Search Results (1,144)

Background: Antimicrobial resistance (AMR) poses an escalating threat to global health, agriculture, and the environment, demanding urgent multisectoral action under the One Health framework. Despite global awareness efforts, understanding of AMR among the general population remains insufficient, particularly in low- and middle-income countries such as Brazil. This study aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of the Brazilian population regarding AMR. Methods: An online questionnaire was distributed through social media platforms between April and August 2025, resulting in 945 valid responses after data cleaning. Quasi-Poisson models were applied to identify demographic predictors of KAP scores while logistic regression models were used to assess the association between KAP scores and antibiotic use-related practices. Results: Education level was the strongest predictor of higher KAP scores, whereas age and gender showed inconsistent influence. Only 40.3% of respondents correctly identified antibiotics among commonly used medicines, and 25.9% reported proper disposal of antibiotic packaging. More than half (54.2%) were willing to pay more for antibiotic-free products, although only 26.7% had ever noticed such labeling. Network analysis of open-ended responses indicated that concerns about potential health risks and AMR awareness were the primary motivators for purchasing antibiotic-free products. Conclusions: These findings reveal significant gaps in public understanding of antibiotic use and resistance in Brazil, emphasizing the urgent need for targeted educational initiatives, improved public communication, and behavioral interventions to support antimicrobial stewardship and sustainable antibiotic use. Full article

Background/Objectives: South Korea has experienced a rapid transition from widespread food insecurity and undernutrition to a comprehensive and institutionalized nutrition policy system. This study aimed to examine the historical evolution of Korean nutrition policy and nutrition education from the 1960s to the present and to explore its implications for global nutrition governance and nutrition-related Official Development Assistance (ODA). Methods: A narrative review was conducted using historical documents, government reports, nutrition policies, national health plans, legislation, and previous academic studies related to Korean nutrition policy and nutrition education. Results: Korean nutrition policy evolved through several developmental phases, including an aid-dependent relief period, a state-led food security and school feeding expansion phase, a preventive health and nutrition education phase, and a stage of legal and institutional consolidation. More recently, policies have shifted toward evidence-based, equity-oriented, and life-course approaches. Korea has also expanded its nutrition policy experience through ODA initiatives by supporting institutional development, workforce training, community-based nutrition education, and adaptable nutrition management systems in developing countries. Conclusions: Korea’s experience demonstrates how long-term governmental commitment, legislation, surveillance systems, and nutrition education can contribute to national nutrition improvement during rapid socioeconomic transition. These findings may provide useful insights for countries facing the double burden of malnutrition and seeking sustainable and adaptive nutrition policy systems. Full article

This study addresses the critical question of when green investments pay off by investigating how firm size generates asymmetric threshold effects in the relationship between eco-innovation and corporate financial performance. While prior research reports mixed findings, most studies rely on linear specifications that overlook structural breaks across firm scales. Using a dynamic panel threshold regression model on a global sample of 383 non-financial firms (3830 firm-year observations) from 2013–2022, we endogenously identify divergent size thresholds for operational (ROA) and shareholder (ROE) performance. Our findings unveil a significant regime-switching dynamic: for ROA, the positive impact of eco-innovation is confined to firms below the 20.106 threshold, turning marginally negative at larger scales due to coordination and complexity costs. In striking contrast, for ROE, eco-innovation initially imposes a financial burden on smaller firms but becomes a significant value driver once the 21.497 ‘critical mass’ threshold is surpassed. These asymmetric thresholds reconcile prior contradictory evidence by demonstrating that financial outcomes are strictly regime-dependent. The study advances the Natural Resource-Based View by uncovering scale-dependent capability thresholds and provides size-contingent implications for managers and policymakers to mitigate the “liability of smallness” through targeted support and to maximize the financial viability of green transitions. Full article

This paper explores how higher education institutions (HEIs) in the Gulf Cooperation Council (GCC) are advancing the Sustainable Development Goals (SDGs) amid rapidly evolving national development agendas. This study reviews publicly available institutional documents and global SDG ranking data to identify patterns of SDG integration: through academic programs, research, and community engagement. The data shows active engagement of the universities in the region linked with varying SDGs. The analysis also reveals that sustainability initiatives in Gulf universities are not purely educational or environmental undertakings; rather, they function as strategic instruments aligned with national visions, international positioning and soft power objectives. Accordingly, this study assesses institutional commitment to the SDGs as expressed through, and made visible by, publicly available reporting, rather than the effectiveness or real-world impact of that engagement, which the available data cannot establish. Guided by theoretical perspectives, the paper argues that SDG engagement remains largely shaped by global ranking frameworks and policy imperatives. While the GCC higher education sector is increasingly embedded in the global sustainability discourse, meaningful localization of SDG practices and data transparency remain limited. By drawing attention to these dynamics, the study contributes to the literature on higher education and sustainable development in the Arab Gulf, emphasizing the need for context-sensitive frameworks and stronger regional collaboration to advance the 2030 Agenda. It calls for strengthened collaboration, capacity development, and tailored policy approaches to fully harness the transformative potential of the SDGs. Future research should explore the sociopolitical drivers of SDG adoption to deepen understanding of HEIs’ contributions to sustainable development in the region. Full article

Background: Anal fissure is a common benign condition, yet its management varies widely. The International Society of University Colon and Rectal Surgeons (ISUCRS) conducted a global snapshot audit to describe contemporary real-world management patterns. Methods: During a 2-week period (June–July 2022), 56 colorectal surgeons from 21 countries prospectively recorded data for consecutive patients presenting with anal fissure. Exclusion criteria included inflammatory bowel disease, pregnancy or lactation, psychiatric disorders, immunosuppression, and anorectal sepsis. Acute fissure was defined as symptoms <6 weeks without sentinel pile; chronic fissure as >6 weeks or fibrotic edges/sentinel pile. The “Cure” was defined as complete symptom resolution or healed fissure on clinical or tele-follow-up. Results: A total of 302 patients were analyzed (mean age 41 ± 13 years; 52% women). Acute fissure was present in 42%, chronic in 58%. Conservative treatment (dietary advice, stool-softeners, topical agents, botulin toxin, pelvic-floor training) was initiated in 236 (78%) patients, while 66 (22%) underwent surgery, most commonly lateral internal sphincterotomy (LIS). At 8-week follow-up, 73% of patients treated conservatively and 88% of those treated surgically achieved clinical resolution of symptoms or healed fissure. Conclusions: Global management of anal fissure remains heterogeneous. Most surgeons favor conservative measures such as first-line therapy, reserving LIS for chronic or refractory fissures. Standardized definitions and outcome reporting are needed to improve comparability and guide future international guidelines. Full article

Background/Objectives: Cognitive decline and dementia represent a growing global crisis, affecting over 57 million individuals worldwide, projected to exceed 150 million by 2050. The 2024 Lancet Commission identified hearing loss as the single largest modifiable dementia risk factor (~7% population-attributable fraction). Obstructive sleep apnea (OSA), affecting ~936 million adults, is an increasingly recognized contributor yet remains underdiagnosed, especially in low- and middle-income countries (LMICs). This review synthesizes evidence on the global burden of cognitive decline associated with both conditions, evaluates causality debates, and identifies research gaps. Methods: Following SANRA guidelines, a search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library through February 2026. Original studies, systematic reviews, meta-analyses, and WHO/GBD reports were included; editorials and non-English publications were excluded. After deduplication, 3847 records were screened, and 96 studies met the inclusion criteria. Results: OSA has been linked to cognitive decline through several plausible mechanisms, including intermittent hypoxia, sleep fragmentation, impaired glymphatic clearance, and amyloid-beta accumulation, though the directionality of these associations requires confirmation from longitudinal studies. Hearing loss contributes to cognitive load, social isolation, and cortical reorganization. Both conditions disproportionately affect LMICs, where access to diagnosis and treatment remains limited. CPAP and hearing rehabilitation show cognitive benefits when initiated early, though evidence for reversing established impairment remains limited. A synergistic interaction between the two conditions is biologically plausible but empirically underexplored. Conclusions: OSA and hearing loss are highly prevalent conditions associated with increased dementia risk, though the certainty of causal relationships and the magnitude of intervention effects differ between the two conditions and across the available evidence. Integrated screening and early intervention could yield substantial neuroprotective benefits in high-risk populations and LMICs. Future longitudinal studies should examine combined cognitive trajectories and optimal intervention timing. Full article

Using data from the 41 companies listed on the Borsa Istanbul Sustainability Index between 2020 and 2024, this study examines the relationship between board characteristics, concentrated ownership structure, shareholder activism and sustainability transparency. Reports published on a voluntary basis were subjected to content analysis based on criteria selected from the Global Reporting Initiative (GRI) standards, and a sustainability disclosure score was calculated. The relationship between board characteristics, concentrated ownership structure, shareholder activism, financial metrics identified as control variables, and sustainability scores was evaluated via robust random effects (static) and System Generalized Method of Moments (System GMM) (dynamic) panel data estimators. According to the static estimation results, board meeting frequency and the ratio of female members serve as positive drivers for sustainability transparency. In the dynamic model estimates, these governance mechanisms lose their explanatory power and show no statistically observable effect. However, across both methodological approaches, firm size, which was integrated as a control factor, consistently demonstrates a robust positive correlation with levels of disclosure. These findings reveal that governance mechanisms such as the percentage of female members and meeting frequency have a short-term and marginal effect, but structural factors such as company size are the main determinants for a long-term and sustainable level of transparency in Türkiye. Consequently, market regulators should deploy policy frameworks that incentivize disclosure trajectories aligned with international frameworks while fostering voluntary reporting. Concurrently, corporate managers should look beyond mere statutory compliance and continuously embrace extensive global reporting standards. Full article

Background: Endometriosis is a chronic estrogen-dependent inflammatory disease estimated to affect up to 190 million women of reproductive age worldwide based on clinical and population-based estimates, although only 22.3 million prevalent cases were formally documented—a gap that itself reflects substantial under-diagnosis. Despite an exponential increase in systematic reviews (SRs) and meta-analyses (MAs), the evidence base remains fragmented across clinical domains. An umbrella review provides the methodologically highest level of evidence synthesis and allows critical appraisal and hierarchical classification of published SRs and MAs. Objective: The aim of this study was to conduct a comprehensive critical synthesis of published SRs and MAs on the epidemiology, pathogenesis, diagnosis, treatment, and long-term consequences of endometriosis and to assess their methodological quality using AMSTAR-2. Methods: Systematic searches were conducted in PubMed, Embase, Cochrane Library, and Scopus (2016–2026). Eligibility: SRs with or without MA covering any clinical aspect of endometriosis in women were considered eligible. Quality was assessed using AMSTAR-2. Association strength was classified as convincing (Class I), highly suggestive (Class II), suggestive (Class III), weak (Class IV), or non-significant (NS). Results: Fifty-two SRs and MAs were included (total sample > 6,000,000 participants). AMSTAR-2 quality: high 25% (n = 13), moderate 40% (n = 21), low 29% (n = 15), critically low 6% (n = 3). Class I evidence: short menstrual cycle (<27 days) associated with endometriosis risk (OR 1.68; 95% CI 1.48–1.89). Class II: post-operative dienogest reduces recurrence by 70% (OR 0.30; 95% CI 0.18–0.53); the risks of anxiety (RR 2.82; 95% CI 1.69–4.68) and depression (RR 2.78; 95% CI 1.63–5.25) are markedly elevated. Diagnostic delay persists at 4–12 years globally. Multi-biomarker platforms and AI-assisted imaging (e.g., PromarkerEndo and IMAGENDO) have shown promising preliminary diagnostic performance (reported AUCs of 0.997 and 0.906, respectively) in initial validation studies, although external validation in larger and more diverse cohorts is required before clinical implementation can be recommended. Conclusions: Endometriosis is a systemic, chronically under-diagnosed disease requiring a multidisciplinary approach. The available evidence supports dienogest as one of the preferred options for post-operative maintenance therapy, identifies multi-biomarker platforms as a promising—though not yet clinically validated—avenue for non-invasive diagnosis, and underscores the importance of incorporating psychological assessment into multidisciplinary management. Full article

Background and Objectives: The neurocognitive sequelae of COVID-19 have attracted attention as part of post-COVID condition (PCC), yet standardized tools for screening and quantifying PCC-related cognitive impairment remain scarce. The present study aimed to develop and validate the Screening for Neurocognitive Abilities Post-COVID (SNAP-COVID), a self-report questionnaire designed to capture current symptom burden and perceived changes in cognitive functioning relative to pre-COVID status in a Greek-speaking sample. Materials and Methods: Data collection occurred in three phases between August 2024 and February 2025. Dataset A (N = 27) was used for test–retest reliability. Dataset B (N = 300) was used for exploratory factor analysis (EFA), reliability testing, and convergent validity analyses with the Brain Fog Scale (BFS). Dataset C (N = 317) was used for independent validation through confirmatory factor analysis (CFA). Results: Initial EFA of the 30-item SNAP-COVID scale suggested a four-factor model, yet further item refinement yielded a robust three-factor, 24-item solution: (1) General Cognitive Functions (17 items, α = 0.948), (2) Sensory Hypersensitivity (4 items, α = 0.829), and (3) Language and Communication (3 items, α = 0.950). The total scale demonstrated excellent internal consistency (α = 0.95). Convergent validity was evident by significant correlations between SNAP impact scores and BFS scores (r = −0.442, p < 0.001). CFA confirmed the three-factor structure with acceptable fit indices (χ²(249) = 677.29, p < 0.001; CFI = 0.882; TLI = 0.869; RMSEA = 0.074; SRMR = 0.032). Conclusions: The SNAP-COVID scale is a reliable and valid instrument. Its multidimensional structure captures global and domain-specific difficulties, addressing a critical gap in post-infectious cognitive assessment. Full article

The Hsp20 protein family, essential in heat stress responses across all organisms, is part of the heat shock protein (Hsp) superfamily, recognized for its conserved alpha-crystallin domain (ACD). Hsp20s are the smallest proteins in the superfamily and primarily assist in protein refolding during stress and developmental processes. We present an in silico characterization of the Hsp20 gene family in Chenopodium quinoa (2n = 4x = 36) using an integrative approach. Quinoa is well known for its global contributions to food production and tolerance to various abiotic stresses. We identified 69 CqHsp20 genes that exhibit a well-conserved evolutionary pattern, characterized by a balanced copy number distributed symmetrically across 19 homeologous pairs in both subgenomes (A and B), with localized expansions driven by tandem duplications on eight chromosomes. High sequence identity in contiguous gene pairs and Ka/Ks ratios consistently below 1 (0.14–0.84) mathematically demonstrate that strict purifying selection has maintained the structural and sequence integrity of these genes since the ancestral polyploidization event. The phylogenetic analysis grouped CqHsp20 into two main clusters, splitted into four sub-clusters based on peptides’ cellular localization, consistent with a characteristic gene structure and conserved motif analysis, which may reflect the evolutionary trajectory and functional specialization of the Hsp20 family in plants. The integration of transcriptomic data from published experiments enabled us to detect a cluster of putatively ubiquitously expressed CqHsp20, as well as other groups that showed differential responses across abiotic stress conditions. The pattern shows that more genes exhibit higher transcription abundance under drought and salinity than under heat, key adaptive traits underlying quinoa’s known ecological versatility. Some of these genes, which are undetectable or have low abundance under heat stress, encode organelle-targeting peptides, a phenomenon not reported in other model plant studies. Differential expression analysis revealed a highly transcribed sub-cluster where six out of seven of nuclear CqHsp20 genes were active in aerial tissue during initial heat stress, with a specific cohort of four genes (CQ025082, CQ031384, CQ041158, and CQ055373) maintaining significant upregulation ($|{log}_2\mathrm{Fold}\mathrm{Change}|\ge 1.0$, $\mathrm{padj}<0.05$) under prolonged and simultaneous shoot/root exposure. Varying expression within CqHsp20 homologous and paralogs supports the idea that gene duplication creates genomic diversity, facilitating adaptation to variable extreme environments. However, while theoretical and in silico analysis provide valuable insight into quinoa Hsp20 response, empirical data are essential to unequivocally understand how these gene expression variations affect quinoa response to abiotic stressors. Full article

This study examines the global wood products market to propose an eco-label for the Chilean sector with an international orientation. A national prior certification framework and governance structure were established, aligned with international regulations to ensure compliance with target market standards. By doing so, the initiative aims to expedite the entry of Chilean products into foreign markets while incentivizing the supply and demand for sustainable goods locally. Through a historical review of eco-labels and an assessment of environmental declarations in the timber industry, this research identified critical regulations and designed a comprehensive management model. The findings reveal that existing certifications predominantly focus on indoor air quality (IAQ), specifically regarding volatile organic compound (VOC) and formaldehyde (HCHO) emissions in wood products for the construction sector (CLT, GLULAM, panels, etc.) using fossil-based adhesives. This study concluded that governance should be spearheaded by the Chilean Environment Ministry in collaboration with a specialized technical committee. Consequently, as a result, a hybrid (quantitative and qualitative) eco-label is proposed to communicate emissions limit compliance, enabling Chilean firms to report it emissions, prior to initiating formal international certification processes. Full article

Arthropod natural enemies—encompassing predators and parasitoids—form the backbone of sustainable agriculture, delivering irreplaceable ecosystem services via biological pest suppression. Driven by global demand for eco-friendly alternatives to synthetic pesticides, research in this domain has grown sharply over the past decade. Here, we report a systematic bibliometric analysis of 6515 Web of Science Core Collection papers focused on arthropod natural enemies in biological control (2016–2025), with the goal of charting the field’s intellectual structure. Performance metrics confirmed an initial rapid increase from 2016 to 2019 followed by a plateau and a slight rise in 2025, with the US, China, and Brazil dominating output. Keyword co-occurrence networks pinpointed core themes, including conservation biological control, predatory mites, and integrated pest management (IPM). Temporal trends further revealed a pivot toward applied work on invasive pest systems. Co-citation analysis uncovered six foundational research clusters, while bibliographic coupling of 2021–2025 papers uncovered five active emerging subfields: landscape ecology and habitat manipulation, tri-trophic interaction mechanisms, high-impact invasive pest biocontrol, non-target risk assessment for introduced agents, and fall armyworm integrated management. We synthesize cross-cutting implications and outline future priorities—including AI-enabled rearing systems, functional biodiversity boosting, climate adaptation, and multifunctional landscape tuning. By consolidating historical progress and forward-looking directions, this framework empowers researchers, extension practitioners, and policymakers to scale sustainable pest management worldwide. Full article

Background: The use of sports supplements among adolescents is rising globally, driven by fitness trends and social media influence, yet knowledge gaps persist. This study aimed to assess supplement usage patterns, knowledge, attitudes, information sources, and the impact of a social media educational intervention among Serbian secondary school students. Methods: A single-group pre–post educational intervention study was conducted in secondary school students (aged 14–18) in Vojvodina, Serbia. A 21-question anonymous questionnaire was distributed to 1000 students along with parental informed consent forms. Pre-intervention survey assessed sociodemographics, physical activity and social media habits, supplement use information sources, and awareness of risks and banned substances. Based on the initial findings, an educational campaign delivered 56 short videos (≈70 s each) on Instagram and TikTok covering most frequently used supplements (e.g., creatine, proteins, caffeine, energy drinks). After, the intervention survey was repeated. The data were analyzed using the McNemar–Bowker test of symmetry. Results: In this study, 65% of Serbian secondary school adolescents reported being physically active, engaging predominantly in gym workouts and team sports. The majority of participants initiate dietary supplement use independently, without consulting healthcare professionals or adults. The most commonly used supplements were vitamins and minerals, while energy drinks ranked notably high. Social media intervention had a limited impact due to its short duration; however, certain changes were detected. Conclusions: Serbian adolescents frequently use sports supplements without adequate professional guidance. Long-term TikTok/Instagram interventions could be used in the future in order to influence behaviors and improve knowledge about sport supplement use. Full article

Background: In response to the World Health Organization’s Global Medication Safety Challenge, many countries, including Saudi Arabia, have launched implementation initiatives. This study examined how Saudi hospitals have addressed the WHO Global Medication Safety Challenge. Methods: A cross-sectional survey was conducted between January and June 2025 among medication safety officers at secondary and tertiary care hospitals in Saudi Arabia. Participants reported interventions implemented to enhance medication safety during or before 2025 using a self-administered survey adapted from a previously published tool. Interventions were categorized according to the domains, subdomains, and priority areas of the WHO Medication Safety Challenge framework. Descriptive statistics summarized responses, and thematic analysis was used to categorize interventions. Results: Twenty-eight hospitals reported 162 interventions. Most respondents were medication safety officers (75%). The most frequently reported domains were medication systems and practices (41.3%), followed by healthcare professionals (29%), medicines (22.5%), and patients/public (6.7%). Nearly 60% of interventions addressed WHO priority areas, primarily high-risk situations (81.4%), followed by transitions of care (11.3%) and polypharmacy (7.2%). Conclusions: The study findings suggest that selected hospitals in Saudi Arabia have primarily focused on medication systems, healthcare professionals, and high-risk situations. Expanding initiatives to address polypharmacy and patient/public engagement may further strengthen medication safety efforts. Full article

Background: Adenovirus-vectored vaccines played an important role in the global response to SARS-CoV-2. Adenovirus platforms have many advantages including a simple and readily transferred manufacturing process, low cost, and thermostability. Speed of production of an initial Good Manufacturing Practice (GMP)-compliant batch has, however, been viewed as a limitation of adenovirus vectors relative to mRNA platforms. Production of the initial viral starting material and release testing are key rate-limiting steps. Methods: Production of viral starting material from DNA, and release testing in accordance with regulatory expectations, for first-in-human trials of adenovirus-vectored vaccines. Results: We describe experience of these stages in the production of the first GMP batches for multiple adenovirus-vectored candidates and the adaptations made for ChAdOx1 nCoV-19 (the Oxford COVID-19 vaccine) in early 2020. We also report development of a streamlined approach to starting material generation, enabling initial GMP batch availability within c. 60 days of publication of a new pathogen sequence. Using a New World arenavirus vaccine construct as a proof of concept, we demonstrate reproducible execution of this pipeline, maintaining acceptable infectivity and other quality attributes. Conclusions: We discuss opportunities for additional time savings in the future. This work demonstrates suitability of an adenovirus platform to contribute to the “100 Days Mission” for vaccines against “Disease X”. Full article