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27 pages, 590 KB  
Article
Behavioral Rigidity vs. Strategic Flexibility: Family Firms in a Global Crisis
by Viviana Fernandez
World 2026, 7(5), 87; https://doi.org/10.3390/world7050087 (registering DOI) - 21 May 2026
Abstract
Global crises often force a pivotal choice between protecting human legacy and ensuring financial survival, yet the psychological drivers behind these trade-offs remain poorly understood. While family firms are traditionally viewed as inherently resilient, the unique emotional attachments of their owners may constrain [...] Read more.
Global crises often force a pivotal choice between protecting human legacy and ensuring financial survival, yet the psychological drivers behind these trade-offs remain poorly understood. While family firms are traditionally viewed as inherently resilient, the unique emotional attachments of their owners may constrain their ability to adapt to unprecedented shocks. This study examines the behavioral underpinnings of crisis management across 11 European nations during the COVID-19 pandemic, challenging the traditional stewardship paradigm. Findings reveal a significant tension between preserving socioemotional wealth and economic survival. While family-managed firms prioritized personnel retention and financial autonomy, thus avoiding the psychological stigma of government aid, these non-financial priorities often proved detrimental to liquidity and business survival. This suggests that high emotional endowment can induce behavioral rigidity and an escalation of commitment, hindering strategic pivots. Furthermore, the results highlight a trend toward mimetic isomorphism, where extreme uncertainty forced a convergence of crisis responses across diverse organizational structures. Overall, the contribution of this study is to challenge the resilience myth, illustrating that acute shocks often override the distinctive behavioral archetype of family firms, forcing a shift toward institutional conformity and standardized mandates. Full article
(This article belongs to the Special Issue Strategic Sustainability: Managing Small Business Volatility)
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26 pages, 2005 KB  
Article
Dependence and Spillover Dynamics Between Clean Energy, Non-Ferrous Metals, and Technological Innovation: Insights from a Global Stress Event
by Noureddine Benlagha and Slim Mseddi
Energies 2026, 19(10), 2427; https://doi.org/10.3390/en19102427 - 18 May 2026
Viewed by 78
Abstract
The rapid expansion of clean energy markets, coupled with the growing importance of non-ferrous metals and technological innovation, has created a highly interconnected financial and economic system. Understanding the dynamics of these interdependencies is essential for assessing market resilience, investment diversification, and the [...] Read more.
The rapid expansion of clean energy markets, coupled with the growing importance of non-ferrous metals and technological innovation, has created a highly interconnected financial and economic system. Understanding the dynamics of these interdependencies is essential for assessing market resilience, investment diversification, and the sustainability of the global energy transition. This paper investigates the dynamic dependence and connectedness between clean energy, non-ferrous metals, and technological innovation indices, with particular attention to the impact of the COVID-19 pandemic as a global stress event. Using daily data from December 2004 to July 2020, we employ a comprehensive empirical framework that combines copula-based dependence modeling with a dynamic connectedness approach. This methodology allows us to capture nonlinear relationships, tail dependencies, and volatility spillovers across markets. The results reveal that the dependence structure between clean energy and the other sectors is symmetric and time-varying, with stronger linkages observed between clean energy and technological innovation than with non-ferrous metals. The connectedness analysis indicates a moderate level of total spillovers, with clean energy acting as the main transmitter of shocks and technological innovation as the primary receiver. Focusing on the COVID-19 period, we find a significant increase in both dependence and connectedness, suggesting that these markets become more severely integrated during periods of extreme uncertainty. These findings support the presence of contagion effects and highlight the reduced effectiveness of diversification strategies during crisis episodes. The results offer forward-looking implications for investors and policymakers regarding risk transmission, portfolio management, and the resilience of markets supporting the global transition toward sustainable energy. Full article
22 pages, 1293 KB  
Article
Does Crop–Livestock Integration Enhance Economic Resilience in Organic Farming? Evidence from Polish FADN During the 2020–2022 Multi-Crisis Period
by Andrzej Madej and Adam Kleofas Berbeć
Agriculture 2026, 16(10), 1104; https://doi.org/10.3390/agriculture16101104 - 17 May 2026
Viewed by 205
Abstract
Agriculture, as a production sector, is exposed to external shocks. The instability of agricultural markets, changes in prices of inputs, dropping crop prices, or changes in climate patterns put their economic resilience to the test. Agroecological diversification of production is widely cited as [...] Read more.
Agriculture, as a production sector, is exposed to external shocks. The instability of agricultural markets, changes in prices of inputs, dropping crop prices, or changes in climate patterns put their economic resilience to the test. Agroecological diversification of production is widely cited as a key adaptive strategy to increase farms’ resilience to these shocks. At the same time, empirical evidence linking crop diversity to economic stability across different production systems remains limited. The aim of the study was to assess whether the integration of more complex crop rotations and livestock production increases the economic resilience of organic farms compared to stockless organic farms and conventional farms. The analysis utilized data from the Polish FADN covering the multi-crisis period of 2020–2022, which included the COVID-19 pandemic, Russia’s war against Ukraine, and the sharp rise in fertilizer and energy prices. Farms were grouped by production type. Crop diversity was assessed using the Shannon–Wiener index (H′) and the Pielou evenness index (J′). The economic resilience of tested farms was determined based on their income, income variability during the study period, and the ability to maintain income above the parity threshold. The results indicated the existence of different pathways for building resilience. Organic farms with permanent crops and field crops were characterized by the highest crop diversity on arable land, while organic farms with dairy cows had the highest overall economic resilience, despite relatively low crop diversity on arable land. This phenomenon can be explained by the high proportion of permanent grasslands, which promoted feed self-sufficiency and the internal circulation of nutrients. The results indicate that in organic systems, the integration of crop and livestock production, based on permanent grassland, may be a more effective way to strengthen economic resilience than crop diversification on arable land alone. Full article
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30 pages, 1881 KB  
Article
Waste Prevention and Minimisation in Western Consumer Behaviour: Is It Attainable?
by Eleni Iacovidou, Spyridoula Gerassimidou and Daniel O’Shiel
Sustainability 2026, 18(10), 4872; https://doi.org/10.3390/su18104872 - 13 May 2026
Viewed by 152
Abstract
By delving into the waste crisis in Western hyperconsumerist societies as an analytical case study, this study advances an actionable theory of minimalism to address systemic overproduction and overconsumption. Drawing on the interdisciplinary literature, the study analyses the structural, cultural, and psychological drivers [...] Read more.
By delving into the waste crisis in Western hyperconsumerist societies as an analytical case study, this study advances an actionable theory of minimalism to address systemic overproduction and overconsumption. Drawing on the interdisciplinary literature, the study analyses the structural, cultural, and psychological drivers of waste generation, synthesising critiques of hypercapitalism and hyperhedonism into a unified theoretical framework that exposes systemic lock-ins and the conflation of wants with socially legitimised needs. In response, the study develops a minimalist ethics framework that repositions sufficiency as a guiding principle for systemic transformation. Minimalism is conceptualised not as an individual restraint but as a multidimensional governance strategy capable of informing economic, technical/technological, regulatory, ecological, and cultural interventions to effectively tackle the waste crisis in Western hyperconsumerist societies. Full article
(This article belongs to the Section Resources and Sustainable Utilization)
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18 pages, 343 KB  
Article
Financial Markets and the Economic Development Index in South Africa: An Econometric Approach
by Dintuku Maggie Kgomo and Thobeka Ncanywa
Economies 2026, 14(5), 174; https://doi.org/10.3390/economies14050174 - 12 May 2026
Viewed by 286
Abstract
Economic development is a phenomenon that involves the financial stability and standard of living of a nation’s population. To achieve economic prosperity, sound financial development, as a fundamental basis for economic development, is important. The effect of financial markets on economic development in [...] Read more.
Economic development is a phenomenon that involves the financial stability and standard of living of a nation’s population. To achieve economic prosperity, sound financial development, as a fundamental basis for economic development, is important. The effect of financial markets on economic development in South Africa is considered for the period 1998 to 2021. The economic development index (EDI) was used as the response variable as an indicator for economic development; financial markets were used as the explanatory variables, namely the foreign exchange (forex) markets, stock markets and money markets. The autoregressive distributed-lag econometric approach was applied. The stock market and money market were found to have a positive effect on the EDI, although only the stock market was statistically significant in terms of the probability value. The causality test showed that there exist unidirectional relationships between the stock market and the EDI; the EDI and the money market; and the forex market and the EDI. Sound financial markets and financial institutions make up a stable financial system, which makes the economy resilient to adverse shocks. Hence, unstable financial systems will have an adverse effect on the functioning of the economy by increasing the likelihood of a financial crisis. Full article
(This article belongs to the Special Issue Advances in Financial Market Phenomenology)
17 pages, 1007 KB  
Article
The Effect of Macroeconomic Factors on Carbon Emissions in the USA: A Statistical Analysis by Industry Sector
by Mekdes Bekele Sime and Salim Lahmiri
Sustainability 2026, 18(10), 4745; https://doi.org/10.3390/su18104745 - 10 May 2026
Viewed by 779
Abstract
This study investigates how economic factors such as gross domestic product (GDP), industrial production, inflation, and the federal funds effective rate affect carbon dioxide (CO2) emissions across nine major sectors in the United States (U.S). While previous research has primarily concentrated [...] Read more.
This study investigates how economic factors such as gross domestic product (GDP), industrial production, inflation, and the federal funds effective rate affect carbon dioxide (CO2) emissions across nine major sectors in the United States (U.S). While previous research has primarily concentrated on aggregate national emissions, this analysis takes a sectoral approach by using linear regression analysis to quantify how each economic variable impacts specific categories of CO2 emissions. The findings indicate that economic growth and industrial production are significant contributors to emissions, although their effects differ from one sector to another. Inflation and monetary policy appear to have the weakest and limited statistical significance and influence across sectors. The most significant decrease in CO2 emissions is observed in coal and electric power sectors. Furthermore, we found no significant effects of the 2008 financial crisis and the COVID-19 pandemic on carbon emissions, except a significant impact of the 2008 financial crisis on carbon emissions in the transportation sector. The results highlight the complexity of the relationship between the economy and emissions, underscoring the need for sector-specific policies and technological innovation to help achieve the U.S. goal of net-zero emissions by 2050. This research provides evidence-based insights for policymakers who aim to balance economic development with environmental sustainability. Full article
(This article belongs to the Section Economic and Business Aspects of Sustainability)
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16 pages, 1419 KB  
Review
Rewiring Adipocyte Plasticity: The Redox–Mitochondrial Axis as a Driver of Beige Fat Immunometabolism and Adipose Inflammation
by Faycal Aissa-Brahim, Shuwen Yang, Xunyong Zhou, Zhong Li and Su Bu
Biomolecules 2026, 16(5), 701; https://doi.org/10.3390/biom16050701 (registering DOI) - 9 May 2026
Viewed by 562
Abstract
Obesity is a major health crisis that impacts social and economic burdens worldwide, and it is being studied intensively to understand the molecular mechanisms and regulators of this complex condition. Over the past decade, significant insights into adipocyte fate have been gained, demonstrating [...] Read more.
Obesity is a major health crisis that impacts social and economic burdens worldwide, and it is being studied intensively to understand the molecular mechanisms and regulators of this complex condition. Over the past decade, significant insights into adipocyte fate have been gained, demonstrating that adipocyte behavior is influenced by intracellular pathways, systemic mediators, and environmental signals. In this review, we discuss the current understanding of key molecular and functional changes in adipose tissue. We focused on ER–mitochondrial dynamics and their role in beige adipocytes. We examined the biological properties of beige fat cells, including their inflammatory status, redox balance, and regulation of adipocyte transdifferentiation via signaling molecules. Finally, we explored the effects of naturally derived compounds on adipocyte function and their potential to combat obesity using a comprehensive approach. The process of adipocyte beiging induced by coordinated intracellular signaling pathways highlights mechanisms that can reprogram metabolic homeostasis and reduce obesity-related phenotypes. Full article
(This article belongs to the Section Biomacromolecules: Proteins, Nucleic Acids and Carbohydrates)
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78 pages, 14761 KB  
Review
Combating Antibacterial Resistance: The Integrative Role of Artificial Intelligence in Bio-Based Product Development
by Renuka Gudepu, Swapna Sirikonda, Ravinaik Banoth, Praveen Kumar Annagowni, Swati Dahariya and Aditya Velidandi
Antibiotics 2026, 15(5), 478; https://doi.org/10.3390/antibiotics15050478 - 8 May 2026
Viewed by 224
Abstract
The escalating crisis of antimicrobial resistance claims nearly 5 million lives annually. Resistant infections now account for 4.95 million deaths worldwide and economic losses projected to reach $300 billion by 2030. Despite this urgent threat, traditional antibiotic discovery has declined precipitously. New chemical [...] Read more.
The escalating crisis of antimicrobial resistance claims nearly 5 million lives annually. Resistant infections now account for 4.95 million deaths worldwide and economic losses projected to reach $300 billion by 2030. Despite this urgent threat, traditional antibiotic discovery has declined precipitously. New chemical entity approvals have fallen by over 50%, while existing therapeutics are rapidly rendered obsolete by sophisticated bacterial resistance mechanisms including extended-spectrum β-lactamases, carbapenemases, and multidrug efflux pumps. Bio-based products have historically provided humanity’s most transformative antibiotics, yet conventional discovery pipelines face insurmountable bottlenecks. A total of 99.9% of environmental microbes remain unculturable. Biosynthetic gene clusters are predominantly silent under laboratory conditions, and dereplication efforts achieve only 2 to 5% annotation rates. This review presents a comprehensive examination of how artificial intelligence (AI) is revolutionizing bio-based product-based antibacterial discovery. We analyze AI-driven genome mining tools that have identified over 170,000 biosynthetic gene clusters across bacterial genomes, deep learning architectures achieving 88.5% bioactivity prediction accuracy, and generative models delivering experimental hit rates exceeding 50%—representing 50- to 90-fold improvements over traditional screening. Through validated case studies spanning in silico prediction to in vivo efficacy, we demonstrate that AI integration is not merely accelerating discovery but fundamentally transforming our capacity to access nature’s previously inaccessible chemical diversity in the fight against antimicrobial resistance. Full article
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19 pages, 527 KB  
Article
The Financial Resilience of Hungarian Local Governments During the COVID-19 Pandemic and the Russian–Ukrainian War: An Empirical Study Based on Data from 2020–2023
by Szilárd Hegedűs and Petronella Molnár
Risks 2026, 14(5), 106; https://doi.org/10.3390/risks14050106 - 6 May 2026
Viewed by 269
Abstract
This study examines the financial resilience of Hungarian local governments in the period 2020–2023, which was characterised by successive economic shocks caused by the COVID-19 pandemic and the Russian–Ukrainian war. Based on a panel database covering 556 local governments, we constructed a composite [...] Read more.
This study examines the financial resilience of Hungarian local governments in the period 2020–2023, which was characterised by successive economic shocks caused by the COVID-19 pandemic and the Russian–Ukrainian war. Based on a panel database covering 556 local governments, we constructed a composite resilience index normalised on a scale of 0–1 by integrating three dimensions: liquidity position, capital structure stability and operational efficiency. We used linear mixed models to examine temporal dynamics, while cluster analysis and non-parametric validation procedures were used to explore structural heterogeneity. The results show that there is no uniform, sector-level average shift in the composite resilience index during the period under review, but a significant part of the variance can be attributed to municipality-specific, persistent factors. The impact of the liquidity sub-index is significantly amplified in crisis years, especially in 2021, suggesting that liquidity plays a key role in managing financial shocks. Cluster analysis based on the period average of the sub-indices identified four markedly different resilience profiles, which are moderately but significantly related to the type of settlement. The research points out that municipal financial resilience is not a homogeneous and purely time-dependent phenomenon, but a multidimensional, structurally embedded adaptive capacity. From a policy perspective, the results support the need for differentiated, resilience-based fiscal interventions. Full article
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18 pages, 2851 KB  
Article
Family Resilience and Hardship During the Severe Economic Crisis in Lebanon: Perspectives from Four Discussion Groups of Professionals
by Rudy S. Younes, Chantale D. Ibrahim, Clara Moukarzel and Mirna Abboud Mzawak
Soc. Sci. 2026, 15(5), 300; https://doi.org/10.3390/socsci15050300 - 5 May 2026
Viewed by 398
Abstract
Lebanon has experienced a prolonged series of crises marked by economic collapse, political instability, institutional failure, and repeated collective trauma. While families are often assumed to serve as key sources of support in such contexts, little is known about how they sustain resilience [...] Read more.
Lebanon has experienced a prolonged series of crises marked by economic collapse, political instability, institutional failure, and repeated collective trauma. While families are often assumed to serve as key sources of support in such contexts, little is known about how they sustain resilience under conditions of chronic uncertainty. This qualitative study explores how Lebanese families experience hardship, adapt, and strive to remain resilient during the severe cumulative crisis in Lebanon. The study draws on four expert group discussions involving professionals in psychology, social work, community intervention, and social policy (N = 44). Using a systematic thematic analysis, the study developed a conceptual and context-specific model of family resilience shaped by macro-level factors, processes of adaptation and coping, and available support systems. The findings suggest that family resilience in this context is less about recovery and more about endurance and continuous adjustment. Strategies such as migration emerged as central yet emotionally and relationally challenging. Participants also highlighted significant limitations in institutional and policy responses to family needs, particularly the fragmentation of existing initiatives. Preserving the family and its resilience in Lebanon requires targeted and collaborative interventions, especially on the macro level, that extend beyond short-term emergency responses. Full article
(This article belongs to the Section Family Studies)
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44 pages, 3824 KB  
Article
Geoeconomic Fragmentation and Market Decoupling: A Time–Frequency Anatomy of Oil–Ruble Volatility Spillovers (2020–2025)
by Erdost Torun, Erhan Demireli and Simon Grima
Risks 2026, 14(5), 104; https://doi.org/10.3390/risks14050104 - 3 May 2026
Viewed by 464
Abstract
The interaction between crude oil prices and exchange rates is central to understanding global financial stability and macro-economic balances. Contrary to traditional static analyses, the heterogeneous market hypothesis argues that market participants have different time horizons and that multi-scale analysis is necessary to [...] Read more.
The interaction between crude oil prices and exchange rates is central to understanding global financial stability and macro-economic balances. Contrary to traditional static analyses, the heterogeneous market hypothesis argues that market participants have different time horizons and that multi-scale analysis is necessary to capture dynamic changes in crisis periods. This study examines volatility spillovers between WTI crude oil and the Russian ruble using wavelet coherence, phase difference, and predictive information flow analysis in a time–frequency framework. The analysis separates short-term [2–32 days] transient shocks from long-term [32–256 days] structural changes. Findings show that a negative spillover, initially led by WTI, with evidence of dynamic, frequency-dependent leadership shifts during the 2020 shock, was interpreted as a result of the overnight price gap and a failure of microstructural synchronisation. With the outbreak of the 2022 Russia–Ukraine war, the relationship shifted to a strong, positive, and high-intensity risk transfer, consistent with contagion theory. Crucially, by 2024, a structural decoupling emerged due to geoeconomic fragmentation, signalling that the ruble no longer exhibits traditional petro-currency behaviour. These results offer critical signals for policymakers regarding reserve management and for market participants regarding new liquidity risks. Full article
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35 pages, 1316 KB  
Article
The Rhetoric of Energy Transition Coverage: Analyzing Lexical Patterns and Rhetorical Strategies as Framing Tools in News Discourse of English-Language Mainstream Media
by Ekaterina Veselinovna Teneva
Journal. Media 2026, 7(2), 95; https://doi.org/10.3390/journalmedia7020095 - 1 May 2026
Viewed by 798
Abstract
The 2021–2024 global energy crisis intensified the energy transition, with mainstream media coverage playing a pivotal role in shaping public perceptions. Guided by Burke’s and Lippmann’s theories, and supported by corpus-based critical and rhetorical discourse analyses, this interdisciplinary study aimed to analyze the [...] Read more.
The 2021–2024 global energy crisis intensified the energy transition, with mainstream media coverage playing a pivotal role in shaping public perceptions. Guided by Burke’s and Lippmann’s theories, and supported by corpus-based critical and rhetorical discourse analyses, this interdisciplinary study aimed to analyze the role of lexical patterns and rhetorical strategies in framing the transition within a corpus of 1341 news articles retrieved from the websites of five English-language mainstream media outlets. Corpus-based analysis identified generic frames, including economic consequences, responsibility, conflict, technological, emotion, and moral duty frames. Rhetorical discourse analysis revealed specific frames, including economic opportunities, technological progress and challenges, energy security and independence, global leadership, energy partnerships, partisan divide, global disparities, corporate greenwashing, necessity, hope, and uncertainty frames, that indicated an ambivalence in the framing of the transition, thereby contributing to the polarization and manipulation of public opinion. The findings indicated a discrepancy: while British, American, and Brazilian media focused more on political divides, Indian and Chinese media emphasized energy partnerships and patriotism. Appeals to experts were less frequent, whereas appeals to emotions were often employed to shape public perceptions. The findings illustrate how lexical patterns and rhetorical strategies function as powerful framing tools within journalism, applied linguistics, and media rhetoric. Full article
(This article belongs to the Special Issue Media, Journalism and Environmental Resilience)
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33 pages, 3879 KB  
Article
Use of Knowledge Management to Enhance International Research Collaboration
by Siri-on Umarin, Thanwadee Chinda and Takashi Hashimoto
Adm. Sci. 2026, 16(5), 219; https://doi.org/10.3390/admsci16050219 - 1 May 2026
Viewed by 1201
Abstract
With globalization and rapid changes in the international research environment from technological advancement, political instability, and economic crisis, knowledge management (KM) is crucial to help research institutions operate international research collaboration (IRC) effectively and sustainably. This study uses systematic literature review to extract [...] Read more.
With globalization and rapid changes in the international research environment from technological advancement, political instability, and economic crisis, knowledge management (KM) is crucial to help research institutions operate international research collaboration (IRC) effectively and sustainably. This study uses systematic literature review to extract key KM factors for IRC enhancement. Exploratory factor analysis and structural equation modeling methods are performed to confirm KM factors and explore how key KM and IRC factors relate to each other. Several KM strategies are established based on study results to achieve sustainable IRC development. The results show that five key KM factors, including knowledge sharing (KS), knowledge creation (KC), knowledge retention (KR), knowledge storage (KT), and knowledge utilization (KU), influence each other. They have both direct and indirect impacts on IRC. The KU factor is crucial for immediate IRC improvement. Research institutions can use existing knowledge and resources to address current IRC opportunities. For example, personnel with IRC experience can act as coaches and mentors to facilitate activities, and integrating IRC into career paths can be beneficial. Activities related to KC, KR, and KT should support KU implementation. Setting up a task force, improving organizational structure, and engaging management in KM can help achieve better IRC performance. The KS factor should be emphasized for sustaining IRC. The plan should involve activities to raise the processes of knowledge sharing effectively. The study results provide guidelines for research institutions aiming for sustainable IRC in the long term. Full article
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12 pages, 1232 KB  
Brief Report
Community Health Workers in School Systems: Social Prescribing for Healthcare Access and Resource Allocation
by Marcie Johnson, Kendra Summers, LaShawn McClary, Mindi B. Levin, Catherine Ling, Natalie Exum, Kimberly Hailey-Fair, Elisabeth Vanderpool, Rebecca Chen, Anthony Rivetti, Ursula E. Gately, Amanda Toohey, Jacqueline Bryan, Jordyn Gunville-Pourier, Z. Thomasina Watts, Meghan Brown, Olivia Banks, Brittany Martin, Annette Anderson and Panagis Galiatsatos
Healthcare 2026, 14(9), 1217; https://doi.org/10.3390/healthcare14091217 - 1 May 2026
Viewed by 363
Abstract
Background: During the early years of the coronavirus disease 2019 (COVID-19) pandemic, many schools found their staff, specifically teachers, adapting their roles to address social and health challenges, such as food insecurity and health literacy. Given the challenges these school-based communities faced, and [...] Read more.
Background: During the early years of the coronavirus disease 2019 (COVID-19) pandemic, many schools found their staff, specifically teachers, adapting their roles to address social and health challenges, such as food insecurity and health literacy. Given the challenges these school-based communities faced, and continue to face, a clear gap was exposed during these early years of the public health crisis: a lack of community-centered professionals who can assist with social health factors impacting health and well-being. Methods: In this descriptive report, we examine the process and implementation of training two teachers to become community-centered professionals, specifically community health workers (CHWs), to serve schools located in socioeconomically challenged neighborhoods of urban regions. We explore their training and how these CHW–teachers prescribed social health interventions across four major domains: (a) access to medical and environmental equipment, (b) mental health challenges, (c) food insecurity, and (d) health literacy. We describe the specific interventions they implemented and the potential economic value and practicality of the overall initiative. Outputs: In less than one year, two teachers were successfully trained as CHWs in and for underserved communities. These CHW–teachers conducted informal surveys based on objectives of health themes that aligned with absenteeism. Both the process and implementation of the CHW training and CHW-led school-based interventions proved cost-effective and practical. Conclusions: Having CHW–teachers in schools is practical, may offer economic value, and is likely to complement additional health initiatives at schools (e.g., school nurses). As a small-scale pilot initiative, further studies should evaluate CHW–teacher impact on school-based goals, such as attendance rates, while this report focuses on early implementation processes. Full article
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19 pages, 610 KB  
Article
Cost Burden, Readmission Dynamics, and Service Management in Psychiatric Care: A Financial Performance Analysis in a Romanian Public Hospital
by Laura Ioana Bondar, Roland Fazakas, Cris Virgiliu Precup, Denis Bogdan Butari, Florin Mihai Șandor, Ana-Liana Bouroș-Tataru, Elisaveta Ligia Piroș, Mariana Adelina Mariș, Liviu Gavrila-Ardelean and Florin Cornel Dumiter
Healthcare 2026, 14(9), 1204; https://doi.org/10.3390/healthcare14091204 - 30 Apr 2026
Viewed by 346
Abstract
Background/Objectives: Psychiatric inpatient care varies substantially in its clinical goals, resource demands, and financial implications. Acute units focus on short-term crisis stabilization, whereas chronic units provide prolonged supervision for patients with persistent functional impairment. Limited evidence exists from Eastern Europe on how these [...] Read more.
Background/Objectives: Psychiatric inpatient care varies substantially in its clinical goals, resource demands, and financial implications. Acute units focus on short-term crisis stabilization, whereas chronic units provide prolonged supervision for patients with persistent functional impairment. Limited evidence exists from Eastern Europe on how these differing service models impact both hospital costs and clinical outcomes such as early rehospitalization. This study aimed to compare the economic and operational performance of Acute versus Chronic Psychiatry and to identify predictors of 30-day readmission following acute psychiatric hospitalization. Methods: This retrospective observational study analyzed routinely collected data from a Romanian public hospital. All adult admissions to Acute and Chronic Psychiatry recorded between 1 January 2024 and 31 December 2024 were included. Standardized financial indicators were derived from administrative data, while clinical variables and readmission outcomes were extracted from electronic medical records. Between-group comparisons of economic and operational indicators were performed using t-tests. Multivariable logistic regression was used to determine independent predictors of 30-day readmission in Acute Psychiatry, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model performance was evaluated with area under the curve (AUC), Hosmer–Lemeshow tests, and Nagelkerke R2. Results: Acute Psychiatry demonstrated significantly higher mean cost per bed-day (798.76 vs. 373.75 lei; p < 0.001), but a lower mean cost per patient due to shorter hospitalization (10.17 vs. 53.32 days). A total of 188 acute patients (13.7%) were readmitted within 30 days. No early readmissions occurred in Chronic Psychiatry, consistent with its long-stay care model. Independent predictors of readmission included psychotic disorder diagnosis (aOR = 1.62, 95% CI: 1.18–2.23), multiple prior admissions (aOR = 1.35, 95% CI: 1.18–1.54), shorter length of stay (LOS) (aOR = 0.88 per 5-day increase, p = 0.006), and absence of a post-discharge plan (aOR = 0.54, 95% CI: 0.39–0.76). Model discrimination was acceptable (AUC = 0.74). Conclusions: Acute and chronic psychiatric services differ markedly in cost structures and care pathways. Early rehospitalization is a clinically relevant outcome within acute psychiatric care and is influenced by both patient-level and continuity-of-care factors. Enhancing discharge coordination, expanding continuity-of-care strategies, and optimizing resource allocation toward community-based support may reduce early rehospitalizations while improving hospital cost-efficiency. Full article
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