Search Results (6,855)

This paper extends a benchmark reversible job-choice framework by imposing a subsistence-consumption constraint. The agent chooses consumption, portfolio allocation, and one of two jobs in continuous time. The first job provides low income and high leisure, whereas the second job provides high income and low leisure. We focus on the case in which the coefficient of relative risk aversion satisfies $\gamma >1$, so that the transformed risk-aversion parameter also satisfies ${\gamma }_1>1$. Consumption must satisfy the lower bound $c_t\ge \underline{c}$ under both jobs. The constraint changes both the natural solvency boundary and the job-switching rule. In the dual problem, each job generates a subsistence-adjusted reward whose form depends on whether the consumption floor is binding. The optimal job is selected by the upper envelope of the two dual rewards. We prove that, when $\gamma >1$, the resulting dual switching function has a unique positive zero. We also characterize the location of this zero explicitly in terms of the income gap $Y_1-Y_0$ and the subsistence level $\underline{c}$. Hence the optimal job policy remains a one-threshold rule: the agent chooses the high-income job at low wealth and the high-leisure job at high wealth. The consumption floor shifts this boundary and implies that near the solvency boundary the agent necessarily consumes at the subsistence level and works in the high-income job. We provide a complete closed-form representation of the dual value function in all possible regimes. Full article

Background: Non-operative management (NOM) is the standard of care for haemodynamically stable patients with blunt splenic injury; however, failure of NOM remains clinically significant, particularly in settings where adjunctive interventions such as splenic artery embolisation are not routinely utilised. This study aimed to evaluate NOM outcomes and identify predictors of failure at a South African Level I trauma centre. Methods: A retrospective cohort study of adult patients with blunt splenic injury over a 5-year period (2020–2025) was conducted. Patients were stratified according to their initial management strategy into operative and non-operative groups. Categorical variables were compared using Fisher’s exact test, and continuous variables using the Mann–Whitney U test. Multivariable logistic regression analysis was performed to identify independent predictors of NOM failure. Results: A total of 136 patients were included. Twelve patients (8.8%) underwent immediate operative management, while 124 (91.2%) were initially managed non-operatively. NOM was successful in 112 patients (90.3%), with 12 patients (9.7%) requiring delayed operative intervention. Overall mortality was 4.4% (6/136), with all deaths attributable to associated injuries rather than isolated splenic trauma. Increased admission heart rate was independently associated with NOM failure (OR 1.04 per beat increase; 95% CI 1.01–1.08; p = 0.009). Higher Injury Severity Scores and severe traumatic brain injury were more frequent in patients with NOM failure but were not independently predictive. Splenic artery embolisation was not utilised in this cohort. Conclusions: Non-operative management is safe and effective for blunt splenic injury, with high rates of splenic preservation. Admission tachycardia predicts NOM failure and may guide early clinical decision-making. These findings support the use of NOM in low- and middle-income settings where interventional radiology is not routinely available. Full article

Background: The association between female reproductive factors and laryngopharyngeal reflux (LPR) remains poorly understood. This study investigated the relationship between reproductive history and LPR risk in women using a large nationally representative cohort. Methods: We conducted a nested case–control study using linked data from the Korean National Health and Nutrition Examination Survey and the National Health Insurance Service database (2007–2017). Among 57,559 participants, 1347 women diagnosed with LPR were matched 1:1 with 1347 controls without reflux disease using propensity score matching based on age, income, and education level. Multivariable logistic regression analyses were performed to evaluate the associations between reproductive factors and LPR risk after adjustment for metabolic and lifestyle variables. Results: Women with a first childbirth at age ≥27 years had a significantly higher risk of LPR than those with earlier childbirth (adjusted odds ratio [aOR] 1.33, 95% confidence interval [CI] 1.08–1.63; p = 0.007). A menarche-to-first-birth interval of ≥17 years was also associated with an increased risk of LPR (aOR 1.56, 95% CI 1.15–2.15; p = 0.005). In addition, breastfeeding for <12 months was independently associated with a higher risk of LPR (aOR 1.26, 95% CI 1.04–1.53; p = 0.019). These associations remained significant after adjustment for potential confounders. Conclusions: Female reproductive factors potentially reflecting cumulative hormonal exposure were independently associated with LPR risk in this nationally representative cohort. First delivery at age ≥27 years, a menarche-to-first-birth interval ≥17 years, and breastfeeding <12 months were associated with LPR, suggesting that reproductive history should be considered when evaluating women with reflux-related symptoms. Full article

Economic well-being is essential for assessing sustainability of human settlement in urbanizing regions; however, the geographic factors linking settlement characteristics to residents’ well-being remain underexplored, particularly in counties in China undergoing urban–rural transformation. In this study, six representative Chinese counties (Yanshou, Wafangdian, Bazhou, Yugan, Yongsheng, and Raoping) with varying urbanization levels are investigated to establish a multidimensional evaluation framework and reveal the geographic factors underlying economic well-being. Through original household surveys conducted across these six geographically and economically diverse counties, we collected primary data from 1659 households; these data provide unique insights into residents’ lived experiences. By integrating these original survey data with objective indicators from statistical yearbooks and geographic features from multisource spatial data, key drivers were identified using Pearson correlation and random forest models. The results show the following trends: (1) significant county-level variation in subjective well-being, with Wafangdian ranking the highest and Bazhou ranking the lowest, while well-being aligned more closely with economic development levels; (2) income and happiness were the dominant determinants of subjective well-being, with work-related factors also contributing substantially, whereas nighttime light intensity, building density, and construction land area drove fusion well-being; and (3) multifactor modeling demonstrated strong explanatory power for fusion well-being (training set R² = 0.8313; validation set R² = 0.7531), indicating generalizability. The primary data collection across varied settlement settings provides strong empirical grounding. The findings reveal the spatial differentiation of economic well-being in urbanizing settlements, offering empirical support for targeted settlement planning and urban governance policies to improve sustainability and residents’ well-being in developing countries. Full article

Background: Breast cancer comprises 31.4% of all female cancers in Saudi Arabia (2020 Cancer Registry). Despite free national screening services existing since 2005, mammography utilization remains critically low. This study assessed breast cancer knowledge, attitudes, and practices (KAP) among females in Saudi Arabia and identified independent predictors of screening behavior. Methods: A cross-sectional study (December 2024–February 2025) enrolled 426 females aged ≥20 years from all 13 Saudi administrative regions using a quota-based design combining facility-based and online recruitment. Attitude and barrier domains were adapted from Champion’s Health Belief Model Scale (CHBMS), validated in Arabic; knowledge items used validated regional instruments. Knowledge-score reliability: KR-20 = 0.45; attitude subscale: α = 0.74. Binary logistic regression identified independent predictors of screening uptake (outcome: any screening in the preceding five years, coded as screened = 1; not screened = 0). Results: Mean composite knowledge score: 4.51 ± 1.52/7 (KR-20 = 0.45); 54.0% achieved high knowledge (≥5). Mammography uptake was 30.5% overall and 52.2% among women aged ≥40 (n = 136; the recommended target group). Predominant barriers: Fear of diagnosis (83.6%), belief in incurability (76.3%), radiation concern (73.2%), and pain anxiety (72.3%). Logistic regression (χ²(8) = 188.96, p < 0.001; McFadden’s pseudo R² = 0.323) identified older age (OR = 1.52; 95% CI: 1.21–1.92), higher income (OR = 1.57; 95% CI: 1.25–1.99), transportation barriers (OR = 3.39; 95% CI: 1.95–5.89), and family discouragement (OR = 3.03; 95% CI: 1.72–5.34) as significant predictors (all p < 0.001). Conclusions: A significant knowledge–practice gap persists across all 13 Saudi regions. These findings suggest several implications for a multi-level public health response to be evaluated through future intervention research; multi-level strategies targeting CHBMS Barriers are needed. Full article

Financial literacy has become critical for mitigating everyday financial risks and sustaining saving behavior, particularly in professions with stable but often constrained income such as teaching. This study examines whether financial literacy predicts teachers’ saving habits indirectly through financial practices, and whether technological access may be associated with the link between practices and saving. Using a cross-sectional survey of 180 teachers from public educational institutions in the Jequetepeque Valley (Peru) in 2025, we tested a moderated mediation model (PROCESS Model 14). Financial literacy showed a strong positive association with financial practices, while its direct effect on saving habits was not significant after controls. The indirect effect through financial practices was significant across levels of technological access; however, the moderation effect of technological access was only marginally significant (p = 0.057) and the index of moderated mediation did not reach statistical significance at α = 0.05, indicating that the moderating role of technology requires further investigation. Overall, the results suggest that financial knowledge alone does not predict saving habits: the effect operates through consistent financial practices, and digital access may facilitate the continuity of these practices. The study contributes to financial risk management research in teacher populations and to Sustainable Development Goals (SDGs) 4, 8, and 9 in rural educational contexts. Full article

Background: While pediatric obesity prevalence is rising, the association between ICD-coded obesity, healthcare resource utilization, and inpatient outcomes in middle-income countries remains poorly quantified. This study examined inpatient diagnostic patterns, resource utilization, and in-hospital mortality among hospitalized pediatric patients with ICD-coded obesity in Thailand’s Universal Coverage scheme during a 9-year period. Methods: We analyzed nationwide inpatient administrative data from January 2015 to December 2023 for children aged 1 month to <18 years. ICD-coded obesity was defined using ICD-10-TM codes recorded as either a principal diagnosis or a comorbidity. Outcomes included length of stay, hospital costs, and in-hospital mortality. Univariable and multivariable regression models were used to estimate associations between ICD-coded obesity and inpatient outcomes, with adjustment for age, sex, region, hospital level, admission year, and disease categories. Results: Among 14,483,566 hospitalized children, 42,168 had ICD-coded obesity. Notably, 95.7% of children with ICD-coded obesity were recorded as a comorbidity rather than the primary reason for admission. Children with ICD-coded obesity as a comorbidity had 156.8% higher median hospital costs. Across all major categories of common acute diseases (respiratory, intestinal, digestive), children with ICD-coded obesity had significantly higher median costs and longer length of stay compared to children without ICD-coded obesity. In regression analyses, ICD-coded obesity remained associated with longer length of stay (adjusted ratio, 1.21; 95% CI, 1.16–1.26; p < 0.001) and higher hospitalization cost (adjusted cost ratio, 1.42; 95% CI, 1.32–1.53; p < 0.001). The association with in-hospital mortality was observed in the unadjusted model but was attenuated after adjustment and was not statistically significant (adjusted odds ratio, 1.14; 95% CI, 0.89–1.45; p = 0.303). Conclusions: In Thailand’s national universal coverage scheme, ICD-coded obesity was associated with greater inpatient resource utilization, especially longer length of stay and higher hospitalization costs. These findings support the need for weight-aware inpatient management and adjusted funding models for hospitals treating this higher-resource-utilization subgroup. Full article

Persistent urban–rural inequality remains a major challenge for sustainable regional development, especially in countries where rural communities still face limited access to markets, employment, and public services. This study examines whether rural road network density promotes inclusive regional growth in China. Using county-level panel data from 2013 to 2024, we construct an inclusive regional growth index that combines economic output, nighttime-light-measured economic activity, rural income, and the urban–rural income gap. rural road network density is measured by the length of county, township, and village roads per 100 square kilometers. Two-way fixed-effects models, mechanism tests, robustness checks, instrumental-variable estimation, and heterogeneity analysis are employed. The results show that rural road network density significantly improves inclusive regional growth. Dimensional analysis indicates that higher rural road network density increases real GDP per capita, strengthens nighttime-light-measured economic activity, raises rural income, and reduces the urban–rural income gap. Mechanism analysis shows that these effects operate through labor mobility, market access, and non-agricultural industrial development. The results remain robust to alternative road measures, lagged specifications, outlier treatment, sample restrictions, and instrumental-variable estimation. Heterogeneity analysis further shows that the effects are larger in central-western counties, low-accessibility counties, and less-developed counties. These findings suggest that rural road network density is not only a transport infrastructure indicator but also a key spatial condition for promoting sustainable and inclusive regional development. Full article

This study analyses the economic performance, sustainability, and resilience of family farming systems in São Tomé and Príncipe, using an approach that combines quantitative and qualitative data. Primary data were collected through a survey of 50 rural families from the seven districts of the country, focus group discussions, and field observations. Quantitative analysis included descriptive statistics and exploratory comparative procedures, complemented by economic evaluation, while thematic analysis examined the qualitative data. The findings reveal diversified agroforestry systems, integrating up to 33 crops and small-scale livestock production. At the individual and aggregate levels, agroforestry shows viable economic performance, with a net profit margin of 57.4%, capable of generating income and marketable surpluses. This improves rural livelihoods, strengthens resilience to climate and market shocks, and supports both subsistence and market-oriented production. Despite these strengths, structural constraints persist, including fragile value chains, limitations in access to credit and markets, low technology adoption, and climate vulnerability. Human capital, particularly education, emerges as a key factor in improving productivity and value creation. Integrated policies on access to resources and education are needed to promote diversification, multi-activity, and market integration as central strategies for increasing sustainability, food security, and risk reduction in family farming. Full article

This study examines investor heterogeneity in relative priorities for AI-based financial services using a large-scale survey of Japanese online investors. We use data from the 2026 wave of the “Survey on Life and Money,” administered by Rakuten Securities and Kadoya Lab at Hiroshima University. The final analytical sample comprises 14,432 respondents. Respondents selected their first-, second-, and third-preferred AI-based services from 11 options, which were grouped into five functional categories: administrative procedure proxy services, consultation for troubles and emergencies, education and literacy support, information provision and planning support, and advisory and management for investment. Because respondents were required to select their top three preferred services, the dependent variables capture relative priorities rather than absolute willingness to use AI services. Binary probit and ordered probit models show that investor characteristics are associated with relative priorities across service categories, although the estimated marginal effects are generally modest. Information provision and planning support is more strongly prioritized by male respondents, more-educated respondents, and those with greater household financial assets. Advisory and management services are more strongly prioritized by higher-income and more impatient respondents, while risk aversion is negatively associated with this category. Additional robustness checks suggest that these patterns are not explained entirely by unequal category sizes, although option-level results reveal some within-category heterogeneity. These findings suggest that AI-based financial services should reflect investor heterogeneity while recognizing that service categories may contain diverse underlying functions. Full article

Background: Sepsis is a leading cause of pediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries (LMICs). However, timely recognition of potential sepsis and access to healthcare resources needed to diagnose pediatric sepsis according to international guidelines are challenging in LMICs. This exploratory study aimed to develop machine learning (ML) models to detect pediatric sepsis and septic shock using a simplified set of clinical data contextualized for practical use in resource-limited settings. Methods: This was a secondary analysis of an observational study of 100 children with potential sepsis admitted to a non-profit referral hospital in Dhaka, Bangladesh. The outcomes were sepsis as defined by a Phoenix Sepsis Score (PSS) ≥ 2 and septic shock (sepsis plus PSS cardiovascular sub-score ≥ 1). Models were trained using either clinical + laboratory variables or clinical-only variables. A single 24 h worst-value assessment window was derived per patient; stratified 5-fold cross-validation was used to maintain class proportions across the training and test folds. Model performance was assessed using area under the precision–recall curve (AUPRC) and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CIs) derived from a 2000-resample patient-level bootstrap of out-of-fold classifications. Logistic regression coefficients were used to assess feature contributions. Results: For sepsis classification, the non-laboratory model achieved an AUPRC of 0.942 (95% CI: 0.884–0.979) and an AUROC of 0.945 (95% CI: 0.890–0.983), with comparable performance from the clinical + laboratory model (AUPRC 0.941, 95% CI: 0.880–0.981; AUROC 0.945, 95% CI: 0.881–0.986). For septic shock, AUROCs of 0.870 (95% CI: 0.761–0.952) and 0.878 (95% CI: 0.758–0.967) were observed. However, these estimates should be interpreted cautiously, given the low prevalence (23%) and absence of external validation. SpO₂:FiO₂ ratio, GCS, and systolic blood pressure were consistently strong predictors across models. Conclusions: ML models using pragmatic clinical variables demonstrate preliminary diagnostic performance, with the non-laboratory model showing discrimination comparable to models incorporating laboratory data. Logistic regression demonstrated the most stable performance and may represent an early proof of concept for assistive diagnostic support. However, these models are not clinically usable without external validation. These findings are hypothesis-generating; external validation in larger, independent cohorts is essential before any clinical use, particularly for septic shock. Full article

Background/Objectives: Breast cancer is the most prevalent malignancy among women worldwide and a major public health concern. Early detection through screening methods such as breast self-examination, clinical breast examination, and mammography is associated with improved prognosis and reduced mortality. However, adherence to screening recommendations remains suboptimal and is influenced by multiple sociodemographic and psychosocial factors. Aims: This study aimed to assess women’s knowledge, attitudes, and practices regarding breast cancer screening and to identify factors associated with preventive behavior. Methods: A cross-sectional study was conducted using a structured self-administered questionnaire. The sample consisted of 1233 women from the general population. Data collected included sociodemographic characteristics, awareness of screening methods, attitudes toward prevention, and screening practices. Statistical analysis involved descriptive measures and multivariate regression models to identify predictors of knowledge and attitudes. Results: High levels of awareness were observed, with 96.5% reporting knowledge of breast self-examination, 94.5% clinical examination, and 95.0% mammography. Despite this, a gap between knowledge and practice was evident. Although 79.5% reported knowing how to perform breast self-examination, only 22.7% practiced it monthly, and 19.2% never performed it. Clinical examination within the past year was reported by 49.4%, while 13.3% had never undergone it. Among the women 45+ years old, 86% reported undergoing mammography every two years. Education, income, age, and place of residence were significantly associated with outcomes. Conclusions: A substantial gap exists between awareness and practice. Effective interventions should address behavioral, psychosocial, and structural barriers to improve screening uptake. Full article

Background: Malocclusion has important functional, esthetic, and psychosocial consequences; however, access to orthodontic treatment remains uneven and strongly influenced by socio-economic factors. While these disparities are well documented internationally, evidence from Romania remains limited. This study aimed to evaluate the influence of socio-economic factors on orthodontic treatment initiation within the Romanian population. Methods: A cross-sectional questionnaire-based study was conducted in 2025 using an online survey distributed through social media and community networks. A total of 285 adults were included. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: Overall, 56.5% of respondents reported having undergone orthodontic treatment. Age and self-perceived information level were significantly associated with treatment initiation in the multivariable model. Participants older than 30 years were significantly less likely to have undergone orthodontic treatment compared with those aged 18–30 years (OR = 0.28, 95% CI: 0.12–0.62, p = 0.002). Higher levels of self-perceived information were associated with a greater likelihood of having undergone orthodontic treatment (OR = 0.75, 95% CI: 0.59–0.96, p = 0.020). Income and area of residence were not significantly associated with treatment initiation. However, respondents with lower income levels were significantly more likely to perceive treatment cost as a barrier to orthodontic care. Conclusions: Within this surveyed sample, age and self-perceived information level were independently associated with orthodontic treatment initiation. Although income was not associated with treatment uptake, financial cost remained an important perceived barrier, particularly among lower-income respondents. Given the convenience sampling strategy and limited representativeness of the sample, the findings should be interpreted as exploratory and require confirmation in larger population-based studies. Full article

Traditional shellfish harvesting plays a crucial role in food security, local livelihoods and the preservation of cultural heritage in coastal communities. This study examined environmental, socioeconomic and circular economy perceptions associated with the artisanal fishery of the “black chinese” snail (Hexaplex nigritus) in the Navachiste Lagoon system, located in the south-eastern Gulf of California. A quantitative, exploratory–descriptive approach was employed using a structured Likert-scale questionnaire administered to 225 fishers. Four analytical dimensions were evaluated: environmental perception, personal-family-social, economic, and circular economy perception. Given the multidimensional nature of the questionnaire, the results were interpreted through item-level response patterns. An exploratory hierarchical cluster analysis using Ward’s method suggested greater similarity between environmental and economic perception profiles, without establishing a definitive relationship. The descriptive results indicated moderate environmental concern ($\overline{\mathrm{x}}$ = 3.12), high sociocultural value ($\overline{\mathrm{x}}$ = 4.49), a negative economic perception ($\overline{\mathrm{x}}$ = 2.32) associated with low income and dependence on intermediaries, and limited adoption of circular economy practices ($\overline{\mathrm{x}}$ = 1.36). It is concluded that, despite its cultural importance, surveyed fishers perceive that the fishery faces environmental pressures and economic constraints and shows an almost total lack of integration of circular economy practices. These findings underscore the potential importance of developing comprehensive policies to promote sustainable management, strengthen marketing, and foster a circular economy for the H. nigritus fishery with the aim of contributing to its long-term sustainability in the region. Full article

Parents play a central role in their child’s school outcomes. For working parents, however, particularly those working low-wage jobs, managing work and family demands is a constant and often overwhelming reality that can have significant and adverse effects on engagement with family and children. Much of our understanding of the relationship between parental work and child school outcomes, however, has been limited to broad contextual factors (e.g., income level, time). As articulated through Bioecological theory, the context through which children’s school outcomes may be influenced is layered and multifactorial. The Job Demands-Resources model and spillover-crossover model of the work-family interface provide a theoretical lens through which we can examine how direct work factors, as well as parental efforts to navigate the work-family interface, impact child school outcomes. The purpose of this paper is to explicate the integration of Bioecological theory and Spillover-crossover theory to provide a framework for examining these factors and to highlight several areas in the work-family literature that are ripe for exploration of their role in child school outcomes. For children of parents working low-wage jobs, the detrimental effects of parent work factors on parent–child interactions and child outcomes are particularly salient. By leveraging work-family theory and established literature on parental involvement, this review provides an interdisciplinary approach to understanding the link between the systems that shape parent experiences (i.e., their work roles) and child cognitive and academic outcomes. Full article