搜索结果：Economics and Econometrics

Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50·9 million (95% UI 46·1-56·1) road injury incident cases, 1·34 million (1·04-1·58) deaths, and 75·3 million (59·8-89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9-39·7) and mortality decreased by 32·3% (6·1-49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7-56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1-7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9-947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.

The coordinated development of older adult care service resource supply and the needs of older adults is not only pivotal for advancing the construction of China's older adult care service system and improving the social security framework, but is also essential for the effective implementation of the national strategy for actively addressing population aging. However, a structural imbalance currently exists between older adult care service supply and the needs of older adults, with pronounced developmental disparities across the eastern, central, and western regions, underscoring an urgent need for in-depth analysis of the evolutionary patterns of supply-demand coordination and its spatial transmission mechanisms from a systems coupling perspective. This study theoretically transcends the conventional paradigm of unidirectional supply-side or demand-side analysis by constructing an analytical framework for supply-demand coordination in older adult care services from a systems coupling perspective, thereby extending the application boundaries of coupling coordination theory to the social services domain; empirically, it employs multiple spatial econometric methods to systematically reveal the spatiotemporal evolutionary patterns, spatial agglomeration characteristics, and regionally heterogeneous driving mechanisms of the supply-demand coupling coordination degree, providing a quantitative basis for the scientific formulation of differentiated older adult care policies. Based on panel data from 31 provinces and municipalities in China spanning 2014 to 2023, the entropy weight method was applied to measure supply and demand levels, the coupling coordination degree model was employed to evaluate the level of coordinated development, Moran's Index was used to characterize spatial agglomeration features, and a spatiotemporal dual fixed-effects Spatial Durbin Model was constructed to analyze the direct, indirect, and total effects of the influencing factors. The findings indicate that the supply-demand coupling coordination degree of older adult care service resources in China has followed a steadily upward yet slowly progressing trend, remaining at an overall low level of coordination. Significant regional differentiation is evident, manifesting as a spatial pattern of "high in the east, low in the west," with this divergence continuously intensifying. Significant spatial autocorrelation has given rise to relatively stable high-high and low-low clustering zones, reflecting that the structural imbalance between supply and demand constitutes the fundamental constraint on coordinated development. Multi-dimensional driving factors - including population aging, economic development, and fiscal investment - exhibit marked regional heterogeneity in their effects on the coupling coordination degree, with considerable differences in development dynamics across regions. Older adult care service resources display a structural imbalance in which supply quality lags behind the upgrading of demand. The eastern region maintains a relative lead in coupling coordination, the central region is in a phase of steady catch-up, and the western region continues to face fundamental bottlenecks. Each region should, in accordance with its own stage of development and regional characteristics, pursue differentiated supply-demand coordination pathways by optimizing fiscal investment structures, establishing regional vertical cooperation mechanisms, and implementing targeted reforms in resource allocation, so as to effectively advance the dynamic equilibrium between older adult care service supply and the needs of older adults.

Vaccination and screening services are essential components of preventive care, yet access to these services remains unequal in many low- and middle-income countries (LMICs). This narrative review examines health equity barriers affecting access to vaccination and screening services in LMICs, with screening evidence drawn predominantly from cervical cancer/HPV-related programs and selected other preventive screening contexts, and identifies strategies to improve equity in preventive care. Relevant English-language literature was identified through PubMed and Scopus and synthesized thematically. The review examined cross-cutting equity barriers across vaccination and the screening contexts represented in this evidence base. Barriers operated across individual and household, community and sociocultural, health system, and policy and structural domains. Common barriers included poverty, transportation costs, low health literacy, stigma, weak primary care, workforce shortages, and inadequate financing. Vaccination-specific challenges included weak cold-chain systems, reliance on campaign-based delivery, vaccine hesitancy, and missed immunization schedules, whereas screening-specific challenges included repeated visits, weak referral and follow-up systems, stigma related to cancer and reproductive health screening, and delayed diagnosis. These barriers disproportionately affected rural populations, low-income households, women and girls, migrants, ethnic minorities, people with disabilities, and other marginalized groups, contributing to persistent inequities by income, gender, education, and rural-urban residence. Advancing equity in preventive care requires strengthening primary health care, reducing financial and geographic barriers, improving culturally responsive communication, using disaggregated data for equity-focused planning, and investing in workforce and service delivery improvements.

Global climate change is set to create a future where natural hazards become more catastrophic and more frequent, with impacts on real estate expected to be substantial. At the same time, the transition to a low-carbon economy is reshaping asset values, with high-emission assets becoming less attractive. We adopted a systematic map approach to assess how the impact of climate risks, i.e., physical climate risks and transition climate risks, has been assessed in the academic and grey literature related to real estate valuation, published between 2014 and 2023. The retained corpus of 130 documents was coded according to a pre-defined coding framework, covering geographic distribution, evaluation methods, the type of real estate assets and impact assessment methods. Across the 130 included documents (peer-reviewed and grey literature), the evidence base is dominated by studies that quantify physical climate risk effects on real-estate values, most often using econometric capitalization approaches (e.g., hedonic regressions, DiD, repeat-sales). The most frequently studied hazards are hydrological ones, especially coastal and fluvial floods, typically operationalized using official hazard maps (particularly in US case studies) or through proxies such as elevation and distance to from the shoreline. A smaller subset of studies evaluates adaptation-relevant outcomes (e.g., damages via depth-damage functions) or uses alternative valuation variables such as asking prices, appraisals, or operating and maintenance costs in retrofit-focused works. Evidence on transition climate risks is present but much smaller in volume and is concentrated on a limited set of drivers, notably minimum energy performance requirements, energy labels and local externalities linked to renewable-energy deployment. This patterns partly reflects the study's focus on transition risks explicitly linked to decarbonization. In terms of geography, the literature is heavily concentrated in the United States, while European studies cluster in a few large economies (notably Germany, Italy, and the United Kingdom). The corpus is overwhelmingly focused on one- and two-family housing, with comparatively fewer studies examining multi-family housing and commercial real estate. A small number of papers touch on ecosystem or environmental amenities changes affecting values, including cases linked to invasive or alien species (e.g., algae blooms), but these studies remain relatively rare in the overall corpus. The systematic map highlights several priority gaps for future research and evidence synthesis. First, transition risks remain underexplored beyond a narrow focus on energy-performance regulation, energy labels and renewable-energy proximity; more work is needed on additional channels such as disclosure regimes, financing and insurance repricing, changing tenant demand, and stranded-asset dynamics. Second, compound and cascading risks are rarely analyzed explicitly, even though real-estate exposure often reflects interacting hazards and changing baselines; advancing datasets and methods that represent multi-hazard interactions is therefore a key priority. Third, the geographic evidence base is skewed toward the United States, and more comparable, data-rich studies are needed across Europe to strengthen external validity. Fourth, research remains focused on single-family housing, limiting transferability to urban contexts where multi-family and commercial assets, and different ownership, tenancy, and financing structures, are central. Finally, ecosystem-related valuation impacts appear in only a small portion of the academic corpus and are limited in grey literature, suggesting a need for clearer conceptualization and more systematic integration of biodiversity and ecosystem mechanisms in real-estate climate-risk assessment.

Herpes zoster (HZ) is common in Finland, leading to long-term postherpetic neuralgia (PHN) especially with ageing. HZ reduces productivity, placing an economic burden on society. An integrated actuarial and macroeconomic model assessed the return on investment of recombinant zoster vaccine (RZV) in Finland for adults ≥ 50 years versus no vaccination. A validated economic model determined HZ cases and complications avoided, health gains (quality-adjusted life-years, QALYs), and healthcare cost-savings. Actuarial techniques projected population trends incorporating employment factors. Lost productivity averted through vaccination provided fiscal revenue for the government, and increased gross domestic product (GDP) for society. QALY gains were monetised using 1-3xGDP per QALY. RZV was administered for 20 years, with lifetime impact assessment. RZV vaccination of around 790,000 50year-olds was estimated to save 3,779 QALYs and €52 million (M) in healthcare costs. Averted productivity losses generated €152 M in fiscal revenue and €367 M in GDP, while vaccination costs were €236 M. From the fiscal perspective, 90% of vaccination costs were offset by fiscal and healthcare cost savings (without considering QALY gains). From the societal perspective, for every €1 invested in vaccination, €2.60-4.10 was saved (depending on QALY value). The benefit-cost ratio (BCR) remained positive across sensitivity analyses. The highest BCRs were achieved when vaccinating adults aged 50 years; or 65 years when excluding productivity benefits. RZV vaccination in working-age adults yielded economic benefits in Finland, generating €2.60-4.10 for society per €1 invested in vaccination, and with fiscal benefits offsetting 90% of vaccination costs. WHAT IS THE CONTEXT?: Shingles (herpes zoster, HZ) is a common illness in Finland, especially in older adults. It can cause long-term nerve pain (postherpetic neuralgia, PHN) and other complications. HZ also reduces work productivity, creating economic costs for individuals and society. This economic study assessed the return on investment of introducing vaccination for adults aged 50 years and older with the recombinant zoster vaccine (RZV) versus no HZ vaccination (current situation). WHAT WAS DONE?: An economic model estimated the benefits of vaccination over 20 years, considering avoided HZ and PHN cases, healthcare cost-savings, and economic gains from reduced productivity loss, such as tax revenue and increased economic output (gross domestic product, GDP). The study also calculated the return on investment by comparing vaccination costs to financial benefits. The financial value of health benefits (quality-adjusted life-years, QALYs) gained through vaccination were also considered. WHAT WAS LEARNED?: Over the analysis timeframe, around 790,000 adults aged 50 years were vaccinated, saving 3,779 QALYs and €52 million in healthcare costs. Reduced productivity loss generated €367 million in GDP gains, including €152 million in tax revenue. The benefit-cost ratio showed that every €1 spent on vaccination returned €2.60–4.10 to society. The highest returns were seen when vaccinating at age 50, or at age 65 when productivity gains were excluded. CONCLUSION: RZV vaccination in working-age adults is a positive investment for Finland, benefiting both public health and the economy.

Invasive meningococcal disease (IMD) is a severe infectious disease that can cause mortality and debilitating sequelae. IMD is typically vaccine-preventable. In the Netherlands, meningococcal serogroup B (MenB) causes almost all IMD cases. The objective of this study was to assess the cost-effectiveness of routine infant MenB vaccination in the Netherlands, using the latest incidence data, real-world evidence and vaccine data. We used the dynamic transmission cost-effectiveness (DyCE) model to compare routine infant vaccination with three doses of the four-component meningococcal B vaccine (4CMenB) versus no MenB vaccination, from a societal perspective. The model followed 100 cohorts over lifetime, was updated with the most recent Dutch epidemiological evidence, and was adapted in accordance with the latest Dutch health economic guidelines. Additionally, IMD incidence was varied in scenario analyses to model the unpredictable incidence of MenB IMD and potential outbreaks of this disease. Over lifetime, 2367 MenB IMD cases, 1077 long-term sequelae cases and 116 deaths were prevented with 4CMenB vaccination in the base case. 4CMenB vaccination saved 14,703 quality-adjusted life years (QALYs), predominantly by preventing long-term sequelae (45.5%) and deaths (52.2%). The incremental cost-effectiveness ratio (ICER) was €99,752 per QALY gained in the base case and decreased below the willingness-to-pay threshold of 80,000 if the IMD incidence increased by 24%, or if the vaccine acquisition costs decreased by 22% (from €78.5 to €61.45). The ICER was most sensitive to variations in vaccine effectiveness, the incidence of MenB IMD and vaccine acquisition costs. In the Netherlands, 4CMenB vaccination is likely to be cost-effective if MenB incidence increases by 24%. This comprehensive analysis provides decision-makers with new and updated information on the cost-effectiveness of infant vaccination with 4CMenB in the Netherlands. In the Netherlands, Neisseria meningitidis serogroup B (MenB) is the leading cause of invasive meningococcal disease, with an incidence that is cyclic but difficult to predict. Although vaccines are available to prevent infection with MenB, they are not currently included in the Dutch National Immunisation Programme. A previous analysis from 2013 showed that vaccination against MenB in the Netherlands was not cost-effective. However, since then, new data on the MenB vaccine and the disease burden of invasive meningococcal disease have become available. The current study provides an updated analysis of the cost-effectiveness of infant vaccination against MenB in the Netherlands, using the dynamic transmission-based cost-effectiveness model. Over a lifelong runtime of 100 cohorts, the model predicts that vaccination of infants with 4CMenB would prevent 2367 invasive meningococcal disease cases, 1077 long-term sequelae cases and 116 deaths. In the Netherlands, infant vaccination with 4CMenB is likely to become cost-effective if the number of MenB cases increases by 24% or if the vaccine acquisition costs decreases by 22%.

Indonesia has one of the highest number of tuberculosis (TB) cases globally. The previous treatment policy of the Ministry of Health was to administer TB drugs intermittently (three times per week) during the continuation phase. Since 2023, the treatment policy has changed to daily dosing during the continuation phase. However, evidence comparing the treatment outcomes and tolerability of these agents remains limited. This study compared patient characteristics, treatment success, and reported adverse events between intermittent and daily regimens among drug-susceptible TB patients. An observational cohort study was conducted using secondary data from medical records and the National TB Information System, with prospective ascertainment of adverse events via standardized telephone and face-to-face interviews among a subset of participants. Group comparisons were performed using chi-square tests, t-tests, and multivariable logistic regression (adjusted for age, HIV status, diabetes status, and baseline sputum). A total of 532 drug-susceptible TB patients were included (intermittent n&#x2009;=&#x2009;247; daily n&#x2009;=&#x2009;285). The daily group had a higher mean age and a greater proportion of HIV-positive and diabetic patients (p&#x2009;<&#x2009;0.05). Treatment success rates were comparable between the two groups (87.85% vs. 87.37%; p&#x2009;=&#x2009;0.850), with no significant association observed in the adjusted analyses (aOR&#x2009;=&#x2009;1.23 [0.69-2.18]; p&#x2009;=&#x2009;0.494). Among 327 patients with adverse event data available (61.47%), reported adverse events were more frequent in the daily group (100.00% vs. 84.38%; p&#x2009;<&#x2009;0.001), particularly nausea/vomiting/fatigue/fever (aOR&#x2009;=&#x2009;3.03; 95% CI: 1.69-5.55) and itching (aOR&#x2009;=&#x2009;2.07; 95% CI: 1.27-3.41); however, these findings were based on a subset of participants and may be subject to recall and reporting bias. Intermittent and daily continuation-phase regimens showed comparable treatment success in this observational study. Among participants with available adverse event data, daily dosing was associated with more frequently reported adverse events; however, causal inference could not be made due to non-random regimen allocation, baseline differences between groups, incomplete ascertainment of adverse events, and potential recall and reporting bias. These findings suggest the potential importance of routine tolerability monitoring and targeted patient support in programmatic TB care, though confirmation from multicenter prospective studies is needed given the single-center design and incomplete adverse event ascertainment. Clinical trial number: not applicable.

The coronavirus disease 2019 (COVID-19) pandemic created substantial social, economic, and psychological challenges worldwide. This study examines changes in subjective well-being and happiness patterns during the COVID-19 period compared with the pre-pandemic period in T&#xfc;rkiye as an emerging country context. We analyze nationally representative Life Satisfaction Survey data from the Turkish Statistical Institute (TurkStat) for the 2019-2021 period, covering approximately 10 thousand individuals aged 18 and above each year. Multinomial logistic regression models are employed for each year, preserving the original five-category happiness variable ranging from "very happy" to "very unhappy". First, during the COVID-19 period, the percentage of individuals who defined themselves as happy or very happy decreased from approximately 54% in 2019 to 48.7% in 2020, before slightly recovering to 50.1% in 2021. Second, "health" remained the most frequently reported source of happiness among categories such as success, job, love, and money both before and during the pandemic period. The findings indicate that the main determinants of happiness remained broadly stable during the pandemic-period years, although the magnitude of several associations changed. Women reported higher happiness levels than men, whereas employed women exhibited relatively lower happiness levels. Having a job alone did not consistently affect happiness; however, employed individuals with at least a high school education tended to report higher happiness levels before the pandemic period. Furthermore, higher income, being married, health satisfaction, income satisfaction, and social life satisfaction were positively associated with happiness. A U-shaped relationship between happiness and age groups was also observed. Although higher-income individuals consistently reported greater happiness levels, the strength of this association weakened during the pandemic-period years. Finally, hopefulness about the future demonstrated the strongest and most consistent association with happiness. Hopeful individuals exhibited substantially greater odds of belonging to the "very happy" category, with odds ratios of approximately 18.0 in 2019, 15.1 in 2020, and 17.9 in 2021. The findings suggest that although happiness levels declined during the COVID-19 period in T&#xfc;rkiye, the main determinants of happiness remained largely stable. Socioeconomic conditions, health satisfaction, and future expectations were important factors associated with happiness, while hopefulness about the future emerged as the strongest and most consistent predictor across all years.

Land use and land cover change (LUCC) exerts substantial influence on ecosystem service values (ESV). But conventional ESV valuation approaches frequently neglect temporal shifts in crop economic returns. Integrating high-resolution land use data (2000-2020) with the Patch-generating Land Use Simulation (PLUS) model-and augmenting it with spatial econometric analysis-we project 2030 land use configurations under four policy-relevant scenarios: Business-as-Usual (BAU), Economic Development Priority (EDP), Ecological Protection Priority (EPP), and Ecological Economic Balance (EEB). Under EDP, construction land expands by 5.52%, critically low-ESV areas increase by 476.83 km2 (a 2.7-fold surge relative to the 2010-2020 period), and net ESV declines by 1.04%. By contrast, EPP achieves a 10.19% reduction in urban land through targeted ecological restoration, effectively arresting ESV degradation. High-value ESV zones are concentrated in water bodies and forests, which dominate regional regulating services. The three-province in the Middle Reaches of the Yangtze River epitomizes the inherent tension between rapid urbanization and ESV conservation. These findings provide a basis for assessing the social, economic and environmental factors. Furthermore, the results provide a new solution approach for formulating differentiated ecological environment protection policies in the study area and addressing key technical challenges in land use planning for large-scale ecological functional area.

Despite socio-economic progress, prevalence of childhood stunting remains high in South Asia-a phenomenon often referred to as the "Asian Enigma." This paradox stems from suppressed women's empowerment, poor water, sanitation, and hygiene (WaSH) conditions and inadequate child-feeding. Evidence shows that women's empowerment improves these underlying factors associated with improved stunting. We examined how domains of women's empowerment relate to the risk of childhood stunting in South Asia directly and indirectly in interaction with household improved WaSH&#xa0;facility and age-appropriate food consumption. Using recent Demographic and Health Survey data from Bangladesh, India, Nepal, and Pakistan, we analyzed a sample of 37,620 married women, aged 15-49 years, currently cohabiting with husbands and having an under-five child. We constructed three domains of survey-based women's empowerment index-global: social independence, intrinsic agency, and instrumental agency, by confirmatory factor analysis, using generalized structural equation modelling. We developed three different models by using generalized linear mixed-effects models with robust error variance to estimate the relative risk (RR) of stunting with 95% confidence interval (CI). We found social independence [RR: 0.86, 95% CI: 0.83,&#x2009;0.90], intrinsic agency [0.98&#x2009;(0.97,&#x2009;0.99)] and instrumental agency [0.99&#x2009;(0.98,&#x2009;0.99)] were associated with reduced risk of stunting in South Asia. Though interaction between social independence and WaSH was associated with reduced risk [0.92&#x2009;(0.86,&#x2009;0.99)], interaction between social independence [1.12&#x2009;(1.07,&#x2009;1.17)] and instrumental agency [1.03&#x2009;(1.01,&#x2009;1.05)] and food consumption increased risk of stunting in South Asia. Interactions between women's empowerment and WaSH and food consumption reveal complex effects including both synergy and trade-offs, highlighting the need for integrated strategies combining women's empowerment, WaSH improvements, and targeted nutrition specific interventions in South Asia.

Institutional legitimacy-the belief that authorities are just and deserving of compliance-depends on the interplay of participation, pluralism, transparency, and trust. This study applies the Voice-Choice-Transparency-Trust (VCTT) framework to construct a composite institutional quality index (INST) and to examine how elite behaviour, market structure, inequality, and development jointly shape legitimacy across countries. Using an unbalanced panel of 22 countries from 2020 to 2024 (T = 5), the study combines hierarchical multiple imputation with panel econometrics. Institutional quality (INST) was derived from equally weighted, standardised VCTT pillars. Core regressors include the Elite Quality Index (EQx), market power (mark-up), the Gini coefficient, and GDP per capita. Two complementary estimators were applied: a pooled panel specification and a Mundlak correlated random-effects model with within-between decomposition, both corrected for heteroskedasticity and cross-sectional dependence using Driscoll-Kraay robust standard errors. Higher Elite index values are positively associated with institutional quality, whereas greater market concentration is negatively associated with it. The Mundlak model confirms a positive within-country effect of elite quality and a negative within-country effect of rising inequality, while between-country averages suggest that nations with productive elites and moderate inequality sustain stronger institutions. Across the sample, institutional legitimacy strengthens where elites are value-creating and markets remain competitive. Concentrated market power erodes institutional quality, and inequality's influence is context-dependent-detrimental when it widens domestically but more neutral when moderate and embedded in stable development trajectories. Because the panel covers only five annual waves, the findings are interpreted as robust associations rather than definitive long-run causal estimates.

Adults with cardiovascular-kidney-metabolic (CKM) syndrome, characterized by interactions among metabolic, chronic kidney disease (CKD) and cardiovascular disease, face a high symptomatic burden, mortality risk and costs. Dapagliflozin has demonstrated significant benefits in adults with type 2 diabetes (T2D), heart failure (HF) and CKD. This modelling study aimed to estimate the clinical events and associated healthcare costs of dapagliflozin in adults with CKM syndrome from the Spanish National Health System (NHS) perspective over 3&#x2009;years. A cost-offset model compared clinical events and their associated costs of 100,000 adults with CKM syndrome treated with dapagliflozin added to standard of care (SoC) and SoC alone. Clinical event rates were derived from dapagliflozin trials (DECLARE-TIMI 58, DAPA-HF, DAPA-CKD and DELIVER), and costs from national databases and literature. Robustness was assessed through scenario and subgroup analyses. The carbon dioxide (CO2) footprint impact associated with hospitalization for heart failure (HF), urgent HF visits and end-stage renal disease was assessed in an exploratory analysis. Over 3&#x2009;years, dapagliflozin added to SoC prevented 10,151 clinical events (2,822 cardiovascular; 5,519 renal; 1,810 deaths) and saved &#x20ac;159.11 million per 100,000 adults compared to SoC, mainly by preventing end-stage renal disease (69%; -&#x20ac;110.32 million). Considering drug acquisition cost, the net cost saving was &#x20ac;52.47 million per 100,000 adults, representing a &#x20ac;1.49 return for every euro invested in dapagliflozin. Scenario analyses were consistent with the base case. Subgroup analyses showed greater benefits in adults with multiple comorbidities, especially those with all three conditions. The CO2 footprint reduction was 2,176 tons of CO2 per 100,000 adults. Dapagliflozin in adults with CKM syndrome reduced the incidence of clinical events, generating cost savings and improving the sustainability of the Spanish NHS.

Extreme heat and disease transmission triggered by global warming pose severe threats to human health, creating an urgent need to promote low-carbon development. It is widely recognized that mixed land-use strategies play a critical role in reducing carbon emissions and mitigating global warming. In contrast to existing literature that solely focuses on either land structure mix or land function mix, this research integrates both into a unified analytical framework for comparative analysis. This approach aims to clarify the key directions that mixed land-use strategies should prioritize. By employing the information entropy method, this study utilizes remote sensing imagery and Point of Interest (POI) data to characterize structural and functional mixed land use across 268 prefecture-level cities in China, and further analyzes their impacts on carbon emission intensity. The experimental results show that land structure mix significantly reduces the carbon emission intensity; in contrast, the land function mix increases the carbon emission intensity. The mechanism analysis shows that the former generates positive externalities by promoting economic agglomeration, offsetting the negative effects of traffic congestion, whereas the latter intensifies the urban traffic pressure and does not show significant agglomeration effects. The spatial econometrics results further show that a significant spatial spillover effect of functional mixing, which further amplifies the carbon emission pressure in the city. The article further proposes policy recommendations.

Agricultural productivity and health expenditures are closely interconnected, influencing both economic development and social welfare. Despite growing interest in the health-agriculture nexus, empirical evidence on their bidirectional relationship across Organisation for Economic Co-operation and Development (OECD) countries remains limited. This study investigates the relationship between health expenditures and agricultural productivity using an dataset covering 38 OECD countries from 2010 to 2021. In the first stage, agricultural productivity was measured using a Super-Efficiency Data Envelopment Analysis (DEA) model, allowing for the ranking of efficient countries beyond the conventional efficiency frontier. In the second stage, panel data models were employed to examine the effects of health expenditure indicators on agricultural productivity and the reverse effects of agricultural productivity on health expenditures. The findings indicate substantial heterogeneity in agricultural productivity across OECD countries. Panel estimations reveal that public health expenditures have a positive and statistically significant effect on agricultural productivity, whereas private and out-of-pocket health expenditures exhibit limited or insignificant effects. Furthermore, higher agricultural productivity is associated with increases in per capita and public health expenditures, suggesting a reciprocal relationship between agricultural performance and health investment. The results highlight the importance of health financing in strengthening labor productivity and supporting sustainable agricultural development. Health expenditures contribute not only to improved population health but also to enhanced agricultural efficiency and economic performance. Policies aimed at expanding public healthcare investments, particularly in rural areas, may generate productivity gains in agriculture while promoting broader sustainable development objectives. By integrating Super-Efficiency DEA with panel econometric techniques, this study provides novel empirical evidence on the health-agriculture nexus in OECD countries and offers relevant policy implications for both health and agricultural sectors.

The global demographic transition indicates a rapid shift toward an aging population structure. Good mental health in advanced ages is critical for a healthy aging. Problems such as depression reduce life expectancy and impose a societal burden. This study aims to examine, through a multidimensional approach, the sociodemographic, economic, health-related, functional, and psychosocial factors affecting depression levels among individuals aged 65 and over in T&#xfc;rkiye. In this study, microdata from the T&#xfc;rkiye Older Adult Profile Survey conducted by Turkish Statistical Institute (TurkStat) in 2023 was utilized. The analysis included a total of 10,348 individuals aged 65 and over who personally responded to perception-related questions. The dependent variable, depression level, was categorized as "not depressed," "mild," and "severe" according to Geriatric Depression Scale scores. In the analysis of the data, a generalized ordered logit model and marginal effects were employed due to the violation of the parallel lines assumption. Depression was common among older adults, with 46.71% exhibiting mild depressive symptoms. Specifically, 34.26% were mildly depressed and 12.45% were severely depressed, while 53.29% were classified as non-depressed. According to the analysis results, female gender, living alone, low-income level, and experiencing financial hardship significantly increase the risk of depression. In terms of health status, poor self-rated general health, sensory impairments (vision/hearing difficulties), history of falls, and the need for home care are the main factors increasing the likelihood of depression. An increase in functional independence (KATZ index) and maintaining a physically active lifestyle exhibit protective effects. Additionally, strong neighbor support, a higher number of support people, and a sense of autonomy in decision-making processes significantly reduce the level of depression. Geriatric depression in T&#xfc;rkiye is a multidimensional phenomenon with complex socioeconomic and environmental determinants, in addition to biological factors. In particular, older women, individuals living alone, and economically disadvantaged groups are at high risk. The findings indicate that, to support healthy aging, clinical interventions alone are insufficient; strengthening social support networks, enhancing urban accessibility, and urgently developing inclusive public health policies that promote older adults'autonomy are required.

Digital-intelligent transformation (DIT) has become an important driver of sustainable urban development, yet its impact on urban eco-efficiency (EE) remains insufficiently understood. Using panel data for 281 prefecture-level cities in China from 2010 to 2023, this study examines the effect of DIT on urban EE, incorporating mechanism analysis, heterogeneity, and spatial effects. DIT is measured using the entropy-weight method, and urban EE is calculated based on the super-efficiency slack-based measure (Super-SBM) model. A two-way fixed effects framework, combined with mediation, moderation, and spatial econometric models, is employed for empirical analysis. The results show that DIT significantly improves urban EE, and this finding remains robust after multiple robustness checks and endogeneity treatments. The effect operates mainly through innovation-driven development and industrial structure upgrading, while human capital and fiscal transparency further strengthen this relationship. Significant heterogeneity is observed across regions, industrial structures, and environmental regulation levels, with stronger effects in northeastern and western regions, in cities with lower industrial dependence, and in areas with weaker environmental regulation. In addition, DIT generates positive spatial spillover effects, while also being associated with a potential widening of regional disparities. This study integrates DIT and urban EE into a unified analytical framework, providing new empirical evidence on their mechanisms and spatial dynamics, and offering useful implications for policy design.

The World Health Organization recommends high-risk human papillomavirus (hrHPV) testing as the primary method for cervical cancer screening. Combining samples in a pool can reduce the expense associated with large numbers of commercially available tests. This study simulated the potential test-saving impact of pooled hrHPV testing using real-world data from two low- and middle-income countries (LMICs). We simulated a two- and three-stage hrHPV pooling in Bangladesh (hrHPV prevalence 2.10%) and Uganda (hrHPV prevalence 22.52%) using real-world laboratory data. Measurements included the number of tests per stage, the total number of tests, and the percentage of tests saved. We performed sensitivity analysis to assess the impact of a 1.00% loss of sensitivity and specificity per additional sample in the pool on the false-negative rate (FNR). In Bangladesh, the two-stage strategy (eight samples per pool) and the three-stage strategy saved 71.21% and 77.21% of tests, respectively, compared to testing individually. In Uganda, the two-stage strategy (three samples per pool) reduced the number of tests by 15.34% compared to testing individually. Assuming loss of sensitivity and specificity due to pooling, the FNR was higher (FNR&#x2009;=&#x2009;0.012-0.134) when hrHPV prevalence was low under the two-stage strategy. Pooled hrHPV testing has the potential to reduce the number of tests used and enhance screening capacity in resource-limited settings. Notably, a lower prevalence of hrHPV allows for more efficient pooled testing. Despite the potential loss of sensitivity and specificity, pooled hrHPV testing could offer benefits for LMICs and warrant further verification.

Excessive sugar consumption is associated with substantial health and economic burdens. Public policies aimed at reducing sugar intake, such as education campaigns and product labelling, have shown limited effectiveness, prompting growing interest in fiscal measures such as sugar taxes. While taxes on sugar-sweetened beverages have demonstrated reductions in consumption, evidence remains limited regarding their extension to other high-sugar products. This study assesses the potential impacts of sugar taxation policies in France, the United Kingdom, and Spain on three key product categories that contribute substantially to sugar intake: non-alcoholic beverages, biscuits, and dairy desserts. Using nationally representative scanner data and a structural econometric model, we estimate demand, model firm pricing behavior under oligopolistic competition, and simulate the effects of a two-tiered sugar-based tax. Results indicate that firms generally over-shift the tax to prices, leading to significant reductions in purchases and sugar intake, with the largest impacts observed in non-alcoholic beverages and French dairy desserts. The tax is particularly effective among households with overweight or obese adults. Although consumer surplus and firm profits decline, these losses are outweighed by fiscal revenues and reductions in the social costs of excessive sugar intake. Overall, our findings suggest that extending sugar taxes to other food and drink products can reduce sugar consumption and generate positive welfare effects. We then provide valuable evidence for policymakers considering broader fiscal measures to address diet-related health challenges.

Data on long-term outcomes of surgical management of rectal endometriosis are scarce and generally provided by cohort studies where choice of surgical technique is based on various uncontrolled factors with significant lost-to-follow up patient rates. Based on the cohort of women enrolled in the ENDORE randomized trial, closely followed up over 10 years, we aimed to assess the long-term outcomes of surgical management of rectal endometriosis by nodule excision or segmental resection. Ten-year follow-up of a randomized controlled trial cohort enrolled in one center from May 2011 to October 2013 at Rouen University Hospital. 55 patients were managed for deep endometriosis infiltrating the rectum up to 15 cm from the anus, with more than a 20 mm-diameter area over the muscular layer and maximum 50% of rectal circumference. Patients randomly received either nodule excision (shaving or disc excision) or segmental colorectal resection. The primary endpoint of both the randomized trial and the present study was the number of patients experiencing at least one of the following symptoms: constipation (1 stool/>5 consecutive days), defecation pain, frequent bowel movements (>= 3 stools/day), anal incontinence, bladder dysfunction (at least one of the last three questions of the Urinary Symptom Profile score >=1). Secondary endpoints were values taken from the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS), Gastrointestinal Quality of Life Index (GIQLI), Wexner scale, Urinary Symptom Profile (USP), pregnancy rate, recurrences and reoperation rates. Fifty-five patients were enrolled, and 5 patients stopped follow-up prior to 10 years (9.1%). The primary endpoint was present in respectively 74.1% vs. 71.4% of patients (OR 0.88, 95% CI 0.27-2.9, P=0.83), while 59.1% vs. 58.3% of patients subjectively reported normal bowel movements (OR 0.97, 95%CI 0.30-3.1, P=0.96). An intention-to-treat comparison of overall KESS, GIQLI, Wexner, USP and SF36 scores did not reveal significant differences between the two arms 10 years postoperatively. Longitudinal Generalized Estimating Equations analysis revealed no differences between functional outcome trajectories over time for conservative and radical rectal surgery. The 10-year recurrence rates of rectal endometriosis in the excision vs. the segmental resection arms were 7.4 % vs. 3.6% (OR 0.46, 95%CI 0.04-5.4, P=0.54). Among patients with pregnancy intention after surgery, the pregnancy rate was 85.3%, with most conceiving naturally (64.4%). 45 children were born to 27 women. Second surgeries related to endometriosis were recorded in 32.7% of cases, with no difference between groups. Ten-year follow-up data show no statistically significant differences between conservative and radical rectal surgery for long-term functional digestive outcomes, rectal recurrence rate and risk of reoperation in this population of women with large involvement of the rectum. Most patients considered their bowel movements normal. Our study suggests that in patients undergoing surgical management of severe deep endometriosis of the rectum, the surgery-related benefits persist over 10 years postoperatively, with a low risk of rectal recurrence.