Search Results (6,359)

Background: Suicide prevention strategies in university settings largely rely on detecting explicit suicidal ideation. However, students experiencing severe psychiatric distress may not endorse suicidal thoughts and therefore remain unidentified by ideation-centered screening models. This study aimed to identify and clinically characterize university students with high depressive symptoms, poor sleep quality, and elevated impulsivity who deny suicidal ideation in order to examine whether they represent a vulnerable yet overlooked subgroup. Methods: This cross-sectional secondary analysis included 814 undergraduate students from the National Sleep Research Resource (ANSWERS dataset). Participants were classified into three groups based on median splits of depressive symptoms (CES-D), sleep quality (PSQI), impulsivity (UPPS-P), and the presence or absence of suicidal ideation in the past three months: Invisible (high symptoms without ideation), Visible (high symptoms with ideation), and Healthy (low symptoms without ideation). Group differences were examined using ANOVA and chi-square tests. Multivariate logistic regression was conducted to assess independent predictors of suicidal ideation. Results: The Invisible group comprised 11.8% of the sample. Compared with Healthy participants, these individuals showed poorer sleep quality and higher levels of thwarted belongingness and perceived burdensomeness (all p < 0.001). Cannabis use was most prevalent in the Invisible group (54.2%), exceeding both Visible and Healthy groups (p < 0.001). In adjusted analyses, depressive symptoms (OR = 1.10, 95% CI: 1.08–1.12) and sleep disturbance (OR = 1.06, 95% CI: 1.01–1.12) independently predicted suicidal ideation, whereas impulsivity did not. Conclusions: A clinically meaningful subgroup of students experience severe psychological distress without endorsing suicidal ideation yet show behavioral and interpersonal vulnerability. These findings highlight a limitation of ideation-focused screening and support broader, symptom-informed mental health assessment strategies in university populations. Full article

River fragmentation caused by dam construction threatens global fish conservation. Mediterranean ecosystems are particularly affected, and the Iberian Peninsula, with its highly fragmented rivers, exemplifies this challenge. Endemic allopatric congeneric barbels (Luciobarbus bocagei and L. sclateri) are particularly vulnerable cyprinids because they rely on river connectivity for migration. Despite the deployment of fishways, their effectiveness in Mediterranean rivers with variable hydrology and high endemism remains unclear. This study compares the passage of L. bocagei (Duero basin) and L. sclateri (Segura basin) across two fishway types: Vertical Slot and Submerged Notch with Bottom Orifice. Passage trials were analysed using standardised metrics, motivation, ascent success, and transit time, under a time-to-event framework. Results suggest that species, size, ecohydrological context, and fishway interact to shape passage outcomes. L. sclateri exhibited higher motivation and faster passage attempts, likely reflecting adaptation to ephemeral flows. Ascent success was similar between species and fishway type. Larger individuals demonstrated greater motivation and shorter transit times, regardless of species or fishway. These findings highlight the importance of integrating ecohydrological context and behavioural variability into fishway assessment. Adaptive management accounting for species- and site-specific traits is essential to enhance connectivity and support endemic populations under growing anthropogenic and climatic pressures. Full article

Reconciling environmental conservation with socioeconomic development remains a fundamental challenge for tropical forest governance. Thirty-five years ago, the Brazilian Amazon pioneered Extractive Reserves (RESEXs) as a radical model for socio-environmental synergy; however, their long-term efficacy faces increasing contestation. Through a systematic review of three and a half decades of research, we analyze the RESEX model’s performance in balancing forest integrity with the livelihoods of traditional communities. Our synthesis reveals a persistent conservation–development misalignment, where the prioritization of ecological preservation is coupled with chronic underinvestment in socioeconomic infrastructure. We demonstrate that this imbalance has yielded a “vulnerability trap,” where stagnant agro-extractive initiatives and insufficient technological integration inadvertently push local populations toward predatory land-use alternatives. We argue that prioritizing forest cover metrics while neglecting the economic agency of traditional populations constitutes an inadequate strategy for the Amazon’s future. Following the outcomes of the 30th Conference of the Parties (COP30) in Belém, we propose a paradigm shift toward a technologically enabled bioeconomy—a move essential for the pragmatic success of global climate goals and the protection of the Amazonian climate anchor. Full article

Kuwait experiences persistently high levels of air pollution driven by industrial emissions, transportation, oil-related activities, and frequent desert dust storms. This study aims to synthesize and critically evaluate the available evidence on the relationship between air pollution, Air Quality Index (AQI), and health outcomes in Kuwait using a guided narrative review approach. A guided literature search identified 26 peer-reviewed studies published between 2014 and 2026 about Kuwait air pollution, which were assessed for methodological characteristics, pollutant types, health outcome categories, and vulnerable populations. The most frequently examined pollutants were particulate matter (PM_2.5: 69%; PM₁₀: 38%), followed by NO₂ (23%), multi-pollutant and AQI-based (19%), O₃ (12%), SO₂ (12%), VOCs and PAHs (8%). Health-related investigations most commonly addressed mortality and respiratory morbidity, while cardiovascular, metabolic, biomarker-based, and cancer-related outcomes were less frequently represented. Among studies reporting direct health outcomes, elevated PM_2.5 exposure was generally associated with increased risks of respiratory hospitalizations, cardiovascular events, and all-cause mortality. Susceptible populations identified across the literature include children, older adults, individuals with pre-existing chronic conditions, and outdoor workers, who may experience higher exposure levels and greater health vulnerability. However, a substantial proportion of the included studies focused primarily on exposure characterization or pollutant modeling without direct assessment of health outcomes. These studies nonetheless indicate consistently elevated pollutant levels and seasonal variability, which may plausibly contribute to population health risks. Overall, while the available Kuwait-specific evidence suggests potential adverse health effects linked to air pollution, the strength of direct epidemiological evidence remains limited. Important gaps persist, including the scarcity of long-term cohort studies, limited multi-pollutant analyses, and insufficient integration of AQI categories with health outcomes. These limitations highlight the need for more robust and longitudinal research to better quantify health risks and inform public health policy in Kuwait. Full article

Background: Mild and moderate pain represent a large proportion of emergency department (ED) presentations but are frequently underestimated and inconsistently managed, particularly in vulnerable populations such as children and older adults. Standardised and evidence-based approaches are needed to ensure timely, safe, and effective pain control across the entire emergency care pathway. Methods: A national multidisciplinary Delphi consensus was conducted under the auspices of the Italian Society of Emergency Medicine (SIMEU). A Scientific Steering Committee performed a systematic literature review and developed 26 statements comprising 92 items across four thematic areas: analgesia at triage, risk factors and analgesia at discharge, analgesia in children, and analgesia in elderly patients. Thirty-three experts from across Italy participated in three Delphi rounds, rating each item using a five-point Likert scale. Consensus was defined as ≥66% agreement (scores 4–5). Results: Consensus was achieved for 78 out of 92 items. Key recommendations include early pain assessment at triage using validated scales, paracetamol as first-line therapy for mild and moderate pain across all age groups, and the use of multimodal analgesia for moderate pain. Fixed-dose combinations of paracetamol and ibuprofen were strongly endorsed for their efficacy, safety, and opioid-sparing effect in adults, children, and elderly patients. Clear guidance was also provided for analgesic selection at discharge, duration of therapy, patient education, and management of special populations. Conclusions: This multidisciplinary Delphi consensus provides practical, evidence-based recommendations to harmonize the management of mild and moderate pain in ED. Implementation of these recommendations may improve pain control, patient safety, and quality of care in non-urgent emergency settings. Full article

Climate change and population growth are intensifying water scarcity in arid regions, yet previous analyses focusing on a single driver may not fully capture the compounded effects of climatic and anthropogenic factors. This study integrates water-balance analysis, trend analysis, and correlation-based statistical analysis to examine the combined effects of hydroclimatic anomalies and socioeconomic activities on water resource dynamics in ecologically vulnerable Northwest China. Our results show that despite increasing precipitation, warming-associated increases in evapotranspiration, together with irrigation-based water use accounting for 89.8% of total consumption, have offset the potential runoff gains, suggesting that agricultural water use is a major anthropogenic contributor to regional water stress. Based on these findings and a comparative review of representative arid-region practices in Israel, Australia, and Saudi Arabia, we propose a technology-market-institution tripartite governance framework for Northwest China. This framework is intended to support more proactive adaptation in regional water management and to provide a context-specific reference for advancing SDG 6 and SDG 13 in dryland regions. Full article

Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population. Full article

Grid-level population projection is essential for spatial planning under demographic decline, particularly for ensuring that population allocation accounts for grid extinction risk. This study develops a two-stage machine learning framework to predict residential grid transitions across South Korea’s 1 km grid system and assess how spatial policies shape depopulation outcomes through 2050. Stage 1 employs Random Forest classification to predict grid state transitions (macro-averaged F1 score = 0.694), while Stage 2 applies LightGBM regression for population prediction (coefficient of determination = 0.950). The extinction probability map from Stage 1 is incorporated into scenario simulations to adjust population allocation based on predicted residential viability. Feature importance analysis reveals that baseline population, household count, and demographic composition are key determinants of grid-level residential transitions. Five spatial development scenarios simulated through 2050 reveal substantial policy sensitivity. Cumulative extinction rates range from 3.1% under extreme dispersion to 24.5% under extreme concentration, representing a 25 percentage point divergence attributable to spatial allocation policy. Provincial heterogeneity is pronounced, with rural provinces facing extinction rates up to 39.9% while metropolitan areas remain largely unaffected. Comparing scenario outcomes enables pre-identification of policy-sensitive grids (19.5%) where allocation choices determine residential survival. These grids are predominantly located in areas with high forest cover and greater spatial isolation compared to stable grids, but differ in demographic profiles. Aging-Vulnerable grids (14.0%) exhibit high aging ratios with limited economic base, while Moderate-Vulnerability grids (5.5%) show younger demographics with relatively higher economic activity. These differential characteristics provide a spatially explicit basis for differentiated policy responses. Beyond depopulation planning, the spatial outputs of this framework can inform related planning domains such as land use transition planning, carbon management, and infrastructure prioritization under demographic decline. Full article

Streptococcus pneumoniae remains a leading cause of morbidity and mortality worldwide, with current polysaccharide-based vaccines offering limited serotype coverage, high production costs, and reduced efficacy in vulnerable populations. These limitations have prompted the search for conserved pneumococcal proteins as universal vaccine candidates. Among them, pneumococcal surface protein A (PspA) stands out as a major virulence factor, present in virtually all clinically relevant strains, and capable of interfering with complement activation, opsonophagocytosis, and host defense mechanisms. Over three decades of research have demonstrated PspA’s strong immunogenicity, protective efficacy in multiple animal models, and safety in early-phase clinical trials. Here, we critically review advances in PspA-based vaccine development, including recombinant protein fragments, fusion constructs, nanoparticle formulations, and live-vector platforms. We highlight the structural and immunological determinants underlying its protective potential, while discussing major challenges such as antigenic variability and cross-reactivity across pneumococcal strains expressing distinct PspA clades. By integrating recent experimental and translational findings, this review outlines the opportunities and obstacles for the implementation of serotype-independent PspA-based vaccines. Full article

Background: Miami-Dade County ranks first in Florida for HIV cases, yet broad epidemiological data often masks the “on-the-ground” reality of its most vulnerable residents. While standard reports suggest declining domestic violence, these statistics fail to account for community-defined health crises—the “SAVA” syndemic (substance use, violence, and HIV/AIDS)—occurring within localized micro-communities. Methods: Leveraging five years of Community-Based Participatory Research (CBPR) and Grounded Theory, this study engaged 97 community members and leaders to unmask these hidden burdens. We employed a multi-level sequential design and methodological triangulation, incorporating community forums, focus groups, and interviews with farm-workers, inner-city residents, and LGBTQ+ individuals. Results: Findings reveal a disconnect between official data and community reporting, including “Party and Play” methamphetamine/sex-trafficking networks in the LGBTQ+ scene, rampant youth vaping in inner cities, and child sexual abuse and opioids in farm-working communities. Mental health emerged as a pervasive need, masked by substance use and suppressed by cultural stigmas and institutional fears. Conclusions: Findings from this study highlight the value of community-level approaches in generating localized, culturally grounded insights that may not be fully captured in more aggregated geographic analyses (e.g., zip code, county, or state levels). We propose a collaborative, multi-sectoral model to address the systemic factors underlying the SAVA syndemic in these communities. Full article

Motherhood is a profoundly transformative stage, associated with both emotional fulfillment and psychological and physical vulnerability. The aim of this study was to assess the perceptions, difficulties and resources needed by mothers in the experience of motherhood. We conducted an exploratory cross-sectional observational study, based on an online questionnaire administered to 172 mothers. We analyzed socio-demographic data, experiences related to pregnancy and childbirth, perceived level of support, emotional difficulties, and resources considered useful in the role of motherhood. Most participants were women aged 30 to 45, with university or postgraduate education, married and with one or more children. Although motherhood was predominantly described in positive terms such as “fulfillment”, “love” and “joy”, a significant percentage of mothers reported increased fatigue, lack of personal time and emotional difficulties. The resources considered essential for maternal balance were family support, personal time, emotional support and access to clear and empathetic medical information. In conclusion motherhood is perceived as a complex experience, in which fulfillment frequently coexists with emotional overload and vulnerability. This exploratory study highlights the complex emotional and psychosocial dimensions of motherhood among Romanian women. The findings suggest the need for accessible emotional and social support resources. A comprehensive approach addressing both emotional and practical needs may contribute to improved maternal well-being. Full article

Small-scale inland fisheries in the Amazon are critical for food security, yet their sustainability is increasingly threatened by overexploitation and environmental degradation. In data-limited contexts such as the northern Ecuadorian Amazon, the absence of continuous monitoring constrains the development of adaptive management strategies. This study develops an integrated socio-ecological baseline to support the establishment of fisheries agreements in five Indigenous communities of the Napo and Aguarico rivers. Through a participatory monitoring approach, we generated reproductive parameters (gonadosomatic index, fecundity, size at first maturity), population structure metrics, and length–weight relationships for key subsistence species across three hydrological phases. Reproductive investment exhibited marked seasonality, with peak gonadosomatic indices during rising waters in most species, identifying a critical period for protection. Life-history strategies ranged from high-fecundity periodic strategists to low-fecundity equilibrium species, implying differentiated vulnerability to harvesting. Community perceptions prioritized large migratory catfish and floodplain habitats, aligning with biological indicators of vulnerability. High performance in technical training demonstrated the feasibility of long-term local monitoring systems. By linking biological indicators with local ecological knowledge, this study proposes a pathway from baseline assessment to adaptive co-management. The framework presented here provides a transferable model for strengthening sustainability, governance, and food security in tropical small-scale fisheries facing persistent data limitations. Full article

Cladocora caespitosa is an endemic hermatypic scleractinian in the Mediterranean Sea, currently threatened by both environmental and anthropogenic pressures, whereas Oculina patagonica is a cryptogenic hermatypic scleractinian that is expanding across the basin. This study provides the first assessment of co-occurring natural populations of these shallow-water taxa, examining their population structures, habitat preferences, and responses to environmental stressors based on SCUBA surveys conducted in the summers and autumns of 2022 and 2023. Both species were dominated by medium- to large-sized colonies, indicating relatively stable population structures, with C. caespitosa exhibiting significantly higher densities than O. patagonica. Both scleractinians showed a preference for sub-vertical and vertical rocky substrates, although O. patagonica appeared more tolerant of horizontal surfaces. Disease events were more frequent and severe in C. caespitosa, particularly affecting larger colonies during autumn 2022, whereas O. patagonica showed lower incidence and greater resilience overall. Temporal comparisons suggest that O. patagonica may act as a strong competitor to C. caespitosa; however, both species demonstrate a considerable capacity for recovery, likely due to adaptation to high-stress environments. These findings highlight key differences in ecological strategies and vulnerability to environmental stressors, emphasizing the need for targeted conservation approaches to preserve Mediterranean shallow-water coral communities under accelerating climate change. Full article

The global aging process has increased the number of older individuals providing care for relatives with severe mental disorders (SMD). This population faces unique health challenges. The present cross-sectional study examined the relationship between self-perceived health (SPH) and clinical, functional, and sociodemographic variables among 71 older caregivers (median age: 65 years) in Bogotá, Colombia. SPH was assessed by answering the question: “How would you describe your overall health status?” and dichotomized into good versus poor perception. Comorbidity was measured as the number of self-reported chronic conditions. Caregiver burden was evaluated using the Zarit Caregiver Burden Interview, and health-related quality of life (HRQoL) was assessed using the SF-36, including dimensions such as physical functioning, emotional well-being, bodily pain, and general health. Descriptive analyses, non-parametric comparisons, and logistic regression models were conducted. The results revealed a marked feminization of caregiving (92.96%) and a high prevalence of good SPH (70.42%), despite a substantial burden of physical comorbidities (mean: 3.21). Dimensions such as physical functioning, emotional well-being, and pain were significant in univariate analyses. However, the multivariate model identified general health as the only independent predictor of good SPH (adjusted odds ratio [OR]: 1.112; 95% confidence interval [CI]: 1.053–1.174; p < 0.001). These findings suggest that subjective health assessment may transcend objective disease counts for older caregivers. Public health policies could prioritize wellness-based interventions and emotional support over traditional disease-centered approaches to improve the quality of life of this growing, active, socially valuable, yet vulnerable population. Full article

Laryngeal squamous cell carcinoma (LSCC) remains a major clinical challenge within head and neck oncology, with five-year survival rates showing minimal improvement over recent decades despite advances in surgical and multimodal therapeutic strategies. Increasing evidence identifies metabolic reprogramming as a central driver of tumor progression, therapeutic resistance, and immune evasion in LSCC. Beyond the classical Warburg effect, LSCC exhibits profound metabolic reprogramming, involving coordinated alterations in carbohydrate, amino acid, lipid, and iron metabolism that support adaptation to hypoxic and nutrient-deprived microenvironments. Hypoxia-inducible factors, particularly HIF-1α, coordinate these key biochemical pathways and enzymatic steps by integrating glycolysis, glutaminolysis, folate-dependent one-carbon pathways, lipid synthesis, and mitochondrial remodeling, while also influencing stromal and immune components of the tumor microenvironment. Metabolic crosstalk between tumor cells, cancer-associated fibroblasts, and immune populations promotes immunosuppression through nutrient competition and accumulation of metabolites such as lactate and lipid-derived mediators. In parallel, dysregulated iron handling and altered ferroptosis susceptibility emerge as key determinants of tumor aggressiveness and treatment response. This review synthesizes current evidence on metabolic rewiring in laryngeal squamous cell carcinoma, highlighting how alterations in metabolic pathways create targetable vulnerabilities that drive tumor biology, immune modulation, and resistance to conventional and emerging therapies. Elucidating these metabolic dependencies may support the development of metabolism-based biomarkers and therapeutic strategies in laryngeal squamous cell carcinoma, providing an integrated and translational perspective that links tumor metabolism with microenvironmental interactions and immune modulation, while highlights emerging therapeutic vulnerabilities. Full article