Search Results (615)

Background/Objectives: In neonatal intensive care, intraventricular haemorrhage (IVH) is one of the most frequent brain morbidities in very preterm infants, but maximum IVH grade may not fully capture developmental risk. We assessed whether a serial cranial ultrasound (CUS) phenotype integrating IVH grade, associated parenchymal lesion visible on serial CUS (visible APL) and ventricular morbidity refined developmental risk stratification. Methods: We studied 2756 very preterm infants from a single-centre cohort of 3081 who had at least two protocolised CUS examinations. IVH was classified by maximum serial CUS grade. Visible APL, severe ventriculomegaly (VM), post-haemorrhagic hydrocephalus (PHH), cerebral palsy (CP), clinically classified school-age cognitive sequelae and sustained developmental/educational support were analysed. Results: Visible APL and ventricular morbidity increased with maximum IVH grade. Among infants with grade 3 IVH (IVH3), visible APL was present in 60.5%, severe VM in 40.8% and PHH in 21.7%. In the isolated-IVH analysis, CP occurred in 1.4% of the reference group (no IVH/no visible APL), 2.9% with isolated grade 1 IVH, 2.8% with isolated grade 2 IVH and 27.5% with IVH3. Isolated IVH3 was associated with CP (aOR 28.55, 95% CI 11.31–72.11), school-age cognitive sequelae and sustained support. After adding severe VM, the CP aOR for isolated IVH3 attenuated to 12.94, while severe VM remained associated with CP, cognitive sequelae and support. Conclusions: Our findings support interpreting IVH as a multidimensional serial CUS risk-stratification phenotype beyond maximum grade alone, with the potential to inform bedside counselling and targeted developmental follow-up in neonatal intensive care, pending external validation. Full article

To the best of our knowledge, this is the first study that centres Indigenous queer (henceforth, Indigiqueer) and Indigenous older people and Elders’ voices to explore the everyday tensions between protecting Indigenous cultural protocols against colonial incursions and the challenges presented by shifts in essentialist understandings of gender in the country now called Australia. There is to date very little written that address this topic, although there are two seminal works that investigate the matters more broadly, one by leading Aboriginal scholar Professor Bronwyn Carlson, and another by Noongar Wardandi scholar Professor Braden Hil. Our study uses a set of vignettes based on two interviews with Indigiqueer people and a yarning circle with Indigenous older people and Elders. The interviews and yarning circle are structured as a discussion between community members to provide some preliminary analysis about contemporary dynamic intergenerational debates within Indigenous communities in which competing understandings of culture, gender, safety, and responsibility coexist. For participants, intergenerationality is seen as central to both harm and healing, feelings of belonging and ostracism and ultimately to current and future Indigenous and Indigiqueer survivance and thrivance. Indigenous older people and Elders demonstrate an openness to different sexualities and an acceptance of sexuality-diverse people but are hesitant to allow gender-diverse people to participate in gendered community activities such as playing the didgeridoo (yidaki). To the contrary, Indigenous queer (henceforth Indigiqueer) participants articulate their fears regarding safety, exclusion, care and social isolation emerging from exclusionist gendered binary protocols. Younger generations are seen by all participants as sites of potentiality, that in combination with the power of shared storytelling and mutually constructed understandings, enable a shift towards greater acceptance, openness, and visibility. The paper also reveals the ways in which Indigiqueer people navigate spatial, cultural and social differences between regional and urban spaces, that are seen as differentially accepting of either their Indigeneity or their gender and sexuality diversity. The study’s findings also demonstrate the importance of Indigiqueer-controlled spaces and culturally safe organisations, that are grounded in community-led practices of care, belonging, and self-determination. Full article

Central and Eastern Europe (CEE) carries some of the widest immunisation gaps in Europe, and improving coverage there is often treated as a problem of access infrastructure. On 14 May 2026, a multi-stakeholder meeting hosted at the Romanian Parliament brought together around twenty-five speakers, among some fifty participants in all, from Romania, Poland, the Czech Republic, and Bulgaria, together with international contributors, to agree which barriers to vaccine confidence matter most in the region, which interventions are deliverable within 12 to 24 months, and how responsibility for them should be divided among stakeholders. This Perspective synthesises that discussion as a set of strategies for coverage. Meeting-derived priorities are set against published coverage and confidence data for the region and against the published intervention literature. We argue that the central problem across the region is eroded trust rather than missing information, because misinformation succeeds mainly where trust has already broken down, a process deepened by a historically conditioned, post-communist distrust of public institutions. The two recommendations carried most strongly, as both high in expected impact and achievable within 12 to 24 months, were continuing professional education for primary care on vaccine communication and the resourcing of locally trusted community figures, including health mediators working with marginalised populations. We then show how system-design reforms already demonstrated in the region, in particular pharmacy-based vaccination, direct reimbursement, and targeted outreach to under-vaccinated and marginalised groups, turn restored confidence into measurable coverage while narrowing inequities. We close with a 12-to-24-month agenda for CEE, organised around a clear multi-stakeholder division of labour. These are stakeholder-derived priorities that now require implementation and evaluation. Full article

Primary hyperparathyroidism (PHPT) and vitamin D deficiency (VD) are two frequent medical conditions in the Western world. Purely by dint of their prevalence, these conditions are commonly comorbid. Moreover, they can interact with one another: VD may stimulate PTH secretion, while PHPT may lead to unregulated vitamin D activation from 25-hydroxyvitamin D (25OHD) to 1,25-dihydroxyvitamin D (1,25OH2D), thereby lowering 25OHD levels and further exacerbating VD. Thus, a real conundrum arises: should the careful clinician replete VD in PHPT or not? On the one hand, both conditions could lead to bone mineral density (BMD) loss if untreated, ultimately resulting in osteoporosis and fragility fractures; on the other hand, vitamin D supplementation could lead to further worsening of hypercalcemia and its dreaded complications. To complicate matters, patients undergoing parathyroidectomy (PTX) after long-standing PHPT can also suffer from postoperative hungry-bone syndrome and symptomatic hypocalcemia, which may be further exacerbated by VD. This narrative review aims to summarize the relevant pathophysiological mechanisms underlying these two diseases and their complex interactions. The latest evidence regarding thresholds and targets for vitamin D supplementation in PHPT will be discussed, with a focus on the balance between benefits and risks. Full article

Background: Non-massive hemoptysis is generally considered low-risk and manageable with conservative treatment. However, some patients progress to massive hemoptysis during follow-up. Identifying high-risk patients early in the emergency department matters for calibrating monitoring intensity, guiding timely intervention, and allocating acute care resources. This study aimed to identify clinical, laboratory, and radiological predictors of progression to massive hemoptysis within the first 72 h in emergency department patients presenting with non-massive hemoptysis who were managed conservatively. Methods: This prospective cohort study enrolled patients at a tertiary university hospital emergency department between November 2023 and June 2025. Adult patients presenting with non-massive hemoptysis were enrolled consecutively. The primary outcome was development of massive hemoptysis within 72 h of admission. Patients were divided into two groups: those who developed massive hemoptysis within 72 h and those who did not. Demographic, bleeding, laboratory, imaging, and bronchoscopy data were recorded for all patients. Multivariate logistic regression was used to identify independent predictors. Results: Of 199 patients, 10.6% developed massive hemoptysis within the first 72 h. On multivariate analysis, bright red hemoptysis (3.17-fold increase in risk), a cavity or mass on thoracic CT (7.13-fold increase in risk), and bleeding volume ≥20 mL in a single episode (3.3-fold increase in risk) were independent predictors of massive hemoptysis. Conclusions: A meaningful proportion of patients presenting with non-massive hemoptysis go on to develop massive hemoptysis in the early period. Simple clinical and radiological parameters available at admission can support early risk stratification and inform decisions regarding monitoring intensity and early inpatient management during the critical first 72 h after emergency department admission. These findings may assist early risk stratification but should complement, rather than replace, clinical judgement. Full article

Background: Drilling slurry, a waste material generated during natural gas extraction, requires careful chemical characterization to determine its environmental hazard classification and inform appropriate management strategies. Methods: This study characterizes the drilling fluid used as raw material and the resulting drilling slurry waste, using a case study sample from the Buzău extraction area (Well 1 Florica, S.N.G.N. Romgaz S.A.), including total composition analysis, three-stage leaching tests, linear regression of leaching kinetics, and standardized geoaccumulation indices (Igeo, CF, PLI). Results: Total composition analysis confirmed low heavy metal concentrations (Cd = 0.02, Cr = 0.05, Pb = 0.64, Zn = 2.82 mg/kg dry matter). All leachate parameters remained below non-hazardous waste thresholds (Order No. 95/2005), with safety factors of 20–100× for regulated metals and 1.2–2.7× for chlorides, sulphates, and dissolved organic carbon. Standardized pollution indices confirmed Class 0 (unpolluted) status for all five metals, with a composite Pollution Load Index of 0.0124. Leaching regression analysis revealed dissolution-controlled release for chlorides, sulphates, and zinc (R² > 0.93) versus matrix-retention behavior for copper, nickel, cadmium, and chromium. Comparative analysis showed horizontal drilling generates approximately 146% more waste volume than conventional vertical drilling (170 m³ versus 69 m³ at 2100 m depth). Conclusions: The analyzed drilling slurry meets non-hazardous waste classification with substantial safety margins, corroborated by three independent analytical frameworks. Waste minimization strategies and biodegradable fluid substitution offer practical pathways to reduce the environmental footprint of natural gas drilling operations. Full article

Background/Objective: White matter hyperintensities (WMH) are frequently observed in adults without atherosclerotic cardiovascular disease (ASCVD), yet antiplatelet agents are often prescribed empirically. We aimed to explore whether antiplatelet treatment is associated with stroke prevention in this specific population. Methods: This retrospective analysis used prospectively collected data from adults undergoing regular health examinations (2011–2019). We assessed associations between antiplatelet use and stroke outcomes according to WMH Fazekas (1–3) and cerebral small-vessel disease (cSVD) scores (0–4). The primary outcomes were stroke of any type, ischemic stroke, and hemorrhagic stroke. Results: Among 1672 participants (mean age 57.1 ± 8.5 years; 15.6% on antiplatelets), 28 (1.7%) strokes of any type, 26 (1.6%) ischemic strokes, and 2 (0.2%) hemorrhagic strokes occurred during a mean 3.5-year follow-up. The risk of any stroke was higher in those with cSVD scores 3–4 compared to score 0 (adjusted HR 8.45; 95% CI 1.53–46.53). WMH severity was not independently related to increased risk of any outcome events. The relative risk of those with cSVD scores 3–4 for stroke of any type and ischemic stroke was not different across subgroups stratified by antiplatelet use (all P_interaction > 0.05). Post hoc power analysis showed 0.12 power for both strokes of any type and ischemic strokes. Conclusions: While cSVD score may help identify higher stroke risk, our findings suggest that antiplatelet agents might not provide significant additional benefit for stroke prevention in ASCVD-naïve adults. These results should be considered hypothesis-generating, emphasizing the need for careful risk factor management over empirical antiplatelet prescription. Full article

Background/Objectives: Environmental air pollution and structural barriers to preventive dental care are increasingly recognized as determinants of population health inequalities. However, their combined association with oral disease burden across European Union (EU) Member States remains insufficiently examined. This study evaluated whether ambient particulate matter (PM2.5) exposure is associated with oral health outcomes and whether preventive system capacity modifies this association. Methods: An ecological panel analysis was conducted using country-level data from the 27 EU Member States for the period 2020–2023. Age-standardized prevalence of untreated dental caries (primary outcome), edentulism (secondary outcome), and periodontal diseases (exploratory outcome) were obtained from the Global Burden of Disease database. PM2.5 exposure was operationalized using national mean annual baseline values. Preventive care access was proxied by the percentage of the population reporting unmet dental care needs (Eurostat EU-SILC). Pooled panel regression models with year fixed effects and country-clustered robust standard errors were estimated. An interaction term between PM2.5 exposure and unmet dental care needs was included to assess effect modification. Results: PM2.5 exposure was not independently associated with caries prevalence after adjustment for preventive access and GDP per capita. However, a statistically significant interaction was observed: higher PM2.5 levels were associated with increased caries prevalence in countries reporting greater unmet dental care needs. PM2.5 exposure was positively associated with edentulism prevalence, independent of preventive access. No significant associations were detected for periodontal diseases. Conclusions: Based on this ecological analysis of European Union Member States, higher PM2.5 exposure in combination with greater unmet dental care needs was associated with higher population-level caries prevalence, whereas PM2.5 exposure alone showed a positive association with edentulism prevalence. These findings are exploratory and should be interpreted with caution, given the use of aggregated country-level data, the potential for ecological fallacy, and the absence of causal inference. Further individual-level and longitudinal studies are needed to clarify these relationships and their underlying mechanisms. Full article

Progression independent of relapse activity (PIRA) and smouldering multiple sclerosis (MS) represent major unmet challenges in contemporary MS care. Disability may accumulate independently of clinical relapses, driven in part by chronic compartmentalised inflammation behind a relatively intact blood–brain barrier and incompletely captured by conventional monitoring tools. This narrative review synthesises evidence across four complementary biomarker domains for detecting smouldering MS and PIRA: advanced MRI (paramagnetic rim lesions [PRLs], slowly expanding lesions, deep grey matter atrophy, quantitative susceptibility mapping); fluid biomarkers (serum glial fibrillary acidic protein [sGFAP], serum neurofilament light chain [sNfL]); retinal optical coherence tomography (ganglion cell–inner plexiform layer thinning); and digital health metrics (wearable accelerometry, digital Symbol Digit Modalities Test). In a single prospective cohort, combined elevation of sGFAP and sNfL conferred a 4.71-fold increased hazard for PIRA (HR 4.71; 95% CI 2.05–9.77); independent data suggest sGFAP may carry selectivity for progression beyond sNfL, although this remains to be confirmed. No single domain sufficiently characterises smouldering pathology. We therefore propose a hypothesis-generating Multimodal PIRA Score (MPS) as a conceptual validation scaffold intended to structure—rather than inform—prospective multicentre evaluation against a long-horizon disability endpoint. Harmonisation of acquisition protocols, reference ranges, and digital phenotyping algorithms remains a prerequisite. Full article

This article examines how differently positioned migrant parents gain unequal access to voice, trust and participation in parent–ECEC collaboration in Norway. Rather than understanding parental engagement primarily as a matter of parents’ willingness or interest, the article analyses how engagement is shaped by institutional expectations and by the forms of communication, trust and participation that ECEC staff recognise as legitimate. This article draws on selected material from a broader qualitative project, including interviews with refugee parents, professional interviews and focus groups with ECEC professionals, and fieldwork in four ECECs. It also includes a newly analysed interview with an American migrant father, used as a contrast to the refugee-parent material. The analysis is conducted as a theoretically informed, abductive and reflexive thematic analysis through the lens of the politics of belonging. The findings identify four forms of positioning: guarded belonging, confident belonging, normative belonging and bounded participation. The analysis shows that migrant parents are not positioned as one group. Rather, their possibilities of being recognised as legitimate co-educators are shaped by language, institutional familiarity, trust, cultural recognisability and staff expectations of “the good parent”. The article contributes to parental engagement research by showing that equitable parent–ECEC partnerships require more than formal opportunities for involvement. They require institutional conditions in which different parental voices are heard as sources of legitimate knowledge about children’s education, care, and belonging. Full article

Introduction: As diabetes care becomes increasingly digitalized, stratified, and differentiated, psychosocial vulnerability risks becoming less visible within routine care and documentation. To ensure that differentiated care pathways meaningfully incorporate psychosocial stratification, vulnerability must be identifiable, documented, and revisited as part of routine clinical practice. Aim: The aim of this study is to explore how healthcare professionals identify psychosocial vulnerability in routine diabetes care and how such vulnerability is documented and followed up in the electronic medical record (EMR). Methods: This quality improvement audit with a descriptive analysis component was conducted at Steno Diabetes Center Copenhagen as part of the development of a new differentiated outpatient pathway. Healthcare professionals across disciplines submitted cases of persons with diabetes whom they considered psychosocially vulnerable. Documentation from the preceding six months was reviewed descriptively in order to find patterns of identification, documentation, care planning, and follow-up. Results: A total of 334 referrals representing 275 unique persons with diabetes were submitted. Psychosocial vulnerability extended beyond predefined high-risk categories, as 37% of identified cases did not align with any of the six vulnerability groups described in the Danish VIVE framework. Vulnerability often reflected cumulative everyday-life strain rather than formal diagnoses. While healthcare professionals demonstrated substantial relational attentiveness to psychosocial concerns, this knowledge was not consistently evident in formal documentation. Explicit care plans and longitudinal follow-up were uncommon, and psychosocial concerns were frequently documented as isolated observations rather than as part of structured ongoing care. Conclusions: Psychosocial vulnerability was frequently identified through clinical dialogue and professional judgement and often extended beyond predefined vulnerability categories. The findings highlight the importance of developing shared approaches and a shared understanding of psychosocial vulnerability across professional groups. If psychosocial stratification is to become an operational component of differentiated diabetes care, information about what burdens matter to the person must be identifiable, documented, and carried forward across encounters alongside biomedical information. Full article

Fine particulate matter with an aerodynamic diameter of 2.5 μm or smaller (PM2.5) is a major environmental health risk that threatens individuals’ health, quality of life, and sustainable well-being. In the digital era, protective behaviors are increasingly shaped by people’s ability to access, evaluate, and use health information from online sources. This cross-sectional descriptive correlational study examined the levels of health literacy, digital health literacy, and self-care behaviors for PM2.5 protection and examined their associations with self-care behaviors among adults in Mueang District, Samut Songkhram Province, Thailand. A proportionate stratified sample of 375 adults from 11 subdistricts completed structured questionnaires. Data were analyzed using descriptive statistics and multiple linear regression. Most participants had moderate health literacy (55.2%), digital health literacy (52.0%), and self-care behaviors for PM2.5 protection (56.3%). The health literacy and digital health literacy dimensions jointly explained 28.1% of the variance in self-care behaviors. Using digital information for health decision-making showed the largest unique association with self-care behaviors (β = 0.31), followed by decision-making for PM2.5 protection (β = 0.26) and evaluation of information credibility (β = 0.24). Understanding PM2.5 information did not contribute independently after the other literacy dimensions were considered. PM2.5 risk communication should therefore move beyond information provision and strengthen credibility assessment, information appraisal, and action-oriented decision-making while addressing socioeconomic and digital-access barriers. Full article

This paper examines how conversational daily deep dive news podcasts build journalistic authority and legitimacy through what we call the “journalist-as-guest” (JAG) format. Applying a deep analytical listening methodology that honors the aurality of the medium and positions listening as a core analytical method, we analyzed eight daily deep dive news podcasts from Canada and Australia, attending to how sonic elements interact with conversational performance to produce podcasting’s characteristic intimacy and parasocial listener bonds that support authority and legitimacy claims for journalism. Our findings expand on our previous identification of the JAG format as a key element of explanatory-type daily deep dive podcasts. Here, we reveal how it operates through three key mechanisms: recurring self-referential speech that reinforces journalistic cultural belonging; intentional unpacking of the reporting process to reveal behind-the-scenes work; and the careful construction of journalists as subject-matter experts. Together, these mechanisms transform performative conversation into metajournalism, creating a space in which journalistic expertise is displayed and validated through colleague-to-colleague dialogue. We term this dynamic “intimate authority.” We argue that the JAG format capitalizes on podcasting’s affordances for intimacy, parasociality, and extended metajournalistic conversation to invite audiences into the news-making process while positioning journalists as credible experts and sense-makers. In doing so, it functions as a mechanism for establishing authority and legitimacy claims in digital media environments. As daily news podcasting becomes increasingly central to remediation efforts aimed at restoring trust in journalism, both legacy and independent news podcasters appear to be counting on the JAG format as a strategic response to concurrent crises of news avoidance and relevance. Full article

Academic setbacks are common in college, yet instructor responses to poor performance vary widely and may shape students’ motivation, emotional reactions, and perceptions of faculty support. Prior work suggests that supportive communication matters, but less is known about which types of messages students prefer after academic failure or whether faculty accurately anticipate these preferences. The present research examined how college students and instructors evaluate different instructor responses to a disappointing exam grade and assessed alignment between student preferences and faculty perceptions. Using a mixed-methods design, college instructors and undergraduate students responded to parallel vignette scenarios involving a poor exam outcome and rated brief instructor comments representing three response types: solution-focused, emotional validation, and interpersonal affirmation. Participants also provided open-ended responses describing what they would say to a student or want to hear from an instructor. Across two studies, students rated affirmation as most effective, validation as moderately helpful, and solution-focused responses as least effective, despite perceiving solution-focused comments as most common in actual classrooms. Faculty in our sample rated validation and affirmation as more effective than solution-focused responses but primarily generated strategy-focused advice in their own responses. Faculty correctly anticipated students’ preference for encouragement but rarely offered such messages. These findings point to a gap between what faculty believe students value and what they typically communicate following academic setbacks, suggesting that incorporating brief affirming and emotionally responsive messages may strengthen student–teacher relationships by signaling care, understanding, and support in moments of academic difficulty. Full article

Pigment implantation (semi-permanent make-up, microblading and cosmetic tattooing) introduces complex pigment mixtures into the dermis, resulting in direct exposure of keratinocytes, fibroblasts and resident immune cells to metals, organic dyes and nanoparticles. Within Somatology and Somatic therapy practice, an allied health discipline concerned with evidence-based care of the skin and body, Somatic Therapists operate at the interface of dermal intervention, molecular exposure and occupational health, underscoring the relevance of mechanistic toxicology for risk-informed professional practice. This PRISMA-guided systematic review synthesises molecular toxicology and omics-based evidence, emphasising oxidative stress generation, inflammatory signalling via NF-κB/MAPK pathways, apoptosis and genotoxicity, T-cell-mediated type IV hypersensitivity reactions associated with modern red azo pigments, and dermal-to-lymphatic transport of particulate matter. Transcriptomic and metabolomic studies consistently demonstrate pigment-specific inflammatory responses and wound-healing gene signatures, supporting mechanism-driven biocompatibility profiling. Regulatory frameworks, including EU REACH Annex XVII Entry 75 and recent FDA guidance on microbial contamination, have strengthened compliance requirements; however, surveillance continues to identify mislabelling, restricted pigments and microbial contamination in some inks. For Somatology and Somatic therapy practice, these findings highlight the importance of evidence-based pigment selection, traceable sourcing, aseptic technique, ventilation, personal protective equipment and informed consent addressing pigment migration and delayed adverse reactions. The integration of molecular outcomes with omics technologies and regulatory oversight provides a next-generation risk assessment framework to advance safe cosmetic practice and public health. Full article