Search Results (9,379)

This study investigates how board gender diversity affects firms’ long-term investment behavior in Korea, focusing on capital expenditures and R&D spending from 2011 to 2021. Using firm fixed-effects regressions and robustness tests with alternative measures of gender diversity, the results show that independent female directors are positively associated with long-term investment. However, this effect is significant only in non-Chaebol firms, where board independence is stronger, and gender diversity reflects genuine governance engagement. In Chaebol-affiliated firms, where female directors are often appointed to meet regulatory requirements, the relationship is insignificant, suggesting that diversity driven by formal compliance fails to enhance strategic decision-making. These findings highlight that the effectiveness of gender diversity depends on institutional authenticity rather than numerical representation. The study contributes to the corporate governance literature by showing how ownership structure and board independence condition the real impact of gender-diverse boards and offers policy implications for promoting substantive rather than symbolic diversity reforms. Full article

China has implemented a series of clean air policies, resulting in improved air quality since 2013. However, there remains a paucity of national prospective evidence regarding the relationship between fine particulate matter (PM_2.5) and kidney disease (KD) incidence in China, as well as the potential mediating effects of lipid profiles in this association. This study aimed to assess the association of decreased PM_2.5 concentration and KD incidence in China from 2013 to 2020. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we included 15,368 participants who were free of KD in 2013 and followed up until 2020. For each participant, we calculated the 3-year and 2-year average PM_2.5 concentrations. The Cox proportional hazards model was employed to estimate the association between PM_2.5 exposure and KD incidence. Mediation analyses were conducted using eight lipid indices, and subgroup analyses were performed. The annual average PM_2.5 concentration for CHARLS participants reduced from 61.72 μg/m³ in 2013 to 32.75 μg/m³ in 2020. A reduction of 5 μg/m³ in 3-year and 2-year average PM_2.5 concentrations was associated with 14.3% (hazard ratio [HR]: 0.857, 95% confidence interval [CI]: 0.841, 0.873) and 14.4% (HR: 0.856, 95% CI: 0.840, 0.873) reductions in KD incidence in the fully adjusted models. The TyG-BMI and TyG-WHtR indices exhibited small mediating effects of 7.36% (95% CI: 2.35%, 12.38%) and 4.48% (95% CI: 0.51%, 8.45%) on the relationship of PM_2.5–KD, while other indicators did not demonstrate significant mediation. The findings of this study suggest that reductions in PM_2.5 concentration were associated with a decreased incidence of KD during the period from 2013 to 2020. The implementation of clean air policies since 2013 may have contributed to the decrease in chronic diseases like KD. Full article

Purpose: A growing body of evidence has emerged on the role of diet for health outcomes in cancer survivors. Patients transitioning to post-treatment care may seek guidance on dietary changes, and summaries of the evidence for dietary patterns recommended by guidelines can support providers in effectively answering questions. Increasing evidence suggests that food choices impact planetary health. Plant-based diets are one eating pattern that may improve patient outcomes and planetary health. Methods: We performed a literature review and used narrative reporting to summarize evidence for plant-based diets and offer specific guidance for breast, colorectal, and prostate cancer patients who are post-diagnosis. Specifically, we reviewed impacts on recurrence, all-cause, and cancer-specific mortality. Results: Increased fibre intake by consuming foods like fruits, vegetables, and whole grains is associated with a decreased risk of breast cancer-specific and all-cause mortality, as well as reduced colon cancer-specific mortality. Replacing refined grains with whole grains is associated with improved disease-free survival for colon cancer survivors. Higher tree nut consumption is associated with improved disease-free survival for breast, colorectal, and prostate cancer survivors. Soy is safe to consume for breast cancer survivors and is associated with a reduced risk of recurrence. Conversely, more Western dietary patterns high in processed meat intake are associated with an increased risk of colon cancer recurrence and prostate cancer mortality. There are also environmental benefits of a shift towards plant-based diets to address the adverse health outcomes associated with climate change and its potential impact on cancer care delivery as previously outlined in a 2024 ASCO policy statement. Conclusions: Based on the best existing evidence, providers can suggest that patients consider plant-based dietary patterns in the post-treatment phase of their cancer care to support health outcomes and planetary health. Full article

Background: Patients with catastrophic health conditions have continuously faced substantial out-of-pocket (OOP) costs for non-covered services despite universal health coverage in South Korea. In 2013, the National Health Insurance Service (NHIS) expanded coverage for four major catastrophic conditions—cancers, cardiovascular diseases, cerebrovascular diseases, and rare illnesses—aiming to strengthen financial protection for patients with catastrophic conditions. However, concerns remain that providers may respond by inducing more use of non-covered services, potentially offsetting reductions in patients’ financial burden. Methods: We evaluated the impact of the 2013 catastrophic coverage expansion on patients’ OOP spending for non-covered services using a quasi-experimental difference-in-differences design. Using nationally representative longitudinal healthcare expenditure data, the Korean Health Panel Survey (KHPS), from 2011 to 2016, we compared patients with the four targeted conditions to a control group with clinically comparable conditions. A two-part model was applied to separately estimate changes in the probability of incurring any non-covered OOP spending and changes in spending levels conditional on positive expenditures. We further examined whether effects differed by supplemental private health insurance (PHI) status. Results: We found that 7.3-, 5.2-, and 7.7-percentage-point decreases in annual probability of incurring any non-covered OOP spending for total, inpatient, and outpatient services, respectively, after policy implementation. Among patients with positive spending, OOP spending for total and inpatient non-covered services decreased by approximately 164 USD and 254 USD per year, while outpatient spending showed no statistically significant change. No statistically significant differential effects were also observed by PHI status. Conclusion: The catastrophic coverage expansion reduced patients’ exposure to and burden of non-covered OOP spending, indicating improved financial protection without evidence of compensatory increases in non-covered service use. These findings suggest that targeted benefit expansions for high-cost conditions can enhance financial equity within universal health systems. Full article

Background and Clinical Significance: Oral ulcers are a common disease for dental practitioners. The policy of treating oral ulcers includes removing etiology and medication. Standard management of oral ulcers includes elimination of etiologic factors and pharmacologic therapy. Topical corticosteroids are the most commonly used medicine for oral ulcers. Exclude possible etiologies related to ulcers; refractory ulcers need systemic evaluation and precise medication use to improve patients’ quality and satisfaction. Case Presentation: We present a case of refractory oral ulcers resistant to multiple conventional treatments, which were found to be ineffective. These ulcers significantly impact patient quality of life. We prescribed a series of oral ulcer treatments following the removal of cause factors, such as rounding the teeth and making a soft occlusal bite plate to reduce traumatic sources from the patient’s Parkinson’s disease. A biopsy of the ulcer lesions was also done. All the treatments involving corticosteroids and removing the ulcer-associated etiology were ineffective. Conclusions: Finally, combined therapy using low-dose thalidomide (50 mg/day) and colchicine (1.5 mg/day) resulted in substantial clinical improvement, and complete remission was sustained for over six months without recurrence. A narrative discussion of relevant literature is provided to contextualize therapeutic considerations in refractory oral ulceration. Conclusion: This case suggests that low-dose thalidomide and colchicine combination therapy may be a therapeutic consideration for refractory oral ulcers when conventional management fails; however, the observation is hypothesis-generating and further studies are required to evaluate efficacy and safety. Full article

Climate change-induced extreme weather events increasingly threaten public health, with a particularly acute impact on the mental well-being of urban populations. This study evaluates regional disparities in mental health outcomes associated with climate-induced extreme weather in urban environments, where social and infrastructural vulnerabilities exacerbate environmental stressors. We synthesized data from cohort and cross-sectional studies using both traditional frequentist and Bayesian meta-analytic frameworks to assess the mental health sequelae of extreme weather events (e.g., heatwaves, floods, droughts, and storms). The traditional meta-analysis indicated a significant increase in the odds of adverse mental health outcomes (OR = 1.32, 95% CI: 1.07–1.57). However, this global estimate was characterized by extreme heterogeneity (I² = 95.8%), indicating that the risk is not uniform but highly context-dependent. Subgroup analyses revealed that this risk is concentrated in specific regions; the strongest associations were observed in Africa (OR = 2.23) and Europe (OR = 2.26). Conversely, the Bayesian analysis yielded a conservative estimate, suggesting a slight reduction in odds (mean OR = 0.92, 95% CrI: 0.87–0.98). This divergence is driven by the Bayesian model’s shrinkage of high-magnitude outliers toward the high-precision data observed in resilient, high-income settings (e.g., USA). Given the extreme heterogeneity observed (I² = 95.8%), we caution against interpreting either pooled estimate as a universal effect size. Instead, the regional subgroup findings—particularly the consistently elevated risks in Africa and Europe—offer more stable and policy-relevant conclusions. These findings emphasize urgent, context-specific interventions in urban areas facing compounded climate social risks. Full article

The composition of air pollutants in industrial complexes differs from that of general urban areas, often containing more hazardous substances that pose significant health risks to both workers and residents nearby. In this study, PM_2.5 and its 29 chemical components (eight ions, two carbon species, and 19 trace elements) were measured and analyzed at five monitoring sites adjacent to the Yeosu and Gwangyang industrial complexes from August 2020 to December 2024. Chemical characterization and source identification were conducted. The average PM_2.5 concentration was 18.63 ± 9.71 μg/m³, with notably higher levels observed during winter and spring. A low correlation (R = 0.56) between elemental carbon (EC) and organic carbon (OC) suggests a dominance of secondary aerosols. The charge balance analysis of [NH₄⁺] with [SO₄²⁻], [NO₃⁻], and [Cl⁻] showed slopes below the 1:1 line, indicating that NH₄⁺ is capable of neutralizing these anions. Positive matrix factorization (PMF) identified eight contributing sources—biomass burning (10.4%), sea salt (11.8%), suspended particles (7.1%), industrial sources (4.6%), Asian dust (5.2%), steel industry (21.8%), secondary nitrate (16.4%), and secondary sulfate (22.7%). These findings provide valuable insights for the development of targeted mitigation strategies and the establishment of effective emission control policies in industrial regions. Full article

Dogs increasingly function as relational beings, shaping their guardians’ emotional well-being and daily routines. Consequently, dog owner education has expanded beyond behaviour-focused training toward integrative approaches that address the emotional, relational, and cognitive dimensions of the human–dog relationship. Despite this shift, international comparative research on the organisation and institutionalisation of dog owner education remains limited. The study applies a qualitative exploratory comparative case study to examine systems in the United States, the United Kingdom, Germany, Japan, and Australia, identifying national patterns and shared components to inform context-appropriate frameworks, particularly in South Korea. The study examines legal and policy documents, institutional guidelines, and standardised education programmes that function as national or de facto standards using document and content analysis. It integrates within- and cross-case comparisons and interprets findings through a framework drawing on human–animal interaction, attachment, canine behaviour, and cognitive–behavioural coaching theories. The analysis reveals five shared components of behaviour change: guardian responsibility and animal welfare, science-based positive reinforcement, early socialisation and prevention, a balance between standardisation and individualisation, and guardians’ emotional and relational engagement. These findings suggest that dog owner education functions as an integrated system that supports responsible guardianship and stable human–dog relationships across sociocultural contexts. Full article

Education systems worldwide face a growing pressure to align with Sustainable Development Goal 4.7 by embedding Education for Sustainable Development (ESD) into school life. This study examines how primary school headteachers in Cyprus interpret and enact sustainable leadership to advance ESD within a small, highly centralised system. Drawing on sustainable and distributed leadership theories and a whole-school lens, the study employed semi-structured interviews with ten headteachers from diverse regions (urban, rural, and semi-rural). Reflective thematic analysis identified four patterns: (1) leaders sought a strategic integration of ESD into planning and culture; (2) empowerment and participation were pursued through teacher working groups, student eco-councils, and community partnerships; (3) systemic constraints, a rigid curriculum, limited autonomy, and scarce professional development produced a policy–practice gap; and (4) leaders relied on adaptive, collaborative micro-practices to sustain momentum. The findings suggest that, in Cyprus, sustainable leadership operates as a values-based stewardship enacted through ‘quiet activism’. The study highlights implications for leadership development, such as reflexivity, systems thinking, and ethical reasoning, as well as policy design, such as time, autonomy, and structured support for whole-school ESD, in small-state contexts. Full article

Workplace weight stigma is a form of discrimination affecting equality, health, and careers, yet occupational research remains fragmented. This gender-sensitive systematic review synthesizes evidence on workplace weight stigma among adult workers and job applicants since 2000. Following PRISMA procedures, we searched psychological, medical, sociological, and economic databases, identifying 25 included studies examining work outcomes. The corpus includes experimental vignette and correspondence studies, surveys, and qualitative designs, predominantly from high-income Western countries. Higher body weight is consistently associated with disadvantages across the employment life cycle: reduced callbacks and hiring, lower wages and wage growth, fewer promotions, and negative performance evaluations. Penalties are systematically stronger for women; intersectional analyses remain rare. Weight-based teasing, unfair treatment, and stereotype threat are linked to poorer self-rated health, psychological distress, burnout, reduced work ability, lower job satisfaction and commitment, and stronger turnover intentions. Organizational-level evidence is indirect but suggests detrimental effects on engagement and citizenship behaviors. Findings support conceptualizing workplace weight stigma as both a psychosocial hazard and a structural driver of labor-market inequality, underscoring the need for size-inclusive HR practices, leadership, and occupational risk-prevention policies. Full article

Australia’s National Housing Accord aims to deliver 1.2 million new dwellings between mid-2024 and mid-2029, representing 240,000 annual completions—a 37% increase above the 2024 baseline of 175,000. This study employs a comprehensive system dynamics model with 79 equations (10 stocks, 69 auxiliary variables) to analyze whether this target is structurally achievable, given construction industry capacity constraints. The model integrates builder population dynamics, workforce capacity, construction cost inflation, material supply constraints, and financial market conditions across a ten-year simulation horizon (2024.5–2035). Three policy scenarios test the effectiveness of interventions, including capacity expansion (±10–15%), cost inflation management (±15–20%), planning reforms (+5–15% efficiency), and workforce development programs (+1000–4000 annual graduates). Model validation against Australian Bureau of Statistics data from 2015 to 2024 demonstrates strong empirical foundations. Results show that structural capacity constraints—driven by three simultaneous bottlenecks in material supply, workforce availability, and financing—create a supply ceiling of around 180,000–195,000 annual completions. Even under optimistic policy assumptions, the model projects cumulative completions of 880,000–920,000 dwellings over the Accord period, falling 23–27% short of the 1.2 million target. Critical findings include the following: (1) builder insolvencies exceeding entry rates by 15–25% annually under stress conditions, (2) capacity decline trends of 0.6–0.8% per year due to productivity losses, infrastructure bottlenecks, and regulatory burden, (3) system efficiency degradation from 100% to 96% over the projection period, and (4) non-linear capacity utilization, showing saturation above 82% baseline levels. The analysis reveals that demand-side policies cannot overcome supply-side structural limits, suggesting that policymakers must either substantially reduce targets or implement transformative capacity-building interventions beyond current policy contemplation. Full article

Artificial intelligence (AI) promises large productivity gains, yet growing concern surrounds its implications for social sustainability. This paper develops and empirically evaluates a simple behavioral framework in which unequal access to AI generates mutually reinforcing gaps in economic performance and social visibility, potentially undermining the long-run stability of social systems. Individuals fall into two groups—AI adopters and non-adopters—and differences in productivity and social recognition give rise to two exchange rates: an Economic Exchange Rate (EER), capturing relative economic advantage, and a Social Exchange Rate (SER), capturing relative social visibility and recognition. AI strengthens the feedback between economic success and social standing, and the joint evolution of EER and SER is stable only when the product of two feedback parameters lies below unity. When this threshold is approached, the system enters a regime of systemic disequilibrium, in which economic and social disparities expand endogenously. Using panel data for 30 economies over the period 2012–2025, we provide empirical evidence of strong mutual reinforcement between economic and social advantage, with feedback strength rising as AI diffusion accelerates. The findings suggest that unequal AI access poses risks not only to equality but to social sustainability itself. The paper contributes a diagnostic framework for socially sustainable AI diffusion, highlighting the need for policies that dampen amplification mechanisms and strengthen inclusive pathways from economic performance to social recognition. Full article

Megacity clusters are the key battlegrounds for carbon emission reduction in China, and the polycentric spatial structure of these clusters has a profound impact on their carbon emission intensity. This paper focuses on five major megacity clusters: the Beijing–Tianjin–Hebei (BTH), Yangtze River Delta (YRD), Pearl River Delta (PRD), the middle reaches of the Yangtze River (MRYR), and the Chengdu–Chongqing (CY) City Clusters. We construct an inter-period panel dataset spanning from 2002 to 2023 and utilize an index of polycentric spatial structure, which equally considers both morphology and functionality. A fixed-effects model is employed, and the Lind–Mehlum U-shape test is applied to identify the nonlinear relationship. Additionally, a two-step approach is used to examine the mediating effect of industrial agglomeration, while interaction terms help identify the moderating effects of technological innovation and transport infrastructure. The results indicate a significant U-shaped relationship between the polycentric structure of megacity clusters and carbon emission intensity. When the polycentric spatial structure index reaches a specific threshold, carbon emission intensity is minimized, suggesting that a moderate degree of polycentricity is most conducive to carbon reduction. Mechanism analysis reveals that industrial agglomeration functions as a significant mediator, whereas technological innovation and transport infrastructure serve as critical moderators in this relationship. Based on these findings, we propose several policy recommendations: to guide the moderate adjustment of the polycentric structure of city clusters with stage-specific targets, optimize the mechanism of industrial synergy and transfer, differentiate the allocation of innovation resources, and achieve a fine-tuned alignment between the transport system and spatial structure. These measures will support the high-quality, low-carbon transformation of city clusters. Full article

Sub-Saharan Africa has the potential to achieve sustainable development through facilitating green transition projects, leveraging the revenue generated from its abundant natural resources. However, the resource curse hypothesis suggests that developing nations often face problems with corruption that hinder economic development in these countries. The present study aims to investigate how environmental sustainability can be advanced in Sub-Saharan Africa using revenue from natural resources in the presence of green financial technology and clean energy. Therefore, data for Sub-Saharan Africa from 2000 to 2023 are employed in the analysis. The analysis of these data is undertaken with the ‘Method of Moments Quantile Regression’ technique, and the ‘Panel Correlated Standard Errors’ is used for robustness checks. The key findings presented in this research depict the importance of natural resource rents in supporting sustainable environments in Sub-Saharan Africa. Therefore, the revenue from natural resources can be used to support green transition projects in developing nations with high natural resource endowments. Moreover, renewable energy and green finance foster a reduction in ecological footprint, hence supporting environmental sustainability. Consequently, technological innovation and financial development do not promote the achievement of environmental sustainability, raising questions about the environmental policies and regulations in Sub-Saharan Africa. To this end, there is a need for policy reforms and corruption control in order to prevent the misallocation and misuse of resources designed to support green transition projects. Full article

Adoption of electric vehicles (EVs) is widely considered as a crucial step in decarbonizing urban mobility. While access to private ownership of EVs is socially and spatially still highly unequal, shared electric mobility has been suggested as a more accessible alternative. However, access to shared electric mobility is still inequitable; hence, there is a need for practical insights and recommendations for urban policymakers on how to improve this. This study addressed this need with a ‘practice consultation’, comprising 15 in-depth interviews with practice experts from Belgium, Denmark, Finland and the Netherlands, on the current state of shared electric mobility, the associated policies and realistic policy options to promote and ensure equitable access. The study revealed not only a diverse offer of shared electric mobility but also the persistence of earlier-identified barriers to equitable access. Current policies focus more on the orderly and safe integration of shared mobility services and improving access to shared mobility more generally. Yet, various recent plans, experiments and pilots with policy options for more equitable access were mentioned. Some options are novel and open up new ways to equitable access, while other already-suggested ones were confirmed as relevant and feasible by practice experts. Full article