Search Results (95)

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

The Crimean–Congo hemorrhagic fever virus (CCHFV) is a single-stranded, segmented RNA virus belonging to the Nairoviridae family, and it is rapidly expanding across Africa, Asia, and southern Europe, probably favored by climate change and livestock trade. Its fatality rate in humans reaches up to 40%, and there is currently no specific treatment or vaccine available. Therefore, the development of therapies against CCHFV is essential, and their design requires understanding of the molecular evolution and genetic distribution of the virus. Motivated by these concerns, we present a comprehensive review of the molecular evolution, genetic characterization, and phylogeography of CCHFV, and we discuss their potential implications for therapeutic design. Specifically, we describe the virus’s capacity to increase its genetic diversity through numerous mutations, recombination events, and genomic reassortments, which affect fundamental viral functions such as RNA binding, host–virus interactions, viral entry, and polymerase activity. We also assess the presence of temporal heterogeneous rates of evolution and molecular adaptation among CCHFV coding regions, where purifying selection is generally predominant but diversifying selection is observed in molecular regions associated with host adaptation and transmission. We emphasize the importance of understanding the complex molecular evolution of CCHFV for the rational design of therapies and highlight the need for efforts in surveillance, evolutionary prediction, and therapeutic development. Full article

Nowadays, society is becoming increasingly committed to traveling by plane for work, tourism, and leisure in general. However, either due to internal, specific factors or to external determinants, like terrorism and climate changes, a growing number of travelers have experienced the so-called fear of flying, a persistent, irrational fear of flight-related situations for which a clear, efficacious therapy does not yet exist. Based on the usual interaction with the surrounding environment, conducted by means of the five human senses, and particularly on the neurophysiological pathway followed by the chemical senses, in this study, we revise the findings in the related literature on the topic, proposing an alternative way to alleviate the anxiety related to the fear of flight. This is based on chemosensory stimulation being applied directly during a flight and is possibly concerned with the consumption of meals, an usual activity performed onboard. After an introductory section aimed at understanding the problem, we present some studies related to chemosensory perception during the flight, highlighting the specificities of the scenarios, followed by a description of findings related to the meals proposed by flight companies in this context, and finally wrapping up the possible alternative approaches that could be conducted by such providers to alleviate the fear of flying condition through chemosensory stimulation vehiculated by meals, and enhance the quality of flight experience related to food consumption onboard. Full article

To date, there has been a noticeable lack of a systematic and structured approach to the development of forest therapy tourism. This study addresses this problem by introducing a forest tourism attractiveness model and an evidence-based framework for the conceptual development of Forest Climatic Spa Resorts. Based on an attributive theory approach, a comprehensive set of forest tourism attractiveness attributes is defined, a model of forest tourism attractiveness is developed, and theoretical and conceptual foundations to support the criteria for the development of Forest Climatic Spa Resorts are presented. This research contributes to the ongoing discourse on sustainable tourism practices and emphasises the role of forest environments in promoting health and well-being in therapeutic tourism activities. Ultimately, our findings offer valuable insights for policymakers, tourism developers, and practitioners in the field of forest therapy tourism, providing a foundation for future initiatives aimed at enhancing the appeal and sustainability of forest-based tourism experiences. Full article

Affecting around 30–40% of the population worldwide, allergic disorders including asthma, rhinitis, eczema, and food allergies, are relatively common. Environmental factors, such as air pollution and climate change, which aggravate allergic reactions, contribute to the growth of these diseases. Although conventional treatments such as antihistamines and immunotherapy remain the standard for symptom management, growing interest in natural remedies highlights the potential value of medicinal plants as complementary therapies. Commonly present in plants, vitamins and antioxidants have strong anti-inflammatory and antioxidant actions that can control immune responses, lower oxidative stress, and thus reduce inflammation, which is the main element in allergic reactions. By focusing on the fundamental causes of inflammation and immunological dysregulation, phytochemicals have shown encouraging effects in reducing allergic symptoms. This review investigates the role of plant flavonoids, polyphenols, and vitamins in lowering allergic symptoms and inflammation, and suggests their potential in allergy management. It also aims to provide a short review of various plant species that are used in folk medicine for allergy treatment. The inclusion of plant-based compounds in allergy therapy could provide more complete and environmentally friendly remedies to enhance patients’ quality of life. Full article

Background: Severe asthma is a respiratory condition, involving treatments (i.e., inhaled steroids, systemic steroids, hospitalization) capable of increasing significant carbon footprint, raising concerns about environmental sustainability in healthcare. Sustainable healthcare policies and use of environmentally friendly treatment options are crucial in balancing effective asthma management with climate responsibility. Objectives: With this manuscript, we want to assess the impact, in terms of CO₂ production, of patients suffering from severe asthma and treated with biological drugs, to show the reduction in carbon footprint after the use of these drugs compared to the time when they were not prescribed. We analyzed data from three studies, all conducted in real life in Italy, of patients treated with mepolizumab, benralizumab and dupilumab, for the control of severe asthma. Methods: Data on number of exacerbations and hospitalizations, systemic corticosteroids (CS) cycles and their dose, were collected by three already published real-life trials, on the above-mentioned biologics, and used to calculate carbon footprint impact before and after biological therapy. For the mepolizumab study, the data collected referred to patients who started the drug between June 2017 and January 2019; for dupilumab, there were no age limits with patients enrolled between December 2019 and July 2020, whereas in the benralizumab study, all patients had to be over 18 years old. The statistical analysis was performed with Shapiro–Wilk test, t test and Cohen’s test. Results: The use of biologic drugs showed a significant reduction in CO₂ production after the introduction of these therapies, mainly secondary to a reduction in exacerbations, hospitalizations and CS use. In numerical terms, an average reduction of 75% in CO₂ production, per patient, is shown. Conclusions: Disease control, clinical remission of disease, in patients with severe asthma is certainly a determining factor in assessing the effectiveness of a treatment. Provided these goals are achieved, biological drug therapy has also proved to be particularly virtuous from the fundamental environmental point of view, allowing a significant reduction in CO₂ production for the management of these patients. Full article

Background: Spirituality has emerged as a potential protective factor that may promote mental well-being and resilience among healthcare workers. Aim: This study aims to examine the relationship between spirituality, stress, and depression among healthcare professionals in Greece. Methods: This cross-sectional study surveyed 412 employees at the Corinth General Hospital in Greece, including medical, nursing, and administrative personnel. The data were collected using the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being 12 (FACIT-SP12), the Perceived Stress Questionnaire (PSQ), and the Center for Epidemiologic Studies Depression Scale (CES-D). The statistical analyses included non-parametric tests, correlation coefficients, and multiple regression. Results: The mean spirituality score was 34.6 (±6.83), while the stress and depression scores were 74.6 (±14.87) and 14.7 (±10.20), respectively. Spirituality was significantly and negatively correlated with both stress (r = −0.479, p < 0.001) and depression (r = −0.452, p < 0.001). Gender, years of service, educational level, and marital status were also associated with variations in stress, depression, and spirituality levels. Women and those with lower education reported significantly higher levels of stress and depression. Additionally, some demographic variables such as age and sector of employment did not show significant associations with spirituality or depression. The regression analysis confirmed spirituality as an independent predictor of lower stress levels (B = −1.158, p < 0.001). Conclusions: Spirituality is a significant predictor in mitigating stress and depression among healthcare workers. Promoting a supportive spiritual climate and incorporating elements of spiritual leadership in healthcare settings may enhance employee well-being and resilience. Future research should expand on these findings across diverse institutional and cultural contexts. Full article

School bullying is a pervasive issue with significant physical, mental, and social consequences for victims and bullies. Occupational therapy practitioners are uniquely positioned to address bullying due to their expertise in mental health, social participation, and child development. This systematic review synthesizes evidence on school bullying interventions to identify strategies that are relevant to occupational therapy practice. A systematic search was conducted across nine databases and identified 187 studies on occupation-based school bullying interventions. The review included studies employing a wide range of interventions, categorized into three tiers. Universal interventions (Tier 1) were the most effective, often following Social and Emotional Learning frameworks to foster positive school climates and address systemic bullying dynamics. Targeted interventions (Tier 2), such as peer mentoring and social skills training, demonstrated moderate effectiveness for at-risk populations. Intensive interventions (Tier 3) were less effective as standalone approaches but provided essential individualized support. This review highlights the potential for occupational therapy practitioners to play a pivotal role in addressing school bullying through evidence-based, occupation-focused interventions. Full article

Background: Leishmaniasis is a vector-borne zoonotic disease caused by protozoa of the genus Leishmania. While it is endemic in the Mediterranean Basin and the Balkans, Romania remains a non-endemic country. However, climate change, increased international travel, and the documented presence of competent vectors (Phlebotomus spp.) have raised concerns about the potential emergence of autochthonous cases. Case Presentation: We report two cases of imported cutaneous leishmaniasis (CL) diagnosed in central Romania, a region without previously confirmed human or animal cases. The first case involved a 31-year-old male with a recent travel history to Spain, presenting with erythematous papules and plaques that evolved into ulcerated lesions. The diagnosis was confirmed histopathologically and by a PCR. Treatment with miltefosine was effective, with minimal hepatic toxicity and a sustained response at a six-month follow-up. The second case concerned an 11-year-old boy who had traveled to Elba, Italy. He developed ulcerative lesions that progressed rapidly and were complicated by Pseudomonas aeruginosa superinfection. Despite an initially negative smear, PCR testing of the skin lesion confirmed the presence of CL. Antifungal therapy with fluconazole led to clinical improvement; treatment was ongoing at the time of publication. Discussion: These cases highlight the diagnostic and therapeutic challenges associated with CL in non-endemic settings. The varied clinical evolution underscores the importance of considering leishmaniasis in the differential diagnosis of chronic, non-healing cutaneous lesions, particularly in patients with a travel history to endemic regions. Conclusions: Increased awareness among clinicians, supported by accurate diagnostic tools and public health surveillance, is essential to identify and manage imported leishmaniasis. Given the absence of a licensed vaccine and the growing risk of vector expansion in Eastern Europe, these cases support the WHO’s inclusion of leishmaniasis among the priority neglected tropical diseases targeted for intensified global control efforts by 2030. Full article

Yersinia bacteria (Yersinia enterocolitica, Yersinia pseudotuberculosis) are commonly found in nature in all climatic zones and are isolated from food (mainly raw pork, unpasteurized milk, or contaminated water), soil, and surface water, rarely from contaminated blood. Yersinia infection occurs through sick or asymptomatic carriers and contact with the feces of infected animals. The invasion of specific bacterial serotypes into the host cell is based on the type 3 secretion system (T3SS), which directly introduces many effector proteins (Yersinia outer proteins—Yops) into the host cell. The course of yersiniosis can be acute or chronic, with the predominant symptoms of acute enteritis (rarely pseudo-appendicitis or septicemia develops). Clinical and laboratory diagnosis of yersiniosis is difficult. The infection requires confirmation by isolating Yersinia bacteria from feces or other biological materials, including lymph nodes, synovial fluid, urine, bile, or blood. The detection of antibodies in blood serum or synovial fluid is useful in the diagnostic process. The treatment of yersiniosis is mainly symptomatic. Uncomplicated infections (diarrhea and abdominal pain) usually do not require antibiotic therapy, which is indicated in severe cases. Surgical intervention is undertaken in the situations of intestinal necrosis. Given the diagnostic and therapeutic difficulties, this review discusses the prevalence of Y. enterocolitica and Y. pseudotuberculosis, their mechanisms of disease induction (virulence factors and host response), clinical manifestations, diagnostic and preventive methods, and treatment strategies in the context of current knowledge and available recommendations. Full article

Introduction: Orbitocerebral mucormycosis, caused by Apophysomyces, is a rare infection, usually occurring in tropical and subtropical climates, with a high mortality rate. We report a case of orbitocerebral mucormycosis caused by A. elegans in a person living with HIV (PLWHIV) from Africa alongside a systematic literature review updating current diagnostic and treatment strategies for orbitocerebral mucormycosis caused by Apophysomyces. Methods: The presented case was treated in our hospital for polytrauma following a motor vehicle accident (MVA) with aggressive surgical debridement and therapy with liposomal Amphotericin B (AMB). We evaluated clinical presentation, imaging, surgery, and postoperative outcomes. A systematic review of English or German language articles (published between 1985 and 2025) was performed according to PRISMA guidelines. Articles describing patients with mucormycosis due to Apophysomyces were summarized. Quantitative values for relevant parameters that indicated a reduction in mortality and morbidity were obtained. Results: The systematic search initially identified 452 publications, from which 79 studies were retrieved. Seventeen publications comprising 21 cases were included, along with one additional case from our institution, for a total of 22 rhino-orbito-cerebral infections caused by the genus Apophysomyces. Apophysomyces elegans (A. elegans) was the most frequently isolated species (n = 17), followed by A. variabilis (n = 4) and A. ossiformis (n = 1); A. trapeziformis was not reported. The majority of patients were male (72.7%), with a mean age of 40.7 ± 15.9 years. Trauma (27.3%) and diabetes mellitus (18.2%) were the most common underlying risk factors, with SARS-CoV-2 infection identified in 13.6% of cases. Conclusion: Mucormycosis due to Apophysomyces is a rare but potentially devastating condition. Based on our experience and the literature, we suggest that the early diagnosis of Apophysomyces treated with liposomal AMB and aggressive surgical debridement is essential to reduce morbidity and mortality. Full article

As bacteriophages (phages) are viruses that infect and destroy bacterial cells, they can be considered natural bactericides that can either directly or indirectly contribute to the achievement of the United Nations Sustainable Development Goals (UN SDGs) on health and well-being, food production and food security, as well as environmental protection and climate change mitigation, thus contributing to the success of the European “One Health” strategy to combat antimicrobial resistance in humans, animals, plants, and the environment. The biological activity of lytic bacteriophages can operate in the fields of microbiology and biotechnology for clinical, veterinary, agricultural, and industrial applications, among others, to achieve the proposed goals, mainly because the phages can help increase crop productivity by reducing bacterial diseases; constitute alternative therapies against infections caused by multidrug-resistant bacteria; can reduce populations of pathogenic bacteria that contaminate soil and water, therefore ensuring healthier and safer food production; and they can help reduce environmental pollution caused by the presence of agrochemicals and antibiotics. Phage-based therapies developed through research and innovation have the potential to promote greater global food security and health in a more environmentally friendly and eco-sustainable way. Full article

Cutaneous leishmaniasis (CL) is a vector-borne infection caused by protozoan parasites belonging to the genus Leishmania. CL is an emerging global health concern due to increasing migration, travel, and climate change. Traditionally, it was confined to endemic regions such as the Americas, the Middle East, and Central Asia; however, it is now spreading to non-endemic areas. Climate change has further contributed to the expansion of sandfly habitats, increasing CL transmission risk in previously unaffected areas. Healthcare providers in non-endemic regions often misdiagnose CL, delaying treatment and morbidity. Diagnosis remains challenging due to the need for species-specific identification, while treatment is limited by cost, availability, and personnel expertise. This review explores the epidemiology, clinical presentation, diagnostic challenges, and management of CL in the context of global mobility. It highlights rising CL cases in refugee settlements, particularly in Lebanon and Jordan, due to poor living conditions, inadequate vector control, and healthcare barriers. While there have been advances in systemic and topical therapies, access in refugee and resource-poor settings remains a barrier. Addressing the global burden of CL requires improved surveillance, healthcare provider training, and increased awareness. By enhancing global collaboration and policy changes, public health efforts can mitigate the expanding impact of CL. Full article

Healthcare professionals in pediatric oncology are at a high risk of burnout. Art therapy is being increasingly recognized as a potential tool for reducing stress and improving emotional well-being. The Art-Out pilot project aimed at nursing staff was initiated in a pediatric oncology unit. The staff members participating in the project were guided in a team-building course integrated with art and clay therapy, aiming to reduce burnout levels, improve emotional climate, and strengthen resilience. Methods: Burnout levels were assessed through the Maslach Burnout Inventory (MBI), alexithymia was measured with the Toronto Alexithymia Scale (TAS-20), and emotional regulation difficulties were evaluated through the Difficulties in Emotion Regulation Scale (DERS); these tests were assessed before (T0) and after (T1) the team-building course (Art-Out project). Results: Data analysis showed a significant reduction in burnout, alexithymia, and emotional dysregulation, highlighting the positive impact of this approach in improving team dynamics and emotional management. Conclusions: Our study confirms the high risk of burnout, alexithymia, and emotional dysregulation among pediatric oncology healthcare workers, underscoring the need for targeted interventions to prevent and mitigate these risks. Full article

Chikungunya virus (CHIKV) and other alphaviruses that primarily induce arthritogenic disease in humans, known as “Old World” alphaviruses, present an emerging public health concern as geographic ranges of mosquito vectors expand due to climate change. While a vaccine against CHIKV has recently been approved by several countries in North America and Europe, access to effective preventative countermeasures against disease induced by Old World alphaviruses remains elusive for the most vulnerable populations. Furthermore, treatment options continue to be limited to supportive care. Atypical neurological disease manifestations caused by Old World alphaviruses, which make up as many as 25% of the cases in some CHIKV outbreaks, present special challenges when considering strategies for developing effective countermeasures. This review focuses on Old World alphaviruses, specifically CHIKV, Ross River virus, O’nyoug-nyoug virus, and Mayaro virus, concentrating on the atypical neurological disease manifestations they may cause. Our current understanding of Old World alphavirus neuropathogenesis, gained from human cases and preclinical animal models, is discussed, including viral and host factors’ roles in disease development. The current state of alphavirus preventatives and treatments, both virus-targeting and host-directed therapies, is then summarized and discussed in the context of addressing neurological disease induced by Old World alphaviruses. Full article