Search Results (1,320)

Background: Community-acquired pneumonia (CAP) in children may be complicated by necrotizing pneumonia (NP), complicated parapneumonic effusion (CPPE), and lung abscess. These complications prolong hospitalization and require medical and surgical intervention. Objectives. To describe clinical course, diagnostic workup, and management of cCAP (complicated CAP) in children admitted to the Women’s and Children’s Health Department, Padua University Hospital, between January 2022 and September 2024. To identify factors associated with disease severity and evaluate outcomes. Methods: All children hospitalized for cCAP during the study period were included. Data collected comprised clinical features, laboratory and imaging findings, medical and surgical management, and outcomes. Results: Forty patients (mean age 4.4 y; 13.15% of pneumonia admission) were included: 67.5% had NP with CPPE, 22.5% isolated effusion, 10% NP without effusion. All patients were febrile at onset, 62.2% had cough, 32.5% abdominal pain, 30% rhinitis. NP was confirmed by contrast-enhanced chest CT. Thirty patients (75%) had positive microbiological testing, mainly Streptococcus pneumoniae and Streptococcus pyogenes. 77.5% required oxygen therapy (five invasive ventilation and one with ECMO). Median fever duration 18 days (IQR 15–27) with elevated CRP (median peak 300 mg/L). Pleural drainage was performed in 66.7%, fibrinolytics in 17.5%, thoracoscopic decortication in 12.5%, and lobectomy in one patient. Radiological resolution occurred at a median of 31 days post-discharge, with normal pulmonary function at a median of 15 months. Conclusions: Despite pediatric cCAP severity, short- and long-term outcomes are favorable. Early recognition and integrated management are crucial, and further prospective studies are warranted to optimize care and identify severity predictors. Full article

Background/Objectives: Multiple sclerosis (MS) is a chronic neurological disease characterized by demyelination, inflammation, and autoimmunity, leading to progressive physical and psychological impairments. Anxiety and depression are among the most prevalent neuropsychiatric comorbidities in MS, significantly impacting patients’ quality of life (QoL). This study aimed to assess the evolution of anxiety and depression in individuals with relapsing-remitting multiple sclerosis (RRMS) over a six-month follow-up period, identify associated factors, and explore potential predictors of these psychological conditions. Methods: A prospective observational study was conducted with 35 RRMS patients diagnosed at the Lucus Augusti University Hospital between January 2023 and March 2025. Psychological symptoms were assessed at baseline, after 3 months, and after 6 months using the Goldberg Anxiety and Depression Scale (GADS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Data were analyzed using non-parametric tests to account for the small sample size and non-normal distribution of variables. Results: Anxiety and depression were prevalent and persistent in the study population, with no significant changes in mean scores over time (p > 0.05). However, specific symptoms, such as pessimism and loss of pleasure, showed worsening trends, while sadness and guilt remained stable. Sociodemographic factors, including lower income and employment status, were significantly associated with higher anxiety and depression scores (p < 0.05). Additionally, clinical factors such as autoimmune comorbidities and a history of mononucleosis were linked to higher depressive symptoms. Baseline anxiety and depression scores emerged as strong predictors of future levels (p < 0.01), emphasizing the importance of early assessments. Conclusions: Anxiety and depression are prevalent and persistent in RRMS patients, with specific symptoms fluctuating over time. Sociodemographic and clinical factors play a significant role in psychological outcomes, highlighting the need for integrated care models that address both physical and psychosocial aspects of MS. Early psychological assessments and targeted interventions are critical for improving QoL and mitigating the long-term burden of mental health challenges in RRMS. Full article

Background: Health care work contributes significantly to greenhouse gas emissions. Primary health care is community-based and focused on wellness and disease prevention. Within primary health care, pharmacists are most frequently the stewards of medicines, supplies, and other tangible products that contribute to carbon footprints. Pharmacists are in a unique position to help adapt to and mitigate climate change-related issues. Objective: To examine pharmacists’ perspectives on climate adaptation and mitigation strategies in primary health care delivery in interprofessional settings. Methods: Semi-structured qualitative interviews with primary care pharmacists were undertaken. Constant-comparative data analysis was used to code and categorize findings. The COREQ system was applied to ensure rigor and quality of research. Results: A total of 21 primary care pharmacists participated in this research. Several core themes emerged as follows: (a) universal agreement that climate change is real and primary health care needs to evolve rapidly to address it; (b) recognition that primary health care is time-pressured and resource constrained so successful solutions need to be pragmatic and work within realities of practice; (c) identification of actionable priorities with high potential for mitigation impact; and (d) mobilization of a coalition to develop system-wide initiatives that could be implemented in primary health care. Conclusions: Collaborative approaches and those that focus on the implementation of regulatory requirements were identified as being most productive in this setting. Full article

Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023–2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale (“very” or “extremely”) for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised. Full article

Breastfeeding is universally regarded as the cornerstone of infant feeding, as it is the ideal infant feeding choice for optimal nutrition and development. Socio-structural factors of breastfeeding in child health play an important role in guiding women’s decisions on options to feed their babies. A cross-sectional study was conducted among mothers with infants aged 0–6 months in Mthatha, Eastern Cape, with the aim of assessing the role of socio-structural factors in shaping feeding intentions and practices among mothers with infants. Written Informed consent was obtained in accordance with the Declaration of Helsinki from the participants prior to data collection. Data was gathered with a validated designed questionnaire as well as analyzed using Social Sciences (SPSS) version 29. A total of 181 mothers were enrolled. Only 45.9% reported that they exclusively breastfed their babies, of which the highest proportion of exclusive breastfeeding (EBF) was observed among the 21–29 age group at 51.8%, and the lowest among those aged 20 years and below (3.6%). Marital status (p = 0.005) and employment status (p < 0.001) were significantly associated with exclusive breastfeeding, with higher EBF rates observed among married mothers and those who were self-employed. Both the EBF mothers and non-EBF mothers shared a common belief that colostrum was not beneficial for infants (p = 0.854), whereas their views differed significantly on the amount of water given to infants before they reached six months (p = 0.001). There was no significant relationship between EBF status and having a family member who had breastfed in the past six months (p = 0.815); also, a weak association was noted for having a friend who had breastfed recently (p = 0.057). The difference in EBF practice between those receiving antenatal care (ANC) breastfeeding education and those not receiving it was not statistically significant (p = 0.591). A statistically significant association was found between the support level and exclusive breastfeeding status (p < 0.001). This study highlights that the successful practice of exclusive breastfeeding (EBF) is strongly associated with high levels of social support. Interventions are needed to engage active partners, family members, and community members in creating a supportive environment for breastfeeding mothers. Full article

This article presents a case study from a Social and Health Care School in Denmark, where a rooftop garden was designed to promote student health and support nature-based teaching across subject areas. A novel aspect of the project is the formal integration of the garden into teaching, implying that its long-term impact may extend beyond the students to the end-users they will later encounter in nursing homes and hospitals nationwide. This study applies the Evidence-Based Health Design in Landscape Architecture (EBHDL) process model, encompassing evidence collection, programming, and concept design, with the University of Copenhagen acting in a consultancy role. A co-design process with students and teachers was included as a novel source of case-specific evidence. Methodologically, this is a participatory practice-based case study focusing on the full design and construction processes, combining continuous documentation with reflective analysis of ‘process insights,’ generating lessons learned from the application of the EBHDL process model. This study identifies two categories of lessons learned. First, general insights emerged concerning governance, stakeholder roles, and the critical importance of site selection, procurement, and continuity of design responsibility. Second, specific insights were gained regarding the application of the EBHDL model, including its alignment with Danish and international standardised construction phases. These insights are particularly relevant for project managers in nature-based initiatives. The results also show how the EBHDL model aligns with Danish and international standardised construction phases, offering a bridge between health design methods and established building practice. The case focuses on the EBHDL process rather than verified outcomes and demonstrates how evidence-based and participatory approaches can help structure complex design processes, facilitate stakeholder engagement, and support decision-making in institutional projects. Full article

Purpose: Child sexual abuse (CSA) is a major public health and forensic concern, often involving delayed disclosure that limits evidence collection and affects judicial outcomes. This study analyzed disclosure patterns, victim–perpetrator characteristics, and forensic findings in CSA cases evaluated in Greece, contributing to the limited Southern European evidence base. Material and Methods: A retrospective review of 89 CSA cases (2014–2024) examined by a certified forensic physician at the Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, was conducted. Data from official medico-legal reports included demographics, abuse context, forensic findings, and disclosure interval. Statistical analyses explored factors associated with delayed disclosure (>7 days). Results: Victims were predominantly female (69.7%) with a mean age of 9.8 years. Most perpetrators were adult males, and over half of cases (53.9%) involved intrafamilial abuse. The mean delay in disclosure was 79 days; only 29.2% reported within one week. Recurrent abuse correlated with delayed disclosure (p = 0.006), while early disclosure was associated with biological evidence collection (p < 0.001). Physical injuries were observed in 23.6% of victims, genital findings in 17%, and anal findings in 3.4%. Conclusions: Delayed disclosure was common and significantly reduced the likelihood of identifying forensic evidence. The early application of trauma-informed examinations, which adopt a child-centered approach emphasizing safety, emotional regulation, and the prevention of re-traumatization, is essential for the medical and forensic evaluation of abused children. Adopting hospital-based multidisciplinary units could improve forensic documentation, interagency coordination, and psychosocial care in Greece. Full article

Amid escalating ecological degradation, social fragmentation, and rising mental health challenges—especially in rural and agricultural communities—there is an urgent need to reimagine systems that support both planetary and human flourishing. This viewpoint examines an emerging paradigm in agriculture that emphasizes the role of farmers’ inner development in fostering practices that enhance ecological health, community well-being, and a resilient food system. A key goal is to draw more academic attention to growing community calls for more holistic, relational, and spiritually grounded approaches to food systems as an important focus for ongoing research. Drawing on diverse case studies from Japan, India, and Europe, we examine how small-scale and natural farming initiatives are integrating inner development, universal human values, and ecological consciousness. These case studies were developed and/or refined through a program led by the Conscious Food Systems Alliance (CoFSA), an initiative of the United Nations Development Programme (UNDP) that seeks to integrate inner transformation with sustainable food systems change. The initiatives are intended as illustrative examples of how agriculture can transcend its conventional, anthropocentric role as a food production system to become a site for cultivating deeper self-awareness, spiritual connection, and regenerative relationships with nature. Participants in these cases reported significant shifts in mindset—from materialistic and extractive worldviews to more relational and value-driven orientations rooted in care, cooperation, and sustainability. Core practices such as mindfulness, experiential learning, and spiritual ecology helped reframe farming as a holistic process that nurtures both land and life. These exploratory case studies suggest that when farmers are supported in aligning with inner values and natural systems, they become empowered as agents of systemic change. By linking personal growth with planetary stewardship, these models offer pathways toward more integrated, life-affirming approaches to agriculture and future academic research. Full article

The COVID-19 pandemic exacerbated structural, social, economic, and racial inequalities affecting immigrant, refugee, and asylum-seeking men—vulnerable populations often overlooked in men’s health research. This study investigated the health conditions of immigrant, refugee, and asylum-seeking men during the COVID-19 pandemic. A scoping review was conducted following Joanna Briggs Institute guidance, and a qualitative lexical analysis (text-mining of standardized study syntheses) was performed in IRaMuTeQ using similarity analysis, descending hierarchical classification, and factorial correspondence analysis. We identified 93 studies published between 2020 and 2023 across 35 countries. The evidence highlighted vaccine hesitancy, high epidemiological risks (infection, hospitalization, and mortality), barriers to accessing services and information, socioeconomic vulnerabilities, psychological distress (e.g., anxiety and depression), and structural inequalities. Findings were synthesized into four integrated thematic categories emphasizing the role of gender constructs in help-seeking and gaps in governmental responses. Most studies focused on immigrants, with limited evidence on refugees and especially asylum seekers; therefore, conclusions should be interpreted cautiously for these groups. Overall, the review underscores the urgency of multisectoral interventions, universal access to healthcare regardless of migration status, culturally and linguistically appropriate outreach, and gender-sensitive primary care strategies to support inclusive and resilient health systems. Full article

(1) Background: The climate impact of health care work has raised interest in climate-conscious health care practice. Medications contribute significantly to the carbon footprint; there has been insufficient work describing climate-conscious medication therapy management practices that could be useful to address climate change caused by health care work. (2) Methods: This exploratory qualitative research study focused on climate-conscious medication therapy management practices. A semi-structured interview protocol was used. A total of 17 primary care pharmacists were interviewed (following informed consent) to the point of thematic saturation. A constant-comparative analysis was undertaken to identify and categorize themes. The research was undertaken based on a protocol approved by the University of Toronto Research Ethics Board. (3) Result: Three main themes emerged: (a) There is insufficient evidence currently available to guide climate conscious medication therapy management; (b) seven specific climate-conscious medication therapy management strategies were identified as being most likely to be acceptable by primary care pharmacists; (c) medication therapy management services focused on climate adaptation strategies for patients should be expanded; (4) Conclusions: As medications become the primary intervention used in health care, climate-conscious medication therapy management becomes more essential than ever. Further work in providing evidence to guide climate-conscious prescribing decisions is needed. Full article

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe. Full article

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health Care Utilization in Individuals who died by Suicide in Sweden 2015, conducted at Lund University, Sweden. The aim was to examine symptoms and diagnoses in children and young adults who died by suicide, as documented in their medical records at their last visits for primary care, somatic specialist care, or psychiatric care 24 months prior to suicide, and to apply contemporary psychological research in youth suicidality to the findings to formulate clinical implications. The proportions of symptoms and diagnoses in children (0–17 years), young adults (18–24 years), males, and females are described. The main symptoms noted in the cohort were depressive symptoms (28%), anxiety symptoms (26%), and pain (25%). The diagnoses predominately covered mental and behavioural disorders, and the most frequent of the mental and behavioural diagnoses were neurotic, stress-related, and somatoform disorders (32%) and mood (affective) disorders (29%). The diagnoses and symptoms were not sufficient to uncover suicidality in children and young adults. The clinical implications for alternative assessments and preventive interventions are discussed. Full article

(1) Background: School-based mental health interventions represent a promising approach to address the substantial treatment gap affecting adolescents, with only 20% of youth with diagnosable mental health conditions receiving adequate care. (2) Methods: This meta-analysis synthesized evidence from 18 randomized controlled trials to examine the effectiveness of school-based mental health interventions and potential moderators of outcomes. (3) Results: Using Hedges’ g as the effect size index and a random-effects model, the analysis revealed a statistically significant overall effect size of 0.068 (95% CI [0.019, 0.117], p = 0.006), indicating small but reliable improvements in adolescent academic, social, emotional, behavioral, and mental health outcomes. Heterogeneity across studies was minimal (I² = 15%), suggesting consistent effects across diverse intervention types and contexts. Meta-regression analyses examining eight potential moderators including intervention focus, grade level, provider type, delivery format, duration, study design, geographic location, and theoretical foundation did not reveal statistically significant moderation effects, likely due to limited statistical power. However, descriptive patterns suggested that targeted interventions, small-group formats, and interventions delivered by mental health professionals may produce larger effects than universal programs, classroom-based approaches, and teacher-delivered interventions. (4) Conclusions: These findings support continued investment in school-based mental health programming while highlighting the need for specialized focus to optimize outcomes for all adolescents. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

This qualitative single-case study examines how spirituality promotes mental health within a stigmatized occupation by analyzing an in-depth interview with “Perla,” a 62-year-old Mexican woman with decades of experience in sex work. Guided by Virginia Satir’s Transformational Systemic Therapy (STST), specifically the Self-Mandala and Iceberg Metaphor, we conceptualize spirituality as a universal human dimension of meaning, moral orientation, and relational connection that may be expressed within or beyond formal religion. Narrative thematic analysis identifies processes through which Perla cultivates congruence (alignment of inner experience and outward conduct), safeguards dignity, and sustains hope amid systemic constraints. Her Catholic practices (prayer, ritual boundaries regarding Eucharist) coexist with a broader spiritual agency that supports self-worth, emotional regulation, boundary-setting, and coherent identity, factors associated with mental well-being. Interdisciplinary implications bridge marriage and family therapy, psychology, pastoral care, and cultural studies. Clinically, we translate Satir’s constructs (yearnings, perceptions, expectations, coping stances) into practical assessment and intervention steps that can be applied in secular settings without religious presuppositions. Analytic rigor was supported through reflective memoing, a structured three-level coding process, constant comparison, and verification by a second coder. The case challenges pathologizing frames of sex workers by demonstrating how spirituality can function as a protective, growth-oriented resource that fosters agency and moral coherence. Full article