Pub Date : 2026-05-01Epub Date: 2026-02-03DOI: 10.1016/j.glt.2026.02.001
Xiaoyue Shi , Wei Cao , Chenran Wang , Yadi Zheng , Jiaxin Xie , Zilin Luo , Xiaolu Chen , Zeming Guo , Fei Wang , Xuesi Dong , Ni Li
Objectives
The burden of urological cancers attributable to modifiable risk factors varies across sociodemographic contexts, yet a comprehensive assessment of the impact of development levels remains lacking.
Methods
Using data from the Global Burden of Disease 2021 study, we assessed associations between the Sociodemographic Index (SDI) and age-standardized mortality rates (ASMRs) of urological cancers attributable to modifiable risk factors across 204 countries in 2021. Trends in ASMRs and disability-adjusted life year (DALY) rates from 1990 to 2021 were analyzed using estimated annual percentage change (EAPC). Mortality changes were decomposed into four components. Inequalities were quantified using the slope index of inequality (SII) and concentration index (CI).
Results
SDI was positively correlated with ASMRs for all five attributable burdens. Countries with higher SDI exhibited the highest ASMR and DALY rates. Notably, in low-middle SDI countries, bladder cancer due to high FPG and kidney cancer due to high BMI showed the steepest increases. These countries also experienced slower declines or even upward trends in smoking-attributable mortality. Decomposition revealed varying contributions of risk-deleted rates and aging. Most SDI-related inequalities widened or remained stable.
Conclusion
Sociodemographic development critically shapes the burden of urological cancers attributable to modifiable risks, highlighting the need for development-tailored preventive strategies.
{"title":"Impact of sociodemographic development on the global burden of urological cancers attributable to modifiable risk factors, 1990–2021: A population-based study","authors":"Xiaoyue Shi , Wei Cao , Chenran Wang , Yadi Zheng , Jiaxin Xie , Zilin Luo , Xiaolu Chen , Zeming Guo , Fei Wang , Xuesi Dong , Ni Li","doi":"10.1016/j.glt.2026.02.001","DOIUrl":"10.1016/j.glt.2026.02.001","url":null,"abstract":"<div><h3>Objectives</h3><div>The burden of urological cancers attributable to modifiable risk factors varies across sociodemographic contexts, yet a comprehensive assessment of the impact of development levels remains lacking.</div></div><div><h3>Methods</h3><div>Using data from the Global Burden of Disease 2021 study, we assessed associations between the Sociodemographic Index (SDI) and age-standardized mortality rates (ASMRs) of urological cancers attributable to modifiable risk factors across 204 countries in 2021. Trends in ASMRs and disability-adjusted life year (DALY) rates from 1990 to 2021 were analyzed using estimated annual percentage change (EAPC). Mortality changes were decomposed into four components. Inequalities were quantified using the slope index of inequality (SII) and concentration index (CI).</div></div><div><h3>Results</h3><div>SDI was positively correlated with ASMRs for all five attributable burdens. Countries with higher SDI exhibited the highest ASMR and DALY rates. Notably, in low-middle SDI countries, bladder cancer due to high FPG and kidney cancer due to high BMI showed the steepest increases. These countries also experienced slower declines or even upward trends in smoking-attributable mortality. Decomposition revealed varying contributions of risk-deleted rates and aging. Most SDI-related inequalities widened or remained stable.</div></div><div><h3>Conclusion</h3><div>Sociodemographic development critically shapes the burden of urological cancers attributable to modifiable risks, highlighting the need for development-tailored preventive strategies.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 231-238"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-27DOI: 10.1016/j.glt.2026.01.004
Tianran Wang , Jinyu He , Yiran Wang , Wenwen Liu , Xueyao Zhang , Ning Zhang , Wannian Liang
<div><h3>Background</h3><div>Residents' health behaviors are crucial factors in the prevention of diseases. A city's digitalization degree refers to the extent to which digital infrastructure and products can empower local industries and residents. Existing studies about the influence of digital technologies and products on health behaviors are mainly individual-level studies. Extant city-level studies primarily investigate the influence of cities' digitalization degrees on economic and environmental factors. There is a lack of city-level study examining the impact of cities' digitalization degrees on residents' health behaviors.</div></div><div><h3>Method</h3><div>This study constructs a panel dataset comprising the data of 289 prefecture-level or above cities in China in the period from 2020 to 2023. Regression models are employed to examine the relationship between cities' digitalization degrees and residents’ health behaviors. Based on geographic locations, cities are sorted as “eastern or middle cities” and “western cities”. According to the concentration level of economic and social resources, cities are sorted into “central cities” and “non-central cities”. Based on these two categorizations, the heterogeneity of the main effect is also investigated. Furthermore, the average slopes and the dummy variable indicating whether a city is selected by the “Broadband China Strategy” are utilized as instrumental variables to address the endogeneity caused by omitted variables.</div></div><div><h3>Results</h3><div>In the basic regression model, cities' digitalization degrees show significantly positive relationship with residents' health behaviors (β<sub>1</sub> = 0.178, 95 % CI [0.042, 0.315], p = 0.011; β<sub>2</sub> = 0.841, 95 % CI [0.458, 1.225], p < 0.001). The result is robust in the regression models using instrumental variables. Heterogeneity analysis indicates that for “eastern and middle cities”, there is a significantly positive relationship between cities' digitalization degrees and residents' health behaviors (β<sub>1</sub> = 0.251, 95 % CI [0.105, 0.396], p = 0.001; β<sub>2</sub> = 0.986, 95 % CI [0.512, 1.459], p < 0.001), while this relationship is not significant for “western cities” (β<sub>1</sub> = 0.032, 95 % CI [-0.176, 0.242], p = 0.759; β<sub>2</sub> = 0.500, 95 % CI [-0.138, 1.139], p = 0.123). For “non-central cities”, there is a significantly positive relationship between cities' digitalization degrees and residents’ health behaviors (β<sub>1</sub> = 0.285, 95 % CI [0.107, 0.463], p = 0.002; β<sub>2</sub> = 1.097, 95 % CI [0.670, 1.524], p < 0.001), while this relationship is not significant for “central cities” (β<sub>1</sub> = 0.014, 95 % CI [-0.184, 0.213], p = 0.885; β<sub>2</sub> = 0.146, 95 % CI [-0.593, 0.886], p = 0.690).</div></div><div><h3>Interpretation</h3><div>Digitalization of cities can promote residents' health behaviors for three potential reasons. First, cities' digitalization degrees improve loc
总统的健康行为是预防疾病的关键因素。一个城市的数字化程度是指数字化基础设施和产品对当地产业和居民的赋能程度。现有关于数字技术和产品对健康行为影响的研究主要是个体层面的研究。现有的城市层面研究主要考察城市数字化程度对经济和环境因素的影响。城市数字化程度对居民健康行为影响的城市层面研究缺乏。方法构建了中国289个地级以上城市2020 - 2023年的面板数据集。采用回归模型检验城市数字化程度与居民健康行为之间的关系。根据地理位置，城市分为“东部或中部城市”和“西部城市”。根据经济和社会资源的集中程度，将城市分为“中心城市”和“非中心城市”。在此基础上，研究了主效应的异质性。此外，利用平均斜率和表示城市是否被“宽带中国战略”选中的虚拟变量作为工具变量来解决遗漏变量引起的内质性问题。结果在基本回归模型中，城市数字化程度与居民健康行为呈显著正相关（β1 = 0.178, 95% CI [0.042, 0.315], p = 0.011; β2 = 0.841, 95% CI [0.458, 1.225], p < 0.001）。在使用工具变量的回归模型中，结果是稳健的。异质性分析表明，“东中部城市”城市数字化程度与居民健康行为呈显著正相关（β1 = 0.251, 95% CI [0.105, 0.396], p = 0.001; β2 = 0.986, 95% CI [0.512, 1.459], p < 0.001），“西部城市”城市数字化程度与居民健康行为呈显著正相关（β1 = 0.032, 95% CI [-0.176, 0.242], p = 0.759; β2 = 0.500, 95% CI [-0.138, 1.139], p = 0.123）。对于“非中心城市”，城市数字化程度与居民健康行为呈显著正相关（β1 = 0.285, 95% CI [0.107, 0.463], p = 0.002; β2 = 1.097, 95% CI [0.670, 1.524], p < 0.001），而对于“中心城市”，这种关系不显著（β1 = 0.014, 95% CI [-0.184, 0.213], p = 0.885; β2 = 0.146, 95% CI [-0.593, 0.886], p = 0.690）。城市数字化可以促进居民的健康行为，原因可能有三。首先，城市数字化程度提高了当地居民对卫生资源的可及性。第二，城市数字化程度增强了当地居民健康行为能力。第三，城市数字化程度提高了当地居民对卫生资源的购买力。
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Pub Date : 2026-05-01Epub Date: 2025-12-19DOI: 10.1016/j.glt.2025.12.002
Bridget Pratt , David G. Kirchhoffer
Healthcare systems have an ethical duty to ensure equal access to high-quality healthcare as a matter of social justice. In their pursuit of that duty, they generate substantial environmental harms. For that reason, healthcare systems also have an ethical duty to minimise their environmental impacts as a matter of environmental justice and ecological justice. Many countries are already transitioning to less environmentally harmful healthcare. This study investigates whether the two duties come into tension when designing new green hospitals and how such tensions (if found to eventuate) are navigated in practice. We conducted case study research in collaboration with an Australian hospital network, with one of the network's new public hospital builds comprising our case of focus. We undertook semi-structured interviews between March and June 2023 with those responsible for making design decisions in relation to the new public hospital being built. We analysed interview data thematically and report three main themes: separating the clinical and the environmental; tensions; and addressing tensions. We conclude by providing analysis of what is at stake in identified tensions using theories of justice, offering lessons that can help other hospitals mitigate against such tensions arising, and considering whether and when the moral reasoning employed in the case-under-study should be used to navigate the tensions. This study provides those responsible for green hospital design with a better understanding of what tensions they are likely to encounter between health, social, and environmental goods and how to reduce those tensions' occurrence. That understanding will help them to identify and avoid such tensions in their practice, but further work is needed to develop ethical guidance on how they should navigate the tensions when they occur.
{"title":"When ethical duties to ensure patient health and to minimise environmental impacts conflict in hospital design: Lessons from an Australian case study","authors":"Bridget Pratt , David G. Kirchhoffer","doi":"10.1016/j.glt.2025.12.002","DOIUrl":"10.1016/j.glt.2025.12.002","url":null,"abstract":"<div><div>Healthcare systems have an ethical duty to ensure equal access to high-quality healthcare as a matter of social justice. In their pursuit of that duty, they generate substantial environmental harms. For that reason, healthcare systems <em>also</em> have an ethical duty to minimise their environmental impacts as a matter of environmental justice and ecological justice. Many countries are already transitioning to less environmentally harmful healthcare. This study investigates whether the two duties come into tension when designing new green hospitals and how such tensions (if found to eventuate) are navigated in practice. We conducted case study research in collaboration with an Australian hospital network, with one of the network's new public hospital builds comprising our case of focus. We undertook semi-structured interviews between March and June 2023 with those responsible for making design decisions in relation to the new public hospital being built. We analysed interview data thematically and report three main themes: separating the clinical and the environmental; tensions; and addressing tensions. We conclude by providing analysis of what is at stake in identified tensions using theories of justice, offering lessons that can help other hospitals mitigate against such tensions arising, and considering whether and when the moral reasoning employed in the case-under-study should be used to navigate the tensions. This study provides those responsible for green hospital design with a better understanding of what tensions they are likely to encounter between health, social, and environmental goods and how to reduce those tensions' occurrence. That understanding will help them to identify and avoid such tensions in their practice, but further work is needed to develop ethical guidance on how they should navigate the tensions when they occur.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 181-192"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-10-28DOI: 10.1016/j.glt.2025.10.004
Liyuan Tao , Jue Liu , Xiaoqin Lu , Yali Zhao , Yifan Zhang , Zuyi Zhu , Ting Li , Zhishou Zhang , Yipin Zhang , Wenxin Yan , Min Liu , Wannian Liang
Background
Domain-specific large language models (LLMs) may aid primary care, but reliability and safety are uncertain, and general-practice evaluations remain limited.
Methods
Observational, exam-based comparison (Feb–May 2025) using standardized items from the Chinese General Practitioner Licensing Examination. A general-practice LLM (AIGP) was evaluated against 389 physicians on the same items under deterministic decoding. Each item was run 50 technical replicates. Outcomes: accuracy; stability (coefficient of variation, ICC(2,k)); and expert-rated potential clinical harm for incorrect outputs.
Results
AIGP achieved 88.41 % ± 1.87 accuracy vs physicians 72.12 % ± 4.97 (mean difference 16.29, 95 % CI 15.56–17.01; P < .001). Stability favored AIGP (CV 2.12 vs 6.89; agreement across replicates ICC(2,k) = 0.993, 95 % CI 0.991–0.995). Although overall errors were fewer, AIGP's mistakes were systematic and carried higher average harm ratings, clustering in red-flag contexts (pregnancy, pediatrics, anticoagulation, acute chest pain).
Conclusions
In a controlled test setting, AIGP outperformed physicians and showed excellent stability. Findings are exploratory and context-limited (exam-based, text-only) and reveal systematic higher-harm failure modes. AIGP is a starting point for decision support, not a deployable clinical tool without prospective real-world validation and safety guardrails (human-in-the-loop review, contraindication/dose checks, uncertainty-aware refusal).
领域特定的大型语言模型（llm）可能有助于初级保健，但可靠性和安全性是不确定的，并且一般实践评估仍然有限。方法观察性、基于考试的比较（2025年2月- 5月），采用中国全科医师执业资格考试的标准化试题。在确定性解码下，对一名全科执业LLM （AIGP）与389名医生在相同项目上进行了评估。每个项目都进行了50次技术重复。结果:准确;稳定性（变异系数，ICC(2,k)）；专家评估了不正确输出的潜在临床危害。结果saigp与医师的准确率分别为88.41%±1.87与72.12%±4.97（平均差16.29,95% CI 15.56 ~ 17.01; P < 0.001）。稳定性倾向于AIGP （CV 2.12 vs 6.89；重复间一致性ICC(2,k) = 0.993, 95% CI 0.991-0.995）。尽管总体错误较少，但AIGP的错误是系统性的，并且具有较高的平均危害等级，集中在红旗环境（怀孕，儿科，抗凝血，急性胸痛）。结论在对照试验环境下，AIGP表现优于内科医生，且具有良好的稳定性。研究结果是探索性的，上下文有限的（基于测试，仅限文本），揭示了系统性的高危害失效模式。AIGP是一个决策支持的起点，而不是一个可部署的临床工具，没有前瞻性的现实验证和安全护栏（人在环审查，禁忌症/剂量检查，不确定性意识拒绝）。
{"title":"Performance of the large language model in general medicine","authors":"Liyuan Tao , Jue Liu , Xiaoqin Lu , Yali Zhao , Yifan Zhang , Zuyi Zhu , Ting Li , Zhishou Zhang , Yipin Zhang , Wenxin Yan , Min Liu , Wannian Liang","doi":"10.1016/j.glt.2025.10.004","DOIUrl":"10.1016/j.glt.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Domain-specific large language models (LLMs) may aid primary care, but reliability and safety are uncertain, and general-practice evaluations remain limited.</div></div><div><h3>Methods</h3><div>Observational, exam-based comparison (Feb–May 2025) using standardized items from the Chinese General Practitioner Licensing Examination. A general-practice LLM (AIGP) was evaluated against 389 physicians on the same items under deterministic decoding. Each item was run 50 technical replicates. Outcomes: accuracy; stability (coefficient of variation, ICC(2,k)); and expert-rated potential clinical harm for incorrect outputs.</div></div><div><h3>Results</h3><div>AIGP achieved 88.41 % ± 1.87 accuracy vs physicians 72.12 % ± 4.97 (mean difference 16.29, 95 % CI 15.56–17.01; P < .001). Stability favored AIGP (CV 2.12 vs 6.89; agreement across replicates ICC(2,k) = 0.993, 95 % CI 0.991–0.995). Although overall errors were fewer, AIGP's mistakes were systematic and carried higher average harm ratings, clustering in red-flag contexts (pregnancy, pediatrics, anticoagulation, acute chest pain).</div></div><div><h3>Conclusions</h3><div>In a controlled test setting, AIGP outperformed physicians and showed excellent stability. Findings are exploratory and context-limited (exam-based, text-only) and reveal systematic higher-harm failure modes. AIGP is a starting point for decision support, not a deployable clinical tool without prospective real-world validation and safety guardrails (human-in-the-loop review, contraindication/dose checks, uncertainty-aware refusal).</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 101-109"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2026-01-07DOI: 10.1016/j.glt.2026.01.001
Mohammad Ridwan , Md. Rajabul Hassan , Amit Debnath , Afsana Akther , Khurshid Khudoykulov , Md. Emran Hossain , Miguel Angel Esquivias
Rising ecological footprints in G-7 countries pose significant challenges to global sustainability, despite their economic and technological leadership. While prior research has examined individual drivers of environmental degradation in advanced economies, there remains a critical gap in understanding the integrated roles of artificial intelligence (AI), financial accessibility, and government effectiveness in mitigating ecological pressures, particularly through comprehensive panel data analysis in the G-7 context. This study addresses this gap by exploring how these factors influence environmental sustainability across G-7 nations, using the ecological footprint as a key indicator from 2010Q1 to 2022Q4. Employing the Panel Mean Group Autoregressive Distributed Lag model as the primary estimator, with Augmented Mean Group and Common Correlated Effects Mean Group estimators for robustness, the empirical results reveal that economic growth and urbanization significantly exacerbate ecological degradation in both the long and short run. Conversely, AI innovation, financial accessibility, and effective governance substantially reduce environmental impacts. These findings advance the discourse on Sustainable Development Goals (SDGs), especially SDG 9 (Industry, Innovation and Infrastructure), SDG 11 (Sustainable Cities and Communities), and SDG 13 (Climate Action). To foster a sustainable transition, policymakers should prioritize investments in AI-driven green technologies to optimize resource efficiency, expand inclusive financial mechanisms to fund eco-innovations and renewable projects, and implement governance reforms that enforce stringent environmental regulations in G-7 economies.
{"title":"Leveraging AI innovation for a sustainable environment in G-7: Finance and governance roles","authors":"Mohammad Ridwan , Md. Rajabul Hassan , Amit Debnath , Afsana Akther , Khurshid Khudoykulov , Md. Emran Hossain , Miguel Angel Esquivias","doi":"10.1016/j.glt.2026.01.001","DOIUrl":"10.1016/j.glt.2026.01.001","url":null,"abstract":"<div><div>Rising ecological footprints in G-7 countries pose significant challenges to global sustainability, despite their economic and technological leadership. While prior research has examined individual drivers of environmental degradation in advanced economies, there remains a critical gap in understanding the integrated roles of artificial intelligence (AI), financial accessibility, and government effectiveness in mitigating ecological pressures, particularly through comprehensive panel data analysis in the G-7 context. This study addresses this gap by exploring how these factors influence environmental sustainability across G-7 nations, using the ecological footprint as a key indicator from 2010Q1 to 2022Q4. Employing the Panel Mean Group Autoregressive Distributed Lag model as the primary estimator, with Augmented Mean Group and Common Correlated Effects Mean Group estimators for robustness, the empirical results reveal that economic growth and urbanization significantly exacerbate ecological degradation in both the long and short run. Conversely, AI innovation, financial accessibility, and effective governance substantially reduce environmental impacts. These findings advance the discourse on Sustainable Development Goals (SDGs), especially SDG 9 (Industry, Innovation and Infrastructure), SDG 11 (Sustainable Cities and Communities), and SDG 13 (Climate Action). To foster a sustainable transition, policymakers should prioritize investments in AI-driven green technologies to optimize resource efficiency, expand inclusive financial mechanisms to fund eco-innovations and renewable projects, and implement governance reforms that enforce stringent environmental regulations in G-7 economies.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 166-180"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-08-07DOI: 10.1016/j.glt.2025.08.001
Guangwen Liu , Chenlu Hong , Yujie Huang , Boyuan Guan , Yating Liu , Zhaorui Liu , Yanan Luo
<div><h3>Background</h3><div>This study aimed to explore the association between epigenetic age acceleration and the transition between different cognitive status during dementia process. We also verified the racial disparities in the above relationships.</div></div><div><h3>Methods</h3><div>Data was from the US Health and Retirement Study, involving 3593 participants (50+) with a 4-year follow-up. Normal cognition (NC), mild cognitive impairment (MCI) and dementia was evaluated by the modified Telephone Interview for Cognitive Status. Epigenetic age was determined by epigenetic clocks based on DNA methylation patterns and dichotomized into acceleration and deceleration according to residual from the regression of epigenetic age on chronological age. Cox regression models were conducted to examine the association between epigenetic age acceleration and risk of transition between NC, MCI and dementia. Subgroup analysis was conducted to verify racial disparities.</div></div><div><h3>Results</h3><div>Among those with NC at baseline (n = 2671), 1053 (39.42 %) were male, 1618 (60.58 %) were female, 2057 (77.01 %) were Whites, and 614 (22.99 %) were Non-Whites. A total of 278 participants developed the transition from NC to MCI and 42 participants developed the transition from NC to dementia during the median follow-up of 3.92 years (interquartile range: 1.17–4.83 years). Accelerated epigenetic aging measured by GrimAge clock was associated with higher risk of MCI incidence (HR = 1.56, 95 % CI: 1.15–2.11) whereas epigenetic age acceleration measured by all the seven epigenetic clocks and the risk of transition from NC to dementia was not associated. Among those with MCI at baseline (n = 922), 408 (44.25 %) were male, 514 (55.75 %) were female, 633 (68.66 %) were Whites, and 289 (31.34 %) were Non-Whites. A total of 132 participants experienced transition from MCI to dementia during the median follow-up of 3.58 years (interquartile range: 1.17–4.67 years). Participants with age acceleration measured by Horvath's skin&blood clock had a higher risk of transition from MCI to dementia (HR = 1.62, 95 % CI: 1.09–2.40). Heterogeneity of race was found in the relationship of epigenetic aging with transition between cognitive status and the observed associations only existed among non-Whites. Specifically, associations between GrimAge AccelAge and higher risk of transition from NC to MCI (HR = 2.04, 95 % CI: 1.10–3.79, <em>P</em> for interaction = 0.039) as well as transition from NC to dementia (HR = 3.71, 95 % CI: 1.03–13.34, <em>P</em> for interaction = 0.040) were only found among Non-White participants. In addition, significant association between epigenetic age acceleration measured by Hannum (HR = 2.16, 95 % CI: 1.10–4.24, <em>P</em> for interaction = 0.048), Horvath's skin&blood (HR = 4.33, 95 % CI: 2.04–9.20, <em>P</em> for interaction = 0.046), and Zhang's clock (HR = 1.94, 95 % CI: 1.07–3.51, <em>P</em> for interaction = 0.046), and the higher
{"title":"Racial disparities in the association of epigenetic age acceleration with the transition between normal cognition, mild cognitive impairment and dementia","authors":"Guangwen Liu , Chenlu Hong , Yujie Huang , Boyuan Guan , Yating Liu , Zhaorui Liu , Yanan Luo","doi":"10.1016/j.glt.2025.08.001","DOIUrl":"10.1016/j.glt.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to explore the association between epigenetic age acceleration and the transition between different cognitive status during dementia process. We also verified the racial disparities in the above relationships.</div></div><div><h3>Methods</h3><div>Data was from the US Health and Retirement Study, involving 3593 participants (50+) with a 4-year follow-up. Normal cognition (NC), mild cognitive impairment (MCI) and dementia was evaluated by the modified Telephone Interview for Cognitive Status. Epigenetic age was determined by epigenetic clocks based on DNA methylation patterns and dichotomized into acceleration and deceleration according to residual from the regression of epigenetic age on chronological age. Cox regression models were conducted to examine the association between epigenetic age acceleration and risk of transition between NC, MCI and dementia. Subgroup analysis was conducted to verify racial disparities.</div></div><div><h3>Results</h3><div>Among those with NC at baseline (n = 2671), 1053 (39.42 %) were male, 1618 (60.58 %) were female, 2057 (77.01 %) were Whites, and 614 (22.99 %) were Non-Whites. A total of 278 participants developed the transition from NC to MCI and 42 participants developed the transition from NC to dementia during the median follow-up of 3.92 years (interquartile range: 1.17–4.83 years). Accelerated epigenetic aging measured by GrimAge clock was associated with higher risk of MCI incidence (HR = 1.56, 95 % CI: 1.15–2.11) whereas epigenetic age acceleration measured by all the seven epigenetic clocks and the risk of transition from NC to dementia was not associated. Among those with MCI at baseline (n = 922), 408 (44.25 %) were male, 514 (55.75 %) were female, 633 (68.66 %) were Whites, and 289 (31.34 %) were Non-Whites. A total of 132 participants experienced transition from MCI to dementia during the median follow-up of 3.58 years (interquartile range: 1.17–4.67 years). Participants with age acceleration measured by Horvath's skin&blood clock had a higher risk of transition from MCI to dementia (HR = 1.62, 95 % CI: 1.09–2.40). Heterogeneity of race was found in the relationship of epigenetic aging with transition between cognitive status and the observed associations only existed among non-Whites. Specifically, associations between GrimAge AccelAge and higher risk of transition from NC to MCI (HR = 2.04, 95 % CI: 1.10–3.79, <em>P</em> for interaction = 0.039) as well as transition from NC to dementia (HR = 3.71, 95 % CI: 1.03–13.34, <em>P</em> for interaction = 0.040) were only found among Non-White participants. In addition, significant association between epigenetic age acceleration measured by Hannum (HR = 2.16, 95 % CI: 1.10–4.24, <em>P</em> for interaction = 0.048), Horvath's skin&blood (HR = 4.33, 95 % CI: 2.04–9.20, <em>P</em> for interaction = 0.046), and Zhang's clock (HR = 1.94, 95 % CI: 1.07–3.51, <em>P</em> for interaction = 0.046), and the higher","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 1-9"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-09-03DOI: 10.1016/j.glt.2025.09.002
Madior Ndiaye, Raafat George Saade, Hao Liu
Digitalization has become ubiquitous; however, stakeholders have varying degrees of integration globally. Within the context of this study, a digitalization strategy has the potential for economic growth, enhanced health services, and ensuring national stability, thereby improving social well-being and facilitating a country's emergence as a developing nation. This study seeks to examine Senegal's digital landscape, with a particular focus on its impact on health and well-being, which are pivotal in the nation's progression towards becoming an emerging country. This study identifies key themes and factors contributing to Senegal's digital transformation and its potential to enhance overall quality of life. A systematic literature review (SLR) revealed a paucity of relevant research specific to the Senegalese context. Through thematic analysis, we identified research gaps (themes) that could assist Senegal in achieving its digitalization objectives: incremental transitioning facilitated by broadband improvements; digitalization of the economic, political, and human resources sectors; influence of trust and perceived risk on the adoption of emerging technologies; and integration of emerging technologies across all facets of life. Moreover, we conducted a pilot survey based on the Unified Theory of Acceptance and Use of Technology to obtain additional insights into digital healthcare adoption.
{"title":"Understanding the impact of digitalization transition of Senegal and its implication on human health and wellbeing","authors":"Madior Ndiaye, Raafat George Saade, Hao Liu","doi":"10.1016/j.glt.2025.09.002","DOIUrl":"10.1016/j.glt.2025.09.002","url":null,"abstract":"<div><div>Digitalization has become ubiquitous; however, stakeholders have varying degrees of integration globally. Within the context of this study, a digitalization strategy has the potential for economic growth, enhanced health services, and ensuring national stability, thereby improving social well-being and facilitating a country's emergence as a developing nation. This study seeks to examine Senegal's digital landscape, with a particular focus on its impact on health and well-being, which are pivotal in the nation's progression towards becoming an emerging country. This study identifies key themes and factors contributing to Senegal's digital transformation and its potential to enhance overall quality of life. A systematic literature review (SLR) revealed a paucity of relevant research specific to the Senegalese context. Through thematic analysis, we identified research gaps (themes) that could assist Senegal in achieving its digitalization objectives: incremental transitioning facilitated by broadband improvements; digitalization of the economic, political, and human resources sectors; influence of trust and perceived risk on the adoption of emerging technologies; and integration of emerging technologies across all facets of life. Moreover, we conducted a pilot survey based on the Unified Theory of Acceptance and Use of Technology to obtain additional insights into digital healthcare adoption.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 37-55"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-10-11DOI: 10.1016/j.glt.2025.10.002
Kaiyuan Chen , Yuhan Suo , Shaowei Cui , Yuanqing Xia , Wannian Liang , Shuo Wang
This paper addresses the problem of trajectory optimization for unmanned aerial vehicles (UAVs) performing time-sensitive medical deliveries in urban environments. Specifically, we consider a single UAV with 3-degree-of-freedom dynamics tasked with delivering blood packages to multiple hospitals, each with a predefined time window and priority. Mission objectives are encoded using Signal Temporal Logic (STL), enabling the formal specification of spatial-temporal constraints. To ensure safety, city buildings are modeled as 3D convex obstacles, and obstacle avoidance is handled through a Convex Feasible Set (CFS) method. The entire planning problem—combining UAV dynamics, STL satisfaction, and collision avoidance—is formulated as a convex optimization problem that ensures tractability and can be solved efficiently using standard convex programming techniques. Simulation results demonstrate that the proposed method generates dynamically feasible, collision-free trajectories that satisfy temporal mission goals, providing a scalable and reliable approach for autonomous UAV-based medical logistics.
{"title":"Trajectory optimization for UAV-based medical delivery with temporal logic constraints and convex feasible set collision avoidance","authors":"Kaiyuan Chen , Yuhan Suo , Shaowei Cui , Yuanqing Xia , Wannian Liang , Shuo Wang","doi":"10.1016/j.glt.2025.10.002","DOIUrl":"10.1016/j.glt.2025.10.002","url":null,"abstract":"<div><div>This paper addresses the problem of trajectory optimization for unmanned aerial vehicles (UAVs) performing time-sensitive medical deliveries in urban environments. Specifically, we consider a single UAV with 3-degree-of-freedom dynamics tasked with delivering blood packages to multiple hospitals, each with a predefined time window and priority. Mission objectives are encoded using Signal Temporal Logic (STL), enabling the formal specification of spatial-temporal constraints. To ensure safety, city buildings are modeled as 3D convex obstacles, and obstacle avoidance is handled through a Convex Feasible Set (CFS) method. The entire planning problem—combining UAV dynamics, STL satisfaction, and collision avoidance—is formulated as a convex optimization problem that ensures tractability and can be solved efficiently using standard convex programming techniques. Simulation results demonstrate that the proposed method generates dynamically feasible, collision-free trajectories that satisfy temporal mission goals, providing a scalable and reliable approach for autonomous UAV-based medical logistics.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 110-119"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Citizens’ active engagement in public sphere environmental behaviors (e.g., environmental policy support and environmental activism) can drive sustainable policy development and implementation. This study aims to assess how motivational and socio-political factors predict the public sphere environmental behaviors, and to evaluate how motivational factors (e.g., norms, attitude, and environmental concerns) and socio-political factors (e.g., social and institutional trust) are associated. The target population is well-educated people living in Bangkok city of Thailand as their active participation in the behaviors can powerfully encourage other entities or organizations to act environmentally. Questionnaire surveys were conducted with 540 well-educated residents living in Bangkok city. First, model measurement was assessed via confirmatory factor analysis; subsequently, a path analysis was performed to test causal associations among the variables predicting public-sphere environmental behaviors. The results revealed that social and institutional trust were significantly associated with a motivational factor (the attitude toward public sphere environmental behaviors) and the attitude could subsequently predict the behaviors. There were also significant associations between motivational factors, and these associations had a significant power to explain public sphere environmental behaviors. Both social norms and personal norms were significantly associated with the attitude. Social norms could also significantly predict the behaviors, but personal norms could not. Personal norms had only an indirect influence on the behaviors via the attitude. Moreover, local environmental concerns were a weak predictor as they had only a significant indirect influence on the behaviors via the attitude. Global environmental concerns could directly and indirectly predict the behaviors. Thus, educating the public with global environmental issues and promoting the attitude and social norms could be powerful in promoting public sphere environmental behaviors. To promote a positive attitude towards the behaviors, both institutional and social trust could play an important role.
{"title":"An integrative model of public sphere environmental behaviors: The association between motivational and socio-political factors","authors":"Piyapong Janmaimool , Surapong Chudech , Jaruwan Chontanawat , Kriengsak Thamma-aphiphol","doi":"10.1016/j.glt.2025.12.001","DOIUrl":"10.1016/j.glt.2025.12.001","url":null,"abstract":"<div><div>Citizens’ active engagement in public sphere environmental behaviors (e.g., environmental policy support and environmental activism) can drive sustainable policy development and implementation. This study aims to assess how motivational and socio-political factors predict the public sphere environmental behaviors, and to evaluate how motivational factors (e.g., norms, attitude, and environmental concerns) and socio-political factors (e.g., social and institutional trust) are associated. The target population is well-educated people living in Bangkok city of Thailand as their active participation in the behaviors can powerfully encourage other entities or organizations to act environmentally. Questionnaire surveys were conducted with 540 well-educated residents living in Bangkok city. First, model measurement was assessed via confirmatory factor analysis; subsequently, a path analysis was performed to test causal associations among the variables predicting public-sphere environmental behaviors. The results revealed that social and institutional trust were significantly associated with a motivational factor (the attitude toward public sphere environmental behaviors) and the attitude could subsequently predict the behaviors. There were also significant associations between motivational factors, and these associations had a significant power to explain public sphere environmental behaviors. Both social norms and personal norms were significantly associated with the attitude. Social norms could also significantly predict the behaviors, but personal norms could not. Personal norms had only an indirect influence on the behaviors via the attitude. Moreover, local environmental concerns were a weak predictor as they had only a significant indirect influence on the behaviors via the attitude. Global environmental concerns could directly and indirectly predict the behaviors. Thus, educating the public with global environmental issues and promoting the attitude and social norms could be powerful in promoting public sphere environmental behaviors. To promote a positive attitude towards the behaviors, both institutional and social trust could play an important role.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 129-143"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-10-11DOI: 10.1016/j.glt.2025.10.003
Hien Thi Nguyen , Charuai Suwanbamrung , Apichai Wattanapisit , Thang Nguyen , Warapone Satheannoppakao , Dung Tam Nguyen Huynh , Tam Thai Thanh Tran , Khanh Hoang Pham , Cua Ngoc Le
Introduction
Vietnam is undergoing a rapid demographic transition, with an increasingly aging population, posing new challenges for the healthcare system. Sarcopenia, an important contributor to frailty, functional decline, and disability in older adults, remains underdiagnosed due to the inconvenience of standardized assessment tools and the lack of validated anthropometric thresholds for specific populations.
Methods
We conducted a cross-sectional study involving 416 community-dwelling individuals aged ≥60 years in Can Tho, Vietnam. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cutoff values for body mass index (BMI), calf circumference (CC), arm circumference (AC), and waist circumference (WC), with the Youden index applied to determine the most accurate thresholds.
Results
The identified Vietnam-specific anthropometric thresholds for sarcopenia were: BMI ≤22.6 kg/m2 for men and ≤21.2 kg/m2 for women; CC ≤ 34.5 cm and ≤32.0 cm; AC ≤26.0 cm and ≤24.0 cm; WC ≤ 85.0 cm and ≤78.0 cm, respectively. These localized thresholds improved diagnostic accuracy, with BMI showing the strongest performance. CC and AC were less reliable among women, while WC offered high specificity but lower sensitivity.
Conclusion
Our results endorse Vietnam-specific anthropometric cutoffs, particularly BMI, as a practical, cost-effective sarcopenia screening tool for under-resourced primary care. Integrating these thresholds into national guidelines can accelerate universal health coverage and sustainable aging by enabling early detection and community-based interventions to avert functional decline in Vietnam's aging population.
{"title":"Transforming health systems in Vietnam's demographic transition: sarcopenia screening thresholds","authors":"Hien Thi Nguyen , Charuai Suwanbamrung , Apichai Wattanapisit , Thang Nguyen , Warapone Satheannoppakao , Dung Tam Nguyen Huynh , Tam Thai Thanh Tran , Khanh Hoang Pham , Cua Ngoc Le","doi":"10.1016/j.glt.2025.10.003","DOIUrl":"10.1016/j.glt.2025.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Vietnam is undergoing a rapid demographic transition, with an increasingly aging population, posing new challenges for the healthcare system. Sarcopenia, an important contributor to frailty, functional decline, and disability in older adults, remains underdiagnosed due to the inconvenience of standardized assessment tools and the lack of validated anthropometric thresholds for specific populations.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study involving 416 community-dwelling individuals aged ≥60 years in Can Tho, Vietnam. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cutoff values for body mass index (BMI), calf circumference (CC), arm circumference (AC), and waist circumference (WC), with the Youden index applied to determine the most accurate thresholds.</div></div><div><h3>Results</h3><div>The identified Vietnam-specific anthropometric thresholds for sarcopenia were: BMI ≤22.6 kg/m<sup>2</sup> for men and ≤21.2 kg/m<sup>2</sup> for women; CC ≤ 34.5 cm and ≤32.0 cm; AC ≤26.0 cm and ≤24.0 cm; WC ≤ 85.0 cm and ≤78.0 cm, respectively. These localized thresholds improved diagnostic accuracy, with BMI showing the strongest performance. CC and AC were less reliable among women, while WC offered high specificity but lower sensitivity.</div></div><div><h3>Conclusion</h3><div>Our results endorse Vietnam-specific anthropometric cutoffs, particularly BMI, as a practical, cost-effective sarcopenia screening tool for under-resourced primary care. Integrating these thresholds into national guidelines can accelerate universal health coverage and sustainable aging by enabling early detection and community-based interventions to avert functional decline in Vietnam's aging population.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 120-128"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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