Search Results (5,245)

Background: Given the increasing consumption of ultra-processed foods (UPFs) and the public health importance of cognitive decline in ageing, understanding how UPFs impact cognitive performance is highly relevant. However, evidence in older adults - particularly in Italy—remains scarce, despite the country’s rapidly ageing population, its comparatively low UPF intake, and its distinct Mediterranean dietary context. Methods: We analysed cross-sectional data from 809 community-dwelling adults aged ≥ 65 years (59.4% women) participating in the NutBrain population-based cohort. Dietary intake was assessed using a 102-item semi-quantitative food frequency questionnaire, and daily grams of foods were classified according to the NOVA system into groups, which were analysed using a compositional data analysis approach. Global cognition and domain-specific performance were measured using standardised neuropsychological tests. Associations between NOVA groups and cognitive outcomes were estimated using multiple linear regression models adjusted for potential confounders. Gender-stratified analyses were also performed. Results: UPFs accounted for 21% of total energy intake, with bakery products as the main contributors. A relative increase of unprocessed or minimally processed foods was associated with better cognitive function (B = 0.36, p = 0.014), whereas a greater contribution of UPFs relative to the overall diet was associated with worse global cognitive function (B = −0.26, p = 0.003). The strongest associations were observed for episodic memory, particularly among women. Conclusions: A higher relative consumption of UPF was associated with worse global and memory-related cognitive performance. Longitudinal and experimental studies are warranted to clarify causality and underlying mechanisms. Full article

In the context of SDG 7 and SDG 13 of the 2030 Sustainable Development Agenda, a new performance indicator has started to gain momentum in scientific research: renewable energy productivity. Understanding the drivers and the challenges of green energy productivity could help add on to the classical focus of renewable energy research on infrastructure, technical and economic feasibility, and environmental and social impacts, by considering the performance indicators in this field more. Only very few studies have explored the influencing factors of renewable energy productivity. Thus, this research aims to reveal the impact of social, economic, energy, and environmental variables on green energy productivity. The methodological approach involves bibliometric analyses of the literature on green energy productivity (GEP) and panel data regression models involving 16 independent variables. The main findings indicate positive effects of green taxes, female participation in the workforce, and highly educated people on GEP, pointing out the importance of green taxation, education, and gender equality in sustainable development. On the other hand, negative relationships of green energy productivity with economic growth, traditional energy variables, and air pollution were found for the European Union’s member states over 2007 and 2023. The results suggest that the analyzed European countries based their economic growth on traditional resources, with less importance given to renewable resources and green technologies, as the share of renewable resources of GDP was also negatively correlated. While private financial resources increase green energy productivity, questions about research and development investments, urbanization, and diversity index are still debatable. Full article

Background: Odontogenic keratocysts are developmental cysts of the jaws that often remain asymptomatic until they reach considerable size and are most frequently located in the mandibular angle and ramus regions. Due to their high recurrence potential, the optimal treatment approach remains controversial. The aim of this study was to evaluate treatment modalities associated with lower recurrence rates in odontogenic keratocysts. Material and Methods: Patients diagnosed with odontogenic keratocyst between 2000 and 2024 at the Department of Oral and Maxillofacial Surgery, Gazi University, were retrospectively evaluated. Associations between gender, age, lesion localization, histological subtype, treatment modality, and recurrence were analyzed. Statistical analyses were performed using SPSS for Windows (version 27). Results: A total of 291 cases were included, with an overall recurrence rate of 16.2%. The highest recurrence rate was observed in patients treated with enucleation (19.2%), whereas a lower recurrence rate was found in cases treated with marsupialization (5%). No recurrence was observed in patients who underwent resection. A statistically significant association was found between treatment modality and recurrence (p = 0.014). Conclusions: Treatment selection for odontogenic keratocysts should be carefully planned. In the present study, marsupialization was associated with a lower recurrence rate than enucleation in selected cases. However, because of the retrospective design and non-randomized treatment allocation, these findings should be interpreted with caution and should not be considered evidence of a causal relationship. Long-term clinical and radiological follow-up remains essential because of the potential for late recurrence. Full article

The selection of an appropriate occlusal pattern for prosthodontic and orthodontic rehabilitation remains a subject of ongoing debate within the scientific literature. A potential resolution to this controversy involves investigating the prevalence of various dynamic occlusal schemes in the natural permanent dentition. This cross-sectional study was designed to assess the typical dynamic occlusion patterns observed in both younger and older populations and to examine whether these patterns are influenced by age. The study included a total of 207 participants possessing natural dentition with no prosthetic restorations. The age of the individuals ranged from 15 to 73 years. Dynamic occlusal patterns were recorded in all participants through a clinical assessment of lateral and protrusive mandibular excursions guided by the teeth. Dynamic occlusion was categorized into five types: (O1) bilateral canine guidance, (O2) unilateral canine guidance, (O3) group function, (O4) balanced occlusion, and a category labeled “other occlusions” (O5). The overall distribution of occlusal patterns was similar between male and female participants. “The aim of this study was to evaluate the prevalence of dynamic occlusal patterns in subjects with natural dentition and to determine whether these patterns are associated with age.” Because occlusal wear accumulates throughout life, it was hypothesized that the prevalence of canine-guided occlusion would decrease with age, while group function occlusion would become more frequent. The study group consisted of 207 patients, 112 women (54.1%) and 95 men (45.9%), ranging in age from 15 to 73 years (mean = 32.79 ± 13.87). Informed consent was first explained to the participants, who then signed a consent form. We performed Pearson’s chi-square test to determine the association between demographic variables (gender and/or age) on the dynamic occlusion models (DINs) described above. The association between age groups and occlusal patterns was assessed using Pearson’s chi-squared test. The strength of the association was estimated using Cramer’s V coefficient. A p-value < 0.05 was considered statistically significant. The analysis using Pearson’s chi-squared test did not show a statistically significant association between age groups and dynamic occlusion patterns (χ² = 15.17; df = 12; p = 0.232). The effect size, assessed using Cramer’s V coefficient, was 0.156, indicating a weak association between the two variables. Although descriptive differences were observed in the distribution of some occlusal patterns among the age groups, these differences did not reach statistical significance. Full article

Background: Medication adherence is a major determinant of treatment effectiveness in psychiatric care and is influenced by patients’ attitudes toward medication and beliefs about treatment. Objective: This study aimed to evaluate medication adherence, drug attitudes, and beliefs about medicines, and to examine their relationships in the study population. Methods: A total of 300 participants were assessed using the Medication Adherence Rating Scale (MARS), Drug Attitude Inventory-10 (DAI-10), and Beliefs about Medicines Questionnaire (BMQ-General and BMQ-Specific). Descriptive statistics, independent-samples t-tests, Pearson correlation analyses, and multiple linear regression were performed. Results: The mean DAI-10 score was 3.57 ± 3.44, indicating an overall positive attitude toward medication, although 27.33% of participants had neutral or negative attitudes. The mean MARS score was 6.27 ± 2.24, suggesting moderate adherence. Mean BMQ-General and BMQ-Specific scores were 21.70 ± 5.81 and 31.64 ± 6.13, respectively. Significant gender differences were found across all scales. DAI-10 was positively correlated with MARS, while BMQ-General was negatively correlated with MARS. Multiple regression showed that DAI-10, BMQ-General, and BMQ-Specific significantly predicted MARS scores, explained 30.8% of variance after adjustment. Conclusions: Medication adherence was moderate and was significantly associated with treatment attitudes and beliefs about medicines. The findings support multidimensional assessment and targeted interventions addressing both positive attitudes and negative medication beliefs. Full article

Environmental sustainability has become a critical priority for higher education institutions, which play a key role in promoting awareness and shaping students’ perceptions of sustainable practices. Understanding students’ awareness and perceptions is essential for evaluating the effectiveness of institutional sustainability initiatives. This study aimed to assess students’ awareness and perceptions of environmental sustainability at Prince Sattam bin Abdulaziz University and to examine the influence of demographic factors and the relationship between awareness and perception. A quantitative cross-sectional survey was conducted among 323 university students. Data were collected using a structured questionnaire measuring environmental awareness (18 items) and perception of sustainability practices (14 items) on a 5-point Likert scale. Composite scores were computed as the means of item responses. Descriptive statistics, independent t-tests, one-way ANOVA, and multivariable linear regression analyses were performed. Students demonstrated a moderate level of environmental awareness (mean = 3.116 ± 0.403) and moderate perceptions of sustainability practices (mean = 2.887 ± 0.199). Environmental awareness was significantly higher among female students and those in science-related disciplines (p < 0.001). Perception of sustainability was significantly associated with field of study and level of study (p < 0.001). In multivariable analysis, gender and field of study remained significant predictors of awareness, while gender, field of study, and level of study predicted perception. A significant but negative association was observed between awareness and perception of environmental sustainability (B = −0.496, p < 0.001). While students demonstrated a moderate level of environmental awareness, perceptions of sustainability practices were inconsistent. The findings highlight the need for enhanced sustainability education and engagement initiatives within universities. Future research should explore how awareness and perception translate into meaningful engagement with sustainability practices. Full article

Aim: The aim of this study was to correlate single-nucleotide polymorphisms (SNPs) in the FTO and MC4R genes with body composition (BC) in populations with various levels of physical activity, and to investigate associations of SREBF1 methylation with the level of physical activity (PA) and BC. Methods: Fifty-six participants aged 18–65 years old with no underlying medical conditions were included in the study and were classified into sedentary/light PA (SLPA), moderate PA (MPA) and vigorous PA (VPA) groups using the International PA questionnaire (IPAQ). Anthropometric measures such as age, gender, body mass index (BMI) and body fat percentage (BFP) were recorded at the time of recruitment. Venous blood samples were collected during participant recruitment and DNA was extracted. Genotyping assays were performed for SNPs in FTO (rs9939609) and MC4R (rs17782313) using Taqman^® RT qPCR and TaqMan Genotyper software 1.7.1. Methylation analysis assay for CpG sites in the SREBF1 gene was performed on 56 samples using PyroMark^® Q48 Autoprep (Qiagen, Venlo, The Netherlands). The results were statistically analysed to identify any associations between FTO/MC4R genotypes and the level of PA, and between SREBF1 methylation status and the level of PA. This is the first study to investigate links between PA and quantitative methylation of SREBF1. Results: According to IPAQ guidance, the 56 participants were classified into SLPA n = 14, MPA n = 11 and VPA n = 31. The correlation analysis revealed that the FTO rs9939609 ‘A’ risk allele had a significant negative association with BFP in the VPA group (p = 0.0387); the MC4R rs17782313 ‘C’ risk allele had a significant positive association with BMI in the VPA group (p = 0.0256). In the SREBF1 pyrosequencing analysis, higher levels of methylation were observed in the VPA group (p = 0.07). Conclusions: We concluded that SNPs associated with obesity identified in FTO rs9939609 and MC4R rs17782313 could help to predict the molecular effects of PA. A high frequency of FTO risk variants in the cohort was observed and the VPA group could help maintain a healthy BFP. Full article

Background/Objectives: The Al Haouz earthquake that struck Morocco on 8 September 2023, resulted in substantial material, human, and psychological impacts. Children are at increased risk of psychological disorders, notably post-traumatic stress disorder (PTSD). This study aims to assess probable PTSD and its associated factors among children exposed to the Al Haouz earthquake. Methods: This cross-sectional study, conducted between December 2024 and January 2025, included 536 children from the affected areas. Probable PTSD was assessed using the 20 item Child and Adolescent Trauma Screen (CATS). Sociodemographic and exposure-related data, including post-earthquake conditions, were collected using a structured questionnaire. Data analysis was performed using SPSS software, version 25. Results: Analysis revealed that 47.6% of the children presented with probable PTSD. Multivariable analysis identified several factors independently associated with probable PTSD among children exposed to the earthquake, including age between 11 and 15 years (AOR = 2.02; p < 0.001), female gender (AOR = 1.82; p = 0.001), advanced level of education (AOR = 1.87; p = 0.006), housing damage (AOR = 2.08; p = 0.015), physical injury (AOR = 1.86; p = 0.012), proximity to the epicenter (AOR = 2.22; p = 0.006), temporary shelter in tents (AOR = 1.75; p = 0.02), difficulty of evacuation (OR = 1.97; p = 0.01), and loss of a family member (AOR = 1.98; p = 0.013). Conclusions: This study revealed a high frequency of probable PTSD in children exposed to the Al Haouz earthquake and identifies several associated factors, highlighting the need to targeted, multidimensional interventions. Full article

Background: Heart failure (HF) is a complex clinical syndrome, and its prognosis depends on many factors, including its etiology and the patient’s sex. We aimed to perform gendered evaluations on ischemic etiology’s impact on HF prognosis. Methods: Hospitalized patients and outpatients were enrolled in the Heart Failure Observational Study (HEROES), which is a prospective, multicenter cohort study, between April 2022 and January 2024. The primary endpoint was all-cause mortality. Results: Among 1410 patients included in the analysis (28.4% females and 71.6% males), 41.1% had ischemic HF etiology, and 58.9% had non-ischemic HF etiology. Ischemic etiology was identified in 28.5% of females and 46.0% of males; p < 0.001. The adjusted hazard ratio (aHR) was 1.16 (95% CI 0.85–1.58; p = 0.363) for all-cause mortality in the non-ischemic group relative to the ischemic reference category. The aHR for all-cause mortality in women relative to men was 1.14 (95% CI: 0.67–1.94; p = 0.633) for ischemic HF and 0.85 (95% CI: 0.56–1.27; p = 0.420) for non-ischemic HF. Conclusions: We found that ischemic and non-ischemic etiologies are associated with comparable all-cause mortality risk in patients with HF. Sex-stratified analyses revealed no significant mortality differentials between women and men within either etiologic category. Full article

Background and Objectives: Neurological complications of SARS-CoV-2 infection frequently impair patients’ long-term quality of life. This study aimed to identify clinical and laboratory risk factors—including inflammatory markers and micronutrients—for the occurrence or worsening of neurocognitive disorders in long COVID patients. Materials and Methods: In this prospective observational study, patients presenting with long COVID neurological manifestations were stratified by baseline MoCA score into two groups (≥23 and <23). Clinical, laboratory (inflammatory markers, 25-hydroxy vitamin D, vitamin B12, folic acid), and neuroimaging assessments (global cortical atrophy scale, Fazekas score) were performed over 24 months. Propensity score matching (PSM) for age, gender, and neurological comorbidities yielded 54 patients per group. Results: In the MoCA ≥ 23 group, significant predictors of cognitive decline included severe COVID-19 (OR = 2.211, 95% CI = 1.819–5.973, p = 0.012), autoimmune comorbidities (OR = 1.676, 95% CI = 1.191–2.390, p = 0.043), and elevated neutrophil-to-lymphocyte ratio (NLR; OR = 1.586, 95% CI = 1.431–2.122, p = 0.011). In the MoCA < 23 group, independent predictors were diabetes mellitus (OR = 3.021, 95% CI = 2.65–14.004, p = 0.016), autoimmune comorbidities (OR = 4.987, 95% CI = 1.412–6.033, p = 0.021), and NLR (OR = 5.944, 95% CI = 2.353–19.321, p = 0.015). Serum vitamin D levels were significantly associated with MoCA scores in both groups. Conclusions: COVID-19 severity, autoimmune comorbidities, NLR, and serum vitamin D represent key risk factors for neurocognitive decline in long COVID, highlighting potential targets for early intervention. Full article

Fish venom biology reaches far beyond addressing risks of human envenomation. The critical understanding of venom composition and the drivers that modulate it will enable scientists to deliver a span of novel bioresources with multiple potential biotechnological applications. The lesser weever fish (Echiichtys vipera), common in the surf of sandy beaches in Portugal, is a noteworthy case study due to frequent envenomation episodes during summer, albeit the lack of information regarding its venom system and the composition of its venom. We collected about one hundred animals from Costa da Caparica (W Portugal) as beach trawl (arte xávega) by-catch. Histology showed a similar essential microanatomical structure of glands in both venomous spines (dorsal and opercular) and no obvious gender differences. Transversal sections across the spines showed a T-shaped supportive bone structure that harbor masses of large, glandular cells that bear large sacculi. The structure is surrounded by a retractable layer of skin, thicker in the opercular spines comparatively to dorsal. The lack of muscular tissue near the glands and missing venom delivery ducts in the spines suggest that venom secretion in this species is holocrine, i.e., that venom is delivered through rupture of the skin and underlying glandular tissue upon mechanical pressure. Proteomics of the venomous spines (dorsal and opercular) showed a different proteomic signature between males and females, pointing to intersexual variation and suggesting that other biotic and abiotic factors might influence venom composition (maturation stage or geographic distribution). Additionally, protein homology matches performed against known toxins from marine venomous fishes indicated the presence of novel unexplored toxins in this species besides expected cytolysins. Our focus in the future is to identify, isolate and characterize the individual components of this venom. We anticipate new insights on the intraspecific adaptation of fish venom systems to specific ecological needs and advocate for sustainable bioprospecting for novel proteins with high biotechnological potential. Full article

Background: Adverse event reporting is a critical component of patient safety systems; however, nurses’ engagement in reporting is influenced not only by reporting procedures but also by broader organizational characteristics of the nursing practice environment. Although previous studies have examined reporting behaviors in various healthcare settings, limited evidence is available regarding how organizational factors influence nurses’ perceptions of adverse event reporting in post-Soviet primary healthcare systems. Objective: To examine the relationship between the nursing practice environment and nurses’ perceived benefits of adverse event reporting in primary healthcare settings in Kazakhstan and to explore the underlying factor structure of the nursing practice environment within this context. Methods: A cross-sectional survey was conducted among 468 primary healthcare nurses from six major cities in Kazakhstan. Participants were recruited through professional and educational networks using a targeted convenience sampling strategy. The nursing practice environment was assessed using the Revised Professional Practice Environment (RPPE) scale, while attitudes toward adverse event reporting were measured using the Reporting of Clinical Adverse Events Scale (RoCAES), focusing on the perceived benefits of reporting dimension. Exploratory factor analysis was performed to identify the underlying structure of the RPPE scale. Associations between EFA-derived factors and perceived benefits of adverse event reporting were examined using Spearman correlation analysis and multivariable logistic regression with adjustment for age, gender, city, and professional position. Results: Exploratory factor analysis identified three dimensions of the nursing practice environment: Professional Motivation and Teamwork, Interprofessional Conflict and Workplace Relationships, and Staffing Adequacy. Spearman correlation analysis demonstrated significant associations between all three factors and perceived benefits of adverse event reporting. Factor 1 (Professional Motivation and Teamwork) showed the strongest negative correlation with the outcome (r = −0.562, p < 0.001), followed by Factor 3 (Staffing Adequacy) (r = −0.434, p < 0.001), whereas Factor 2 (Interprofessional Conflict and Workplace Relationships) demonstrated a positive correlation (r = 0.227, p < 0.001). In the multivariable logistic regression model adjusted for age, gender, city, and professional position, Factor 1 was negatively associated with favorable perceptions of adverse event reporting (OR = 0.389, p < 0.001), whereas Factor 2 demonstrated a positive association (OR = 1.763, p = 0.002). Factor 3 and demographic variables were not statistically significant. Conclusions: The findings suggest that nurses’ perceptions of the benefits of adverse event reporting are influenced by multiple dimensions of the nursing practice environment. Exploratory factor analysis identified three organizational dimensions—Professional Motivation and Teamwork, Interprofessional Conflict and Workplace Relationships, and Staffing Adequacy—that were associated with reporting perceptions. After adjustment for demographic characteristics, Professional Motivation and Teamwork and Interprofessional Conflict and Workplace Relationships remained independently associated with perceived benefits of adverse event reporting, whereas demographic factors did not demonstrate significant associations. These findings highlight the importance of organizational conditions, communication processes, and professional engagement in shaping nurses’ attitudes toward adverse event reporting. Efforts to strengthen patient safety reporting systems should therefore extend beyond reporting procedures alone and include broader organizational strategies aimed at improving communication, teamwork, and supportive work environments within primary healthcare settings. Full article

Background: Carotid body tumors (CBTs) are rare neuroendocrine neoplasms whose hardness (soft vs. hard) correlates with surgical complexity and perioperative complications. This study aimed to identify predictive multimodal imaging biomarkers of CBTs’ hardness. Methods: This single-center retrospective cohort study included 82 patients with CBTs who underwent surgical resection. Preoperative multimodal imaging and clinical data were analyzed; tumor hardness was assessed via Masson-stained fibrous proportion. Multivariate logistic regression was performed to identify independent predictors. Results: The mean age of the 82 patients was 46 ± 13 years, including 37 males, with no significant intergroup differences in age or gender. Hard CBTs were associated with longer operative durations and a higher incidence of perioperative complications including pre-, intra-, and postoperative nerve and vascular injury. Multimodal imaging analysis revealed differences in signal homogeneity on T1WI and T1WI-CE sequences of MRI between soft and hard CBTs. The CBT-to-sternocleidomastoid muscle (SCM) value on T2WI (OR 0.329; 95% CI 0.151–0.591, p < 0.001) and the erosion of perivascular fat space (PFS) (OR 19.2; 95% CI 4.390–115.884, p < 0.001) were associated with the hardness of CBTs. ROC curve analysis demonstrated that an optimal cutoff value of 2.44 for the CBT/SCM ratio on T2WI predicted hard CBTs with a specificity of 100% and a sensitivity of 67.7% (PPV 100%, NPV 83.6%, AUC = 0.892). Conclusions: Preliminary findings suggest that CBT/SCM value on T2WI and PFS erosion are promising imaging biomarkers for predicting hardness. These parameters may facilitate preoperative risk prediction, though further prospective validation is required. Full article

This study aimed to examine variables associated with manipulation tendency levels in adults and to describe current patterns using a decision tree method as a classification-based analytical approach. The research sample consisted of 543 adults (358 women, 65.93%; 185 men, 34.07%) residing in Turkey, aged 18 to 45 years (M = 25.79, SD = 4.23). Data were collected using a researcher-developed personal information form, the Manipulation Scale in Human Relations, the Rosenberg Self-Esteem Scale, and the Relationship Scales Questionnaire. The total composite score of the Manipulation Scale was used as the outcome variable and is referred to throughout as “manipulation tendency.” Manipulation tendency scores were dichotomized into low versus high groups using a median split to facilitate C&RT-based classification. Classification and Regression Tree was used to examine the hierarchical structure of variables related to manipulation tendency levels and to identify classification patterns among study variables. The decision tree approach was used not merely as an alternative statistical technique, but as an interpretable classification framework capable of identifying hierarchical and conditional pathways associated with manipulation tendency. Data were stratified-randomly split into training and test sets (70/30), and tree complexity was tuned via cross-validation using cost-complexity pruning. Model performance indicated acceptable classification accuracy within this sample, with a test-set accuracy of 0.81 (sensitivity = 0.74, specificity = 0.88, precision = 0.86, F1 = 0.79) and training accuracy of 0.86. The findings indicated several influential variables in classifying manipulation tendency levels, ranked by importance: preoccupied attachment style, self-esteem, age, dismissive attachment style, gender, secure attachment style, and fearful attachment style. Preoccupied attachment style was identified as the most salient variable in differentiating between high and low manipulation tendency groups. The decision tree structure showed that younger adults with higher preoccupied attachment scores were more frequently classified into the high manipulation tendency group. Self-esteem emerged as the second most influential variable, with lower self-esteem levels being more commonly observed among individuals classified in the high manipulation tendency group. Age also played a notable role in classification, with higher manipulation tendency classifications occurring more frequently among younger individuals. Dismissive attachment style contributed to the differentiation of manipulation tendency levels, particularly within specific attachment and age profiles. Gender-related patterns indicated that men were more frequently classified into higher manipulation tendency groups, especially among individuals with low self-esteem. Overall, the findings highlight the multifactorial and hierarchical nature of manipulation tendency classifications. They contribute to the literature by showing how attachment-related characteristics, developmental factors, and psychological variables jointly differentiate manipulation tendency profiles. These findings highlight the value of decision tree modelling for translating conventional psychological predictors into interpretable classification profiles of manipulation tendency. Full article

We examine the association between Environmental, Social, and Governance (ESG) initiatives and corporate performance using a sample of 360 S&P 500 firms from 2010 to 2018. Employing MSCI ESG ratings and controlling for industry and time effects, we find that environmental initiatives positively associate with current profitability (ROA), while gender diversity correlates with long-term growth prospects (Tobin’s Q). This study moves beyond aggregated ESG metrics by providing a disaggregated analysis, revealing that different ESG dimensions affect performance through distinct financial mechanisms. To address common endogeneity concerns, we implement a rigorous empirical identification strategy, including propensity score matching, Heckman selection models, and instrumental variable approaches using industry-average instruments. Our results quantify the economic magnitude of these effects, demonstrating that a one-standard-deviation increase in environmental performance corresponds to a 0.92 percentage point increase in ROA, representing approximately $176 million in additional annual net income for the median firm. These findings provide theoretical advancement for the resource-based view and stakeholder theory by showing that specific ESG capabilities serve as valuable, inimitable resources. Ultimately, the study contributes standardized, high-resolution evidence on how specific ESG dimensions drive superior corporate performance. Through mechanism analysis, we show that environmental effects operate primarily via operational cost reduction and risk mitigation, while gender diversity creates value through enhanced innovation findings, which has direct implications for corporate ESG strategy. Full article