Search Results (211)

Background: Cancer is one of the leading causes of morbidity and mortality worldwide and in Spain. Individuals with cancer are at a higher risk of suicide compared to the general population due to both general and disease-specific risk factors. Objective: To update knowledge on nursing care measures to address the risk of suicide in cancer patients. Methods: A narrative review was conducted by searching PubMed, WOS, Scopus, and CINAHL during February and March 2025. The inclusion criteria comprised original qualitative, quantitative, and/or mixed-methods studies related to the topic of the review. Results: Of the 289 identified studies, 23 were selected. Twelve studies of cancer patients, ten studies of healthcare professionals, and one study of caregivers and survivors were included. Regarding suicide risk factors, eight studies addressed demographic aspects, fifteen socio-economic factors, twenty-one psycho-emotional factors, and seventeen physical factors. Key risk factors included male sex, advanced age, social isolation, lack of social support, hopelessness, and physical deterioration. Seventeen studies highlighted the need for continuous and comprehensive nursing care using validated tools for systematic assessment of suicide risk. Eight emphasised the importance of ongoing training in suicide prevention, which is essential for developing communication skills and improving therapeutic relationships. Five studies underscored the relevance of a holistic approach that addresses the physical, emotional, social, and spiritual dimensions of patient care. Six extended this approach to include family members and caregivers. Conclusions: Suicide risk in cancer patients is associated with multiple risk factors. Emotional support and a comprehensive, continuous nursing approach—based on systematic assessments, specialised training, and a holistic focus—are key to effective suicide prevention. Full article

Background: Burnout syndrome (BS) is an occupational condition resulting from chronic stress, characterized by three dimensions, emotional exhaustion (EE), depersonalization (DE), and diminished personal accomplishment (PA), particularly prevalent in caregiving professions such as healthcare. The aim of this study is to analyse the prevalence of BS among Spanish dental implantology specialists, along with the impact of demographic, educational, and professional aspects. Methods: This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines and was open to respondents from May to December 2024. An electronic survey based on the Maslach Burnout Inventory—Human Services Survey (MBI–HSS) was sent to members of the Spanish Society of Implants. The data were analysed using descriptive analysis. Results: A total of 305 participants (20.9%) (31.5% females and 68.5% males) completed the questionnaire. The prevalence of BS was 4.3%; however, 61.0% of the dentists showed signs of suffering from the syndrome. The mean values of EE were “average” (20.3 ± 13.8) and of DE and EE “low” (5.1 ± 5.9, and 32.5 ± 14.5, respectively). The factors significantly associated with suffering from BS were being female and having more than 20 years of experience in dental implant treatments. Conclusions: It is advisable to conduct instructive and awareness-raising initiatives among dental professionals to promote an awareness of their mental health, ultimately aiming at preserving their physical and emotional well-being while delivering optimal care to their patients. Full article

Background: Awake craniotomy (AC) surgeries are less common in the pediatric population in comparison to their adult counterparts. Nonetheless, they can be considered for selected cases whereby speech preservation is paramount during maximal safe resection of intracranial lesions. We describe a case of AC for the excision of a brain arteriovenous malformation (bAVM) with language mapping in a pediatric patient. Methods: A previously well 16-year-old male presented with a spontaneous left frontal intracranial hemorrhage. Neuroimaging confirmed the cause to be a left antero-temporal bAVM centered in the insula. A decision was made for AC bAVM excision with language mapping for speech preservation. Results: As part of the pre-operative preparation, the patient and his caregivers were reviewed by a multidisciplinary team. For the conduct of the AC, the asleep–awake–asleep technique was used with processed EEG to guide anesthesia management. Additional modifications to make the patient comfortable included the avoidance of rigid cranial skull pins, urinary catheterization and central line insertion at the start of the surgery. Conclusions: Our experience concurs with the evidence that AC in children is a feasible option for select individuals. To our knowledge, this is the first detailed case description of a pediatric patient undergoing AC with language mapping for a bAVM. Emphases include a strong rapport between the patient and the managing multidisciplinary team, flexibility to adjust conventional workflows and limitations of neuroimaging adjuncts. Full article

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

Background: Autism spectrum disorder (ASD) is associated with social-communication challenges that can hinder timely diagnosis and treatment during acute medical events (AMEs). The purpose of this report is to review the literature on medical comorbidities and AMEs in adults with profound ASD and highlight how healthcare teams can better understand atypical presentations of acute pain and discomfort in adults with profound ASD to reduce delayed diagnoses, delays in treatment, and ultimately improve health outcomes. Methods: The literature on medical comorbidities and AMEs in adults with profound ASD was reviewed using the following databases: PubMed, PsycINFO, and Google Scholar. The histories of three adults with profound ASD who experienced AMEs—specifically, appendicitis, nephrolithiasis, and eosinophilic esophagitis (EoE)—are described. The clinical cases were selected to illustrate the challenges inherent in diagnosing and treating AMEs in adults with profound ASD in the context of the review. Results: In Case 1, a 31-year-old male with autism was diagnosed with perforated appendicitis after his family noticed behavioral changes. In Case 2, a 36-year-old male with autism experienced intermittent pain from nephrolithiasis and communicated his discomfort through irritability and pointing. In Case 3, a 34-year-old male with autism exhibited atypical behavior due to pain from undiagnosed EoE, identified after years of untreated pain and multiple unsuccessful clinical procedures. Conclusions: This review and the illustrative cases demonstrate the significant role that communication barriers play in delayed medical diagnoses for adults with profound ASD during AMEs. Integrating caregiver insights and recognizing atypical pain expressions are essential for improving the accuracy and timeliness of diagnosis and treatment in this population. Full article

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

This article examines the intersecting forces of gender, class, and education in early twentieth-century Britain through a feminist reading of Pip Williams’ historical novel The Bookbinder of Jericho. Centering on the fictional character Peggy Jones—a working-class young woman employed in the Oxford University Press bindery—the study explores how women’s intellectual ambitions were constrained by economic hardship, institutional gatekeeping, and patriarchal social norms. By integrating close literary analysis with historical research on women bookbinders, educational reform, and the impact of World War I, the paper reveals how the novel functions as both a narrative of personal development and a broader critique of systemic exclusion. Drawing on the genre of the female Bildungsroman, the article argues that Peggy’s journey—from bindery worker to aspiring scholar—mirrors the real struggles of working-class women who sought education and recognition in a male-dominated society. It also highlights the significance of female solidarity, especially among those who served as volunteers, caregivers, and community organizers during wartime. Through the symbolic geography of Oxford and its working-class district of Jericho, the novel foregrounds the spatial and social divides that shaped women’s lives and labor. Ultimately, this study shows how The Bookbinder of Jericho offers not only a fictional portrait of one woman’s aspirations but also a feminist intervention that recovers and reinterprets the overlooked histories of British women workers. The novel becomes a literary space for reclaiming agency, articulating resistance, and criticizing the gendered boundaries of knowledge, work, and belonging. Full article

Pediatric palliative care (PPC) is an evolving field that focuses on supporting children with life-limiting conditions, where the quality of care is vital. This study is a retrospective observational investigation that examines the experiences of caregivers to inform health and social service planning and enhance PPC quality. Methods: Data of pediatric patients aged 3 months to 18 years admitted to a PPC inpatient unit over two years were retrospectively reviewed. Sociodemographic characteristics of primary caregivers, including age, gender, number of siblings, education, income, occupation, and marital status, were recorded. Caregiver burden and burnout were assessed using the Zarit Burden Interview and the Maslach Burnout Inventory, respectively. Associations between caregiver characteristics and these measures were analyzed. Results: A total of 118 patients and caregivers were evaluated; 54.2% of patients were male. The most common diagnoses were neurological diseases (44.9%), followed by syndromic–genetic disorders (28.8%). About 34% of patients required more than three medical devices. Most caregivers were female (91.5%), mainly mothers and 53% had only primary education. No significant differences in care burden or burnout were found based on caregiver gender, marital status, or child’s diagnosis. However, the use of nasogastric tubes and multiple medical devices was associated with higher burnout. Lower income was significantly linked to higher care burden, while longer caregiving duration correlated with both increased burden and burnout. A moderate positive correlation was found between Zarit and Maslach scores. Conclusions: The complexity of PPC patients’ care increases caregiver burden and burnout. Expanding specialized PPC services is crucial to support caregivers and sustain home-based care. Full article

Background: Childhood obesity is a global health concern. Early development of fundamental movement skills (FMS) and adherence to the Mediterranean diet (MD) are key modifiable factors for prevention. This study assessed the effectiveness of a multidisciplinary, school-based intervention for childhood obesity prevention. Methods: Children aged 3–5 years from a preschool in Messina, Italy, participated in a 9-month intervention integrating nutritional education and physical activity. FMS were evaluated using the MOBAK test. Anthropometric measurements and MD adherence (through the Kid-Med questionnaire) were collected. Caregivers completed an online survey reporting lifestyle changes. Results: Significant improvements were observed in FMS: object control (score 1) increased from 2.67 ± 1.78 to 4.28 ± 1.82, locomotor skills (score 2) from 4.69 ± 1.96 to 5.83, 5.83 ± 1.70, and total MOBAK score (score 3) from 7.35 ± 3.09 to 10.11± 2.94. (p < 0.001 for all). Kid-Med scores significantly improved from (3.79 ± 2.31 vs. 5.03 ± 2.69) (p = 0.0027), indicating enhanced MD adherence. Post-intervention, adherence was classified as poor (27.4%), moderate (53.2%), and optimal (19.4%). Although only a minority of parents reported lifestyle changes, over 50% noted increased fruit and vegetable intake in their children. Males showed higher FMS scores and waist circumference compared to females. Conclusions: A school-based multidisciplinary intervention significantly improved motor competence and dietary habits in preschool children. These findings underscore the importance of early, integrated strategies involving families and educators to support healthy development and prevent childhood obesity. Full article

Background/Objectives: Canadian guidelines for diagnosing fetal alcohol spectrum disorder (FASD) strongly recommend using direct measures to assess brain domains whenever possible. Executive functioning, one of the brain domains assessed, can be measured using direct and indirect measures; however, research has found discrepancies between these two forms of assessment and has not examined this relationship using ratings from the newest version of one of the most commonly used indirect measure of executive functioning, the second version of the Behavior Rating Inventory of Executive Functioning (BRIEF2). Academic achievement may also help explain discrepancies between these forms of assessment, especially in indirect executive functioning skills at school, because many of the items on the BRIEF2 Teacher Form are related to school skills. This study aimed to examine the relationship between direct measures of executive functioning, indirect measures of executive functioning, and academic achievement. Methods: Charts of 74 children who completed an FASD diagnostic assessment in Canada were included in this study (61% males; 58% with FASD; M_age = 11.77). Direct and indirect measures of executive functioning across settings and academic achievement were assessed. Results: Few correlations between corresponding BRIEF2 and direct measures of executive functioning were significantly associated. There were several significant correlations between academic achievement and (a) educator ratings on the BRIEF2 and (b) direct measures of executive functioning. None of the caregiver ratings on the BRIEF2 were significantly associated with academic achievement. Conclusions: The results suggest that academic performance is related to BRIEF2 ratings of executive functioning skills at school and direct measures of executive functioning. Aside from a few exceptions, direct and indirect measures of the same executive functioning skill were not correlated. Full article

Background/Objectives: Childhood anemia remains a serious public health issue, negatively affecting cognitive and psychomotor development, with repercussions on school performance and adult productivity. This study aimed to characterize the profile of children aged 6 months to 5 years diagnosed with or at risk of anemia who attended a pediatric hospital in Lisbon, Portugal. Methods: A hospital-based, cross-sectional descriptive study was conducted from September 2023 to September 2024. Descriptive statistics, including frequency distributions and cross-tabulations, summarized participant characteristics and key variables. Results: We observed that 33.3% (74/222) of the children were either anemic or at risk of anemia. Among these, 93.2% (69/74) were confirmed anemic or at risk based on hemoglobin levels. Five children (6.8%) had normal hemoglobin but abnormal red-cell indices, with microcytic (60.0%; 3/5) or normocytic (40.0%; 2/5) patterns. Anemia rates were higher in males (55.1%), children aged 24–59 months, those residing in the Metropolitan Lisbon Area (82.6%), children whose caregivers had only basic or secondary education (58.0%), and those whose mothers were born in foreign countries (48.4%). Microcytic red-cell indices were observed in 63.1% of cases. Serum iron results indicated that 32.0% were pre-anemic and 40.0% anemic. Ferritin levels showed iron-deficiency anemia in 22.2% of tested cases. In addition, 33.3% carried the sickle cell trait, and 35.0% had elevated C-reactive protein, suggesting anemia of inflammation. Conclusions: Anemia is a moderate public health issue, mainly affecting children with less-educated caregivers and migrant mothers. Targeted public health actions, including systematic screening, caregiver education, and multiculturally sensitive interventions, are crucial to address anemia. Full article

Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications of hip hemiarthroplasty for fractures of the femoral neck in a series of patients with CP, emphasizing the role of precision medicine in management. Methods: Six cases of hip hemiarthroplasty in six male patients with cerebral palsy and displaced femoral neck fractures have been reviewed in this study. The patients’ mean age at the time of surgery was 55.6 ± 14.1 years (range, 33–71). All the patients were independent indoor ambulators before their femoral neck fracture and had various medical comorbidities. Five patients had intellectual disabilities. Results: The mean clinical and radiographic follow-ups for the patients included in this series were 91.5 and 71.3 months, respectively. All the patients developed significant heterotopic ossification (HO) around the operated hip, which was observed as early as the second week postoperatively on radiographs. HO progressed throughout the follow-up for all the patients. One patient had an early postoperative dislocation with femoral stem loosening, which was managed by implant revision. Another patient had an acetabular protrusion, leading to the loss of their weight-bearing ability and mobility due to pain. Four patients were deceased at a mean of 86.5 months after the index surgery. Conclusions: After considering the preliminary evidence provided with this small case series, this study suggests the overall guarded outcomes of hip hemiarthroplasty in patients with CP. Given the 100% rate of heterotopic ossification, a precision medicine framework with consideration for HO prophylaxis may be recommended after hip hemiarthroplasty in patients with CP. It may also be reasonable to scrutinize a personalized risk assessment approach in this patient subset regarding decision making, surgical approach, and rehabilitation program. The clinical outcomes and the risks of complications following hemiarthroplasty should be sensibly presented to patients with cerebral palsy and their caregivers to achieve reasonable postoperative expectations. Full article

Background: Disorders of Gut–Brain Interaction (DGBIs) are present in 23.0% of the paediatric population, according to Rome IV. Latin American (LA) prevalence of DGBIs in children with Autism Spectrum Disorder (ASD) is unknown. The aim of this study was to determine the prevalence of DGBIs and possible associations in schoolchildren and adolescents with ASD from LA. Methods: An observational analytical study was conducted in LA cities. Caregivers of children with ASD completed the Rome IV Questionnaire for Pediatric Gastrointestinal Symptoms to identify DGBIs. Sociodemographic, clinical, and family variables were included. Statistical analysis involved central tendency measures, univariate and bivariate analysis, calculation odds ratios (ORs), and 95% confidence intervals (95%CIs), with p < 0.05 significance. Results: The study included 353 children with ASD. Predominantly male (78.8%), white (56.1%), attending private schools (79.3%), altered nutritional status (43.9%), born by c-section (57.5%), firstborn (54.7%), level of autism not classified at the time of the study (49.0%). A total of 58.9% presented DGBI. Functional constipation (FC) was the most frequent (27.2%). Those from Central America (CA) had a higher likelihood of presenting a DGBI (OR = 1.98, 95% CI = 1.25–3.12, p = 0.0018). Conclusions: Over half of LA schoolchildren and adolescents with ASD presented DGBI, FC being the most common, and higher likelihood of DGBI in CA. Full article

Background/Objectives: This study aims to explore how gender influences the role of informal caregivers aged 65 years, considering the increasing involvement of men in caregiving due to longer life expectancy and societal norms. Methods: A two-year cross-sectional study was conducted in the Valencian Community, Spain, involving informal caregivers of 65 years of age and older who provided home-based care for dependent individuals with chronic conditions. The participants were recruited through public health schools, carers’ associations, and clinical consultations. The caregivers completed a comprehensive semi-structured interview, which included items from the Zarit Brief Scale (seven items) to assess caregiver burden and questions about their caregiving responsibilities, training, and experience, as well as the self-perceived frequency of medication errors. Results: A sample of 80 caregivers over 65 years old was analyzed, including 23 men (28.8%) and 57 women (71.2%). Male caregivers were significantly less experienced (mean = 3.1 years, SD = 5.9) compared to female caregivers (mean = 10.1 years, SD = 13.0; p = 0.004). Men reported lower emotional and physical burdens than women (p-value = 0.003), as reflected in the Zarit scores. Caregiving performance, measured by self-reported errors, was comparable between genders. Conclusions: This study explores the growing role of older male caregivers, highlighting their lower experience and training compared to those of women but similar caregiving performance and lower burden. Additionally, trained caregivers demonstrated significantly lower odds of experiencing burden, underscoring the importance of training as a modifiable factor. The findings emphasize the need for gender-sensitive support and tailored training programs to address disparities, reduce caregiver burden, and enhance caregiving quality and equity. Full article

Background/Objectives: Chronic attention problems occur in approximately 25% of children after acquired brain injury (ABI). When delivered daily, transcranial direct current stimulation (tDCS) may improve attention; however, access to daily in-clinic tDCS treatment can be limited by other commitments, including concurrent therapy, school commitments, and caregiver schedules. Treatment access can be improved through home-based interventions, though these require several practical and safety considerations in a pediatric ABI population. This study evaluated the safety, feasibility, and tolerability of remotely monitored at-home tDCS during online gamified attention training in pediatric ABI. Methods: We conducted a randomized, single-blind, dose-controlled clinical trial of at home tDCS in Brisbane, Australia (10 tDCS sessions; 20 min; 1 mA or 2 mA; bilateral dorsolateral prefrontal cortex). Participants attended our clinic at baseline for clinical assessments, fitting of the personalized tDCS headband, and training in how to use tDCS at home. All sessions were remotely supervised using live videoconferencing. We assessed the feasibility and tolerability of at-home tDCS and our customized, personalized at-home tDCS headband as primary outcomes. As secondary outcomes, we evaluated changes in functional connectivity (fc) and reaction time (RT). Results: Seventy-three participants were contacted over six months (January-June 2023) and ten were enrolled (5 males; mean age: 12.10 y [SD: 2.9]), satisfying a priori recruitment timelines (CONSORT reporting). All families successfully set up tDCS and completed attention training with excellent protocol adherence. There were no serious adverse events over the 100 total sessions. Nine participants completed all stimulation sessions (1 mA: n = 5, 2 mA: n = 4). Participants in the 2 mA group reported greater tingling, itching, and discomfort (all p < 0.05). One participant in the 1 mA group was unable to complete all sessions due to tolerability challenges; however, these challenges were resolved in the second half of the intervention by gradually increasing the stimulation duration across the 10 days alongside additional coaching and support. Conclusions: Overall, daily remotely supervised at-home tDCS in patients with pediatric ABI is safe, feasible, and tolerable. Our results support larger, sham-controlled efficacy trials and provide a foundation for the development of safe and effective at-home stimulation therapeutics that may offer targeted improvement of neurocognitive symptoms in children. Full article