Search Results (18)

Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has been the subject of limited systematic attention. This review synthesises evidence on the knowledge, attitudes, and experiences of nurses and individuals with mental illness regarding these practices in EMR psychiatric settings. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD42023383751), we systematically searched nine electronic databases for studies published up to June 2023, supplemented by backward and forward citation searching. Multiple reviewers independently screened records against predefined eligibility criteria, with disagreements resolved through consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal tools, and reporting quality was evaluated using an adapted CROSS checklist; these two appraisal dimensions were conducted and reported independently. Findings were integrated through narrative synthesis. Results: From 4634 identified records, 19 studies conducted across 11 EMR countries met the inclusion criteria. Nursing knowledge deficits were identified across multiple settings, and attitudes towards restraint practices were predominantly negative. Individuals with mental illness consistently described restraint as humiliating, punitive, and physically distressing. Recurrent challenges identified across studies included inadequate staff training, chronic understaffing, and limited access to restraint-reduction alternatives. Conclusions: Substantial gaps in nursing knowledge and training persist across the EMR. The findings of this review, while derived predominantly from cross-sectional studies with convenience samples, suggest that evidence-based education programmes, standardised restraint-reduction policies, and patient-centred care frameworks warrant prioritisation to safeguard the rights, safety, and dignity of individuals with mental illness in this region. Longitudinal and experimental research is needed to confirm these directions and establish their effectiveness within EMR contexts. Full article

Structural Equation Modeling (SEM) is a key framework for analyzing complex economic relationships involving latent variables, mediation effects, and endogeneity, yet the choice between frequentist and Bayesian estimation remains theoretically and practically contested, especially in settings with non-stationary data and small samples. This study provides a formal comparison of the two approaches by formulating SEM as a probabilistic graphical model and deriving the corresponding estimation procedures, identifiability conditions, and uncertainty measures. We examine asymptotic properties of frequentist estimators and posterior consistency in Bayesian SEM, with particular attention to integrated time-series SEM applications such as shadow economy estimation. The analysis shows that while both approaches converge under large-sample conditions, important differences arise in finite samples. Bayesian methods exhibit more stable point estimates through coherent uncertainty quantification, particularly when prior information regularizes an otherwise ill-conditioned likelihood. Under model misspecification, Bayesian posteriors concentrate around the pseudo-true parameter defined by the Kullback-Leibler projection, providing a probabilistic representation of misspecification uncertainty through posterior spread—an advantage over frequentist inference, which typically conditions on the maintained model as exact. These findings carry direct implications for empirical economic modeling under realistic data constraints. In settings where sample sizes are small, identification is weak, and model uncertainty is substantial, conditions that routinely characterize macroeconomic research, the choice of inferential framework is not a matter of philosophical preference but a determinant of whether policy-relevant conclusions can be credibly defended. Bayesian SEM offers a principled and transparent path forward in precisely these conditions. Full article

Background: Neonatal hypoxic–ischemic encephalopathy remains a leading cause of neonatal mortality and long-term neurodevelopmental disability worldwide. Despite the widespread adoption of therapeutic hypothermia, a substantial proportion of affected infants experience death or significant neurological impairment. Given their metabolic vulnerability, ketogenic diet strategies and ketone bodies have emerged as potential adjunctive neuroprotective interventions. This scoping review aims to critically evaluate the mechanistic rationale, preclinical evidence, and clinical feasibility of ketogenic approaches. Methods: A scoping review of the literature was conducted, including experimental and clinical studies investigating ketogenic diets, endogenous ketosis, and exogenous ketone supplementation in neonatal hypoxia–ischemia. Evidence was synthesized across mechanistic, preclinical, nutritional, and clinical domains, with particular attention to developmental context, timing of intervention, safety considerations, and translational relevance in the contest of therapeutic hypothermia. Results: Preclinical studies consistently demonstrate that ketone bodies enhance cerebral energy metabolism, support mitochondrial function, reduce excitotoxic signaling, and attenuate oxidative stress and neuroinflammation in the immature brain. Neonatal models show preferential utilization of β-hydroxybutyrate over glucose during hypoxic–ischemic stress, suggesting intrinsic metabolic advantages. Emerging evidence also supports potential long-term effects on epigenetic regulation and white matter development, although direct causal validation in neonatal HIE remains limited. Nutritional studies indicate that carefully monitored enteral and parenteral feeding is feasible in critically ill neonates, identifying a potential window for metabolic interventions. Conclusions: Ketogenic strategies represent a plausible, multimodal approach to targeting the metabolic and inflammatory sequelae of neonatal HIE. While current evidence is insufficient to support clinical implementation, this scoping review provides a hypothesis-generating framework to guide future translational research and the design of carefully controlled clinical trials in neonatal neurocritical care. Full article

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

Self-care is a complex concept that incorporates various strategies designed to promote personal wellbeing and prevent illness, which is a critical need in nursing given the profession’s inherent stressors. The physical, emotional, spiritual, and psychological demands placed on nurses can significantly influence their wellbeing and the quality of care they provide. Yet, professional accountability and responsibility for self-care remains contested within the profession. To support a healthier and more sustainable healthcare workforce, Approved Education Institutions (AEIs) delivering pre-registration nursing programmes can play a pivotal role in embedding self-care ethos and practices into the nursing curricula. Grounded in educational psychology and drawing on insights from related theories, this paper explores barriers to self-care, proposes actionable interventions, and advocates for its integration as a cornerstone of nursing education. Full article

The phenomenon of contrast-induced nephropathy (CIN) and contrast-associated nephropathy (CAN) has been acknowledged for an extensive duration. Recently, there has been a significant rise in research on the topic due to the enhanced availability of imaging investigations. This theory has been thoroughly validated and extensively reported in the scholarly literature. The primary risk factors are chronic kidney disease, diabetes, sepsis, critical illness, circulatory shock, anemia, advanced age, inadequate hydration, and the use of nephrotoxic medications. The principal preventive strategies are the use of iso-osmolar contrast agents and sufficient hydration, which includes the use of intravenous isotonic saline. The administration of N-acetylcysteine has been shown to decrease the occurrence of CIN without impacting outcomes like mortality or the need for dialysis. Recently, a growing number of scholarly studies have contested this phenomenon, or at least, questioned its clinical significance, rendering it primarily a biochemical occurrence. This review aims to evaluate the previously listed studies. Overestimating the possible dangers of post-contrast nephropathy may diminish the sensitivity of imaging tests that may otherwise utilize contrast, so substantially lowering their clinical relevance. This hypothesis is critically significant to science, medicine, and patients, warranting attention despite the necessity for additional research to validate it. The present study demonstrates that the frequency and importance of CIN may be overestimated. Full article

This study implements a minded approach to studying Ebola virus disease (EVD) by dividing the infected population into aware and unaware groups and including a hospitalized compartment. This offers a more detailed understanding of illness distribution, potential analyses, and the influence of public knowledge. The findings might improve healthcare budget apportionment, public health policy, and contest Ebola and related infections. In this study, we fully observe the new model $SEIHR$ that we have constructed. We start by outlining the essential concepts of the model and confirming its mathematical reliability. Next, we calculate the fundamental reproductive number $\left(R_0\right)$, which is critical for appreciating how the infection spreads and how effective treatments might be. We also study stability analysis, which looks at when the disease may decline or become chronic. Furthermore, we exhibit the occurrence of bifurcation in the EVD Epidemic Model and perform a sensitivity analysis of $\left(R_0\right)$. The main findings of this study show that for $R_0<1$, the disease-free equilibrium, is globally stable, meaning the disease will die out, whereas for $R_0>1$, the endemic equilibrium is stable, meaning the disease persists. Additionally, the sensitivity analysis reveals that the most influential parameters in controlling $R_0$ are the transmission rate and the recovery rate, which could guide effective intervention strategies. Finally, we use numerical simulations so that out outcomes are more significant. Full article

Multiple chemical sensitivity (MCS) is a contested environmental illness that can be debilitating and life limiting. Those with MCS develop an array of physical symptoms to doses of chemicals in everyday life that are currently considered safe for human health by scientific and political actors. (1) Background: The purpose of this project is to understand how people with MCS practice chemical avoidance, describe MCS as a “relational illness”, and understand the interactional strategies for navigating relational chemical exposures. (2) Methods: This is an ethnographically embedded interview project that consists of two field trips, thirty-three interviews, and content analysis of MCS materials such as newsletters, books, and websites. (3) Results: This article finds that personal protection strategies for chemical avoidance are insufficient in the case of MCS. By redefining the hazards posed by spaces and other people’s bodies, those with MCS transform chemicals into an object of relational concern. This creates opportunities for other people to reevaluate their own chemical relationships and accommodate those with MCS, but it can also lead to denial, dismissal, and social exclusion. (4) Conclusions: This work on demonstrates that chemical contamination is an issue of interactional concern and adds to the literature on contested illness and relationships. Full article

The term “Medically Unexplained Symptoms” (MUS) describes chronic symptoms for which medical investigations fail to reveal a specific pathology or biomarker. Even as MUS are among the most prevalent chronic health problems in the global north, patients who experience them reside in a nebulous space. Such nebulousness is heightened for women patients. Moreover, women report MUS at higher rates than men. In this review essay, we analyze the medicalization and feminization processes vis-à-vis MUS by focusing on two particular syndromes: Fibromyalgia (FMS) and Long COVID (LC). FMS and LC present clear parallels that allow us to trace an unhappy marriage of women and MUS. We demonstrate how the medical constructions of these two syndromes as knowledge categories are representations of medical uncertainty vis-a-vis women patients. We then scrutinize the resulting gendered consequences of these categories for the illness experience. We conclude our review by calling for a cultural reorientation in our thinking about MUS that centers a recognition that the origins and manifestations of a great deal of human suffering reside outside of medicine’s ways of knowing. In so doing, we connect to foundational claims in medical anthropology and sociology; namely, that illness is more than disease, and health cannot be achieved primarily via biomedical means. Full article

This article examines the strategies of resistance enacted by an informal network of solidarity comprised of Afghan youths on the move in Europe and their Swedish allies. In 2015, thousands of Afghan children fleeing from the Taliban regime arrived in Europe as unaccompanied minors. Many have been hosted in Sweden and lived there for several years, until coming of age. Reaching 18 years prompted a series of consecutive losses, as the Swedish state limited their opportunities to remain in the country or even illegalized them. Subjected to threats of detention, deportation, and ill treatment, many Afghan youths re-escaped into other European countries, crafting networks of informal solidarity to help them resist border violence. This article is based on an ethnographic study that delves into the lived experiences of four Afghan youths who lived in Lisbon between February 2019 and February 2020, particularly focusing on the journey of Ahmed, a young man of Hazara ethnicity. The empirical data shed light on the solidarity enactments that enhanced the youths’ resistance in hostile environments, inviting reflection on the impacts of the European border regime and the importance of agency, care, and political contestation. Full article

Even though there are approximately half a million new cases of Lyme disease in the US annually, according to the CDC, it is often undiagnosed or misdiagnosed, which can result in a chronic, multisystemic condition. Lyme disease is a recognized public health threat and is a designated “notifiable disease”. As such, Lyme disease is mandated to be reported by the CDC. Despite this, both acute and chronic Lyme disease (CLD) have been relegated to the category of “contested illnesses”, which can lead to medical gaslighting. By analyzing results from an online survey of respondents with Lyme disease (n = 986), we elucidate the lived experiences of people who have been pushed to the margins of the medical system by having their symptoms attributed to mental illness, anxiety, stress, and aging. Further, respondents have had their blood tests and erythema migrans (EM) rashes discounted and were told that CLD simply does not exist. As a result, a series of fruitless consultations often result in the delay of a correct diagnosis, which has deleterious consequences. This is the first study that addresses an extensive range of gaslighting techniques experienced by this patient population. Full article

This qualitative study examines the characteristics exhibited by Chinese patients with somatization symptoms during their treatment process, focusing on changes in illness interpretation and language use. A semi-structured in-depth interview was conducted with 10 patients receiving treatment in a clinical psychology department of a general hospital who reported somatic symptoms as their main complaint. The interview data were recorded and transcribed, and analyzed using interpretive phenomenological analysis. Two core themes emerged from the analysis: avoidance at the utterance level; and at the semantic level, power and contestation. Patients with somatization symptoms exhibit avoidance behaviors, and their experience of illness and the therapeutic process impact their discourse. Professionals should pay attention to patients’ own interpretations, cultural background and acceptance of the illness. Full article

The Michigan PBB Oral History Project documented community residents’ descriptions of a large-scale chemical contamination—the PBB contamination—that occurred in Michigan in 1973. These oral histories document residents’ and others’ experiences during and after the contamination. We conducted a grounded theory qualitative analysis of 31 oral histories to examine the experiences of community members, researchers, lawyers, and others who actively sought out and contributed essential information about the contamination and its impacts. Our findings highlight several challenges encountered in the development of this knowledge including four central themes—contested knowledge, community skills, inaction, and uncertainty. Integrating environmental health literacy, community capacity, and contested illness frameworks, we examine the contributions of community residents, scientists (from inside and outside the community), and others to the development of knowledge to inform decisions and sustain action regarding this large-scale contamination. We close with a discussion of lessons learned regarding efforts to build environmental health knowledge within uncertain and often contested contexts and for promoting environmental health and action related to large-scale chemical contaminations. Our findings suggest the importance of integrated frameworks for examining and promoting the critical role of community skills, leadership, participation, sense of community, and community power in promoting environmental health. Full article

The blood–brain barrier (BBB) has shown to be a significant obstacle to brain medication delivery. The BBB in a healthy brain is a diffusion barrier that prevents most substances from passing from the blood to the brain; only tiny molecules can pass across the BBB. The BBB is disturbed in specific pathological illnesses such as stroke, diabetes, seizures, multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease. The goal of this study is to offer a general overview of current brain medication delivery techniques and associated topics from the last five years. It is anticipated that this review will stimulate readers to look into new ways to deliver medications to the brain. Following an introduction of the construction and function of the BBB in both healthy and pathological conditions, this review revisits certain contested questions, such as whether nanoparticles may cross the BBB on their own and if medications are selectively delivered to the brain by deliberately targeted nanoparticles. Current non-nanoparticle options are also discussed, including drug delivery via the permeable BBB under pathological circumstances and the use of non-invasive approaches to improve brain medication absorption. Full article

It is widely recognized that body dissatisfaction is an important public health concern. In the past, being a fashion model was almost synonymous with anorexia/bulimia, and even today, there are cases of eating disorders in young women whose ambition is to become a top model. Moreover, stress can play a substantial role within ill health via related behaviors such as smoking, substance abuse, and inappropriate eating. In our study, we examined 112 aspiring fashion models aged between 15 and 24 years (M = 19.5, SD = 2.08) from 32 different countries of the world during an international contest, and 100 students (control group), aged between 16 and 22 years (M = 18.6, SD = 1.39). The purpose of this cross-sectional study was to examine whether stress mediated the relationship between body dissatisfaction and eating disorders. The study included the administration of stress and self-efficacy and the locus of control dimensions, body (image) dissatisfaction, and eating attitude disorder. Results indicated higher scores on body dissatisfaction, stress level, and eating attitudes disorder among the group of fashion models compared to the control. Mediational analyses showed that body dissatisfaction was partially mediated by stress level on eating disorders. Especially in the aspiring fashion models, there are often many possibilities that competitive stress causes candidates to exacerbate attempts to maintain their body weight below normal weight/height parameters. These results indicated that appropriate intervention for the management of stress level could possibly defend against the negative impact of body dissatisfaction on eating disorder symptoms. The presence of skilled health workers in the field of nutrition and psychology can be extremely important in the field of fashion to maintain an adequate quality of life. Full article