Search Results (4,873)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

Economic systems face critical challenges, including widening income inequality, unemployment driven by automation, mounting public debt, and environmental degradation. This study introduces Economocracy as a transformative framework aimed at addressing these systemic issues by integrating democratic principles into economic decision-making to achieve social equity, economic efficiency, and environmental sustainability. The research focuses on two core mechanisms: Economic Productive Resets (EPRs) and Economic Periodic Injections (EPIs). EPRs facilitate proportional redistribution of resources to reduce income disparities, while EPIs target investments to stimulate job creation, mitigate automion-related job displacement, and support sustainable development. The study employs a theoretical and analytical methodology, developing mathematical models to quantify the impact of EPRs and EPIs on key economic indicators, including the Gini coefficient for inequality, unemployment rates, average wages, and job displacement due to automation. Hypothetical scenarios simulate baseline conditions, EPR implementation, and the combined application of EPRs and EPIs. The methodology is threefold: (1) a mathematical–theoretical validation of the Cycle of Money framework, establishing internal consistency; (2) an econometric analysis using global historical data (2000–2023) to evaluate the correlation between GNI per capita, Gini coefficient, and average wages; and (3) scenario simulations and Difference-in-Differences (DiD) estimates to test the systemic impact of implementing EPR/EPI policies on inequality and labor outcomes. The models are further strengthened through tools such as OLS regression, and Impulse results to assess causality and dynamic interactions. Empirical results confirm that EPR/EPI can substantially reduce income inequality and unemployment, while increasing wage levels, findings supported by both the theoretical architecture and data-driven outcomes. Results demonstrate that Economocracy can significantly lower income inequality, reduce unemployment, increase wages, and mitigate automation’s effects on the labor market. These findings highlight Economocracy’s potential as a viable alternative to traditional economic systems, offering a sustainable pathway that harmonizes growth, social justice, and environmental stewardship in the global economy. Economocracy demonstrates potential to reduce debt per capita by increasing the efficiency of public resource allocation and enhancing average income levels. As EPIs stimulate employment and productivity while EPRs moderate inequality, the resulting economic growth expands the tax base and alleviates fiscal pressures. These dynamics lead to lower per capita debt burdens over time. The analysis is situated within the broader discourse of institutional economics to demonstrate that Economocracy is not merely a policy correction but a new economic system akin to democracy in political life. Full article

The rapid development of digital technology is reshaping the global economic landscape. However, its impact on firms’ capacity utilization rate (CUR), particularly through technological innovation, remains unclear. This study investigates this issue by developing an endogenous growth model that connects digital technology to CUR. The empirical analysis is based on data from Chinese A-share manufacturing firms. The methods employed include quantile regression, instrumental variable techniques, and various tests to explore underlying mechanisms. CUR is calculated using a special model that looks at random variations, and digital transformation is assessed using text analysis powered by machine learning. The findings indicate that digital transformation significantly enhances CUR, especially for firms with average capacity utilization levels, but has a limited effect on low- and high-end firms. Moreover, technological innovation mediates this relationship; however, factors like “double arbitrage” (involving policy and capital markets) and “herd effects” tend to prioritize quantity over quality, which constrains innovation potential. Improvements in CUR lead to enhanced firm performance and productivity, generating industry spillovers and demonstrating the broader economic externalities of digitalization. This study uniquely applies endogenous growth theory to examine the role of digital transformation in optimizing CUR. It introduces the “quantity-quality” technology innovation paradox as a crucial mechanism and highlights industry spillovers to address overcapacity while offering insights for fostering sustainable economic and social development in emerging markets. Full article

Contemporary muralism has gained increasing cultural and social relevance in recent years, becoming a prominent form of urban artistic expression. However, its outdoor exposure makes it highly vulnerable to environmental degradation, raising significant challenges for long-term preservation. While solar radiation is widely recognized as a main agent of deterioration, the impact of rainfall has received comparatively little attention. This study addresses this gap by evaluating the durability of commercial protective coatings applied to modern paints (alkyd, acrylic, and styrene-acrylic) under simulated rain exposure. The ageing protocol replicates approximately 10 years of cumulative rainfall in Central-Southern Europe. A key innovation of this research is the use of a custom-built rain chamber, uniquely designed to expose a large number of samples simultaneously under highly uniform and controlled rain conditions. The system ensures reproducible exposure through a precision-controlled moving platform and programmable rain delivery. A comprehensive set of analytical techniques was employed to assess morphological, chemical, and functional changes in the coatings and paints before and after ageing. Results highlight the limited performance of current protective materials and the need for more effective solutions for the conservation of contemporary outdoor artworks. Full article

The market for plant-based alternatives to animal foods has increased rapidly in the past decade, mainly due to consumer demand. Little evidence is available regarding nutritional impacts, drivers, and barriers to using these products as substitutes for animal foods in real-life conditions. This pilot study followed 16 Danish adults (30 ± 11 years old; 11 females) for 4 weeks with substituting milk, cheese, and yogurt with plant-based analogues to dairy (PBADs) and assessed their drivers and barriers to applying the intervention with a mixed-method approach. PBADs are constantly compared to their animal counterparts, both regarding product characteristics, such as price and sensory properties, as well as cultural roles and subjective memories. The mixed methods showed dairy attachment, price, and taste were the main barriers to consuming PBAD, while changes in life and social circles were drivers (qualitative data). As for the liking of PBADs, plant-based yoghurt was the preferred intervention product (73.5/100, p < 0.05), followed by plant-based drinks (65.9/100), while plant-based cheese was the lowest rated (47.9/100, p < 0.05). As for dietary changes, a lower average intake of sugars, saturated fatty acids, cholesterol, calcium, phosphorus, and zinc was observed after the intervention. Additionally, this study describes the attachment of the study population to milk and dairy products. It shows that choosing dairy is beyond nourishment but is connected to tradition, culture, pleasure, memories, and a sense of belonging. In contrast, there is no history or attachment to PBADs. Full article

Autism Spectrum Disorder (ASD) remains significantly underdiagnosed in women, resulting in a persistent gender gap with important clinical, functional, and psychosocial implications. This narrative review explores the multifactorial barriers contributing to diagnostic disparities, including the male-oriented structure of current diagnostic criteria, the prevalence of co-occurring psychiatric conditions, and the phenomenon of social camouflaging shaped by culturally reinforced gender norms. These factors frequently lead to delayed identification, clinical misinterpretation, and suboptimal care. The review synthesizes evidence from clinical, psychological, and sociocultural research to demonstrate how the under-recognition of ASD in women impacts mental health outcomes, access to education, occupational stability, and overall quality of life. Special emphasis is placed on the consequences of missed or late diagnoses for healthcare delivery and the educational needs of clinicians involved in ASD assessment and care. This article concludes with actionable, evidence-based recommendations for enhancing diagnostic sensitivity, developing gender-responsive screening strategies, and integrating training on female autism presentation into medical and allied health education. Addressing these challenges is essential to reducing diagnostic inequities and ensuring timely, accurate, and person-centered care for autistic women throughout their lifespan. Full article

This study evaluates the effectiveness of the B Impact Assessment (BIA) as a catalyst for integrating sustainability into industrial firms through a qualitative case study of LC Paper, the first B Corp-certified tissue manufacturer globally and a pioneer in applying BIA in the pulp and paper sector. Based on semi-structured interviews, organizational documents, and direct observation, this study examines how BIA influences corporate governance, environmental practices, and stakeholder engagement. The findings show that BIA fosters structured goal setting and the implementation of measurable actions aligned with environmental stewardship, social responsibility, and economic resilience. Tangible outcomes include improved stakeholder trust, internal transparency, and employee development, while implementation challenges such as resource allocation and procedural complexity are also reported. Although the single-case design limits generalizability, this study identifies mechanisms transferable to other firms, particularly those in environmentally intensive sectors. The case studied also illustrates how leadership commitment, participatory governance, and data-driven tools facilitate the operationalization of sustainability. By integrating stakeholder and institutional theory, this study contributes conceptually to understanding certification frameworks as tools for embedding sustainability. This research offers both theoretical and practical insights into how firms can align strategy and impact, expanding the application of BIA beyond early adopters and into traditional industrial contexts. Full article

Objectives: Diabetes Mellitus involves demanding challenges that interfere with family functioning and routines. In turn, family and social context impacts individual glycemic control. This study aims to identify this recursive interplay, the mutual influences of family systems and diabetes management. Design: Data was collected through a cross-sectional design comparing patients, aged 22–55, with and without metabolic control. Methods: Participants filled out a set of self-report measures of sociodemographic, clinical and family systems assessment. Patients (91) were also invited to describe their perception about disease management interference regarding family functioning. We first examined the extent to which family variables grouped dataset to determine if there were similarities and dissimilarities that fit with our initial diabetic groups’ classification. Results: Cluster analysis results identify a two-cluster solution validating initial classification of two groups of patients: 49 with metabolic control (MC) and 42 without metabolic control (NoMC). Independent sample tests suggested statistically significant differences between groups in family subscales- family difficulties and family communication (p < 0.05). Binary logistic regression shed light on predictors of explained variance to no metabolic control, in four models: Sociodemographic, Clinical data, SCORE-15/Congruence Scale and Eating Behavior. Furthermore, groups differ on family support, level and sources of family conflict caused by diabetes management issues. Considering only patients who co-habit with a partner for more than one year (N = 44), NoMC patients score lower on marital functioning in all categories (p < 0.05). Discussion: Family-Chronic illness interaction plays a significant role in a patient’s adherence to treatment. This study highlights the Standards of Medical Care for Diabetes, considering caregivers and family members on diabetes care. Full article

The Red River Jig is a traditional Métis dance practiced among Indigenous and non-Indigenous Peoples. While exercise improves physical health and fitness, the impacts of cultural dances on wholistic health are less clear. This study aimed to investigate the psychosocial (cultural and mental), social, physical function, and physical fitness benefits of a Red River Jig intervention. In partnership with Li Toneur Nimiyitoohk Métis Dance Group, Indigenous and non-Indigenous adults (N = 40, 39 ± 15 years, 32 females) completed an 8-week Red River Jig intervention. Social support, cultural identity, memory, and mental wellbeing questionnaires, seated blood pressure and heart rate, weight, pulse-wave velocity, heart rate variability, baroreceptor sensitivity, jump height, sit-and-reach flexibility, one-leg and tandem balance, and six-minute walk test were assessed pre- and post-intervention. Community, family, and friend support scores, six-minute walk distance (553.0 ± 88.7 m vs. 602.2 ± 138.6 m, p = 0.002), jump, leg power, and systolic blood pressure low-to-high-frequency ratio increased after the intervention. Ethnic identity remained the same while affirmation and belonging declined, leading to declines in overall cultural identity, as learning about Métis culture through the Red River Jig may highlight gaps in cultural knowledge. Seated systolic blood pressure (116.5 ± 7.3 mmHg vs. 112.5 ± 10.7 mmHg, p = 0.01) and lower peripheral pulse-wave velocity (10.0 ± 2.0 m·s⁻¹ vs. 9.4 ± 1.9 m·s⁻¹, p = 0.04) decreased after the intervention. Red River Jig dance training can improve social support, physical function, and physical fitness for Indigenous and non-Indigenous adults. Full article

Joint attention, the capacity of two or more individuals to focus on a common event simultaneously, is fundamental to human–human interaction, enabling effective communication. When considering the field of social robotics, emulating this capability might be necessary for promoting natural interactions and thus improving user engagement. Responding to joint attention (RJA), defined as the ability to react to external attentional cues by aligning focus with another individual, plays a critical role in promoting mutual understanding. This study examines how RJA impacts user engagement during human–robot interaction. The participants play a turn-taking game against a social robot under two conditions: with our RJA system active and with the system inactive. Auditory and visual stimuli are introduced to simulate real-world dynamics, testing the robot’s ability to detect and follow the user’s focus of attention. We use a twofold approach to evaluate the system’s impact on the user’s experience during the interaction. On the one hand, we use head pose telemetry to quantify attentional aspects of engagement, including measures of distraction and focus during the interaction. On the other hand, we use a post-experimental questionnaire incorporating the User Engagement Scale Short Form to assess engagement. The results regarding telemetry data reveal reduced distraction and improved attentional consistency, highlighting the system’s ability to maintain attention on the current task effectively. Furthermore, the questionnaire responses show that RJA significantly enhances self-reported engagement when the system is active. We believe these findings confirm the value of attentional mechanisms in promoting engaging human–robot interactions. Full article

Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. Methods: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, t-tests, and logistic regression were used for analysis. Results: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (t = 4.408, p < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. Conclusions: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs. Full article

The restrictions on business and social activity during the COVID-19 pandemic have led to significant changes in consumption patterns worldwide. Such changes are causing structural shifts in the markets of goods and services, thus affecting regional resilience. In this article, we aim to assess the changing structure of the consumption of goods and services in highly urbanized Russian regions under the impact of the COVID-19 pandemic and to analyze its effects on the lifestyle of the population. According to our results, some Russian regions demonstrate a return to previous consumption levels, while others exhibit the emergence of new dynamics. The conclusion is made that COVID restrictions have invoked a paradigm shift in consumer behavior toward investment in self-development, safety, and comfort. This observation should be taken into account when developing strategies for the recovery growth of regional economies. Full article

Monitoring water quality is crucial for achieving clean water and sanitation goals, particularly in remote areas. The project “Morbidity vs. Water Quality for Human Consumption in Tonosí: A Pilot Study” aimed to enhance water quality assessments in Panama using advanced analytical techniques to assess volatile organic compounds, heavy metals, and microbiological pathogens. To support this, the Technical Unit for Water Quality (UTECH) was established, featuring a novel mobile laboratory with cutting-edge technology for accurate testing, minimal chemical reagent use, reduced waste generation, and equipped with a solar-powered battery system. The aim of this paper is to explore the design, deployment, and impact of the UTECH. Furthermore, this study presents results from three sampling points in Tonosí, where several parameters exceeded regulatory limits, demonstrating the capabilities of the UTECH and highlighting the need for ongoing monitoring and intervention. The study also assesses the environmental, social, and economic impacts of the UTECH in alignment with the Sustainable Development Goals and national initiatives. Finally, a SWOT analysis illustrates the UTECH’s potential to improve water quality assessments in Panama while identifying areas for sustainable growth. The study showcases the successful integration of advanced mobile laboratory technologies into water quality monitoring, contributing to sustainable development in Panama and offering a replicable model for similar initiatives in other regions. Full article

Despite growing global momentum to reduce the number of children who never received a dose of any vaccine, i.e., zero-dose (ZD) children, persistent geographic and social inequities continue to undermine progress toward universal immunization coverage. In Madagascar, where routine vaccination coverage remains below 50% in most regions, the non-governmental organization Doctors for Madagascar and public sector partners are implementing the SOAMEVA program: a targeted community-based initiative to identify and reach ZD children in sixteen underserved districts in the country’s south. This paper outlines the equity-sensitive evaluation design developed to assess the implementation and impact of SOAMEVA. It presents a forward-looking evaluation framework that integrates both quantitative program monitoring and qualitative community insights. By focusing at the fokontany level—the smallest administrative unit in Madagascar—the evaluation captures small-scale variation in ZD prevalence and program reach, allowing for a detailed analysis of disparities often masked in aggregated data. Importantly, the evaluation includes structured feedback loops with community health workers and caregivers, surfacing local knowledge on barriers to immunization access and program adoption. It also tracks real-time adaptations to implementation strategy across diverse contexts, offering insight into how routine immunization programs can be made more responsive, sustainable, and equitable. We propose eight design principles for conducting equity-sensitive evaluation of immunization programs in similar fragile settings. Full article

This study presents the scientific and methodological foundation of Spain’s first national framework for the ethical management of community cat populations: the Action Plan for the Management of Community Cat Colonies (PACF), launched in 2025 under the mandate of Law 7/2023. This pioneering legislation introduces a standardized, nationwide obligation for trap–neuter–return (TNR)-based management of free-roaming cats, defined as animals living freely, territorially attached, and with limited socialization toward humans. The PACF aims to support municipalities in implementing this mandate through evidence-based strategies that integrate animal welfare, biodiversity protection, and public health objectives. Using standardized data submitted by 1128 municipalities (13.9% of Spain’s total), we estimated a baseline population of 1.81 million community cats distributed across 125,000 colonies. These data were stratified by municipal population size and applied to national census figures to generate a model-ready demographic structure. We then implemented a stochastic simulation using Vortex software to project long-term population dynamics over a 25-year horizon. The model integrated eight demographic–environmental scenarios defined by a combination of urban–rural classification and ecological reproductive potential based on photoperiod and winter temperature. Parameters included reproductive output, mortality, sterilization coverage, abandonment and adoption rates, stochastic catastrophic events, and territorial carrying capacity. Under current sterilization rates (~20%), our projections indicate that Spain’s community cat population could surpass 5 million individuals by 2050, saturating ecological and social thresholds within a decade. In contrast, a differentiated sterilization strategy aligned with territorial reproductive intensity (50% in most areas, 60–70% in high-pressure zones) achieves population stabilization by 2030 at approximately 1.5 million cats, followed by a gradual long-term decline. This scenario prioritizes feasibility while substantially reducing reproductive output, particularly in rural and high-intensity contexts. The PACF combines stratified demographic modeling with spatial sensitivity, offering a flexible framework adaptable to local conditions. It incorporates One Health principles and introduces tools for adaptive management, including digital monitoring platforms and standardized welfare protocols. While ecological impacts were not directly assessed, the proposed demographic stabilization is designed to mitigate population-driven risks to biodiversity and public health without relying on lethal control. By integrating legal mandates, stratified modeling, and realistic intervention goals, this study outlines a replicable and scalable framework for coordinated action across administrative levels. It exemplifies how national policy can be operationalized through data-driven, territorially sensitive planning tools. The findings support the strategic deployment of TNR-based programs across diverse municipal contexts, providing a model for other countries seeking to align animal welfare policy with ecological planning under a multi-level governance perspective. Full article