness evaluation, framed through Stimulus–Organism–Response (S–O–R) theory. In this context, Workplace Physical Activity-Based Programs (WPABPs) serve as environmental stimulation that influences employees’ emotional states, which in turn shape mental health outcomes and behavioral responses. Research Purpose: This systematic review examines WPABPs through the social dimension of the Environmental, Social, Governance (ESG-S) framework, with a focus on their impact on employees’ mental health. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, eligibility was assessed via the PICO (Population, Intervention, Comparison, Outcome) framework. The ScienceDirect, Scopus, Google Scholar, and PubMed databases were searched using Medical Subject Headings (MeSH) aligned keywords and Boolean operators. Results: Of the 961 articles identified, 15 studies (2021–2025) met the inclusion criteria. WPABPs were found to improve employee mental health, reduce stress, and enhance well-being. Individualized interventions supported targeted psychological benefits, while group formats promoted social cohesion and engagement. Variations in type, duration, and delivery, as well as accessibility barriers for underrepresented employees, were noted. WPABPs enhance employee well-being and organizational outcomes, contributing to the Sustainable Development Goals (SDGs), specifically SDG 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth). Conclusions: Hybrid models combining individual and group approaches with managerial and digital support are recommended. Integrating WPABPs within ESG-S and Corporate Social Responsibility (CSR) frameworks can institutionalize sustainable workplace health promotion, while future research should focus on standardized, inclusive, and long-term evaluations. Full article

Background: Obesity, gastrointestinal disorders, and mental health conditions are major drivers of employer healthcare expenditures, yet nutrition-focused interventions are infrequently reimbursed by health insurance. Precision nutrition, which integrates genetic, gut microbiome, biometric, and behavioral data to guide personalized dietary and lifestyle changes, may offer a scalable approach to reducing costs associated with diet-responsive conditions. Objectives: To evaluate the impact of a precision nutrition digital therapeutic on employer medical spending for diet-responsive conditions in self-insured U.S. health plans. Methods: We conducted a retrospective cohort study of medical claims from January 2022 to December 2024 across seven U.S. self-insured employers. Employees enrolled in a precision nutrition digital therapeutic (n = 258) were compared with never-enrolled peers (n = 8268). We estimated treatment effects using a two-stage difference-in-differences model with member and calendar-month fixed effects and clustered standard errors, focusing on per-member-per-year (PMPY) employer-paid medical spending overall and for predefined diet-responsive condition categories. PMPY estimates were defined conditional on months with positive employer-paid spending and therefore reflect changes in the intensity of spending among members generating claims rather than unconditional per-capita costs. Results: Enrollment in the precision nutrition digital therapeutic was associated with a −$3012 PMPY reduction in diet-responsive medical spending (p = 0.021) relative to non-enrolled peers on this conditional basis. The largest relative reductions were observed for digestive disorders (−$9240 PMPY; p = 0.029) and obesity (−$4884 PMPY; p = 0.007), with a smaller reduction for anxiety-related conditions (−$1356 PMPY; p = 0.043). Total medical spending decreased by −$4044 PMPY but this change did not reach statistical significance (p = 0.09). Conclusions: In this multi-employer claims analysis, participation in a precision nutrition digital therapeutic was associated with lower employer-paid medical expenditures for diet-responsive conditions, particularly digestive disorders and obesity. These findings suggest that precision nutrition digital therapeutics may represent a scalable strategy for employers to address the economic burden of chronic disease within self-insured health plans by reducing the intensity of medical spending among members. Full article

Background: Fibromyalgia (FM) is a chronic nociplastic pain condition predominantly affecting women. Although often addressed within biomedical frameworks, its structural and relational dimensions remain underexplored. This study examined how social, familial, and economic factors are associated with symptom severity and self-perceived mental health among women with FM, with particular emphasis on social participation and perceived discrimination. Methods: A cross-sectional study was conducted among women diagnosed with FM in Chile. Participants were recruited through patient organizations and community networks and completed a self-administered questionnaire covering biopsychosocial aspects of FM. Multifactor ANOVA models were used to explore associations between social and familial variables and symptom count and perceived mental health. Results: Participants were mostly middle-aged women who reported a high burden of symptoms and moderate levels of self-perceived mental health. Involvement in FM-related organizations was significantly associated with differences in symptom perception and better mental health, while perceived discrimination was linked to poorer mental health outcomes. Conclusions: Social participation and supportive environments emerge as potential determinants of health among women with FM. Primary care providers should adopt social and gender-sensitive approaches that acknowledge the influence of discrimination, economic vulnerability, and support networks in shaping the illness experience. Full article

Climate change is expected to have significant yet distinct impacts on arthropods. Studying the species distribution of odonates, which are considered a model taxon for studying climate change and a flagship group for assessing ecosystem health, can reveal potential future patterns of geographic change. My study predicts the impacts of different climate change scenarios on the future habitat and distribution of odonates. I used MaxEnt to construct species distribution models (SDMs) for 30 North American odonate species across seven functional groups, categorized based on functional traits about each genus’s life history, dispersal, morphology, and ecology. Each model was applied to three future years and three different Shared Socio-economic Pathways (SSPs). My results show that odonates will experience increasing overall habitat suitability and increasing range size with shifts northward; however, the total suitable habitat will shrink into smaller, geographically separated pockets. While most functional groups will follow the aforementioned trends, Libellula will experience a decrease in range size, and Aeshna will move the furthest north while experiencing the greatest increase in overall habitat suitability and range size. Overall, SSP5 will result in increased variability among functional groups in their habitat and distribution. This study has implications for understanding invertebrate responses to global change and may refocus conservation efforts on species with specific functional traits. The functional approach used here may be further applicable to other organisms and regions. Full article

Urban parks provide critical benefits for public health, mental well-being, and social connection. However, inequities in park access and use persist, particularly among socially and economically vulnerable populations. While previous studies have established that segregation and social vulnerability each contribute to uneven park access, little is known about how these two forces interact to shape real visitation patterns. This study addresses this research gap and answers the research question: How does highway segregation relate to differences in the different aspects of social vulnerability in influencing park access across Austin’s east–west divide? SafeGraph mobility data from 2019 and the Social Vulnerability Index (SVI), which included four themes (i.e., socioeconomic status, household composition, minority status and language, and housing and transportation characteristics), were analyzed through fixed-effects regression models for Austin, Texas. Results show that household composition and minority vulnerabilities have negative associations with park visitation, indicating that areas with more elderly, single-parent, or minority residents visit parks less frequently. Interaction terms reveal that highway segregation functions as a structural barrier that conditions the influence of social vulnerability on park use. Those associated with socioeconomic resources diminish, while the disadvantages linked to household composition and minority status intensify on the east side of I-35, reflecting the cumulative effects of segregation and infrastructural division. These findings confirm that inequities in park access are more pronounced on the east side of the I-35, consistent with the highway’s role in reinforcing segregation. Efforts to strengthen connectivity represent key strategies for advancing equitable park visitation across Austin. Full article

Rapid urbanization and industrialization have intensified air pollution, posing severe challenges to sustainable development and public health. As a core economic zone in China, the Beijing–Tianjin–Hebei (BTH) region faces persistent air quality deterioration, highlighting the urgent need for accurate and intelligent prediction models. However, existing studies often suffer from limited adaptability of single models and subjective feature selection thresholds, constraining predictive performance and generalization capability. To address these challenges, this study proposes a feature-optimized hybrid deep learning framework for AQI prediction across Beijing, Tianjin, and Shijiazhuang. An adaptive feature selection strategy is first developed by integrating the Relief_F algorithm with the Bat Optimization Algorithm (BOA), which adaptively determines feature importance, thereby enhancing objectivity and effectiveness in identifying key pollutant and meteorological indicators. Subsequently, an attention-enhanced CNN–BiLSTM–GRU hybrid network is constructed, where the attention mechanism emphasizes critical temporal information that most influences prediction results. Experiments show that the proposed model achieves MAPE values of 1.00%, 1.15%, and 1.09% for Beijing, Tianjin, and Shijiazhuang, outperforming benchmark models by 18.43–45.05%. These results confirm the framework’s reliability for practical application with strong robustness and statistical validity. Full article

Conventional cereal production in coastal saline–alkali drylands is constrained by low productivity and soil degradation. While diversified cropping and biochar application have each been shown to enhance soil quality, the effects of their short-term integration into continuous cereal systems remain unclear, particularly regarding crop yield, soil health, and economic returns. A field experiment was conducted to compare a continuous wheat–maize rotation (W) with systems where one cycle of that was replaced by an alfalfa–sweetpotato (A) or rapeseed–soybean (R) rotation, under biochar-amended and non-amended conditions. Diversified rotations increased subsequent wheat yields by 6.6–16.2%. System A achieved 216% and 439% higher cumulative equivalent yield and economic benefit than System W, respectively. Even without biochar, A and R systems increased soil organic matter content, aggregate stability, and fungal richness by 16.3–21.0%, 20.6–26.5%, and 8.60–10.2%, respectively, compared to W. Biochar further enhanced crop yields by 6.36–16.3% and integrated fertility score by 7.78–9.01%, but its initial cost reduced profitability. Comprehensive evaluation conducted via a weighted model indicated that system A, combined with biochar, achieved the optimal balance among productivity, soil fertility, economics, and microbial diversity. These findings demonstrate that integrating “green” (diversified cropping) and “black” (biochar) strategies offers synergistic benefits for sustainable production in coastal saline–alkali drylands. Full article

Environmental sustainability in tourism and hospitality has emerged as a critical focus of Saudi Arabia’s Vision 2030, aligning with global Sustainable Development Goals (SDGs) and national priorities such as environmental stewardship, human health, and future economic diversification. This study examines how perceived leader favoritism influences non-green behavior among hospitality employees, exploring malicious envy as a mediator and perceived organizational injustice as a moderator. A cross-sectional survey was administered to 412 employees across five major hotels in Riyadh. Measures included validated scales for perceived leader favoritism, malicious envy, non-green behavior, and organizational justice. Structural equation modeling tested hypothesized relationships and moderation effects. Perceived leader favoritism was positively associated with non-green behavior (β = 0.39, p < 0.001) and malicious envy (β = 0.58, p < 0.001). Malicious envy mediated the favoritism–behavior link (indirect effect β = 0.17, p < 0.01). High perceptions of organizational injustice strengthened these effects, exacerbating environmentally harmful behaviors. Interpretation: The findings reveal that unfair leadership practices undermine corporate sustainability efforts by provoking negative emotions and unethical environmental actions. Managerial interventions to enhance fairness and mitigate envy are imperative for achieving SDG 12 (Responsible Consumption and Production) and SDG 13 (Climate Action), supporting Saudi Arabia’s goals in environmental sustainability, basic needs fulfillment, and future economies. Implementing justice-centered leadership programs can foster healthier organizational climates, promoting both employee well-being and ecological resilience. Full article

Obesity has emerged as one of the most complex and urgent public health challenges of the twenty-first century, driven by genetic, environmental, metabolic, and psychosocial determinants that collectively disturb energy homeostasis and systemic health. It is characterized by adipose tissue dysfunction, insulin resistance, chronic low-grade inflammation, and gut microbiota dysbiosis, all of which interact to perpetuate metabolic and cardiovascular diseases. Beyond the biological dimension, obesity profoundly affects mental health, being closely linked to depression, anxiety, body-image dissatisfaction, and stigma, which further reduce adherence to treatment. Current therapeutic strategies rely on a stepped-care approach, beginning with lifestyle interventions encompassing dietary modification, physical activity, and behavioral therapy. Pharmacologic treatments, particularly incretin-based agents such as semaglutide, liraglutide, and tirzepatide have transformed medical management through substantial and sustained weight loss, while bariatric surgery remains the most effective long-term option for severe obesity. Emerging approaches, including gene therapy, microbiome modulation, and nanomedicine, offer mechanistically targeted and potentially safer alternatives, though they remain largely experimental. Pharmacoeconomic analyses support the cost-effectiveness of combining behavioral, pharmacological, and surgical modalities, highlighting the economic advantage of integrated care models. Meanwhile, artificial intelligence and machine learning are redefining obesity research and management, enhancing cancer risk prediction, personalizing pharmacotherapy, optimizing resource allocation, and enabling precision medicine through multi-omics and imaging integration. Collectively, these insights support a shift toward a learning health-system paradigm that unites mechanistically anchored therapies with digital and AI-driven personalization to achieve sustainable weight reduction, reduce cardiometabolic and cancer burden, and improve global health outcomes. Full article

The concept of carbon-neutral buildings encompasses not only carbon emission reductions but also sustainability. Building sustainability includes the physical durability of the structure, the health and safety of its tenants, and harmony with the surrounding environment. The achievement of these goals requires alignment among diverse stakeholders associated with buildings; however, such alignment is limited by economic (cost), environmental (global warming), and social (institutions and policies) factors. This study proposes an operation model that integrates buildings, the carbon permit market, and deep reinforcement learning (DRL) to address these limitations. The DRL model reduces energy consumption while maintaining indoor comfort, generates carbon permits equivalent to the amount of energy saved, and creates a new revenue stream by selling them. To achieve more precise comfort management, the model incorporates a policy that combines predicted mean vote (PMV) and Humidex. In the context of a privately owned commercial office building, the DRL model achieved indoor comfort levels of 98.51% for PMV and 97.22% for Humidex, while reducing energy consumption by 34,376 kWh, lowering carbon emissions by 26,607 kgCO₂eq, and generating USD 176 in carbon permit revenue. These results translated into a total reduction in operating costs of 7.5%, amounting to USD 2951. Consequently, the proposed approach provides cost reductions for building owners, comfort for tenants, efficiency for managers, and carbon emission reductions that contribute to carbon neutrality. Full article

Background: Global immunization against Haemophilus influenzae type b (Hib) has expanded with Gavi support. We estimated health, economic benefits, equity and cost-effectiveness in 159 countries (1990–2021), and projected effects of future introduction in China. Methods: We used a random forest model to simulate counterfactual scenarios without Hib vaccine introduction in 159 countries (1990–2021) and to project effects of Hib vaccine introduction in China over the next decade. Ten variables were sourced from the World Bank and WHO; Hib disease burden estimates were from the Global Burden of Disease Study 2021. We compared counterfactual and actual results to quantify benefits, equity, and cost-effectiveness. Extensive uncertainty analyses were performed. Results: Between 1990 and 2021, Hib immunization averted an estimated 1,321,123 (95% uncertainty interval [UI] 32,034–2,723,304) deaths and 90,973,504 (95% UI 3,573,718–197,099,799) disability-adjusted life-years globally. Greatest health and economic gains occurred in Africa and low- and middle-income countries (LMICs). Deaths averted decreased with later vaccine introduction (Pearson’s r = −0.56). Vaccination did not improve health equity, and access remains limited in Africa and LMICs. Hib immunization was cost-saving in all countries. In China, introduction at any point in the next decade would provide health and economic benefits and be cost-effective, with earlier introduction yielding greater gains. Conclusions: Hib immunization provide substantial, cost-effective health and economic benefits globally. Persistent inequities in vaccine access for LMICs require targeted solutions. Policymakers in China should consider these findings for future vaccine introduction. Full article

Brominated Flame Retardants (BFRs), widely used in Electrical and Electronic Equipment (EEE), pose severe health and environmental risks and complicate recycling at the end-of-life stage, calling for innovative, sustainable detection and sorting solutions. In this context, new strategies that are efficient, reliable, sustainable, and cost-effective are required. This study investigates Short-Wave Infrared (SWIR) spectroscopy for detecting brominated plastics and quantifying bromine (Br) and antimony (Sb) content in Cathode-Ray Tube (CRT) e-waste. X-Ray Fluorescence (XRF) provided reference measurements, while Support Vector Machine (SVM) models were trained on reflectance spectra acquired with a portable spectroradiometer. The SVM–Discriminant Analysis models achieved near-perfect classification, with 100% accuracy in distinguishing samples above and below the regulatory thresholds for Br (2000 mg/kg) and Sb (8354 mg/kg). SVM regression yielded excellent quantitative predictions, with R²_P = 0.996 and RMSEP = 2671 mg/kg for Br, and R²_P = 0.999 and RMSEP = 1056 mg/kg for Sb. These performances confirm the robustness of SWIR spectroscopy for rapid, non-destructive monitoring of hazardous plastics, even in highly heterogeneous waste streams. The integration of SWIR spectroscopy with machine learning supports selective recycling and safer resource recovery, directly contributing to United Nations Sustainable Development Goals on Decent Work and Economic Growth (SDG 8), Industry, Innovation and Infrastructure (SDG 9), and Responsible Consumption and Production (SDG 12). Full article