Search Results (406)

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

This paper examines Krivelj, a copper mining village in Serbia, as a critical yet overlooked node within global extractive networks. Despite supplying copper essential for renewable energy and sustainable architecture, Krivelj experiences severe ecological disruption, forced relocations, and socio-spatial destabilization, becoming a “sacrifice zone”—an area deliberately subjected to harm for broader economic interests. Employing a hybrid methodology that combines ethnographic fieldwork with Geographic Information Systems (GISs), this study spatializes narratives of extractive violence collected from residents through walking interviews, field sketches, and annotated aerial imagery. By integrating satellite data, legal documents, environmental sensors, and lived testimonies, it uncovers the concept of “slow violence,” where incremental harm occurs through bureaucratic neglect, ambient pollution, and legal ambiguity. Critiquing the abstraction of Planetary Urbanization theory, this research employs countertopography and forensic spatial analysis to propose a counter-cartographic framework that integrates geospatial analysis with local narratives. It demonstrates how global mining finance manifests locally through tangible experiences, such as respiratory illnesses and disrupted community relationships, emphasizing the potential of counter-cartography as a tool for visualizing and contesting systemic injustice. Full article

Hypomagnesemia is a frequent and often underrecognized electrolyte disturbance with important clinical consequences, especially in hospitalized and critically ill patients. This multifactorial condition arises from impaired intestinal absorption, renal magnesium wasting, and the effects of various medications. Magnesium, the second most abundant intracellular cation, is crucial in enzymatic and physiological processes; its deficiency is associated with neuromuscular, cardiovascular, and metabolic complications. This narrative review focuses on the mechanisms and clinical consequences of drug-induced hypomagnesemia, highlighting the major drug classes involved such as diuretics, antibiotics, antineoplastic agents, and immunosuppressants. Management strategies include magnesium supplementation and adjunctive therapies like amiloride and SGLT2 inhibitors to reduce renal magnesium losses. Recognizing and addressing drug-induced hypomagnesemia is essential to improve patient outcomes and prevent long-term complications. Full article

Pre-oxygenation is the key step prior to endotracheal intubation, particularly in a critically ill patient, to prevent life-threatening peri-procedural hypoxemia. This narrative review explores the emerging interest of Non-Invasive Positive Pressure Ventilation (NIPPV) as a pre-oxygenation modality in the intensive care unit (ICU) context. We reviewed data from randomized controlled trials (RCTs) and observational studies published from 2000 to 2024 that compare NIPPV to conventional oxygen therapy and High Flow Nasal Cannula Oxygen (HFNCO). The pathophysiological mechanisms for the successful use of NIPPV, including alveolar recruitment, the decrease of shunting, and the maintenance of functional residual capacity, were reviewed in depth. Existing studies show that NIPPV significantly prolongs the apnea time, reduces the rate of peri-intubation severe hypoxaemia in selected patients and is especially effective for patients with acute hypoxaemic respiratory failure. Nevertheless, appropriate patient selection is still crucial because some diseases can contraindicate or even be harmful with NIPPV. We further discussed the practical aspects of how to use this ventilatory support (the best ventilator settings, which interface, and when to apply it). We lastly discuss unanswered questions and offer suggestions and opportunities for future exploration in guiding the role of NIPPV use in the pre-oxygenation of the critically ill patient requiring emergent airway management. Full article

Children living with chronic diseases represent a great challenge for the health care system, their families, and communities. These young patients face continuous medical needs that affect not only their health but also their daily routines, emotional well-being, and family dynamics. In response, clinical practice is increasingly integrating psychosocial indicators alongside traditional medical parameters. Consequently, there is a growing consensus that the evaluation of pediatric chronic diseases should address not only clinical dimensions but also the disease’s impact on socialization, emotional health, and daily functioning. This narrative review explores the role of psychosocial variables in the management of pediatric chronic illnesses, including the experiences of parents and siblings, with a focus on effective strategies to improve everyday life. The integration of quality of life and well-being within a multidimensional care model could be instrumental in both symptom management and psychosocial support. Recognizing that children with chronic conditions are at increased risk for long-term adverse outcomes, it is critical to develop interventions that go beyond clinical care, encompassing education, coping reinforcement, and family-centered approaches. Full article

Maternal mental illness significantly impacts caregiving, influencing both mothers and their children. This narrative review examines the challenges faced by mothers with conditions such as depression, anxiety, bipolar disorder, and schizophrenia, which often disrupt caregiving routines, emotional stability, and social integration. These difficulties can hinder secure attachments and contribute to adverse developmental outcomes in children, including heightened risks of anxiety, depression, behavioral issues, and cognitive impairments. Children of mothers with mental illnesses are 1.8 times more likely to develop emotional or behavioral problems and face a 2.7 times higher risk of suicidal ideation during adolescence. Intergenerational transmission of mental illness is also prevalent, with affected children showing a 2.5 times greater likelihood of developing mental illnesses in adulthood. Effective interventions include cognitive behavioral therapy (CBT), family-based approaches, and community programs integrating parenting education and mental health resources. These strategies have demonstrated improvements in maternal well-being and child resilience. The review highlights the need for comprehensive policies addressing maternal mental health, early intervention for children, and culturally sensitive support systems to break cycles of intergenerational mental illness. Future research should prioritize evaluating long-term intervention effectiveness and exploring innovative tools like digital mental illnesses solutions to support affected families. Full article

Determining the optimal duration of antibiotic therapy for infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) is a critical challenge in clinical medicine, balancing therapeutic efficacy against the risks of adverse effects and antimicrobial resistance. This narrative review synthesises current evidence and guidelines regarding antibiotic duration for MDR-GNB infections, emphasising bloodstream infections (BSI), hospital-acquired and ventilator-associated pneumonia (HAP/VAP), complicated urinary tract infections (cUTIs), and intra-abdominal infections (IAIs). Despite robust evidence supporting shorter courses (3–7 days) in uncomplicated infections caused by more susceptible pathogens, data guiding optimal therapy duration for MDR-GNB remain limited, particularly concerning carbapenem-resistant Enterobacterales (CRE), difficult-to-treat Pseudomonas aeruginosa (DTR-Pa), and carbapenem-resistant Acinetobacter baumannii (CRAB). Current guidelines from major societies, including IDSA and ESCMID, provide explicit antimicrobial selection advice but notably lack detailed recommendations on the duration of therapy. Existing studies demonstrate non-inferiority of shorter versus longer antibiotic courses in specific clinical contexts but frequently exclude critically ill patients or those infected with non-fermenting MDR pathogens. Individualised duration decisions must integrate clinical response, patient immunologic status, infection severity, source control adequacy, and pharmacologic considerations. Significant knowledge gaps persist, underscoring the urgent need for targeted research, particularly randomised controlled trials assessing optimal antibiotic duration for the most challenging MDR-GNB infections. Clinicians must navigate considerable uncertainty, relying on nuanced judgement and close monitoring to achieve successful outcomes while advancing antimicrobial stewardship goals. Full article

Climate change and air pollution are reshaping viral circulation patterns and increasing host vulnerability, amplifying the burden of respiratory illness in early childhood. This narrative review synthesizes current evidence on how environmental exposures, particularly to nitrogen dioxide, ozone, and fine particulate matter, contribute to the incidence and severity of bronchiolitis, with a focus on biological mechanisms, epidemiological trends, and public health implications. Bronchiolitis remains one of the leading causes of hospitalization in infancy, with Respiratory Syncytial Virus (RSV) being responsible for the majority of severe cases. Airborne pollutants penetrate deep into the airways, triggering inflammation, compromising mucosal defenses, and impairing immune function, especially in infants with pre-existing vulnerabilities. These interactions can intensify the clinical course of viral infections and contribute to more severe disease presentations. Children in urban areas exposed to high levels of traffic-related emissions are disproportionately affected, underscoring the need for integrated public health interventions. These include stricter emission controls, urban design strategies to reduce exposure, and real-time health alerts during pollution peaks. Prevention strategies should also address indoor air quality and promote risk awareness among families and caregivers. Further research is needed to standardize exposure assessments, clarify dose–response relationships, and deepen our understanding of how pollution interacts with viral immunity. Bronchiolitis emerges as a sentinel condition at the crossroads of climate, environment, and pediatric health, highlighting the urgent need for collaboration across clinical medicine, epidemiology, and environmental science. Full article

Pediatric delirium (PD) is an acute neuropsychiatric syndrome marked by fluctuating disturbances in attention and cognition, frequently observed in pediatric intensive care units (PICUs) and associated with increased morbidity, mortality, and long-term cognitive impairment. Despite its clinical significance, PD remains underdiagnosed due to challenges inherent in assessing consciousness and cognition in children at varying developmental stages. Several bedside tools have been developed and validated in recent years, including the Cornell Assessment of Pediatric Delirium (CAPD), PreSchool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU); Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), and Sophia Observation Withdrawal Symptoms—Pediatric Delirium Scale (SOS-PD), enhancing early recognition and management of PD in critically ill children. This narrative review explores the historical background, epidemiology, risk factors, pathophysiology, clinical subtypes, diagnostic tools, and current prevention and treatment strategies for PD from newborns to 21 years old. The screening tools available and the integration of non-pharmacological interventions, such as environmental modifications and family-centered care, as well as cautious and selective pharmacological management, are emphasized in this review. Early identification and targeted interventions are essential to mitigate the adverse outcomes associated with PD. Full article

Background/Objectives: Acute respiratory tract infections (ARTIs) are a significant global health burden, contributing to increased healthcare use, absenteeism, and economic strain. While clinical treatments exist, many individuals use traditional dietary remedies such as soup to relieve symptoms. Soup is thought to support recovery through hydration, warmth, nutritional content, and possible anti-inflammatory effects. This systematic review aimed to evaluate the therapeutic effects of soup consumption on adults with ARTIs, focusing on symptom severity, illness duration, absenteeism, immune response, inflammatory biomarkers, and overall well-being. Methods: A systematic literature search was conducted in February 2024 across MEDLINE, Scopus, CINAHL, the Cochrane Library, clinical trial registries, and supplementary sources. Eligible studies included randomized controlled trials, non-randomized trials, and controlled before-after studies evaluating soup as an intervention for ARTIs. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. A narrative synthesis was undertaken due to heterogeneity in study design and outcome measures. The protocol was registered with PROSPERO (CRD42023481236). Results: Four studies (n = 342) met inclusion criteria. Interventions commonly included chicken-based soups with vegetables and herbs. Comparators varied (e.g., no treatment, water, or alternative soup). Findings showed modest reductions in symptom severity and illness duration (by 1–2.5 days). Two studies reported reductions in inflammatory biomarkers (IL-6, TNF-α, CRP). No studies reported on absenteeism or well-being. Conclusions: Soup may offer modest benefits for ARTIs, particularly for symptom relief and inflammation. Further well-designed studies are needed to evaluate its broader clinical and functional impacts. Full article

Background/Objectives: Chronic illness after COVID-19 vaccination (longvax) lacks a therapeutic protocol anchored in pathophysiology. Persistent vaccine derived spike protein appears to trigger microvascular fibrin amyloid microclots, immune dysfunction, pathogen reactivation and multisystem injury. This article proposes an integrative approach, Vaxtherapy, to tackle these mechanisms. Methods: A narrative synthesis of peer reviewed literature from 2021 to 2025 on spike related injury and vaccine adverse events was conducted, supplemented by clinical case series and mechanistic observations from long COVID. The findings were arranged into a four stage therapeutic sequence ordered by pathophysiological precedence. Results: Stage one aims to reopen hypoperfused tissue through oral fibrinolytics that degrade fibrin amyloid resistant microclots; stage two intends to neutralise circulating or tissue bound spike via a receptor binding domain monoclonal antibody cocktail; stage three seeks to eliminate reactivated viral or microbial reservoirs with targeted antivirals or antimicrobials once perfusion is improved; and stage four aspires to support tissue repair with mitochondrial supplements and, when indicated, cell based therapies. Omitting or reordering stages may reduce efficacy or foster resistance. Conclusions: This hypothesis driven framework outlines a biologically plausible roadmap for longvax research. By matching interventions to specific mechanisms (fibrinolysis, spike neutralisation, pathogen clearance and regeneration), it aims to guide controlled trials and compassionate pilot programs directed at durable recovery rather than chronic symptom management. Full article

Pregnancy and birth are biological processes shaped by social factors, requiring sociological approaches to explain reproductive behaviour. This narrative review outlines the importance of health sociology against the background that health and illness behaviour is influenced by the social environment. The aim of this paper is to summarize the current state of research on the influence of social systems and social milieu behaviour on reproduction, pregnancy, and childbirth in order to make it easier for midwives and doctors to take these factors into account in their everyday clinical and outpatient work. First, the paper lays out the basics of how health and illness are socially constructed, looking at it from both a structural and action-oriented perspective. It then goes on to explain what this means for pregnancy and childbirth as social processes, how women’s health is related to the social construction of gender roles, that breastfeeding is also a social process, and what conclusions can be drawn for the work of midwives. Pregnancy and birth are social processes based on norms and role attributions: “Decisions” regarding one’s own reproductivity are usually only “self-determined” to a limited extent and tend to occur in the context of social norms and milieu-specific role expectations. The promotion of women’s health depends on how milieu-specific norms and logics of action are understood. For all the professions involved in obstetrics, this results in the need for a critical examination of the sociological aspects of health. This implies the necessity for all obstetric professions to critically examine aspects of the sociology of health in order to provide women and their families with appropriate, evidence-based and client-centred care in the context of pregnancy, birth and the postpartum period, against the background of constant social change. Full article

Human adenoviruses (HAdVs) are pathogens causing different illnesses, particularly in pediatric and immunocompromised patients in developed countries. The clinical spectrum of HAdV-infections ranges from mild to severe, and the clinical presentation varies widely. Certain HAdVs types, including types B3, E4, B7, B14, B21, G55, and B66, may be associated with lower respiratory tract infections and thus lead to higher hospitalization, increased morbidity, as well as lethality rates. The aim of this article is to synthesize and analyze the prevalence of specific HAdV types in pediatric patients worldwide. A systematic literature search was performed using MEDLINE, Scopus, and Web of Science. In total, n = 1167 titles and abstracts were screened, and 105 full-text articles were assessed for eligibility. Screening, data extraction, and appraisal were analyzed by reviewers, in accordance with PRISMA guidelines and JBI recommendations. We included studies reporting on currently circulating HAdV types (n = 16). Based on a systematic and narrative approach, relevant types of HAdV biology and infections in children are presented. In detail, HAdV-B3 and HAdV-B7 were commonly associated with severe respiratory tract infections, while HAdV-F40 and HAdV-F41 caused acute gastroenteritis. Moreover, detailed research revealed the critical role of HAdV-C2 and the necessity for particular attention to HAdVs in acute neurological infections. This comprehensive analysis highlights the significant global distribution and diverse clinical implications of different HAdV types in children, pointing out the need for continued surveillance to better understand HAdVs epidemiology and its implications for public health, and future preventive measures, in particular among vulnerable patients. Full article

The literature details the healthcare needs of migrant people living with chronic illnesses and the consequent economic, social, and healthcare needs of their caregivers. Similarly, some studies have underscored the social and healthcare needs of 2SLGBTQIA+ (two-spirit, lesbian, gay, bisexual, transgender, queer, and intersex individuals, including diverse sexual and gender identities under the “+” symbol) adults living with chronic illnesses and their caregivers. This narrative review presents the context of migrant 2SLGBTQIA+ unpaid caregivers and how their intersecting identities influence their caregiving roles for family members with chronic illnesses. In this article, caregivers are defined as family members or chosen families who provide unpaid support that may last for three months or longer for people living with chronic illnesses. Most studies and policies overlook 2SLGBTQIA+ migrants who are also unpaid caregivers of individuals living with chronic illnesses, leaving them unsupported through discrimination at the intersection of racism, homophobia, transphobia, ageism, and ableism, forcing them to remain vulnerable to increased emotional and physical strain. There is a presence of pervasive systemic barriers, including a lack of training and education among social and healthcare providers, about the needs of migrant 2SLGBTQIA+ unpaid caregivers. Additional challenges stem from inadequate policies and insufficient targeted resources, particularly for caregivers from marginalized racial and ethnic backgrounds. The findings of this study highlight the necessity for a call to action to address these gaps and improve support systems for these highly marginalized communities. Full article

The global consumption of fresh and ready-to-eat (RTE) fruits and vegetables has surged due to increasing awareness of their nutritional benefits. However, this trend has been accompanied by a rise in foodborne illness outbreaks linked to microbial contamination. This narrative review synthesizes current knowledge on the prevalence and diversity of foodborne pathogens in fresh produce, including bacterial, viral, and fungal agents. It critically evaluates both conventional and emerging detection methods, ranging from culture-based techniques and immunoassays to advanced molecular diagnostics, biosensors, flow cytometry (FC), and hyperspectral imaging (HSI). Additionally, this review discusses cutting-edge control strategies, such as natural antifungal agents, essential oils, biocontrol methods, and non-thermal technologies like cold plasma and UV-C treatment. Emphasis is placed on sampling methodologies, sustainability, One Health perspectives, and regulatory considerations. By highlighting recent technological advances and their limitations, this review aims to support the development of integrated, effective, and safe microbial control approaches for the fresh produce supply chain. Full article