BACKGROUND:Dementia prevention is increasingly conceptualised as an exposome issue, reflecting life course eco-psychosocial exposures. For Aboriginal and Torres Strait Islander peoples in Australia, these exposures can be articulated through the Social and Emotional Wellbeing (SEWB) framework and Indigenous conceptualisations of Place. However, dementia research and policy often rely on spatial and socioeconomic proxies that overlook Place-based opportunities for brain health. We employed research yarning to examine how Place influences brain health and inform strengths-based, locally-tailored dementia prevention policy. METHODS:Data were collected via research yarning across eight urban, regional, and rural/remote Australian sites. Data were analysed using reflexive thematic analysis, combining deductive coding guided by the SEWB framework with inductive analysis centring Aboriginal perspectives. RESULTS:Thirteen yarns were held with 88 participants from 6 ACCHOs and 7 communities across 8 sites, with 33 additional participants attending feedback yarns. Participants described brain health as supported through everyday relational and cultural exposures accumulating from birth. Connection to Country, Culture, spirituality, family, and Community reinforced brain health through intergenerational continuity and relationship to ancestral lands. Structural factors - educational access, socioeconomic conditions, health system design, and cultural governance - could enhance or disrupt these relationships. Geographic remoteness did not uniformly predict vulnerability; its effects were mediated by kinship and community structures. CONCLUSION:For Aboriginal and Torres Strait Islander peoples, Place represents a nexus of structural and cultural determinants relevant to brain health. Community-led examination of Place-based exposures extends exposomic frameworks, offering an ethically-grounded foundation for dementia prevention policy with potential relevance for Indigenous populations globally.
Although shame is recognised as a powerful force in clinical settings, it may be understood as an individual emotion and an episodic experience. Drawing on life course theory and narrative analysis, this paper examines how shame creates a barrier to engaging with health care. We analysed 32 stories submitted by older people to an anonymous online story-sharing platform in Aotearoa New Zealand during 2024, in which participants described times they felt too embarrassed or ashamed to seek health care. Participants described experiences of dismissal, disbelief, and moral judgment, with past encounters shaping anticipation of future care. Accounts were situated within shifting health care discourses that promised patient empowerment while continuing to enact hierarchical authority in practice. Dismissal and disbelief were viewed as strategies to bolster medical authority, practices which ironically contributed to scepticism and rejection of medicine. Agency was narrated as a constrained response: participants rejected being positioned as shameful, persisted in seeking recognition and responsive care, but often withdrew after repeated episodes of dismissal. These accumulated experiences shape trust, credibility, and willingness to engage with care. This analysis highlights the need for primary care practitioners to recognise that consultations are shaped by accumulated histories, not solely by presenting concerns. In doing so, it foregrounds shame as a structurally produced affective process, shaped by medical authority and irreducible to individual encounters or to physician communication style.
Medical records mediate clinical work at multiple levels. Focusing on the transition from paper-based medical records to Electronic Health Records (EHRs), we analyze how the incorporation of digital infrastructures reconfigures healthcare networks and reshapes practices of writing, reading, and narration. Our analysis draws on ethnographic research conducted between 2024 and 2025 in two psychiatric settings in southwestern Colombia. We trace how the implementation of EHRs redistributed agency within clinical documentation and altered relations among clinicians, administrative staff, software systems, and regulatory arrangements. Four interrelated transformations are identified: (i) shifting distribution of agency across sociotechnical networks; (ii) coexistence of writing and capturing clinical information; (iii) alteration in reading practices shaped by user profiles and distinct interfaces; and (iv) changeover from case histories anchored in biography and temporality toward label-oriented case conceptualization. We show that the integration of clinical, administrative, and financial records within EHR infrastructures privileges charting practices oriented toward diagnostic coding and billable services, while weakening the temporal and biographical anchors that previously sustained continuity and meaning-making in psychiatric documentation aimed at understanding the patient as a whole. These changes may reshape which forms of information become consequential as clinical knowledge.
Background Food insecurity in climate-vulnerable coastal settings extends beyond limited food access or availability; it is lived as a gendered, embodied, and psychosocial experience. Guided by Psychological Stress Theory, the stress process model, and gendered embodiment, we use “embodied scarcity” to describe how inadequate and uncertain food access becomes bodily, emotional, moral, and relational suffering as women absorb household deprivation through hunger, nutritional self-denial, caregiving responsibility, shame, and constrained coping. This study explores how women in southwest coastal Bangladesh interpret and embody food insecurity and its psychosocial consequences. Methods This qualitative study used Interpretative Phenomenological Analysis (IPA). Thirty-seven women were purposively selected for one-on-one, in-depth interviews using an open-ended guide. Data were analyzed inductively through an iterative IPA process to identify experiential meanings and superordinate themes. Results Three interrelated superordinate themes were identified: food insecurity as chronic psychosocial stress; embodied gender burdens of maternal sacrifice and shame; and faith, informal support, and constrained coping. Women experienced scarcity through hunger, nutritional self-denial, sleeplessness, anxiety, maternal guilt, social judgment, and emotional exhaustion. These findings show how material deprivation becomes embodied as psychosocial suffering. Conclusion Embodied scarcity links food insecurity to women’s mental distress by showing how deprivation is internalized through bodies, emotions, caregiving identities, and social relations. Multilevel interventions should integrate livelihood support, food security programs, gender-transformative approaches, shared caregiving, and community-based mental health care in environmentally vulnerable settings.
In contemporary Western psychiatry, the paradigm of recovery has become a dominant framework, shaping both therapeutic practice and the architectural design of inpatient facilities. Recovery-oriented approaches emphasize hope, autonomy, and individualized pathways to wellbeing. However, translating these ideals into acute psychiatric settings remains challenging, as coercion, containment, and crisis management continue to structure everyday life on inpatient wards. This paper examines how acute distress is managed within a psychiatric hospital in Denmark designed to support recovery. Drawing on 200 h of ethnographic fieldwork (June 2016-August 2017) observing interactions between staff and patients in inpatient spaces, we show how episodes of acute distress become critical moments in which care practices, spatial arrangements, and clinical understandings are reconfigured. Drawing on Science and Technology Studies, we analyze how responses to acute distress unfold through coordinated movements of bodies, objects and spaces. We identify three forms of movement: (i) calibrated circulation, (ii) reactive reconfiguration, and (iii) recursive reorientation. We conceptualize these movements as enacting choreographies of care and restraint through which seemingly incompatible logics of care and coercion are enacted and held together in the situated management of acute distress. Extending existing discussions of choreographies of care, the paper contributes to debates on the possibilities and limits of recovery in inpatient psychiatry by demonstrating how such tensions are managed rather than resolved, as recovery ideals are continuously negotiated, displaced, or sidelined in everyday institutional practice.
In 2025, the European Union (EU) adopted the European Health Data Space Regulation (EHDS)-a new legal framework for health data. Beyond enabling patient-level and cross-border access to health data for medical care, the EHDS also establishes infrastructures and governance mechanisms oriented to promoting health data reuse by a broader range of actors, including policymakers and industry. A growing literature base suggests that the EHDS involves highly controversial elements, yet it received little attention during its development period. In this article, we examine what makes the EHDS absent in some places and present in others. We engage with perspectives from Science and Technology Studies to reflect on the concept of absence, including the basis for making claims about a particular policy initiative not receiving adequate attention. We do so from a cross-European perspective informed by interviews (N = 27) with participants across 10 European countries, participant observation, and analysis of media coverage in four EU member states. We suggest understanding how a policy initiative can be present in some places and absent in others through four kinds of 'distance': temporal, experiential, affective, and scalar. Approaching absence as a social achievement rather than a non-event points to potential avenues through which scholars and others might intervene.
Population health research involves multiple disciplines including epidemiology, economics, biostatistics, health promotion, and social sciences. Disciplinary differences are widely acknowledged but rarely analysed, leaving the nature and source of interdisciplinary tension underspecified. Drawing on the concept of epistemic cultures and interviews with 45 international researchers sampled from a bibliometric network of health equity scholars, I investigate whether distinct epistemic cultures exist within population health research, and identify specific features underpinning reported interdisciplinary tensions. Analysis identified four distinct knowledge types: knowledge about society, knowledge about disease, knowledge about behaviour, and knowledge about how to get knowledge (‘negative knowledge’). These were associated with particular epistemic virtues, conceptualisations of health, and long-term goals. Three corresponded with epistemological styles previously described by Lamont; the fourth, directed at the apparatus of inquiry itself, fell outside this framework. What interviewees described as 'disciplinary differences' comprised a connected set of tensions across knowledge types, classification strengths, collection codes, and tolerance for complexity. Evaluative terms such as 'new', 'useful', and 'progress' did not carry consistent meanings across cultures, contributing to frustration and misrecognition in interdisciplinary collaboration. Written academic genres were a significant source of tension, reflecting the ways journals embed and reproduce disciplinary norms. The epistemic cultures identified were not independent: epidemiology's paradigmatic dominance exerts normative force, shaping the questions researchers ask and the form of acceptable answers. These differences have substance — they are specifiable, empirically grounded, and analytically decomposable — and they have consequences, for the questions researchers ask, the knowledge they produce, and their capacity to collaborate.
Hospitals can play a key role in identifying and treating substance use disorders (SUD), and a process known as Screening, Brief Intervention, and Referral to Treatment (SBIRT) exists to assist with this process. However, SBIRT is often implemented in ways that minimize disruption to operational workflows; screening is performed but not referral to treatment. This pattern of hospital practices aligns with and may be indicative of "decoupling," the symbolic adoption of new practices in suboptimal ways to comply with legitimacy pressures. This study seeks to investigate whether hospital characteristics consistent with those theorized to relate to decoupling are linked with incomplete SBIRT implementation, as viewing SBIRT through this lens may provide new insights into hospital systems and practices that contribute to care gaps. Using the National Survey of Healthcare Organizations and Systems 2017-2018 hospital survey, we regress incomplete implementation (systems for screening but limited referral) on hospital characteristics aligned with those hypothesized to influence two unique types of decoupling: goals-system decoupling (decoupling between an organization's stated goals and the systems designed to implement them) and system-practice decoupling (decoupling between the systems designed to guide daily activities and the activities as practiced). 49.05% of hospitals reported incomplete SBIRT implementation. Having more processes to disseminate best practices was associated with lower prevalence of incomplete implementation (adjusted prevalence ratio (aPR) = 0.91, p = 0.01). A less robust association (i.e., at 0.10 level) was also observed between decentralized decision and incomplete implementation (aPR = 0.81, p = 0.06). The pattern of associations is more consistent with characteristics theorized to relate to system-practice decoupling and suggests that investment in infrastructure to disseminate best practices and, perhaps, autonomy in physician decision making may improve implementation and reduce treatment gaps.
Pharmaceutical supply chain vulnerabilities threaten patient safety, prompting firms to invest in artificial intelligence (AI) to strengthen resilience. Yet AI's resilience benefits may depend on firms' adaptive capabilities and the stressors they confront. Drawing on complex adaptive systems (CAS) theory, this study examines pharmaceutical supply chain resilience (PSCRE) and the conditions under which AI moderates these firm-level associations. We operationalize self-organization through R&D intensity, co-evolution through supply chain relationship stability, and environmental awareness through perceived policy uncertainty. Using panel data from Chinese A-share pharmaceutical manufacturers (2008-2023), we measure the engineering dimension of resilience with the bullwhip effect. The results indicate that R&D intensity and supply chain relationship stability are associated with lower bullwhip effect, whereas perceived policy uncertainty is associated with higher bullwhip effects. AI's moderating role is contingent: it strengthens the negative associations of R&D intensity and supply chain relationship stability with the bullwhip effect but does not reliably attenuate the positive association of perceived policy uncertainty with it. These findings delineate AI's boundary conditions and offer implications for managerial strategy, policy implementation, and medicine supply continuity.
Family involvement is widely recognized as essential to mental health care. Yet, it remains particularly difficult in forensic mental health settings. While existing studies have predominantly examined challenges in family involvement in forensic mental health, little is known about how families assume and embody different roles within this setting. This study explored the lived experiences of family members who had relatives in the Ontario forensic mental health system. Using interpretive phenomenological analysis and leveraging a theoretical framework rooted in the critical work of Jacques Donzelot, we conducted in-depth interviews with 17 family members, 11 of whom were parents, recruited from two forensic mental health hospitals. This article examines a significant phenomenological thread that emerged within the accounts of parents, namely that their child's entry into the forensic mental health system fundamentally transformed their own sense of self. Our findings, presented under three phenomenological streams - (1) It's a barnacle on my back, (2) Removal of iron wings, and (3) From being so involved, to being totally cut out - illustrate how the micropolitics of forensic mental health care transform the identities of family members. We conclude by discussing implications for forensic mental health professionals, emphasizing the need to recognize and support the identity transformations parents undergo when navigating forensic mental health systems.
Urban sanitation is essential for health and well-being, yet provision remains deeply unequal, particularly in informal settlements. This study compares lived sanitation experiences across Nairobi's informal and formal settlements and examines how water insecurity - too much, too little, too dirty water - intersects with sanitation. We combined eight focus group discussions (n = 65 participants) with household surveys (n = 545) to analyse disparities across Human Right to Sanitation (HRtS) normative content dimensions of availability, accessibility, quality, safety, affordability, and acceptability. Nearly all surveyed households in formal settlements have private, sewered facilities, whereas in informal settlements, private toilets are rare, often poorly constructed, shared, and unsafely managed. Low incomes, insecure land tenure, and user fees constrain infrastructure investment and maintenance, further restricting HRtS realisation. Sanitation systems in informal settlements are highly vulnerable to water insecurity, which can compromise waste containment and hygiene, with potential implications for exposure to waterborne diseases. In formal settlements, sewered systems limit disruptions, but water insecurity can compromise sanitation functionality and maintenance, while excess water can trigger sewer overflows and short-term service disruptions. HRtS realisation requires attention to all normative dimensions, integrating resilient infrastructure, safe faecal waste management, participatory governance, and community involvement, with attention to vulnerable groups, including women, children, and low-income households. Climate-resilient, systems-oriented approaches are essential to prevent faecal contamination, maintain service continuity, and support equitable health outcomes. By highlighting interactions between sanitation and water insecurity, this study provides actionable insights for designing urban sanitation systems that safeguard human rights, health, and dignity in rapidly urbanising cities.
This article draws attention to Do-It-Yourself (DIY) global health, a concept that highlights global health activities that are unmoored from organizational structures and accountabilities typically constraining global health work. I use this conceptual orientation to examine short-term medical missions (STMMs), where clinicians briefly travel from the global North to the South to volunteer in pop-up clinics. I draw on theoretical frameworks that bring to the fore how privileged social positions in global hierarchies enable volunteers in DIY global health to evaluate their actions based on their intent rather than on outcomes. Drawing on ethnographic research in Guatemala (2000-2014), I analyze how the combination of privilege + informality characterizing DIY global health has created foundational ideologies driving STMMs: that people attending STMMs lack access to care; that the impact of STMMs is immediately evident; and that saving just one life makes everything worthwhile. These enable volunteers to judge success via intent/feelings, not outcomes, creating a self-perpetuating cycle where fulfilling experiences convince volunteers of impact and spur recruitment, while harms remain untracked. Technical reforms (e.g., partnerships, best practices) fall short of addressing deficits of DIY global health, because problems are ideological, not technical. Privilege insulates volunteers from reckoning with claims that lack evidence, making DIY global health appear morally self-evident despite the clear absence of accountability. Recognizing DIY global health reveals why reformist approaches cannot resolve the foundational flaws inherent to this set of practices.
BACKGROUND:Household food insecurity (HFI) is a critical social determinant of health that can adversely influence cancer prevention, treatment, and survivorship, while a cancer diagnosis with its financial and functional consequences may also increase the risk of HFI. This study aimed to examine the associations between HFI and cancer-related outcomes. METHODS:A systematic search was done in PubMed, Embase, Scopus, Web of Science, and Cochrane Library until July 29, 2025. Eligible studies were observational in adults (≥18 years) evaluating the associations between HFI and cancer outcomes, with effects operating in both directions. The quality assessment was done using the Newcastle-Ottawa Scale. Pooled relative effect estimate with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup, sensitivity, and publication bias analyses were performed, and the certainty of evidence was assessed using GRADE tool. RESULTS:Forty-four studies (n = 1,135,888 adults) from high- (United States) and middle-income (Iran and Brazil) countries met inclusion criteria. Meta-analysis of six studies (509,291 participants; nine effect sizes) showed that HFI was significantly associated with lower cancer screening uptake (pooled relative effect estimate = 0.91; 95% CI: 0.87, 0.96; I2 = 78.8%; p < 0.001). Subgroup analyses demonstrated significant associations for both colorectal cancer screening (pooled relative effect estimate = 0.83; 95% CI: 0.70, 0.98; I2 = 72.9%; p = 0.025) and breast cancer screening (pooled relative effect estimate = 0.72; 95% CI: 0.54, 0.96; I2 = 85.9%; p = 0.026). HFI prevalence reported in the included studies among cancer patients ranged from 14% to 78%, with highest rates in low-income clinical sub-populations. HFI predicted worse treatment outcomes, including higher surgical complications, longer hospital stays, increased mortality, and lower quality of life. Among cancer survivors, HFI was associated with poor diet quality, treatment non-adherence, psychosocial distress, and increased all-cause and cancer-specific mortality. CONCLUSIONS:HFI can act as a barrier to cancer screening, treatment adherence, and survivorship, thereby contributing to inequities in cancer outcomes. Integrating HFI screening and nutrition support into the continuum of oncological care, alongside the implementation of equity-driven policies, will be important to addressing survival rates and enhance the quality of life for vulnerable populations.
Capacity building dimensions of Traditional Chinese Medicine (TCM) internationalization remain theoretically underdeveloped. This conceptual analysis introduces capacity building theory from development studies into TCM cooperation research, comparing the United Arab Emirates (UAE) and Saudi Arabia under a most-similar-systems design across five capacity dimensions: institutional, talent, technological, industrial, and discourse. Both countries regulate traditional medicine, but their frameworks differ in kind rather than in scale. UAE licensing is administered at emirate level and accords TCM integrated-whole status alongside two other codified ethnomedical systems federally and in Dubai, and four others in Abu Dhabi, whereas Saudi Arabia licenses acupuncture as a discrete practice and accords that status to no codified system. Abu Dhabi licenses acupuncture separately as well, so whole-system recognition and practice-level licensing are not alternatives; the two countries differ in the presence of the former. Neither has developed commensurate capacity in local education, research infrastructure, or comparative scholarship. The broader recognition accorded in the UAE has not produced proportionately greater capacity elsewhere, which indicates that statutory recognition of traditional medicine practice is a necessary but insufficient condition for comprehensive capacity building. The analysis contributes to South-South cooperation literature by showing what capacity building theory brings into view that output-oriented assessment obscures, and identifies the structural dominance of biomedicine as a constraint across all five dimensions. Sustainable capacity outcomes require cooperation frameworks prioritising education system development and knowledge transfer, an emphasis consistent with the WHO Global Traditional Medicine Strategy 2025-2034.
The emergence of zoonotic diseases is increasingly recognized as a critical global health threat, especially in rural Southeast Asia experiencing rapid socio-demographic and environmental changes. However, the socio-material and economic dimensions influencing spillover risks remain poorly understood by institutional health frameworks. This ethnographic study examines how economic precarity, environmental degradation, and inadequate veterinary services shape human-animal relations and animal health practices in three rural communities of Battambang province in Cambodia. Based on ethnographic observations and 60 interviews (55 respondents) conducted between December 2023 and July 2025, we document how farmers rationally navigate animal husbandry and disease management within structural constraints that limit their options. Rather than viewing these practices as cultural barriers to disease prevention, we highlight how they represent adaptive responses to poverty, service gaps, and ecological stress. We analyze how dead animal commerce functions as both an informal economic safety net and an unregulated disease exposure pathway. This analysis provides anthropological knowledge - processual, relational, and embodied - revealing the situated complexity through which animal health risks emerge and are managed in practice. We argue that effective interventions must address the economic and environmental drivers of risk while partnering with local community knowledge rather than attempting to replace it.
Communication is essential to understanding the ways in which inequities occur in complex interaction-driven institutions. However, efforts to address disparities in healthcare communication overwhelmingly focus on interventions that address individual behavior. In-depth observation and interviews with physicians and patients' family members at four different hospitals' medical intensive care units (ICUs) demonstrated that structural elements, including the built environment, physician staffing, and the organization of care, contributed to institutional variation in communication and decision-making about life-sustaining treatments in medical ICUs. Structural elements combined to create emergent harms, resulting in collective inequity between the demographically distinct patient populations served at different institutions. I argue that well-intentioned and even effective interventions to address individual behavior are unlikely to address collective inequities and that addressing structural elements is essential to alleviating disparities in communication and decision-making and outcomes resulting from these interactions.
BACKGROUND:Previous research has suggested that early-life education can help build cognitive reserve, providing resilience against late-life cognitive decline. The research on education and late-life cognitive health, however, has focused more on developed nations and higher levels of education. This research examines the effects of an elementary school policy on literacy, education, and late-life cognitive health. METHODS:We analyzed, through a shift-share instrumental variable approach, the causal effect on late-life cognitive health of an exogenous policy change that introduced free and mandatory textbooks in 1960 for elementary schools in Mexico. This change essentially made elementary school attendance universal. For our analysis, we used the Mexican Health and Aging Study (MHAS) and Census datasets linked to 1960 literacy rates for cohorts born between 1930 and 1965. The MHAS and Censuses include data on literacy and early-life education. The MHAS additionally includes data on late-life cognitive engagement and functioning. RESULTS:We found that the textbook program increased literacy, years of education, and late-life cognitive engagement. We found improvements in cognition for those with lower early-life socioeconomic status. CONCLUSIONS:There is scarce literature analyzing the causal effect of literacy and early-life education policies in developing countries on late-life cognitive engagement and functioning. Our results, particularly for the most vulnerable populations, suggest that elementary educational policies in low- and middle-income countries can boost cognitive engagement and function in late life.
BACKGROUND:Bullying is a major public health concern among adolescents. Ecological frameworks suggest that bullying is shaped not only by individual characteristics but also by broader school, institutional, and macro-level contexts. We examined whether country-level between-school socioeconomic segregation helps explain differences in bullying perpetration and victimization. METHODS:We analyzed nationally representative data from 101,287 adolescents aged 11-15 years in 21 countries and regions across Europe and Canada participating in the 2017-2018 Health Behaviour in School-aged Children study. Between-school socioeconomic segregation was measured at the country level using the bias-adjusted Duncan dissimilarity index based on family socioeconomic position. Multilevel logistic regression models examined associations with bullying perpetration and victimization, adjusting for individual characteristics, GDP per capita, and Gini index. RESULTS:Each one percentage-point increase in between-school socioeconomic segregation was significantly associated with 5-6% higher odds of bullying perpetration (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.03-1.07) and victimization (OR = 1.06, 95% CI = 1.04-1.09). Segregation accounted for roughly half of the between-country variation in bullying perpetration (49.6%) and victimization (56.3%), although the absolute magnitudes were modest. However, it did not significantly modify socioeconomic differences in these behaviors (P-interaction > 0.05). CONCLUSIONS:Between-school socioeconomic segregation is an important contextual factor associated with adolescent bullying. Because the association between segregation and bullying was observed across the socioeconomic spectrum, policy responses should, in addition to targeting disadvantaged groups, be more universal and structural. Reducing socioeconomic segregation between schools may promote more socially cohesive educational environments and help reduce bullying.
