Search Results (46)

Urban resilience (UR) is shaped by multiple interacting factors, yet existing studies have paid limited attention to the differentiated nonlinear and interactive mechanisms across different resilience dimensions. Based on panel data from 110 prefecture-level and above cities in the Yangtze River Economic Belt (YREB) from 2015 to 2024, this study adopts a four-dimensional framework covering social, economic, ecological, and infrastructure resilience. Spatial analysis and the XGBoost-SHAP model are combined to examine the spatiotemporal evolution, key drivers, nonlinear responses, turning point characteristics, and factor interactions of overall UR and its four dimensions. The results show that overall UR increased steadily, while the four dimensions followed distinct evolutionary trajectories: economic and infrastructure resilience improved most rapidly, ecological resilience increased steadily, and social resilience improved relatively slowly. The importance and effects of key drivers also varied across overall resilience and its four dimensions. Major factors, including technological investment, non-registered population, unemployment insurance coverage, land use, and natural population growth, exhibited distinct nonlinear responses and turning point characteristics, with their effects changing across different variable levels. Furthermore, significant interactions were identified among population and industrial structure, population and transportation, industry and technology, and industry and social security across different resilience dimensions. Overall, UR in the YREB is characterized by differentiated development, nonlinear responses, nonlinear transition patterns, and joint influences of multiple factors. Full article

Background/Objectives: This study examined the association between low protein intake and pregnancy outcomes to test whether low protein intake was associated with higher rates of small for gestational age (SGA), gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (HDP), and lower rates of large for gestational age (LGA). Methods: A secondary analysis was performed using the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (NuMoM2b). Participants missing diet data or pregnancy outcomes and whose pregnancy ended <20 weeks were excluded. Protein intake was calculated in grams per kilogram of bodyweight per day and stratified into quartiles. Multi-variable analyses were done to assess the association between protein intake quartiles and rates of HDP, GDM, SGA, and LGA, adjusting for relevant covariates. Results: Participants (n = 7067) were categorized into quartiles by daily protein intake: Q1 (<0.6 g/kg), Q2 (0.6–<0.8 g/kg), Q3 (0.8–<1.1 g/kg), and Q4 (≥1.1 g/kg). Lower protein intake was common among Black women (p = 0.001), women with less than a high school education (p < 0.001), unemployment (p = 0.004), lower income (p = 0.003), or government insurance (p = 0.04). After adjusting for age, insurance, education, income, chronic hypertension, and dietary kcal, protein intake resulted in significantly lower odds of developing SGA < 10th percentile for women in Q3 (aOR 0.78, 95% CI 0.61–0.99 for Q3). Protein in-take was not significantly associated with HDP, GDM or LGA. Conclusions: Moderate to high protein intake in the first trimester was associated with reduced SGA risk; however, these findings are exploratory and require confirmation in future studies. Full article

Background/Objectives: Stroke is the leading cause of death and disability among adults in China. Most survivors experience debilitating symptoms, including limb weakness, pain, fatigue, and depression, which impair quality of life and increase caregiver burden. This study aimed to identify clusters of symptoms and functional status in patients with stroke, their associated factors, and the influence of family burden. Methods: From February 2023 to February 2024, 779 patients with stroke from three Chinese tertiary hospitals completed an electronic questionnaire covering demographics and Patient-Reported Outcomes Measurement Information System measures, including depression, anxiety, pain interference, physical and cognitive function, social participation, and family burden. Using SPSS 26.0 and Mplus 8.0, chi-square tests, analysis of variance, latent class analysis, and multiple logistic regression were performed. Results: Latent class analysis identified three distinct symptom–functional clusters among stroke patients: “low-symptom high-function” (36.4%), “moderate-symptom moderate-function” (54.6%), and “high-symptom low-function” (9.0%). Multinomial logistic regression revealed that age ≥ 60 years (OR = 0.15, p = 0.001), freelancing (OR = 2.75, p = 0.019), unemployment (OR = 2.73, p = 0.018), monthly income ≥ 5000 yuan (OR = 2.56, p = 0.026), no medical insurance (OR = 4.26, p = 0.01), living alone (OR = 2.45, p = 0.031), and family burden (OR = 0.95, p < 0.001) were associated with the “high-symptom low-function class”. Conclusions: Chinese stroke patients exhibit substantial heterogeneity in symptom and functional profiles. To optimize stroke rehabilitation, healthcare professionals should develop targeted management strategies, prioritizing high-risk populations, particularly socio-economically vulnerable and socially isolated patients. Full article

This article examines the later life experiences of women who participated in the revolutionary period in Cork city and county who did not go on to marry. Many within this cohort of Cork female activists experienced poverty, ill health, economic dependency and loneliness in the aftermath of the revolutionary period. Their unmarried status left these women particularly vulnerable in a patriarchal state structured—legally, economically and culturally—on an essentialist view of the married, childbearing woman. The invisibility of adult dependency in Ireland was summed up in the 1926 Census of Population report: ‘no account is taken in this inquiry of adults who may be supported out of the household income’. Mary Daly notes the ‘high proportion of the population working within a family economy which had little reliance on money incomes and waged employment’. This may, as she states, ‘have reduced the numbers exposed to the blunt instrument of unemployment’ in the context of the 1930s depression. However, the emotional and psychological effects of economic dependency have not been considered in any depth. The lack of statutory benefits for lower-class single women who were unable to access paid employment and who did not have the requisite social insurance stamps meant that they faced a vista of poverty and dependency on charity and family members. The latter were often begrudging and indisposed to assume the financial burdens of those who they often deemed economically ‘unproductive’. This article argues that, in so many cases, financial dependency resulted in the loss of agency and autonomy for unmarried women. Full article

Statistical Process Control (SPC) plays a crucial role in monitoring and improving manufacturing processes to ensure product quality. Control charts using exponentially weighted moving averages (EWMA) and their extensions, including Extended EWMA (EEWMA) and New Extended EWMA (NEEWMA), have been developed to increase the sensitivity for detecting small to medium process changes. This research proposes a method for calculating the Average Run Length (ARL) and Standard Deviation of Run Length (SDRL) of control charts under a symmetric distribution using the Markov Chain Approach (MCA). This method is based on the probability of state transitions between controlled and uncontrolled states. The MCA method is more efficient than the Monte Carlo Simulation Approach (MC) in terms of accuracy and significantly reduces processing time. This research also demonstrates the application of ARL and SDRL calculations using the MCA method in various studies. Firstly, the performance of control charts is compared using the Mean Percentage Error (MPE) and Mean Absolute Percentage Error (MAPE). Secondly, the impact of symmetrically distributed process parameters on the performance of control charts is examined. Thirdly, a practical application of the control charts is presented. This research applies the proposed method to detect changes in unemployment insurance claims (UI) using seasonally adjusted initial claims assessment (ICSA) and continuing claims assessment (CCSA) rates from 2021 to 2025. The results show that the MCA method is more efficient than the MC method in terms of accuracy and significantly reduces processing time. Full article

This study examines whether stricter enforcement of mandatory social insurance contributions affects corporate income tax behavior in China. In the Chinese institutional context, mandatory social insurance refers to payroll-based employer and employee contributions to five statutory programs: basic pension insurance, basic medical insurance, work-injury insurance, unemployment insurance, and maternity insurance. These programs are directly related to social sustainability because they finance old-age income security, medical protection, workplace injury compensation, unemployment support, maternity protection, and labor-market stability. Using China’s 2018 social insurance collection reform as a quasi-natural experiment, we analyze A-share listed companies from 2014 to 2024 through a difference-in-differences design based on differential exposure between private firms and state-owned enterprises. To assess the reliability of the identification strategy, we employ firm and year fixed effects, event-study analysis, placebo tests, alternative measures of tax avoidance, and propensity score matching difference-in-differences robustness checks. The findings show a tax-fee seesaw effect: private firms subject to extensive regulatory scrutiny respond to more rigorous enforcement of social insurance contributions by increasing corporate income tax avoidance. Analysis of the mechanisms shows that the Whited-Wu index of financial constraints partially explains this phenomenon. The effect is more pronounced in firms with higher labor costs and greater administrative expense intensity, indicating that the increased response is driven by labor cost exposure and organizational discretion. By contrast, the effect is weaker among firms audited by the Big Four accounting networks—Deloitte, PricewaterhouseCoopers, Ernst & Young, and KPMG—indicating that high-quality external audits constrain aggressive tax planning. Regionally, the effect is most pronounced in eastern China, where markets, labor costs, and tax-planning services are more developed. The findings contribute to the sustainable development literature by demonstrating that reforms designed to strengthen social insurance sustainability can unintentionally weaken tax compliance if payroll contributions, tax administration, and corporate financial pressures are not coordinated. The study highlights the importance of integrated fiscal governance for achieving socially sustainable and fiscally balanced development. Full article

Objective: The aim of this study was to investigate the association between dental caries and multidimensional poverty in Colombia using data from the National Oral Health Survey (ENSAB IV, Spanish acronym). Methods: A cross-sectional analytical study was conducted using data from 20,534 individuals in six regions of the country. Dental caries was assessed using the ICDAS system, and multidimensional poverty was measured using a proxy Multidimensional Poverty Index (MPI) adapted from the method adjusted for Colombia. Descriptive analyses and bivariate comparisons were carried out, and Poisson regression models adjusted for sociodemographic variables were applied. Results: Households containing at least one member with caries had a higher incidence (59.9%) and intensity (46.7%) of multidimensional poverty compared to those without caries (52.6% and 45.6%, respectively). Significant associations were identified between caries and deprivation in education (low educational attainment: RR = 1.27), child labor (RR = 1.16), unemployment (RR = 1.04), lack of health insurance (RR = 1.09), and inadequate housing conditions (RR = 1.19). The model that analyzed the presence of caries in a household and multidimensional poverty, when controlled for housing conditions, confirmed a positive association between the MPI and the presence of caries (IRR = 1.08; 95% CI: 1.050–1.107; p-value < 0.001). A female head of household and rural residence were also identified as variables associated with the presence of caries in a household. Conclusions: The presence of a household member with dental caries is significantly associated with multidimensional poverty in Colombia. This study highlights the need to consider oral health as a sensitive indicator of structural inequality and proposes its inclusion in social progress metrics. The findings support the design of comprehensive public health strategies that address the social determinants of oral health, especially in vulnerable populations. Full article

This paper introduces a novel framework for designing fair and sustainable unemployment benefits, grounded in cooperative game theory and real-time fiscal policy. The labor market is modeled as a coalitional game, where a random subset of participants is employed, generating stochastic economic output. To ensure fairness, we adopt equal employment opportunity as a normative benchmark and propose a dichotomous valuation rule that assigns value to both employed and unemployed participants. Within a continuous-time, balanced budget framework, we derive a closed-form payroll tax rate that is fair, debt-free, and asymptotically risk-free. This tax rule is robust across alternative objectives and promotes employment, productivity, and equality of outcome. The framework naturally extends to other domains involving random bipartitions and shared payoffs, such as voting rights, health insurance, road tolling, and feature selection in machine learning. Our approach offers a transparent, theoretically grounded policy tool for reducing poverty and economic inequality while maintaining fiscal discipline. Full article

Objectives: This study aims to explore the relationship between dental caries and unemployment among U.S. adults who have engaged in illicit drug use, such as cocaine, heroin, and methamphetamine. Methods: The National Health and Nutrition Examination Survey (2015–2018) data were analyzed. The independent variable was severe dental caries (defined as DMFT > 13.99), and the dependent variable was employment status. The sample was categorized into non-users, current users (used in the past year), and former users (used prior to the past year). Covariates included age, education, race, gender, smoking status, family income-to-federal poverty level ratio, and health insurance status. Logistic regression with survey weights was applied to assess associations between severe dental caries and employment status. Results: The total sample (n = 5476) represented 131,848,604 U.S. adults aged 18–59 years, with 4% current users and 12% former users of the specified drugs. Among current users, those with severe caries had higher odds of unemployment (OR = 2.6, p = 0.025) compared to those without severe caries. No significant association was found between severe caries and employment status among former users after controlling for covariates. Conclusions: The study underscores a significant association between severe dental caries and unemployment among U.S. adults who have used illicit drugs in the past year. These findings suggest a potential need for targeted oral health interventions in this population to improve economic well-being. Future research should focus on longitudinal studies to establish causality and explore mechanisms through which dental health may impact employment prospects. Full article

Chronic exposure to structural violence and environmental hazards may disrupt stress regulation, trigger inflammation, and impair iron metabolism in women. Iron deficiency has been associated with depression, but the combined impact of environmental stressors and anemia on maternal mental health remains understudied. We analyzed associations between 28 neighborhood-level environmental stressors, hemoglobin levels, and depressive symptoms (measured by the Patient Health Questionnaire-9) during early pregnancy, using retrospective data from 1964 pregnant patients (2015–2019) at an urban health center in Chicago. Demographic and residential data were linked to environmental indicators from the Chicago Health Atlas. Factor analysis reduced the environmental variables, and multivariable regression models examined associations with PHQ-9 scores at first pregnancy encounter. Participants were predominantly non-Hispanic Black (56%) and Hispanic (27%), with 13% anemic and 16% screening positive for depressive symptoms. Poverty, non-Hispanic Black race, single status, public or no insurance, and unemployment were associated with higher depressive symptoms. Among anemic individuals, neighborhood crime was significantly associated with depressive symptoms, while hemoglobin levels and gestational age were not. These findings highlight how environmental and social inequities contribute to maternal mental health disparities and support the need for integrated, equity-focused prenatal care interventions. Full article

This study explores economic and risk perceptions that spark off-shore irregular migration among West Africans through the Mediterranean Sea to countries of destination (CODs). This study is timely because deaths on the Mediterranean Sea, which are unprecedented in migration history, result in a need to create awareness and save lives. Grounded in the Theory of Reasoned Action and the Cultural Theory of Risk Perception, this study explores the economic and risk perceptions of off-shore irregular migration. This study comprised a literature review, otherwise known as a “meta study”. The study’s findings reveal that there is a nexus between a person’s attitude and behaviours in terms of human action. Human nurturing determines a person’s attitudes and behaviours. The human mind does what it wants when one is desperate for economic survival. This forces humankind to engage in dangerous activities to survive. Therefore, irregular migrants’ choice of unsafe routes through the Mediterranean Sea to CODs depends on their expected outcomes. Irregular migrants consider migration as an “insurance”, and flee from hardship towards opportunities. The perceptions that lead to this range from salary disparities to economic freedom. I argue that spiritual beliefs, peer pressure, media platforms, and personal factors influence irregular route choices. This study recommends collaboration among the ECOWAS, African nations’ governments, and the IOM to engage returning migrants to narrate their in-depth experiences about the routes’ dangers to create awareness. Returning migrants’ narratives should be disseminated in mass media and on social media platforms to target youth. This would discourage West African youth from choosing unsafe routes to CODs. Collaboration should be extended to youth training in entrepreneurship to equip youth as job creators rather than job seekers to curb unemployment, which usually sparks off-shore irregular migration. Full article

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning in the 1990s, a protocol was developed to proactively monitor children with surgical or conservative interventions. After three decades, we undertook a prospective institutional review, board-approved 25–45-year-old adults callback study. Inclusion criteria were all children treated through childhood who could be located and were willing to return for a full evaluation. Results: Pediatric orthopedic interventions focused on regular surveillance with proactive treatment of progressive deformities. When function was impacted, we utilized multi-level orthopedic surgery guided by instrumented gait analysis. Childhood outcomes of this approach were evaluated through retrospective studies. Results show high correction rates were achieved for planovalgus foot deformity, knee flexion contracture, torsional malalignments, and stiff-knee gait. Our prospective adult callback study evaluated 136 adults with CP, gross motor function classification system levels I (21%), II (51%), III (22%), and IV (7%), with average ages of 16 ± 3 years (adolescent visit) compared with 29 ± 3 years (adult visit). Adults in the study had an average of 2.5 multi-level orthopedic surgery events and 10.4 surgical procedures. Compared with adults without disability, daily walking ability was lower in adults with CP. Adults with CP had limitations in physical function but no increased depression. A higher frequency of chronic pain compared with normal adults was present, but pain interference in daily life was not different. Adults demonstrated similar levels of education but higher rates of unemployment, caregiver needs, and utilization of Social Security disability insurance. Conclusions: The experience from our center suggests that consistent, proactive musculoskeletal management at regular intervals during childhood and adolescence may help maintain in gait and mobility function from adolescence to young adulthood in individuals with CP. Full article

Antimicrobial resistance (AMR) represents a critical global health threat, with inappropriate antibiotic self-medication (ASM) being a key contributor. China—as the world’s largest antibiotic consumer—faces significant challenges despite regulatory efforts, compounded by limited contemporary data during the COVID-19 pandemic. A nationwide cross-sectional study was conducted using the 2021 China Family Health Index Survey (n = 11,031 participants across 120 cities). Trained investigators administered face-to-face questionnaires assessing ASM practices, decision-making factors, and sociodemographic characteristics. Multivariate logistic regression identified determinants of ASM. Overall, ASM prevalence was 33.7% (n = 3717), with no urban-rural difference (p > 0.05). Physician advice (78.2%), drug safety (67.1%), and efficacy (64.2%) were primary selection criteria; rural residents prioritized drug price and salesperson recommendations more than their urban counterparts (p < 0.01). Key predictors included higher ASM odds among females (OR = 1.30, 95%CI:1.18–1.43), middle-aged adults (46–59 years; OR = 1.20, 95%CI:1.02–1.42), those with health insurance (resident: OR = 1.33; commercial: OR = 1.62), and individuals with drinking histories (OR = 1.20, 95%CI:1.10–1.31). Lower odds were associated with primary education (OR = 0.69, 95%CI:0.58–0.81), unemployment (OR = 0.88, 95%CI:0.79–0.98), and absence of chronic diseases (OR = 0.56, 95%CI:0.47–0.67). One-third of Chinese residents engaged in ASM during the pandemic, driven by intersecting demographic and behavioral factors. Despite converging urban-rural prevalence rates, distinct decision-making drivers necessitate context-specific interventions, including strengthened pharmacy regulation in rural areas, tailored education programs for high-risk groups, and insurance system reforms to disincentivize self-medication. Full article

The economic downturns in South Africa present a significant threat, with the potential to disrupt the nation’s notable advances in addressing the persistent challenges of high unemployment, widespread poverty and stark inequality. In the absence of substantial and extensive structural transformation, South Africa’s aspirations to achieve its ambitious development goals may remain unattainable. Building on the precedent of a blend of literature review, comprehensive ex post analysis, and applied general equilibrium modelling tailored for ex ante assessments, this paper assesses options and impacts of alternative ambitious developmental interventions. The results indicate that, despite implementing a variety of strategies, there remains a disheartening underperformance in economic indicators. However, ex ante evaluations indicate that with targeted interventions and supportive government policies, the country can achieve economic growth and job creation. Simulation results identify sectors of personal and social service activities, transport, finance, and insurance as having the most formidable potential to significantly reduce unemployment while simultaneously catalysing robust economic growth. These pivotal sectors, nestled within the broader services and industries, are uniquely poised to bolster overall productivity and diminish unemployment, while adeptly absorbing a considerable influx of highly educated and skilled labour. This suggests that South Africa can decisively accelerate its economic progress by embracing a dual-pronged approach: fostering structural shifts towards manufacturing and services, while steadfastly advancing the upskilling of its dynamic workforce. Full article

This study investigated the determinants of the Healthcare Quality Index (HQI) in Saudi Arabia over the period from 1990 to 2024. It specifically analyzed the impact of six key variables: Medical Insurance Penetration Rate (MIPR), Gross Domestic Product per Capita (GDP), Unemployment Rate (UR), Inflation Rate (IR), Government Healthcare Expenditure as a Percentage of GDP (GHE), and Foreign Direct Investment in the Healthcare Sector (FDI). Utilizing the Autoregressive Distributed Lag (ARDL) and Vector Error Correction Model (VECM) techniques, this research explored both the short-term dynamics and the long-term equilibrium relationships among these time-series variables, while also accounting for cointegration and potential endogeneity. This study contributes to the existing literature by applying the ARDL and VECM methodologies to comprehensively analyze the combined impact of these factors on HQI within the unique economic and social framework of Saudi Arabia, addressing a notable void in this specific context and exploring both transient fluctuations and sustained equilibrium relationships. The key findings revealed distinct influences across time horizons. In the short term, GDP and GHE significantly and positively affect HQI, whereas UR and IR demonstrate a significant negative impact. Short-term impacts of MIPR and FDI are found to be positive but not statistically significant. The long-term analysis indicates that MIPR, GHE, and FDI have a significant positive influence on HQI, while IR maintains a significant negative impact. GDP and UR effects are not statistically significant in the long term. Further analysis using Granger causality tests and VECM confirmed that MIPR, GDP, GHE, and FDI collectively Granger-cause HQI, with government healthcare expenditure playing a crucial role in correcting short-term deviations toward long-term equilibrium. This study concludes that long-term strategies focusing on expanding insurance coverage, increasing government healthcare investment, and attracting foreign direct investment are vital for significantly enhancing healthcare quality in Saudi Arabia. The sustained positive influence of these factors and the critical role of government spending in maintaining long-term stability underscore their importance for effective healthcare policy. While emphasizing these long-term drivers, policymakers should also remain cognizant of the significant negative short-term fluctuations caused by unemployment and inflation. Full article