Search Results (38)

Background/Objectives: Febrile illness in returning travelers presents a diagnostic and operational challenge for emergency medicine clinicians as early symptoms of high-consequence tropical infections often overlap with common viral syndromes. This review synthesizes current evidence to guide frontline clinicians in the systematic evaluation, diagnosis, and management of internally acquired febrile illnesses with a focus on pathogen of greatest relevance to United States (US) emergency departments (ED). Methods: We conducted a narrative review of the literature addressing epidemiology, clinical presentation, diagnostic testing, and management strategies for key travel-associated infections. Special consideration was given to rapid diagnostic modalities, pediatric risk factors, and infections most frequently implicated in returning travelers, including chikungunya (CHIK), dengue virus (DENV) disease, Ebola virus (EBV) disease, malaria, Mpox, typhoid fever (TF), yellow fever (YF), and Zika virus (ZIKV) disease. Results: Effective evaluation begins with a detailed travel and exposure history, recognition of epidemiologic and clinical red flags, and targeted use of rapid diagnostic tests. Malaria remains the most common life-threatening cause of post-travel fever and the only pathogen with reliable Food and Drug Administration (FDA)-cleared rapid testing available in the ED. Arboviral infections such as DENV, CHIK, ZIKV, and YFrequire region-specific consideration and phase-appropriate molecular or serologic evaluation. Emerging and high-consequence pathogens, including Mpox and EBV, necessitate strict infection control measures and coordination with public health authorities. Pediatric travelers, particularly those visiting friends and relatives, face disproportionate risk for severe systemic infections and often require broader diagnostic testing. Conclusions: A structured approach integrating travel history, focused examination, rapid diagnostics, and early recognition of high-risk features is essential to improving outcomes for febrile returning travelers. Strengthened vector control, enhanced vaccination uptake, and global surveillance are critical to reducing future disease burden. Full article

Background/Objectives: Psilocybin has re-emerged as a promising intervention for neuropsychiatric disorders including major depressive disorder, treatment-resistant depression, anxiety associated with life-threatening illness, obsessive compulsive disorder, and substance use disorders. However, conventional randomized controlled trials (RCTs)—the current gold standard in evidence-based medicine—may not adequately capture the therapeutic complexity of psilocybin, which depends not only on pharmacological action but also on contextual, psychological, and interpersonal factors. This critical narrative review aimed to evaluate the adequacy of existing clinical research frameworks for assessing psilocybin’s therapeutic potential and to explore alternative methodologies that may better reflect real-world clinical conditions. Methods: Using the Web of Science Core Collection database, we identified and analysed the ten most cited clinical studies on psilocybin published between 2015 and 2025 inclusive. Additional literature was included through reference cross-checking, systematic reviews, meta-analyses, and interdisciplinary sources covering neurobiology, history, and real-world evidence (RWE). The review synthesizes clinical outcomes, methodological constraints, and epistemic considerations relevant to psychedelic-assisted therapy. Results: Evidence from highly cited trials demonstrates rapid and sustained antidepressant and anxiolytic effects of psilocybin, with notable benefits also observed in addiction treatment. However, significant methodological limitations were identified, including selection bias, challenges in placebo design and blinding, small sample sizes, and the underrepresentation of diverse populations. Psilocybin outcomes were strongly influenced by subjective experience and contextual factors such as set and setting. Emerging RWE studies revealed heterogeneous patterns of response and provided insights unattainable through RCTs alone. Conclusions: Psilocybin shows considerable therapeutic promise, but current RCT methodologies capture only part of its clinical effects. Comprehensive evaluation will require larger and more diverse clinical trials, long-term follow-up, standardized psychotherapeutic protocols, and the integration of RWE to reflect real-world practice. Psychedelic-assisted therapy should be conceptualized as a complex intervention that combines pharmacological and psychotherapeutic components. Full article

Background/Objectives: This article is a narrative review that examines the development of attachment from intrauterine life to the first thousand days of a child’s life, integrating psychoanalytic, neuroscientific, genetic, and cross-cultural perspectives. Biological, relational, neurological, and cultural factors interact and shape individual differences in socio-emotional functioning. This paper aims to propose a reinterpretation of early attachment, describing it as both a clinical and relational phenomenon and an adaptive process inscribed in human evolutionary history, according to the Four-Domain Integrative Framework described herein. Methods: The review examined three main areas of evidence: early attachment characteristics, cross-cultural caregiving variations, and genetic and epigenetic mechanisms underlying environmental sensitivity. Results: The review first identified seven characteristics of early attachment (proximity seeking, emotional attunement, intrauterine experiences, maternal holding, security patterns, brain plasticity, and maternal stress) which represent developmental mechanisms that generate individual differences in trust, self-regulation, resilience, and psychopathological vulnerability. Second, cross-cultural variations in six distinct caregiving contexts were examined, demonstrating that secure attachment emerges through culturally specific pathways, differentially influencing motor development, sleep patterns, hypothalamic–pituitary–adrenal axis maturation, and social skills. Finally, the differential susceptibility model was provided through the analysis of five genetic and epigenetic systems (oxytocin receptor gene, serotonin transporter gene, dopamine receptor gene, glucocorticoid receptor methylation, and fetal programming) that modulate environmental sensitivity. Conclusions: Biological, relational, neurological, and cultural factors interact and shape individual differences in socio-emotional functioning. Full article

This article investigates narrative and storytelling as critical methods for understanding how relationships with land in Aotearoa New Zealand are shaped by colonial histories and ongoing systemic displacement of Māori (Indigenous peoples of Aotearoa). Colonialism is not a past event; it continues to structure daily life, disrupting our embodied connections to whenua (land) and reshaping what we call home. Drawing on the research project Tō mātou kāinga, tō mātou ūkaipō, Whānau conceptions of home we explore the concept of body–land, emerging from Indigenous women’s struggles and grounded knowledges, to examine how the land is not only a living genealogical ancestor but also a maker of our bodies and identities. Through narrative, we trace the ways land has been taken and commodified under colonial logics that frame it as property to be owned and extracted from, which contrasts with Indigenous ontologies that understand land as kin and relationality as central to existence. By centering Māori women’s embodied experiences, this article articulates home as a relationship rather than a fixed place and considers how these understandings open pathways toward relational, sustainable futures. This work contributes to broader conversations on decolonial praxis, Indigenous feminist theory, and the embodied politics of land and belonging. Full article

Background: Children’s development is dependent on a range of factors influencing their life course outcomes. Protective and challenging social and cultural determinants impact how Indigenous families support their children’s developmental foundations. However, there is a lack of international evidence investigating Indigenous child development interventions. To gain a perspective across nations with comparable settler-colonial histories, this scoping review summarised studies on family and community-centred approaches among Indigenous populations in Australia, Canada, New Zealand, and the United States, focusing on outcomes and evidence gaps. Methods: A scoping review followed PRISMA-ScR guidelines. Medline, CINAHL, and PsycINFO (Ovid) were searched from their inception to October 2025, including grey literature sources from Aboriginal HealthInfoNet, the Lowitja Institute and the Secretariat of National Aboriginal and Islander Child Care. Empirical studies, including quantitative, mixed-methods, evaluation studies, and descriptive or case-study designs, were included provided they reported empirical data on intervention outcomes. Due to study heterogeneity, data were synthesised narratively. Results: Following screening of 2355 records, eight from 2013 to 2020 met the inclusion criteria. These were mostly small-scale, non-randomising designs evaluating different interventions, with the behavioural and emotional domain being the most frequently assessed outcome, alongside developmental vulnerability and academic/educational areas. There was limited consideration of protective cultural determinants of health in the study design and implementation. Six studies reported positive associations between interventions or programmes and early childhood development outcomes. Conclusions: While the number and rigour of identified interventions were limited, several demonstrated potential benefits for Indigenous children’s early childhood development. However, strengthening the evidence base requires culturally grounded, adequately powered evaluations using rigorous study designs that include culturally co-designed adaptations conducted with Indigenous families and communities. Support is recommended for capacity building and funding. Full article

Background/Objectives: Workplace violence (WPV) is a major occupational concern in psychiatric settings, where mental health nurses (MHNs) are consistently identified as a high-risk professional group. Within this context, sexual violence (SV) remains understudied as a distinct phenomenon and is often embedded within aggregated measures of WPV. This systematic review aimed to synthesize the available evidence on SV against MHNs working in inpatient settings by: (1) describing its prevalence, forms, and characteristics; (2) examining psychological, occupational, and physical outcomes; and (3) identifying associated risk factors. Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251103606). A literature search was performed across PubMed, CINAHL, Scopus, Web of Science, and PsycInfo, supplemented by reference list checking and citation tracking. Peer-reviewed quantitative and qualitative studies published in English or Italian were eligible if they involved MHNs working in inpatient settings and addressed SV. Study selection, data extraction, and risk-of-bias assessment were conducted independently by two reviewers. A narrative synthesis following SWiM guidance was undertaken, and the certainty of evidence for statistically significant outcomes was assessed using the GRADE approach. Results: Twenty-five studies published between 2003 and 2025 were included. Definitions of SV varied substantially. Reported prevalence ranged from 0% to 68%, with verbal sexual harassment ranging from 19.5% to 53.4%, physical sexual harassment ranging from 14% to 42.9%, and sexual assault up to 18.6%. Evidence indicated associations between SV exposure and poorer quality of life, burnout, and days lost from work. The main risk factors included gender, age, education, work experience, employment type, acute psychiatric settings, night shifts, normalization of violence, and history of physical and sexual violence. Conclusions: SV against MHNs represents a relevant issue in psychiatric settings. Findings suggest significant psychological and occupational consequences. Standardized definitions and measurement, longitudinal research, and intervention studies are needed to inform effective prevention strategies and organizational responses. Full article

Background: Thoracic endovascular aortic repair (TEVAR) has evolved the management of descending thoracic aortic disease, but neurological complications—particularly spinal cord ischemia (SCI), stroke, and postoperative delirium—remain among the most feared adverse events, adversely affecting survival, quality of life, and functional independence. Objectives: The aim of this study was to provide a contemporary narrative synthesis (2000–2025) of the incidence, mechanisms, risk factors, prevention, and management of neurological complications after TEVAR, emphasizing how current evidence supports individualized and risk-adapted strategies for prevention and management. Methods: A narrative, non-systematic search (PubMed/MEDLINE, Scopus, Cochrane Library; 2000–2025) was conducted using terms related to TEVAR, SCI, cerebrovascular events, delirium, and cognitive dysfunction. Priority was given to large registries, cohort studies, and systematic reviews in adult TEVAR populations. Results: Perioperative stroke occurs in ~2–6% of TEVAR cases, with higher rates in arch/zone 0–2 procedures and when the left subclavian artery (LSA) is covered without revascularization. SCI incidence ranges from ~2–9%, influenced by aortic extent and urgency; Vascular Quality Initiative data report SCI in 3.7% of procedures, with markedly reduced 1-year survival. Major SCI risk factors include extensive thoracic coverage, prior aortic repair, vertebral or hypogastric occlusion, emergency presentation, low perioperative mean arterial pressure, anemia, and chronic kidney disease. Postoperative delirium occurs in ~13% of TEVAR-treated type B dissections and correlates with longer hospitalization and early complications. Emerging nomograms for SCI and delirium enable individualized risk stratification. Conclusions: Neurological complications after TEVAR remain clinically significant. Contemporary evidence supports personalized prevention—selective cerebrospinal fluid (CSF) drainage, LSA revascularization, staging, neuromonitoring, and tailored hemodynamic targets—guided by anatomical complexity, comorbidities, collateral network integrity, and prior aortic history. Further research should refine prediction tools, standardize definitions, and evaluate individualized neuroprotective bundles. Full article

Background/Objectives: Topical steroid withdrawal syndrome is an underrecognized (and at times controversial) diagnosis, predominantly seen in individuals with a history of prolonged medium- to high-potency steroid use with sudden cessation. We aim to present topical steroid withdrawal clinical cases along with a narrative review of the literature to better characterize this understudied phenomenon. Methods: A total of 16 patients with a history of topical steroid withdrawal were enrolled in an IRB-approved clinical trial (NCT04864886). Participants underwent clinical assessments at the National Institutes of Health, including a history and physical examination, photography, genome sequencing, and comprehensive blood work. A follow-up survey assessed symptom activity and functional impact. Results: All patients reported severe itch, heat and photosensitivity, erythema, skin dryness, and pain. A total of 11 patients exhibited elevated IgE levels, 9 patients noted metallic-smelling skin, and 4 had peripheral blood eosinophilia. Symptomatic relief was observed with dupilumab, berberine, naltrexone, and various home remedies including topical ointments, vitamins, and probiotics, though effectiveness varied and often required trial and error. At follow-up, most respondents reported partial but ongoing symptoms, with several describing residual itch and intermittent interference with daily activities. Some participants continued therapeutic interventions, such as berberine, over two years after their initial evaluation. Conclusions: Our findings report improvement in patient symptoms such as itch and detail emerging management strategies that have not been discussed before. Improved recognition, physician consensus, and systemic evaluation of therapeutic options are needed to guide care and enhance quality of life for affected patients. Full article

Taiwan’s rural regions face aging populations, digital divides, and fragmented heritage narratives that limit sustainable cultural revitalization. This study investigates how a community-based Alternate Reality Game (ARG) can integrate dispersed cultural assets in Shiding District into a coherent, immersive experience that supports intergenerational learning and community engagement. Drawing on ARG/transmedia narrative theory, scaffolding theory, intergenerational learning, and value co-creation, the research adopts an exploratory sequential mixed-methods design: qualitative interviews and co-design workshops inform ARG system development, followed by field implementation and pre–post evaluation with 78 participants across three age groups. The results show large improvements in user experience and immersion, while quantitative changes in cultural understanding, perceived learning support, and community engagement are modest and not consistently positive, despite rich qualitative accounts of heightened awareness of local history and community life. Participants’ narratives highlight a reciprocal scaffolding dynamic, in which younger visitors provide digital assistance and older residents contribute local knowledge, as well as strong perceptions of co-creation with community hosts. These findings suggest that a low-cost, participatory ARG can effectively reduce on-site narrative fragmentation and foster emotionally engaging, intergenerational experiences, but that deeper and more durable cultural learning effects likely require refined measurement and longer-term engagement. The study contributes an integrated design and evaluation framework for rural ARG applications and offers practical guidelines for communities and policymakers seeking inclusive, story-driven models of digital heritage revitalization. Full article

Background: Survival among children and adolescents and young adults (AYA) with cancer has improved substantially over recent decades; however, dominant survivorship models remain reactive—activated post-treatment and anchored to static exposure- and organ-based screening. This design underuses the anticipatory window at diagnosis and overlooks environmental and social determinants that modulate outcomes across the life course. Methods: We narratively reviewed international frameworks including the Children’s Oncology Group (COG), the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG), the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer (PanCare) and the National Comprehensive Cancer Network (NCCN), and synthesized evidence on environmental determinants, exposomics, toxicogenomics, and implementation. Building on two decades of real-world practice, we describe the evolution from the Pediatric Environmental History (PEHis) to the Ambiomic Health Compass (AHC), integrating genomic, exposomic, geospatial, clinical, and biomonitoring layers into routine care. In this framework, survivorship is conceptualized as beginning at the time of cancer diagnosis (“day 0”). Results: PEHis operationalizes guideline-based care with structured environmental and social assessment, personalized plans, and community integration, contributing to improved survival, healthier behaviors, reduced treatment-related mortality and stronger oncology–primary-care coordination. AHC extends PEHis with dynamic risk recalibration, contextual alerts, targeted biomonitoring, and toxicogenomic interpretation, enabling anticipatory decisions from day 0. The manuscript summarizes the paradigm shift (current vs. Ambiomic models), the domain-specific expansion over existing guidelines, the core clinical/system tools, and time-bound metrics (12, 24, 60 months) to support implementation and evaluation. Conclusions: Survivorship should move upstream—from late surveillance to ambiomic, exposure-aware care beginning at diagnosis. Integrating advanced exposomics, mutational epidemiology, and explainable analytics can reduce preventable events and chronicity, enhance equity, and align pediatric oncology with planetary health. The PEHis–AHC continuum offers a scalable blueprint for next-generation survivorship programs in Europe and beyond. Ambiomic medicine does not replace precision medicine—it completes and extends it by integrating exposomics, social context, and anticipatory analytics from day 0. Full article

Background and Objectives: Mental health recovery is conceived as a personal process going beyond symptom remission and thus involving identity reconstruction, search for meaning and active participation in everyday life. This study aimed to analyze the influence of life history, identity, competence and context on the recovery process of people with mental illness. Methods: A qualitative phenomenological study was conducted and registered in the Open Science Framework. Participants were 159 individuals diagnosed with mental disorders who attended a community mental health association. Data were collected using the standardized Occupational Performance History Interview-II (OPHI-II) and analyzed through an inductive phenomenological approach with researcher triangulation. Results: Findings showed that life history is central to recovery, as it helps rebuild identity, recognize personal capacities and restore a sense of continuity. Daily occupations and social support emerged as key factors for inclusion and participation. Conclusions: Results highlight the importance of integrating biographical narratives and occupational perspective into mental health interventions through a standardized tool that surpasses traditional diagnosis-based or methodologically weak approaches. This perspective fosters practices aligned with individuals’ values, goals and contexts, promoting autonomy, empowerment, and social inclusion. These findings may inform person-centered recovery programs in community services. Full article

Neuroendocrine neoplasms (NENs) are rare and heterogeneous tumors with heterogeneity in morphology and molecular profile and consequently resulting in a heterogeneous biological behavior. They have a more indolent natural history compared to the classic cancer and may emerge in any site of the human body, but usually they have gastroenteropancreatic (GEP) or bronchopulmonary (BP) origin. When NENs are well differentiated, they are called neuroendocrine tumors (NETs) as opposed to poorly differentiated neuroendocrine carcinomas (NECs). They may secrete a bioactive molecule resulting in a secretory syndrome or they may not be associated with any secretory product, defining functional and non-functional NENs. The hormonal hypersecretion syndromes, the chronic symptom burden, the tumor-related inflammation, and the treatment side effects impair nutritional intake and absorption while increasing metabolic needs. The present comprehensive narrative review is summarizing established and emerging methods of nutritional and body composition assessment, and the recent evidence of interventions for sarcopenia and malnutrition in patients with NETs. Early identification and management of malnutrition and sarcopenia are fundamental steps to improve quality of life and clinical outcomes in these patients during the long natural history of these neoplasms. Full article

Food labels are common elements of everyday life. However, from the point of view of communication researchers (especially visual communication), they are incredibly interesting cultural artifacts, located at the intersection of communication, design, technology, and regulation. This article analyzes the evolution of the labels of Muszynianka, a leading mineral water brand in Poland, from the perspective of media archaeology. It treats labels as dual artifacts—media (information carriers, regulatory objects) and artistic (elements of applied art, design). This article emphasizes the importance of materiality, the non-linearity of history and the analysis of the technological–regulatory “archive.” It develops concepts of labels as complex, multimodal messages, especially in a historical context. The authors conducted a visual analysis of the evolution of Muszynianka’s labels, placing them within broader design trends. To explore recurring visual and narrative motifs, a topoi analysis method was used to identify three basic topoi: Topos of Nature/Mountain Origin, Topos of Health/Vitality/Purity, and Topos of Modernity/Technology. Full article

Background and Objective: Postpartum depression (PPD) is a prevalent psychiatric condition with significant consequences for maternal, paternal, and infant well-being. In Saudi Arabia, some reported prevalence rates exceed global averages. This narrative review synthesizes the current literature on the prevalence, risk factors, awareness, and quality-of-life impact of PPD in Saudi Arabia. The aim is to identify methodological inconsistencies, highlight the risk factors, and guide future research and policy. Method: A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Studies published between 2010 and May 2025 were included if they addressed PPD in Saudi Arabia and the inclusion criteria were met. 38 articles were selected for full-text analysis and incorporation in the study. Results: PPD prevalence in Saudi Arabia ranges from 5.1% to 75.7%, with regional variation attributed to inconsistent methodologies, screening instruments, and diagnostic cutoffs. Risk factors encompass psychiatric history, marital conflict, limited social support, low income, cesarean delivery, unplanned pregnancy, anemia, and sleep disturbance. Nutritional and newborn-related predictors were inconsistently reported. Awareness among the public and healthcare professionals remains limited, and paternal postpartum depression is underrecognized. PPD exerts a pronounced negative impact on maternal quality of life, spanning physical, psychological, and social domains. Conclusions: PPD poses a substantial public health burden in Saudi Arabia. Routine screening with validated tools, integrated perinatal mental health services, and targeted public education campaigns may help address diagnostic delays and stigma. Future studies must adopt standardized diagnostic criteria and longitudinal designs to generate nationally representative prevalence estimates and evaluate preventive strategies. Full article

Background: Disorders of gut–brain interaction (DGBI) have a significant impact on the quality of life of children and families. Forty percent of children with recurrent abdominal pain continue to have symptoms into adulthood. Specialized programs for the transition of adolescents with DGBI to adult care are scarce. There are no widely accepted guidelines for transition of care. Identifying risk factors for persistence of symptoms into adulthood is key to identifying the optimal population that should be part of such programs and guidelines design. Methods: A narrative comprehensive review was conducted using predefined keywords to identify risk factors for persistent DGBI in children/adolescents. Results: Female sex, psychological distress, family history of DGBI, and certain comorbidities had stronger evidence for persistence, whereas other risk factors rely on limited data. Conclusions: It is suggested that transition programs should focus on adolescents presenting with multiple coexisting risk factors. The program should at least include pediatric and adult neurogastroenterologists, dieticians, psychologists, and social workers. Tertiary prevention through psychological support, school-based programs, and management of anxiety and sleep disturbances may reduce the persistence of symptoms. Prospective studies should refine risk stratification and guide transition strategies. Full article