Search Results (122)

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: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

Background and Clinical Significance: Radial nerve palsy typically presents as wrist drop due to nerve compression, with conventional management often yielding prolonged recovery. We report a case where ultrasound-guided hydrodissection (HD) with 5% dextrose in water (D5W) achieved immediate functional restoration, suggesting neurapraxia as the underlying pathology. Case Presentation: A 54-year-old diabetic female presented with acute left wrist drop without trauma. Examination confirmed radial nerve palsy (MRC grade 0 wrist extension), while radiographs ruled out structural causes. Ultrasound revealed fascicular swelling at the spiral groove. Under real-time guidance, 50 mL D5W (no local anesthetic) was injected to hydrodissect the radial nerve. Immediate post-procedure assessment showed restored wrist extension (medical research council (MRC) grade 4+). At one- and three-month follow-ups, the patient maintained complete resolution of symptoms and normal function. Conclusions: This case highlights two key findings: (1) HD with D5W can serve as both a diagnostic tool (confirming reversible neurapraxia through immediate response) and therapeutic intervention, and (2) early HD may circumvent prolonged disability associated with conservative management. The absence of electrodiagnostic studies limits objective severity assessment, though ultrasound localized the lesion. While promising, these observations require validation through controlled trials comparing HD to standard care, particularly in diabetic patients with heightened compression susceptibility. Technical considerations—including optimal injectate volume and the role of adjuvant therapies—warrant further investigation. US-guided HD with D5W emerges as a minimally invasive, surgery-sparing option for acute compressive radial neuropathies, with potential to redefine treatment paradigms when applied at symptom onset. Full article

Background/Objectives: The increased accessibility of information has resulted in a rise in patients trying to self-diagnose and opting for self-medication, either as a primary treatment or as a supplement to medical care. Our objective was to evaluate the reliability, comprehensibility, and readability of the responses provided by ChatGPT 4.0 when queried about the most prevalent orthopaedic problems, thus ascertaining the occurrence of misguidance and the necessity for an audit of the disseminated information. Methods: ChatGPT 4.0 was presented with 26 open-ended questions. The responses were evaluated by two observers using a Likert scale in the categories of diagnosis, recommendation, and referral. The scores from the responses were subjected to subgroup analysis according to the area of interest (AoI) and anatomical region. The readability and comprehensibility of the chatbot’s responses were analyzed using the Flesch–Kincaid Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Results: The majority of the responses were rated as either ‘adequate’ or ‘excellent’. However, in the diagnosis category, a significant difference was found in the evaluation made according to the AoI (p = 0.007), which is attributed to trauma-related questions. No significant difference was identified in any other category. The mean FKGL score was 7.8 ± 1.267, and the mean FRES was 52.68 ± 8.6. The average estimated reading level required to understand the text was considered as “high school”. Conclusions: ChatGPT 4.0 facilitates the self-diagnosis and self-treatment tendencies of patients with musculoskeletal disorders. However, it is imperative for patients to have a robust understanding of the limitations of chatbot-generated advice, particularly in trauma-related conditions. Full article

Background: Borderline personality disorder (BPD) is a severe psychiatric condition characterised by emotional instability, impulsivity, interpersonal dysfunction, and self-injurious behaviours. Despite growing clinical interest, the neuropsychological mechanisms underlying these symptoms are still not fully understood. This review aims to summarise findings from neuroimaging, psychophysiological, and neurodevelopmental studies in order to clarify the neurobiological and physiological basis of BPD, with a particular focus on emotional dysregulation and implications for the treatment of adolescents. Methods: A narrative review was conducted, integrating results from longitudinal neurodevelopmental studies, functional and structural neuroimaging research (e.g. FMRI and PET), and psychophysiological assessments (e.g., heart rate variability and cortisol reactivity). Studies were selected based on their contribution to understanding the neural correlates of BPD symptom dimensions, particularly emotion dysregulation, impulsivity, interpersonal dysfunction, and self-harm. Results: Findings suggest that early reductions in amygdala volume, as early as age 13 predict later BPD symptoms. Hyperactivity of the amygdala, combined with hypoactivity in the prefrontal cortex, underlies deficits in emotion regulation. Orbitofrontal abnormalities correlate with impulsivity, while disruptions in the default mode network and oxytocin signaling are related to interpersonal dysfunction. Self-injurious behaviour appears to serve a neuropsychological function in regulating emotional pain and trauma-related arousal. This is linked to disruption of the hypothalamic-pituitary-adrenal (HPA) axis and structural brain alterations. The Unified Protocol for Adolescents (UP-A) was more effective to Mentalization-Based Therapy for Adolescents (MBT-A) at reducing emotional dysregulation compared, though challenges in treating identity disturbance and relational difficulties remain. Discussion: The reviewed evidence suggests that BPD has its in early neurodevelopmental vulnerability and is sustained by maladaptive neurophysiological processes. Emotional dysregulation emerges as a central transdiagnostic mechanism. Self-harm may serve as a strategy for regulating emotions in response to trauma-related neural dysregulation. These findings advocate for the integration of neuroscience into psychotherapeutic practice, including the application of neuromodulation techniques and psychophysiological monitoring. Conclusions: A comprehensive understanding of BPD requires a neuropsychologically informed framework. Personalised treatment approaches combining pharmacotherapy, brain-based interventions, and developmentally adapted psychotherapies—particularly DBT, psychodynamic therapy, and trauma-informed care—are essential. Future research should prioritise interdisciplinary, longitudinal studies to further bridge the gap between neurobiological findings and clinical innovation. Full article

This study aimed to evaluate and compare the performance of four advanced artificial intelligence-powered chatbots—ChatGPT-4 Omni (ChatGPT-4o), DeepSeek, Gemini Advanced, and Claude 3.7 Sonnet—in responding to questions related to traumatic dental injuries (TDIs) in the primary dentition. The assessment focused on accuracy, completeness, readability, and response time, aligning with the 2020 International Association of Dental Traumatology guidelines. Twenty-five open-ended TDI questions were submitted to each model in two separate sessions. Responses were anonymized and evaluated by four pediatric dentists. Accuracy and completeness were rated using Likert scales; readability was assessed using five standard indices; and response times were recorded in seconds. ChatGPT-4o demonstrated significantly higher accuracy than Gemini Advanced (p = 0.005), while DeepSeek outperformed Gemini Advanced in completeness (p = 0.010). Response times differed significantly (p < 0.001), with DeepSeek being the slowest and ChatGPT-4o and Gemini Advanced being the fastest. DeepSeek produced the most readable outputs relatively, though none met public readability standards. Claude 3.7 generated the most complex texts (p < 0.001). A strong correlation existed between accuracy and completeness (ρ = 0.701, p < 0.001). These findings emphasize the cautious integration of artificial intelligence chatbots into pediatric dental care due to varied performance. Clinical accuracy, completeness, and readability are critical when offering information aligned with guidelines to support decisions in dental trauma management. Full article

Refugee and immigrant communities face a host of dynamic health challenges. This essay discusses the importance of prioritizing the impacts of resettlement on mental health and provides examples of how creating a collective network of culturally responsive, trauma-informed, and healing-centered providers—centered on community-based best practices and knowledge—is integral to fostering community resilience. Additionally, it will examine how resettlement challenges intersect with systemic barriers to culturally responsive care and related Social Determinants of Health (SDOH), including economic stability, health care access and quality, and social and community contexts. Drawing upon experiences from a statewide network spanning southern and northern California—and based on interim mixed-methods program evaluation data and practitioner reflections highlighting one community partner’s experience—we provide key learnings that demonstrate how coalition building, cultural humility, and provider training can improve client well-being, reduce mental health disparities, and address the relevant SDOH. Key learnings illustrate the importance of the following: (1) coalition building to co-create trusted provider referral networks and support peer-to-peer learning to enhance client care; (2) provider trainings and capacity building on healing-centered and culturally responsive practices to address SDOH; (3) centering cultural humility; and (4) building a peer-based workforce who speak similar languages and share lived experiences to provide deeper cultural connections and build trust. Our experiences demonstrate that the co-creation of strong mental health provider networks is critical to strengthening the fabric of community resilience. Full article

Background and Objectives: On 6 February 2023, two catastrophic earthquakes struck southeastern Türkiye, affecting over 13 million individuals and causing widespread destruction. While the physical damage was immediate, the psychological consequences—particularly posttraumatic stress disorder (PTSD) and depression—have proven long-lasting. This study aimed to evaluate the severity and course of PTSD symptoms among survivors and to examine the effectiveness of a telepsychiatry-based mental health intervention in a post-disaster setting. Materials and Methods: This naturalistic, observational study included 153 adult participants from the affected regions who underwent at least two telepsychiatry sessions between the first and sixth month post-disaster. Initial screening was conducted using the General Health Questionnaire (GHQ-12), and individuals scoring ≥ 13 were further assessed with the PTSD Checklist—Civilian Version (PCL-C) and the Beck Depression Inventory (BDI). Follow-up evaluations and pharmacological or psychoeducational interventions were offered as clinically indicated. Results: At the one-month follow-up, 94.4% of participants met the threshold for PTSD symptoms (PCL-C > 22) and 77.6% had severe depressive symptoms (BDI > 30). By the sixth month, PTSD symptoms had significantly decreased (mean PCL-C score reduced from 42.47 ± 12.22 to 33.02 ± 12.23, p < 0.001). Greater symptom reduction was associated with higher educational attainment and perceived social support, while prior trauma predicted poorer outcomes. Depression severity emerged as the strongest predictor of chronic PTSD. Conclusions: This study highlights the psychological burden following the 2023 earthquakes in Türkiye and demonstrates the feasibility and potential effectiveness of telepsychiatry in disaster mental health care. Integrating digital mental health services into disaster response systems may help reach vulnerable populations and improve long-term psychological recovery. Full article

Background/Objectives: Non-Communicable Diseases (NCDs) place an excessive strain on health systems in disaster-affected settings and may lead to a parallel public health emergency lasting months or years after a disaster. Although NCDs are increasingly recognized as a major challenge in disasters and humanitarian emergencies, a dedicated and standardized response plan is missing, as well as a shortage of evidence-based guidelines for NCD management in theses contexts. Over the years, Emergency Medical Teams (EMTs) have traditionally been deployed to manage acute conditions such as trauma and infectious diseases that quickly impact health systems. However, greater attention is needed to address acute exacerbation of NCDs and to ensure continuity of care for people with chronic health needs in disasters and emergencies. Methods: We conducted a scoping review exploring the EMTs’ management of chronic NCDs during disasters and humanitarian emergencies, in order to identify the strategies adopted, the challenges faced, and the recommendations provided to address this health problem. The online databases PubMed, Scopus, and EBSCO were searched to identify relevant papers. Results: After screening the papers against the eligibility criteria, 17 publications were retrieved. Five different areas of intervention concerning EMTs and NCDs management were identified: (i) EMTs pre-departure preparation, operational time, and length of stay; (ii) EMTs staff composition and training; (iii) EMTs logistics; (iv) EMTs integration with local health services; (v) EMTs clinical data record. Conclusions: The findings emerging from this study showed that NCDs significantly impact disaster response in different settings, underlining the need to implement a range of EMTs activities to guarantee assistance for chronic health needs. In view of strengthening the ability of health systems to cope with the NCDs’ burden, the EMTs’ initiatives should be considered as a bridge between the support provided during the acute phase of an emergency and the continuation of care ensured by the system in its early recovery phase. Full article

Internet scams have become more sophisticated and prevalent in countries such as Canada, the US, the UK, and Australia. Australia has made some progress in effective scam intervention strategies and seen possible growth in public awareness. However, there is a lack of insight into factors associated with profound shame and embarrassment, emotional distress such as anxiety and depression, and trauma and suicide in scam victims. To fill this gap, this perspective paper aimed to provide insight into the factors associated with the negative mental health impacts of internet scams by integrating a narrative literature review with a victim case study detailing a group’s experience of an investment scam in Australia. It found that internet scams cause emotional and social issues like depression, anxiety, trauma, and isolation, mostly prolonged upon substantial loss. The author’s insight into the intensely negative mental health impacts of an investment scam allows for the presentation of a group who struggled to access adequate support and mental health care in their response to insidious organized crime. Better education, resilience-building, and support systems are needed. These shortcomings call for strategies for tailored digital mental health services such as emotionally attuned, trauma-informed digital companionship through human-like artificial intelligence (AI) applications. Full article

Early caregiving can evoke feelings of helplessness in mothers that are potentially associated with disintegrative responses, i.e., intrusive thoughts and dissociative experiences in the context of infant care. Given the associated increase in stress and exposure to life-threatening dangers, crises such as pandemics and wars may intensify these responses, but this has not previously been tested. Objectives: This cross-sectional study aimed to (1) examine maternal disintegrative responses across three contexts—a high-intensity phase of the COVID-19 pandemic, a subsequent low-intensity pandemic period, and the Israel–Hamas war—and (2) compare the two crisis periods in terms of trauma-related exposure, a damaged experience of childbirth and childcare, and their links to disintegrative responses. Method: This study had two parts and was conducted among Israeli mothers. Part 1 involved 1416 mothers across three groups: high-intensity pandemic (N = 637), low-intensity pandemic (N = 360), and war (N = 419). Part 2 involved a subsample from Part 1 comparing the 1056 mothers from the high-intensity pandemic and war groups. All the participants completed questionnaires assessing maternal disintegrative responses, trauma-related exposure, and a damaged experience of childbirth and childcare. The analyses included ANOVA and mediation models, controlling for maternal characteristics. Results: Intrusive thoughts and dissociative experiences were significantly higher during both the high-intensity pandemic and war periods compared to the low-intensity pandemic period. Trauma exposure indirectly predicted intrusive thoughts and dissociative experiences through a damaged experience of childbirth and childcare, particularly during war. Conclusions: The findings indicate that maternal disintegrative responses were higher during high-intensity crisis contexts, with the highest levels reported by mothers during the war. Trauma exposure and a damaged experience of childbirth and childcare were associated with more intrusive thoughts and dissociative experiences, underscoring the need for targeted support to protect maternal well-being and caregiving during crises. Full article

Background/Objectives: Mothers of infants admitted to the neonatal intensive care unit (NICU) experience significant stress, which can have lasting effects on mental health and parent–infant bonding. This mixed-methods study aimed to explore maternal stress response, coping, and resilience by examining physiological stress markers and maternal narratives. Methods: A total of 28 mothers who had an infant hospitalized in the NICU within the past three years participated in a two-hour laboratory session, which included stress induction using the Trier Social Stress Test (TSST). Salivary cortisol (sCort) and heart rate variability (HRV) were measured to assess physiological responses. Results: Qualitative analysis of maternal narratives identified two distinct response patterns: an anger/trauma (AT) group (n = 7) and a gratitude/optimism (GO) group (n = 6), with the remaining 15 mothers classified as a mixed (M) group. GO mothers exhibited significantly higher cortisol reactivity during recovery compared to AT mothers (p < 0.01). While GO mothers had higher baseline HF-HRV, no significant between-group differences were found in HRV responses. Conclusions: Findings suggest that maternal perception of NICU experiences is associated with distinct physiological stress response patterns, highlighting the importance of stress appraisal and coping in maternal well-being. Full article

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root fractures accompanied by coronal extrusions in immature maxillary permanent central incisors, underscoring the necessity for tailored approaches when guidelines for intervention were unmet. Methods: The case involves an eight-year-old boy who delayed seeking care for approximately a year after suffering trauma to his upper front teeth in a fall accident at school. The clinical examination revealed partial displacement of two maxillary central incisors in an incisal direction, resulting in increased mobility. Radiographs further showed horizontal root fractures in the apical third of both extruded incisors. Encouragingly, the injured teeth exhibited a normal response to electric pulp testing without signs or symptoms of pulpal pathology, suggesting pulp vitality and eliminating the need for root canal treatment. The extruded coronal fragments were repositioned orthodontically using a utility arch. Results: At the 14-month follow-up, the affected incisors were clinically asymptomatic, functionally satisfactory, and esthetically pleasing. Conclusions: Conservative orthodontic management of extrusive luxation concomitant with root fracture in immature permanent teeth may prove effective in select cases, particularly when long-term follow-up and proper oral care are maintained. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Automated ventilator controllers have the potential to simplify oxygen and carbon dioxide management for trauma. In the pre-hospital or military medicine environment, trauma care can be required for prolonged periods by personnel with limited ventilator management training. As such, there is a need for closed-loop control systems that can adapt ventilator management to a complex, ever-changing medical environment. Here, we present a novel hardware-in-loop test platform for the independent troubleshooting and evaluation of oxygen and carbon dioxide automated ventilator management capabilities. The oxygen management system provides an analogue blood oxygen signal that is responsive to the fraction of inspired oxygen and the peak inspiratory pressure ventilator settings. A tested oxygenation controller successfully reached the target oxygen saturation within 5 min. The carbon dioxide removal system integrates with commercial ventilator technology and mimics carbon dioxide generation, lung compliance, and airway resistance while providing an end-tidal carbon dioxide level that is responsive to changes in the tidal volume and respiratory rate settings. A test mechanical ventilator controller was able to regulate EtCO₂ regardless of the starting value within 10 min. This highlights the system’s functionality and provides proof-of-concept demonstrations for how the hardware-in-loop test platforms can be used for evaluating closed-loop controller technologies. Full article