搜索结果：Medicine, health care, and philosophy

Tuberous sclerosis complex (TSC) is a rare genetic disorder caused by pathogenic variants in the TSC1 or TSC2 genes. Apart from multisystem physical manifestations, most individuals with TSC experience TSC-associated neuropsychiatric disorders (TAND). Little is known about how TAND severity changes over time and what factors may predict these changes. Preliminary data suggest the presence of differential TAND severity trajectories. Caregiver well-being may act as a mediator of TAND severity, and a well-being intervention designed for caregivers of children with developmental disabilities may improve caregiver well-being. The study aims are to (1) examine longitudinal trajectories of TAND severity in a large sample of individuals with TSC and to examine potential predictors of differential trajectories, (2) evaluate the association between caregiver well-being characteristics, TAND severity, and severity trajectories, and (3) adapt and evaluate the feasibility, acceptability, and potential efficacy of a brief, online group-based well-being intervention for family caregivers. For the first 2 aims, 500 individuals with TSC or their caregivers will be recruited in an accelerated longitudinal design to document TAND severity at 5 time points over 12 months via a web-based app. At each time point, participants will complete demographic, TSC characteristics, intervention, and well-being questionnaires. Data will be analyzed using latent class mixed and multinomial regression modeling (aim 1) and structural equation and mediation modeling (aim 2). Participatory methods will be used to adapt an existing caregiver well-being intervention for the TSC community (aim 3). Thirty caregivers will be invited to participate in the adapted group-based online well-being intervention. This study was funded from July 2024 (HT94252410790 and HT94252410791), and ethics approvals were obtained from the University of Cape Town (July 2024), Vrije Universiteit Brussel (November 2024), and the Department of Defense Office of Human Research Oversight (December 2024). The TAND Toolkit app was adapted for longitudinal data collection (aims 1 and 2). Recruitment started in December 2025 and will continue until 500 participants are enrolled (anticipated December 2026). Primary outputs are expected by July 2028. For aim 3, experiential and adaptation workshops were completed in June 2025, the pilot intervention was delivered in November 2025, and data collection will continue till May 2026. Outputs are expected by December 2026. Identification of differential longitudinal TAND trajectories and their correlates will stimulate research in TSC and generate evidence for the self-report quantified TAND checklist as a clinical outcome measure. Understanding the association between caregiver well-being and TAND severity will provide support for targeted well-being interventions. A successful pilot trial will provide preliminary data for larger-scale clinical trials, with the potential to support caregivers and improve TAND outcomes. Together, the findings from the study will help close the gap in interventions for TAND. ClinicalTrials.gov NCT06879665; https://clinicaltrials.gov/study/NCT06879665. DERR1-10.2196/91726.

Background: More than three decades after the Bosnian war (1992-1995), its psychological consequences persist. While early post-war mental health outcomes have been extensively studied, little is known about the long-term psychological experiences of women who lost multiple family members.Objective: This study aimed to explore the current mental health status and lived psychological consequences of women from Srebrenica and surrounding regions who experienced multiple war-related losses.Methods: Two focus group discussions were conducted with 25 women. Audio-recorded data were transcribed, translated, and analysed using qualitative content analysis to identify central themes and subthemes.Results: Five overarching themes emerged: (1) enduring war trauma, loss, and emotional consequences; (2) justice, institutional responses, and systemic failures; (3) stigma and barriers to mental health care; (4) personal and everyday coping strategies; and (5) external support systems. Participants described persistent traumatic grief, chronic psychological distress, and ongoing somatic and emotional symptoms three decades after the conflict. Narratives revealed diverse coping strategies rooted in meaning-making, work, family, spirituality, and peer support. Institutional neglect, stigma, and limited access to mental health care were identified as major obstacles to recovery, whereas NGO-based and group-based interventions were experienced as particularly valuable.Conclusions: Thirty years after the Bosnian war, women survivors from Srebrenica and surrounding regions continue to live with profound and enduring psychological consequences of trauma and loss. Their narratives highlight the long-term nature of war-related suffering, the central role of social and institutional context, and the importance of culturally embedded, relational forms of support. These findings underscore the need for sustained, survivor-centered, and trauma-informed mental health services in post-conflict settings and contribute to a deeper understanding of long-term female survivor consequences following mass violence. Many women continue to live with the psychological consequences of war-related loss and trauma decades after the conflict.The experience of grief was characterized as unresolved and enduring, influenced by uncertainty and repeated encounters with loss.Women described everyday coping through work, family responsibilities, spirituality, and support from NGOs and peer groups. Antecedentes: Más de tres décadas después de la Guerra de Bosnia (1992–1995), sus secuelas psicológicas continúan siendo evidentes. Si bien las consecuencias tempranas para la salud mental en el período posguerra han sido ampliamente documentadas, las experiencias psicológicas a largo plazo de mujeres que sufrieron la pérdida de múltiples familiares permanecen escasamente comprendidas. Objetivo: Este estudio buscó explorar el estado actual de salud mental y las consecuencias psicológicas vividas por mujeres de Srebrenica y las regiones circundantes que experimentaron pérdidas múltiples relacionadas con la guerra. Métodos: Se llevaron a cabo dos discusiones grupales (grupos focales) con 25 mujeres. Los datos registrados en audio fueron transcritos, traducidos y sometidos a análisis de contenido cualitativo para identificar temas centrales y subtemas. Resultados: Emergieron cinco temas principales: (1) trauma de guerra persistente, pérdida y secuelas emocionales; (2) justicia, respuestas institucionales y fallos sistémicos; (3) estigma y barreras para el acceso a la atención en salud mental; (4) estrategias de afrontamiento personales y cotidianas; y (5) sistemas de apoyo externo. Las participantes describieron duelo traumático persistente, malestar psicológico crónico y sintomatología somática y emocional persistentes tres décadas después del conflicto. Las narrativas revelaron estrategias de afrontamiento diversas, arraigadas en la construcción de sentido, la actividad laboral, los vínculos familiares, la espiritualidad y el apoyo entre pares. La negligencia institucional, el estigma social y el acceso limitado a los servicios de salud mental fueron identificados como obstáculos principales para la recuperación, mientras que las intervenciones basadas en organizaciones no gubernamentales y en formato grupal fueron percibidas como particularmente beneficiosas. Conclusiones: Treinta años después de la Guerra de Bosnia, las mujeres sobrevivientes de Srebrenica y las regiones circundantes continúan viviendo con consecuencias psicológicas profundas y duraderas derivadas del trauma y la pérdida. Sus narrativas subrayan el carácter prolongado del sufrimiento relacionado con la guerra, el papel central del contexto social e institucional en la configuración de las trayectorias de recuperación, y la importancia de las formas de apoyo relacionales y culturalmente situadas. Estos hallazgos destacan la necesidad de servicios de salud mental sostenidos, centrados en los sobrevivientes y orientados por un enfoque informado en trauma en contextos de posguerra, y contribuyen a una comprensión más profunda de las consecuencias psicológicas a largo plazo en mujeres sobrevivientes de violencia masiva.

While intravenous ketamine is not approved by the US Food and Drug Administration, it is increasingly used with off-label indications as a novel treatment for suicidal and depressive symptoms. To systematically review and metasynthesize the efficacy and safety data for intravenous ketamine in treating major depressive episodes (MDEs). PubMed, PsycInfo, Cochrane Library, and Embase were systematically searched from database inception through November 7, 2025, with no language limits. Randomized clinical trials (RCTs) with (1) diagnosis of an MDE; (2) intervention and comparator groups consisting of intravenous ketamine and controls (eg, saline or midazolam); and (3) suicidal and depressive symptoms as efficacy outcomes were included. Hedges g standardized mean differences (SMDs) were used to analyze improvement in suicidal and depressive symptoms using random-effects models. Multiple subgroup analyses were also conducted. The main outcomes included the following: (1) changes in suicidal and depressive symptoms; (2) response and remission rates of depressive symptoms; and (3) safety measures (eg, adverse events and serious adverse events). A total of 26 RCTs comprising 1166 patients with an MDE (n = 626 receiving ketamine and n = 540 as control patients) were included. For suicidal symptoms, patients receiving a single ketamine infusion, compared with control patients, had significantly lower symptoms at 24 hours (SMD, -0.69 [95% CI, -0.98 to -0.40]) and at 1 month (SMD, -0.70 [95% CI, -1.17 to -0.24]). Those with repeated ketamine infusions showed a similar reduction of suicidal symptoms at the end of the treatment (SMD, -0.72 [95% CI, -1.00 to -0.43]). For depressive symptoms, significant reductions were shown at 4 hours (SMD, -1.74 [95% CI, -2.43 to -1.06]), 24 hours (SMD, -1.15 [95% CI, -1.58 to -0.72]), 3 days (SMD, -0.97 [95% CI, -1.73 to -0.20]), and 1 week (SMD, -0.89 [95% CI, -1.65 to -0.13]) after a single ketamine infusion and at the end of the treatment after repeated infusions (SMD, -0.81 [95% CI, -1.16 to -0.46]). Reported serious adverse events (eg, hospitalizations and deaths) were unrelated to the interventions, and other adverse events (eg, headache) were transient and resolved during the trials. The findings of this systematic review and meta-analysis suggest that single and repeated intravenous ketamine infusions are efficacious in reducing suicidal and depressive symptoms in patients with an MDE in the acute phase, while longer-term outcomes are not well established.

This article argues that Plato was a pioneer of the philosophy of health. It examines the psychosomatic interrelationship between soul (psychē) and body (sōma) primarily in the Charmides and the Timaeus, with selective references to other dialogues, notably the Republic and Phaedrus. The central claim is that Plato's account of the psychosomatic interrelationship can be adequately understood only when its sociopolitical dimension is taken into account. Although this emphasis is relatively novel in contemporary scholarship, it was commonplace in Plato's milieu to conceive of human beings as members and citizens of the city-state (polis). The article further argues that Plato's approach to psychosomatic phenomena extends beyond states of pain or disease and instead encompasses a holistic vision of health and human flourishing. Accordingly, this study aims to deepen the current understanding of Plato's philosophy of health. Given that the philosophy of health is an emerging interdisciplinary field, the article also seeks to contribute to its conceptual development.

Effective health governance is essential for ensuring accessible, equitable, efficient, and high-quality healthcare services. Yet it is often overlooked or oversimplified in health services studies in rural China. We examine the unique role of village doctors in shaping public health governance in rural China. A two-phase ethnographic study was conducted in Gaomi, Shandong, from February to May 2023. Phase one involved a one-month in-field rapid assessment of the local health system. Phase two included two months of fieldwork, with participant observation and informal interviews with patients, clinicians, and officials. Village doctors acted as "quasi-officials," mediating between state authority and local community life. Their practices are shaped by state directives, local moral norms, and market pressures, producing adaptive governance within a "third sphere", which translates national policies into locally workable arrangements. Three overlapping roles for the village doctors emerged: state agent (implementing policies), health care giver (balancing ethics with community embeddedness), and entrepreneur (navigating entrepreneurial pressures). Although these roles can lead to conflicts and create a precarious professional scenario, village doctors exercise strategic agency, negotiating competing responsibilities to sustain their legitimacy and livelihood. Public health practices in rural China emerge within a "third sphere," where state, market, and community intersect. Village doctors negotiate multiple, often conflicting roles, balancing professional ethics, community obligations, and entrepreneurial pressures. This study challenges simplistic binaries of state versus society, revealing public health governance as a dynamic interplay between structural forces and localized practices.

Climate change increasingly affects population health and healthcare systems. While normative frameworks emphasize physicians' societal role in climate protection, empirical evidence on how general practitioners perceive and address climate- and environment-related issues in daily clinical practice remains somewhat limited and not yet fully consistent across studies. We conducted a nationwide cross-sectional online survey among general practitioners (N&#x2009;=&#x2009;500; 38.2% female) in Germany. The questionnaire assessed attitudes toward climate protection, attribution of responsibility for climate- and environment-related practice in healthcare, and the frequency of addressing climate- and environment-related issues in practice by patients and practitioners. Data were analyzed using descriptive statistics, group comparisons, and correlation analyses. A majority of respondents (65.8%) considered climate- and environment-related issues relevant to their professional role and endorsed physicians' function as societal role models. Agreement regarding individual responsibility within clinical practice was comparatively moderate (22.6%), with responsibility more frequently attributed to institutional (29.1%) and policy levels (49.2%). Attitudes toward environmental responsibility were largely consistent across subgroups defined by federal state, community size, practice type, and professional experience, while female general practitioners reported higher levels of environmental concern (M&#x2009;=&#x2009;3.94 vs. M&#x2009;=&#x2009;3.43; p < .001), indicating a small to moderate effect. Climate- and environment-related issues were reported to arise regularly in general practice, initiated by both physicians and patients (monthly or more often in physicians 68.4% versus patients 59.2%; never in physicians 12.4% versus patients 12.6%). The findings suggest that German general practitioners broadly acknowledge the relevance of climate- and environment-related issues to their professional role and are open to integrating such considerations into clinical context. At the same time, ambivalence regarding individual responsibility highlights the need for clearer normative orientation. Integrating climate- and environment-related considerations into professional standards, clinical guidelines, and medical education may help provide such orientation and support physicians in navigating ethical tensions.

BACKGROUND AND OBJECTIVES: The prevalence of sarcopenia among older adults is rising annually, highlighting the importance of enhancing awareness and self-management in sarcopenia prevention as a critical public health priority. This study aimed to develop and validate the Health Belief Scale for Sarcopenia Prevention and Management (HBSPM) in older adults and to assess its reliability and validity. METHODS: This study was conducted in two phases. Guided by the Health Belief Model (HBM), the HBSPM was developed through a comprehensive literature review, expert consultation, and cognitive interviews. In May 2024, 701 older adults were recruited through stratified convenience sampling across from cities classified into three tiers according to their 2023 GDP levels in Guangdong Province. The validity of the HBSPM was assessed using item analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS: The scale consists of 30 items across six dimensions: Susceptibility (5 items), Seriousness (6 items), Benefits (4 items), Barriers (5 items), Cues for Action (5 items), and Self-Efficacy (5 items). EFA revealed that these six factors accounted for 60.42% of the total variance. Factor loadings for the 30 items ranged from 0.615 to 0.759. The scale demonstrated good validity (&#x3c7;&#xb2;/df&#x2009;=&#x2009;1.466, RMSEA&#x2009;=&#x2009;0.045, TLI&#x2009;=&#x2009;0.965, IFI&#x2009;=&#x2009;0.961, NFI&#x2009;=&#x2009;0.897, CFI&#x2009;=&#x2009;0.965, GFI&#x2009;=&#x2009;0.852, I-CVI&#x2009;>&#x2009;0.86, S-CVI&#x2009;=&#x2009;0.989) and reliability (Cronbach&#x2019;s alpha&#x2009;=&#x2009;0.935). CONCLUSION: This study demonstrates that the HBSPM is an effective tool for measuring health belief regarding sarcopenia prevention and management among older adults and provides a robust foundation for targeted health education and behavioral interventions.

This paper brings insights from classical Indic, Tantric, Daoist, and Hellenistic medical traditions into dialogue with contemporary developmental science to examine the metaphysical, relational, and moral status of the embryo during its formation. Modern embryology provides detailed scientific explanations of genetic, epigenetic, and physiological development. However, it pays comparatively less attention to how embodied life emerges and to the philosophical significance of early embryonic development. The study adopts a comparative health humanities approach to examine how concepts such as garbha, pr&#x101;&#x1e47;a, q&#xec;, pneuma, developmental plasticity, and maternal-fetal relationality reflects different cultural and philosophical understandings of embryological formation. Rather than treating classical traditions as precursors of modern biology, the analysis identifies both convergences and divergences in how these traditions conceptualize vitality, embodiment, temporality, and developmental continuity. Across these traditions, embryological development is understood not as the unfolding of a pre-existing essence but as the progressive organization of embodied life through interacting physiological, environmental, temporal, and relational conditions. The comparison reveals both shared insights and important differences among these traditions. Although concepts such as pr&#x101;&#x1e47;a, q&#xec;, and pneuma describe aspects of formative life, they should not be reduced to modern biological categories. By bringing these perspectives into dialogue, the paper shows how comparative health humanities can broaden contemporary understandings of development, embodiment, vulnerability, and care while respecting the historical context of each tradition.

This conceptual review examines how autonomy became the dominant moral grammar of late modern Western societies and how its expansion reshapes subjectivity, institutions, public life, and healthcare practice. A genealogy traces autonomy from Enlightenment duty bound self legislation and civic self rule, through liberal non interference, to later forms shaped by expressive individualism, therapeutic culture, and recognition based claims. The paper argues that autonomy's normative achievements remain decisive, yet its cultural absolutization can generate a fragile subject who is highly expressive but insufficiently equipped for sustained responsibility. Five linked pathologies are analysed: autonomy as entitlement and boundary protection, transgression emptied by indeterminate norms, opinion transformed into performative positioning under hyperpluralism and platform surveillance, symbolic authority eroded across education and the professions, and duties devalued within a rights centred moral economy. In response, the paper proposes a reconstructive framework that redefines autonomy as ethical maturity, a formed capability sustained by responsibility, legitimate authority, deliberative practices of opinion, and duty. Particular attention is given to philosophy of medicine, where patient autonomy and professional autonomy illuminate the difference between supported agency and consumerist choice. Methodologically, the article combines genealogical reconstruction, phenomenological interpretation, and a purposive interdisciplinary synthesis of sociology, developmental psychology, philosophy of medicine, moral psychology, and media studies. Implications are sketched for education, healthcare, professional trust, and platform governance, with emphasis on proportional accountability and repair.

Canadian emergency staff have been dealing with record patient attendances, long wait times, bed blocking, and department overcrowding. We sought to report temporal trends in Canadian emergency physician burnout, and describe the impact of emergency medicine practice on physician well-being. We undertook a longitudinal study on Canadian emergency physician wellness that enrolled participants in April 2020. Participants were invited to 3 follow-up surveys in November 2020, September 2022, and January 2025. The primary outcomes were emotional exhaustion, depersonalization, and personal accomplishment scores. We conducted a deductive qualitative thematic analysis of the 2025 survey free-text responses by applying the framework created with our 2022 survey, to identify interconnected themes explaining burnout causes, consequences, and mechanisms that physicians use to stay in the specialty. The response rate to the survey was 410/615 (67%) in January 2025, from respondents in all provinces or territories in Canada except Yukon and Nunavut. Of 410 participants, 41 (10%) had left the profession. Among those who remained in emergency medicine and completed the full survey, 69/351 (20%) had taken time off emergency medicine and 170/351 (48%) had reduced their clinical hours in emergency medicine. In total, 229/351 (65%) scored either high emotional exhaustion, high depersonalization, or both. Burnout levels in 2020, 2022, and 2025 remained unchanged. Respondents pointed to a broken health care system, unrealistic societal expectations, and insurmountable workplace challenges as reasons for burnout. The consequences were physician distress and leaving the profession. Mechanisms to continue in emergency medicine were reducing work hours, modifying work roles, and changing health care institutions. Emergency physician burnout remains high, with almost half of respondents having reduced their work hours, and 10% having left the profession. Provincial, regional, and institutional health care leaders could reduce emergency physician burnout by following EM:POWER recommendations and instituting work models that facilitate reducing clinical hours and taking time away from emergency medicine when needed.

As the number of people with a migration background in Germany continues to rise, it is becoming increasingly critical to provide dementia care that addresses their needs. This study investigates the specific needs and barriers faced by people with a Turkish migration background in accessing dementia-related services, as well as the challenges experienced by healthcare professionals. By directly comparing family caregivers with and without a Turkish migration background, and by including healthcare professionals with and without a migration background, this study addresses an important research gap and explores how cultural narratives shape perceptions of good dementia care. We conducted semi-structured, in-depth interviews with 11 professionals and 15 family caregivers of Turkish and German descent in Germany from November 2023 to June 2024. Data were analyzed using qualitative content analysis to identify key themes related to care experiences, service accessibility, and cultural perceptions of good dementia care. Family caregivers with a Turkish migration background often had limited knowledge of dementia, experienced cultural stigma, and preferred to care for their relatives at home due to strong familial and cultural expectations as well as financial barriers. They made little use of formal support services, often due to language barriers, fear of social judgment, and lack of culturally appropriate care options. In contrast, caregivers without migration background were generally better informed, more open to external help, and more likely to access professional care services. These differences were also influenced by the educational level of the interviewees, with higher levels of education linked to better knowledge and greater use of support structures. Interviews with professionals supported these findings. The need for diagnosis tools for foreign-born people and the need for culturally sensitive care based on biographical information was emphasized. This study highlights the urgent need for culturally sensitive dementia care in Germany with the aim of addressing the knowledge gaps, language barriers, and ethical conflicts encountered by people with a migration background. Incorporating individuals' cultural needs into healthcare can improve access, alleviate the burden on families, and ensure that care is addressed to their needs.

Modern healthcare faces a mismatch in terms of supply and demand which makes careful priority setting imperative. The debate on priority setting in healthcare has focussed on pharmaceuticals and other tangible medical interventions. This article instead looks at the time that healthcare professionals have at their disposal. How should healthcare professionals divide their time between tangible medical interventions and communication with patients? What communicative goals should be prioritised?&#xa0;This normative analysis focusses on situations which involve time consuming communication between professionals and patients, which cannot easily be carried out alongside other medical interventions or is itself the main intervention as in psychotherapy. The arguments brought forth are applicable across the healthcare panorama and apply to all healthcare professions. It is argued that there are many different communicative goals which cannot be reduced to one type. Some recommendations are given and defended regarding the priority setting of different communicative goals. For reasons of value coherence and formal equality, all patients should be given a baseline amount of time for communication and time beyond that should be prioritised based on healthcare needs. If accepted, the arguments here highlight that a substantive part of healthcare's (time) resources should be spent on communicative tasks. Indeed, it is time that we take time for communication seriously.

The current state of medical practice is going through tremendous and rapid changes. There is an increasing prevalence of burnout among physicians, where they are questioning the value of practicing medicine. There is also a growing frustration among patients over reduced access to physicians, feeling rushed at appointments and generally feeling that they are not being heard. These conditions point to a sense among doctors and patients that the doctor-patient relationship is compromised without a viable pathway to repair this vital connection. In this paper, I want to show how applying philosophy, particularly, Martin Heidegger's discussion of angst and death can help to show a way for doctors to have a deeper ontological understanding of their patients' conditions, which can provide a bridge for doctors to re-establish a deep doctor-patient relationship. I will use vertigo as a paradigm condition of a disorder in which doctors have a poor understanding of their patients' condition. This leads to frustrating interactions with patients and breakdown of the doctor-patient relationship. M&#xe9;ni&#xe8;re's disease is a particular type of vertigo disorder which will serve as the foundation for this study which will examine the severe vertigo attacks and chronic disequilibrium these patients experience through the lens of Heidegger's highly technical phenomenological analysis of angst and death. M&#xe9;ni&#xe8;re's disease is an inner ear disorder that causes violent vertigo attacks and hearing loss followed by severe disequilibrium. During the attacks patients are incapacitated by the vertigo, and after the attack subsides, the disequilibrium makes life's normal pursuits meaningless. These patients understand the role of entities in their lives, but entities do not matter to them. Heidegger introduces the concept of for-the-sake-of-which to describe how entities in the world are interrelated with Dasein's purpose of disclosing a world. He provides a sense of for-the-sake-of-which where everyday entities are used to fulfill Dasein's activities which is an existentiell mode of for-the-sake-of-which. His famous example is the hammer in the workshop. He also gives a sense of for-the-sake-of-which where the totality of entities in the world are related to Dasein's ultimate goal of being a discloser of its world. This is Dasein's ultimate for-the-sake-of-which, which is an existential mode. In this paper I show that for-the-sakes-of-which can be thought of as having an existentiell and existential sense, and the existentiell for-the-sakes-of-which can be inauthentic or authentic. I will show how Heidegger's analysis of Dasein can be applied to concrete human existence, using the inner ear disorder, M&#xe9;ni&#xe8;re's Disease as an example. I am suggesting that the disequilibrium from M&#xe9;ni&#xe8;re's disease is a naturalized account of Heideggerian angst and is being-towards-death. I am also suggesting that the M&#xe9;ni&#xe8;re's attack is an experience of existential death because all possibilities and solicitations are impossible. I show that some M&#xe9;ni&#xe8;re's patients are able to take on authentic for-the-sake-of-which by becoming resolute and anticipating death.

Patient-centered care (PCC) is widely endorsed in contemporary medicine, yet philosophical analyses often approach it through concept-first approaches that define patienthood in advance-typically in terms of autonomy, holistic personhood, or rational agency-and then assess clinical practice by reference to these ideals. This paper argues that such an approach can obscure how patienthood is configured in practice. We develop a tool-first approach that treats cognitive, communicative, and material tools as analytically primary for understanding how patients are individuated in clinical reasoning. The argument is grounded in an ethnographic case study conducted in a specialized cancer hospital, focusing on outpatient clinics in medical oncology, colorectal surgery, and palliative care. Rather than treating ethnography as descriptive background, we use it to identify tools-in-use that structure what becomes salient, actionable, and patient-relevant in situated encounters. Across these settings, distinct configurations of tools generate systematically different modes of patienthood. In oncology, staging systems and expectation management configure patients as therapeutic trajectories oriented toward uncertain futures. In surgery, anatomical diagrams and probabilistic framings individuate patients as operative bodies embedded in structured decision spaces. In palliative care, symptom scales, narrative practices, and informational scaffolding configure patients as experiential subjects and epistemic agents. We analyze these differences as instances of structural plurality: patterned, tool-mediated modes of patient individuation that are internally coherent yet irreducible to a single model. On this account, ethical ideals commonly associated with PCC-such as autonomy, shared decision-making, and informed consent-can be understood less as prior normative standards applied to practice, and more as contingent achievements that depend on how tools structure salience, understanding, and possibilities for agency in clinical contexts.

Rehabilitation care concerns not only the restoration of function but also how persons live through disruption. Injury and illness may bring loss, uncertainty, altered dependence, changed self-understanding, and a changed horizon of life. Concepts such as coping and resilience capture important aspects of adaptation but do not fully clarify the inner work involved in bearing and inhabiting such change. This paper argues that inner strength can provide a useful concept for clarifying that work. The paper develops a philosophical framework with a preparatory layer and two related dimensions. Inner base names foundational exercises of attention, breath, and body awareness. Inner balance names the centering work of recollection and steadier judgment, while inner posture names the orienting work of finding a viable relation to limitation, vulnerability, and a wider horizon of meaning. Drawing on Pierre Hadot's account of philosophy as a way of life, the paper interprets inner balance and inner posture through the complementary movements of concentration and expansion. It places this proposal in dialogue with rehabilitation research on inner posture and global meaning, and with literature on meaning-making, resilience, mindfulness, and existential care. The framework is conceptual rather than a validated intervention model. It offers a more differentiated vocabulary for grounding, centering, and orientation in rehabilitation care.

To explore families' experiences of deceased organ donation and examine the perceived influence of participation in the donation process on grief and bereavement in Spain. Qualitative study with a phenomenological orientation, conducted as the qualitative component of a broader mixed-method prospective cohort study, using semi-structured interviews and thematic analysis informed by an abductive approach. The study was conducted in Spain with relatives of patients declared dead by neurological or circulatory criteria following potential deceased organ donation processes. 47 relatives were interviewed approximately 1&#x2009;month after the death of their family member. Interviews explored experiences of end-of-life care, communication with healthcare professionals, the organ donation request process and grief. Participants described organ donation as a meaningful experience that, in many cases, contributed to consolation, emotional well-being and a more adaptive grieving process. Trust in healthcare professionals, clear and compassionate communication, understanding of death determination and knowledge of the deceased person's wishes emerged as important facilitating factors. However, some participants also reported ambivalence, uncertainty, guilt or regret, particularly when disagreement within the family or doubts regarding the diagnosis persisted. Beyond its practical implications, organ donation was frequently associated with symbolic meanings such as continuity of life, solidarity and the preservation of the deceased person's legacy. Families' experiences of organ donation are complex and emotionally nuanced. When relatives feel supported, informed and confident in the decision-making process, organ donation may help provide meaning and comfort during bereavement. These findings highlight the importance of sensitive, family-centred communication and relational care practices in deceased organ donation processes.

Global discussions of nursing in low- and middle-income countries (LMICs) are dominated by the language of shortage, staffing, retention, and migration. Although useful, this technocratic vocabulary obscures a deeper philosophical crisis: nurses may be numerically produced yet institutionally denied authority over knowledge, care, and professional futures. Using Nepal as a theory-generating case, this conceptual article employs critical interpretive synthesis and philosophical analysis of nursing, policy, migration, and interdisciplinary scholarship to argue that the central problem is not workforce scarcity alone but a crisis of 'nursing sovereignty'. The paper introduces three concepts. First, epistemic drain extends the idea of brain drain by naming the erosion of mentorship, pedagogical continuity, professional memory, policy voice, research capacity, and the public credibility of nursing knowledge. Second, professionalised for exit captures a paradox of production in which nursing education expands global mobility more readily than local authority, making migration a morally justified reaction to constrained socioeconomic prospects, rather than a lack of professional dedication. Third, nursing sovereignty names the collective capacity of nurses to shape the ends, authority, knowledge, and institutional conditions of their profession. Drawing together social epistemology, feminist ethics, decolonial lens, political economy, sociology of professions, spatial theory, and digital pedagogy, the article argues that Nepal illuminates a wider LMIC condition in which nurses are essential yet disposable, mobile yet institutionally voiceless, and professionalised yet epistemically diminished. It concludes with a six-domain normative framework for institutional redesign: epistemic authority, educational integrity, governance voice, material justice, spatial and digital parity, and mobility justice. Reframing nursing in this way shifts debate from retention to justice, from labour supply to institutional re-design, and from workforce management to the political philosophy underpinning nursing practice.

This paper explores the critical role, experience, and wisdom of traditional healers in providing culturally-safe dementia care for Indigenous populations in North America, particularly as the prevalence of dementia in these communities continues to rise. It highlights the varying perceptions of dementia across cultures; for instance, while Western medicine often views it as a disease, many Indigenous cultures interpret it as a spiritual transition within the life cycle. A literature review conducted from 2000 to 2025 indicates that the marginalization of traditional healers within formal healthcare systems significantly hinders the delivery of culturally sensitive dementia care. Community-led models illustrate that the integration of traditional healing methods with contemporary practices is vital for offering respectful care to Indigenous people living with dementia. These models are grounded in concepts such as co-design, relational accountability, and "Two-Eyed Seeing," which establish traditional healers as crucial partners in the care process. The World Health Organization (WHO) formally recognized traditional healers as "community stakeholders" for dementia care and prevention globally. However, without the engagement and empowerment of traditional healers in the screening and diagnosis process of dementia, the implementation of the WHO Global Action Plan (2017-2025) on the public health response to dementia will be hindered, as these traditional healers are essential community stakeholders and allied partners for dementia care and prevention worldwide. The paper advocates for systemic reforms to support traditional healers and promote Indigenous self-determination in dementia care and calls for the development of medical education specifically tailored for traditional healers to establish a biocultural dementia care model that encompasses community support systems, spiritual approaches, a dementia-friendly environment, language preferences, and Indigenous culture, including arts, sciences, and philosophy.

Medicalization has become a key topic in contemporary philosophy of medicine. Discussions about what should be medicalized, what kinds of medicalization are desirable, and how specific cases ought to be evaluated increasingly shape debates about the boundaries and responsibilities of medicine. The medicalization debate is increasingly shaped by pragmatic considerations that draw attention to the complex interactions between mind and body and to the role of social and environmental conditions in shaping health. From this perspective, the value of medical interventions and resources lies in their capacity to contribute to broader goals such as alleviating human suffering and promoting individual and collective well-being. While pragmatic approaches address several shortcomings of stricter, often essentialist frameworks, their existing analytical tools remain limited when it comes to evaluating controversial cases of medicalization. This paper examines these limitations and develops a refined pragmatic framework for distinguishing good from problematic medicalization. Using the case study of the pharmaceutical treatment of behavioral and mood-related symptoms associated with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), I propose a two-step approach. This two-step approach acknowledges the complexities of pragmatic medicalization and distinguishes between the potential usefulness of medicines to achieve pragmatic goals and the realization of this potential in actual practice.