Search Results (34,112)

Background: Older adults (aged 65 and older) faced a disproportionate burden of mortality during the COVID-19 pandemic, yet substantial geographical and sociodemographic disparities in vaccine uptake persisted within this vulnerable population. Objective: To examine the temporal dynamics of COVID-19 vaccination rates among older adults and investigate the association between vaccination uptake and neighborhood-level social determinants of health (SDOHs), including disability and poverty. Methods: COVID-19 vaccination data for older adult residents in Jefferson County, Kentucky, were obtained from the Kentucky Immunization Registry (KYIR). ZIP-code-level vaccination rates were calculated at three time points: 28 February 2021 (Q1), 31 May 2021 (Q2), and 31 May 2022 (Q6). The rates were linked to 2021 American Community Survey (ACS) ZIP code-level estimates of disability, poverty, and household composition. Two-dose COVID-19 vaccination rates stratified by race, ethnicity, and geographic region were used as outcome measures. Pearson correlation coefficients, bivariate, and multivariate linear models were used to estimate the association between COVID-19 vaccination rates and the SDOHs at the ZIP code level. Results: Among the estimated 139,222 older adults, overall two-dose vaccination rates rose from 22.4% in Q1 to 77.5% by Q6. Significant regional disparities were observed early in the campaign, with Q1 rates ranging from 12.6% in the Southwest to 35.4% in the Inner East county regions. Bivariate analyses showed ZIP-code-level disability and poverty rates were negatively associated with ZIP-code-level vaccination uptake in Q1 (disability slope: −0.38; 95% CI, −0.63 to −0.13; poverty slope: −0.36; 95% CI, −0.65 to −0.07). By Q6, the negative association between disability and vaccination had weakened significantly and was no longer statistically significant, while the negative association between poverty rate and vaccination rate remained persistent across all time points. Conclusions: The disability-associated gaps in older adults’ vaccination rates were dynamic and narrowed over time, whereas the poverty-associated gaps remained persistent and static. The low uptake observed among Black and Hispanic older adults in historically underserved areas suggests that understanding the specific factors that most negatively associate with vaccination rates in these populations, such as specific disabilities, may mitigate structural barriers. Future public health interventions should prioritize socioeconomically disadvantaged neighborhoods and account for the evolving association of functional impairments and healthcare access. Full article

Background: The end of the COVID-19 public health emergency of international concern (PHEIC) in May 2023 marked a transition from disruption to recovery and rebuilding of health systems. The WHO African Region entered this period with declining routine immunization coverage, widening inequities, and fragile surveillance systems. We conducted a critical narrative synthesis of post-PHEIC recovery and the transformation of immunization systems in the region from 2023 to 2025. Methods: We thematically analyzed publicly available data from the WHO and other sources using a systems-oriented framework covering immunization coverage, equity, vaccine introductions, disease control, governance, financing, and data systems. Results: Regional coverage for most antigens was restored to 2019 pre-pandemic levels by 2024, e.g., three doses of diphtheria-tetanus-pertussis-containing vaccines at 76%. However, progress remains insufficient to meet the Immunization Agenda 2030 (IA2030) target of 90% coverage. In addition, there were 6.7 million zero-dose children in the 2024 birth cohort (6.3% higher than the 6.3 million in 2019), concentrated in a few countries. The IA2030 target is a 50% reduction in the number of zero-dose children by 2030, compared to 2019. Recovery initiatives have restored services, while accelerated introductions (e.g., malaria vaccines introduced in 20 new countries in 2024–2025) signal renewed system momentum. Yet, progress has plateaued at pre-pandemic levels, reflecting structural constraints rather than sustained transformation. Concurrently, recurrent outbreaks of measles, yellow fever, and other vaccine-preventable diseases highlight persistent immunity gaps and surveillance limitations. Structural constraints (including financing fragility, subnational inequities, and system fragmentation) continue to limit sustained progress. Conclusion: This study offers important insights that can inform immunization policymaking in the WHO African Region and beyond. Current post-PHEIC trends reflect recovery without transformation. Achieving IA2030 targets will require a shift from broad coverage expansion to precision delivery approaches that prioritize zero-dose and underserved populations. Immunization must be positioned as a central pillar of primary health care and health security systems. Full article

Understanding how information flows across financial segments during global crises is crucial for analyzing complex and highly interconnected markets. This study investigated the dynamic information flow between cryptocurrencies, commodities, stock market indices of G10 countries, five-year sovereign CDS spreads, ten-year government bond yields, foreign exchange market variables, and technology company stocks using daily return data spanning from 1 January 2018 to 24 March 2026. Transfer Entropy is estimated using two alternative approaches: directly from the original variables and from independent components obtained via Independent Component Analysis (ICA), which reduces noise and uncovers latent relationships. A sliding-window framework is employed to capture time-varying directional information flow and to assess changes across major global events, including the COVID-19 pandemic, the Russia–Ukraine conflict, and the Middle East tensions. The results indicate that the magnitude and direction of information flow change significantly during crisis periods, revealing an event-sensitive and dynamically evolving connectivity structure between financial segments. Overall, the integration of ICA and Transfer Entropy provides a clearer and more reliable representation of directional interactions in multidimensional financial systems under the conditions of heightened uncertainty. Full article

Vietnam’s exports expanded dramatically from $14.5 billion in 2000 to $405 billion in 2024, elevating the country to the world’s 22nd largest exporter despite persistent global shocks. This paper introduces the application of the Causal Machine Learning Approach to Resilience Estimation (CLARE) to industry-level trade analysis, utilizing a comprehensive panel of 97 HS2 sectors from 2000 to 2024 (2425 observations) drawn from UN COMTRADE and WITS databases. We implement Double Machine Learning to estimate causal effects of the Global Financial Crisis (2008–2009) and COVID-19 pandemic (2020–2021) on export growth. Results reveal stark industry disparities: electrical machinery (HS85) exhibits exceptional resilience, fueled by 72% high-technology content and low product concentration, while knitted apparel (HS61) proves highly vulnerable. Fixed effect regressions substantiate core hypotheses: a 10-percentage-point increase in high-tech share elevates the resilience index by 0.031 points (approximately 4.1% relative to the sample mean); a one-standard-deviation reduction in product HHI (0.14 units) yields a 0.026-point gain (3.6% relative); and each additional FTA contributes 0.047 points (approximately 6.2% relative), with all estimates significant at conventional levels. Robustness encompassing alternative learners, detrended outcomes, and synthetic controls upholds findings. Policy recommendations center on accelerating high-tech global value chain integration—targeting semiconductors and electric vehicles—while optimizing CPTPP and EVFTA utilization (currently 35%) and mitigating US–China market concentration (45% of exports). These insights chart pathways for Vietnam’s Vision 2045 high-income ambition amid intensifying geopolitical and climate risks, providing a replicable framework for other export-reliant emerging economies. Full article

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic presented significant psychosocial challenges to intensive care unit health care workers (ICU HCW). Prior studies typically used single cross-sectional samples to focus on elements of burnout and psychological stress. We sought to serially assess quality of life and willingness to work before, during, and after the first peak of COVID-19. Methods: Two survey instruments were prospectively administered at regular intervals to multidisciplinary ICU HCWs, initiating at the local onset of COVID-19 and ending 6 months after the first peak ICU census of COVID-19 patients. Results: ICU HCWs reported high levels of compassion satisfaction, burnout, and secondary traumatic stress before, during and after the first peak of COVID-19. Motivation to work declined, and hesitation to work increased from study initiation to the peak ICU census of COVID-19 patients. Hesitation to work was greater in female HCWs and cardiothoracic ICU HCWs. Motivation to work was higher in those working in operating rooms compared to those in the ICU. Concerns about becoming infected, feelings of isolation, and exhaustion were associated with high hesitation to work. Feeling protected by the government and hospital was associated with decreased hesitation and increased motivation to work. Conclusions: ICU HCWs experienced high levels of stress throughout the first year of COVID-19, while satisfaction with work remained high. Willingness to work was associated with gender, work location, ICU subtype, concerns about infection risk, feelings of exhaustion, and feelings of institutional protection. Because the study methodology precludes causal inference and low survey response rates indicate that findings should be interpreted with caution, these results are best viewed as hypothesis-generating for future work aimed at improving stress mitigation in ICU HCWs. Full article

Disruptions caused by disasters, pandemics, and systemic crises have increased the complexity and vulnerability of global supply chains, highlighting the need for advanced analytical approaches to risk and resilience management. In this context, artificial intelligence (AI) has emerged as a promising analytical capability for improving risk assessment and decision-making in disrupted supply chains. The study follows PRISMA 2020 reporting guidelines adapted for bibliometric research and presents a bibliometric and knowledge-mapping analysis of artificial intelligence applications in disaster supply chain risk and resilience management. Using the Web of Science Core Collection, a dataset of 288 peer-reviewed publications was analyzed through keyword co-occurrence, bibliographic coupling, citation analysis, and collaboration network mapping. The findings indicate a rapidly expanding research field in which AI supports predictive risk assessment, real-time monitoring, and resilience-oriented decision-making in disaster-prone supply networks. The analysis identifies dominant thematic clusters, emerging research directions, and opportunities for integrating AI-enabled analytics into supply chain risk management frameworks. The mapped literature also suggests secondary interpretive implications for financial risk exposure and supply chain finance, rather than indicating a separately operationalized finance-specific bibliometric subfield. To enhance interpretive depth, an AI-assisted analytical layer was applied to refine thematic clusters and detect emerging trends. However, this layer operates as a complementary interpretive tool and is subject to methodological limitations, including sensitivity to keyword semantics, dependence on bibliometric outputs, and potential interpretive bias in AI-assisted thematic labeling. Consequently, the AI-assisted analysis is used to support, rather than replace, bibliometric findings. Overall, this study contributes to the emerging literature on artificial intelligence in disaster supply chain risk management and highlights future research opportunities, including improved methodological integration and enhanced analytical transparency in AI-assisted bibliometric research. Full article

Working from home (WFH) has increasingly been adopted globally as a family-friendly arrangement that enables employees with greater family responsibilities to reconcile work and family demands. However, little is known about which parents take up WFH in the Chinese context. Using nationally representative pre-pandemic data from the China General Social Survey 2015, this paper examines the sociodemographic determinants of parents working from home in China, with particular attention to gendered patterns among mothers and fathers. The results show no statistically significant gender difference in the overall likelihood of WFH among parents. However, the sociodemographic determinants of WFH show different patterns among mothers and fathers. Specifically, Chinese mothers are more likely to WFH when they are engaged in non-standard employment arrangements and do not live with grandparents, whereas Chinese fathers are more likely to WFH when they are employed in the agricultural sector and hold more traditional gender role attitudes. A positive but weak association is observed between the number of children and mothers’ likelihood of WFH, while no such association is found among fathers. In addition, unlike in Western contexts, WFH uptake among Chinese parents is not found to be concentrated among more advantaged groups. Full article

Background: Vancomycin-resistant Enterococcus (VRE) bacteremia represents a major therapeutic and epidemiological challenge, particularly in regions with high antimicrobial resistance rates such as Southern Europe. Longitudinal local data are essential to guide infection control and antimicrobial stewardship strategies. This study aimed to evaluate temporal trends in incidence, management, and mortality of VRE bacteremia in a tertiary care center in Greece over a six-year period, including comparison before and after the coronavirus disease 2019 (COVID-19) pandemic. Methods: This retrospective observational study included adult patients with VRE bacteremia at the University Hospital of Heraklion, Greece, from 2018 to 2023. Demographic and clinical data, such as the Pitt Bacteremia Index (PBI), as well as microbiological, and treatment data were collected from patient records. Incidence was calculated per 10,000 patient-days. Comparisons were performed between survivors and non-survivors and between pre- and post-COVID-19 eras. Multivariate regression analysis was used to identify predictors of in-hospital mortality. Results: A total of 96 patients were included (mean age 68.6 ± 14.5 years; 56.3% male). The incidence of VRE bacteremia increased more than five-fold during the study period, from 0.242 cases per 10,000 patient-days in 2018 to a peak of 1.344 per 10,000 patient-days in 2022, remaining elevated in 2023 (1.001 per 10,000 patient-days). The overall in-hospital mortality was 54.2%. Non-survivors had significantly higher PBI scores compared to survivors (median 2.5 vs. 0, p = 0.005). In the multivariate analysis, higher PBI was independently associated with in-hospital mortality [odds ratio: 1.449 (95% confidence intervals: 1.166–1.801)]. Appropriate empirical therapy was administered in 41.7% of cases and was not significantly associated with survival. Post-COVID-19 patients were older (69.9 vs. 61.4 years, p = 0.0365), and antimicrobial regimens were more frequently adjusted according to susceptibility testing (55.7% vs. 18.2%, p = 0.0141), but mortality did not significantly differ between periods. Conclusion: VRE bacteremia incidence increased dramatically over the six-year study period in our tertiary center, with persistently high mortality exceeding 50%. Severity of illness at the diagnosis of bacteremia, as measured by the PBI, was an independent predictor of in-hospital mortality. Strengthened infection prevention measures, optimized antimicrobial stewardship, and early aggressive management are urgently needed to mitigate the growing burden of VRE bacteremia. Full article

This study investigates the roles gold and the US dollar play as safe-haven, hedging, or diversifier assets relating to six important financial stock market indices: the S&P 500, FTSE 100, Hang Seng, CAC 40 (Paris), Shanghai Composite Index, and Nikkei 225. This paper applies the bivariate dynamic copula technique and the DCC-GARCH econometric advanced methods from January 2013 to July 2024 by focusing on four serious market crashes: the Chinese stock market meltdown (2015–2016), the trade war between the US and China (2018–2020), the COVID-19 pandemic (2020–2022), and the conflict between Russia and Ukraine (2022–2024). The results show that the US dollar displays reliable hedging and safe-haven characteristics with strong evidence mainly for its role as a safe-haven asset against the FTSE 100, Hang Seng, and S&P 500. Our findings support the idea that the US dollar serves consistently as a safe-haven asset. In contrast, gold showcased a twofold function, serving as a hedge for the FTSE 100 and the S&P 500 during crisis times and acting as a diversifier for the CAC 40 and the Shanghai Composite Index in times of market stability. This dynamic was specifically noticeable in the COVID-19 period, when gold’s hedging properties were outstanding and its role as a diversifier became more pronounced in the Paris and Shanghai markets. Our results suggest that the consistent reliability of the US dollar as a safe-haven asset combined with gold’s dual role presents a compelling argument for including both in well-diversified portfolios. This strategy enables investors to mitigate risk and safeguard their wealth, especially during periods of financial market volatility. Full article

Prices and quantities in agricultural commodity and food product markets are subject to constant changes due to evolving supply and demand conditions. Big and sudden shifts in supply or demand may lead to price movements that bring negative consequences for food producers or consumers. Factors causing such movements can be of different natures, but substantial changes in the world energy price levels are supposed to be one of the most important. The purpose of the study was to investigate the effect of global energy price shocks on the evolution of food commodities and food consumer prices. Using the World Bank data on the respective price indices, we looked for shocks in these data series by utilizing statistical tools. Having identified three global energy price shocks in the period 2000–2024 induced by the financial crisis of 2008, the COVID-19 pandemic, and the outbreak of war in Ukraine, their influence on the world agricultural commodity prices and food consumer prices was assessed. It was found that the series of energy, food commodity, and food consumer price indices were related in the long term. Also, the occurrence of global energy price shocks to a visible extent translated into global food commodity and food consumer price shocks. Applying various statistical and econometric techniques, including Chow tests and MS-VAR modelling, enables the identification of which breaking points led to regime changes between the analysed variables. The most sensitive to the structural breaking points appeared to be the relation between energy and consumer food prices. This discovery can be considered our major contribution. Full article

This study proposes a novel dual-role weighting framework for dry port location selection, bridging the gap between commercial logistics efficiency and strategic disaster resilience. Designed to establish a new theoretical evaluation paradigm, the research utilizes the Fuzzy Rough SWARA (FR-SWARA) method and a 12-person expert panel to weigh a comprehensive set of 31 criteria under high-dimensional uncertainty. The findings reveal a decisive hierarchical shift, where spatial and infrastructure-related dimensions significantly outweigh traditional cost considerations. This empirical evidence substantiates the transition from ‘just-in-time’ to ‘Just-in-Case’ logistics architectures. Ultimately, the study reconceptualizes the dry port as a ‘strategic stabilizer’—a critical infrastructure node that absorbs systemic shocks and maintains supply chain continuity during diverse crises, including natural disasters and the COVID-19 pandemic. The proposed weighting framework offers a robust theoretical roadmap for policy and managerial decision-making in volatile geographies. Full article

Choosing a future career represents a complex developmental task, often accompanied by multiple concerns and anxieties. The Social Cognitive Career Theory and Life Design paradigm emphasize the importance of supporting individuals in managing career-related challenges. However, global stressors—such as the COVID-19 pandemic, the war in Ukraine, and increasing awareness of the climate emergency—have introduced new and multifaceted sources of uncertainty that are not adequately captured by existing instruments. This gap highlights the need for a psychometrically sound measure to assess emerging career-related concerns in the contemporary context. Accordingly, the study aimed to develop and validate the Career Concerns related to Perceived Environmental Challenges (CC-PEC Scale). Four studies were conducted. Study 1 employed exploratory factor analysis, supporting a three-factor structure (Career-related COVID-19 pandemic concern, Career-related war concern, and Career-related climate emergency concern). Study 2 confirmed this structure using confirmatory factor analysis and demonstrated measurement invariance across gender, supporting a hierarchical factorial model. Study 3 provided evidence of concurrent and discriminant validity through associations with related constructs. Study 4 offered preliminary evidence of stability and predictive validity using life satisfaction and flourishing as outcome variables. Overall, the findings support the CC-PEC Scale as a reliable and valid instrument for assessing career-related concerns linked to global environmental challenges. These results have important implications for research and career guidance interventions aimed at supporting young people’s career development in increasingly uncertain contexts. Full article

The not-yet-forgotten pandemic restrictions related to COVID-19, which affected the religious sector in an unprecedented manner, significantly contributed to the intimisation and virtualisation of spiritual expressions. Religiosity that had previously been experienced both internally and externally, two essential dimensions of any religious act, was transformed into a predominantly private and virtual phenomenon. This transformation affected not only the ordinary liturgical life intrinsically linked to ecclesial community and sacred space, but also extraordinary forms of religiosity, including pilgrimage. Although the phenomenon of virtual pilgrimage to online chapels and shrines was known prior to the pandemic, developments in recent years have substantially increased interest in this form of devotion. Since pilgrimage to a sacred site requires both spiritual engagement and bodily participation, this study examines the possibilities and prospects of this emerging form of a traditional religious practice. The question of whether virtual pilgrimage may, in the future, constitute an independent and, in a certain sense, autonomous form of spiritual expression, or whether it represents merely a temporary phenomenon, emerges from an analysis of faith in both its bodily (external) and spiritual (internal) dimensions. Since these two dimensions are inseparable components of faith, virtual pilgrimage can be considered as a distinct phenomenon only in relation, whether close or remote, to physical pilgrimage. Nevertheless, to adequately acknowledge that virtual pilgrimage bears the characteristics of the “signs of the times”, it should be evaluated in a new, more comprehensive, and open manner. It may thus be understood as a primary spiritual phenomenon with the potential to significantly influence the pilgrim’s inner disposition and thereby substantially contribute to the attainment of the goals of pilgrimage, whether or not physical participation is possible. Full article

Amid Europe’s demographic decline and the intensifying global “war for talent,” migration is increasingly viewed as a critical source of human capital capable of sustaining economic growth and welfare systems. Nevertheless, the literature on Macro-Talent Management (MTM) has primarily focused on the attraction of highly skilled expatriates, paying limited attention to how national integration systems shape the broader capacity of countries to attract and retain migrant talent. Addressing this gap, the present study conceptualizes migrant integration as a strategic component of macro-level talent management and evaluates the “talent attractiveness” of different European welfare and migration regimes. Methodologically, the study develops a multi-criteria evaluation framework based on the PROMETHEE II (Preference Ranking Organization Method for Enrichment of Evaluations) outranking method, enabling the simultaneous assessment of institutional, socio-economic, and administrative dimensions of migration governance. The model integrates nine indicators combining policy inclusiveness (e.g., Migrant Integration Policy Index—MIPEX (Migrant Integration Policy Index), citizenship accessibility), labor market outcomes (employment and gender gaps), and systemic pressures on migration management (asylum applications). By integrating policy indicators with real-world labor market performance and administrative capacity, the proposed framework offers a novel analytical tool for comparative migration policy evaluation and decision support. The empirical application covers six European countries representing distinct migration regimes: Portugal, Sweden, France, Poland, Greece, and Germany. The results challenge the conventional assumption that economic strength alone determines migrant attractiveness. Portugal emerges as the most attractive destination, demonstrating that inclusive rights-based integration policies can offset lower GDP levels. In contrast, Germany ranks last in the sample, revealing signs of systemic overextension due to extreme administrative pressure, while Greece occupies the fifth position characterized by structural integration deficits. The study contributes to the literature by linking migration governance, integration policy effectiveness, and macro-level talent management and by introducing a multi-criteria decision-analytic approach for evaluating national migration systems in Europe. The study offers a reassessment of the ‘talent attractiveness’ of European welfare models in a post-pandemic context (2023). Full article