The stay-at-home orders, lockdowns, and states of emergency of the Coronavirus Infectious Disease emerged in 2019 (COVID-19) pandemic have affected the mental health of school-aged children. Previous reports of psychological distress in adolescents during the pandemic have been mixed, however, with some reports showing increases in psychological distress and others suggesting decreases. To accurately assess the impact of the pandemic, we need to be able to compare psychological assessments longitudinally, both before and during the pandemic. However, current statistical methods have limitations for reconstructing the complex trajectory of psychological states as captured by short-item questionnaires. In this study, we analyzed monthly Kessler 6-item Psychological Distress Scale (K6) questionnaire responses collected from 16- to 18-year-old high school students participating in the population-neuroscience Tokyo TEEN Cohort (pn-TTC) in Japan (1,278 responses from 84 participants). Participants included 42 males and 42 females. The pn-TTC is a population-based longitudinal study conducted in Tokyo, Japan that follows children to investigate their developmental and mental health trajectories. In addition to conventional statistical approaches that summarize multiple questionnaire items into a composite score, we applied "energy landscape analysis," a method derived from statistical physics that models multivariate psychological states as a dynamic system of interactions among K6 questionnaire items, to visualize longitudinal changes in psychological distress before and during the COVID-19 pandemic (July 2019 to September 2021). Here, we define the depressive and healthy states as configurations in which all six K6 items are above or below each participant's individual mean, respectively. Before the pandemic, the healthy state occurred 11.0 times as frequently as the depressive state. In contrast, during the pandemic, the relative frequency of the healthy state increased to 18.2, 18.5, and 15.0 times that of the depressive state, respectively. The evolving energy landscape revealed an association between the pandemic period and a lower likelihood of being in a depressive state. We also identified two groups of students with different K6 dynamics and energy landscapes. The first group consisted of 61 participants whose total K6 score was relatively low (less than 5) and stable over time, and the second group consisted of 23 participants whose total K6 score was higher (with most being higher than 5) and less stable. The latter group showed a greater change in cortical thickness in the caudal part of the middle frontal gyrus (cMFG) (t-statistic = -2.36, p-value = 0.019, q-value = 0.048) and the temporal pole (TP) (t = 3.08, p = 0.0023, q = 0.012), as measured by magnetic resonance imaging, in the direction of accelerated adolescent brain development. Because all participants lived in Tokyo, generalizability remains limited, and as the association between psychological states and brain development is descriptive, future studies in diverse cohorts are needed to examine causality. By revealing associations between the COVID-19 pandemic and lower levels of psychological distress and healthier mental health states, our work demonstrates the potential of using dynamical systems theory, such as the energy landscape analysis, to interpret health and disease metrics in psychology and psychiatry. This approach may improve mental health surveillance for the next pandemic.
Nancy Scheper-Hughes's and Margaret Lock's (1987) article on the "the mindful body," in which they introduce their framework of three interconnected bodies (individual, social, and the body politic), has shaped debates in medical anthropology over the last three decades and, as Yates-Doerr (2017: 142) puts it, represented "a zeitgeist for the field" (italics in original). Scheper-Hughes's related, but more politicized idea of the "rebel body," however-which she sketches in the following reprint-has not yet entered mainstream debates.Originally published only in print in the Traditional Acupuncture Society Journal (Scheper-Hughes, 1991), the article conceptualizes the rebel body as one that "refuse[s] the demand to suffer quietly" and thereby reveals and challenges political etiologies of illness. We discovered the article in our preparation of the special issue (see Führer and Vorhölter, 2025) and found it to be extremely valuable for our reflections on liberation medicine-and surprisingly timely. The article offers a compelling analysis of the political causes and potentials of illness, of pain and its demand for recognition, and of the power of refusal. While some of these themes have since been prominently discussed in more recent scholarship (see e.g., Buchbinder, 2015; Hamdy, 2008; Rose Hunt, 2016; McGranahan, 2016; Simpson, 2014), the conceptualization of the rebel body remains provocative and relevant to contemporary debates in and on medicine. By republishing this article here, we hope to make it accessible to a new generation of scholars, practitioners, patients, and activists and hereby further their aspirations toward an understanding of medicine as a form of everyday resistance.The article begins with a survey of anthropological understandings of and debates on the body, embodiment, and somatization. Based on her own fieldwork in North-Western Brazil, and using the framework of the "three bodies," Scheper-Hughes reflects on the interrelations between the individual body, the social body, and the body politic. Through a reworking of established notions of illness, suffering, and healing, she proposes to understand illness as a form of bodily praxis that can be read as an expression of protest and rebellion to unequal and unjust social and political orders. Thus read, the moment of illness carries the potential for radical reflection and subsequent action, which medicine as well as society can either mute through biomedical cooptation or respond to with engagement in political therapy.We are republishing the article with the kind permission of the British Acupuncture Council. The text has been lightly edited and this introductory note/abstract has been added by Amand-Gabriel Führer and Julia Vorhölter. We have added references that were missing in the original article and have removed those that were not mentioned in the text. Furthermore, we have included the works that we cite in this introductory note/abstract in the reference section. The article in the present form is reprinted with the permission of the author.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Medical assistance in dying (MAiD) became a legal end-of-life option on December 10, 2015, in Québec, and on June 17, 2016, in the rest of Canada. Since its legalization, there has been a steady increase in the number of MAiD requests and provisions. Across permissive jurisdictions, Québec now has the highest rate of assisted death. Despite the growing use of MAiD, research examining the factors driving this increase remains limited and fragmented. Existing studies offer partial and sometimes contradictory explanations, with little integration of legal, institutional, societal, and individual dimensions. Further research is needed to better understand the determinants of MAiD requests and practices, particularly in the Canadian and Québec contexts. This research aims to understand the factors influencing changes in MAiD requests and administrations in Québec by examining laws, practices, societal perspectives, organization of care and services, and individual characteristics of those requesting MAiD, as well as their interrelationships. We present the protocol developed by the Consortium interdisciplinaire de recherche sur l'aide médicale à mourir, an interdisciplinary research consortium, including an international advisory committee, set up for this research. The design of this protocol is multimethods and convergent mixed methods, including (1) an international cross-thematical approach with 4 main research methods (a scoping review, key informant interviews, focus groups with health care professionals, and a population-based survey) chosen to partially answer research questions across the entire study and to compare with other jurisdictions and (2) 11 theme-specific methods (including community forums, media coverage analysis, comparative legal analyses, case studies of triads, individual interviews, and system mapping) to enrich and complement findings from the cross-thematical approach. When this 3-year funded study started in July 2024, several research methods not requiring ethics committee approval (because no human participants were involved) were initiated, including scoping and systematic reviews, media coverage analysis, and comparative legal analyses. By August 2025, interviews with key informants were completed, and analyses took place in September. Concurrently, other subteams started data collection (focus groups December 2025) or are getting ready to seek ethics approval for their protocols and data collection processes involving human participants: case studies of triads, individual interviews, and community forums. Findings from the international cross-thematical approach and theme-specific methods will provide a comprehensive understanding of the factors influencing the use of MAiD in Québec. This study has strengths, including the use of a specific theoretical framework, a variety of complementary methods, and an integrated knowledge mobilization strategy. As for its limitations, we foresee challenges with the comparison of jurisdictions in terms of language, culture, and legal systems, as well as access to data about MAiD cases, since reporting systems may differ between jurisdictions. DERR1-10.2196/83549.
Psychedelic medicine is a rapidly growing, billion-dollar industry poised to transform mental health care by incorporating spiritual experiences into clinical psychiatry. However, while the blending of psychiatry and mystical experience has long made this field unique, the blurred boundaries between science and spiritual practice have sparked increasing public debate. What does the entanglement of science and religion in psychedelic medicine reveal about the concerns, anxieties, and yearnings of our contemporary social and political moment? This article draws on an analysis of public discourse alongside ethnographic and qualitative research within a psychedelic church, a psychedelic-assisted therapy training program, and psychedelic science conferences in the United States. Through stories of the intertwining of science and religion, psychotherapy and mysticism, and attempts to distinguish between drugs, medicine, and sacraments in both clinical and non-clinical spaces, I argue that the mainstreaming of psychedelic medicine is not only shifting paradigms of mental health care but also creating new forms of secular mysticism in an age of disenchantment.
To identify priority domains that influence healthcare provider sedation practices and to describe key sedation protocol elements reported by participants that serve as facilitators and barriers to sedation practice change. We conducted qualitative individual semi-structured interviews with critical care healthcare providers, including physicians/nurse practitioners, nurses, pharmacists, respiratory therapists, and physiotherapists, to understand sedation practices and define key factors that limit the opportunity for optimization of ICU sedation practices. We analyzed responses with deductive content analysis using the Theoretical Domains Framework (TDF) to identify priority domains related to sedation practices and describe constructs within the priority domains. We conducted 29 semi-structured interviews virtually from April 29 to December 10, 2024, consisting of 12 physicians/nurse practitioners, 5 respiratory therapists, 8 nurses, 3 pharmacists, and 1 physiotherapist. We identified seven priority TDF domains across healthcare provider groups including: Beliefs about consequences, Beliefs about capabilities, Reinforcement, Memory, attention, and decision processes, Environmental context and resources, Social influence, and Social/professional roles. Participants reported sedation use for multiple purposes including patient and staff safety, unit culture, and to address environmental and organizational challenges (e.g., patient care efficiency). Participants reported several recommendations for optimizing sedation delivery including available nursing-driven sedation protocols for specific patient populations (e.g., alcohol withdrawal) and specific sedation weaning recommendations. Critical care healthcare providers identified several domains relevant to sedation practices, underpinned by patient and staff safety, key patient-specific factors, and socioenvironmental factors. In understanding priority domains and underlying factors that influence sedation practice, implementation strategies using protocol-driven sedation as a tool to improve guideline adherence should be designed targeting the identified priority domains and underlying driving factors. Protocol-driven sedation strategies are more likely to succeed when interventions intentionally address the priority domains and driving factors that influence adherence to clinical practice guidelines during implementation processes.
Equity, diversity, and inclusion (EDI) initiatives are politically polarizing and increasingly adopted in the health care setting. Their broader impact across different health care career types, career stages, and various levels of education remains largely unknown. To assess EDI programs and their associated outcomes within health care institutions. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review searching PubMed, Scopus, Web of Science, CINAHL, and PsychINFO databases from January 2010 to December 2023. Two independent reviewers screened studies that assessed EDI programs or policies in health care institutions. Programs were categorized based on reported outcomes, including participant satisfaction, increased awareness of EDI-related topics, increases in the proportion of underrepresented minority individuals within medical education or the health care workforce, and overall program impact. Odds ratios (ORs) were pooled using a random-effects model. Analyses followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Analysis was conducted June 2025. Outcome measures included the proportion of diversity among the workforce, employee and patient satisfaction, and the proportion of employees recruited and retained after program implementation. In total, 43 studies incorporating more than 15 000 individuals involved in EDI programs were included. Interventions were multifaceted, including 14 career advancement and training programs, 16 diversity representation programs, 11 academia and research support initiatives, and the growth of 2 pipeline programs. Furthermore, interventions demonstrated consistent improvement in EDI initiatives, with perceived benefit in promoting underrepresented minority populations. Findings from the meta-analysis of 2 studies showed that minority representation in competitive medical residencies increased after implementation of 2 EDI interventions (OR, 1.73; 95% CI, 1.21-2.47). Among the 43 studies included in the Joanna Briggs Institute assessment of methodological quality, 7 (16.3%) were rated as high quality, 20 (46.5%) as moderate quality, and 16 (37.2%) as low quality. In this systematic review and meta-analysis of EDI initiatives in health care institutions, programs were associated with an increased workforce diversity. These findings support the continued use of EDI initiatives to promote a more inclusive and equitable health care culture.
Antipsychotic medications remain widely used in nursing homes (NHs) despite guidelines discouraging potentially inappropriate use. While home-level variation is known, less is understood at the unit and organization levels, or across other psychotropic and non-psychotropic drugs. We examined prescribing variation across NHs in Ontario, Canada. We examined prescribing variation for psychotropic and non-psychotropic drugs across NH units, homes, and organizations in Ontario, Canada. We conducted a retrospective cohort study of NH residents using EMR data from April 1, 2022, to March 31, 2023. Outcomes included whether residents were prescribed any antipsychotic, antidepressant, statins, cardiovascular disease (CVD) medications, and trazodone for at least 1 day during the follow-up period. Multi-level logistic regression models adjusted for resident characteristics and included random intercepts for units, homes, and organizations. Among 16,896 NH residents across 179 homes and five organizations, 39% were prescribed antipsychotics, 65.5% antidepressants, 33% statins, 65% CVD medications, and 38% trazodone. Substantial variation was observed across all medications. For antipsychotics, the home-level median odds ratio (MOR) was 1.65 (95% CrI: 1.52-1.78) and unit-level MOR was 1.24 (95% CrI: 1.10-1.33). Trazodone exhibited the highest variation (home-level MOR: 2.06, 95% CrI 1.75-2.37; unit-level MOR: 1.87, 95% CrI 1.76-1.97). No significant variation was found at the organization level. Resident characteristics, like aggression and dementia, were associated with prescribing but did not explain unit and home-level differences. Prescribing variation extends beyond antipsychotics to other common pharmacotherapies. Unit-level variation reveals additional unexplained variation not captured in previous home-level studies, providing new targets for research and quality improvement interventions. Future research should explore potential unit- and home-level contributors, such as staffing, practice culture, clinician decision-making, and policies.
Problematic usage of the internet (PUI) is a growing global concern, emerging among more than 5.3 billion people who use the internet worldwide. While specific forms such as online gaming and gambling are recognized as disorders or conditions for further study in diagnostic manuals, global data on prevalence, treatment, and health responses to PUI remain limited. This study aimed to obtain perspectives from representatives of addiction medicine/psychiatry societies regarding the scope, treatment, and health responses to PUI and identify gaps. A global survey was conducted through the International Society of Addiction Medicine's Global Expert Network (ISAM-GEN), involving addiction societies from 38 countries across Europe, Asia/Oceania, the Americas, and Africa. The survey assessed responses to non-specific PUI and five subtypes: online gaming, gambling, pornography, social media, and online shopping. It included case scenarios and questions on the significance and severity of PUI, and country-level health responses. Online gambling (94.8%) and gaming (86.9%) were the most frequently reported PUI forms, followed by social media (84.2%), pornography (68.3%), and online shopping (52.6%). Psychotherapeutic approaches, particularly cognitive behavioral therapy, were the most widely available treatments, reported as accessible by over 70% of country respondents. Despite growing awareness-reflected in the formation of PUI interest groups in 44.7% of societies-gaps were reported, including lack of professional certification (78.9%), insufficient practitioner education (68.4%), and inadequate expert training (63.2%). Notably, 65.8% rated the 10-year severity of PUI as extremely or very important. Global attention to PUI is increasing, but more robust healthcare responses are needed. Addressing existing gaps requires enhanced training and sustainable international efforts.
Algeria's mental health system still bears the scars of a colonial asylum regime that delegitimized indigenous cosmologies and ruptured ties among self, family, community, and the sacred. Drawing on psychological, anthropological, historical, and Islamic literatures, this article reframes those ties as a relational nucleus composed of three interlinked processes: persistent colonial mistrust, the level of dialogical safety that clinicians and communities can co-create, and the degree of spiritual consonance between therapeutic methods and local moral worlds. This article proposes an integrative framework that partners evidence-based psychology with Qur'anic ethics, Amazigh and maraboutic healing, and legal safeguards for patient rights. By rooting assessment and intervention in the relational nucleus, the model aims to deliver epistemic justice, cultural legitimacy, and clinical efficacy, positioning decolonized mental health care as both a therapeutic and societal imperative in postcolonial Algeria.
This study examines climate change-related emotional responses among young adults engaged in climate activism and an intergenerational group of non-activists through an ecofeminist lens, which highlights interconnected oppression within patriarchal societies. The objectives were to understand how environmental decline influences young adults' climate engagement, thoughts, actions, and behaviors and to describe the emotional and psychological impacts of the climate crisis on both young adults and the intergenerational group. The study comprised two phases: young adult activists created digital stories, and an intergenerational focus group of non-activists viewed these stories and participated in a discussion. Thematic analysis constructed key themes: among activists, youth environmental awareness, psychoterratic syndromes, and activism; among non-activists, climate change perspectives and intergenerational injustice. Both groups expressed concern, anxiety, sadness, and grief, although activists reported experiencing these emotions more frequently and expressed worry about human health. Activists also conveyed hope for climate action, similar to older non-activists, whereas younger non-activists reported feelings of hopelessness and lack of motivation, and older non-activists showed little interest in collective action. Despite emotional burdens, young activists remained hopeful and motivated through collective efforts. Both groups underscored the disproportionate responsibility placed on young people to address climate change, calling for greater support and equitable distribution of responsibility.
Postpartum depression (PPD) is linked to neuroimmune dysregulation. Brexanolone, an intravenous formulation of the neurosteroid allopregnanolone and the first FDA-approved treatment for PPD, produces rapid and sustained antidepressant effects. However, its long-term mechanisms of action remain unclear. This study evaluated brexanolone's prolonged impact on two groups of biomarkers in whole blood: inflammatory mediators and growth/differentiation/neurotrophic factors. Whole blood was also maintained in culture (4 h) and subjected to lipopolysaccharide (LPS) stimulation of the TLR4 inflammatory pathway. Ten individuals with moderate-to-severe PPD received brexanolone and were assessed before, and at 6 h, ~7, and ~30 days post-infusion. BDNF significantly increased and remained elevated through 30 days, representing a sustained neurotrophic response. In contrast, inflammatory mediators CCL11, IL-6, TNF-α, and IL-18 showed rapid reductions by 6 h. TNF-α suppression lasted up to 7 days, while CCL11 and IL-6 remained suppressed through 30 days. These changes were associated with reductions in Hamilton Depression Rating Scale (HAM-D) scores over time. LPS-stimulated whole blood cultures revealed suppression of TLR4-induced CCL11, IL-1β, IL-6, IL-8, IL-18, TNF-α, HMGB1, and MIP-1β at 6 h. IL-8, IL-18, and TNF-α remained suppressed through 7 days, while IL-1β and CCL11 remained suppressed through 30 days, aligning with sustained HAM-D score improvements. Biomarker × time interactions suggested dynamic regulation of inflammatory and neurotrophic pathways. Given the small sample size, these findings should be interpreted as a pilot study, but they indicate that brexanolone promotes both rapid and sustained anti-inflammatory and neurotrophic effects supporting lasting symptom remission in PPD.
Non-suicidal self-injury (NSSI) and gambling are considered notable public health challenges, each linked to emotion dysregulation, impulsivity, and heightened mental health risks. Although examined separately, their co-occurrence may reflect overlapping vulnerabilities. The present study examined the prevalence, correlates, and predictors of NSSI among ndividuals who gamble online and identified distinct behavioral subgroups using latent class analysis. A cross-sectional study was conducted among individuals with past-year online gambling (N = 1047; 50% males; mean age = 39.60 years [SD = 12.46]). Measures included psychometric scales assessing problem-gambling severity, NSSI, impulsivity, sleep difficulties, and psychological distress. Multinomial logistic regressions tested associations between gambling severity and NSSI, and latent class analysis (LCA) was conducted to identify NSSI subgroups. Hierarchical multinomial regressions assessed demographic, gambling-related, and psychological predictors of class membership. Lifetime NSSI was reported by 64% of participants, with higher odds among those with scores reflecting problem gambling. LCA identified three subgroups: low/no self-harming (61.6%), moderate/occasional self-harming (23.2%), and high/multi-method self-harming (15.2%), reflecting stepwise increases in frequency and method diversity. NSSI class membership was significantly associated with problem-gambling severity (χ2[3] = 45.0, p < .001). Younger age, insomnia, impulsivity, and psychological distress predicted higher NSSI class membership, with insomnia and distress emerging as the strongest independent predictors. NSSI is a prevalent and clinically significant correlate of online gambling, emerging even at lower levels of problem-gambling severity, underscoring the importance of integrating emotion regulation and distress-focused support into interventions targeting problem gambling. The study's findings deepen the understanding of psychological pathways linking gambling and self-injury among adults.
The Examining Normative Heterogeneity of Aging and Neurodegeneration in Chinese Elders (ENHANCE) project addresses gaps in Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) research by prioritizing Chinese-speaking communities-an underrepresented but rapidly growing population in the United States (US) and globally. ENHANCE uses a transadaptation approach to develop cognitive assessments that reflect the language and culture of Cantonese and Mandarin speakers, making tools more relevant and appropriate. The project brings together data from older Chinese American participants at University of California San Francisco (UCSF) and Icahn School of Medicine at Mount Sinai (ISMMS), guided by community input and pilot testing results of research instruments. By combining data from ISMMS, UCSF, and the National Alzheimer's Coordinating Center (NACC), ENHANCE explores meaningful cross-cultural differences in AD/ADRD risk and progression. The goal is to improve diagnostic accuracy and representation in AD/ADRD research. ENHANCE helps make AD/ADRD research more responsive to language and cultural backgrounds in the older Chinese American community, supporting the goal of precision medicine in diverse population.
Children of migrants are often exposed to more than one language from an early age. The Avicenne ELAL© test has been created to better assess language skills, avoid misdiagnosing learning disabilities, and inform early interventions. Plurilingual children aged 3.5 to 6.5 take the test in their mother tongues, with an interpreter's assistance. The test comprises three scales: Comprehension, Expression, and Storytelling. The objectives of this study were to describe steps of the transcultural validation of the Avicenne ELAL© for the Soninke culture and language, both for children living in a monolingual environment in Mauritania and for migrant children living in a multilingual environment in France; to compare the performance of these two groups; and to explore its qualitative use in studying language pathways among bilingual and plurilingual children. A total of 71 children participated in this study in Mauritania (n = 25) and France (n = 46). The Avicenne ELAL©, a 30-minute plurilingual language assessment using objects, picture boards, and storytelling tasks, was administered in Soninke (and in French for children in France) to migrant children in France and to children in Mauritania, with standardized procedures to minimize distractions and ensure comfort. All sessions were recorded, de-identified, and supplemented with field notes and a logbook to capture contextual and qualitative elements of children's language use. The results of the two groups of children were analyzed and compared with quantitative and qualitative methods. Given the excellent results of the monolingual children, the ELAL in the Soninke language can be considered valid. Statistical analysis confirmed significant differences between the children's scores in Mauritania and France, for both the total score and each separate scale (Comprehension, Expression, and Storytelling). The results also showed that the quality of the narrative skills (storytelling) was strongly correlated with the child's age. Comparing the language assessments collected in these two settings highlights the variations and cultural specificities that should be considered when studying the language skills of Soninke-speaking migrant children.
This guideline summarizes updated safety data (2017-2025) and provides expert recommendations on the use of low intensity transcranial electrical stimulation (tES) in humans. tES encompasses several techniques including transcranial direct current stimulation (tDCS), oscillatory transcranial direct current stimulation (otDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), transcranial temporal interference stimulation (tTIS), and their combinations or variations. Across over 300,000 sessions involving healthy individuals, patients with neuropsychiatric conditions, and other clinical populations, no tES-related serious adverse events (AEs) have been reported. Moderate AEs are rare and limited to a small range of specific applications. Mild AEs are common and include transient symptoms such as localized sensations (e.g., tingling or burning), headaches, and fatigue. Similar mild AEs are also reported by individuals receiving placebo stimulation. The frequency, magnitude, and type of AEs are comparable across healthy, clinical, and vulnerable groups, including children, elderly, or pregnant women. Combined interventions (e.g., co-application with EEG, TMS, or neuroimaging) have not shown increased safety risks. Safety is well-established for both bipolar and multichannel tES when applied up to 4 mA and up to 60 min per day. Higher intensities and longer stimulation durations may also be safe. Nevertheless, the number of studies using intensities above 4 mA or stimulating longer than 60 min is low. Home-based use of treatments is growing rapidly, leveraging remote supervision to provide patients with greater access and enable repeated, sustained dosing paradigms. We recommend using screening and AE questionnaires in future controlled studies, in particular when planning to extend the stimulation parameters applied. We discuss recent regulatory and ethical issues.
What does it mean to come of age on the spectrum for autistic adolescents and their families? And how might this transitional stage be related to phenomenological questions of dwelling? As part of a broader research project on family life, autism, and coming-of-age in Denmark, this paper explores the case of the autistic adolescent Leo and his family to illuminate how families with autistic adolescents experience and respond to the coming-of-age process. Engaging with perspectives from anthropology of autism, disability, and critical phenomenology including the notion of dwelling, the paper demonstrates how coming-of-age poses pressing demands of (re)imagining, and searching for spaces of belonging and possibilities for becoming in both present and future horizons. These demands are often negotiated and shaped within a world that is dominated by neuronormative and chrononormative expectations, where the dynamics of misfitting are seldom a question of chance. I argue that families like Leo's face not only practical and bureaucratic hurdles related to coming-of-age, but profound existential concerns. They face what I call an intensified dwelling problem of reimagining and searching for ways to feel at home in the world.
Cognitive deficits are common in spinocerebellar ataxia type 3 (SCA3), but their neurobiological correlates remain largely unknown. To investigate cognitive performance in a large international cohort of SCA3 mutation carriers covering the entire disease course and to explore associations with posterior cerebellar volumes, basal ganglia and thalamus volumes, and plasma neurofilament light chain (NfL) concentration. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive impairment in this prospective, observational cohort study involving 13 ataxia referral centers. Standardized motor assessments, brain MR imaging, and peripheral blood biosampling were also performed. MoCA data were collected from 61 pre-ataxic SCA3 mutation carriers, 231 ataxic SCA3 patients, and 111 healthy controls. After adjustments for educational level and age, there were significant differences in MoCA total score, as well as visuospatial/executive, attention, language, and abstraction subscores, between healthy controls and ataxic, but not pre-ataxic individuals. MoCA scores declined with ataxia severity, especially in patients with a lower educational level. Patients with a MoCA score < 26 had lower pallidal volumes and higher plasma NfL concentrations than those with a score ≥ 26. However, only the interaction term between ataxia severity and educational level was independently associated with cognitive performance in multivariable regression analyses containing demographic, clinical, volumetric, and biochemical parameters. Cognitive deficits in SCA3 generally appear after clinical ataxia onset and progress in parallel with ataxia severity, especially in patients with a lower cognitive reserve. Other measured biochemical and imaging parameters did not have a significant additional contribution.
Psychiatry is facing a crisis of credibility, fueled by public disillusionment with inflated claims about the etiological understanding of mental disorders. Overconfident narratives have emerged from a vicious cycle of certainty: psychiatry's desire to be recognized as a "real" medical discipline, the public's longing for clear answers and quick fixes, and the vested interests of the pharmaceutical industry. Breaking this cycle requires that mental health professionals reintroduce uncertainty as a foundational premise and cultivate negative capability, described as the ability to remain comfortable with ambiguity and doubt, both individually and collectively. This shift can be nurtured intellectually through conceptual competence and emotionally through engagement with the arts, particularly literature. Uncertainty invites complexity, offering a richer understanding of the interplay of biological, psychological, and social dimensions of mental health. By learning to tolerate and even value uncertainty, psychiatry can rebuild trust and renew its credibility.
This article examines pharmacological microcontroversies (PMC) surrounding attention deficit hyperactivity disorder (ADHD) in Chile, based on a comparative, multisited ethnography in four educational contexts with differing socioeconomic and territorial profiles. Drawing on science and technology studies, microcontroversies studies, and Norbert Elias's sociology of interdependence, the study conceptualizes ADHD as a situational configuration in which diagnosis and treatment emerge from interwoven relations among children, caregivers, educators, and health professionals. Data were collected through focused ethnography, open interviews, discussion groups, and triangular groups and analyzed via emergent content and sociological discourse analysis. Two axes structure PMC: (i) desired effect-stillness versus performance, and (ii) normative model-external conduct versus internal capacities. Across sites, pharmaceuticals were embedded in distinct "civilizational grammars" linking bodily regulation, moral expectations, and educational aims: from medication as protection against criminality to a "concentration pill" enabling hidden potential. These grammars mediate acceptance, rejection, or ambivalence toward medication crossed by other vectors as class and gender. ADHD-related debates thus constitute territorially situated normative arrangements, revealing how local trajectories and interdependencies shape diagnoses and the production of children's interiority.