Search Results (16,205)

In the context of the global energy transition and a strengthening climate agenda, this study provides a comparative assessment of sustainable development strategies adopted by leading national oil and gas companies in China and Russia, focusing on their contribution to decarbonisation and SDG 7 and SDG 13. The study combines content analysis of corporate ESG reporting with a quantitative assessment of key environmental indicators. The analysis covers Gazprom, Rosneft, Lukoil, Novatek and Tatneft (Russia), and CNPC (PetroChina), Sinopec and CNOOC (China) over 2020–2024. The quantitative assessment includes Scope 1–2 greenhouse gas emissions, emissions intensity per unit of energy produced, operational energy consumption, renewable energy share, water intensity and green capital expenditures. The results reveal differences in national adaptation models: Chinese companies follow a centralised, state-driven approach integrated into strategic planning and five-year programmes, while Russian companies demonstrate a more fragmented, corporate-oriented model focused on technological modernisation. The strongest divergence is observed in governance integration and low-carbon investment structures, while emissions intensity trends remain gradual in both cases. Based on these findings, recommendations are proposed to strengthen sustainability and climate governance in Russian and Chinese oil and gas companies. The findings rely on self-reported ESG data, which involve differences in reporting boundaries and calculation methodologies. Full article

Background/Objectives: Sport-related concussion (SRC) elicits multi-systemic symptoms, including nausea, fatigue, and cognitive changes. Gastrointestinal (GI) symptoms are not well captured in current concussion assessments and may be under-recognised in clinical follow-up. GI disturbances may influence intake tolerance and day-to-day fuelling during post-SRC recovery. This study investigated the prevalence and severity of self-reported GI symptoms in Irish athletes after their most recent SRC, examined sex-based patterns, and evaluated the rationale for integrating GI symptom checks into standard concussion tools (e.g., SCAT6) and post-injury monitoring. Methods: An online survey was completed by recreational, competitive, and elite athletes who retrospectively self-reported concussion history, GI symptoms, and bowel function post-SRC and at the time of survey completion (ToSC; 0.03–216 months post-injury). The survey used the Bristol Stool Chart, Rivermead Post-Concussion Symptoms Questionnaire, and validated GI symptom measures. Descriptive statistics and chi-square tests examined timepoint- and sex-based differences. Results: A total of 106 athletes participated (55.7% female; mean age 26.4 ± 7.7 years), of whom 90.6% reported ≥1 GI symptom post-SRC, with greater severity observed for appetite loss, bloating, and abdominal discomfort. Bowel habits shifted bidirectionally for 42.5%, and 26.4% were experiencing ongoing symptoms at ToSC. Conclusions: Self-reported GI symptoms were common and appear under-recognised post-SRC. These findings support greater attention to GI symptom assessment and suggest that brief GI checks and facilitated access to nutrition advice where symptoms persist may be feasible within multidisciplinary, athlete-centred care. Prospective studies are needed to determine clinical relevance and to evaluate nutrition-related strategies. Full article

Background: Medical emergencies in dental practice are uncommon but may have serious consequences if not promptly recognized and managed. Dentists are expected to identify and initiate appropriate interventions during such events; however, the extent to which theoretical knowledge translates into clinical confidence and preparedness remains unclear. Methods: This nationwide cross-sectional survey evaluated dentists’ knowledge, attitudes, and preparedness regarding medical emergencies encountered in routine dental practice. A total of 300 dentists practicing in Türkiye completed two structured questionnaires: a scenario-based single-best-answer multiple-choice questionnaire assessing knowledge of medical emergencies and a Likert-scale questionnaire evaluating attitudes and clinical preparedness. Of the 450 dentists invited to participate, 300 completed the survey (response rate: 66.6%). Overall knowledge scores were calculated from 16 emergency scenarios, and participants were categorized into knowledge-level groups. Associations between knowledge, attitudes, and availability of emergency resources were analyzed using chi-square tests with effect size estimation. Results: The median overall knowledge score was 11 (IQR: 9–13). While high correct response rates were observed for commonly encountered emergencies such as syncope and intraoral bleeding, lower accuracy was noted for high-risk conditions including hypertensive crisis, anaphylaxis, and epileptic seizures. Only 40% of dentists reported feeling sufficiently competent to manage medical emergencies, and avoidance of treating high-risk patients was common. Higher knowledge levels and availability of emergency equipment and medications were significantly associated with greater self-perceived competence and reduced avoidance behavior. Conclusions: Although dentists demonstrate adequate theoretical knowledge of medical emergencies, significant gaps persist in clinical confidence, preparedness, and management of high-risk scenarios. Strengthening emergency preparedness in dental practice requires structured, hands-on training and improved access to essential emergency resources to ensure patient safety and support effective clinical decision-making. Full article

Background: Anorexia nervosa (AN) is a severe psychiatric disorder marked by restrictive eating, distorted body image, and high relapse rates. While cognitive-behavioral therapy (CBT) is a widely used treatment, its mechanisms of action in AN remain incompletely understood, particularly beyond self-reported symptom change. This study investigated the effects of a 12-week CBT intervention on both clinical and multimodal laboratory-based outcomes in women with restrictive-type AN. Methods: In a two-arm, pre–post randomized controlled trial (ClinicalTrials.gov: NCT07037017), 59 women with restrictive-type AN were randomized to a CBT intervention (n = 30) or no-treatment control (n = 29). A total of 50 participants (CBT: 26; control: 24) completed baseline and post-intervention assessments and were included in analyses. Outcomes included psychometric measures (eating disorder symptoms, depression, anxiety, body image-related obsessive–compulsive symptoms, and cognitive emotion regulation) and laboratory-based indices: electroencephalography (EEG), galvanic skin response (GSR), and eye-tracking during exposure to food- and body-related stimuli. Group × Time effects were analyzed using repeated-measures mixed-effects models, and statistical analyses were conducted using SPSS (Version 31; IBM Corp., Armonk, NY, USA). Results: Significant Group × Time interactions indicated greater improvements in the CBT group across all psychometric outcomes, including reduced eating disorder symptom severity (p < 0.001, η_p² = 0.28) and increased adaptive emotion regulation. CBT participants also showed significant reductions in EEG P300 and late positive potential (LPP) amplitudes to body-related stimuli, increased frontal alpha asymmetry, decreased visual fixation on salient body and food cues, and attenuated GSR reactivity (all p < 0.05). Exploratory correlations revealed that symptom improvements were associated with reductions in neurophysiological and attentional reactivity. Conclusions: To our knowledge, this is the first RCT in AN to demonstrate that CBT not only improves self-reported outcomes but also modulates neurophysiological and attentional processes implicated in the maintenance of the disorder. Multimodal laboratory assessments provided mechanistic insight into treatment effects and may inform personalized intervention strategies. CBT appears to facilitate recovery through both cognitive–emotional and physiological recalibration. Full article

Background: Multiple evanescent white dot syndrome (MEWDS) is usually acute and self-limited, whereas multifocal choroiditis (MFC)/punctate inner choroidopathy (PIC) is relapsing; overlap can obscure early diagnosis and requires longitudinal multimodal imaging. Methods: We report a 4-year follow-up of a 31-year-old woman with fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT), plus a systemic/neurologic/rheumatologic work-up. Treatment included intravenous methylprednisolone for presumed optic neuritis, followed by topical, periocular, intravitreal, and systemic corticosteroids, later escalated to adalimumab and an intravitreal dexamethasone implant. Because foveal granularity could not be documented, baseline was termed “MEWDS-like”. Diagnostic labelling was benchmarked against Standardization of Uveitis Nomenclature (SUN) criteria, and choroidal neovascularization (CNV) was assessed at each relapse by OCT and FA. Results: The right eye initially showed a MEWDS-like pattern with wreath-like FA lesions and disc leakage, hyperautofluorescent FAF lesions, focal ellipsoid zone disruption on SD-OCT, and multifocal ICGA hypofluorescent spots. A relapse at 6 months with peripapillary inflammatory foci and recurrent cystoid macular edema supported reclassification to a unilateral MFC/PIC-spectrum phenotype. At 2 years, the fellow eye developed mild vitritis, peripapillary hyperautofluorescence, peripapillary/arcade leakage on FA, delayed peripapillary filling on ICGA, and cystoid macular edema, establishing sequential bilateral MFC; no CNV developed and anti-vascular endothelial growth factor (anti-VEGF) therapy was not required. Complications included steroid-induced ocular hypertension and cataract surgery. Conclusions: The purpose of this report is to highlight longitudinal imaging “red flags” that supported reclassification from a MEWDS-like phenotype to a sequential bilateral MFC/PIC-spectrum disease. Full article

Objectives: Autism Spectrum Disorder (ASD) and psychotic disorders have long been considered separate diagnostic entities, yet increasing evidence highlights shared neurodevelopmental mechanisms and symptom overlap. Psychotic-like experiences have been frequently reported in individuals with ASD, while subthreshold autistic traits (ATs) in first-degree relatives may also confer vulnerability to psychotic symptoms. This cross-sectional study aimed to compare psychotic spectrum manifestations among adults with ASD, their first-degree relatives (BAP), and controls (HCs), to explore associations between psychotic and ATs, and to evaluate whether psychotic symptoms predict diagnostic group membership. Methods: 22 adults with ASD, 22 BAP, and 24 HCs were evaluated with the Psychotic Spectrum–Self Report (PSY-SR) and the Adult Autism Subthreshold Spectrum (AdAS Spectrum). Results: ASD participants scored significantly higher on the PSY-SR. BAP individuals showed higher PSY-SR total scores compared to HCs, though less severe than in ASD. All PSY-SR domains positively correlated with all AdAS Spectrum domains, with few exceptions. Multinomial regressions showed that higher PSY-SR total scores significantly predicted ASD and BAP membership, and that the PSY-SR Paranoid domain score specifically predicted inclusion in both groups in relation to HCs. Conclusions: Psychotic spectrum symptoms are elevated not only in individuals with ASD but also among first-degree relatives, supporting a continuum linking autistic and psychotic vulnerabilities. The strong association between paranoid symptoms and ATs highlights a dimension of potential clinical relevance for early identification and assessment. These findings reinforce shared neurodevelopmental pathways between the autism and psychosis spectra and underscore the importance of dimensional approaches across diagnostic categories. Full article

Peer victimization during preadolescence constitutes a significant public mental health concern, particularly for children with special educational needs (SEN). Family relational factors, and especially paternal acceptance–rejection, may influence children’s psychosocial adjustment and vulnerability to victimization. The present study examined the associations between perceived paternal acceptance–rejection, multidimensional self-perception, and peer victimization among preadolescents with and without SEN. A total of 660 students attending the final grades of Greek primary schools (553 without SEN; 107 with formally identified SEN) completed standardized self-report measures of peer victimization, perceived paternal acceptance–rejection, and self-perception domains. Separate path analyses were conducted for each group to examine direct and indirect relational pathways. Among children without SEN, perceived paternal hostility/aggression was directly associated with peer victimization and indirectly associated through behavioral conduct problems and lower school competence. In contrast, among children with SEN, the absence of paternal warmth and perceived paternal indifference/rejection were directly associated with victimization, whereas paternal hostility was not significantly associated, and self-perception did not function as a mediator. Model fit indices indicated excellent fit in both groups. These findings suggest distinct paternal relational mechanisms underlying peer victimization depending on SEN status. Interventions aimed at preventing victimization may benefit from incorporating father-focused family components alongside school-based strategies, with particular emphasis on emotional warmth and support for children with SEN. Full article

Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and defibrillation (BLS-D) skills. However, evidence on their level of knowledge, attitudes, and perceived preparedness remains limited in Southern Italy. Methods: A cross-sectional observational study was conducted between mid-December 2025 and 15 January 2026 among undergraduate healthcare students at the Magna Graecia University of Catanzaro (Italy). Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, CPR/AED knowledge, attitudes, and perceived confidence. Composite knowledge scores were calculated and categorized as poor, sufficient, good, or excellent. Statistical analyses included chi-square tests, Cramér’s V, and Spearman’s rank correlation. Results: A total of 604 students were included (mean age 24.4 ± 6.7 years; 69.9% female), of whom 46.4% reported prior BLS-D training. Knowledge levels were heterogeneous: myocardial infarction was widely recognized as a cause of cardiac arrest (81.1%), whereas recognition of non-shockable rhythms, including asystole and pulseless electrical activity, remained low (<25%). Procedural knowledge, particularly regarding the chain of survival and chest compression rate, improved with academic year and prior BLS-D training. Conversely, ventilation skills and correct AED pad placement were consistently inadequate. Attitudes toward CPR were largely positive; however, perceived confidence in performing resuscitation was moderate to low, especially in complex scenarios. More than 80% of students expressed strong interest in further training and supported mandatory BLS-D education. Conclusions: Healthcare students demonstrated favorable attitudes toward CPR but insufficient and uneven knowledge, particularly in rhythm recognition, ventilation, and AED use. Academic progression and structured BLS-D training were associated with improved competencies, although critical gaps persisted. Integrating mandatory, hands-on BLS-D training with regular refresher sessions into healthcare curricula should enhance preparedness and potentially reduce OHCA-related mortality, especially in high-risk regions such as Calabria. Full article

Aesthetic medicine has progressed from the early 2000s fascination with bio-stimulation to the current dominance of hyaluronic acid (HA) fillers, prized for immediate, predictable, and reversible volumizing effects. Recently, demand for more natural results, stronger emphasis on skin quality, and increased post-pandemic self-scrutiny have renewed interest in regenerative strategies, sometimes called the “second wave of bio-stimulation.” This trend highlights the need for clearer terminology and a cautious, evidence-based reading of proposed biological mechanisms. This narrative review proposes a framework in which bio-regeneration denotes a hypothesized, controlled induction of physiological processes, fibroblast activation, collagen and elastin synthesis, extracellular matrix remodeling, and immune modulation, potentially producing sustained improvements in dermal structure and function beyond simple filling. Among emerging technologies, polyethylene glycol diglycidyl ether (PEGDE) cross-linking is reported to create a stable, flexible HA scaffold with homogeneous tissue integration, favorable rheology, thermal stability, and a reduced inflammatory profile, supporting safer multimodal use with energy-based devices. The framework is illustrated with PEGDE-crosslinked HA combined with low-concentration calcium hydroxyapatite (CaHA), exemplified by a PEGDE-HA filler containing CaHA microspheres plus glycine and L-proline. These formulations aim to deliver immediate correction via HA and delayed stimulatory effects possibly driven by gradual CaHA exposure and macrophage-associated signaling. Available clinical, imaging, and histological observations, including prospective ultrasound and biopsy assessments, suggest progressive dermal thickening and predominant type I collagen expression, without pathological inflammation or granuloma formation. Although evidence remains preliminary and largely non-comparative, findings are compatible with controlled remodeling and resolving inflammation; however, the underlying mechanism and any ‘regenerative’ versus ‘reparative’ classification require controlled comparative studies. Full article

Background: Childhood and adolescence represent a critical period for shaping long-term dietary habits, including whole grain consumption, which remains low despite well-documented health benefits. Objective: This cross-sectional study (November–December 2024) examined Slovenian adolescents’ attitudes toward whole-grain foods in the context of organized school meals. Methods: Participants aged 10–12 years and 14–19 years (N = 501; mean age 15.6 ± 2.6) completed an online questionnaire assessing knowledge, self-reported consumption frequency, preferences, motivational factors, and food neophobia using the translated Italian Child Food Neophobia Scale (ICFNS). Based on ICFNS scores, participants were classified as low (≤17), medium (18–24), or high (≥25) in food neophobia. Results: Older adolescents demonstrated better knowledge of whole-grain health benefits; however, greater knowledge was not associated with higher self-reported consumption. Food neophobia was strongly associated with lower consumption frequency and reduced willingness to try whole-grain foods, including whole-grain bread, oatmeal, buckwheat porridge and brown rice. Across all groups, taste was the most consistent motivator for trying whole-grain foods. Older adolescents prioritized health and appearance as key reasons for eating more whole grain foods. Conclusions: Findings suggest that improving taste, increasing exposure, and leveraging institutional settings such as schools, where availability, preparation, and social cues can be managed, may be effective in promoting whole-grain food consumption. Full article

Physically Active Learning (PAL) integrates physical activity into classroom teaching and has been shown to benefit students’ cognitive, social, and academic outcomes. Despite these advantages, PAL is not yet sustainably implemented in everyday school practice, highlighting the need for effective professional development (PD) formats for teachers. This randomized controlled experimental study examined how different PD formats, varying in their mode of engagement with ready-to-use PAL materials, affect teachers’ motivation, professional competence, and implementation of PAL. A total of 153 in-service primary teachers participated in a 2.5 h PD training and were randomly assigned to one of three formats: example-based learning, experience-based learning, or problem-solving. Data were collected at pre-test, post-test, and a six-week follow-up using standardized questionnaires. Results showed that teachers in the experience-based format reported significantly higher motivation during the PD training than those in the other formats. Across all formats, attitude and self-efficacy regarding PAL increased over time, whereas no significant gains in knowledge were observed. No significant differences between PD formats regarding overall implementation of PAL were observed. Exploratory analyses indicated a potential advantage of the experience-based format. Overall, the findings suggest that immersive, experience-based PD formats may be particularly effective in fostering teachers’ motivation. Full article

Background and Objectives: While associations between attachment styles and certain dermatologic conditions have been documented, their role in chronic pruritus remains unexplored. Given the significant psychosomatic component in the etiology of chronic pruritus, this study aimed to assess attachment styles in patients with chronic pruritus in the absence of organic or psychiatric disorders and to examine their potential contribution to its development. Methods: Sixty patients with chronic pruritus were compared with a healthy control group (n = 60). Socio-demographic data, the duration of the disease, and the itch severity were noted. Additionally, assessments performed via the Questionnaire of Relation Scale, Questionnaire of Relation, Hospital Anxiety and Depression Scale, General Health Questionnaire, and Dermatology Life Quality Index (DLQI). Results: Statistically higher scores of fearful, dismissive, and preoccupied attachment styles were observed in the patient group compared to the control group. Among patients, those with moderate to high itch severity had higher mean scores of anxiety and preoccupied attachment than those with low itch severity. In contrast, secure attachment scores were significantly higher in the control group than in the patient group. Limitations: Attachment styles were examined with a self-report instrument without stimulated recall procedures. Conclusions: Our findings clearly demonstrate that patients with chronic pruritus exhibit significantly higher levels of insecure attachment styles alongside elevated anxiety, depression, and psychosocial burden. Notably, the association between preoccupied attachment and greater itch severity highlights how emotional dysregulation may intensify pruritus symptoms. Due to limited research directly examining attachment in chronic pruritus, our study provides novel insight and supports a biopsychosocial approach to care. Full article

Purpose: This study systematically reviews research on six emerging technologies in external auditing, Big Data, Blockchain, Machine Learning, Deep Learning, Artificial Intelligence (AI), and Robotic Process Automation (RPA), to clarify what is currently known and to identify where the main gaps remain. Rather than treating each technology in isolation, this study brings them together under a single integrative review to provide a consolidated reference point for scholars assessing their impact on external audit practices. Design/Methodology/Approach: Following a structured systematic review protocol, searches were conducted in Scopus, ScienceDirect and SpringerLink (2000–2024) using technology-related keywords combined with “audit”, “auditor” and “auditing”. After applying explicit inclusion and exclusion criteria, 471 records were reduced to 32 ABS-listed journal articles, which were analysed thematically. Findings: The review shows that research on emerging technologies in external auditing is still fragmented, with substantial variation in the depth and maturity of evidence across the six technologies. The strongest empirical base is concentrated in Big Data analytics and ML-based predictive models (including more advanced Deep Learning variants), whereas Blockchain and RPA work remains predominantly conceptual or confined to small-scale design-science implementations. Across technologies, most studies are single-country and either rely on auditors’ self-reported perceptions of adoption and impact or evaluate model performance without tracing effects on audit strategies and engagement outcomes, which limits external validity and construct measurement. Very few articles explicitly integrate the Audit Risk Model or other formal theories, and almost no work examines multi-technology “audit stacks” or generative AI, leaving substantial gaps in understanding how these tools jointly reshape inherent, control and detection risk across the audit cycle. Originality/Value: By integrating six technologies within a single external audit framework, the review offers a technology-specific evidence map and a targeted future research agenda that can guide scholars, audit firms and regulators in designing studies and policies aligned with actual gaps in the current literature. Full article

Background/Objectives: Primary dysmenorrhea is a common menstrual condition that significantly affects women’s daily functioning and quality of life. Although physiotherapy has been shown to reduce menstrual pain, the awareness of these methods in Saudi Arabia remains unclear. This study aimed to assess women’s awareness and experiences of physiotherapy methods for managing primary dysmenorrhea in Saudi Arabia. Methods: A cross-sectional online survey was conducted among women living in SA between 16 and 28 February 2024. The questionnaire collected information on six sections including on sociodemographic characteristics, menstrual history and pain severity, work-related impact, pain-management practices, healthcare utilisation, and awareness and use of physiotherapy modalities. Convenience sampling was employed, and participation was voluntary and anonymous. Descriptive data analysis was performed using SPSS software. Results: A total of 431 women participated; most were Saudis (91.9%) and aged 18–24 years (43.2%). Primary dysmenorrhea was reported by 86.5% of participants. More than half (58%) had used at least one physiotherapy-related method, mainly heat, massage, or exercise, and 55.2% considered these methods effective. However, most relied on basic home strategies rather than structured physiotherapy interventions. Additionally, 60.8% expressed willingness to use physiotherapy in the future. Conclusions: Despite the frequent use of simple home-based methods, structured physiotherapy interventions remain underutilised. Increasing public education, improving access to physiotherapy services, and integrating self-management guidance and telerehabilitation into women’s health programmes may enhance menstrual pain management and overall quality of life. Full article

Precarious and informal employment has been increasingly recognized as a key social determinant of health, particularly in countries of the Global South. In Chile, despite relatively strong labor institutions, informal employment remains widespread, yet contemporary evidence on its health implications is limited. This study examines the association between the absence of a written employment contract, used as an indicator of labor informality, and multiple health and well-being outcomes among employed adults in Chile. A cross-sectional analysis was conducted using data from the nationally representative 2022–2023 National Health and Sexuality Survey (ENSEX), restricted to the urban employed population (n = 5193). Informal employment was defined by self-reported absence of a written contract. Health outcomes included perceived general health, quality of life, physician-diagnosed conditions, and recent anxiety–depressive symptoms assessed with the PHQ-4. Weighted descriptive analyses and logistic regression models were estimated, accounting for the complex survey design and adjusting for sex, age, and educational level. Approximately 12.8% of employed individuals reported not having a written contract. Contract absence was associated with higher odds of anxiety–depressive symptoms and lower odds of reporting good quality of life after adjustment. Associations with general health and chronic physical conditions were weaker and not statistically significant. These findings suggest that contractual informality is particularly linked to reduced psychological well-being and quality of life, highlighting the relevance of informal employment as a public health concern beyond traditional disease outcomes. Full article