Search Results (5,630)

Background/Objectives: The COVID-19 pandemic caused pronounced disorder in healthcare delivery globally, including ophthalmology. Our study explores how ophthalmologists in Puerto Rico (PR) altered their practices during the pandemic, confronting obstacles such as resource shortages, evolving public health mandates, and unique socio-economic and geographic constraints. The study aims to enhance preparedness for future public health crises. Methods: We conducted descriptive analyses on four online surveys distributed at crucial time points of the pandemic (March 2020, May 2020, August 2020, August 2021) to all practicing ophthalmologists in PR (N ≈ 200), capturing data on closures, patient volume, personal protective equipment (PPE) access, telemedicine use, and financial relief. Results: Survey responses ranged from 41% (n = 81) to 56% (n = 111). By March 2020, 22% (24/111) of respondents closed their offices. By May 2020, 20% (19/93) of respondents maintained a closed office, while 89% (64/72) of open offices reported seeing less than 25% of their usual patient volume. Access to PPE was a challenge, with 59% (65/111) reporting difficulty obtaining N95 masks in March 2020. Telemedicine usage increased initially, peaking in May 2020 and declining in July 2020. By August 2021, all respondents were fully vaccinated and most practices returned to pre-pandemic levels. Overall, 86% (70/81) of respondents found the surveys to be useful for navigating practice changes during the pandemic. Conclusions: PR ophthalmologists showed adaptability during the COVID-19 pandemic to maintain care given limited resources. Guidelines from professional organizations and real time surveys play an important role in future crisis preparedness. Full article

Background/Introduction: Psychological inflexibility, which includes experiential avoidance, is a transdiagnostic process associated with multiple mental health issues in adolescence. Physical fitness (PF) has shown benefits for mental well-being, yet its specific relationship with psychological inflexibility remains understudied, particularly among youth. Objectives: To examine the association between components of PF and psychological inflexibility, measured by the Acceptance and Action Questionnaire-II (AAQ-II), in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 631 adolescents (aged 12–17) participating in the Eating Healthy and Daily Life Activities (EHDLA) study. PF was assessed by the Assessing the Levels of PHysical Activity and Fitness (ALPHA-Fit) Test Battery (cardiorespiratory fitness, muscular strength, agility, and flexibility). Psychological inflexibility was measured using the AAQ-II. Generalized linear models (GLMs) were used to evaluate associations, adjusting for age, sex, body mass index, socioeconomic status, physical activity, sedentary behavior, sleep duration, and energy intake. Results: Unadjusted analyses showed weak but significant associations between psychological inflexibility and performance in the 20 m shuttle run test (p = 0.002), the 4 × 10 shuttle run test (p = 0.005), and the sit-and-reach test (p < 0.001). However, after adjusting for covariates, none of the PF components maintained a statistically significant association with the AAQ-II scores. Conclusions: In this adolescent sample, PF components were not independently associated with psychological inflexibility after adjustment for key confounders. These findings suggest that, while PF may contribute to general well-being, it is not a primary determinant of psychological inflexibility. Further longitudinal and intervention studies are needed to clarify the mechanisms linking physical and psychological health in youth. Full article

At a time when globalisation and the economic crisis have forced a reduction in public expenditure at all levels, social policy and social welfare systems’ efforts for sustainable development are focused on identifying alternative ways to provide integrated services and achieve balanced social development. Post-colonial Cyprus has experienced radical socio-political changes that have demanded rapid responses to address its needs. This paper aims to discuss the role of the Cypriot voluntary sector in the national integrated care. Within the spectrum of ensuring social rights and social justice, the voluntary sector has emerged as a key factor of social policy implementation. Through the exploration and analysis of this context, an in-depth insight is given into socio-political and economic factors, dimensions, relationships, processes, patterns, and critical junctures that, under the influence of history, have shaped the voluntary sector’s path, formed its major stages of transformation, and defined its relationship with structures and institutions. Full article

Hyperloop ultra-high-speed transport presents a transformative opportunity for future mobility systems in smart cities. However, assessing its socio-economic impact remains challenging due to Hyperloop’s unique technological, modal, and operational characteristics. As a novel, fifth mode of transportation—distinct from both aviation and rail—Hyperloop requires tailored evaluation tools for policymakers. This study proposes a custom-designed framework to quantify its macroeconomic effects through changes in gross domestic product (GDP) at the city level. Unlike traditional economic models, the proposed approach is specifically adapted to Hyperloop’s multimodality, infrastructure, speed profile, and digital-green footprint. A Poisson pseudo-maximum likelihood (PPML) model is developed and applied at two technology readiness levels (TRL-6 and TRL-9). Case studies of Glasgow, Berlin, and Busan are used to simulate impacts based on geo-spatial features and city-specific trade and accessibility indicators. Results indicate substantial GDP increases driven by factors such as expanded 60 min commute catchment zones, improved trade flows, and connectivity node density. For instance, under TRL-9 conditions, GDP uplift reaches over 260% in certain scenarios. The framework offers a scalable, reproducible tool for policymakers and urban planners to evaluate the economic potential of Hyperloop within the context of sustainable smart city development. Full article

Road networks are essential for access, resource distribution, and population evacuation during natural events. These challenges are pronounced in rural areas, where network redundancy is limited and communities may have social disparities. While traditional risk management systems often focus on the physical consequences of hazard events alone, specialized literature increasingly suggests the development of a more comprehensive approach for risk assessment, where not only physical aspects associated with infrastructure, such as damage level or disruptions, but also the social and economic attributes of the affected population are considered. Consequently, this paper proposes a Vulnerability Access Index (VAI) to support road network decision-making that integrates the social vulnerability of rural communities exposed to natural events, their accessibility to nearby critical infrastructure, and physical risk. The research methodology considers (i) the Social Vulnerability Index (SVI) calculation based on socioeconomic variables, (ii) Importance Index estimation (I_imp) to evaluate access to critical infrastructure, (iii) VAI calculation combining SVI and I_imp, and (iv) application to a case study in the influence area of the Villarrica volcano in southern Chile. The results show that when incorporating social variables and accessibility, infrastructure criticality varies significantly compared to the infrastructure criticality assessment based solely on physical risk, modifying the decision-making regarding road infrastructure robustness and resilience improvements. Full article

Background: Biological aging influences cancer outcomes, but its changes during chemotherapy and impact on chemotoxicity in colorectal cancer (CRC) remain underinvestigated. We examined (1) trajectories of biological aging (using Levine Phenotypic Age) during six months of chemotherapy, (2) sociodemographic and clinical risk factors for biological aging, and (3) links between biological aging and chemotoxicity. Methods: Using data from electronic health records (2013–2019) from 1129 adult CRC patients, we computed biological aging (raw Levine Phenotypic Age and its age acceleration [Levine Phenotypic Age–chronological age]) from routine blood tests (e.g., complete blood counts, hepatorenal/inflammatory markers). Chemotoxicity was identified primarily via International Classification of Diseases (ICD-9 and -10) codes. Results: Chemotherapy accelerated biological aging over time. Biological aging at baseline and changes over time predicted chemotoxicity. However, changes in biological aging over time showed stronger associations than baseline biological aging. Advanced cancer stages, higher comorbidity burden, and socioeconomic disadvantage (especially area-level deprivation) were associated with accelerated biological aging at baseline and over time. Biological aging occurred across both young and older adults. Conclusions: Levine Phenotypic Age, computed from routine blood tests in EHRs, offers a feasible clinical tool for aging-related chemotoxicity risk stratification. Validation in diverse cohorts and the development of predictive models are needed. Full article

Although the strawberry tree (A. unedo L.) has been long considered a neglected species of the Mediterranean maquis, the valorization of its fruit production may enhance its socioeconomic value, especially in rural areas. In this study, strawberry trees from different Sicilian sites were investigated in terms of macronutrients, fatty acid (FA) composition, tocopherols, total phenols, carotenoids, and minerals. Sicilian berries were a good source of carbohydrates (mainly fructose, glucose and sucrose) and dietary fiber. They were low in fat; however, the FA composition revealed the abundance of unsaturated FAs over saturated FAs and an advantageous n-6/n-3 ratio. Additionally, Sicilian berries showed an inversed linoleic/α-linolenic acid ratio with respect to berries from other Mediterranean regions, that had previously investigated in literature. This evidence suggests that this ratio may have a chemotaxonomic relevance. Considering antioxidants, the fruits had levels of tocopherols, particularly α-tocopherol, total phenols and carotenoids similar to those of certain commercial fruits. Precious amounts of minerals, such as Ca, K, Zn and Fe were also determined. Interestingly, berries harvested near a Sicilian volcanic area had higher levels of minerals, as well as tocopherols, phenols and carotenoids, than fruits from other Sicilian sites, thereby advancing the hypothesis that fruits from volcanic areas may have a superior nutritional value. Overall, data from this study elaborated by a proper statistical analysis revealed that the geographical origin was a relevant variable to consider in the reliable study of this fruit species. Full article

Background: School-based tobacco control policies are critical for preventing youth tobacco use. While many districts adopt formal policies to create smoke- and vape-free environments, the degree to which these policies are enforced at the school level may vary, influencing their effectiveness. Little is known about how consistently such policies are implemented across schools within urban school districts. Objectives: This study aimed to examine the existence and enforcement of school-level tobacco control policies in an urban public school system, using Baltimore City schools as a case example. Methods: We conducted a survey of school personnel from 20 high schools in Baltimore City in 2024. The survey instrument assessed the presence and enforcement of policies related to tobacco use prevention, communication, signage, disciplinary actions, and institutional support. Descriptive statistics (frequencies and percentages) were used to summarize responses. Spearman correlations were also used for bivariate correlations. Additional school-level and neighborhood-level contextual data were collected from the internet (neighborhood socioeconomic status and school performance). Results: While many policies existed across the 20 participating schools, their enforcement was widely inconsistent. Most schools reported the existence of policies prohibiting tobacco use in school buildings (60%) and vehicles (55%). However, few schools had visible tobacco-free signage (35%) or offered cessation programs (15%). Communication of policies to students (70%) and staff (65%) was the most commonly enforced aspect of tobacco control policies. Conclusions: Findings suggest that while tobacco control policies may be adopted across urban school systems, their enforcement at the school level remains uneven. Greater attention may be needed to support policy implementation and to reduce variability in school-level practices. Baltimore City serves as a useful case study to understand these challenges and identify opportunities for strengthening school-based tobacco prevention efforts. Full article

Against the backdrop of increasingly frequent extreme weather events and heightened market price volatility, investigating the relationship between agricultural insurance and farmers’ livelihood resilience is crucial for ensuring rural socioeconomic stability. This study utilizes field survey data from 1196 households across twelve county-level divisions (three cities and nine counties) from China’s Hainan and Yunnan provinces, specifically in natural rubber-producing regions. Using propensity score matching (PSM), we empirically examine agricultural insurance’s impact on household livelihood resilience. The results demonstrate that agricultural insurance increased the effect on farmers’ livelihood resilience by 1%. This effect is particularly pronounced among recently poverty-alleviated households and large-scale farming operations. Furthermore, the analysis highlights the mediating roles of credit availability, adoption of agricultural production technologies, and production initiative in strengthening insurance’s positive impact. Therefore, policies should be refined and expanded, combining agricultural insurance with credit support and agricultural technology extension to leverage their value and ensure the sustainable development of farm households. Full article

By 2050, it is estimated that approximately 200 million people will be displaced due to the impacts of climate change. Vulnerability to climate change is shaped not only by environmental factors but fundamentally by systemic power relations and structural conditions present at both the places of origin and destination. In Latin America, climate-displaced persons predominantly settle in marginalised neighbourhoods, where widely accepted informality facilitates their rapid arrival but obstructs genuine progress and full integration as urban citizens. This paper critically examines the prevailing myths that justify the persistence of informality, revealing the socioeconomic challenges faced by climate migrants in the region. These four dominant myths are (1) Latin America’s inherently low productivity levels; (2) concessions by the ruling class enabling excluded groups to merely survive; (3) the perceived privilege of marginalised neighbourhoods to generate income outside formal legal frameworks, which supports their social capital; and (4) the limited benefits associated with formalisation. Debunking these myths is essential for developing effective public policies aimed at reducing informality and promoting inclusive urban integration, ultimately benefiting both climate migrants and host communities. Full article

In an era where digitalization shapes economic and social landscapes, the intersection of digital skills, ethics, and integrity plays a crucial role in understanding the vulnerability of youth classified as NEET (Not in Education, Employment, or Training). This study explores how risky internet use and digital skill gaps contribute to socio-economic exclusion, integrating a multivariate and spatial approach to assess regional disparities in Europe. This study adopts a systems thinking perspective to explore digital exclusion as an emergent outcome of multiple interrelated subsystems. The research employs logistic regression, Principal Component Analysis (PCA) with Promax rotation, and Geographic Information Systems (GIS) to examine the impact of digital behaviors on NEET status. Using Eurostat data aggregated at the country level for the period (2000–2023) across 28 European countries, this study evaluates 24 digital indicators covering social media usage, instant messaging, daily internet access, data protection awareness, and digital literacy levels. The findings reveal that low digital skills significantly increase the likelihood of being NEET, while excessive social media and internet use show mixed effects depending on socio-economic context. A strong negative correlation between digital security practices and NEET status suggests that youths with a higher awareness of online risks are less prone to socio-economic exclusion. The GIS analysis highlights regional disparities, where countries with limited digital access and lower literacy levels exhibit higher NEET rates. Digital exclusion is not merely a technological issue but a multidimensional socio-economic challenge. To reduce the NEET rate, policies must focus on enhancing digital skills, fostering online security awareness, and addressing regional disparities. Integrating GIS methods allows for the identification of territorial clusters with heightened digital vulnerabilities, guiding targeted interventions for improving youth employability in the digital economy. Full article

The right to development, an inherent human right for all, emphasizes that all individuals and communities have the right to participate in, contribute to, and benefit from development that ensures the full realization of human rights. In Kenya, where a significant portion of the population faces poverty and vulnerability to climate change, access to rights-based needs such as clean water, healthcare, and education still remains a critical challenge. This study explored the implementation of a Human Rights-Based approach to community development through a Public–Private Development Partnership model (PPDP), with a focus on alleviating poverty and improving access to rights-based services at the community level in Narok and Nakuru counties. The research aimed to identify critical success factors for scaling the PPDP model and explore its effects on socio-economic empowerment. The study employed a mixed-methods approach for data collection, using questionnaires to obtain quantitative data, focus group discussions, and key informant interviews with community members, local leaders, and stakeholders to gather qualitative data. We cleaned and analyzed all our data in R (version 4.4.3) and used the chi-square to establish the significance of differences between areas where the PPDP model was implemented and control areas where it was not. Results reveal that communities with the PPDP model experienced statistically significant improvements in employment, income levels, and access to rights-based services compared to control areas. The outcomes underscore the potential of the PPDP model to address inclusive and sustainable development. This study therefore proposes a scalable pathway beginning with access to rights-based needs, followed by improved service delivery, and culminating in economic empowerment. These findings offer valuable insights for governments, development practitioners, investment agencies, and researchers seeking community-driven developments in similar socio-economic contexts across Africa. For the first time, it can be adopted in the design and implementation of development projects in rural and local communities across Africa bringing into focus the need to integrate rights-based needs at the core of the project. Full article

Urban health planning requires a multi-scalar understanding of the territory, capable of capturing socio-economic inequalities and health needs at the local level. In the case of Rome, current administrative subdivisions—Urban Zones (Zone Urbanistiche)—are too large and internally heterogeneous to serve as effective units for equitable health planning. This study presents a methodology for the territorial redefinition of Rome’s Municipality III, aimed at supporting healthcare planning through an integrated analysis of census sections. These were grouped using a combination of census-based socio-demographic indicators (educational attainment, employment status, single-person households) and real estate values (OMI data), alongside administrative and road network data. The resulting territorial units—21 newly defined Mesoareas—are smaller than Urban Zones but larger than individual census sections and correspond to socio-territorially homogeneous neighborhoods; this structure enables a more nuanced spatial understanding of health-related inequalities. The proposed model is replicable, adaptable to other urban contexts, and offers a solid analytical basis for more equitable and targeted health planning, as well as for broader urban policy interventions aimed at promoting spatial justice. Full article

Against the backdrop of China’s fast-growing digital economy and its financial inclusion agenda, there is still little city-level evidence on whether the e-CNY pilot accelerates financial deepening at the grassroots. Using a balanced panel of 271 prefecture-and-above cities for 2016–2022, this study employs a staggered difference-in-differences (SDID) design augmented by the synthetic control method (SCM) to rigorously identify the policy effect of the e-CNY pilot. The results show that the pilot program significantly improves urban financial inclusion, contributing to more equitable access to financial services and supporting inclusive socio-economic development. Mechanism analysis suggests that the effect operates mainly through two channels, a merchant-coverage channel and a transaction-scale channel, with the former contributing the majority of the overall effect. Incorporating a migration-based mobility index shows that most studies’ focus on the merchant-coverage effect is amplified in cities under tight mobility restrictions but wanes where commercial networks are already saturated, whereas the transaction-scale channel is largely insensitive to mobility shocks. Heterogeneity tests further indicate stronger gains in non-provincial capital cities and in the eastern and central regions. Overall, the study uncovers a “penetration-inclusion” network logic and provides policy insights for advancing sustainable financial inclusion through optimized terminal deployment, merchant incentives, and diversified scenario design. Full article

This paper examines the farming systems and operational structures in the Region of Western Macedonia (RWM), Greece and constructs a typology of farms based on structural, operational, and socio-economic characteristics. Agriculture remains a vital pillar of the regional economy, particularly in the context of RWM’s ongoing transition to a post-lignite development model. Using farm-level data from the 2018 Farm Accountancy Data Network (FADN), Principal Component Analysis (PCA) identified four latent dimensions of farm heterogeneity—income and productivity, asset base, land size, and labour structure. Hierarchical and K-means cluster analysis revealed three distinct farm types: (1) medium-sized, high-efficiency farms with moderate reliance on subsidies (30% of the sample); (2) small-scale, family farms with modest productivity and limited capitalisation (48%); and (3) large, asset-rich farms exhibiting structural inefficiencies and lower output per hectare (22%). These findings highlight structural vulnerabilities, particularly the predominance of undercapitalised smallholdings, and provide a data-driven foundation for Thdesigning differentiated policies that support farm resilience, generational renewal, and sustainable rural development. Full article