Search Results (8,170)

Background: Nationwide epidemiologic data on comorbidity burden in early rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are limited. We compared coded diagnoses for concurrent disorders in incident RA and PsA based on administrative healthcare data (AHC). Methods: This retrospective cohort study used AHCs from the National Health Fund between 2009 and 2021. Using composite proxy definitions for RA and PsA diagnosis (combination of ICD-10 codes and prescription data), we identified all new cases of RA and PsA between 2019 and 2021. We utilized a ten-year lookback window for the accrual of concurrent disorder claims. Age-, sex-, serostatus- and calendar year-adjusted models were considered. Crude, relative and adjusted prevalence estimates were calculated using generalized linear models. Results: Using NHF data, we identified 36,285 and 1603 patients with incident RA/PsA, respectively. We estimated the burden of 31 multisystem comorbidities. Most disorders (N = 23, 74.2%) were more frequently coded among RA patients, while only liver diseases were significantly more prevalent in PsA. Chronic back pain (+21.2 pp) and osteoarthritis (+18.3 pp) were tied to the greatest absolute differences, likely mirroring medical contact patterns throughout the differential diagnostic process. Hospitalization due to heart failure and stroke, but not myocardial infarction, was more common in RA vs. PsA. Conclusions: Newly diagnosed patients with RA and PsA show distinct patterns of healthcare utilization for multiple organ disorders. Early RA may be tied to higher comorbidity rates not fully explained by age and sex, as compared to PsA; further studies are necessary to clarify these observations. Full article

Background: While pediatric obesity prevalence is rising, the association between ICD-coded obesity, healthcare resource utilization, and inpatient outcomes in middle-income countries remains poorly quantified. This study examined inpatient diagnostic patterns, resource utilization, and in-hospital mortality among hospitalized pediatric patients with ICD-coded obesity in Thailand’s Universal Coverage scheme during a 9-year period. Methods: We analyzed nationwide inpatient administrative data from January 2015 to December 2023 for children aged 1 month to <18 years. ICD-coded obesity was defined using ICD-10-TM codes recorded as either a principal diagnosis or a comorbidity. Outcomes included length of stay, hospital costs, and in-hospital mortality. Univariable and multivariable regression models were used to estimate associations between ICD-coded obesity and inpatient outcomes, with adjustment for age, sex, region, hospital level, admission year, and disease categories. Results: Among 14,483,566 hospitalized children, 42,168 had ICD-coded obesity. Notably, 95.7% of children with ICD-coded obesity were recorded as a comorbidity rather than the primary reason for admission. Children with ICD-coded obesity as a comorbidity had 156.8% higher median hospital costs. Across all major categories of common acute diseases (respiratory, intestinal, digestive), children with ICD-coded obesity had significantly higher median costs and longer length of stay compared to children without ICD-coded obesity. In regression analyses, ICD-coded obesity remained associated with longer length of stay (adjusted ratio, 1.21; 95% CI, 1.16–1.26; p < 0.001) and higher hospitalization cost (adjusted cost ratio, 1.42; 95% CI, 1.32–1.53; p < 0.001). The association with in-hospital mortality was observed in the unadjusted model but was attenuated after adjustment and was not statistically significant (adjusted odds ratio, 1.14; 95% CI, 0.89–1.45; p = 0.303). Conclusions: In Thailand’s national universal coverage scheme, ICD-coded obesity was associated with greater inpatient resource utilization, especially longer length of stay and higher hospitalization costs. These findings support the need for weight-aware inpatient management and adjusted funding models for hospitals treating this higher-resource-utilization subgroup. Full article

Background/Objectives: Although Clostridioides difficile infection (CDI) is a key cause of global morbidity and mortality, the burden of CDI in mainland China is not well-defined. The objective of this systematic literature review was to summarize the available epidemiologic evidence on the CDI disease burden (cases, hospitalizations, and deaths) in mainland China. Methods: Six databases (three global [PubMed, Embase, Cochrane] and three Chinese [Chinese National Knowledge Infrastructure, Chinese Science Citation, Wanfang]) were searched on 5 August 2025 using CDI-related and epidemiological search terms. No date or language limits were applied. Real-world epidemiologic studies of adults and/or children with laboratory-confirmed CDI in mainland China reporting population-based CDI incidence, hospital-based CDI incidence, and/or CDI admission rates were included. All studies not meeting these criteria were excluded. Risk-of-bias (RoB) assessment was performed using the Newcastle–Ottawa Scale. Results were summarized descriptively. Results: In total, 11 articles formed the evidence base for this review; each was a single-center, hospital-based study conducted in one of six cities in mainland China and published between 2014 and 2023. RoB assessment indicated that the evidence base was appropriate for this study. No study reported population-based CDI incidence. In total, 10 studies reported hospital-based CDI incidence (0 to 82.0/10,000 patient-days), and four reported CDI admission rates (0 to 23.1/1000 admissions). Eight studies reported mortality rates, which varied across studies. Conclusions: Several single-center, hospital-based studies demonstrate that CDI is present in hospitals in mainland China, but there are no published population-based CDI incidence estimates. These results should be interpreted considering this study’s limitations, including potential publication and selection bias, heterogeneity, and limited generalizability. Overall, the burden of CDI is poorly understood in mainland China. Thus, prospective epidemiological studies, including those with sensitive detection methods, are needed to examine CDI burden across multiple cities in mainland China. These efforts would help illuminate the CDI burden and guide prevention efforts. (PROSPERO ID 1140152; registered 17 March 2026; funding by Pfizer Inc.). Full article

Government-funded teacher education in China links financial support, teacher preparation, employment expectations, and post-graduation service obligations. Understanding how pre-service preschool teachers perceive this policy-based pathway is important for explaining their professional identity development; therefore, this study examined how policy satisfaction and perceived teacher support were associated with the professional identity of government-funded pre-service preschool teachers in Chongqing, Southwest China. Based on paper-based questionnaire data from 620 participants, Latent Profile Analysis identified four profiles: Dissatisfied–Low Support, Moderately Satisfied–Moderate Support, Highly Dissatisfied–Low Support, and Highly Satisfied–High Support. Multinomial logistic regression showed that only-child status and age significantly predicted profile membership, and one-way ANOVA and multiple regression further indicated that professional identity differed significantly across profiles, with lower scores observed in the less satisfied and less supported profiles after controlling for demographic covariates. These findings suggest that strengthening policy communication and accessible teacher support may help promote professional identity development among government-funded pre-service preschool teachers. Full article

Construction contract durations are fixed during procurement, yet delivery often changes after risks materialize and formal extensions of time are approved. Although delays, extension-of-time claims, change orders, and risk-based duration estimation are well studied, less is known about how contract-amendment records can be converted into duration multipliers for planning. This paper develops a quantitative, document-based Risk-Calibrated Duration Multiplier framework linking initially contracted duration, approved extensions, and documented risk causes. The framework was applied to 197 signed works contracts from 60 projects within a broader portfolio of 63 EU-funded water and wastewater infrastructure projects, predominantly administered under FIDIC Red and Yellow Book conditions. The analysis combined duration multipliers, impact-weighted attribution of multi-risk amendments, risk-time coefficients, bootstrap uncertainty assessment, concentration indicators, benchmark regression models, and reconstruction validation. For completed contracts, the mean multiplier was 1.372, with P50, P80, and P90 values of 1.233, 1.635, and 1.886. Public-law procedural and design risk categories accounted for 60.9% of the total extension premium. The results show that contract-amendment records can be transformed into statistically interpretable planning parameters and used as a portfolio learning and contract-governance tool for more realistic infrastructure contract planning. Full article

In December 2022, 196 nations around the world committed to protecting at least 30% of terrestrial and inland water areas and marine and coastal areas by 2030, one of the targets of the Convention on Biological Diversity’s Kunming-Montreal Global Biodiversity Framework. The ‘30 × 30’ target is one of the most ambitious conservation targets committed to at a global level, and some countries have also made policy commitments to achieve this target at a national level, including Australia. Australia is making progress towards this target, with 22.57% of Australia’s land already protected in 2024 (up from 7% in the mid-1990s), and support across federal, state and territory jurisdictions for a coordinated national approach. To protect at least an additional 57.2 million hectares of land to meet the 30% coverage target in an ecologically representative manner, clear pathways are required. This article makes the case for the most effective and efficient pathways for Australia to achieve its 30 × 30 ambitions, based on past successful science-informed policy and practice. Four key pathways are outlined. These are (1) establish a new dedicated AU$5 billion fund for the purchase of land of high biodiversity importance to create new public, private or Indigenous protected areas; (2) continue to support the creation of new Indigenous Protected Areas (IPAs) to meet Traditional Owner demand and establish secure long-term funding for IPA management; (3) increase support for the uptake of permanent conservation covenants on private and leasehold land through federal government support for covenant programs, particularly in ecologically under-represented bioregions, develop enhanced protection conservation covenants, and review federal and state tax and financial incentives and barriers to private land conservation; and (4) systematically review public land to identify areas of high conservation significance and subsequent protected area opportunities. Aspects of Australia’s past and potential future approach to meeting area-based protection targets could be useful for other nations as they aim to contribute to the global 30 × 30 target. Full article

In the pursuit of sustainable development, it is crucial to examine whether technological innovation (TI) creates equitable economic distribution or widens income inequality (II). The study aims to investigate TI’s impact on II in BRICS-T and BRICS PLUS-T countries within the context of the technological Kuznets curve (TKC). Along with TI, financial development is a driving force for economic development, and the research explores FD’s influence on II. To analyze these relationships while accounting for globalization (G), the method of moments quantile regression (MMQR) is used. The study’s findings validate the U-shaped TKC, suggesting that TI, in the initial stage, reduces II. However, beyond a certain threshold, TI² significantly widens II in both country groups. We found that the impact of TI on II was more pronounced in BRICS-T countries than in BRICS-PLUS-T countries, and the inclusion of newly added countries did not significantly affect the U-shaped relationship. Additionally, by enhancing financial inclusion, FD had a substantial and negative effect on II. In contrast, G, which concentrates wealth, was associated with higher II in both groups. This study offers a significant contribution by introducing the TKC in the context of BRICS-T and BRICS PLUS-T countries. Furthermore, the research contributes to the literature by evaluating the influence of FD and G within the context of TKC and applying novel MMQR. The study highlights a pathway to achieving the Sustainable Development Goals (SDGs 1, 7, and 10) and provides a policy framework for strategically allocating funds to technological advancements to reduce II. Full article

Trace water is one of the most critical matrix contaminants in ultra-high-purity (UHP) process gases, like argon (Ar), nitrogen (N₂), and many others. Even trace amounts can severely degrade the quality of many products that are reliant on these gases. Despite its importance to advanced technology sectors, notably semiconductor manufacturing, it has proven quite difficult to realize preparative or analytical trace water metrology over the full amount fraction range needed or in the broad spectrum of industrially relevant matrix gases. Within the EU-funded PROMETH2O project consortium, this challenge has been addressed through the development or significant improvement of traceable measurement methods and standards spanning 5 nmol⋅mol⁻¹ to 5 µmol⋅mol⁻¹, tailored for use in UHP process gas production, such as Ar, N₂ and clean dry air (CDA). The measurement ranges were extended and the uncertainties were improved while being consistent with the current best practice at primary humidity standard laboratories. The developed standards provide combined standard uncertainties ranging from approximately 0.4 % to 1.5 % in water vapor amount fraction and from 0.03 °C to 0.07 °C in frost-point temperature, while the comb-assisted CRDS system achieves detection limits in the sub-ppb to ppt range. These capabilities were validated in applications that are relevant to process instrumentation and the gas industry. A distributed metrological infrastructure at various European national metrology institutes and partner sites now provides SI-traceable trace water measurements in UHP gases, strongly supporting and extending the calibration capabilities for the gas and semiconductor industries and the associated stakeholders. Full article

Collagen is a key structural protein of the skin, essential for maintaining its mechanical strength, elasticity, and hydration. Oral collagen supplementation, particularly in the form of collagen peptides, has recently gained significant interest as a nutritional strategy to support skin health and overall wellbeing. However, the evidence regarding its effectiveness in supporting skin health and improving hair, nail, and wound-healing outcomes remains heterogeneous. The aim of this review is to summarize and critically evaluate the current human evidence on oral collagen supplementation and its potential role in supporting skin health, hair and nail quality, and wound healing. A targeted literature search was conducted using PubMed and Web of Science to identify clinical trials and relevant studies assessing the effects of collagen supplementation on skin aging parameters, including elasticity, wrinkles, hydration, and barrier function, as well as hair loss, nail disorders, and wound healing. Collagen-derived peptide supplementation has been associated with improvements in skin hydration, elasticity, wrinkle appearance, and dermal extracellular matrix organization, while also supporting hair thickness and strength, modestly enhancing nail growth, and promoting wound healing. Benefits are most consistent with low-molecular-weight hydroxyproline-rich peptides, with peptide characteristics appearing more important than collagen source. Evidence is limited by short study durations, heterogeneous designs, multi-ingredient formulations, and industry funding, which reduce confidence in the magnitude and consistency of the reported effects. Nevertheless, high-quality, long-term, independently funded trials with standardized outcomes are still required to confirm these findings. Full article

In the last 10 years, the global green bond market has reached an estimated value of USD 6.8 trillion. However, credibility concerns persist due to greenwashing risks and issues regarding the reporting system. The current measurement, reporting, and verification systems (MRV) have high uncertainty levels of 10–30%, and so they contribute to information asymmetries and fuel investor skepticism when allocating capital to green bond instruments. The scope of this study is to develop an integrated management approach that links air quality and greenhouse gas monitoring with financial incentives throughout the lifecycle of green bonds. The central contribution is a four-phase lifecycle model covering issuance, allocation, monitoring, and impact reporting, which systematically identifies where greenwashing risks and verification gaps arise across the investment cycle. Methodologically, the study combines qualitative content analysis, a novel Disclosure Quality Score (DQS) instrument, based on the Regulation (EU) 2023/2631, four documentary case studies, and an advanced verification framework. The content analysis shows that regulatory and market-performance studies dominate the literature, while integrated lifecycle verification frameworks remain less explored. The DQS uses eight indicators, applied to a matched sample of green bonds, in accordance with the European Green Bond Standard (EuGB) and the ICMA Green Bond Principles (GBP). The results demonstrate that bonds issued under the EuGB present higher disclosure quality (mean DQS = 15.4/16) compared to GBP-aligned bonds (mean DQS = 11.4/16). Case studies show strong issuance-stage disclosure, but weak post-issuance verification. The framework enables lifecycle-wide accountability by reducing information asymmetry. The proposed lifecycle framework and DQS instrument offer a replicable model for improving disclosure quality and ESG performance standards, with direct implications for sustainable investment screening and ESG fund selection. Overall, the findings show that improving green bond credibility requires moving beyond issuance-focused disclosure toward lifecycle-wide verification. Full article

The Canadian cancer care landscape faces rising cancer incidence, persistent inequities, and increasing system pressures. Led by the Canadian Association of Provincial Cancer Agencies (CAPCA), this scoping review applied an implementation science lens to evaluate the scalability of innovative cancer care models across Canada. Using a mixed-methods design, innovations were identified through a scoping review (n = 42), grey literature analysis (>50), a pan-Canadian survey (n = 72), and key informant interviews (n = 24). Guided by the Consolidated Framework for Implementation Research (CFIR), this review assessed feasibility, barriers, and facilitators influencing adoption and scale-up of identified innovations. Results revealed widespread adoption across various domains including virtual oncology, artificial intelligence (AI)-driven tools, and expansion of team-based care. At-home models, including home infusion, palliative care, and pharmacist-led chronic disease clinics, demonstrated improved access, patient satisfaction, and reduced hospital burden. CFIR mapping revealed cross-cutting facilitators including strong stakeholder engagement, structured training, and demonstrated patient benefits. However, persistent barriers include regulatory variability, funding instability, digital infrastructure gaps, and workforce capacity constraints. This paper highlights implemented innovations in cancer care and identifies strategic scaling opportunities needed to ensure all people living in Canada benefit from high-quality, person-centred equitable cancer care. Full article

Effectively harnessing the productive potential of local government debt while mitigating financial risks is critical for urban sustainable development. Focusing on the standardized development phase of local government debt in China, this study examines how local government debt affects green technological innovation using Chinese A-share listed firms from 2015 to 2021. We find that regulated explicit debt significantly promotes firms’ green innovation through three channels: green bond issuance, digital infrastructure investment, and improved firm profitability. In contrast, implicit debt exerts a nonlinear inhibitory effect, with significant negative impacts only after a threshold is exceeded. Heterogeneity analysis shows stronger effects in developed regions, areas with more optimized industrial structures, and state-owned, large, and high-ESG firms. Our findings suggest that optimizing debt structure and directing funds to productive green and digital sectors can effectively drive urban green innovation. Full article

Background/Objectives: Private dental markets operating under fee-for-service arrangements lack the structural accountability mechanisms that typically drive quality governance adoption in publicly funded systems. In Romania, where no private dental office currently holds formal accreditation, accreditation-seeking reflects a genuine behavioral choice rather than a regulatory compliance. This study examined whether financing structure and Professional Governance behavior operate as distinct determinants of accreditation-seeking intention among private dental practitioners and which pathway offers a more tractable entry point for quality policy intervention. Methods: A cross-sectional survey was conducted among 98 licensed private dental practitioners in Romania (November 2025–January 2026). Three domain composites were derived from a 31-item de novo instrument anchored in JCI, ANMCS, and EN ISO 9001:2015 standards: Professional Governance, Patient Rights and Ethics, and Patient Safety Behaviors. The financing profile was operationalized as engagement with the national public insurance system (CNAS). Binary logistic regression modeled high accreditation-seeking intention (Q31 ≥ 4) against standardized domain scores and financing engagement, with bootstrap confidence intervals from 2000 replicates. Results: Two predictors independently and significantly predicted high accreditation-seeking intention. CNAS engagement showed the strongest association (OR = 5.05, 95% bootstrap CI [1.87–17.91], and p = 0.003), while the Professional Governance score remained independently associated (OR = 2.68, 95% bootstrap CI [1.63–5.63], and p = 0.003). The Patient Rights and Ethics score was not significant. Practitioners actively exploring CNAS contracting showed the highest accreditation-seeking intention (exceeding that of established contractors), suggesting a possible transitional accountability dynamic during financing transition, though this interpretation requires prospective longitudinal validation. Model performance was good (AUC = 0.788; Nagelkerke R² = 0.339). Conclusions: Both financing engagement and governance behavior predicted accreditation-seeking intention after mutual adjustment, representing distinct pathways to voluntary quality adoption in private dental practice. Policy interventions aligned with entry into public contracting and with practice-level governance development are more likely to support accreditation uptake than normative appeals to professional ethics alone. Full article

Alcohol and psychoactive substance use disorders are major public health challenges in Poland. The COVID-19 pandemic affected both mental health and the organization of addiction treatment services. This study assessed changes in the utilization of publicly funded addiction treatment services in Poland before, during, and after the pandemic, with attention to regional differences. National Health Fund data from 2018 to 2023 were analyzed for alcohol use disorder treatment and treatment of other substance use disorders. Indicators included the number of patients, services provided, and total financial value of services. ANOVA, linear regression, and Pearson correlation analyses were performed. In 2020, the number of patients and services declined, particularly for non-alcohol substance treatment, followed by gradual recovery in 2021–2023. Significant regional differences were observed (p < 0.001), while differences between years were not significant. The financial value of services increased significantly over time, and strong positive correlations were found between patients, services, and costs. The pandemic temporarily reduced access to addiction treatment services in Poland. Although service utilization recovered over time, regional inequalities and increasing treatment costs persisted, highlighting the need to improve accessibility and resilience of addiction care systems. Full article

Background/Objectives: Health systems across Europe are increasingly challenged by population ageing, multimorbidity, and persistent inequities in access to care. Community Nursing has emerged as a promising approach to strengthening preventive, community-based services, yet evidence on stakeholder-perceived needs during early implementation remains limited. This study aimed to explore how different types of needs are perceived and articulated during the early implementation of Community Nursing in Austria. Methods: An interpretive descriptive qualitative study was conducted as part of an Austrian Community Nursing pilot project. Semi-structured interviews were carried out with eleven stakeholders, including informal caregivers, network partners (e.g., local healthcare providers), and local political decision-makers. Data were analyzed using qualitative content analysis, guided deductively by Bradshaw’s Taxonomy of Needs and complemented by inductive sub-category development. Interviews were conducted via telephone or video call (Zoom) and ranged from approximately 30 min to an hour. Results: Normative needs reflected expectations for preventive services, continuity of care, advocacy, and sustainable organizational structures. Felt needs centered on trust, emotional security, and relational continuity. Expressed needs became visible through active use of Community Nursing services, including preventive programs, transitional care support, and administrative navigation. Comparative needs highlighted geographic inequities and differences between municipalities with and without access to Community Nursing. Across stakeholder groups, concerns regarding long-term financing and sustainability were prominent. Conclusions: The findings suggest that Community Nursing addresses multiple stakeholder-perceived needs simultaneously, particularly by providing relational, accessible, and preventive support. However, sustained impact depends on stable funding and systemic integration beyond pilot phases. These results offer transferable insights for the development and scaling of community-based nursing models in ageing societies. Full article