This article examines the ethical and psychological consequences of Medicaid funding cuts through the integrated framework of hermeneutic medicine, Jewish mystical theology, and liberation medicine. Drawing on the kabbalistic concept of shevirat ha-kelim (shattering of the vessels), the dialectic of tzimtzum (divine contraction) and Shekhinah consciousness, and the author's published work on therapeutic presence and sacred listening, this study argues that contemporary healthcare policy represents not merely fiscal reallocation but a profound ontological rupture in the covenant between society and its most vulnerable members. The displacement of millions from continuous primary care relationships constitutes what we term a 'therapeutic exile'—a systematic displacement of patients from sacred healing spaces into the fragmented, episodic realm of emergency medicine. This exile generates cascading psychological trauma: the erosion of narrative continuity, the pathologization of poverty, the internalization of systemic abandonment, and the moral injury inflicted upon clinicians who witness but cannot prevent the suffering of the uninsured. Through synthesis of clinical experience, contemporary phenomenology, and ancient wisdom traditions, this article proposes a reconceptualization of healthcare access as a moral-theological imperative and offers frameworks for clinician resilience and advocacy grounded in the understanding that authentic healing emerges only where sacred presence meets human vulnerability.
Background: Telemedicine in Egypt has shown sustainability while opening a way for more engagement in healthcare. This systematic review examines the use of telemedicine and its impact on Egyptians, focusing on the limited internet accessibility in Egypt. Methods: An exhaustive search was conducted in the PubMed, MEDLINE, Scopus, Web of Science, and EMBASE databases, specifically in the years 2015–2024, to obtain valid articles. Studies were investigated within the framework of pre-designed inclusion criteria, which helped in the identification of 10 articles specific to the report. The JBI checklist was explored to improve the performance of these studies, and narrative synthesis was employed to compile the findings in textual form. Results: The analysis identified five main themes: telemedicine knowledge and attitudes, usage by the public and healthcare practitioners, implementation barriers, impact on patient care, and community led monitoring. Despite the Egyptian community having positive attitudes towards telemedicine, barriers such as technology limitations, data privacy concerns, and reliance on physical wards for diagnosis remain. Private hospitals are more equipped than government facilities, affecting implementation. While challenges exist, telemedicine has the potential to improve patient care by increasing convenience and reducing wait times. Conclusion: Telemedicine can enhance healthcare in Egypt by improving access and patient outcomes. However, success depends on overcoming obstacles such as policy development and institutional capacity. Policymakers must create governance standards, invest in infrastructure, and improve training.
Commercial sex work, while providing a source of livelihood and sexual gratification for those who engage in it, has significant negative impacts on public health. These impacts include increased vulnerability to sexually transmitted infections (STIs), unintended pregnancies, and broader health risks. Although factors such as poverty, peer pressure, and unemployment drive individuals into sex work in most parts of the world, including Nigeria, this practice remains illegal in Nigeria and many other countries globally. Therefore, understanding and designing appropriate interventional strategies, including job creation, skill acquisition programs, and widespread health education and awareness campaigns, will be useful in addressing this public health issue. These measures can contribute significantly to improving a country’s health indices and reducing the negative impact of commercial sex work on public health.
Borderline Personality Disorder (BPD) is a serious mental illness characterized by a chronic pattern of instability in interpersonal relationships and self-image, along with a higher baseline of emotional sensitivity and marked impulsivity that begins by early adulthood and persists regardless of context. Emotion dysregulation, a cardinal feature of the disorder, is of high relevance to clinical and medical contexts since it has been correlated with greater risk of parasuicidal behaviors, co-occurring psychiatric illnesses and multiple hospitalizations. Less understood is the role of emotion dysregulation on somatization and medical comorbidity. Physiological correlates of emotion dysregulation, such as decreased heart rate variability (HRV) and cascades of pro-inflammatory cytokines associated to dysphoric mood can increase the risk of medical comorbidity in the BPD population. This mini review assesses and discusses how maladaptive emotion regulation strategies, such as emotional suppression, and BPD-endogenous traits like attachment-seeking behavior can potentiate detrimental health outcomes through physiological correlates and medical self-harm. Future research directions should assess the role of emotional suppression in somatization and medical comorbidity in both sociodemographic and medically diverse BPD populations. In the clinical setting, encouraging reappraisal instead of emotional suppression can help improve treatment outcomes in both psychiatric and medical domains.
The screening of sleep disorders and obstructive sleep apnea syndrome should be performed routinely in many patients, particularly in high-risk populations. The aim of this study was to evaluate sleep disorders and the determinants of high risk of obstructive sleep apnea among diabetics. Methodology: This was a cross-sectional study which was conducted between March to August 2022 in state health structures in the Mopti region of Mali. This study included diabetic patients aged 18 and above who gave their consent to participate in the study. A standardized questionnaire containing both Berlin self-questionnaires was used for data collection. Results: A total of 289 patients participated in the study. The mean age was 51.59 ± 11.39 years. Among the participants, 66.9% were Type 2 diabetics, 70.9% were women. The body mass index average was 27.62 ± 4.26 kg/m2. The mean of sleep duration was 5.76 ± 1.43 hours per day. The majority of participants (92.4%) had high risk of obstructive sleep apnea syndrome. The variables statistically associated with the dependent variables (OSAS) were: high blood pressure (OR =52.4; 95% CI: [6.3 - 40.3]); non-smoking status (OR=0.04; 95% CI: [0.03 - 0.7]) and the body mass index ≥ 25 (OR=3; 95% CI: [3.1 - 14.9]). Conclusion: This study reveals a high frequency of sleep disorders among diabetics in the Mopti region. It would be necessary to conduct a national study to better estimate the prevalence of this pathology in order to implement effective control strategies.
