Journal articles on the topic 'Australians Saudi Arabia Psychological aspects'

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the numbers of cases and deaths worldwide have begun to increase, the closure of schools, universities, shops, workplaces, and the vast degree of precautionary actions, have left students feeling helpless, isolated, bored, and uncertain of what would happen to their academic advancement. Our study aims to assess the degree of the psychological impact of the COVID-19 pandemic on students in Saudi Arabia. Methods: During the early days of the pandemic, the survey sample was based on non-probability sampling. We conducted an online-based survey using a snowball sample technique. The survey collected data on several aspects of the participants, including the psychological impact of COVID-19, using the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21). The current study shows an extensive analysis of the survey with a focus on the impact of the pandemic on students. Results: A total of 336 students were recruited for the study and responded to the survey. The IES-R showed that 7.1% and 23.8% of the students experienced moderate and severe symptoms, respectively. On the DASS stress subscale, 13.4% and 10.7% of students experienced severe and extremely severe stress symptoms, respectively. With regards to anxiety, 6.0% and 15.8% of students experienced severe and extremely severe symptoms, respectively. As much as 11.6% and 17.6% of the students experienced severe and extremely severe symptoms of depression, respectively. Females were more likely to experience symptoms of Post-traumatic Stress Disorder (PTSD), stress, anxiety, and depression. Having a family member working in the field of health/medicine was significantly associated with depression; poor to average health and previous diagnosis of a psychiatric disorder was associated with a higher chance of developing PTSD, stress, anxiety, and depression. Conclusion: During the early days of the pandemic, nearly one-fourth of students experienced moderate to severe symptoms of PTSD. Our findings could help guide schools and universities in implementing a clear, effective strategy for students to navigate the coming academic year and expand the efforts made on academic and psychological counseling, especially for the vulnerable populations.

Visual pollution takes many forms, but it shares its essence with regard to its relationship to confusion in the brain's processing of inconsistent visual inputs, which negatively affects the individual's health in general, and in particular his mental and psychological health. This research is shedding light on the benefits and significance of physiological health positive impacts aspects of visual pollutions. It also highlights the problems associated with Visual prolusion and suggested the way and significance of removal and getting rid of it. Negative visual views are surveyed and documented by displaying some pictures reflecting the current view of the visual pollution. It also displays the directives and plans of the ministry of municipal and rural Affairs to remove and get rid of visual pollution in the kingdom. The paper suggested that policies should be created, rules should be activated and different media should be encouraged to aware people of the importance of the removal of Visual pollutions and its hazardous on people's health as well as the general view of the environment.

The study investigates the inclusion of children’s rights in the Islamic studies curricula for the upper primary grades in Saudi Arabia for the 2020 academic year. Content analysis was performed using a coding table comprised of 39 paragraphs categorized according to the five main fields of children’s rights, the rights related to social, intellectual, psychological, economic and political aspects. The results of the study revealed that social rights were shown to be included most frequently, followed by intellectual rights; psychological, economic, and political rights were included less often. All were randomly distributed in the examined textbooks, as they did not take into account the cognitive progression, integration, and continuity when presenting children’s rights. There are no statistically significant differences (α≤0.05) between the percentages of each of the children’s rights fields included in Islamic Studies curricula at the primary stage in Saudi Arabia due to the grade level variable. Accordingly, the study recommends preparing and developing the Islamic studies curricula according to a purposeful scientific methodology. The curricula should include explicit or implicit children’s rights with appropriate percentages and take into account the progression and integration when building cognitive experiences and designing enriching activities that integrate the contents of cognitive structure and children’s rights.

(1) Background: ESports is a new trend of sports, which has gained considerable popularity worldwide. There is a scarcity of evidence that focuses on the lifestyle of ESports players (eSP) particularly on symptoms of nomophobia, level of anxiety, sleep quality, food consumption and physical activity. (2) Objective: to determine the prevalence and relationship between symptoms of nomophobia, psychological aspects, insomnia and physical activity of eSP in Saudi Arabia. (3) Methods: A cross-sectional study was conducted between March and April 2021 using a convenient self-selection adult sample. A total of 893 (216 eSP vs. 677 non-eSP (NeSP)) participants aged over 18 years were included. All participants answered a seven-part validated questionnaire that included: (i) sociodemographic questions; (ii) a symptoms of nomophobia questionnaire; (iii) general anxiety disorder questions, (iv) an insomnia severity index, (v) an Internet addiction scale, (vi) the Yale food addiction scale 2.0 short form and (vii) an international physical activity questionnaire. (4) Results: Among the entire population, the prevalence of moderate to severe nomophobia, anxiety, insomnia, Internet addiction and low physical activity were 29.8%, 13.9%, 63.3%, 27% and 2.8%, respectively. The eSP and NeSP differed significantly in nomophobia scale, anxiety and insomnia values. Compared to NeSP, eSP had a higher level of severe nomophobia p = 0.003, a severe level of anxiety p = 0.025 and symptoms of insomnia p = 0.018. Except for food addiction and physical activity, a positive correlation was identified between symptoms of nomophobia, anxiety and insomnia among eSP. (5) Conclusion: This study reported high prevalence of nomophobia, anxiety and insomnia among eSP compared to NeSP.

Background: Holistic practices have been found beneficial for patients as well as nurses. They increase both the nurses and the patients’ health-promoting behaviors, spirituality, and interpersonal relationships. Objective: This study aimed to determine holistic nursing care and compare its differences based on individual characteristics. Methods: This study employed a quantitative-cross sectional approach. It was conducted at the hospitals of Hail region, Kingdom of Saudi Arabia, from February 2020 to March 2020. Selected through convenience sampling, 154 operating room nurses participated in the study. Frequency and percentages were used to analyze the demographic information, and t-tests and analysis of variance were used to test for differences. Results: Holistic nursing dimensions such as physiological (4.72 ± 0.40), socio-cultural (4.53 ± 0.45), psychological (4.66 ± 0.32), and spiritual aspects (4.22 ± 0.73) were consistently carried out in the operating room. On the physiological dimension, no significant differences were found in years of experience [(t) -0.073; p > 0.942], gender [(t) -1.113; p > 0.27], or age [(F) 0.558; p > 0.57), but there was a significant difference with nationality [(t) -3.328; p < 0.001]. On the socio-cultural dimension, the length of experience [(t) 0.599; p > 0.550], gender, [(t) -1.420; p > 0.158], and age [(F) 0.148; p > 0.862] were not significant, but a significant difference was found with nationality [(t) -7.516; p < 0.001]. Regarding the psychological dimension, the length of experience [(t) -1.101; p > 0.276], gender [(t) -1.545; p > 0.129], and age [(F) 1.259; p > 0.287] were not significant, but there was a significant difference with nationality [(t) -5.492; p < 0.001]. Finally, with the spiritual dimension, no significant difference was found on length of experience [(t) -1.101; p > 0.276] or age [(F) 0.584; p > 0.559], but there were significant differences on gender [(t) -3.890; p < 0.001] and nationality [(t) -3.653; p < 0.001]. Conclusion: Nationality is a causal factor to physiological, socio-cultural, psychological, and spiritual dimensions, while gender is significant to spiritual aspect. Regardless of nationality or gender, nurses must be knowledgeable regarding the significance of adopting holistic care to improve the quality of their care to their patients. Funding: Scientific Research Deanship of the University of Ha’il Saudi Arabia (RG-191236).

INTRODUCTION: Heart failure can influence all aspects of patients' health despite the improvement in its treatment. Different factors might affect the quality of life for patients with heart failure. These factors include but are not limited to: age, gender, ejection fraction, culture, and social support. Therefore, the purpose of this study was to examine differences in quality of life and perceived social support in patients with heart failure from Jordan and Saudi Arabia.MATERIALS & METHODS: A cross-sectional correlational design was used to test the objective of this study. A total of 202 patients were recruited from outpatient clinics of three hospitals in Jordan and Saudi Arabia. Data were collected through the SF-36 and the MOS-SSS questionnaires.RESULTS: The results of this study demonstrated that Jordanian patients with heart failure reported significantly greater social support in all MOS-SSS subscales than the Saudi patients except for the tangible support. The Saudi patients reported significantly more mental impairment (p ˂ .01) and lower level of fatigue (p ˂ .01) than the Jordanian patients.CONCLUSIONS: It is important to assess and identify physical and psychological resources available for patients at home and in the community to improve their quality of life.

The prevalence of type 1 diabetes mellitus (T1DM) among children in Saudi Arabia is increasing with unfavorable outcomes. Therefore, in addition to pharmacotherapy, other measures should be studied regarding psychological aspects mainly among adolescents. The family, which acts as the primary caregiver at this age, may play a major role in disease management. Thus, this study is aimed at assessing the perception of adolescents about the behaviors of their families initially and at investigating the correlation between these behaviors and glycemic control. Up to our knowledge, there was no study in Saudi Arabia that addressed this issue previously. This cross-sectional observational study assessed adolescents aged 10–19 years diagnosed with T1DM on insulin and receiving follow-up care at the King Saud University Medical City in Riyadh, Saudi Arabia. Data were collected via telephone interview and the verified “Modified Diabetes Social Support Questionnaire-Family version”. Glycemic control was then assessed using the most recent hemoglobin A1c (HbA1c) level recorded in their electronic files. Fifty-six adolescents participated in this study with an equal sex distribution (each n=28). Almost all participants were Saudis, and the majority were living in Riyadh (n=41). The mean age was 16.1±2.41 years with a mean of 6.1±4.14 years history of diabetes. The mean HbA1c level was 9.6±2.12%. Participants perceived all behaviors as supportive with “support in critical situations” being the highest (77.3%) and the only factor significantly related to HbA1c (p=0.017). Age was significantly related to all factors (p>0.05). Family plays a major role in the management of diabetes. Their supportive behaviors are perceived by their family members diagnosed with T1DM, but there has been no optimal association with disease control. However, the involvement of the family can aid in decreasing possible complications of the disease by intervening in critical situations.

Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value < 0.05. Results There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. The majority of the participants considered that vaginal rejuvenation, “G-spot” augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. Conclusion The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

Psychological capital (PsyCap), which is considered a higher-order construct, is composed of hope, efficacy, optimism, and resilience. The importance of PsyCap stems from the fact that it has the propensity to motivate individuals in their accomplishment of organizational tasks and goals. The concept is related to many behavioral concepts including: subjective well-being, social capital, employee engagement, and emotional intelligence. The majority of the research literature on PsyCap has originated from the West, and limited literature exists about its antecedents and consequences among the Saudi population. Studies undertaken in Saudi Arabia must take into account unique cultural aspects. The present work attempts to identify the contribution that could emerge from the relationship of PsyCap, with constructs like subjective well-being, social capital, and employee engagement, considered through the prism of culture. It also recognizes the influence of, and upon, the external environment. Going beyond the replication of earlier studies, the present work considers the constructs to have a yin-yang relationship. The study presented a model of comprehensive framework emerging from the relevant literature to bring out the complex connections between PsyCap and other constructs. It also emphasized the importance of culture on the identified constructs, and its implication on contribution and performance. The proposed framework needs to be further tested by academics, researchers, and practitioners to confirm its practical implications in industry.

Introduction and Aim:The new coronavirus disease outbreak 2019 (COVID-19, originally referred to as 2019-nCoV and later referred to as SARS-CoV-2) started in Wuhan, Hubei Province, China, after 8 years of the MERS-CoV epidemic outbreak and the root of COVID-19 infection was mostly thought to be the Chinese horseshoe bats]1[. As countries have reported a sharp rise in mental health issues, including anxiety, depression, stress, sleep disorder, and fear, among their people, the ongoing COVID-19 pandemic creates a psycho emotional chaotic situation. Several countries have taken steps or already graduating healthcare professional students early to support professional resources due to the rapid increase in COVID-19 patients and the shortage of health care professionals]4[.The aim of the study was to determine the psychological impact of the COVID-19 on the King Saud bin Abdulaziz University for Health Sciences students in Al-ahsa. Method: Psychological impact of COVID-19 pandemic among KSAU-HS students in Alahsa-Saudi Arabia assessed by the questionnaire. The purpose of the questionnaire to measure the Psychological impact of COVID-19 pandemic among KSAU-HS students in Alahsa-Saudi Arabia.We share the link between the KSAU Al-ahsa and students through email. Allied health science students in KSAU-HS -Al-Ahsa. This study was conducted in KSAU-HS in Al-Ahsa students. The data collected from KSAU Al-ahsa. 30 questions used to assess different aspects of psychological impact on KSAU-HS students, using PHQ-9, GAD-7, and PSS-14 scale with five options (Strongly Disagree – Disagree – Normal – Agree Strongly Agree. In addition, it is cross-sectional because the study collected data at giving point across the study. Result:There are 102 students participate in this study. All of the participants were from KSAU students in Al-ahsa that met the inclusion criteria in this study. 40.2% of the participants have moderate depression, 48% of the participants have moderate anxiety and 82.4% of the participants have moderate stress. Conclusion: PHQ-9 results shows that 2% of the students are normal, 19.6% have mild depression, 40.2% have moderate depression, 34.3% have moderately severe depression and 3.9% have severe depression. GAD-7 results shows that 9.8% of the students are normal, 31.4% have mild anxiety, 48% have moderate anxiety and 10.8% have severe anxiety. PSS-14 result shows that 9.8% of the students have low stress, 82.4% have moderate stress and 7.8% have high-perceived stress.

In January 2020, the WHO declared the novel coronavirus (2019-nCoV) outbreak as a public health emergency of international concern. Due to the rapid spread of 2019-nCoV, all countries started preventive and precautionary measures to prevent COVID-19 infection spread. These measures limited the population mobility and services provided, which subsequently Impact of on children with cancer and cancer care delivery in the many health centers in Saudi Arabia. We did a cross-sectional study to assess the impact of this outbreak on children with cancer concerning all aspects of life including medical services provided, the specific precautions to prevent spread in cancer patients, mental, psychological effects, and its effect on the quality of life. We collected 204 responses during a survey that assessed the impact on the treatment of cancer children at a tertiary institution during the COVID-19 pandemic. The majority of patients were receiving ongoing chemotherapy for leukemia/lymphoma. The majority of these patients (60.5%) reported a delay in treatment received due to hospital cancellation of appointments due to the pandemic. Although the majority of patients in our cohort complained of delayed treatment, fortunately, none of the delays led to fatalities. In the context of global lockdowns and physical distancing to help flatten the COVID-19 curve, telemedicine has proved fundamental to keeping patients and their healthcare providers connected and safe. Children also faced multiple other difficulties such as psychosocial issues during the COVID-19 pandemic. Our long-term goals are to develop new programs that will enable children with cancer to emerge successfully during a pandemic.

On 18 March 2020, the World Health Organization announced that the coronavirus disease 2019 (COVID-19) pandemic had reached global pandemic status. The Ministry of Health in Saudi Arabia implemented a COVID-19 lockdown that lasted for four months. After the period of restrictions ended, people were supposed to return to their normal social lives; however, the lockdown had a psychological impact on people without them being aware of it. This research aimed to study the effect of COVID-19 on social life, mainly focusing on six public activities: visiting shopping malls, mosques, open spaces, interior space, psychological effect, and occupational aspects. The Method survey was distributed during lockdown including the six focus areas and collected using Google Forms. Also, a computer program simulation (ENVI-MET) was used to study and develop an outdoor environment. The research focuses on the outdoor environment to find solutions on a sample used Al Rouda Park in Riyadh. The results demonstrated that people are slowly returning to their social lives during the COVID-19 pandemic by steadily visiting shopping malls, mosques, and open spaces and half of respondents stay at home fearing COVID-19. The research concluded that people should apply health procedures during ongoing time in studied locations and should manage the elaborated psychological effects.&nbsp;

Background: Coronavirus (COVID-19) pandemic has triggered a profound effect on all aspects of society, including mental and physical health in Saudi Arabia and over the globe. The pandemic has put a spotlight on the important role of nutrition in supporting the immune system relative to viral infections. The application of physical separation was the main scale used worldwide to fight COVID-19. Unavoidable nationwide cultural intercessions, such as lockdown, curfew and quarantine, imposed by the governments, resulted in unexpected outcomes such as financial difficulties, economic burden, changes in lifestyle and dietary habits, and the breakdown of psychosocial and metabolic well-being.Methods: This cross-sectional study was conducted to evaluate the impact of COVID-19 pandemic on lifestyle and dietary habits among female university students in Saudi Arabia. Three hundred (300) participants aged 18-25 years were randomly recruited using convenient sampling. A structured self-administrated online questionnaire was used to collect the information on lifestyle, physical activity, health history and dietary habits. We hypothesized that the pandemic and its consequent restriction measures would adversely impact the lifestyle and dietary habits of students.Results: There was a significant association between lockdown and weight gain (p<0.001) with 65% of participants reporting 5-11 kg weight gain during the pandemic. Lifestyle change, availability of food at home and stress/anxiety due to COVID-19 were the most common factors reported for weight gain (47%, 29% and 19%, respectively). A significant association (p<0.001) was found between screen time and COVID-19 lockdown with more than 10 hours spent in front of screens. Similarly, a significant change (p<0.001) was reported in food consumption and dietary behaviour during COVID-19. Most participants consumed home-made food (94%) while only 4% consumed foods from outside and 2% consumed fast food from restaurants.Conclusions: COVID-19 had a negative impact on lifestyle changes, dietary habits and physical activity, which was associated with significant weight gain among Saudi university students. This effect is attributed to the restriction measures that decreased the physical activity, and the psychological aspects that affected the quality and quantity of food consumed. Increasing awareness, healthy dietary plans and physical activity are highly recommended during the pandemic.

Coronavirus disease (COVID-19) has spread from China to the world since December 2019. In addition to being a pandemic with mortality risk, COVID-19 affected global mental health. This study is the first to address the mental health aspects among Saudi pharmacy students during this pandemic and to explore the potential effect on their academic development. An online cross-sectional survey was distributed among 677 students from the Faculty of Pharmacy at King Abdulaziz University, Jeddah, Saudi Arabia. Participants were assessed with demographic information, the validated Generalized Anxiety Disorder 7-item (GAD-7) scale, the validated Patient Health Questionnaire-2 (PHQ-2), and multiple stress factors and motivators that might influence their academic development. Collected data were statistically analyzed. Results demonstrated that 32% of the participants were experiencing mild anxiety, 22% moderate anxiety, and 19% severe anxiety. Statistical significance in anxiety level was seen in students living alone, previously diagnosed with mental illness, and within their 4th pharmacy academic year. 49.5% of the participants were PHQ-2 positive and maybe showing symptoms of depressions. Major academic stressor for students with anxiety was their grades while major academic motivator was the coordination of each course studied. Over 70% of pharmacy students had anxiety, and half of them were PHQ-2 positive. We recommend universities to address all students’ psychological needs more often in the future, especially during a crisis like this pandemic and look into the possibility of having a Pass/Fail outcome rather than a grade-based GPA.

The COVID-19 outbreak emerged as an ongoing crisis at the beginning of the year 2020. Its horrific manifestation at the community level significantly affects various dimensions of the quality of life (QoL) of all individuals. The study aimed to examine some of the predictors of the QoL during the first wave of the COVID-19 pandemic in Saudi Arabia. A cross-sectional online survey questionnaire was used to gather data on the participants’ sociodemographic backgrounds, physical health status, psychological reactions, and QoL. We adapted 12 items from the World Health Organization Quality of Life Instruments (WHOQOL-BREF) to assess the QoL. The Depression, Anxiety and Stress Scale–21 (DASS-21) was used to assess depression, anxiety, and stress. The median and inter-quartile range were used to describe the QoL scores. A multinomial regression analysis was computed between QoL score quartiles and associated factors, and the statistical significance was set at p < 0.05. The results of the multinomial regression analysis demonstrated that males (OR = 1.96; 95% CI = 1.31–2.94); participants aged 26 to 35 years (OR = 5.1; 95% CI = 1.33–19.37); non-Saudi participants (OR = 1.69; 95% CI = 1.06–2.57); individuals with chronic diseases (OR = 2.15; 95% CI = 1.33–3.48); those who lost their job (OR = 2.18; 95% CI = 1.04–4.57); and those with depression (OR = 5.70; 95% CI = 3.59–9.05), anxiety (OR = 5.47; 95% CI = 3.38–8.84), and stress (OR = 6.55; 95% CI = 4.01–10.70) were more likely to be in the first quartile of the QoL scores. While the full model predicting the total QoL score was statistically significant (R2 = 0.962, F (750, 753) = 16,705.4, p < 0.001), the three QoL dimensions explained 0.643, 0.283, and 0.036 of the variability in environmental, social, and religious/spiritual dimensions, respectively. The COVID-19 pandemic has significantly influenced various aspects of individuals’ QoL, as well as their physical and psychological health. Community-based interventions are needed to mitigate the pandemic’s negative effects and enhance the health and QoL of the general population.

Among most medical staff, Smoking is very common and, in this research, we aim To Determine awareness of smoking in medical staff, smoking differences between gender and nationality in KSA.Then we overviewed the rates of smoking in different age groups in the general population. We want also to know the connection of this awareness to smoking or quitting, which may cause future plans that provide for the shedding of light on psychological treatment and mental persuasion to help quit smoking. This study participants were Medical workers from Saudi Arabia and the results may not be applied to different sittings due to differences in facilities and work conditions. Conclusion: It is evident through the results that smoking is very common among doctors, especially men, and smoking is more common among people over 55 years of age than others. In addition to these negatives, most of the sample is aware of the negative aspects of smoking and its risks in the future, but the majority of them still smoke.

This research focuses on specific models of health and illness, explored by many researchers across the world. The sequential variations and critic of each model is summed up by researcher and the relevant theoretical orientations of beta thalassemia major have been tried to integrate. Beta thalassemia major is a common genetic disorder, due to abnormalities in human globin (alpha or beta). The highest prevalence rate of disease has been seen in Saudi Arabia, Jordon, India, Bangladesh and Pakistan, due to repeated cousin marriages, strong beliefs of cultural and traditional practices and lack of knowledge for the prevention and management of beta thalassemia major. The focus of epidemiologists remained on genetic causes and ignored the social, cultural, religious and psychological factors which preponderate over biological aspects of health. The academician and health experts lacked to focus the theoretical orientations of beta thalassemia major, this paper elucidates the models of health and illness and provides and logical theoretical itinerary for beta thalassemia major.

This cross-study aimed to determine the prevalence of IBS and its associated factors among 205 healthcare professionals in the primary health care centers in Al-Madinah City. Cluster sampling was used to select 16 primary health centers from the four regions of the city. A self-administered questionnaire was used to collect data about socio-demographics, Hospital Anxiety and Depression Scale (HADS), the Rome IV Diagnostic Questionnaire, dysphoria scale, and performance scale. Mean (SD) age of participant was 34.5 (6.6). Majority were nurses (40%) and Saudi (93.7%). The prevalence of IBS was 16%. Factors associated with IBS in the univariate analysis were nationality(p=0.023) anxiety (p=0.010), depression (p<0.001), performance (p<0.001) and dysphoria (p=0.003). In multivariate analysis, the significant predictor of IBS was depression (aOR=1.3, 95%CI 1.2-1.4, p<0.001). In conclusion, the prevalence of IBS among healthcare professionals in the current study was 16.1%, with predominantly IBS-Constipation subtype. IBS was associated mainly with depression. Future intervention studies are recommended to establish possible causal inferences between psychological morbidities and quality of life domains for rectification on treatment aspects of IBS.

This study explores the level and frequency of anxiety about COVID-19 infection in some Middle Eastern countries, and differences in this anxiety by country, gender, workplace, and social status. Another aim was to identify the predictive power of anxiety about COVID-19 infection, daily smartphone use hours, and age in smartphone addiction. The participants were 651 males and females from Jordan, Saudi Arabia, the United Arab Emirates, and Egypt. The participants’ ages ranged between 18 and 73 years (M 33.36, SD = 10.69). A questionnaire developed by the authors was used to examine anxiety about COVID-19 infection. Furthermore, the Italian Smartphone Addiction Inventory was used after being translated, adapted, and validated for the purposes of the present study. The results revealed that the percentages of participants with high, average, and low anxiety about COVID-19 infection were 10.3%, 37.3%, and 52.4%, respectively. The mean scores of anxiety about COVID-19 infection in the four countries were average: Egypt (M = 2.655), Saudi Arabia (M = 2.458), the United Arab Emirates (M = 2.413), and Jordan (M = 2.336). Significant differences in anxiety about COVID-19 infection were found between Egypt and Jordan, in favor of Egypt. Significant gender differences were found in favor of females in the Jordanian and Egyptian samples, and in favor of males in the Emirati sample. No significant differences were found regarding workplace and social status. The results also revealed a significant positive relationship between anxiety about COVID-19 infection, daily smartphone use hours, and age on the one hand, and smartphone addiction on the other. The strongest predictor of smartphone addiction was anxiety about COVID-19 infection, followed by daily use hours. Age did not significantly contribute to the prediction of smartphone addiction. The study findings shed light on the psychological health and cognitive aspects of anxiety about COVID-19 infection and its relation to smartphone addiction.

Among most medical staff, Smoking is very common and, in this research, we aim To Determine awareness of smoking in medical staff, smoking differences between gender and nationality in KSA. Then we overviewed the rates of smoking in different age groups in the general population. We want also to know the connection of this awareness to smoking or quitting, which may cause future plans that provide for the shedding of light on psychological treatment and mental persuasion to help quit smoking. These study participants were Medical workers from Saudi Arabia and the results may not be applied to different sittings due to differences in facilities and work conditions. Conclusion: It is evident through the results that smoking is very common among doctors, especially men, and smoking is more common among people over 55 years of age than others. In addition to these negatives, most of the sample is aware of the negative aspects of smoking and its risks in the future, but the majority of them still smoke.

This study aims to map the ontological and epistemological aspects of Negotiative Hermeneutics through a philosophical approach. Negotiative Hermeneutics is a new hermeneutic model initiated by Khaled Abou El Fadl to criticize gender-biased and misogyny fatwas issued by Al-Lajnah ad-Dā`imah li al-Buhūts al-'Ilmiyyah wa al-Iftā`, or the Fatwa Committee Saudi Arabia. Prioritizing texts understanding through a psychological, social context, and other perspective makes this model different from other hermeneutics. Negotiative Hermeneutics more focuses on the negotiation process for sustainable in the three pillars of hermeneutics: author, text, and reader. This iterative process on linguistic, cultural, etc. This study analyzed the weaknesses of the Negotiative Hermeneutics negotiation movement based on the misogyny fatwa case of the Saudi Arabian Fatwa Committee using the critical discourse analysis method. The results indicated that the text is ontologically sacred and authoritative; authorship of the Quran and the Prophet Sunnah stopped at the first author. The epistemological viewed meaning is obtained from endless negotiations among the three pillars of hermeneutics. The weakness is Khaled's disregard for the fact that the ulama's fatwa depends on royal authority. Last, the significance of this paper, especially regarding the shortcomings in Khaled's theory, is to present evidence that a fatwa produced by the ulama's ijtihad is not autonomous at all, even from the ulama itself, because it is also the result of a bargaining chip between ulama and the royal authority

Introduction: The COVID-19 pandemic has affected all aspects of our lives, including education, social relations, and psychological and financial status. Objectives: The study aims to assess the effects of the COVID-19 pandemic on academic performance, hygiene, stress, lifestyle, and financial status among medical students at Northern Border University (NBU), Saudi Arabia. Methods:This cross-sectional study was conducted on medical students at NBU, Arar City. The study collected data on socio-demographic characteristics, academic, hygiene, psychological, lifestyle, and financial impacts of the COVID-19 pandemic among medical students. Results:The study surveyed 332 medical students at the NBU (response rate=86.46%). One-third of students reported deteriorating academic performance during the pandemic. Negative effects of COVID-19 on academic performance were more likely among males, older students, in clinical years, with poor IT skills, and those who had not previously participated in online learning. Over 56% of students reported negative effects on their academic grades and GPA due to the pandemic and over 50% agreed that teachers were not technology-friendly, recorded lectures were better than live lectures, and technical issues interfered with online teaching. Most students reported increased awareness of hygiene and sanitization with the MOH and WHO being the most frequent sources of information (34.94% and 28.92%, respectively). Conclusion: The COVID-19 pandemic has had impacts on medical education at the NBU as regards the academic and clinical skills and physical and psychological health of medical students. This study drew attention to the needs and resources to address challenges faced by medical students during the pandemic.

In treating chronic illnesses, such as sickle cell disease (SCD), outpatient care is essential; poor adherence in attending clinic appointments can lead to serious outcomes. SCD is highly prevalent in Saudi Arabia, and patients with SCD are advised to follow up with their treating physician in order to control this disease manifestation and to better forecast its complications. Studies evaluating missed appointments among patients with SCD are rare. Therefore, the current study aimed to use the health belief model’s modifying factors in order to evaluate the variables associated with poor adherence in attending appointments. A total of 381 participants with SCD from various regions in the Jazan Province, southwestern Saudi Arabia, were included. The survey instrument included socioeconomic determinants, factors associated with poor adherence in attending outpatient appointments, and solutions under the conceptual framework of the health belief model. A descriptive analysis was conducted and the factors that impacted adherence in attending the appointments were evaluated. In the current sample, respondents with SCD from 21 to 30 years represented 41%, which was followed by participants who were 11 to 20 years at 21.5%. In addition, about 60% of the participants were women. Further, approximately 62% of the patients admitted were missing one or more outpatient appointments in the previous year, which was significantly related to various factors, such as socioeconomic characteristics and patient residence. Forgetting the appointment was the main reason for skipping outpatient appointments for patients with SCD; as such, reminders appear to be a good solution for most participants. Our findings indicated that modifying components of the health belief model, including age, level of education, income, patients’ residence, and lacking cues to action (such as reminders) are important in explaining the reason for poor adherence in attending appointments. Thus, efforts are needed to address these factors and to ensure that SCD patients uphold their appointments. Future studies should examine the clinical, psychological, and epidemiological aspects that are linked with missed consultations.

Increasing students’ academic stress especially during exams may result in sleep disorders, fatigue, poor academic performance and low functional efficiency. The aim of this research is to investigate the effect of sleep quality on educational performance of paramedic students. This research depends on a cross-sectional observational study. The samples of the study were 150 individual who will be chosen randomly from Saudi PSMCHS-Dhahran paramedic students. Data related to demographic aspects, work-related information was gathered from the samples of the study. Finally, the data of the study was analyzed through SPSS program. Four sleep scales were adopted for the study like Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Fatigue Severity Scale (FSS) and Kessler Psychological Distress Scale (KPDS). The level of education like diploma and bachelor had a significant relation between the ESS and FSS. Bridging level of education has relation with KPDS. Marital status and BMI were significant with ISI and KPDS respectively. Physiological distress and excessive day time sleepiness were significant with ISI, FSS and KPDS.It can be stated that sleep quality of paramedic students is affected with high ratio by the educational performance. This is because the high stress of work regarding paramedic students leads them to have less amount of sleep quality and then this affects their educational performance.

Purpose Various research studies have been carried out to study Chief Executive Officers’ (CEOs’) transformational leadership in driving organizational performance and success. Evidence shows that few studies were carried out on CEO transformational leadership and top management team (TMT) performance in Gulf Cooperation Council (GCC) region. Thus, this study aims to provide a unique contribution and the first of its kind to examine the CEO leadership–TMT performance link across GCC countries. Design/methodology/approach In this study, the researchers approached 500 employees and 30 CEOs working in 30 different organizations operating in the GCC countries. The firms were selected conveniently from different industries located in the UAE, Saudi Arabia, Kuwait, Oman and Bahrain. The researchers used the PASW (SPSS) program to analyze the data. Findings The findings show that psychological empowerment has no significant role in moderating the transformational leadership – TMT performance relationship. Internal support for innovation plays a significant role in mediating the relationship between transformational leadership and TMT performance. Research limitations/implications The present study has not examined the behavioral aspects of CEO followers. Future research may study behavioral characteristics of the entire TMT. Originality/value This study contributes to body of research that identifies CEO transactional leadership as perceived by the followers was found to be more important in predicting TMT performance than transformational leadership in the context of organizations located in GCC countries. Managerial implications and future research areas are further discussed.

Background: Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Daily Injections (MDI) have been widely used as options in treating diabetes in childhood. Glycemic control is important to reduce diabetes complications; however, more focus needs to be on patients’ Quality of Life (QoL). Diabetes and QoL have strong associations in terms of patients’ overall health including their psychology, physical well-being, compliance with medication. A previous systematic review stressed that strong evidence to deny or prove the benefits of insulin pump therapy on health-related quality of life is deficient. The aim of this study is to assess the health-related quality of life and the psychological impacts of children with diabetes who use CSII and MDI treatment. Methods: A cross-sectional study included 68 pediatric patients with type 1 Diabetes (T1DM) who were treated in a tertiary center in Jeddah, Saudi Arabia. We used the Pediatric Quality of Life Inventory 3.0 Diabetes Module and this module assesses the health-related quality of life of children with diabetes. Results: Thirty-four (50%) participants found to be on MDI, of which 21 (61.8%) are males, compared to 34 (50%) patients using CSII, of which 12 (35.2%) are females. Participants using CSII had statistically significant better symptom control, less treatment difficulties but were more worrisome than MDI participants. Conclusion: CSII group had better quality of life in almost all aspects even though they were more worrisome. Further studies with a larger sample size are needed to give comprehensive generalizations.

Nurses passed through many stressful experiences during nursing work. Emotional support and considering their emotional needs can alleviate such work-associated tension and contribute to the quality of their performance. Nurses’ happiness and awareness of their influence on work are necessary blocks to build the nurses’ emotional steadiness, and thus their work retention and turnover rates would be maintained. This study establishes to attain two aims: First: to identify the levels of nurses’ happiness and the awareness of their influence on work, in governmental and private hospitals, in Jeddah, Kingdom Saudi Arabia (KSA). Second: to determine the correlation between those perceived variables. Thus, a descriptive, correlative and comparative research design was employed with 300 registered nurses in King Abd El Aziz governmental hospital and 200 registered nurses in private International Medical Center, Jeddah, KSA. A survey method was applied for data collection, and the study questionnaire involved three parts. Part one is about nurses’ personal profile. The second part included happiness subscale, which was developed by Warr et al., in 1979 and the third one is the individual influence on the work scale that was developed by Toode et al., in 2015. The study findings reveal that the majority of both study groups reported a fair level of happiness, with a moderate awareness level of their influence on work. Additionally, nurses who are working in private hospital have a higher awareness level of their influence on work and happiness, more than the nurses who are working in the governmental hospital. Study subjects who experience a high level of happiness have a high level of awareness of their influence on the work. Therefore, the correlation coefficient among both research variables in both hospitals indicated a noteworthy stronger positive correlation. Conclusion and recommendations: nurse’s happiness and awareness of their influence on work are essential emotional aspects to be considered in nursing management. Fitting plan for nurses’ psychological stability at work should be designed and implemented, particularly in governmental hospitals in Jeddah. Also, Nurse Manager should assess and maintain a high nurses’ happiness level and awareness of their influence on the work; consequently, nurses work product will be improved. Further studies are needed to investigate the study variables by different measurement tools for behaviors or skills. A study about an assessment of the relation between the nurse’s emotional status and their performance is suggested.

Introduction I am a transmigrant who has moved back and forth between the West and the Rest. I was born and raised in a Muslim family in a predominantly Muslim country, Bangladesh, but I spent several years of my childhood in Pakistan. After my marriage, I lived in the United States for a year and a half, the Middle East for 5 years, Australia for three years, back to the Middle East for another 5 years, then, finally, in Australia for the last 12 years. I speak Bengali (my mother tongue), Urdu (which I learnt in Pakistan), a bit of Arabic (learnt in the Middle East); but English has always been my medium of instruction. So where is home? Is it my place of origin, the Muslim umma, or my land of settlement? Or is it my ‘root’ or my ‘route’ (Blunt and Dowling)? Blunt and Dowling (199) observe that the lives of transmigrants are often interpreted in terms of their ‘roots’ and ‘routes’, which are two frameworks for thinking about home, homeland and diaspora. Whereas ‘roots’ might imply an original homeland from which people have scattered, and to which they might seek to return, ‘routes’ focuses on mobile, multiple and transcultural geographies of home. However, both ‘roots’ and ‘routes’ are attached to emotion and identity, and both invoke a sense of place, belonging or alienation that is intrinsically tied to a sense of self (Blunt and Dowling 196-219). In this paper, I equate home with my root (place of birth) and route (transnational homing) within the context of the ‘diaspora and belonging’. First I define the diaspora and possible criteria of belonging. Next I describe my transnational homing within the framework of diaspora and belonging. Finally, I consider how Australia can be a ‘home’ for me and other Muslim Australians. The Diaspora and Belonging Blunt and Dowling (199) define diaspora as “scattering of people over space and transnational connections between people and the places”. Cohen emphasised the ethno-cultural aspects of the diaspora setting; that is, how migrants identify and position themselves in other nations in terms of their (different) ethnic and cultural orientation. Hall argues that the diasporic subjects form a cultural identity through transformation and difference. Speaking of the Hindu diaspora in the UK and Caribbean, Vertovec (21-23) contends that the migrants’ contact with their original ‘home’ or diaspora depends on four factors: migration processes and factors of settlement, cultural composition, structural and political power, and community development. With regard to the first factor, migration processes and factors of settlement, Vertovec explains that if the migrants are political or economic refugees, or on a temporary visa, they are likely to live in a ‘myth of return’. In the cultural composition context, Vertovec argues that religion, language, region of origin, caste, and degree of cultural homogenisation are factors in which migrants are bound to their homeland. Concerning the social structure and political power issue, Vertovec suggests that the extent and nature of racial and ethnic pluralism or social stigma, class composition, degree of institutionalised racism, involvement in party politics (or active citizenship) determine migrants’ connection to their new or old home. Finally, community development, including membership in organisations (political, union, religious, cultural, leisure), leadership qualities, and ethnic convergence or conflict (trends towards intra-communal or inter-ethnic/inter-religious co-operation) would also affect the migrants’ sense of belonging. Using these scholarly ideas as triggers, I will examine my home and belonging over the last few decades. My Home In an initial stage of my transmigrant history, my home was my root (place of birth, Dhaka, Bangladesh). Subsequently, my routes (settlement in different countries) reshaped my homes. In all respects, the ethno-cultural factors have played a big part in my definition of ‘home’. But on some occasions my ethnic identification has been overridden by my religious identification and vice versa. By ethnic identity, I mean my language (mother tongue) and my connection to my people (Bangladeshi). By my religious identity, I mean my Muslim religion, and my spiritual connection to the umma, a Muslim nation transcending all boundaries. Umma refers to the Muslim identity and unity within a larger Muslim group across national boundaries. The only thing the members of the umma have in common is their Islamic belief (Spencer and Wollman 169-170). In my childhood my father, a banker, was relocated to Karachi, Pakistan (then West Pakistan). Although I lived in Pakistan for much of my childhood, I have never considered it to be my home, even though it is predominantly a Muslim country. In this case, my home was my root (Bangladesh) where my grandparents and extended family lived. Every year I used to visit my grandparents who resided in a small town in Bangladesh (then East Pakistan). Thus my connection with my home was sustained through my extended family, ethnic traditions, language (Bengali/Bangla), and the occasional visits to the landscape of Bangladesh. Smith (9-11) notes that people build their connection or identity to their homeland through their historic land, common historical memories, myths, symbols and traditions. Though Pakistan and Bangladesh had common histories, their traditions of language, dress and ethnic culture were very different. For example, the celebration of the Bengali New Year (Pohela Baishakh), folk dance, folk music and folk tales, drama, poetry, lyrics of poets Rabindranath Tagore (Rabindra Sangeet) and Nazrul Islam (Nazrul Geeti) are distinct in the cultural heritage of Bangladesh. Special musical instruments such as the banshi (a bamboo flute), dhol (drums), ektara (a single-stringed instrument) and dotara (a four-stringed instrument) are unique to Bangladeshi culture. The Bangladeshi cuisine (rice and freshwater fish) is also different from Pakistan where people mainly eat flat round bread (roti) and meat (gosh). However, my bonding factor to Bangladesh was my relatives, particularly my grandparents as they made me feel one of ‘us’. Their affection for me was irreplaceable. The train journey from Dhaka (capital city) to their town, Noakhali, was captivating. The hustle and bustle at the train station and the lush green paddy fields along the train journey reminded me that this was my ‘home’. Though I spoke the official language (Urdu) in Pakistan and had a few Pakistani friends in Karachi, they could never replace my feelings for my friends, extended relatives and cousins who lived in Bangladesh. I could not relate to the landscape or dry weather of Pakistan. More importantly, some Pakistani women (our neighbours) were critical of my mother’s traditional dress (saree), and described it as revealing because it showed a bit of her back. They took pride in their traditional dress (shalwar, kameez, dopatta), which they considered to be more covered and ‘Islamic’. So, because of our traditional dress (saree) and perhaps other differences, we were regarded as the ‘Other’. In 1970 my father was relocated back to Dhaka, Bangladesh, and I was glad to go home. It should be noted that both Pakistan and Bangladesh were separated from India in 1947 – first as one nation; then, in 1971, Bangladesh became independent from Pakistan. The conflict between Bangladesh (then East Pakistan) and Pakistan (then West Pakistan) originated for economic and political reasons. At this time I was a high school student and witnessed acts of genocide committed by the Pakistani regime against the Bangladeshis (March-December 1971). My memories of these acts are vivid and still very painful. After my marriage, I moved from Bangladesh to the United States. In this instance, my new route (Austin, Texas, USA), as it happened, did not become my home. Here the ethno-cultural and Islamic cultural factors took precedence. I spoke the English language, made some American friends, and studied history at the University of Texas. I appreciated the warm friendship extended to me in the US, but experienced a degree of culture shock. I did not appreciate the pub life, alcohol consumption, and what I perceived to be the lack of family bonds (children moving out at the age of 18, families only meeting occasionally on birthdays and Christmas). Furthermore, I could not relate to de facto relationships and acceptance of sex before marriage. However, to me ‘home’ meant a family orientation and living in close contact with family. Besides the cultural divide, my husband and I were living in the US on student visas and, as Vertovec (21-23) noted, temporary visa status can deter people from their sense of belonging to the host country. In retrospect I can see that we lived in the ‘myth of return’. However, our next move for a better life was not to our root (Bangladesh), but another route to the Muslim world of Dhahran in Saudi Arabia. My husband moved to Dhahran not because it was a Muslim world but because it gave him better economic opportunities. However, I thought this new destination would become my home – the home that was coined by Anderson as the imagined nation, or my Muslim umma. Anderson argues that the imagined communities are “to be distinguished, not by their falsity/genuineness, but by the style in which they are imagined” (6; Wood 61). Hall (122) asserts: identity is actually formed through unconscious processes over time, rather than being innate in consciousness at birth. There is always something ‘imaginary’ or fantasized about its unity. It always remains incomplete, is always ‘in process’, always ‘being formed’. As discussed above, when I had returned home to Bangladesh from Pakistan – both Muslim countries – my primary connection to my home country was my ethnic identity, language and traditions. My ethnic identity overshadowed the religious identity. But when I moved to Saudi Arabia, where my ethnic identity differed from that of the mainstream Arabs and Bedouin/nomadic Arabs, my connection to this new land was through my Islamic cultural and religious identity. Admittedly, this connection to the umma was more psychological than physical, but I was now in close proximity to Mecca, and to my home of Dhaka, Bangladesh. Mecca is an important city in Saudi Arabia for Muslims because it is the holy city of Islam, the home to the Ka’aba (the religious centre of Islam), and the birthplace of Prophet Muhammad [Peace Be Upon Him]. It is also the destination of the Hajj, one of the five pillars of Islamic faith. Therefore, Mecca is home to significant events in Islamic history, as well as being an important present day centre for the Islamic faith. We lived in Dhahran, Saudi Arabia for 5 years. Though it was a 2.5 hours flight away, I treasured Mecca’s proximity and regarded Dhahran as my second and spiritual home. Saudi Arabia had a restricted lifestyle for women, but I liked it because it was a Muslim country that gave me the opportunity to perform umrah Hajj (pilgrimage). However, Saudi Arabia did not allow citizenship to expatriates. Saudi Arabia’s government was keen to protect the status quo and did not want to compromise its cultural values or standard of living by allowing foreigners to become a permanent part of society. In exceptional circumstances only, the King granted citizenship to a foreigner for outstanding service to the state over a number of years. Children of foreigners born in Saudi Arabia did not have rights of local citizenship; they automatically assumed the nationality of their parents. If it was available, Saudi citizenship would assure expatriates a secure and permanent living in Saudi Arabia; as it was, there was a fear among the non-Saudis that they would have to leave the country once their job contract expired. Under the circumstances, though my spiritual connection to Mecca was strong, my husband was convinced that Saudi Arabia did not provide any job security. So, in 1987 when Australia offered migration to highly skilled people, my husband decided to migrate to Australia for a better and more secure economic life. I agreed to his decision, but quite reluctantly because we were again moving to a non-Muslim part of the world, which would be culturally different and far away from my original homeland (Bangladesh). In Australia, we lived first in Brisbane, then Adelaide, and after three years we took our Australian citizenship. At that stage I loved the Barossa Valley and Victor Harbour in South Australia, and the Gold Coast and Sunshine Coast in Queensland, but did not feel at home in Australia. We bought a house in Adelaide and I was a full time home-maker but was always apprehensive that my children (two boys) would lose their culture in this non-Muslim world. In 1990 we once again moved back to the Muslim world, this time to Muscat, Sultanate of Oman. My connection to this route was again spiritual. I valued the fact that we would live in a Muslim country and our children would be brought up in a Muslim environment. But my husband’s move was purely financial as he got a lucrative job offer in Muscat. We had another son in Oman. We enjoyed the luxurious lifestyle provided by my husband’s workplace and the service provided by the housemaid. I loved the beaches and freedom to drive my car, and I appreciated the friendly Omani people. I also enjoyed our frequent trips (4 hours flight) to my root, Dhaka, Bangladesh. So our children were raised within our ethnic and Islamic culture, remained close to my root (family in Dhaka), though they attended a British school in Muscat. But by the time I started considering Oman to be my second home, we had to leave once again for a place that could provide us with a more secure future. Oman was like Saudi Arabia; it employed expatriates only on a contract basis, and did not give them citizenship (not even fellow Muslims). So after 5 years it was time to move back to Australia. It was with great reluctance that I moved with my husband to Brisbane in 1995 because once again we were to face a different cultural context. As mentioned earlier, we lived in Brisbane in the late 1980s; I liked the weather, the landscape, but did not consider it home for cultural reasons. Our boys started attending expensive private schools and we bought a house in a prestigious Western suburb in Brisbane. Soon after arriving I started my tertiary education at the University of Queensland, and finished an MA in Historical Studies in Indian History in 1998. Still Australia was not my home. I kept thinking that we would return to my previous routes or the ‘imagined’ homeland somewhere in the Middle East, in close proximity to my root (Bangladesh), where we could remain economically secure in a Muslim country. But gradually I began to feel that Australia was becoming my ‘home’. I had gradually become involved in professional and community activities (with university colleagues, the Bangladeshi community and Muslim women’s organisations), and in retrospect I could see that this was an early stage of my ‘self-actualisation’ (Maslow). Through my involvement with diverse people, I felt emotionally connected with the concerns, hopes and dreams of my Muslim-Australian friends. Subsequently, I also felt connected with my mainstream Australian friends whose emotions and fears (9/11 incident, Bali bombing and 7/7 tragedy) were similar to mine. In late 1998 I started my PhD studies on the immigration history of Australia, with a particular focus on the historical settlement of Muslims in Australia. This entailed retrieving archival files and interviewing people, mostly Muslims and some mainstream Australians, and enquiring into relevant migration issues. I also became more active in community issues, and was not constrained by my circumstances. By circumstances, I mean that even though I belonged to a patriarchally structured Muslim family, where my husband was the main breadwinner, main decision-maker, my independence and research activities (entailing frequent interstate trips for data collection, and public speaking) were not frowned upon or forbidden (Khan 14-15); fortunately, my husband appreciated my passion for research and gave me his trust and support. This, along with the Muslim community’s support (interviews), and the wider community’s recognition (for example, the publication of my letters in Australian newspapers, interviews on radio and television) enabled me to develop my self-esteem and built up my bicultural identity as a Muslim in a predominantly Christian country and as a Bangladeshi-Australian. In 2005, for the sake of a better job opportunity, my husband moved to the UK, but this time I asserted that I would not move again. I felt that here in Australia (now in Perth) I had a job, an identity and a home. This time my husband was able to secure a good job back in Australia and was only away for a year. I no longer dream of finding a home in the Middle East. Through my bicultural identity here in Australia I feel connected to the wider community and to the Muslim umma. However, my attachment to the umma has become ambivalent. I feel proud of my Australian-Muslim identity but I am concerned about the jihadi ideology of militant Muslims. By jihadi ideology, I mean the extremist ideology of the al-Qaeda terrorist group (Farrar 2007). The Muslim umma now incorporates both moderate and radical Muslims. The radical Muslims (though only a tiny minority of 1.4 billion Muslims worldwide) pose a threat to their moderate counterparts as well as to non-Muslims. In the UK, some second- and third-generation Muslims identify themselves with the umma rather than their parents’ homelands or their country of birth (Husain). It should not be a matter of concern if these young Muslims adopt a ‘pure’ Muslim identity, providing at the same time they are loyal to their country of residence. But when they resort to terrorism with their ‘pure’ Muslim identity (e.g., the 7/7 London bombers) they defame my religion Islam, and undermine my spiritual connection to the umma. As a 1st generation immigrant, the defining criteria of my ‘homeliness’ in Australia are my ethno-cultural and religious identity (which includes my family), my active citizenship, and my community development/contribution through my research work – all of which allow me a sense of efficacy in my life. My ethnic and religious identities generally co-exist equally, but when I see some Muslims kill my fellow Australians (such as the Bali bombings in 2002 and 2005) my Australian identity takes precedence. I feel for the victims and condemn the perpetrators. On the other hand, when I see politics play a role over the human rights issues (e.g., the Tampa incident), my religious identity begs me to comment on it (see Kabir, Muslims in Australia 295-305). Problematising ‘Home’ for Muslim Australians In the European context, Grillo (863) and Werbner (904), and in the Australian context, Kabir (Muslims in Australia) and Poynting and Mason, have identified the diversity within Islam (national, ethnic, religious etc). Werbner (904) notes that in spite of the “wishful talk of the emergence of a ‘British Islam’, even today there are Pakistani, Bangladeshi and Arab mosques, as well as Turkish and Shia’a mosques”; thus British Muslims retain their separate identities. Similarly, in Australia, the existence of separate mosques for the Bangladeshi, Pakistani, Arab and Shia’a peoples indicates that Australian Muslims have also kept their ethnic identities discrete (Saeed 64-77). However, in times of crisis, such as the Salman Rushdie affair in 1989, and the 1990-1991 Gulf crises, both British and Australian Muslims were quick to unite and express their Islamic identity by way of resistance (Kabir, Muslims in Australia 160-162; Poynting and Mason 68-70). In both British and Australian contexts, I argue that a peaceful rally or resistance is indicative of active citizenship of Muslims as it reveals their sense of belonging (also Werbner 905). So when a transmigrant Muslim wants to make a peaceful demonstration, the Western world should be encouraged, not threatened – as long as the transmigrant’s allegiances lie also with the host country. In the European context, Grillo (868) writes: when I asked Mehmet if he was planning to stay in Germany he answered without hesitation: ‘Yes, of course’. And then, after a little break, he added ‘as long as we can live here as Muslims’. In this context, I support Mehmet’s desire to live as a Muslim in a non-Muslim world as long as this is peaceful. Paradoxically, living a Muslim life through ijtihad can be either socially progressive or destructive. The Canadian Muslim feminist Irshad Manji relies on ijtihad, but so does Osama bin Laden! Manji emphasises that ijtihad can be, on the one hand, the adaptation of Islam using independent reasoning, hybridity and the contesting of ‘traditional’ family values (c.f. Doogue and Kirkwood 275-276, 314); and, on the other, ijtihad can take the form of conservative, patriarchal and militant Islamic values. The al-Qaeda terrorist Osama bin Laden espouses the jihadi ideology of Sayyid Qutb (1906-1966), an Egyptian who early in his career might have been described as a Muslim modernist who believed that Islam and Western secular ideals could be reconciled. But he discarded that idea after going to the US in 1948-50; there he was treated as ‘different’ and that treatment turned him against the West. He came back to Egypt and embraced a much more rigid and militaristic form of Islam (Esposito 136). Other scholars, such as Cesari, have identified a third orientation – a ‘secularised Islam’, which stresses general beliefs in the values of Islam and an Islamic identity, without too much concern for practices. Grillo (871) observed Islam in the West emphasised diversity. He stressed that, “some [Muslims were] more quietest, some more secular, some more clamorous, some more negotiatory”, while some were exclusively characterised by Islamic identity, such as wearing the burqa (elaborate veils), hijabs (headscarves), beards by men and total abstinence from drinking alcohol. So Mehmet, cited above, could be living a Muslim life within the spectrum of these possibilities, ranging from an integrating mode to a strict, militant Muslim manner. In the UK context, Zubaida (96) contends that marginalised, culturally-impoverished youth are the people for whom radical, militant Islamism may have an appeal, though it must be noted that the 7/7 bombers belonged to affluent families (O’Sullivan 14; Husain). In Australia, Muslim Australians are facing three challenges. First, the Muslim unemployment rate: it was three times higher than the national total in 1996 and 2001 (Kabir, Muslims in Australia 266-278; Kabir, “What Does It Mean” 63). Second, some spiritual leaders have used extreme rhetoric to appeal to marginalised youth; in January 2007, the Australian-born imam of Lebanese background, Sheikh Feiz Mohammad, was alleged to have employed a DVD format to urge children to kill the enemies of Islam and to have praised martyrs with a violent interpretation of jihad (Chulov 2). Third, the proposed citizenship test has the potential to make new migrants’ – particularly Muslims’ – settlement in Australia stressful (Kabir, “What Does It Mean” 62-79); in May 2007, fuelled by perceptions that some migrants – especially Muslims – were not integrating quickly enough, the Howard government introduced a citizenship test bill that proposes to test applicants on their English language skills and knowledge of Australian history and ‘values’. I contend that being able to demonstrate knowledge of history and having English language skills is no guarantee that a migrant will be a good citizen. Through my transmigrant history, I have learnt that developing a bond with a new place takes time, acceptance and a gradual change of identity, which are less likely to happen when facing assimilationist constraints. I spoke English and studied history in the United States, but I did not consider it my home. I did not speak the Arabic language, and did not study Middle Eastern history while I was in the Middle East, but I felt connected to it for cultural and religious reasons. Through my knowledge of history and English language proficiency I did not make Australia my home when I first migrated to Australia. Australia became my home when I started interacting with other Australians, which was made possible by having the time at my disposal and by fortunate circumstances, which included a fairly high level of efficacy and affluence. If I had been rejected because of my lack of knowledge of ‘Australian values’, or had encountered discrimination in the job market, I would have been much less willing to embrace my host country and call it home. I believe a stringent citizenship test is more likely to alienate would-be citizens than to induce their adoption of values and loyalty to their new home. Conclusion Blunt (5) observes that current studies of home often investigate mobile geographies of dwelling and how it shapes one’s identity and belonging. Such geographies of home negotiate from the domestic to the global context, thus mobilising the home beyond a fixed, bounded and confining location. Similarly, in this paper I have discussed how my mobile geography, from the domestic (root) to global (route), has shaped my identity. Though I received a degree of culture shock in the United States, loved the Middle East, and was at first quite resistant to the idea of making Australia my second home, the confidence I acquired in residing in these ‘several homes’ were cumulative and eventually enabled me to regard Australia as my ‘home’. I loved the Middle East, but I did not pursue an active involvement with the Arab community because I was a busy mother. Also I lacked the communication skill (fluency in Arabic) with the local residents who lived outside the expatriates’ campus. I am no longer a cultural freak. I am no longer the same Bangladeshi woman who saw her ethnic and Islamic culture as superior to all other cultures. I have learnt to appreciate Australian values, such as tolerance, ‘a fair go’ and multiculturalism (see Kabir, “What Does It Mean” 62-79). My bicultural identity is my strength. With my ethnic and religious identity, I can relate to the concerns of the Muslim community and other Australian ethnic and religious minorities. And with my Australian identity I have developed ‘a voice’ to pursue active citizenship. Thus my biculturalism has enabled me to retain and merge my former home with my present and permanent home of Australia. References Anderson, Benedict. Imagined Communities: Reflections on the Origin and Spread of Nationalism. London, New York: Verso, 1983. Australian Bureau of Statistics: Census of Housing and Population, 1996 and 2001. Blunt, Alison. Domicile and Diaspora: Anglo-Indian Women and the Spatial Politics of Home. 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Poynting, Scott, and Victoria Mason. “The Resistible Rise of Islamophobia: Anti-Muslim Racism in the UK and Australia before 11 September 2001.” Journal of Sociology 43.1 (2007): 61-86. Saeed, Abdallah. Islam in Australia. Sydney: Allen and Unwin, 2003. Smith, Anthony D. National Identity. Harmondsworth: Penguin, 1991. Spencer, Philip, and Howard Wollman. Nationalism: A Critical Introduction. London: Sage, 2002. Vertovec, Stevens. The Hindu Diaspora: Comparative Patterns. London: Routledge. 2000. Werbner, Pnina, “Theorising Complex Diasporas: Purity and Hybridity in the South Asian Public Sphere in Britain.” Journal of Ethnic and Migration Studies 30.5 (2004): 895-911. Wood, Dennis. “The Diaspora, Community and the Vagrant Space.” In Cynthia Vanden Driesen and Ralph Crane, eds., Diaspora: The Australasian Experience. New Delhi: Prestige, 2005. 59-64. Zubaida, Sami. “Islam in Europe: Unity or Diversity.” Critical Quarterly 45.1-2 (2003): 88-98. Citation reference for this article MLA Style Kabir, Nahid. "Why I Call Australia ‘Home’?: A Transmigrant’s Perspective." M/C Journal 10.4 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0708/15-kabir.php>. APA Style Kabir, N. (Aug. 2007) "Why I Call Australia ‘Home’?: A Transmigrant’s Perspective," M/C Journal, 10(4). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0708/15-kabir.php>.

Background: Quality of Life (QoL) is affected by many factors such as age, sex, mental health, relationships, economic status, sociodemographic characteristics and stress. The COVID-19 pandemic is a stressful factor globally, which may affect QoL. Therefore, this study assessed the QoL among the adult population during the COVID-19 pandemic in Saudi Arabia. Methodology: This cross-sectional study evaluated the QoL in the general population of Saudi Arabia during the COVID-19 pandemic using the World Health Organization Quality of Life-BREF questionnaire. A p-value <0.05 was considered to be statistically significant. Ethical approval was obtained from the Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. Results: A total of 1,978 participants were recruited from across the Kingdom of Saudi Arabia. Half of the participants were women (1136, 57.4%). Most (1,890, 95.6%) were Saudis. Half of the participants had good QoL in the physical, psychological, social, and environment domains, representing 1,104 (55.8%), 1143 (57.8%), 1,233 (62.3%), and 1,022 (51.7%), respectively. A significant association was noticed between age/BMI and the physical domain (p-values of 0.001 and 0.001, respectively). Conclusion: The COVID-19 pandemic has affected QoL in many aspects. Women, university and below students; widowed, separated, and divorced people; the retired; people not working in the medical field and people with a chronic disease reported poor QoL. Key words: Quality of life, COVID-19 pandemic, general population, Saudi Arabia, Adult.

Healthcare workers face several threats when they practice their daily work. These factors can impact their occupational health and safety and negatively impact patient health care by reducing quality health care in the health sector. The purpose of this study is to provide a mini-review of the previous studies about some factors that can considerably impact occupational health and safety for the healthcare team. These factors are physical and psychological aspects. The authors individually completed a literature review for this article via an independent study followed by a collaborative discussion. The authors researched available sources to provide some results about these factors and how they can reduce the level of occupational health and safety for the health team provider and the safe and sound delivery of quality care for the patient. The results of this mini-review indicated that the physical and psychological aspects of the health team workers significantly impact the level of occupational health and safety, which can dramatically affect patient care. Therefore, early and proper educational courses and stress roles are necessary to reduce or even eliminate these factors, which cause negatively influence the occupational health and safety of the staff the patient care, as well as increase the burden on the health organization. This requires a multidisciplinary management approach to meet occupational health and safety requirements. Future research should concentrate on these factors to increase the health care provider’s awareness about maintaining their occupational health and safety during their duty and examine some policy that helps reduce these impacts.

Healthcare workers face several threats when they practice their daily work. These factors can impact their occupational health and safety and negatively impact patient health care by reducing quality health care in the health sector. The purpose of this study is to provide a mini-review of the previous studies about some factors that can considerably impact occupational health and safety for the healthcare team. These factors are physical and psychological aspects. The authors individually completed a literature review for this article via an independent study followed by a collaborative discussion. The authors researched available sources to provide some results about these factors and how they can reduce the level of occupational health and safety for the health team provider and the safe and sound delivery of quality care for the patient. The results of this mini-review indicated that the physical and psychological aspects of the health team workers significantly impact the level of occupational health and safety, which can dramatically affect patient care. Therefore, early and proper educational courses and stress roles are necessary to reduce or even eliminate these factors, which cause negatively influence the occupational health and safety of the staff the patient care, as well as increase the burden on the health organization. This requires a multidisciplinary management approach to meet occupational health and safety requirements. Future research should concentrate on these factors to increase the health care provider’s awareness about maintaining their occupational health and safety during their duty and examine some policy that helps reduce these impacts.

Abstract Background Female cosmetic genital surgery (FCGS) aims for better aesthetic genital appearance and improved functional aspects to enhance women’s self-esteem and satisfaction. Objectives This study aims to assess the satisfaction of women who have undergone FCGS and its impact on their sexual, psychological, and aesthetic aspects. Methods An observational cross-sectional study was conducted in private clinics in Riyadh, Kingdom of Saudi Arabia, between March and June 2019, in women who underwent FCGS. Phone interviews were conducted in the Arabic language. The survey comprised 4 sections: demographics, motives for FCGS, quality-of-life questionnaires about genital appearance satisfaction, and sexual function. Results Out of the 196 women undergoing FCGS during the study period, 11.7% refused to participate, and 37.2% did not answer phone calls; 51% of the women participated in the study. The women’s age ranged between 23 and 55 years; 64% underwent vaginoplasty, and 73% underwent other cosmetic procedures. Ninety-two percent of the women did not have any complications after these procedures. Conclusions In this group of women, FCGS was safe and effective, and the majority of participants reported overall satisfaction and improvement of sexual function, genital appearance, and self-esteem. Level of Evidence: 4

BackgroundThe current (coronavirus disease 2019 [COVID-19]) pandemic is still uncontrolled with associated dramatic changes in daily lifestyle activities. Evidence for studying the impact of these health behavior changes on our mental health is limited. Therefore, this study aimed to estimate the prevalence of psychological distresses and assess their influence by the change in the composite lifestyle behaviors before the COVID-19 pandemic till 16 weeks after the lockdown release in Saudi Arabia.MethodsThis cross-sectional study was conducted between October 10 and 31, 2020 by posting an online survey on social media platforms (WhatsApp and Twitter) to collect data on participants' sociodemographic, lifestyle behaviors, and mental health aspects using a validated Arabic version of the short-form version of the Depression Anxiety Stress Scales-21 (DASS-21).ResultsA total of 363 responded to the questionnaire. The mean age was 36.26 ± 8.54 years, and 238 (65.6%) were men. Depression, stress, and anxiety were reported in 37.5, 26.7, and 16.5% of the participants, respectively. Negative lifestyle behavioral changes were significantly associated with stress and anxiety (p &lt; 0.05). Logistic regression revealed that financial distress and history of psychiatric illnesses were common significant factors for developing the psychological distresses.ConclusionThroughout the post-lockdown stage of the COVID-19 outbreak in Saudi Arabia, there was an evidence of psychological distresses among the adults. Negative health-related changes are directly linked with increased psychological distress. Effective health promotion strategies directed toward adopting and maintaining positive change in the composite health behaviors are crucial.

Aim: The importance of physical activities to individuals of all ages is not up for discussion because the medical and physiological impact is widely known and understood. Furthermore, it is important to avoid sedentary behavior or lifestyle for a long period. Quarantine is the separation and restriction of movement and direct contact of people who have a potential risk of a contagious disease. This differs from isolation in which isolation is a medical separation of people diagnosed with an infectious disease and carries a real risk of spreading the disease to others. The potential health drawbacks of the mandatory mass quarantine need to be highlighted from different prospective related to medical conditions, psychological effects, physical de-conditioning, and obesity. As the restriction of movement and prolonged homestay directly reflects the time, duration, and type of physical activity, it is expected that these factors will decline in the majority of the quarantined community. Material and Method: This study was designed to investigate the quarantine impact on physical activity and related aspects.A cross-sectional, analytical, comparative study using an anonymous electronic survey to the general population aged 20 to 60 years was done in which it showed a self-reported change. The survey covered aspects related to physical activity, sleeping hours, weight changes, and the rate of food intake before and during COVID-19 quarantine. Results: The response rate was 54%. The result shows a trend of an increase in weight of 56.50% and an increase in sleeping hours. Simultaneously, there is a trend of decreasing physical activities both in walking and in gym work of 42.4 and 41.3 percent, respectively. Conclusion: There is an effect on physical status. The co-factors such as the rate of food intake and sleeping also affect the total body status. With the prolonged quarantine, these figures are subject to increase consequently and the drawback on health status may drop to a considerably large percentage in the community.

Objectives: The study aims to explore individual's QoL during COVID-19’s imposed partial curfew in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted. A total of 1353 adult participants completed the World Health Organization Quality of Life - BREF online questionnaire during COVID-19’s imposed curfew. Pearson correlation and one-way ANOVA was conducted to examine the association between the QoL domains, and to examine the association between the QoL domains and sociodemographic characteristics, respectively. Results: The findings showed that social and environmental QoL were the most affected by the pandemic. Sociodemographic characteristics played a role in shaping differences in QoL among the four dimensions of QoL. Men, non-Saudis, private sector employees, and people with income below SAR5,000 reported the lowest QoL. Conclusion: The COVID-19 pandemic changed people’s lives, their activities and relationships. It affected their QoL in different dimensions and based on specific sociodemographic characteristics. The study findings have implications for policymakers to tailor programs that focus on the different aspects of QoL including social, environmental, physical and psychological domains.

Background: Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine health-related quality of life (HRQOL) and its predictors in patients with type 2 diabetes. Methods: A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. Results: Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor’s degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). Conclusion: Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

Background: In the Gulf Cooperation Council (GCC) countries (Kuwait, Qatar, Saudi Arabia, Bahrain, United Arab Emirates, and Oman), as in the rest of the world, the COVID-19 has been spreading since 2019, and it had a significant impact on various aspects of life. The outbreak and the restrictive measures imposed by countries to stop the spread of the virus could harm the mental health condition of the general population. This cross-sectional study aims to assess the impact of the pandemic on mental health and investigate the potential risk factors.Methods: An online survey was collected from individuals in GCC countries from May to October 2020. The final sample included 14,171 participants, 67.3% females and 60.4% younger than 35 years old. The survey consisted of depression, Anxiety, Insomnia, and post-traumatic stress questionnaires. Crude and adjusted Odds ratios are calculated using simple and multivariable logistic regressions to investigate the association between risk factors and mental health issues.Results: Endorsement rates for depression were 11,352 (80.1%), 9,544 (67.3%) for anxiety, 8,845 (63.9%) for insomnia and 9,046 (65.2%) for post-traumatic stress. Being female and younger age were associated with a higher likelihood of developing depression, anxiety, insomnia, and post-traumatic stress. In addition, participants with underlying psychological problems were three times more likely to develop depressive and post-traumatic stress symptoms.Conclusion: According to the findings, women, youth, singles, divorced individuals, and individuals with pre-existing psychological and medical conditions are subject to a higher risk of mental health problems during the pandemic, which policy-makers should consider when imposing restrictive measures.

Background. Autism is a neurological and developmental disorder. Children with autism have problems related to physical, psychological, and mental barriers that can hinder their ability to achieve optimal dental health status. Maintaining the dental health of children with autism is influenced by parents' teaching skills and habits. From previous study, there were about 17.4% children with autism in Saudi Arabia suffering from bleeding of the gingiva. Periodontal disease is often found in children with autism. Objective. This study analyzes the relationship between mother’s behavior with periodontal status and periodontal treatment needs of children with autism. Methods. Analytical observational study with cross-sectional approach at AGCA Centre Surabaya with a total sample of 34 pairs of children with autism and their mothers. This study used the HU-DBI questionnaire which consisted of knowledge, attitude, and mother’s action and oral examination of children with autism with the CPITN index. Results. Of the children with autism, 55.8% had healthy periodontal status. The knowledge, attitudes, and actions of mothers were high. Statistical results with Spearmen correlation test obtained a value of p>0.05 on aspects of knowledge, attitudes, and actions towards the CPITN index and periodontal treatment needs. Conclusion. There was no significant correlation between the mother’s behavior and the periodontal status and periodontal treatment needs of children with autism in managing their oral health.

This qualitative study was conducted to explore the factors affecting Qassim University EFL students’ acquisition of English language speaking skills. Thirty students enrolled in the Intensive Course Program (ICP) in the English Language and Translation Department of the Sciences and Arts College in Unaizah, Saudi Arabia, participated in this study. Information on the factors affecting students’ acquisition of English Language speaking skills was gathered using semi-structured interviews with students who were usually active participants in the classroom. A qualitative content analysis was used to analyze the interview-generated data. The qualitative data was interpreted using manual coding, which requires thoroughly in-depth reading of the transcripts and assigning codes and themes. The findings of the study revealed that Qassim University EFL students’ acquisition of English language speaking skills is affected by a variety of factors including psychological factors such as motivation, lack of confidence, second language anxiety, shyness and introversion, pedagogical factors like classmates’ behaviors, teaching methods and materials, instructor’s feedback, classroom atmosphere, topical knowledge and interest, class size, and linguistic factors such grammatical understanding, vocabulary knowledge, and correct pronunciation. It can therefore be assumed that the factors affecting English language speaking acquisition among EFL students have to be considered within multidimensional aspects rather than simply originating from students themselves. In light of the findings, some pedagogical implications were offered, as well as suggestions for future research.

Abstract Background Mentoring plays a pivotal role in workplace-based learning, especially in the medical realm. Organising a formal mentoring programme can be labor and time intensive and generally impractical in resource constrained medical schools with limited numbers of mentors. Hence, informal mentoring offers a valuable alternative, but will be more likely to be effective when mentors and protégés share similar views. It is therefore important to gain more insight into factors influencing perceptions of informal mentoring. This study aims to explore mentors and protégés’ perceptions of informal mentoring and how these vary (or not) with gender, age and the duration of the relationship. Method We administered an Informal Mentor Role Instrument (IMRI) to medical practitioners and academics from Egypt, Pakistan and Saudi Arabia. The questionnaire was developed for the study from other validated instruments. It contained 39 items grouped into 7 domains: acceptance, counselling, friendship, parenting, psychological support, role modelling and sociability. Results A total of 103 mentors and 91 protégés completed the IMRI. Mentors had a better appreciation for the interpersonal aspects of informal mentoring than protégés, especially regarding acceptance, counselling and friendship. Moreover, being older and engaged in a longer mentoring relationship contributed to more positive perceptions of interpersonal aspects of mentoring, regardless of one’s role (mentor or protégé). Conclusion It can be concluded that the expectations of mentors and protégés differed regarding the content and aim of the interpersonal characteristics of their mentoring relationship. We recommend mentors and protégés to more explicitly exchange their expectations of the informal mentoring relationship, as typically practiced in formal mentoring. Additionally, in our study, seniority and lasting relationships seem crucial for good informal mentoring. It appears beneficial to foster lasting informal mentoring relationships and to give more guidance to younger mentors.

The article discusses the features of the scientific and methodological study of the regulatory role of fatwas used in the deradicalization of the population in Muslim countries. The object of the study is the fatwas issued by the ulema of Egypt, Turkey, and the Kingdom of Saudi Arabia and aimed at deradicalization of the people’s opinions. The subject of the study is the regulatory role and processes of applying fatwas to deradicalize the population of these countries. The study of the subject covers historical, theological, legal, socio-psychological, and political aspects, and to solve the tasks set, several scientific approaches and methods are required. The importance of applying theological and academic approaches is substantiated. According to the theological approach, social and all other processes are explained from the divine point of view. The corresponding norms of religious sources are studied. Each source of the chosen fatwa - sura, verse of the Koran, hadith, or the conclusion of authoritative ulema is subject to analysis and consideration primarily from a theological point of view. However, this approach will not give applied conclusions if the research, along with the theological aspect, involves the issue of radicalization, which requires the study of socio-political, economic, psychological, and other features of the object and subject of research. We think that with the theological approach, it is important to apply the academic approach in Islamic studies. One of the components of the scientific and methodological basis of this study is the comparative method. This method helps to identify the general forms, types, and effectiveness of fatwas. It is necessary to apply the genetic method - a method of studying social phenomena based on an analysis of their development to determine the features of the creation of fatwas. The application of this scientific method allows us to establish the primary problem - a misunderstanding or a controversial situation on a particular religious issue, on which it is necessary to issue a fatwa. Therefore, for in-depth analysis, it is advisable to apply the narrative method, the method of content analysis, and the empirical approach.

<b><i>Introduction:</i></b> In Saudi Arabia (SA), the most important issue for senior students during their modules and hospital training is choosing a medical specialty. Because many factors influence this process, the primary goal of this study was to determine participants’ preferred specialty, location, and other influencing factors. <b><i>Materials and Methods:</i></b> This cross-sectional study involved 6th-year students from the medical schools in Taif city, SA, conducted from November 2020 to June 2021. Baseline characteristics, specialties of interest, place, and psychological aspects of their interests were all evaluated via a self-reported questionnaire. <b><i>Results:</i></b> One hundred forty of 200 surveyed students responded (70% response rate). About 44.3% were females, and 55.7% were male, with a mean grade point average of 3.5/4.0 and were all from Taif University. Nearly 86.4% were interested in SA’s local training programs, and the most preferred hospital for residency program was the Ministry of Health (37.1%), while the most preferred region inside SA was the western region (61.4%). The preferred medical specialties were family medicine followed by ENT, yet 2% were undecided about their future specialty. The most common factor that influenced the students to choose the location for training was quality of training (41.4%), followed by the cooperation of the hospital staff with new trainees (30%). <b><i>Conclusion:</i></b> The majority of medical interns preferred to complete their residency or postgraduate studies in SA, according to the findings of the study. Family medicine and ENT were the most common specialties, regardless of gender. Students’ career decisions are influenced by several factors. Future research that can help create a more accurate career-counseling model and improve successful career-counseling strategies will need to address these factors.

Stand-up is a global phenomenon. It is Australia’s most significant form of advocatorial theatre and a major platform for challenging stigma and prejudice. In the twenty-first century, Australian stand-up is transforming into a more culturally diverse form and extending the spectrum of material addressing human rights. Since the 1980s Australian stand-up routines have moved beyond the old colonial targets of England and America, and Indigenous comics such as Kevin Kopinyeri, Andy Saunders, and Shiralee Hood have gained an established following. Additionally, the turn to Asia is evident not just in trade agreements and the higher education market but also in cultural exchange and in the billing of emerging Asian stand-ups at mainstream events. The major cultural driver for stand-up is the Melbourne International Comedy Festival (MICF), Australia’s largest cultural event, now over 30 years old, and an important site for dissecting constructs of democracy and nationhood. As John McCallum has observed, popular humour in post-World War II Australia drew on widespread feelings of “displacement, migration and otherness—resonant topics in a country of transplanted people and a dispossessed indigenous population arguing over a distinct Australian identity” (205–06). This essay considers the traditional comic strategies of first and second generation immigrant stand-ups in Australia and compares them with the new wave of post 9/11 Asian-Australian and Middle-Eastern-Australian stand-ups whose personas and interrogations are shifting the paradigm. Self-identifying Muslim stand-ups challenge myths of dominant Australian identity in ways which many still find confronting. Furthermore, the theories of incongruity, superiority, and psychological release re-rehearsed in traditional humour studies, by figures such as Palmer (1994) and Morreall (2009), are predicated on models of humour which do not always serve live performance, especially stand-up with its relational dependence on audience interaction.Stand-ups who immigrated to Australia as children or whose parents immigrated and struggled against adversity are important symbols both of the Australian comedy industry and of a national self-understanding of migrant resilience and making good. Szubanski and Berger hail from earlier waves of European migrants in the 1950s and 1960s. Szubanski has written eloquently of her complex Irish-Polish heritage and documented how the “hand-me-down trinkets of family and trauma” and “the culture clash of competing responses to calamity” have been integral to the development of her comic success and the making of her Aussie characters (347). Rachel Berger, the child of Polish holocaust survivors, advertises and connects both identities on her LinkedIn page: “After 23 years as a stand-up comedian, growing up with Jewish guilt and refugee parents, Rachel Berger knows more about survival than any idiot attending tribal council on reality TV.”Anh Do, among Australia’s most famous immigrant stand-ups, identifies as one of the Vietnamese “boat people” and arrived as a toddler in 1976. Do’s tale of his family’s survival against the odds and his creation of a persona which constructs the grateful, happy immigrant clown is the staple of his very successful routine and increasingly problematic. It is a testament to the power of Do’s stand-up that many did not perceive the toll of the loss of his birth country; the grinding poverty; and the pain of his father’s alcoholism, violence, and survivor guilt until the publication of Do’s ironically titled memoir The Happiest Refugee. In fact, the memoir draws on many of the trauma narratives that are still part of his set. One of Do’s most legendary routines is the story of his family’s sea journey to Australia, told here on ABC1’s Talking Heads:There were forty of us on a nine metre fishing boat. On day four of the journey we spot another boat. As the boat gets closer we realise it’s a boatload of Thai pirates. Seven men with knives, machetes and guns get on our boat and they take everything. One of the pirates picks up the smallest child, he lifts up the baby and rips open the baby’s nappy and dollars fall out. And the pirate decides to spare the kid’s life. And that’s a good thing cos that’s my little brother Khoa Do who in 2005 became Young Australian of the Year. And we were saved on the fifth day by a big German merchant ship which took us to a refugee camp in Malaysia and we were there for around three months before Australia says, come to Australia. And we’re very glad that happened. So often we heard Mum and Dad say—what a great country. How good is this place? And the other thing—kids, as you grow up, do as much as you can to give back to this great country and to give back to others less fortunate.Do’s strategy is apparently one of genuflection and gratitude, an adoption of what McCallum refers to as an Australian post-war tradition of the comedy of inadequacy and embarrassment (210–14). Journalists certainly like to bill Do as the happy clown, framing articles about him with headlines like Rosemary Neill’s “Laughing through Adversity.” In fact, Do is direct about his gallows humour and his propensity to darkness: his humour, he says, is a means of countering racism, of “being able to win people over who might have been averse to being friends with an Asian bloke,” but Neill does not linger on this, nor on the revelation that Do felt stigmatised by his refugee origins and terrified and shamed by the crippling poverty of his childhood in Australia. In The Happiest Refugee, Do reveals that, for him, the credibility of his routines with predominantly white Australian audiences lies in the crafting of himself as an “Aussie comedian up there talking about his working-class childhood” (182). This is not the official narrative that is retold even if it is how Do has endeared himself to Australians, and ridding himself of the happy refugee label may yet prove difficult. Suren Jayemanne is well known for his subtle mockery of multiculturalist rhetoric. In his 2016 MICF show, Wu-Tang Clan Name Generator, Jayemanne played on the supposed contradiction of his Sri Lankan-Malaysian heritage against his teenage years in the wealthy suburb of Malvern in Melbourne, his private schooling, and his obsession with hip hop and black American culture. Jayemanne’s strategy is to gently confound his audiences, leading them slowly up a blind alley. He builds up a picture of how to identify Sri Lankan parents, supposedly Sri Lankan qualities such as an exceptional ability at maths, and Sri Lankan employment ambitions which he argues he fulfilled in becoming an accountant. He then undercuts his story by saying he has recently realised that his suburban background, his numerical abilities, his love of black music, and his rejection of accountancy in favour of comedy, in fact prove conclusively that he has, all along, been white. He also confesses that this is a bruising disappointment. Jayemanne exposes the emptiness of the conceits of white, brown, and black and of invented identity markers and plays on his audiences’ preconceptions through an old storyteller’s device, the shaggy dog story. The different constituencies in his audiences enjoy his trick equally, from quite different perspectives.Diana Nguyen, a second generation Vietnamese stand-up, was both traumatised and politicised by Pauline Hanson when she was a teenager. Hanson described Nguyen’s community in Dandenong as “yellow Asian people” (Filmer). Nguyen’s career as a community development worker combating racism relates directly to her activity as a stand-up: migrant stories are integral to Australian history and Nguyen hypothesises that the “Australian psyche of being invaded or taken over” has reignited over the question of Islamic fundamentalism and expresses her concern to Filmer about the Muslim youths under her care.Nguyen’s alarm about the elision of Islamic radicalism with Muslim culture drives an agenda that has led the new generation of self-identified Muslim stand-ups since 9/11. This post 9/11 world is described by Wajahat as gorged with “exaggerated fear, hatred, and hostility toward Islam and Muslim [. . . ] and perpetuated by negative discrimination and the marginalisation and exclusion of Muslims from social, political, and civic life in western societies.” In Australia, Aamer Rahman, Muhamed Elleissi, Khaled Khalafalla, and Nazeem Hussain typify this newer, more assertive form of second generation immigrant stand-up—they identify as Muslim (whether religious or not), as brown, and as Australian. They might be said to symbolise a logical response to Ghassan Hage’s famous White Nation (1998), which argues that a white supremacism underlies the mindset of the white elite in Australia. Their positioning is more nuanced than previous generations of stand-up. Nazeem Hussain’s routines mark a transformation in Australian stand-up, as Waleed Aly has argued: “ethnic comedy” has hitherto been about the parading of stereotypes for comfortable, mainstream consumption, about “minstrel characters” [. . .] but Hussain interrogates his audiences in every direction—and aggravates Muslims too. Hussain’s is the world of post 9/11 Australian Muslims. It’s about more than ethnic stereotyping. It’s about being a consistent target of political opportunism, where everyone from the Prime Minister to the Foreign Minister to an otherwise washed-up backbencher with a view on burqas has you in their sights, where bombs detonate in Western capitals and unrelated nations are invaded.Understandably, a prevalent theme among the new wave of Muslim comics, and not just in Australia, is the focus on the reading of Muslims as manifestly linked with Islamic State (IS). Jokes about mistaken identity, plane crashes, suicide bombing, and the Koran feature prominently. English-Pakistani Muslim, Shazia Mirza, gained comedy notoriety in the UK in the wake of 9/11 by introducing her routine with the words: “My name’s Shazia Mirza. At least that’s what it says on my pilot’s licence” (Bedell). Stand-ups Negin Farsad, Ahmed Ahmed, and Dean Obeidalla are all also activists challenging prevailing myths about Islam, skin colour and terrorism in America. Egyptian-American Ahmed Ahmed acquired prominence for telling audiences in the infamous Axis of Evil Comedy Tour about how his life had changed much for the worse since 9/11. Ahmed Ahmed was the alias used by one of Osama Bin Laden’s devotees and his life became on ongoing struggle with anti-terrorism officials doing security checks (he was once incarcerated) and with the FBI who were certain that the comedian was among their most wanted terrorists. Similarly, Obeidalla, an Italian-Palestinian-Muslim, notes in his TEDx talk that “If you have a Muslim name, you are probably immune to identity theft.” His narration of a very sudden experience of becoming an object of persecution and of others’ paranoia is symptomatic of a shared understanding of a post 9/11 world among many Muslim comics: “On September 10th 2001 I went to bed as a white American and I woke up an Arab,” says Obeidalla, still dazed from the seismic shift in his life.Hussain and Khalafalla demonstrate a new sophistication and directness in their stand-up, and tackle their majority white audiences head-on. There is no hint of the apologetic or deferential stance performed by Anh Do. Many of the jokes in their routines target controversial or taboo issues, which up until recently were shunned in Australian political debate, or are absent or misrepresented in mainstream media. An Egyptian-Australian born in Saudi Arabia, Khaled Khalafalla arrived on the comedy scene in 2011, was runner-up in RAW, Australia’s most prestigious open mic competition, and in 2013 won the best of the Melbourne International Comedy Festival for Devious. Khalafalla’s shows focus on racist stereotypes and identity and he uses a range of Middle Eastern and Indian accents to broach IS recruitment, Muslim cousin marriages, and plane crashes. His 2016 MICF show, Jerk, was a confident and abrasive routine exploring relationships, drug use, the extreme racism of Reclaim Australia rallies, controversial visa checks by Border Force’s Operation Fortitude, and Islamophobia. Within the first minute of his routine, he criticises white people in the audience for their woeful refusal to master Middle Eastern names, calling out to the “brown woman” in the audience for support, before lining up a series of jokes about the (mis)pronunciation of his name. Khalafalla derives his power on stage by what Oliver Double calls “uncovering.” Double contends that “one of the most subversive things stand-up can do is to uncover the unmentionable,” subjects which are difficult or impossible to discuss in everyday conversation or the broadcast media (292). For instance, in Jerk Khalafalla discusses the “whole hating halal movement” in Australia as a metaphor for exposing brutal prejudice: Let me break it down for you. Halal is not voodoo. It’s just a blessing that Muslims do for some things, food amongst other things. But, it’s also a magical spell that turns some people into fuckwits when they see it. Sometimes people think it’s a thing that can get stuck to your t-shirt . . . like ‘Oh fuck, I got halal on me’ [Australian accent]. I saw a guy the other day and he was like Fuck halal, it funds terrorism. And I was like, let me show you the true meaning of Islam. I took a lamb chop out of my pocket and threw it in his face. And, he was like Ah, what was that? A lamb chop. Oh, I fucking love lamb chops. And, I say you fool, it’s halal and he burst into flames.In effect, Khalafalla delivers a contemptuous attack on the white members of his audience, but at the same time his joke relies on those same audience members presuming that they are morally and intellectually superior to the individual who is the butt of the joke. Khalafalla’s considerable charm is a help in this tricky send-up. In 2015 the Australian Department of Defence recognised his symbolic power and invited him to join the Afghanistan Task Force to entertain the troops by providing what Doran describes as “home-grown Australian laughs” (7). On stage in Australia, Khalafalla constructs a persona which is an outsider to the dominant majority and challenges the persecution of Muslim communities. Ironically, on the NATO base, Khalafalla’s act was perceived as representing a diverse but united Australia. McCallum has pointed to such contradictions, moments where white Australia has shown itself to be a “culture which at first authenticates emigrant experience and later abrogates it in times of defiant nationalism” (207). Nazeem Hussain, born in Australia to Sri Lankan parents, is even more confrontational. His stand-up is born of his belief that “comedy protects us from the world around us” and is “an evolutionary defence mechanism” (8–9). His ground-breaking comedy career is embedded in his work as an anti-racism activist and asylum seeker supporter and shaped by his second-generation migrant experiences, law studies, community youth work, and early mentorship by American Muslim comic trio Allah Made Me Funny. He is well-known for his pioneering television successes Legally Brown and Salam Café. In his stand-up, Hussain often dwells witheringly on the failings and peculiarities of white people’s attempts to interact with him. Like all his routines, his sell-out show Fear of the Brown Planet, performed with Aamer Rahman from 2004–2008, explored casual, pathologised racism. Hussain deliberately over-uses the term “white people” in his routines as a provocation and deploys a reverse racism against his majority white audiences, knowing that many will be squirming. “White people ask me how can Muslims have fun if they don’t drink? Muslims have fun! Of course we have fun! You’ve seen us on the news.” For Hussain stand-up is “fundamentally an art of protest,” to be used as “a tool by communities and people with ideas that challenge and provoke the status quo with a spirit of counterculture” (Low 1–3). His larger project is to humanise Muslims to white Australians so that “they see us firstly as human beings” (1–3). Hussain’s 2016 MICF show, Hussain in the Membrane, both satirised media hype and hysterical racism and pushed for a better understanding of the complex problems Muslim communities face in Australia. His show also connected issues to older colonial traditions of racism. In a memorable and beautifully crafted tirade, Hussain inveighed against the 2015 Bendigo riots which occurred after local Muslims lodged an application to Bendigo council to build a mosque in the sleepy Victorian town. [YELLING in an exaggerated Australian accent] No we don’t want Muslims! NO we don’t want Muslims—to come invade Bendigo by application to the local council! That is the most bureaucratic invasion of all times. No place in history has been invaded by lodging an application to a local council. Can you see ISIS running around chasing town planners? Of course not, Muslims like to wait 6–8 months to invade! That’s a polite way to invade. What if white people invaded that way? What a better world we’d be living in. If white people invaded Australia that way, we’d be able to celebrate Australia Day on the same day without so much blood on our hands. What if Captain Cook came to Australia and said [in a British accent] Awe we would like to apply to invade this great land and here is our application. [In an Australian accent] Awe sorry, mate, rejected, but we’ll give you Bendigo.As Waleed Aly sees it, the Australian cultural majority is still “unused to hearing minorities speak with such assertiveness.” Hussain exposes “a binary world where there’s whiteness, and then otherness. Where white people are individuals and non-white people (a singular group) are not” (Aly). Hussain certainly speaks as an insider and goes so far as recognising his coloniser’s guilt in relation to indigenous Australians (Tan). Aly well remembers the hate mail he and Hussain received when they worked on Salam Café: “The message was clear. We were outsiders and should behave as such. We were not real Australians. We should know our place, as supplicants, celebrating the nation’s unblemished virtue.” Khalafalla, Rahman, Elleissi, and Hussain make clear that the new wave of comics identify as Muslim and Australian (which they would argue many in the audiences receive as a provocation). They have zero tolerance of racism, their comedy is intimately connected with their political activism, and they have an unapologetically Australian identity. No longer is it a question of whether the white cultural majority in Australia will anoint them as worthy and acceptable citizens, it is a question of whether the audiences can rise to the moral standards of the stand-ups. The power has been switched. For Hussain laughter is about connection: “that person laughs because they appreciate the point and whether or not they accept what was said was valid isn’t important. What matters is, they’ve understood” (Low 5). 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Introduction Since December 2010 the dramatic spectacle of the spread of mass uprisings, civil unrest, and protest across North Africa and the Middle East have been chronicled daily on mainstream media and new media. Broadly speaking, the Arab Spring—as it came to be known—is challenging repressive, corrupt governments and calling for democracy and human rights. The convulsive events linked with these debates have been striking not only because of the rapid spread of historically momentous mass protests but also because of the ways in which the media “have become inextricably infused inside them” enabling the global media ecology to perform “an integral part in building and mobilizing support, co-ordinating and defining the protests within different Arab societies as well as trans-nationalizing them” (Cottle 295). Images of mass protests have been juxtaposed against those of individuals prepared to self-destruct for political ends. Video clips and photographs of the individual suffering of Tunisian Mohamed Bouazizi’s self-immolation and the Bahraini Abdulhad al-Khawaja’s emaciated body foreground, in very graphic ways, political struggles that larger events would mask or render invisible. Highlighting broad commonalties does not assume uniformity in patterns of protest and media coverage across the region. There has been considerable variation in the global media coverage and nature of the protests in North Africa and the Middle East (Cottle). In Tunisia, Egypt, Libya, and Yemen uprisings overthrew regimes and leaders. In Syria it has led the country to the brink of civil war. In Bahrain, the regime and its militia violently suppressed peaceful protests. As a wave of protests spread across the Middle East and one government after another toppled in front of 24/7 global media coverage, Bahrain became the “Arab revolution that was abandoned by the Arabs, forsaken by the West … forgotten by the world,” and largely ignored by the global media (Al-Jazeera English). Per capita the protests have been among the largest of the Arab Spring (Human Rights First) and the crackdown as brutal as elsewhere. International organizations have condemned the use of military courts to trial protestors, the detaining of medical staff who had treated the injured, and the use of torture, including the torture of children (Fisher). Bahraini and international human rights organizations have been systematically chronicling these violations of human rights, and posting on Websites distressing images of tortured bodies often with warnings about the graphic depictions viewers are about to see. It was in this context of brutal suppression, global media silence, and the reluctance of the international community to intervene, that the Bahraini-Danish human rights activist Abdulhad al-Khawaja launched his “death or freedom” hunger strike. Even this radical action initially failed to interest international editors who were more focused on Egypt, Libya, and Syria, but media attention rose in response to the Bahrain Formula 1 race in April 2012. Pro-democracy activists pledged “days of rage” to coincide with the race in order to highlight continuing human rights abuses in the kingdom (Turner). As Al Khawaja’s health deteriorated the Bahraini government resisted calls for his release (Article 19) from the Danish government who requested that Al Khawaja be extradited there on “humanitarian grounds” for hospital treatment (Fisk). This article does not explore the geo-politics of the Bahraini struggle or the possible reasons why the international community—in contrast to Syria and Egypt—has been largely silent and reluctant to debate the issues. Important as they are, those remain questions for Middle Eastern specialists to address. In this article I am concerned with the overlapping and interpenetration of two ecologies. The first ecology is the ethical framing of a prison hunger strike as a corporeal-environmental act of (self) destruction intended to achieve political ends. The second ecology is the operation of global media where international inaction inadvertently foregrounds the political struggles that larger events and discourses surrounding Egypt, Libya, and Syria overshadow. What connects these two ecologies is the body of the hunger striker, turned into a spectacle and mediated via a politics of affect that invites a global public to empathise and so enter into his suffering. The connection between the two lies in the emaciated body of the hunger striker. An Ecological Humanities Approach This exploration of two ecologies draws on the ecological humanities and its central premise of connectivity. The ecological humanities critique the traditional binaries in Western thinking between nature and culture; the political and social; them and us; the collective and the individual; mind, body and emotion (Rose & Robin, Rieber). Such binaries create artificial hierarchies, divisions, and conflicts that ultimately impede the ability to respond to crises. Crises are major changes that are “out of control” driven—primarily but not exclusively—by social, political, and cultural forces that unleash “runaway systems with their own dynamics” (Rose & Robin 1). The ecological humanities response to crises is premised on the recognition of the all-inclusive connectivity of organisms, systems, and environments and an ethical commitment to action from within this entanglement. A founding premise of connectivity, first articulated by anthropologist and philosopher Gregory Bateson, is that the “unit of survival is not the individual or the species, but the organism-and-its-environment” (Rose & Robin 2). This highlights a dialectic in which an organism is shaped by and shapes the context in which it finds itself. Or, as Harries-Jones puts it, relations are recursive as “events continually enter into, become entangled with, and then re-enter the universe they describe” (3). This ensures constantly evolving ecosystems but it also means any organism that “deteriorates its environment commits suicide” (Rose & Robin 2) with implications for the others in the eco-system. Bateson’s central premise is that organisms are simultaneously independent, as separate beings, but also interdependent. Interactions are not seen purely as exchanges but as dynamic, dialectical, dialogical, and mutually constitutive. Thus, it is presumed that the destruction or protection of others has consequences for oneself. Another dimension of interactions is multi-modality, which implies that human communication cannot be reduced to a single mode such as words, actions, or images but needs to be understood in the complexity of inter-relations between these (see Rieber 16). Nor can dissemination be reduced to a single technological platform whether this is print, television, Internet, or other media (see Cottle). The final point is that interactions are “biologically grounded but not determined” in that the “cognitive, emotional and volitional processes” underpinning face-to-face or mediated communication are “essentially indivisible” and any attempt to separate them by privileging emotion at the expense of thought, or vice versa, is likely to be unhealthy (Rieber 17). This is most graphically demonstrated in a politically-motivated hunger strike where emotion and volition over-rides the survivalist instinct. The Ecology of a Prison Hunger Strike The radical nature of a hunger strike inevitably gives rise to medico-ethical debates. Hunger strikes entail the voluntary refusal of sustenance by an individual and, when prolonged, such deprivation sets off a chain reaction as the less important components in the internal body systems shut down to protect the brain until even that can no longer be protected (see Basoglu et al). This extreme form of protest—essentially an act of self-destruction—raises ethical issues over whether or not doctors or the state should intervene to save a life for humanitarian or political reasons. In 1975 and 1991, the World Medical Association (WMA) sought to negotiate this by distinguishing between, on the one hand, the mentally/psychological impaired individual who chooses a “voluntary fast” and, on the other hand, the hunger striker who chooses a form of protest action to secure an explicit political goal fully aware of fatal consequences of prolonged action (see Annas, Reyes). This binary enables the WMA to label the action of the mentally impaired suicide while claiming that to do so for political protesters would be a “misconception” because the “striker … does not want to die” but to “live better” by obtaining certain political goals for himself, his group or his country. “If necessary he is willing to sacrifice his life for his case, but the aim is certainly not suicide” (Reyes 11). In practice, the boundaries between suicide and political protest are likely to be much more blurred than this but the medico-ethical binary is important because it informs discourses about what form of intervention is ethically appropriate. In the case of the “suicidal” the WMA legitimises force-feeding by a doctor as a life-saving act. In the case of the political protestor, it is de-legitimised in discourses of an infringement of freedom of expression and an act of torture because of the pain involved (see Annas, Reyes). Philosopher Michel Foucault argued that prison is a key site where the embodied subject is explicitly governed and where the exercising of state power in the act of incarceration means the body of the imprisoned no longer solely belongs to the individual. It is also where the “body’s range of significations” is curtailed, “shaped and invested by the very forces that detain and imprison it” (Pugliese 2). Thus, prison creates the circumstances in which the incarcerated is denied the “usual forms of protest and judicial safeguards” available outside its confines. The consequence is that when presented with conditions that violate core beliefs he/she may view acts of self-destruction—such as hunger strikes or lip sewing—as one of the few “means of protesting against, or demanding attention” or achieving political ends still available to them (Reyes 11; Pugliese). The hunger strike implicates the state, which, in the act of imprisoning, has assumed a measure of power and responsibility for the body of the individual. If a protest action is labelled suicidal by medical professionals—for instance at Guantanamo—then the force-feeding of prisoners can be legitimised within the WMA guidelines (Annas). There is considerable political temptation to do so particularly when the hunger striker has become an icon of resistance to the state, the knowledge of his/her action has transcended prison confines, and the alienating conditions that prompted the action are being widely debated in the media. This poses a two-fold danger for the state. On the one hand, there is the possibility that the slow emaciation and death while imprisoned, if covered by the media, may become a spectacle able to mobilise further resistance that can destabilise the polity. On the other hand, there is the fear that in the act of dying, and the spectacle surrounding death, the hunger striker would have secured the public attention to the very cause they are championing. Central to this is whether or not the act of self-destruction is mediated. It is far from inevitable that the media will cover a hunger strike or do so in ways that enable the hunger striker’s appeal to the emotions of others. However, when it does, the international scrutiny and condemnation that follows may undermine the credibility of the state—as happened with the death of the IRA member Bobby Sands in Northern Ireland (Russell). The Media Ecology and the Bahrain Arab Spring The IRA’s use of an “ancient tactic ... to make a blunt appeal to sympathy and emotion” in the form of the Sands hunger strike was seen as “spectacularly successful in gaining worldwide publicity” (Willis 1). Media ecology has evolved dramatically since then. Over the past 20 years communication flows between the local and the global, traditional media formations (broadcast and print), and new communication media (Internet and mobile phones) have escalated. The interactions of the traditional media have historically shaped and been shaped by more “top-down” “politics of representation” in which the primary relationship is between journalists and competing public relations professionals servicing rival politicians, business or NGOs desire for media attention and framing issues in a way that is favourable or sympathetic to their cause. However, rapidly evolving new media platforms offer bottom up, user-generated content, a politics of connectivity, and mobilization of ordinary people (Cottle 31). However, this distinction has increasingly been seen as offering too rigid a binary to capture the complexity of the interactions between traditional and new media as well as the events they capture. The evolution of both meant their content increasingly overlaps and interpenetrates (see Bennett). New media technologies “add new communicative ingredients into the media ecology mix” (Cottle 31) as well as new forms of political protests and new ways of mobilizing dispersed networks of activists (Juris). Despite their pervasiveness, new media technologies are “unlikely to displace the necessity for coverage in mainstream media”; a feature noted by activist groups who have evolved their own “carnivalesque” tactics (Cottle 32) capable of creating the spectacle that meets television demands for action-driven visuals (Juris). New media provide these groups with the tools to publicise their actions pre- and post-event thereby increasing the possibility that mainstream media might cover their protests. However there is no guarantee that traditional and new media content will overlap and interpenetrate as initial coverage of the Bahrain Arab Spring highlights. Peaceful protests began in February 2011 but were violently quelled often by Saudi, Qatari and UAE militia on behalf of the Bahraini government. Mass arrests were made including that of children and medical personnel who had treated those wounded during the suppression of the protests. What followed were a long series of detentions without trial, military court rulings on civilians, and frequent use of torture in prisons (Human Rights Watch 2012). By the end of 2011, the country had the highest number of political prisoners per capita of any country in the world (Amiri) but received little coverage in the US. The Libyan uprising was afforded the most broadcast time (700 minutes) followed by Egypt (500 minutes), Syria (143), and Bahrain (34) (Lobe). Year-end round-ups of the Arab Spring on the American Broadcasting Corporation ignored Bahrain altogether or mentioned it once in a 21-page feature (Cavell). This was not due to a lack of information because a steady stream has flowed from mobile phones, Internet sites and Twitter as NGOs—Bahraini and international—chronicled in images and first-hand accounts the abuses. However, little of this coverage was picked up by the US-dominated global media. It was in this context that the Bahraini-Danish human rights activist Abdulhad Al Khawaja launched his “freedom or death” hunger strike in protest against the violent suppression of peaceful demonstrations, the treatment of prisoners, and the conduct of the trials. Even this radical action failed to persuade international editors to cover the Bahrain Arab Spring or Al Khawaja’s deteriorating health despite being “one of the most important stories to emerge over the Arab Spring” (Nallu). This began to change in April 2012 as a number of things converged. Formula 1 pressed ahead with the Bahrain Grand Prix, and pro-democracy activists pledged “days of rage” over human rights abuses. As these were violently suppressed, editors on global news desks increasingly questioned the government and Formula 1 “spin” that all was well in the kingdom (see BBC; Turner). Claims by the drivers—many of who were sponsored by the Bahraini government—that this was a sports event, not a political one, were met with derision and journalists more familiar with interviewing superstars were diverted into covering protests because their political counterparts had been denied entry to the country (Fisk). This combination of media events and responses created the attention, interest, and space in which Al Khawaja’s deteriorating condition could become a media spectacle. The Mediated Spectacle of Al Khawaja’s Hunger Strike Journalists who had previously struggled to interest editors in Bahrain and Al Khawaja’s plight found that in the weeks leading up to the Grand Prix and since “his condition rapidly deteriorated”’ and there were “daily updates with stories from CNN to the Hindustan Times” (Nulla). Much of this mainstream news was derived from interviews and tweets from Al Khawaja’s family after each visit or phone call. What emerged was an unprecedented composite—a diary of witnesses to a hunger strike interspersed with the family’s struggles with the authorities to get access to him and their almost tangible fear that the Bahraini government would not relent and he would die. As these fears intensified 48 human rights NGOs called for his release from prison (Article 19) and the Danish government formally requested his extradition for hospital treatment on “humanitarian grounds”. Both were rejected. As if to provide evidence of Al Khawaja’s tenuous hold on life, his family released an image of his emaciated body onto Twitter. This graphic depiction of the corporeal-environmental act of (self) destruction was re-tweeted and posted on countless NGO and news Websites (see Al-Jazeera). It was also juxtaposed against images of multi-million dollar cars circling a race-track, funded by similarly large advertising deals and watched by millions of people around the world on satellite channels. Spectator sport had become a grotesque parody of one man’s struggle to speak of what was going on in Bahrain. In an attempt to silence the criticism the Bahraini government imposed a de facto news blackout denying all access to Al Khawaja in hospital where he had been sent after collapsing. The family’s tweets while he was held incommunicado speak of their raw pain, their desperation to find out if he was still alive, and their grief. They also provided a new source of information, and the refrain “where is alkhawaja,” reverberated on Twitter and in global news outlets (see for instance Der Spiegel, Al-Jazeera). In the days immediately after the race the Danish prime minister called for the release of Al Khawaja, saying he is in a “very critical condition” (Guardian), as did the UN’s Ban-Ki Moon (UN News and Media). The silencing of Al Khawaja had become a discourse of callousness and as global media pressure built Bahraini ministers felt compelled to challenge this on non-Arabic media, claiming Al Khawaja was “eating” and “well”. The Bahraini Prime Minister gave one of his first interviews to the Western media in years in which he denied “AlKhawaja’s health is ‘as bad’ as you say. According to the doctors attending to him on a daily basis, he takes liquids” (Der Spiegel Online). Then, after six days of silence, the family was allowed to visit. They tweeted that while incommunicado he had been restrained and force-fed against his will (Almousawi), a statement almost immediately denied by the military hospital (Lebanon Now). The discourses of silence and callousness were replaced with discourses of “torture” through force-feeding. A month later Al Khawaja’s wife announced he was ending his hunger strike because he was being force-fed by two doctors at the prison, family and friends had urged him to eat again, and he felt the strike had achieved its goal of drawing the world’s attention to Bahrain government’s response to pro-democracy protests (Ahlul Bayt News Agency). Conclusion This article has sought to explore two ecologies. The first is of medico-ethical discourses which construct a prison hunger strike as a corporeal-environmental act of (self) destruction to achieve particular political ends. 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