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10 pages, 237 KiB  
Article
Current Status of Mental Health in Mexico City
by Erika Sanchez, Humberto Nicolini, Jorge Villatoro, Marycarmen Bustos, María Elena Medina-Mora, Paola Mejía-Ortiz, Beatriz Robles, Diego Mondragón, Gema Ibarra, Daniela Meza and Alma Delia Genis-Mendoza
Int. J. Environ. Res. Public Health 2025, 22(8), 1217; https://doi.org/10.3390/ijerph22081217 - 2 Aug 2025
Viewed by 41
Abstract
There is limited information on the prevalence of mental health symptoms among the population of Mexico City. To provide an update and determine the prevalence of symptoms associated with various disorders in the city, a modified version of the “Screener Questionnaire” was used, [...] Read more.
There is limited information on the prevalence of mental health symptoms among the population of Mexico City. To provide an update and determine the prevalence of symptoms associated with various disorders in the city, a modified version of the “Screener Questionnaire” was used, the same instrument employed in the National Survey on Drug, Alcohol, and Tobacco Use (ENCODAT) 2016–2017. Data were collected at PILARES centers in different boroughs of Mexico City. A total of 868 questionnaires on symptoms of psychiatric disorders and the use of drugs, alcohol, and tobacco were completed. The most frequently reported symptoms were anxiety (52.67%), depression (39.34%), and post-traumatic stress disorder (44.57%). Additionally, results showed alcohol use at 15.1%, followed by tobacco (13.6%) and illicit drug use (6.8%). The prevalence of these symptoms was also compared with data from ENCODAT 2016–2017 to observe changes over the years. Full article
33 pages, 1497 KiB  
Article
Beyond Compliance: How Disruptive Innovation Unleashes ESG Value Under Digital Institutional Pressure
by Fang Zhang and Jianhua Zhu
Systems 2025, 13(8), 644; https://doi.org/10.3390/systems13080644 (registering DOI) - 1 Aug 2025
Viewed by 266
Abstract
Amid intensifying global ESG regulations and the expanding influence of green finance, China’s digital economy policies have emerged as key institutional instruments for promoting corporate sustainability. Leveraging the implementation of the National Big Data Comprehensive Pilot Zone as a quasi-natural experiment, this study [...] Read more.
Amid intensifying global ESG regulations and the expanding influence of green finance, China’s digital economy policies have emerged as key institutional instruments for promoting corporate sustainability. Leveraging the implementation of the National Big Data Comprehensive Pilot Zone as a quasi-natural experiment, this study utilizes panel data of Chinese listed firms from 2009 to 2023 and applies multi-period Difference-in-Differences (DID) and Spatial DID models to rigorously identify the policy’s effects on corporate ESG performance. Empirical results indicate that the impact of digital economy policy is not exerted through a direct linear pathway but operates via three institutional mechanisms, enhanced information transparency, eased financing constraints, and expanded fiscal support, collectively constructing a logic of “institutional embedding–governance restructuring.” Moreover, disruptive technological innovation significantly amplifies the effects of the transparency and fiscal mechanisms, but exhibits no statistically significant moderating effect on the financing constraint pathway, suggesting a misalignment between innovation heterogeneity and financial responsiveness. Further heterogeneity analysis confirms that the policy effect is concentrated among firms characterized by robust governance structures, high levels of property rights marketization, and greater digital maturity. This study contributes to the literature by developing an integrated moderated mediation framework rooted in institutional theory, agency theory, and dynamic capabilities theory. The findings advance the theoretical understanding of ESG policy transmission by unpacking the micro-foundations of institutional response under digital policy regimes, while offering actionable insights into the strategic alignment of digital transformation and sustainability-oriented governance. Full article
(This article belongs to the Section Systems Practice in Social Science)
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29 pages, 1125 KiB  
Article
Orchestrating Power: The Cultural–Institutional Nexus and the Rise of Digital Innovation Ecosystems in Great Power Rivalry
by Deganit Paikowsky, Dmitry Payson and Yaacov Falkov
Systems 2025, 13(8), 643; https://doi.org/10.3390/systems13080643 (registering DOI) - 1 Aug 2025
Viewed by 284
Abstract
This article examines how digital innovation ecosystems have emerged as strategic institutions of power in contemporary world politics. It argues that, unlike Cold War technological rivalries driven by centralized, state-led control, today’s digital competition depends on states’ capacity to orchestrate scalable, multistakeholder ecosystems. [...] Read more.
This article examines how digital innovation ecosystems have emerged as strategic institutions of power in contemporary world politics. It argues that, unlike Cold War technological rivalries driven by centralized, state-led control, today’s digital competition depends on states’ capacity to orchestrate scalable, multistakeholder ecosystems. Using a cultural–institutional framework, we explain how differences in strategic culture and institutional governance impact the ecosystem’s vitality and performance. A qualitative comparative analysis of the United States, China, and Russia reveals that constructive orchestration, aligning state institutions with generative, commercial-to-national innovation flows, enhances digital leadership, whereas rigid, obstructive governance limits it. This highlights ecosystem governance as a critical dimension of statecraft in the digital age. The findings underscore that the positions of great powers in the global technological hierarchy depend not only on resources or capabilities but also on the effectiveness of ecosystem governance as an evolving instrument of geopolitical power. Full article
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27 pages, 2565 KiB  
Review
The Role of ESG in Driving Sustainable Innovation in Water Sector: From Gaps to Governance
by Gabriel Minea, Elena Simina Lakatos, Roxana Maria Druta, Alina Moldovan, Lucian Marius Lupu and Lucian Ionel Cioca
Water 2025, 17(15), 2259; https://doi.org/10.3390/w17152259 - 29 Jul 2025
Viewed by 400
Abstract
The water sector is facing a convergence of systemic challenges generated by climate change, increasing demand, and increasingly stringent regulations, which threaten its operational and strategic sustainability. In this context, the article examines how ESG (environmental, social, governance) principles are integrated into the [...] Read more.
The water sector is facing a convergence of systemic challenges generated by climate change, increasing demand, and increasingly stringent regulations, which threaten its operational and strategic sustainability. In this context, the article examines how ESG (environmental, social, governance) principles are integrated into the governance, financing, and management of water resources, with a comparative focus on Romania and the European Union. It aims to assess the extent to which ESG practices contribute to the sustainable transformation of the water sector in the face of growing environmental and socio-economic challenges. The methodology is based on a systematic analysis of policy documents, regulatory frameworks, and ESG standards applicable to the water sector at both national (Romania) and EU levels. This study also investigates investment strategies and their alignment with the EU Taxonomy for Sustainable Activities, enabling a comparative perspective on implementation, gaps and strengths. Findings reveal that while ESG principles are increasingly recognized across Europe, their implementation remains uneven (particularly in Romania) due to unclear standards, limited funding mechanisms, and fragmented policy coordination. ESG integration shows clear potential to foster innovation, improve governance transparency, and support long-term resilience in the water sector. These results underline the need for coherent, integrated policies and stronger institutional coordination to ensure consistent ESG adoption across Member States. Policymakers should prioritize the development of clear guidelines and supportive funding instruments to accelerate sustainable outcomes. The originality of our study lies in its comparative approach, offering an in-depth analysis of ESG integration in the water sector across different governance contexts. It provides valuable insights for advancing policy coherence, investment alignment, and sustainable water resource management at both national and European levels. Full article
(This article belongs to the Section Water Resources Management, Policy and Governance)
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14 pages, 479 KiB  
Article
A Quality Assessment and Evaluation of Credible Online Dietary Resources for Patients with an Ileoanal Pouch
by Dakota R. Rhys-Jones, Itai Ghersin, Orestis Argyriou, Sue Blackwell, Jasmine Lester, Peter R. Gibson, Emma P. Halmos, Zaid Ardalan, Janindra Warusavitarne, Kapil Sahnan, Jonathan P. Segal, Ailsa Hart and Chu K. Yao
J. Clin. Med. 2025, 14(15), 5348; https://doi.org/10.3390/jcm14155348 - 29 Jul 2025
Viewed by 288
Abstract
Background/Objectives: Patients with an ileoanal pouch change their diet to manage their symptoms and will often resort to the internet for nutrition advice. Currently, no evidence-based dietary guidelines exist to inform online resources. Hence, this study aims to assess the quality of [...] Read more.
Background/Objectives: Patients with an ileoanal pouch change their diet to manage their symptoms and will often resort to the internet for nutrition advice. Currently, no evidence-based dietary guidelines exist to inform online resources. Hence, this study aims to assess the quality of online nutrition information directed towards patients with an ileoanal pouch. Methods: A systematic Google search was conducted to identify consumer websites including information on nutrition for those with ileoanal pouches. Quality was assessed using the DISCERN instrument, and the readability of written content was assessed using the Flesch–Kincaid score. A summative content analysis was used to identify the frequency of particular topics. Websites were also assessed against standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision-making support tools. Results: A total of 12 websites met the inclusion criteria. Mean total DISCERN scores across all websites are 33 out of 75, indicating that overall, the websites were of poor quality. The mean Flesch–Kincaid score was 57 out of 100, or “fairly difficult” in terms of readability. The main themes according to the content analysis were “general dietary advice for pouch”, “dietary strategies for symptom management”, “addressing risks associated with having a pouch”, and “optimisation of nutritional intake”. Overall, websites did not meet the standards for shared decision-making. Conclusions: Online nutrition information for patients with an ileoanal pouch is of poor quality and difficult to understand. There is a need for higher quality online resources for these patients, ideally co-produced with a multidisciplinary team and patient, to provide patients with good quality, understandable, and accessible nutrition information. Full article
(This article belongs to the Special Issue New Directions for Treatment and Assessment of Ulcerative Colitis)
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13 pages, 589 KiB  
Article
Validating the Arabic Adolescent Nutrition Literacy Scale (ANLS): A Reliable Tool for Measuring Nutrition Literacy
by Sahar Obeid, Souheil Hallit, Feten Fekih-Romdhane, Yonna Sacre, Marie Hokayem, Ayoub Saeidi, Lamya Sabbah, Nikolaos Tzenios and Maha Hoteit
Nutrients 2025, 17(15), 2457; https://doi.org/10.3390/nu17152457 - 28 Jul 2025
Viewed by 154
Abstract
Introduction: Nutrition literacy has garnered growing research attention worldwide, yet only a few instruments have been developed to specifically measure this construct among adolescents. Accordingly, the present research sought to examine the validity and reliability of the Adolescent Nutrition Literacy Scale (ANLS) [...] Read more.
Introduction: Nutrition literacy has garnered growing research attention worldwide, yet only a few instruments have been developed to specifically measure this construct among adolescents. Accordingly, the present research sought to examine the validity and reliability of the Adolescent Nutrition Literacy Scale (ANLS) within a group of Lebanese adolescents. Methods: A cross-sectional study was carried out from December 2022 to March 2023, targeting a nationally representative sample. Results: Fit indices of the three-factor structure were good. Internal reliability was adequate for the following three subscales: Functional Nutrition Literacy (FNL) (ω = 0.88/α = 0.88), Interactive Nutrition Literacy (INL) (ω = 0.87/α = 0.86) and Critical Nutrition Literacy (CNL) (ω = 0.89/α = 0.89). Invariance was established across genders at configural, metric, and scalar levels. A significantly higher mean FNL and INL scores were found in males compared to females, with no significant difference between the two genders in terms of CNL. Higher FNL, but not CNL and INL scores were significantly associated with lower child food security. Conclusions: The Arabic ANLS has exhibited robust psychometric reliability, validity, and cost-effectiveness as a tool for assessing nutrition literacy. By utilizing the Arabic version of the ANLS, we can more efficiently and accurately assess the nutritional literacy of adolescents. Full article
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21 pages, 3802 KiB  
Article
Parameter Identification and Speed Control of a Small-Scale BLDC Motor: Experimental Validation and Real-Time PI Control with Low-Pass Filtering
by Ayman Ibrahim Abouseda, Resat Ozgur Doruk and Ali Amini
Machines 2025, 13(8), 656; https://doi.org/10.3390/machines13080656 - 27 Jul 2025
Viewed by 362
Abstract
This paper presents a structured and experimentally validated approach to the parameter identification, modeling, and real-time speed control of a brushless DC (BLDC) motor. Electrical parameters, including resistance and inductance, were measured through DC and AC testing under controlled conditions, respectively, while mechanical [...] Read more.
This paper presents a structured and experimentally validated approach to the parameter identification, modeling, and real-time speed control of a brushless DC (BLDC) motor. Electrical parameters, including resistance and inductance, were measured through DC and AC testing under controlled conditions, respectively, while mechanical and electromagnetic parameters such as the back electromotive force (EMF) constant and rotor inertia were determined experimentally using an AVL dynamometer. The back EMF was obtained by operating the motor as a generator under varying speeds, and inertia was identified using a deceleration method based on the relationship between angular acceleration and torque. The identified parameters were used to construct a transfer function model of the motor, which was implemented in MATLAB/Simulink R2024b and validated against real-time experimental data using sinusoidal and exponential input signals. The comparison between simulated and measured speed responses showed strong agreement, confirming the accuracy of the model. A proportional–integral (PI) controller was developed and implemented for speed regulation, using a low-cost National Instruments (NI) USB-6009 data acquisition (DAQ) and a Kelly controller. A first-order low-pass filter was integrated into the control loop to suppress high-frequency disturbances and improve transient performance. Experimental tests using a stepwise reference speed profile demonstrated accurate tracking, minimal overshoot, and robust operation. Although the modeling and control techniques applied are well known, the novelty of this work lies in its integration of experimental parameter identification, real-time validation, and practical hardware implementation within a unified and replicable framework. This approach provides a solid foundation for further studies involving more advanced or adaptive control strategies for BLDC motors. Full article
(This article belongs to the Section Electrical Machines and Drives)
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16 pages, 351 KiB  
Article
Assessment of Telehealth Literacy in Users: Survey and Analysis of Demographic and Behavioral Determinants
by Marcela Hechenleitner-Carvallo, Jacqueline Ibarra-Peso and Sergio V. Flores
Healthcare 2025, 13(15), 1825; https://doi.org/10.3390/healthcare13151825 - 26 Jul 2025
Viewed by 290
Abstract
Background: Telehealth is an essential component of modern healthcare, and it was especially relevant during the COVID-19 pandemic, but disparities in digital and technological literacy among health professionals may limit its equitable adoption and impact. Objective: This study seeks to validate [...] Read more.
Background: Telehealth is an essential component of modern healthcare, and it was especially relevant during the COVID-19 pandemic, but disparities in digital and technological literacy among health professionals may limit its equitable adoption and impact. Objective: This study seeks to validate an eight-item telehealth literacy survey among health professionals in Central–South Chile and to examine demographic and behavioral determinants of literacy levels, developing predictive models to identify key factors. Methods: In this cross-sectional study, 2182 health professionals from urban and rural centers in Central–South Chile completed the adapted survey along with questions on age, gender, nationality, and frequency of telehealth use. We assessed internal consistency (Cronbach’s α), explored factor structure via exploratory factor analysis (EFA), and tested associations using Pearson correlations, t-tests, one-way ANOVA, and both linear and multinomial logistic regressions. Results: The instrument demonstrated high reliability (Cronbach’s α = 0.92) and a two-factor structure explaining 65% of variance. Age negatively correlated with literacy (r = −0.26; p < 0.001), while the frequency of telehealth use showed a positive correlation (r = 0.26; p < 0.001). Female professionals and those in urban settings scored significantly higher on telehealth literacy (p = 0.005 and p < 0.001, respectively). The reduced multinomial model achieved moderate classification accuracy (51.65%) in distinguishing low, medium, and high literacy groups. Conclusions: The validated survey is a reliable tool for assessing telehealth literacy among health professionals in Chile. The findings highlight age, gender, and geographic disparities, and support targeted digital literacy interventions to promote equitable telehealth practice. Full article
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24 pages, 319 KiB  
Article
Indigenous Contestations of Carbon Markets, Carbon Colonialism, and Power Dynamics in International Climate Negotiations
by Zeynep Durmaz and Heike Schroeder
Climate 2025, 13(8), 158; https://doi.org/10.3390/cli13080158 - 24 Jul 2025
Viewed by 529
Abstract
This paper examines the intersection of global climate governance, carbon markets, and Indigenous Peoples’ rights under the United Nations Framework Convention on Climate Change. It critically analyses how Indigenous Peoples have contested the Article 6 market mechanisms of the Paris Agreement at the [...] Read more.
This paper examines the intersection of global climate governance, carbon markets, and Indigenous Peoples’ rights under the United Nations Framework Convention on Climate Change. It critically analyses how Indigenous Peoples have contested the Article 6 market mechanisms of the Paris Agreement at the height of their negotiation during COP25 and COP26 by drawing attention to their role in perpetuating “carbon colonialism,” thereby revealing deeper power dynamics in global climate governance. Utilising a political ecology framework, this study explores these power dynamics at play during the climate negotiations, focusing on the instrumental, structural, and discursive forms of power that enable or limit Indigenous participation. Through a qualitative case study approach, the research reveals that while Indigenous Peoples have successfully used discursive strategies to challenge market-based solutions, their influence remains limited due to entrenched structural and instrumental power imbalances within the UNFCCC process. This study highlights the need for equitable policies that integrate human rights safeguards and prioritise Indigenous-led, non-market-based approaches to ecological restoration. Full article
24 pages, 3062 KiB  
Article
Green Hydrogen in Jordan: Stakeholder Perspectives on Technological, Infrastructure, and Economic Barriers
by Hussam J. Khasawneh, Rawan A. Maaitah and Ahmad AlShdaifat
Energies 2025, 18(15), 3929; https://doi.org/10.3390/en18153929 - 23 Jul 2025
Viewed by 306
Abstract
Green hydrogen, produced via renewable-powered electrolysis, offers a promising path toward deep decarbonisation in energy systems. This study investigates the major technological, infrastructural, and economic challenges facing green hydrogen production in Jordan—a resource-constrained yet renewable-rich country. Key barriers were identified through a structured [...] Read more.
Green hydrogen, produced via renewable-powered electrolysis, offers a promising path toward deep decarbonisation in energy systems. This study investigates the major technological, infrastructural, and economic challenges facing green hydrogen production in Jordan—a resource-constrained yet renewable-rich country. Key barriers were identified through a structured survey of 52 national stakeholders, including water scarcity, low electrolysis efficiency, limited grid compatibility, and underdeveloped transport infrastructure. Respondents emphasised that overcoming these challenges requires investment in smart grid technologies, seawater desalination, advanced electrolysers, and policy instruments such as subsidies and public–private partnerships. These findings are consistent with global assessments, which recognise similar structural and financial obstacles in scaling up green hydrogen across emerging economies. Despite the constraints, over 50% of surveyed stakeholders expressed optimism about Jordan’s potential to develop a competitive green hydrogen sector, especially for industrial and power generation uses. This paper provides empirical, context-specific insights into the conditions required to scale green hydrogen in developing economies. It proposes an integrated roadmap focusing on infrastructure modernisation, targeted financial mechanisms, and enabling policy frameworks. Full article
(This article belongs to the Special Issue Green Hydrogen Energy Production)
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31 pages, 2773 KiB  
Review
Actualized Scope of Forestry Biomass Valorization in Chile: Fostering the Bioeconomy
by Cecilia Fuentalba, Victor Ferrer, Luis E. Arteaga-Perez, Jorge Santos, Nacarid Delgado, Yannay Casas-Ledón, Gastón Bravo-Arrepol, Miguel Pereira, Andrea Andrade, Danilo Escobar-Avello and Gustavo Cabrera-Barjas
Forests 2025, 16(8), 1208; https://doi.org/10.3390/f16081208 - 23 Jul 2025
Viewed by 518
Abstract
Chile is among the leading global exporters of pulp and paper, supported by extensive plantations of Pinus radiata and Eucalyptus spp. This review synthesizes recent progress in the valorization of forestry biomass in Chile, including both established practices and emerging bio-based applications. It [...] Read more.
Chile is among the leading global exporters of pulp and paper, supported by extensive plantations of Pinus radiata and Eucalyptus spp. This review synthesizes recent progress in the valorization of forestry biomass in Chile, including both established practices and emerging bio-based applications. It highlights advances in lignin utilization, nanocellulose production, hemicellulose processing, and tannin extraction, as well as developments in thermochemical conversion technologies, including torrefaction, pyrolysis, and gasification. Special attention is given to non-timber forest products and essential oils due to their potential bioactivity. Sustainability perspectives, including Life Cycle Assessments, national policy instruments such as the Circular Economy Roadmap and Extended Producer Responsibility (REP) Law, are integrated to provide context. Barriers to technology transfer and industrial implementation are also discussed. This work contributes to understanding how forestry biomass can support Chile’s transition toward a circular bioeconomy. Full article
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12 pages, 578 KiB  
Article
Cross-Cultural Differences in Fear of Death, Emotional Intelligence, Coping with Death, and Burnout Among Nursing Students: A Comparative Study Between Spain and Portugal
by Miguel Ángel Martín-Parrilla, Noelia Durán-Gómez, Maria do Céu Marques, Casimiro Fermín López-Jurado, Margarida Goes and Macarena C. Cáceres
Behav. Sci. 2025, 15(7), 993; https://doi.org/10.3390/bs15070993 - 21 Jul 2025
Viewed by 388
Abstract
Nursing students often face emotional challenges related to death and dying, affecting their psychological well-being, emotional intelligence, and academic success. Cultural and educational factors may influence how they experience and manage these stressors. This study aimed to compare fear of death, emotional intelligence, [...] Read more.
Nursing students often face emotional challenges related to death and dying, affecting their psychological well-being, emotional intelligence, and academic success. Cultural and educational factors may influence how they experience and manage these stressors. This study aimed to compare fear of death, emotional intelligence, coping with death, and academic burnout among second-year nursing students in Spain and Portugal to identify cross-cultural differences. A cross-sectional study was conducted among 174 second-year nursing students from the University of Extremadura (Spain) and the University of Évora (Portugal) during the 2023/2024 academic year. The instruments used included the Collett–Lester Brief Fear of Death Scale, the Trait Meta-Mood Scale—24 ítems, the Bugen’s Coping with Death Scale, and the Maslach Burnout Inventory—Student Survey. Descriptive statistics were calculated, and group comparisons were performed using independent samples t-tests and Welch’s t-tests, depending on variance homogeneity. A two-way ANOVA was also conducted to explore interactions between gender and nationality. The Spanish sample comprised 86 women and 21 men, and the Portuguese sample included 58 women and 9 men. The mean age across the sample was 21.5 years (SD = 4.15). No significant differences were observed in fear of death or emotional intelligence between the two groups. However, Portuguese students showed significantly better coping with death, but also higher academic burnout and cynicism. Spanish students reported greater perceived efficacy. Although emotional intelligence and death anxiety were similar, Portuguese students demonstrated stronger coping skills but experienced more burnout. This suggests that coping alone may not buffer academic stress, emphasizing the need for culturally tailored interventions to enhance emotional readiness and reduce burnout. Full article
(This article belongs to the Special Issue Burnout and Psychological Well-Being of Healthcare Workers)
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16 pages, 851 KiB  
Article
Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019
by Rafaela Gonçalves Ribeiro-Lucas, Barbara Niegia Garcia de Goulart and Patricia Klarmann Ziegelmann
Int. J. Environ. Res. Public Health 2025, 22(7), 1157; https://doi.org/10.3390/ijerph22071157 - 21 Jul 2025
Viewed by 449
Abstract
Disability in basic and instrumental activities of daily living (BADL and IADL) reflects functional decline in older adults and can be associated with chronic conditions like type 2 diabetes (T2DM) and hypertension (SAH). This cross-sectional study utilized data from the 2013 and 2019 [...] Read more.
Disability in basic and instrumental activities of daily living (BADL and IADL) reflects functional decline in older adults and can be associated with chronic conditions like type 2 diabetes (T2DM) and hypertension (SAH). This cross-sectional study utilized data from the 2013 and 2019 Brazilian National Health Surveys to investigate the associations between T2DM, SAH, and disability levels. Exposures were self-reported diagnoses and outcomes were classified as independent, moderate, or severe. Multivariable Poisson regression models, with robust variance estimates, estimated adjusted prevalence ratios (PRa), accounting for sociodemographic variables and the survey design. In 2013, the absence of diabetes and hypertension was associated with a lower prevalence (PRa = 0.70; 95% CI: 0.58–0.85) of moderate disability in BADL when compared with the presence of only one of the conditions. On the other hand, the coexistence of T2DM and SAH was associated with a higher prevalence (PRa = 1.39; 95% CI: 1.01–1.91). A similar result was found in 2019 with the addition that coexistence was also associated with a higher prevalence of severe disability in BADLs (PRa = 1.82; 95% CI: 1.59–2.07). For IADL, the absence of T2DM and SAH was associated with a lower prevalence of severe disability in 2013 and 2019 and a lower prevalence of moderate disability only in 2019. However, coexistence showed a higher prevalence in both degrees of disability and both years of the survey. These findings highlight the impact of T2DM and SAH on disability in older people. Therefore, it is crucial to develop targeted strategies for vulnerable subgroups to enhance functional independence in aging populations. Full article
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28 pages, 1805 KiB  
Article
Development and Validation of the CHDSI Questionnaire: A New Tool for Measuring Disease-Specific Quality of Life in Children and Adolescents with Congenital Heart Defects
by Paul C. Helm, Ulrike M. M. Bauer, Peter Ewert and Julia Remmele
Medicina 2025, 61(7), 1311; https://doi.org/10.3390/medicina61071311 - 21 Jul 2025
Viewed by 293
Abstract
Background and Objectives: Congenital heart defects (CHD) affect around 1% of the population, making them the most common congenital disease worldwide. Thanks to advances in treatment, over 90% of affected children are able to reach adulthood, shifting focus to long-term outcomes such [...] Read more.
Background and Objectives: Congenital heart defects (CHD) affect around 1% of the population, making them the most common congenital disease worldwide. Thanks to advances in treatment, over 90% of affected children are able to reach adulthood, shifting focus to long-term outcomes such as disease-specific quality of life (DsQoL). To date, there has been no validated, standardized instrument for assessing DsQoL in young German CHD patients. This study introduces the Congenital Heart Disease Specific Inventory (CHDSI), the first freely available German-language instrument for measuring DsQoL in children and adolescents with CHD. Materials and Methods: The CHDSI was developed at the German Heart Center Munich in collaboration with affected children and adolescents and validated nationwide via the National Register for Congenital Heart Defects (NRCHD) with 1201 participants (46 kindergarten children, 530 children, 625 adolescents). Two age-specific versions (36/37 items) and a 31-item preschool version were created, alongside a 6-item short form (CHDSI-SF) for rapid screening. Reliability was assessed using Cronbach’s alpha and split-half methods; construct validity via confirmatory factor analysis (CFA) using DWLS; and score interpretation through standardized stanine scales. The small sample size of kindergarten children precluded a model test for this group. The standard values given for this subsample should therefore be interpreted with caution. Results: The CHDSI showed excellent internal consistency (Cronbach’s α = 0.856 to 0.900) and high split-half reliability (>0.95). CFA confirmed a robust six-factor structure with excellent model fit (CFI and TLI ≥ 0.991, RMSEA ≤ 0.05). Subscales showed strong discriminant validity, and significant differences were found by CHD severity and sex. Conclusions: The CHDSI is a psychometrically valid, age-appropriate, and freely available instrument for assessing DsQoL in children and adolescents with CHD. It provides valuable support for clinical decision-making and research. Further studies should explore international validation and cultural adaptation. Full article
(This article belongs to the Section Cardiology)
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31 pages, 1606 KiB  
Article
Investments, Economics, Renewables and Population Versus Carbon Emissions in ASEAN and Larger Asian Countries: China, India and Pakistan
by Simona-Vasilica Oprea, Adela Bâra and Irina Alexandra Georgescu
Sustainability 2025, 17(14), 6628; https://doi.org/10.3390/su17146628 - 20 Jul 2025
Viewed by 617
Abstract
Our research explores the dynamic relationship between CO2 emissions and four major influencing factors: foreign direct investment (FDI), economic growth (GDP), renewable energy consumption (REN) and population (POP) in the Association of Southeast Asian Nations (ASEAN) and three large Asian countries—China, India [...] Read more.
Our research explores the dynamic relationship between CO2 emissions and four major influencing factors: foreign direct investment (FDI), economic growth (GDP), renewable energy consumption (REN) and population (POP) in the Association of Southeast Asian Nations (ASEAN) and three large Asian countries—China, India and Pakistan, collectively referred to as LACs (larger Asian countries), from 1990 to 2022. The study has three main objectives: (1) to assess the short-run and long-run effects of GDP, FDI, REN and POP on CO2 emissions; (2) to compare the adjustment speeds and environmental policy responsiveness between ASEAN and LAC regions; and (3) to evaluate the role of renewable energy in mitigating environmental degradation. Against the backdrop of increasing environmental challenges and divergent development paths in Asia, this research contributes to the literature by applying a dynamic heterogeneous panel autoregressive distributed lag (panel ARDL) model. Unlike traditional static panel models, the panel ARDL model captures both long-run equilibrium relationships and short-run adjustments, allowing for country-specific dynamics. The results reveal a significant long-run cointegration among the variables. The error correction term (ECT) indicates a faster adjustment to equilibrium in LACs (−1.18) than ASEAN (−0.37), suggesting LACs respond more swiftly to long-run disequilibria in emissions-related dynamics. This may reflect more responsive policy mechanisms, stronger institutional capacities or more aggressive environmental interventions in LACs. In contrast, the slower adjustment in ASEAN highlights potential structural rigidities or delays in implementing effective policy responses, emphasizing the need for enhanced regulatory frameworks and targeted climate strategies to improve policy intervention efficiency. Results show that GDP and FDI increase emissions in both regions, while REN reduces them. POP is insignificant in ASEAN but increases emissions in LACs. These results provide insights into the relative effectiveness of policy instruments in accelerating the transition to a low-carbon economy, highlighting the need for differentiated strategies that align with each country’s institutional capacity, development stage and energy structure. Full article
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