Search Results (294)

Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, methamphetamines, and other synthetic drugs. All major psychoactive substances readily cross the placenta and can remain detectable in breast milk, leading to a shared cascade of obstetric complications (hypertensive disorders, placental abruption, pre-term labor), fetal consequences (growth restriction, structural malformations), and neonatal morbidities such as neonatal abstinence syndrome and sudden infant death. Mechanistically, trans-placental diffusion, oxidative stress, inflammatory signaling, and placental vascular dysfunction converge to disrupt critical neuro- and cardiovascular developmental windows. Early identification hinges on the combined use of validated screening questionnaires (4 P’s Plus, CRAFFT, T-ACE, AUDIT-C, TWEAK) and matrix-specific biomarkers (PEth, EtG, FAEE, CDT), while effective treatment requires integrated obstetric, addiction, and mental health services. Medication for opioid use disorders, particularly buprenorphine, alone or with naloxone, confers superior neonatal outcomes compared to methadone and underscores the value of harm-reducing non-punitive care models. Public-health strategies, such as Mexico’s “first 1 000 days” framework, wrap-around clinics, and home-visiting programs, demonstrate the potential of multisectoral interventions, but are hampered by structural inequities and punitive legislation that deter care-seeking. Research gaps persist in polysubstance exposure, culturally tailored therapies, and long-term neurodevelopmental trajectories. Multigenerational, omics-enabled cohorts, and digital longitudinal-care platforms represent promising avenues for closing these gaps and informing truly preventive perinatal health policies. Full article

Background: The phenomenon of pink teeth represents a notable observation in forensic science, although its interpretation remains complex and not directly attributable to a specific cause of death. Methods: This systematic review provides an updated and comprehensive overview of the morphological and histological mechanisms associated with this finding, with a focus on hemoglobin diffusion and pigment accumulation during putrefaction rather than on detailed biochemical pathways. Results: Environmental conditions, especially high humidity and moderate temperatures, are identified as key facilitators. The synthesis of the available evidence, including case reports, observational series, and experimental studies, confirms that pink discoloration is primarily linked to postmortem hemoglobin diffusion following erythrocyte breakdown and release of heme groups into dentinal structures. This process occurs more frequently under conditions that preserve hemoglobin and facilitate its migration into dental tissues. Importantly, pink teeth have been documented across a wide spectrum of postmortem scenarios, such as hanging, drowning, carbon monoxide poisoning, and prolonged exposure to humid environments, indicating that their presence is neither pathognomonic nor exclusively associated with a specific cause of death. Assessment methods include semi-quantitative visual scoring systems (e.g., SPTC and SPTR), spectrophotometric assays, and histochemical analyses for hemoglobin derivatives. Recent advances in digital forensics, particularly micro-computed tomography and artificial intelligence–based segmentation, may further support the objective evaluation of chromatic dental changes. Conclusions: This review underscores the need for standardized approaches to the identification, classification, and analysis, both qualitative and quantitative, of pink teeth in medico-legal practice. Although not diagnostic in isolation, their systematic study enhances our understanding of decomposition processes and contributes supplementary interpretive data in forensic investigations. Full article

This article explores the papacy as a multifaceted form of cultural heritage, emphasizing the pope not only as a religious leader but also as a living symbol and institutional embodiment of Catholic heritage. Positioned at the intersection of theology, history, and heritage science, the study seeks to bridge the gap between spiritual authority and cultural memory by introducing a novel interpretive category: the pope as a living component of intangible religious heritage. The research combines a comprehensive literature review with an analysis of papal documentation, especially papal constitutions. Special attention is given to public engagement with the papacy, as reflected in internet search trends during significant ecclesiastical events such as papal deaths and conclaves. The results indicate that the pope functions as a living link in the continuity of Catholic identity, with digital indicators revealing peaks of global interest aligned with pivotal moments in Church leadership. The study also defines the roles and functions of the pope as a narrative bearer, initiator, and symbolic custodian of papal cultural heritage. Overall, the findings reinforce the papacy’s dual role as both a theological and sociocultural institution, offering new perspectives for understanding religious leadership as a medium of cultural transmission and public relevance in a digitized world. Full article

Background/Objectives: Colorectal cancer (CRC) ranks third in the Western world in cancer incidence and second as the cause of cancer-related deaths. Despite advances in perioperative care, minimizing postoperative morbidity is crucial in clinical practice. Digitalization of the healthcare process plays a key role in genuinely and effectively engaging patients. Our aim was to evaluate a digital solution for remote monitoring of patients with CRC, from surgery indication to postoperative discharge. Methods: We developed a digital solution using Value Stream Mapping (VSM) to identify patient care flow and Lean Sigma for optimization and efficiency. We incorporated the Enhanced Recovery After Surgery (ERAS)/RICA pentamodal recommendations to create a program with an individualized schedule for each patient, who received tailored educational, medical, and practical information at every stage of the process. Results: A total of 193 patients used the digital solution, with >75% adhering to ERAS recommendations. The median length of hospital stay was 5 days, with low adherence leading to 3.4 (p = 0.628) or 3.27 (p = 0.642) extra days in the hospital compared to patients with intermediate and high adherence, respectively. The mean comprehensive complication index (CCI) was 9.1/100, which was higher in patients with low adherence (15) versus intermediate (8.17; p = 0.027) and high (7.42; p = 0.011) adherence. An increase in self-perception of quality of life by 9.2% was identified at the end of the process compared to the outcome at the beginning (p = 0.09), and 80% rated their overall satisfaction with the care process as 8 or higher out of 10. Conclusions: The digital solution facilitates the monitoring of CRC care and implementation and adherence to ERAS recommendations, improving patient engagement and satisfaction. Full article

Cardiovascular disease (CVD) remains Europe’s leading cause of mortality, responsible for >45% of deaths. Beyond established risk factors (hypertension, diabetes, dyslipidaemia, smoking, obesity), psychosocial elements—depression, anxiety, financial stress, personality traits, and trauma—significantly influence CVD development and progression. Behavioural Cardiology addresses this connection by systematically incorporating psychosocial factors into prevention and rehabilitation protocols. This review examines the HEARTBEAT model, developed by Greece’s first Behavioural Cardiology Unit, which aligns with current European guidelines. The model serves dual purposes: primary prevention (targeting at-risk individuals) and secondary prevention (treating established CVD patients). It is a personalised medicine approach that integrates psychosocial profiling with traditional risk assessment, utilising tailored evaluation tools, caregiver input, and multidisciplinary collaboration to address personality traits, emotional states, socioeconomic circumstances, and cultural contexts. The model emphasises three critical implementation aspects: (1) digital health integration, (2) cost-effectiveness analysis, and (3) healthcare system adaptability. Compared to international approaches, it highlights research gaps in psychosocial interventions and advocates for culturally sensitive adaptations, particularly in resource-limited settings. Special consideration is given to older populations requiring tailored care strategies. Ultimately, Behavioural Cardiology represents a transformative systems-based approach bridging psychology, lifestyle medicine, and cardiovascular treatment. This integration may prove pivotal for optimising chronic disease management through personalised interventions that address both biological and psychosocial determinants of cardiovascular health. Full article

Background/Objectives: Brain metastasis (BM) is a common and often early manifestation in lung adenocarcinoma (LUAD), yet its tumor microenvironment remains poorly defined at the time of initial diagnosis. This study aims to characterize early immune microenvironmental alterations in synchronous BM using spatial proteomic profiling. Methods: We performed digital spatial proteomic profiling using the NanoString GeoMx platform on formalin-fixed paraffin-embedded tissues from five treatment-naïve LUAD patients in whom BM was the initial presenting lesion. Paired primary lung and brain metastatic samples were analyzed across tumor and stromal compartments using 68 immune- and tumor-related protein markers. Results: Spatial profiling revealed distinct expression patterns between primary tumors and brain metastases. Immune regulatory proteins—including IDO-1, PD-1, PD-L1, STAT3, PTEN, and CD44—were significantly reduced in brain metastases (p < 0.01), whereas pS6, a marker of activation-induced T-cell death, was significantly upregulated (p < 0.01). These alterations were observed in both tumor and stromal regions, suggesting a more immunosuppressive and apoptotic microenvironment in brain lesions. Conclusions: This study provides one of the first spatially resolved proteomic characterizations of synchronous BM at initial LUAD diagnosis. Our findings highlight early immune escape mechanisms and suggest the need for site-specific immunotherapeutic strategies in patients with brain metastasis. Full article

Background/Objectives: The growing demand for biocompatible and fluoride-free alternatives in oral care has led to the development of formulations containing nano-hydroxyapatite (nanoHAP). This study aimed to evaluate the antimicrobial, antibiofilm, antioxidant, and anti-inflammatory properties of a novel mouthwash containing nanoHAP, zinc lactate, D-panthenol, licorice extract, and cetylpyridinium chloride, with particular focus on its efficacy against Staphylococcus aureus and its biofilm on various dental materials. Methods: The antimicrobial activities of the mouthwash KWT0000 and control product ELM were assessed via minimal inhibitory concentration (MIC) testing against selected Gram-positive and Gram-negative bacteria and Candida fungi. Antibiofilm activity was evaluated using fluorescence and digital microscopy following 1-h exposure to biofilms of Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. The efficacy was compared across multiple dental materials, including titanium, zirconia, and PMMA. Antioxidant capacity was determined using the 2,2-diphenyl-1-picrylhydrazyl radical (DPPH) assay, and anti-inflammatory potential via hyaluronidase inhibition. Results: KWT0000 exhibited strong antimicrobial activity against S. aureus and C. albicans (MICs: 0.2–1.6%) and moderate activity against Gram-negative strains. Fluorescence imaging revealed significant biofilm disruption and bacterial death after 1 h. On metallic surfaces, especially polished titanium and zirconia, KWT0000 reduced S. aureus biofilm density considerably. The formulation also demonstrated superior antioxidant (55.33 ± 3.34%) and anti-inflammatory (23.33 ± 3.67%) activity compared to a fluoride-based comparator. Conclusions: The tested nanoHAP-based mouthwash shows promising potential in antimicrobial and antibiofilm oral care, particularly for patients with dental implants. Its multifunctional effects may support not only plaque control but also soft tissue health. Full article

In October 2024, a DANA (Isolated Depression at High Levels) triggered torrential rains across the Valencian Community, causing 227 deaths, severe infrastructure damage, and economic losses estimated at €17.8 billion. In this context of crisis, startups, despite having fewer resources and less experience than large corporations, played a significant role in crisis communication, shaping public perception and operational continuity. This study explores the communication strategies adopted by startups during and after the disaster, focusing on their activity on Instagram, TikTok, and Facebook between October 2024 and January 2025. Using a mixed-methods approach, we conducted a quantitative analysis of digital discourse through the Fanpage Karma tool, assessing metrics such as engagement, reach, and posting frequency. Sentiment analysis was performed using GPT-4, an advanced natural language processing model, and in-depth interviews with startup representatives provided qualitative insights into reputational impacts. The findings reveal that startups which aligned their discourse with the social context, prioritizing transparency and emotional proximity, enhanced their visibility and credibility. These results underscore how effective crisis communication not only mitigates reputational risk but also strengthens the local entrepreneurial ecosystem through trust-building and social responsibility. Full article

Background and aims: Rheumatic diseases are chronic, progressive conditions associated with severe pain, joint damage, disability, and even death. Healthcare interventions play a critical role in symptom management, patient education, and adherence to treatment plans. This study evaluates the role of healthcare interventions in the management of patients with rheumatic diseases, focusing on pain management, functional rehabilitation, patient education, and multidisciplinary collaboration. In addition, barriers to optimal care and potential solutions, including digital health technologies, are explored. Materials and methods: We conducted a narrative review of the scientific literature. Studies published between 2014 and 2025 were selected from PubMed, Scopus, Web of Science, Elsevier, Springer, Frontiers, and Wiley Online Library. Key areas of review included nurse-led pain management, education programs, and the impact of interdisciplinary care on patient outcomes. Results: Nursing interventions significantly improve pain control, treatment adherence, and self-management skills in patients with rheumatic diseases. Multidisciplinary approaches improve functional rehabilitation and increase quality of life in patients with rheumatic conditions. However, barriers such as insufficient health care resources, lack of patient awareness, and disparities in the availability of services hinder effective care delivery. Conclusions: A structured, multidisciplinary approach integrating healthcare interventions, digital health solutions, and patient-centered education is essential to optimize the management of rheumatic diseases. Future research should focus on improving access to non-pharmacological therapies and standardizing healthcare protocols for better patient outcomes. Full article

The coronavirus pandemic has spread globally, affecting over 700 million people and resulting in over 7 million deaths. In response, global pharmaceutical companies and disease control centers have urgently sought effective treatments and vaccines. However, the rise of counterfeit drugs has become a significant concern amid this urgency. To standardize the legal provision and usage of genetic resources, the United Nations Development Program (UNDP) introduced the Nagoya Protocol. Despite advancements in drug research, the production process remains tedious, complex and vulnerable to fraud. FairChain addresses this pressing challenge by creating a transparent ecosystem that builds trust among all stakeholders throughout the Drug Development Life Cycle (DDLC) by using decentralized, immutable, and transparent blockchain technology. This makes FairChain the first digital health tool to implement the principles of the UNDP’s Nagoya Protocol among all stakeholders throughout all DDLC stages, starting with sample collection, to discovery and development, to preclinical research, to clinical development, to regulator review, and ending with post-market monitoring. Therefore, FairChain allows pharmaceutical companies to document the entire drug production process, landowners to monitor bio-samples from their land, doctors to share clinical research, and regulatory agencies such as the Food and Drug Authority to oversee samples and authorize production. FairChain should enhance transparency, foster trust and efficiency, and ensure a fair and traceable DDLC. To date, no blockchain-based framework has addressed the integration of traceability, auditability, and Nagoya Protocol compliance within a unified system architecture. This paper introduces FairChain, a system that formalizes these requirements in a modular, policy-aligned, and verifiable digital trust infrastructure. Full article

The United Nations (UN) framework defines indicator 13.1.1 as the number of deaths, missing persons, and directly affected individuals due to disasters per 100,000 population. This indicator is associated with target 13.1, which calls for urgent actions against climate-related hazards and natural disasters in all countries. However, there is a lack of official data providers and well-established methodologies for assessing the resilience of populated areas to natural disasters. Earth observation (EO), geospatial technologies, and local data may support the estimation of this indicator and, as such, enhance the resilience of specific communities against hazards. Thus, the present study aims to enhance the capacity to monitor Sustainable Development Goals (SDGs) using the abovementioned technologies. In this context, a methodology that integrates ecoregion-specific model training and flood potential related geospatial datasets has been developed to estimate the number of houses affected by floods. This methodology relies on disaster-related databases, such as the UN’s DesInventar, and flood- and exposure-related data, including precipitation and soil moisture products combined with hydro-modelling based on digital elevation models, infrastructure datasets, and population products. By integrating these data sources, different machine learning regression models were trained and stratified by ecoregions to predict the number of affected houses and, as such, provide a more comprehensive understanding of community resilience to floods in the Sahel region. This effort is particularly crucial as the frequency and intensity of floods significantly increase in many areas due to climate change. Full article

Background/Objectives: Prostate cancer is the most common cancer among men globally and a leading cause of cancer-related death. Germline genetic evaluation is increasingly recognized as essential for men with high-risk features such as a strong family history or advanced disease. Methods: Comprehensive genetic risk assessment should integrate three components: family history (FH), rare pathogenic mutations (RPMs), and polygenic risk scores (PRS). RPMs in DNA repair genes (e.g., BRCA2, CHEK2, ATM) can inform screening, prognosis, and treatment strategies, particularly for metastatic or aggressive disease. PRS, derived from common genetic variants, provides a personalized and independent measure of prostate cancer risk and may guide decisions on screening intensity and timing. Results: Although PRS cannot yet differentiate between indolent and aggressive cancer, it has the potential to stratify men into low and high-risk categories more effectively than FH or RPMs alone. Knowledge of specific RPMs can influence treatment decisions in clinically advanced prostate cancer. Challenges in clinical implementation include limited provider awareness, underutilization of genetic counseling, and lack of diversity in genomic datasets, which can lead to misdiagnoses. Emerging technologies and digital tools are being developed to streamline genetic testing and counseling. Population-level strategies and tailored screening protocols based on genetic risk are under active investigation. Conclusions: While early evidence suggests high satisfaction with genetic testing among patients, further studies in diverse populations are needed. Integration of germline genetic information into prostate cancer management offers promising avenues for personalized screening, surveillance, and treatment, ultimately aiming to reduce morbidity and mortality. Full article

Brugada syndrome (BrS) is a cardiac disease associated with characteristic ECG abnormalities and a heightened risk of sudden cardiac death, especially in young individuals with structurally normal hearts. The primary aim of this study was to highlight, for the first time, the potential of using droplet digital PCR (ddPCR), a highly sensitive method, to detect C-type natriuretic peptide (CNP) and its receptors, NPR-B and NPR-C, expression in BrS. Whole-blood samples from 12 subjects with type 1 BrS and 12 controls were analyzed. CNP expression was detectable and lower in BrS patients than in the controls, although not significantly. NPR-B and NPR-C expression was significantly reduced in the same patients (p ≤ 0.05). Strong correlations were observed between CNP and NPR-B (p = 0.01) and NPR-C (p < 0.0001), as well as between NPR-B and NPR-C (p = 0.0002). Body weight correlated with CNP (p = 0.02), NPR-B (p = 0.03), and NPR-C (p = 0.02); meanwhile, NPR-B expression was related to height (p = 0.05). This study is the first to analyze CNP expression and its specific receptors using ddPCR technology, showing for the first time their presence and activation in individuals with BrS. Although further research is needed to clarify CNP-related mechanisms, these findings offer a valuable starting point for exploring its role in BrS. Full article

Fishing vessels are essential for the activities of catching, moving, and storing fish. However, fishing vessel accidents claim thousands of deaths every year. This study presents a novel integrated safety monitoring and early warning system designed for fishing vessels, offering significant advancements in maritime safety through real-time alerts based on vessel attitude motion and environmental conditions. The innovation of the system lies in its dual-subsystem architecture: a sensing terminal equipped with a nine-axis sensor, temperature and humidity sensors, a GPS module, and a surveillance camera collects critical data, while a decision support subsystem processes this information via a fuzzy logic-based algorithm to generate a “danger score”. This score quantifies the vessel’s safety status, enabling the system to trigger alerts through SMS and web notifications when predefined thresholds are exceeded. Field trials in the Zhoushan Sea area confirmed the system’s effectiveness in accurately predicting safety hazards and providing timely alerts. The results highlight its potential to enhance operational safety and contribute to the digitization of fisheries management by offering reliable real-time data on vessel conditions. The system’s modular and cost-efficient design ensures it is scalable and adaptable for widespread use across the fishing industry. Our study addresses the limitations of existing technologies by providing a balanced solution that combines comprehensive sensing capabilities with real-time responsiveness and cost-effectiveness, offering a practical and innovative approach to improve fishing vessel safety. Full article

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and facilitators of tobacco cessation interventions at both the population and healthcare system levels in the U.S. Understanding these determinants is critical for narrowing health disparities, optimizing resource allocation, and ultimately, enhancing tobacco cessation success rates across all demographic groups. Methods: A comprehensive literature search was conducted across the PubMed, Embase, and Web of Science databases, guided by the population, intervention, comparison, and outcome framework and quality assessment guided by PRISMA guidelines. Data extraction focused on study characteristics, intervention types, barriers, facilitators, and cessation outcomes at both the population and health system levels. The random effects forest plots were graphed to estimate pooled effect sizes for both medical and non-medical interventions. Results: A total of 35 studies met the inclusion criteria from an initial pool of 1555 identified records. Socioeconomic disadvantages, digital inequities, and low motivation constitute primary barriers at the individual level, while systemic factors such as healthcare access limitations, inadequate provider engagement, and lack of financial support further hinder cessation efforts. Financial incentives, culturally tailored interventions, and digital engagement strategies significantly improve tobacco cessation outcomes. Public health implications: as identified by the study, tailored interventions, the expansion of health coverage policies to include intervention, digital solutions, and healthcare resource workforce training will help improve tobacco cessation intervention outcomes. Full article