Search Results (37)

High-sensitivity cardiac troponin (hs-cTn) assay offers improved diagnostic accuracy for the detection of myocardial infarction but has seen slow adoption in the United States, particularly in rural settings. Limited research has explored the impact of hs-cTn implementation on downstream testing, in rural hospitals where diagnostic delays are common. This study evaluates the effects of transitioning from standard assay to hs-cTn in a rural tertiary care medical center. We conducted a retrospective analysis of de-identified data from four weeks before and after the implementation of an hs-cTn assay. We assessed the presence of downstream cardiovascular testing and consults among emergency department and inpatient chest pain encounters. Lengths of stay were evaluated. In total, 1664 pre- and 1479 post-implementation admissions were evaluated. Demographic characteristics and comorbidities were similar during the study period. Chest pain was reported more frequently during the post-hs-cTn implementation period as the chief complaint (21.4% vs. 28.7%; p = 0.0036). There was a statistically significant decrease in the number of downstream stress tests performed in the second period (aOR 0.55, 95% CI: 0.31–0.98). The adjusted odds ratio (aOR) for cardiac catheterization trended toward a non-significant decrease (aOR 0.57, 95% CI: 0.40–1.11). Lengths of stay were similar between groups. In a retrospective analysis of patients who underwent cardiac troponin assays, we found that the implementation of hs-cTn was associated with a decrease in downstream stress testing without a significant increase in the number of cardiology consultations, coronary angiographies, or coronary computed tomography scans. Full article

Population aging in middle-income economies produces macroeconomic and distributional consequences that aggregate frameworks cannot detect. This paper develops a multi-household CGE model calibrated to a 26-sector Social Accounting Matrix for Thailand (2024) and traces the labor, saving, and fiscal channels of aging across eleven counterfactual scenarios. Three findings emerge. First, aging’s primary macroeconomic cost operates through capital accumulation, not output contraction: investment falls seven times faster than the GDP under a savings-driven closure, because middle-aged households—the economy’s dominant net savers—compress lifecycle saving in response to aging. The saving channel alone amplifies the labor supply shock four-fold (range: 3.5–4.5). Second, aging can raise elderly welfare. When elderly households retain labor market attachment, wage gains from tighter factor markets outweigh declining capital returns—a welfare reversal invisible to representative agent and OLG frameworks by construction. The critical labor income threshold is ${\alpha }_L^{\ast }=35.5\%$ (range: 34.8–36.2%), confirmed across all participation increments tested (elderly welfare gain: THB 341–521 million). Third, no single instrument satisfies efficiency and equity simultaneously. Pension transfers crowd out investment nonlinearly above 12 percent of tax revenue (range: 10–14%); health demand expansion is the decisive complement that converts redistribution into a near-Pareto improvement. Policy complementarity is an empirical necessity, not a theoretical refinement. Collectively, these results reframe demographic aging as a factor price redistribution mechanism whose welfare incidence is determined by the cohort-level income composition—with direct implications for aging policy in middle-income economies facing rapid demographic transitions under tighter fiscal constraints than for advanced economies encountered at equivalent demographic stages. Full article

This study examines the relationship between house prices and the factors driving their growth during the transition from a long-standing currency board regime to Eurozone membership. The main objective is to identify and quantify the key factors explaining the variation in house price growth in Bulgaria under conditions of prolonged currency convergence. The study applies a set of econometric techniques, including stationarity tests (ADF and KPSS), diagnostic checks for normality, serial correlation and heteroscedasticity, and robustness checks. The study is based on 40 quarterly observations covering the period 2015Q4–2025Q3 and 48 selected predictors of the General house price index. The final ARIMAX(0,2,1) model is estimated using second-differenced data. The model includes a first-order moving average component and three exogenous regressors: the owner-occupiers’ housing expenditures, the actual rentals for housing in Bulgaria and the homeowners’ utility expenses. The model explains 87% of the variation in house price acceleration, with a comparatively low mean squared error. The diagnostic analysis confirms model adequacy. The three exogenous regressors are statistically significant at the 1% level with strong and stable effects on house price dynamics. No statistically significant relationship is found for the set of traditional macroeconomic, demographic, financial, and sectoral factors. The results show that during Bulgaria’s transition from a currency board to the Eurozone, the sustained house price growth was driven by country-specific factors. The three statistically significant determinants of the house price acceleration in Bulgaria reflect, respectively, the active investment behaviour of homeowners in improving existing properties, the rational assessment by housing market participants of the balance between mortgage and rental payments, and the burden of utility and maintenance costs borne by owners and tenants, depending on property size and energy efficiency. The first factor is most influential for homeowners, the second for tenants, and the third has a similarly significant impact on both groups. Full article

Land use and land cover change (LULCC) constitutes a major challenge to sustainability worldwide. This also applies to Japan, where urbanization in coastal lowlands is contrasted with widespread agricultural abandonment in rural landscapes. In this systematic review we synthesized the main LULCC trajectories, their driving forces, and specific effects in Japan from 1994 to 2024. Following PRISMA guidelines, 158 peer-reviewed articles were analyzed using quantitative co-occurrence analyses, Chi-squared tests, and Sankey diagrams to map land-use flows. Two dominant and opposing trajectories were confirmed: urban expansion and agricultural abandonment. The most significant land transition flow involved the conversion of agricultural land to forests/natural vegetation, while the conversion of agricultural land to built-up areas came in second place. These transitions were primarily driven by economic and demographic factors, but reforestation trends were strongly influenced by policy and institutional factors (35.70%), reflecting national regreening initiatives. Ecological and biodiversity impacts of LULCC were the most often documented effects (>40% of records). While the published literature describes trends in land-use transformations, the mechanistic understanding of LULCC remains limited. There is an urgent need to move toward process-based predictive modeling that integrates socio-economic variables. Future policies should balance urban density management with the strategic use of rural abandonment for ecosystem services provision and climate mitigation. Full article

China has experienced a population decline since 2022, and its total fertility rate has dropped to about 1.0 in 2025. This is despite the lifting of the one-child policy in 2015 and the pivot to the two-child policy and three-child policy in, respectively, 2016 and 2021. Based on a review of recent research, this paper provides an interpretation that the continued fertility decline reflects a perfect storm of socioeconomic and demographic processes, long-term effects of the one-child policy, and unprecedented social changes in Chinese society. Socioeconomic and demographic changes since the 1950s prepared the ground for the “late, sparse, few” policy, resulting in a sharp fertility decline in the 1970s. While the one-child policy that followed did not result in a fertility decline in the 1980s, its effects appear to be long-lasting, including concentrated investment by the “inverted family” in the only child that drives up society-wide childrearing costs. Significant improvement in women’s educational attainment, individualistic orientation that prioritizes personal goals, increased diversity in family structure, such as one-person households, and changing views about getting married and having children have all contributed to continued downward pressure on fertility. These findings hint at the relevance of the concept of the second demographic transition for China and suggest that policy is only effective if it is aligned with what people want. Full article

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16–29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η² = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases. Full article

Background and Objectives: The objective of this study is to ascertain the predictive criteria for steroid dependence and relapse in patients diagnosed with ulcerative colitis. Additionally, the study aims to provide data that will enable earlier transition to second-line treatment when necessary. Materials and Methods: The study included 62 patients diagnosed with ulcerative colitis between 2018 and 2023, who were followed up at the Department of Pediatric Gastroenterology, Hepatology, and Nutrition at the University of Health Sciences, Izmir Dr. Behçet Uz Children’s Hospital. Demographic data included age and gender at diagnosis, BMI, weight-for-age, and height-for-age. Laboratory parameters recorded were complete blood count, total protein, albumin, CRP, ESR, IgG, IgM, IgA, IgG subclasses, vitamin D, B12, folic acid, and ferritin levels. Results: The study included 62 patients. Thirty-two patients (51.6%) were female. In the univariate regression analysis, there was an inverse correlation between IgM levels and relapse and steroid dependence (p < 0.01, p = 0.03, respectively). Additionally, a relationship was identified between steroid dependence and hemoglobin, hematocrit, white blood cell count, neutrophil count, platelet count, and albumin levels (p = 0.01, p < 0.01, p < 0.01, p = 0.01, p < 0.01, p = 0.03, respectively). There was a significant relationship between MMES and steroid dependence (p < 0.01). MMES was found to be significant in predicting steroid dependence in patients with pancolitis (AUC: 0.75, 95% CI: [0.60–0.90], p = 0.01). Conclusions: We conclude, as for Crohn’s disease, an algorithm or a specific scoring system for ulcerative colitis is needed for the use of anti-TNF drugs as first-line treatment in pediatric ulcerative colitis. The initial severity of the disease appears to be the most important risk factor in terms of steroid dependence. Based on our study and the literature data, a scoring system incorporating parameters such as hemoglobin, hematocrit, WBC, albumin, platelet, and IgM levels, disease involvement type, initial PUCAI score, and MMES would be prudent to adopt. Full article

Public attitudes toward renewable energy sources (RES) have been widely studied at the household level. However, less is known about how citizens differ in their broader perceptions, knowledge, and behavioral orientations toward renewable energy. This study explores such heterogeneity within Polish society using survey data from a representative sample of 974 respondents. An exploratory factor analysis identified six dimensions of renewable energy attitudes: environmental concern, knowledge and awareness, social and economic support, perceived ease of use, perceived benefits, and behavioral intentions. Using these attitudinal dimensions, cluster analysis revealed two distinct consumer segments that differ in their overall level of engagement with renewable energy. The first cluster comprises pro-green and engaged individuals who express strong concern for environmental issues, have a greater awareness of the benefits of renewable energy, and are more ready to adopt such technologies. The second cluster represents respondents who are less engaged or skeptical, with weaker environmental and behavioral commitment. The comparison of sociodemographic characteristics across clusters showed no statistically significant differences in gender, age, education, or place of residence, and only a marginal effect for income. The findings suggest that support for renewable energy in Poland is not driven by demographics but somewhat shaped by cognitive and value-based factors, offering valuable insights for policymakers and communication strategists promoting the energy transition. Full article

The first objective of this study is to review and synthesize research from the past fifteen years on variables associated with personal growth (or post-traumatic growth, PTG) during the transition to motherhood, and to revisit key questions using a uniquely large dataset; the second objective of the study is to compare findings across different PTG scoring methods, to determine whether the long and short forms of the Post-Traumatic Growth Inventory (PTGI) produce equivalent data and whether the five growth domain scores provide additional insights beyond the total scores. Data were aggregated from multiple previous studies, resulting in a large sample (n = 4641) of first-time mothers with infants up to 24 months old (M = 6.82 months, SD = 4.42). Analysis of the associations between demographic and childbirth characteristics and PTG scores revealed that in most cases, the original PTGI and the short version (PTGI-SF) exhibited similar associations with the background variables. The five PTGI domain scores of personal strengths, spirituality, new opportunities, and appreciation of life showed associations consistent with those observed for the two total scores. The findings reinforce and validate previous research, while also offering new insights. Notably, the results suggest that the PTGI-SF is highly useful, as it yields results comparable to those of the original, longer inventory. Full article

Background: The COVID-19 pandemic and the rapid transition to emergency online learning affected the academic and social lives of young people. This study aimed (a) to examine how university students’ well-being was influenced during the second stage of the lockdown due to the COVID-19 pandemic (2020–2021) in Greece and (b) to explore the relationship between university students’ online learning competence and well-being during the pandemic in two universities in Greece. Methods: A cross-sectional study was conducted during 2021 among the students at the Universities of West Attica and Ioannina. Participants completed a self-administered online questionnaire including demographics, the General Health Questionnaire-12, the Flourishing Scale Questionnaire, and an Online Education Experience Questionnaire. Focusing on the Flourishing Scale Questionnaire, factor analysis, reliability, and validity of the identified underlying factor were estimated and multivariable median regression analysis was performed to investigate determinants of well-being. Results: 1103 students participated, 73.6% were female, and 80.4% were aged <25 years. Analysis revealed satisfactory convergent validity and high reliability of the Flourishing Scale Questionnaire (Cronbach’s alpha coefficient = 0.88). Over 50% of the participants reported high levels of well-being. Students with greater confidence in using basic online learning tools and satisfaction with living conditions during lockdown reported well-being (p < 0.001). In contrast, those who reported dissatisfaction with their living conditions (p = 0.002) or whose living arrangements were influenced by financial concerns (p = 0.046) reported unwellness. Conclusions: The results provided useful insight into the complex interrelations between the COVID-19 pandemic quarantine, online education, and young people’s well-being, especially nowadays, when education, employment, and entertainment increasingly rely on internet-delivered modes for young people. Full article

Background: The aim of the present study was to apply machine learning (ML) techniques to define clusters relating patient demographics, compliance, and outcome variables in colorectal enhanced recovery after surgery (ERAS) patients and improve data-driven, predictive decision-making. Methods: To uncover inherent patient subgroups from the data without pre-defined labels, the unsupervised K-means clustering algorithm was utilized. This technique was selected for its effectiveness in partitioning patients into distinct groups by iteratively assigning them to the nearest cluster mean, thereby minimizing within-cluster variance across key variables. The top five recovery goals and the top 10 clinical outcome variables were defined based on clinical considerations (incidence and importance). In a second step, the cluster transition was traced by monitoring the transitions between clusters from demographic through compliance to outcome variables. Results: A total of 1381 patients were available for final analysis, revealing three clusters (low risk, n = 490, 36%; intermediate risk, n = 157, 11%; and high risk, n = 734, 53%) for demographic, two clusters (high compliance, n = 1011, 73%, and low compliance n = 370, 27%) for perioperative, and two clusters (good and poor outcomes) for the top five recovery goals and the top 10 clinical outcomes, respectively. The cluster transition for the top five recovery goals and the top 10 clinical outcomes revealed that most patients (488/490, 99.6%) of the low-risk demographic cluster had high perioperative compliance, and over 90% of them had favorable functional and clinical outcomes. Of the 2/3 of intermediate risk patients who had poor perioperative compliance, over 40% had a poor functional recovery, whereas 83% had good clinical outcomes. Of the high-risk demographic group, 100% (734/734) had low perioperative compliance, and over 40% of them had poor functional recovery. Conclusions: This ML-based analysis of demographic, compliance, and recovery clusters and associated cluster transition allowed us to identify patient clusters as a first step to tailored ERAS protocols aiming to improve compliance and outcomes. Full article

Population aging is a critical demographic trend in China, creating both challenges and opportunities for sustainable development. As aging alters the structure of the workforce and capital demand, understanding its effect on productivity is essential to managing demographic transitions in China. This study investigates the causal impact of population aging on labor productivity, with a focus on the mediating role of the capital–labor ratio and heterogeneities across industries, skill levels, and regions. Using data from Chinese listed firms between 2011 and 2018, this paper employs industry- and year-fixed effects regression models to control for unobservable heterogeneity and conducts a formal causal mediation analysis. The analysis reveals that population aging significantly enhances labor productivity. Specifically, a one-percentage-point increase in the old-age dependency ratio is associated with a 1.47% increase in firm-level labor productivity. The capital–labor ratio emerges as a critical mechanism, mediating the relationship between aging and productivity by incentivizing firms to increase capital intensity in response to labor shortages. Approximately 72.4% of the total effect is mediated through changes in capital intensity. The findings highlight notable heterogeneities. Labor-intensive firms and low-skilled worker segments experience stronger productivity gains from aging compared with their capital-intensive and high-skilled counterparts. At the regional level, the productivity effects are most pronounced in first- and second-tier cities, while third-tier cities show negligible impacts, reflecting resource and structural constraints. This study underscores the dual role of population aging as a challenge and an opportunity. Policy recommendations include (1) expanding targeted fiscal support for capital investment and automation in aging-intensive industries; (2) promoting vocational training programs tailored to older workers and digital skills development; and (3) strengthening infrastructure and institutional capacity in third-tier cities to better absorb productivity spillovers from demographic adjustment. By addressing these demographic and productivity linkages, the study contributes to achieving Sustainable Development Goals 8 (Decent Work and Economic Growth), 9 (Industry, Innovation, and Infrastructure), and 10 (Reduced Inequalities), by promoting inclusive productivity growth, enhancing industrial adaptation to demographic change, and reducing regional and skill-based disparities.These findings offer valuable insights for policymakers and businesses navigating the complexities of aging economies. Full article

In the ongoing debate about the feasibility of enforcing a transition to decentralized energy conversion systems, arguments are often presented that lack scientific rigor. Granted, the issue is multi-faceted and fundamentally multi-disciplinary, and possible solutions strongly depend on the selection of location as well as on local climate and demographics. Furthermore, decentralizing the final energy distribution leads to potential socio-economic considerations that involve value judgements. However, the most serious problem is that media have appropriated the topic and are often publishing opinion papers authored by non-specialists and even by representatives of interest groups. The present paper proposes an approach that is innovative on two counts: first, it treats “final energy” as any other commodity and therefore expands the field of investigation to the problems arising from the decentralization of a generic production line or technological chain; second, it argues that a method solidly rooted in Thermodynamics, the Extended Exergy Accounting, may be used to quantify the total amount of primary exergy resources requested by a decentralized strategy (as opposed to a centralized one), so that a comparison can be performed and discussed on a rational, unbiased and scientific basis. This is an introductory paper that reports some theoretical results of the method: realistic applications are perforce excluded because the idea is that the procedure must be drafted in such a way to be applicable to different socio-economic scenarios and locations and to remain valid under a broad range of boundary conditions. Full article

To delineate new directions of urban development in a context of demographic shrinkage in Southern Europe, the present study illustrates a comparative analysis of the demographic balance in metropolitan Athens, Greece (1956–2021). The analysis delineates short-term and long-term dynamics of the natural population balance, considering the impact of the Great Recession and COVID-19 pandemic, and assuming a contemporary increase in gross mortality rates and a marked fertility reduction associated with birth postponement. To address such objectives, we have compared the natural growth of population (the ratio of the total number of births to deaths) at ten year intervals (1956, 1960, 1970, 1980, 1990, 2000, 2009, 2019, 2020, 2021) in 115 municipalities of metropolitan Athens, controlling for the local context. The empirical results of descriptive statistics, spatial analysis, correlation statistics, non-parametric inference, and exploratory multivariate techniques outline the indirect impact of COVID-19 on population dynamics, being in some ways additive to the already observed effects of the Great Recession, reinforcing demographic shrinkage in specific local contexts. The COVID-19 pandemic and the Great Crisis likely accelerated the typical outcomes (population aging and low fertility) of the second demographic transition in Greece. These dynamics are associated with more volatile (and possibly reduced) immigration flows and with enhanced emigration, fueling urban shrinkage and a progressive economic decline of metropolitan regions, as our evidence suggests for Athens. Additional research should ascertain the aggregate, indirect role of pandemics in population dynamics as a proxy of urban and regional decline in European regions exposed to long-term aging. Full article

Over the past half a century many countries have witnessed a rapid fall in total fertility rates, particularly in the world’s most advanced economies including the industrial powerhouses of Eastern Asia and Europe. Such nations have now passed through the first and second demographic transitions and are currently exhibiting fertility rates well below the replacement threshold of 2.1, with no sign of recovery. This paper examines the factors responsible for driving these demographic transitions and considers their impact on both fertility and fecundity (our fundamental capacity to reproduce). I argue that because the first demographic transition was extremely rapid and largely driven by socioeconomic factors, it has had no lasting impact on the genetic/epigenetic underpinnings of human fecundity. However, the second demographic transition will be different. A series of conditions associated with low fertility societies, including relaxed selection pressure for high-fertility genotypes, the indiscriminate use of assisted reproductive technologies to treat human infertility, and environmental contamination with reproductive toxicants, may impact our genetic constitution in ways that compromise the future fecundity of our species. Since any fundamental change in the genetic foundations of human reproduction will be difficult to reverse, we should actively pursue methods to monitor human fecundity, as sub-replacement fertility levels become established across the globe. Full article