Search Results (1,953)

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic’s impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. Methods: A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Results: Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. Conclusions: These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic. Full article

Thailand is globally recognized for its tourism potential and rich diversity of cultural and natural heritage. Community-based tourism (CBT), in particular, holds significant promise for inclusive and sustainable development. However, CBT initiatives across the country remain fragile in the face of uncertainty, whether from pandemics, climate events, or market shifts, and are often constrained by fragmented practices and the absence of a shared service development framework that addresses sustainability tensions. This study addresses that gap by developing and validating a sustainability-oriented new service development (NSD) process comprising five phases and sixteen steps, tailored specifically for CBT under uncertainty. Through expert interviews and iterative action research in two contrasting Thai communities, the process was refined to include tools for place identity, customer analysis, service testing, and adaptive planning. The framework enables CBT communities to move from ad hoc efforts to structured, resilient, and market-aligned service practices. Expert validation confirmed its effectiveness and adaptability, while also recommending digital transformation and financial integration as future directions. This process offers a pathway for improving CBT outcomes in Thailand, and a potentially adaptable framework for CBT development across diverse contexts in uncertain tourism environments. Full article

This article explores urban ‘societal resilience’ during the global pandemic of 2020–2021. This health crisis involved a complex interweaving of social, cultural, political, and economic processes which involved both top-down measures undertaken by nation-state governments and bottom-up actions by local residents. In a research study undertaken in two European cities—Stuttgart and London—we focussed on two migrant minorities and the involvement by ‘experts’ and ‘non-experts’ in the meso-level where these top-down measures and bottom-up actions met. Our study provided a grounded understanding of ‘layered resilience’ where resiliency develops through the disjunctive order of communication patterns, public service delivery, institutionalized dialogue, narratives, and values. Through distinguishing between resiliency and resilience, we seek to illustrate the ‘elastic’ character of urban modes of integration. Our study suggests the need for more empirically grounded investigations into the continuity and difference between adaptation and adjustment, normality and normalcy, and resilience and resiliency. It also highlights the importance of context-specific and path-dependent notions of resilience and resiliency. Full article

Investigating the characteristics and influencing mechanisms of urban vitality in mountainous cities can contribute to enhanced urban resilience, optimised resource allocation, and sustainable development. However, most existing studies have focused on static analyses at single spatial scales, making it difficult to fully reveal the evolutionary trends of urban vitality under complex topographic constraints or the spatiotemporal heterogeneity of its influencing factors. This study examines Guiyang, one of China’s fastest-growing cities, focusing on both its economic development and population growth. Based on social media data and geospatial big data from 2019 to 2024, the spatiotemporal permutation scan statistics (STPSS) model was employed to identify spatiotemporal areas of interest (ST-AOIs) and to analyse the spatial distribution and day-night dynamics of urban vitality across different phases. Furthermore, by incorporating transportation and topographic factors characteristic of mountainous cities, the multiscale geographically and temporally weighted regression (MGTWR) model was applied to reveal the driving mechanisms of urban vitality. The main findings are as follows: (1) Urban vitality exhibits a multi-center, clustered structure, gradually expanding from gentle to steeper slopes over time, with activity patterns shifting from an afternoon peak to an all-day distribution. (2) Significant differences in regional vitality resilience were observed: the core vitality areas exhibited stable ST-AOI spatial patterns, flexible temporal rhythms, and strong adaptability; the emerging vitality areas recovered quickly with low losses, while low-vitality areas showed slow recovery and insufficient resilience. (3) The density of commercial service facilities and the level of housing prices were continuously enhancing factors for vitality improvement, whereas the density of subway stations and the degree of functional mix played key roles in supporting resilience during the COVID-19 pandemic. (4) The synergistic effect between transportation systems and commercial facilities is crucial for forming high-vitality zones in mountainous cities. In contrast, reliance on a single factor tends to lead to vitality spillover. This study provides a crucial foundation for promoting sustainable urban development in Guiyang and other mountainous regions. Full article

Background/Objectives: The COVID-19 pandemic profoundly disrupted gastric cancer care, reducing access to screening, delaying diagnosis, and altering therapeutic pathways worldwide. Beyond clinical challenges, it exposed structural weaknesses in healthcare systems but also accelerated innovation. Methods: We conducted a narrative review supported by a structured literature search (PubMed/MEDLINE, Scopus, Web of Science; 1 January 2014–30 November 2025), with a narrative synthesis of observational studies, registry analyses, and meta-analyses addressing COVID-19–related changes in gastric cancer epidemiology, diagnosis, treatment, vaccination, and telemedicine. A PRISMA-style flow diagram was used to illustrate study selection. Results: Elective endoscopy volumes fell by up to 80%, leading to diagnostic backlogs and increased proportions of advanced-stage gastric cancer. Surgical postponements, modified chemotherapy and radiotherapy schedules, and reduced molecular/genetic testing further compromised outcomes. Conversely, vaccination, telemedicine, capsule endoscopy, and adaptive triage frameworks enabled partial recovery of services. Geographical variations were observed in the recovery of gastric cancer care services, with regions that had established screening infrastructure generally resuming activity more rapidly, whereas others experienced ongoing delays and diagnostic backlogs. Conclusions: This review integrates epidemiological, diagnostic, and therapeutic evidence to demonstrate how COVID-19 redefined gastric cancer care. By highlighting regional disparities and outlining a conceptual model for oncologic resilience, it provides an innovative framework for future crisis preparedness. The lessons of the pandemic—digital health integration, flexible treatment protocols, and international collaboration—represent a foundation for more robust, equitable gastric cancer management in the post-pandemic era. Full article

Financial crises increasingly exhibit complex, interconnected patterns that traditional risk models fail to capture. The 2008 global financial crisis, 2020 pandemic shock, and recent banking sector stress events demonstrate how systemic risks propagate through multiple channels simultaneously—e.g., network contagion, extreme co-movements, and information cascades—creating a multidimensional phenomenon that exceeds the capabilities of conventional actuarial or econometric approaches alone. This paper addresses the fundamental challenge of modeling this multidimensional systemic risk phenomenon by proposing a mathematically formalized three-tier integration framework that achieves 19.2% accuracy improvement over traditional models through the following: (1) dynamic network-copula coupling that captures 35% more tail dependencies than static approaches, (2) semantic-temporal alignment of textual signals with network evolution, and (3) economically optimized threshold calibration reducing false positives by 35% while maintaining 85% crisis detection sensitivity. Empirical validation on historical data (2000–2023) demonstrates significant improvements over traditional models: 19.2% increase in predictive accuracy (R² from 0.68 to 0.87), 2.7 months earlier crisis detection compared to Basel III credit-to-GDP indicators, and 35% reduction in false positive rates while maintaining 85% crisis detection sensitivity. Case studies of the 2008 crisis and 2020 market turbulence illustrate the model’s ability to identify subtle precursor signals through integrated analysis of network structure evolution and semantic changes in regulatory communications. These advances provide financial regulators and institutions with enhanced tools for macroprudential supervision and countercyclical capital buffer calibration, strengthening financial system resilience against multifaceted systemic risks. Full article

The COVID-19 pandemic exacerbated structural, social, economic, and racial inequalities affecting immigrant, refugee, and asylum-seeking men—vulnerable populations often overlooked in men’s health research. This study investigated the health conditions of immigrant, refugee, and asylum-seeking men during the COVID-19 pandemic. A scoping review was conducted following Joanna Briggs Institute guidance, and a qualitative lexical analysis (text-mining of standardized study syntheses) was performed in IRaMuTeQ using similarity analysis, descending hierarchical classification, and factorial correspondence analysis. We identified 93 studies published between 2020 and 2023 across 35 countries. The evidence highlighted vaccine hesitancy, high epidemiological risks (infection, hospitalization, and mortality), barriers to accessing services and information, socioeconomic vulnerabilities, psychological distress (e.g., anxiety and depression), and structural inequalities. Findings were synthesized into four integrated thematic categories emphasizing the role of gender constructs in help-seeking and gaps in governmental responses. Most studies focused on immigrants, with limited evidence on refugees and especially asylum seekers; therefore, conclusions should be interpreted cautiously for these groups. Overall, the review underscores the urgency of multisectoral interventions, universal access to healthcare regardless of migration status, culturally and linguistically appropriate outreach, and gender-sensitive primary care strategies to support inclusive and resilient health systems. Full article

Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the sense of coherence among public health workers by integrating psychological assessments with physiological markers of stress to identify protective factors against pandemic-related occupational stress. Methods: This longitudinal study was conducted at the Teaching Public Health Institute of Split and Dalmatia County from July 2021 to February 2022 at two time points: the latency phase (between COVID-19 waves) and hyperarousal phase (during an active wave). Fifty-four public health workers participated in the study. There were three questionnaires assessing psychological distress: Kessler Psychological Distress Scale, Impact of Events Scale—Revised and Sense of Coherence Scale-29. Salivary and blood samples were collected at both time points to measure cortisol levels, cortisol awakening response, and interleukin-6 concentrations. Results: The cortisol area under the curve with respect to ground (AUCg) was significantly elevated during the stress phase compared to the latency phase (234.8 vs. 201.8; p = 0.023), indicating heightened physiological stress responses. Epidemiologists demonstrated significantly lower sense of coherence scores compared to non-epidemiologists (117.9 ± 9.1 vs. 125.6 ± 10.5; p = 0.029). A lower sense of coherence was significantly associated with higher psychological distress and post-traumatic stress symptoms. Multiple linear regression analysis revealed that sense of coherence and interleukin-6 levels were significant independent predictors of cortisol changes. Conclusions: The findings demonstrate that public health workers experience measurable physiological stress responses during pandemic peaks, with sense of coherence emerging as a protective psychological factor. Interventions targeting sense of coherence and organizational support may possibly enhance resilience and reduce mental health morbidity in this vulnerable workforce during crisis situations. Full article

Small and medium-sized enterprises (SMEs) play a central role in employment and regional economic development, yet they are highly vulnerable to shocks such as pandemics, energy price spikes, and supply chain disruptions. Scenario modelling, stress testing, and digital twins are used to assess resilience, yet most applications focus on large firms in single-country settings. This article develops a model to stress test the resilience of Slovenian SMEs, calibrated with parameters and mechanisms derived from South African SME resilience studies. A system dynamics model with stocks for cash, inventory, and productive capacity is specified and subjected to demand, supply, financial, and compound shock scenarios, with and without resilience measures such as liquidity buffers, customer and supplier diversification, and basic digital planning capabilities. Results indicate non-linear tipping points where small reductions in liquidity sharply increase the likelihood of distress, and show that combinations of liquidity, diversification, and collaborative supply chain practices reduce the depth and duration of output losses. The study demonstrates how evidence from an African context can inform resilience strategies in a small European economy and provides a transparent, portable modelling architecture that can be adapted to other settings. Implications are discussed for SME managers and for policies supporting sustainable, resilient enterprise ecosystems. Full article

In recent years, global supply chains have become increasingly vulnerable to geopolitical tensions, pandemics, and energy crises, particularly in resource-constrained regions characterized by weak infrastructure and high transaction costs. Using panel data on A-share listed firms in China’s central and western regions from 2010 to 2022, this study examines the effect of firm-level digital transformation on supply chain resilience. We construct a digital transformation index and employ an instrumental-variable approach based on the interaction between terrain ruggedness and lagged digital transformation to address endogeneity concerns. Empirical results show that the digital transformation of enterprises has significantly enhanced the resistance and recovery capabilities of the supply chain, verifying its effectiveness in resource-constrained environments. Mechanism analyses reveal that this effect operates through increased supply chain diversification—especially customer diversification—and improved supply–demand matching enabled by more accurate demand forecasting and inventory management. Heterogeneity tests indicate that the resilience-enhancing effects are more pronounced among non-state-owned firms, manufacturing enterprises, and firms in less technology-intensive industries. Overall, our findings provide empirical support for transaction cost economics, dynamic capability theory, and the resource-based view, highlighting the strategic role of digital investment in strengthening supply chain resilience in infrastructure-constrained settings and contributing to the aims of Sustainable Development Goal 9. Full article

Background/Objectives: Healthcare workers at the frontline of managing pandemics are at increased risk for adverse physical and mental health outcomes, which has been shown to result in burnout. The relationship between personal resilience and burnout among clinical and non-clinical healthcare staff working in an acute care setting was assessed at the start of the COVID-19 pandemic. Methods: A prospective cross-sectional survey design with electronic questionnaires was used to measure resilience (Connor-Davidson Resilience Scale,) and burnout (Maslach Burnout Inventory—Human Services Survey). Linear regression analyses were conducted to examine the relationship between resilience and emotional exhaustion, depersonalization, and personal accomplishment. Results: A significant inverse relationship between resilience and both emotional exhaustion and depersonalization, and a positive relationship between resilience and personal accomplishment were identified. Higher resilience scores were significantly associated with lower emotional exhaustion and depersonalization and higher personal accomplishment under pandemic conditions. Conclusions: Strategies to boost resilience organization-wide amongst healthcare staff providing patient care are critical for providing skills to reduce the onset of burnout and support employee mental health. From a pandemic preparedness lens, organizational-level emergency management should consider the importance of resilience-building among staff to proactively prevent burnout and its subsequent effects on patient-care and general hospital functioning. Full article

Background: Zoonotic spillover events with pandemic potential are increasingly associated with environmental change, ecosystem disruption, and intensified human–animal interactions. Although the specific origin and timing of future pandemics remain uncertain, there is a clear need to complement traditional preparedness strategies with approaches that support earlier anticipation and prevention. Objectives: This study aims to propose a conceptual approach to reframe pandemic preparedness toward proactive surveillance and spillover prevention. Methods: We introduce a tachyon-inspired conceptual approach, using a thought experiment based on hypothetical faster-than-light particles to illustrate anticipatory observation of pandemic emergence. The framework is informed by interdisciplinary literature on emerging infectious diseases, One Health surveillance, predictive epidemiology, and public-health preparedness. Results: The proposed approach highlights the importance of proactive, integrated surveillance systems that combine human, animal, and environmental data. Key elements include the use of advanced analytical tools such as neural networks, early characterization of population risk profiles, strengthened public-health infrastructure, coordinated governance, adaptable financial resources, and a resilient healthcare workforce. The integration of animal welfare considerations, translational research, and planetary health principles is emphasized as central to reducing spillover risk. Conclusions: Tachyon-inspired thinking offers a conceptual tool to support a shift from reactive pandemic response toward proactive anticipation and prevention. Embedding integrated surveillance and One Health principles into public-health systems may enhance early detection capacity and contribute to mitigating the impact of future pandemics. Full article

Background: Psychological services within hospitals are essential to delivering integrated, patient-centred care, yet in many health systems they remain fragmented, variably organised, or confined to specific medical specialties. The Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), represents one of the few examples of a hospital-wide psychological governance model in Italy, but its organisational structure and longitudinal activity have not previously been systematically described. Objective: This study (I) describes the organisational design and operational components of the Gemelli Unit; (II) compares it with international organisational models using a typological framework; and (III) examines its resilience and adaptive capacity during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A descriptive–narrative approach was adopted, integrating institutional documentation, routinely collected service data (2019–2024), anonymised case vignettes, and a structured comparison with national and international psychological care structures. The analysis was informed by theoretical models of integrated health-care delivery and by Donabedian’s structure–process–outcome framework. Results: Between 2019 and 2024, psychological interventions increased from 28,878 to 47,076 (+63%), with a post-pandemic average of 41,868 annual interventions. In 2024, the Unit supported 2150 patients and 340 healthcare professionals, with psycho-oncology accounting for approximately one-third of all activities. The model integrates clinical activity, staff support, conflict management, research, and training under a centralised governance structure, ensuring hospital-wide coverage and coordinated referral pathways. The comparative analysis identified four international organisational types—department-based, liaison/specialty-based, structured health-system, and academic–clinical hybrid—highlighting the hybrid and transversal nature of the Gemelli Unit and its capacity to maintain and adapt services during the COVID-19 emergency. Conclusions: The Gemelli Unit represents a distinctive hospital-wide organisational model that combines centralised governance, transversal deployment, personalised care, and structured support for healthcare professionals. These characteristics position it as a potentially transferable benchmark for health systems seeking to integrate psychological care into core organisational and clinical processes. Future work should prioritise the development of standardised outcome indicators and national frameworks to support the evaluation and harmonisation of hospital-based psychological services. Full article

Enteric viruses in wastewater remain a persistent public health threat. Conventional treatments often achieve only modest viral log₁₀ reductions and can generate toxic disinfection byproducts, but high-energy advanced processes are often unaffordable. Antiviral phytoremediation, which involves virus removal mediated by plants and their rhizosphere microbiota, offers a low-cost, low-energy alternative; however, it has scarcely been studied. A bibliometric analysis of ~23,000 wastewater treatment studies (1976–2025) identified only 30 virus-targeted records within plant-based treatment branches, representing ~0.13% of the total corpus. This critical review structures antiviral phytoremediation into a four-barrier framework: (i) sorption/filtration, (ii) rhizosphere-mediated inactivation, (iii) plant internalization, and (iv) intracellular degradation. Pilot and full-scale studies provide strong support for the first two barriers, whereas evidence for internalization and intracellular degradation is limited, mainly laboratory-based, and often inferred from molecular rather than infectivity assays. Standalone constructed wetlands typically achieve ~1–3 log₁₀ virus reductions, but hybrid configurations that combine wetlands with complementary processes achieve ~3–7 log₁₀ reductions, with performance varying between enveloped and non-enveloped viruses and across climates. This review distills design principles for cost-effective hybrid systems and identifies methodological and governance priorities, positioning rigorously designed phytoremediation as a scalable part of climate- and pandemic-resilient wastewater infrastructure. Full article