Search Results (100)

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

Mental health problems are widespread in prison populations and can negatively affect inmates’ well-being. Although physical activity (PA) is known to benefit mental health in the general population, less is known about this relationship in correctional settings. This study examined the association between PA levels, symptoms of anxiety and depression, as well as coping strategies among 130 male prisoners at Prison No. 1 in Wroclaw, Poland. Data were collected using validated self-report tools: the International Physical Activity Questionnaire (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and the Mini-COPE inventory. Inmates who met the criteria for Health-Enhancing Physical Activity (HEPA) reported fewer symptoms of anxiety and depression than less active participants. Individuals showing signs of mental health difficulties were also more likely to rely on avoidant coping strategies, though no clear link was found between coping style and activity level. Cluster analysis further supported the observed association between low PA and higher psychological distress. These findings suggest a potential role for PA in supporting mental health in prison settings. They also highlight the importance of identifying individuals who may be at risk due to maladaptive coping strategies. Given its exploratory nature, the study’s findings should be interpreted with caution and verified in future research with larger and more diverse samples. Full article

Background: Tuberculosis (TB) is a leading cause of death among people living with HIV (PLHIV). While body mass index (BMI) affects TB risk, its association with latent tuberculosis infection (LTBI) in PLHIV is unclear. High-transmission settings, such as prisons, may further increase LTBI risk, yet this relationship has not been studied across both prison and community populations of PLHIV. Methods: We conducted a dual cross-sectional study of PLHIV in Jiangsu Province, China, recruiting participants from a prison hospital in 2021 and community healthcare facilities from July to November 2023. BMI was calculated from measured height and weight. LTBI was identified by a positive ESAT6-CFP10 (EC) skin test or the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay. Logistic regression and generalized additive models (GAMs) assessed the association between BMI and LTBI, adjusting for demographic, clinical, and behavioral confounders. Results: A total of 1799 PLHIV were included in the analysis, of whom 343 (19.07%) were recruited from prison settings and 1456 (80.93%) from community-based screening. The overall prevalence of LTBI was 13.79% (n = 248). Obesity (BMI ≥ 28 kg/m²) was linked to a significantly lower risk of LTBI (adjusted OR = 0.47, 95% CI: 0.23–0.95, p = 0.036), particularly when identified by EC testing (adjusted OR = 0.13, 95% CI: 0.03–0.54, p = 0.005). The BMI–LTBI association followed a nonlinear “U-shaped” pattern, with the lowest prevalence in individuals who were obese. Among those with CD4+ T cell counts < 500 cells/μL, the inverse association between obesity and LTBI was even more marked (adjusted OR = 0.20, 95% CI: 0.05–0.83, p = 0.027). Conclusion: In summary, obesity is significantly associated with a lower risk of LTBI among PLHIV, with an approximate 54% risk reduction. This inverse relationship was most pronounced when using the EC skin test. Full article

Background/Objectives: Suicide in prison is a significant medico-legal and public health concern, with rates several times higher than in the general population. Vulnerability is heightened by psychiatric disorders, substance use, and custodial stressors such as isolation, overcrowding, and restricted healthcare access. This study examines custodial suicides to identify diagnostic complexities, systemic shortcomings, and possible prevention strategies, including technological innovations. Methods: We conducted a retrospective forensic investigation of sixteen confirmed custodial suicides between 2022 and 2024. Each underwent a standardized protocol comprising crime scene inspection, complete autopsy, histopathology, toxicology, and review of prison medical and psychiatric records. Data on suicide methods, psychiatric comorbidities, and substance use were analyzed. Results: Hanging was the predominant method (12/16), displaying classical forensic signs such as pale, oblique ligature marks and petechial hemorrhages. Four cases involved acute intoxication, often with non-prescribed drugs. Psychiatric disorders were identified in 14 cases, including major depressive disorder, bipolar disorder, and substance use disorder. Toxicological analyses revealed both prescribed and illicit substances, highlighting unauthorized exchanges within facilities. Autopsy findings consistently excluded homicide or natural causes, confirming the vitality of lesions and the mechanism of death. Conclusions: Custodial suicides are strongly associated with untreated or inadequately managed psychiatric conditions, compounded by restrictive prison environments. Comprehensive forensic autopsies are essential for accurate cause-of-death determination and institutional accountability. Preventive strategies should combine psychiatric care, architectural modifications to reduce ligature points, and ethical integration of AI-based surveillance for early detection of suicidal behavior. A multidisciplinary, rights-based approach is crucial to reduce suicide rates and safeguard the dignity and life of incarcerated individuals. Full article

This study explores the implementation of competency-based professional development for correctional staff through the DACUM (Developing A Curriculum) methodology. A National Adaptation Workshop in Portugal engaged professionals from multiple sectors—psychologists, social workers, educators, prison officers, re-education and reintegration technicians—to validate occupational profiles and training needs. Thematic analysis revealed gaps between required and available training, especially in conflict management, mental health, and interdisciplinary collaboration. Key findings show strong support for participatory, practice-informed training, provided it is contextually adapted and accessible. The results underscore the practical need for flexible, modular training frameworks in correctional settings, offering implications for policy and staff retention strategies. Full article

After the end of the Second World War, Hungary, like other war-torn countries, was left with countless orphaned children. The collapsed state structures were unable to care for them, so only various private or church initiatives—such as Gaudopolis, a children’s home set up by the Lutheran pastor Gábor Szehló—provided a means of survival. However, in East-Central Europe—including Hungary, Poland and Romania—where the Soviet Union had a sphere of influence, the emerging Soviet-style system was aimed at the political re-education of society. Ideological goals categorically excluded the possibility of churches being involved in the care and education of youth beyond the existing legal framework. Any person who engaged in such activities was cracked down upon. This study examines the role and responsibility of church persons in the care and upbringing of orphaned children through the fate of the Roman Catholic priest István Regőczi. In the decades of communist dictatorship, István Regőczi repeatedly reorganised orphanages, where he carried out youth education activities based on principles similar to scouting. The values he imparted to the children—such as the Christian religion, family protection, mutual help and social solidarity—were all values of Christian socialism. However, the communist dictatorship—promoting its own political ideology, Marxism—sought to take control of the upbringing and education of children by nationalising all institutions involved in this activity. Anyone who resisted this—as István Regőczi did—was made impossible in the people’s democracy of the 1950s and 1960s, and his child-saving, educating and teaching activities were prevented, even if the courts sentenced him to longer or shorter prison sentences for the crimes of illegal youth organisation, incitement and the abuse of freedom of association. This study, comparing what is described in István Regőczi’s memoirs with the surviving archival sources, shows how during these terrible decades it was possible to save orphaned, needy children and raise them in a Christian spirit, even against the will of the authorities. Full article

Background/Objectives: Substance use disorders and eating disorders frequently co-occur and are both associated with increased aggression. As a result, individuals with these conditions are overrepresented in prison populations. The present study investigated whether symptoms of eating disorders in male forensic psychiatric inpatients with substance use disorders are associated with heightened aggression. To this end, various forms of aggressive behavior—including spontaneous and reactive aggression, excitability, and violent offenses—were analyzed. Methods: Fifty-six male patients from two forensic psychiatric hospitals in Germany participated in the study. Symptoms of eating disorders were evaluated with the German version of the Eating Disorder Examination Questionnaire (EDE-Q), and aggression was measured with the Short Questionnaire for the Assessment of Aggression Factors (K-FAF) and by considering the violent index offense. Data were analyzed by generalized linear models, with age and body mass index (BMI) included as covariates. Results: Higher EDE-Q scores significantly predicted increased spontaneous aggression and excitability. However, no significant association was found between eating disorder symptoms and reactive aggression or the likelihood of a violent index offense. Age and BMI did not significantly influence any aggression subscales. Conclusions: The findings suggest that in patients with substance use disorder, eating disorder symptoms may be linked to heightened internalized forms of aggression. These results support the clinical relevance of screening for eating disorder symptoms in forensic psychiatric settings and integrating dietary interventions into therapeutic efforts to manage aggression. Full article

Background/Objectives: Despite legal frameworks acknowledging the need to protect the rights of female prisoners, penitentiary systems often neglect gender-specific needs, particularly for foreign women. Among them, Muslim women face distinct challenges linked to cultural and religious practices, which are frequently unmet in prison contexts. This review aims to explore the academic literature on the experiences of Muslim women in detention. Methods: A systematic review was conducted using three major bibliographic databases—Scopus, PubMed, and Web of Science—covering the period from 2010 to 2024. Inclusion criteria focused on peer-reviewed studies examining the condition of Muslim women in prison. Of the initial pool, only four articles met the criteria and were included in the final analysis. Results: The review reveals a marked scarcity of research on Muslim women in prison at both national and international levels. This gap may be due to their limited representation or cultural factors that hinder open discourse. The selected studies highlight key issues, including restricted access to services, limited ability to practice religion, and language and cultural barriers. These challenges contribute to increased psychological vulnerability, which is often underestimated in prison settings. Conclusions: There is an urgent need for targeted research and culturally competent training for prison staff to adequately support Muslim women in detention. Greater academic and institutional attention is essential to develop inclusive policies that consider the intersection of gender, religion, and migration, particularly in the post-release reintegration process. Full article

Healthy food service guidelines (HFSG) comprise food, nutrition, behavioral design, and other standards to guide the purchasing, preparation, and offering of foods and beverages in worksites and institutional food service. To date, there have been few attempts to synthesize evidence for HFSG effectiveness in non-K-12 or early childhood education sectors, particularly at worksites and institutional food services. We conducted a scoping review to achieve the following: (1) characterize the existing literature on the effectiveness of HFSG for improving the institution’s food environment, financial outcomes, and consumers’ diet quality and health, and (2) identify gaps in the literature. The initial search in PubMed and Web of Science retrieved 10,358 articles; after screening and snowball searching, 68 articles were included for analysis. Studies varied in terms of HFSG implementation settings, venues, and outcomes in both U.S. (n = 34) and non-U.S. (n = 34) contexts. The majority of HFSG interventions occurred in venues where food is sold (e.g., worksite cafeterias, vending machines). A diversity of HFSG terminology and measurement tools demonstrates the literature’s breadth. Literature gaps include quasi-experimental study designs, as well as interventions in settings that serve dependent populations (e.g., universities, elderly feeding programs, and prisons). Full article

This article examines how religious freedom is enacted and redefined through everyday practices in pluralistic urban settings. Moving beyond the classical notion of negative liberty as non-interference, it explores the social conditions that enable or constrain the practical expression of religious life. Drawing on forty-three qualitative interviews with religious leaders and civic actors in Florence, Italy, the study analyses how religious freedom is experienced across institutional contexts such as hospitals, schools, prisons, workplaces, and sport facilities. The findings reveal a persistent tension between formal legal rights and their uneven implementation in daily life. While legal guarantees are generally upheld, structural barriers and discretionary practices often hinder access to religious expression. At the same time, informal interactions, local networks, and dialogical engagement play a key role in supporting the concrete exercise of religious freedom. The article argues that freedom is not simply a legal status but a social process, realized through relational and institutional arrangements. By foregrounding the role of everyday interaction in shaping the conditions of freedom, this study contributes to broader sociological debates on pluralism, normativity, and the social foundations of institutional life. Full article

The concept of Nash equilibria in pure strategies for quantum extensions of the general form of the Prisoner’s Dilemma game is investigated. The process of quantization involves incorporating two additional unitary strategies, which effectively expand the classical game. We consider five classes of such quantum games, which remain invariant under isomorphic transformations of the classical game. The resulting Nash equilibria are found to be more closely aligned with Pareto-optimal solutions than those of the conventional Nash equilibrium outcome of the classical game. Our results demonstrate the complexity and diversity of strategic behavior in the quantum setting, providing new insights into the dynamics of classical decision-making dilemmas. In particular, we provide a detailed characterization of strategy profiles and their corresponding Nash equilibria, thereby extending the understanding of quantum strategies’ impact on traditional game-theoretical problems. Full article

Globally, 1–3% of the population has an intellectual disability, but some remain undiagnosed, resulting in limited access to essential health and social care services, poor health outcomes, and higher risks of homelessness, substance abuse, and imprisonment. A formal diagnosis enables early intervention and support. A scoping review was conducted to explore research on undiagnosed intellectual disability, screening processes, and identifying indicators. Method: The scoping review search was conducted using academic databases such as CINAHL, PsycINFO, Scopus, and PubMed, along with eight grey literature sources. In addition, the reference lists of the included studies were explored. Information specialists supported and guided the search process. The search included qualitative, quantitative, review, and mixed-method research studies published in English between 2000 and 2024. Two reviewers screened papers for eligibility by title, abstract, and full text. Result: A total of 11,475 papers were screened, with 57 papers from various countries included in the review. Indicators of intellectual disability were identified in three settings: (1) educational settings (preschool, primary, and secondary schools); (2) social care services, including homeless and community services; and (3) criminal services, such as courts, probation, and prisons, highlighting the wide applicability of findings. These indicators were linked to “experiences”, “behaviours”, “challenges”, and “observations”. Conclusion: This review emphasised the importance of early diagnosis by adopting appropriate assessment tools, which require national screening policies. It also highlighted the essential role of professionals working in intellectual disability services in identifying and supporting undiagnosed individuals, particularly within high-risk populations. Implication: The review’s findings will guide policy, practice, and research recommendations for enhancing the early identification of people with intellectual disabilities. Full article

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide and is exacerbated by poor dietary habits, particularly in settings such as women’s prisons. Incarcerated women are often exposed to ultra-processed foods, limited nutritional education, and restricted living conditions that increase their risk of CVD. Objectives: This study aimed to explore the challenges perceived by professionals in a Portuguese women’s prison regarding the prevention of CVD, particularly through dietary interventions. Methods: A qualitative, exploratory and descriptive study was conducted using a focus group with six professionals. Data were collected in July 2024 and analysed using thematic content analysis. Results: Three thematic categories emerged: (1) contextual challenges of the prison system (e.g., sedentary lifestyle, limited food options); (2) socio-cultural resistance to behavioural change (e.g., low adherence to health programmes, use of food as a coping mechanism); and (3) the need for sustainable and interdisciplinary intervention strategies. Conclusions: The findings highlight the complexity of promoting cardiovascular health in female prisoners. Interventions need to take into account mental health support, prisoner autonomy and institutional constraints. Future research should develop and test targeted, context-specific nutrition programmes in similar settings. Full article

Trauma-informed care is an increasingly trending clinical and organizational approach globally. Multiple guidelines exist on implementing trauma-informed care across healthcare systems, behavioral health programs, academic institutions, and prisons, among other settings. Although many studies have assessed the implementation of trauma-informed care guidelines and the integration of training into curricula for healthcare providers, workforces, and in clinical practice with individuals and communities, there have been no studies previously conducted to date on assessing the existing state of coverage on trauma-informed care across social media to inform future, actionable interventions. This represents a critical gap in research and practice given the increasingly prevalent utilization and accessibility of information online, especially via a multitude of social media platforms. This study is the first to assess the sources, format, and content across one of these social media platforms on YouTube. Content on trauma-informed care was examined through conducting a descriptive, observational study to determine the depth and breadth of content that was widely covered and uncovered across the top 100 widely viewed videos. Findings revealed that most of the content was published by professional, nongovernmental sources. A wide range of resources and strategies was presented on social media for utilizing trauma-informed care across diverse settings on individual and community levels. The five principles of trauma-informed care (safety, trustworthiness, collaboration, empowerment, and choice) were heavily reviewed among the widely viewed videos. A multitude of benefits was presented in terms of implementing trauma-informed care on both micro and macro levels. Social determinants of health were not widely covered but formed some of the stressors and triggers examined among the videos. DEI principles were also scantly covered across the videos. Several clinical and organizational implications are presented. Recommendations to integrate widely covered and uncovered content as targets for intervention in informing future trauma-informed approaches are proposed. Full article

Despite the importance of criminogenic thinking in addressing criminal behavior, validated instruments to measure these cognitions in Portuguese forensic settings are scarce. Therefore, the main aim of this study was to explore the psychometric properties of the Criminogenic Cognitions Scale (CCS) in a sample of 364 Portuguese incarcerated males (M_age = 37.88, SD = 10.88). An exploratory factor analysis was conducted, indicating a 15-item, two-factor structure (KMO = 0.82; Bartlett’s test, χ² = 1841.2, df = 105, p < 0.001). The CCS dimensions, comprising Short-Term Orientation and Responsibility Evasion and Authority Resistance, demonstrated satisfactory psychometric properties, including convergent validity with antisocial traits, moral disengagement, and self-control dimensions, as well as internal consistency (omega coefficient = 0.60–0.77; composite reliability = 74–91; coefficient H = 89–95), and sensitivity of items. The CCS is a valuable tool within prison settings for assessing criminogenic thinking patterns, supporting risk assessment, the development of targeted rehabilitation programs, and monitoring cognitive changes over time to reduce recidivism, thereby promoting inmates’ safer reintegration into society. Overall, our findings suggest the CCS is a promising tool for assessing criminogenic cognitions in the forensic Portuguese population. Full article