Search Results (232)

Endometriosis is a chronic and often debilitating condition whose symptoms extend beyond pelvic pain to include fatigue, gastrointestinal and urinary complaints, menstrual irregularities, and reduced work capacity. These symptoms are typically framed within medical or occupational health discourse, yet little attention has been paid to how they are socially interpreted within workplace relationships. Drawing on the workplace bullying literature alongside qualitative research on the lived experience of endometriosis, this conceptual review proposes that endometriosis-related symptoms are minimized through two interconnected mechanisms: symptom fragmentation, in which the disease’s varied and cyclical presentations are perceived as unrelated complaints rather than expressions of one chronic illness, and identity pathologization, in which the resulting pattern of absence and reduced capacity is reattributed to the worker’s character rather than her condition. The review further situates these mechanisms within the broader literature on women-to-women workplace bullying and examines how humor may function as a socially deniable vehicle for mistreatment. Three anonymized vignettes drawn from clinical practice illustrate each mechanism in isolation and in combination, tracing the self-reinforcing loop through which fragmentation and pathologization sustain one another over time. Practical implications are offered for occupational health practice, managerial training, anti-bullying policy, and clinical care. The aim is not to psychologize endometriosis, but to contextualize suffering that currently falls between medical, organizational, and psychological frameworks—and to prevent the gradual transformation of illness into stigma and of symptoms into moral judgment. Full article

Background and Objectives: Platelet-rich fibrin (PRF) has been widely investigated as a biological material to enhance healing after tooth extraction; however, its clinical effectiveness remains uncertain. This systematic review evaluates the available evidence on its effectiveness in post-extraction socket management. Materials and Methods: A literature search was conducted across eight electronic databases for English-language studies published between 2015 and 2025. Only randomized controlled trials, including parallel-group randomized trials and randomized split-mouth trials, involving PRF with a control group were considered. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 1). Due to substantial clinical heterogeneity in PRF preparation protocols, outcome measures, and follow-up periods, a narrative synthesis was performed instead of a meta-analysis. Results: A total of 174 records were identified, of which 9 studies met the inclusion criteria. The methodological quality of the studies included was evaluated to assess the risk of bias, in accordance with the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Overall, 394 patients underwent 817 tooth extractions: 414 sockets were treated with different types of PRF, 251 were left to heal after suturing, and 143 were filled with a hemostatic sponge prior to suturing. Conclusions: PRF demonstrated superior outcomes in soft tissue healing and radiographic new bone density, although no statistically significant differences were observed in other parameters. Therefore, the available evidence does not allow us to draw definitive conclusions regarding the clinical effectiveness of PRF for socket filling after tooth extraction. The literature indicates that it may promote soft and hard tissue healing and reduce pain, swelling, and the risk of alveolar osteitis; however, evidence regarding its therapeutic effect on alveolar socket healing remains contradictory. Full article

Rotator cuff tear (RCT) is a leading cause of shoulder pain encountered by general practitioners. Population-based screening shows that nearly half of full-thickness tears are asymptomatic, allowing many lesions to progress undetected. This narrative review summarises 105 clinical, imaging, biomechanical and rehabilitation studies published in recent years. The review follows the disorder from early tendinopathy to full-thickness tear and discusses crucial risk factors (age, diabetes, hypercholesterolaemia, overhead work). It aims to guide early primary-care management of RCT. We examine the diagnostic accuracy of classic bedside tests, including the supraspinatus weakness and external rotation lag cluster. Furthermore, we explain when ultrasound or MRI adds value and what the classic findings are. An informative overview of patient-reported outcome tools (e.g., SPADI, WOSI, Constant–Murley, ASES) could help physicians select one for follow-up. The article objectively evaluates the evidence for conservative measures—structured exercise protocols, manual therapy, oral analgesics, and corticosteroid or platelet-rich plasma injections. Moreover, we propose an evidence-based postoperative rehabilitation timeline with milestones that incorporate targeted immobilisation and progressive loading. The article presents selected clinical situations, such as the impact of type 2 diabetes on tendon biology. We explore the viability of experimental adjuncts such as extracorporeal shock-wave therapy, low-intensity pulsed ultrasound and electrical stimulation. Finally, we compare recommendations from the American Academy of Orthopaedic Surgeons and the European Society for Surgery of the Shoulder and Elbow. We highlight similarities between the recommendations (e.g., overlapping clinical examination tests), thereby facilitating their clinical application and providing a pragmatic guide for general practitioners. Our synthesis draws on orthopaedic, radiographic and rehabilitation data to reduce diagnostic delay, optimise non-specialist resource use, and improve pain and functional outcomes for the growing population affected by rotator cuff tears. Full article

The failures of securing justice for survivors of sexual violence remain a central concern in contemporary feminist thought. Much recent work has addressed these failures through the frameworks of epistemic and hermeneutical injustice, foregrounding the role of voice in shaping recognition and response. This paper shares that focus on voice but seeks to identify a difficulty that such debates do not fully capture. Drawing on J.M. Coetzee’s Disgrace alongside the later philosophy of Ludwig Wittgenstein, it explores how literature and philosophy together can illuminate this problem. Focusing on the university tribunal scene in Disgrace, which appears to function effectively and deliver justice, the paper argues that something nonetheless remains inadequate. Through a Wittgensteinian account of pain and its expression, the paper comes to show how the tribunal exemplifies a deeper failure—not one of discrediting or disbelieving, but an inability to respond to the human voice of pain as such. Literature and philosophy hereby open a different way of understanding the limits of approaches that prioritise legibility, evidence, and procedural resolution as a way of responding to sexual violence. Rather than securing justice, such approaches risk leaving something essential untouched: what it would mean to answer to another’s suffering. Full article

Bereavement in Southern Africa is not a private event. It is rather a shared and communal experience, shaped by rituals, faith, and relationships. In Botswana, mourning is influenced by Botho, a way of life that says, “I am because we are,” where a whole community carries the pain of loss together and takes responsibility for the bereaved. These communal rituals bring comfort, meaning and a sense of belonging, helping families accept death and move towards healing. Yet research also shows a harder side: many mourning practices are gendered and favors male gender. Widows often face long, strict rituals, social isolation and suspicion, rooted in patriarchy and ideas about impurity or danger, which can harm their emotional, social, and economic well-being. This article uses conceptual/theological analysis within pastoral theology and African relational ethics to examine these practices and to explore how churches and caregivers can honor culture while resisting injustice. Drawing on work of Botho African pastoral care and gender, it shows that the same communal systems that care can also exclude and marginalize widows. The article proposes a Gendered Botho Pastoral Care Model that calls Christian communities to sustain communal solidarity and shared mourning, challenge patriarchal and violent widowhood rites, reinterpret rituals in life-giving ways, and build resilience, dignity and agency for widows, so that mourning spaces become places of healing, justice and restored humanity Pastors for widows in Botswana and across Southern Africa. Full article

Burning Mouth Syndrome (BMS) is a chronic orofacial pain condition characterized by persistent burning sensations in the absence of consistently identifiable pathology. This mismatch between severe symptoms and inconclusive findings challenges conventional diagnostic reasoning, which presumes that subjective complaints reflect underlying biological lesions—leading to repeated investigations, diagnostic delay, and uncertainty about symptom legitimacy. This paper uses BMS as a paradigmatic case to question a core assumption of clinical reasoning: that objective pathology constitutes primary evidence. In this Perspective, drawing on phenomenology and medical anthropology, we argue that when pathology is indeterminate, illness—the lived experience of suffering—must be treated as primary clinical evidence rather than as a secondary expression of disease. We propose a bidirectional conceptual framework in which physiological processes, psychological states, and lived experience interact dynamically, with symptoms actively participating in the maintenance of the condition. This framework explains persistent diagnostic uncertainty, heterogeneous treatment responses, and the clinical significance of validation and meaning-making. Reframing BMS in this way supports earlier recognition, reduces reliance on exclusion-based strategies, and justifies multimodal interventions addressing both biological and experiential dimensions of pain. More broadly, it suggests that clinical reasoning must expand to incorporate lived experience as indispensable evidence wherever pathology is indeterminate. Full article

Children undergoing cancer treatment face repeated, prolonged hospitalisations carrying substantial risks of psychological distress, social isolation, and impaired development. Volunteers offering structured non-medical activities are widely employed to complement professional psychosocial care in paediatric oncology settings, yet empirical evidence examining their role specifically—as distinct from professionally delivered psychosocial interventions—remains sparse. This narrative review, conducted in accordance with SANRA criteria and drawing on a structured search of PubMed, PsycINFO, and Google Scholar (2000–2025), supplemented by a targeted verification search in July 2026, synthesises the theoretical and preliminary empirical basis for volunteer involvement, critically evaluates associated clinical risks, and proposes evidence-informed recommendations for paediatric oncology clinical practice. Three theoretical frameworks provide the conceptual grounding for volunteer activities: developmental psychological models (Piaget; Erikson), stress and coping theory (Lazarus and Folkman), and the biopsychosocial model (Engel). Indirect empirical evidence—derived predominantly from professionally delivered interventions—supports short-term benefits of structured distraction, play, and social activities on procedural anxiety, pain experience, and sense of social inclusion; the sole study examining volunteer-facilitated activities specifically in paediatric oncology reported meaningful reductions in distress and high family satisfaction. Eight categories of clinical risk are identified, including physical and psychological overload, erosion of child autonomy, suppression of authentic emotional expression, and inadequate coordination with healthcare staff. Six practice recommendations are proposed, centred on a working definition of the volunteer role, mandatory pre-access training, genuine individualisation including cultural adaptation, multidisciplinary-team-led coordination, and structured programme evaluation. Volunteer involvement can meaningfully complement professional psychosocial care when delivered within a structured, supervised, and multidisciplinary-team-coordinated framework. The paediatric oncology team occupies a pivotal role in realising the potential benefits while safeguarding children from associated risks. Prospective research employing standardised volunteer programme definitions and validated child-reported outcome measures is urgently needed to build an evidence base commensurate with the clinical importance of this practice. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is among the most prevalent disorders of gut–brain interaction, yet its implications for spine surgery remain poorly characterized. This narrative review examines how IBS influences symptom presentation and postoperative outcomes in spine surgery patients. Methods: We synthesized the neurobiologic, epidemiologic, and perioperative literature linking IBS with musculoskeletal pain, spine-related symptomatology, and surgical outcomes, drawing on spine-specific data where available and on related surgical and chronic-pain populations where it was not. Results: IBS is characterized by central sensitization, impaired descending inhibition, increased temporal summation, autonomic dysregulation, and a high prevalence of psychiatric comorbidity, which manifest as widespread hyperalgesia and symptom amplification that overlap with pain mechanisms common in spine surgery patients. Epidemiologic studies indicate that patients with IBS undergo musculoskeletal and spinal procedures at disproportionately high rates, reflecting both symptom burden and diagnostic uncertainty from viscerosomatic overlap. These same factors have been associated with greater postoperative pain, elevated opioid requirements, slower functional recovery, and reduced satisfaction after spine surgery, although direct IBS-specific spine data remain limited. IBS may also confound preoperative assessment by mimicking radicular, discogenic, or sacroiliac pain. Conclusions: IBS represents an under-recognized potential modifier of symptom localization, perioperative pain trajectories, and functional recovery in spine surgery. Greater awareness of IBS-related nociplastic and psychosocial mechanisms may improve preoperative evaluation, risk stratification, perioperative management, and the design of future outcome studies. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article

Background: While ibuprofen is a widely used non-opioid analgesic with growing evidence in surgical settings, its safety and efficacy in acute burn care remain poorly characterized. This review aims to address this gap. Methods: A systematic search was conducted in accordance with PRISMA-ScR (September 2025) across PubMed, MEDLINE, CENTRAL, CINAHL, and Scopus for original, English-language studies evaluating the safety and/or efficacy of ibuprofen, distinguishable from multimodal regimens, for acute burn analgesia. Results: Of 136 studies, six met inclusion criteria (5 adult, 1 pediatric). Populations primarily consisted of second- and third-degree burns; only two studies included >10% total body surface area (TBSA). Study designs were heterogeneous, all with moderate to high risk of bias, including one retrospective study (oral ibuprofen), two experimental double-blind placebo randomized controlled trials (RCTs) (topical; oral), and three clinical RCTs (intravenous; topical; topical and oral). No study reported associations with increased adverse events; a retrospective study found no increased bleeding risk with perioperative ibuprofen in skin graft patients. Analgesic outcomes were not directly comparable across studies due to heterogeneity. Experimental models found that ibuprofen did not reduce acute burn pain, but attenuated pain within hyperalgesic skin. Among clinical studies, both oral and dressing ibuprofen formulations demonstrated reduced procedural pain. One topical study noted faster wound healing, though this was confounded by less frequent dressing changes. Conclusions: The available studies were insufficient to draw definitive conclusions, limited by sample size, heterogeneity, bias, and exclusion of high-risk patients. Nonetheless, no study reported increased adverse events across diverse ibuprofen protocols. These findings underscore the need for adequately powered, agent-specific trials in clinically representative burn populations to inform evidence-based multimodal compositions amidst growing advocacy for opioid-sparing analgesia. Full article

The introduction of minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded—saving millions of lives and sparing an estimated one billion patients the suffering once inherent to large-incision surgery. Within a single generation, this once highly contested surgical innovation became the global standard of care, transforming surgical practice across disciplines and on a global scale. By every measure of public health, these outcomes place modern minimally invasive and robotic-assisted surgery as among the most consequential life-saving advances in modern medical history. This review examines the clinical impact and global dissemination of MIS, tracing its evolution from Camran Nezhat’s pioneering expansion of laparoscopy beyond diagnostics to complex therapeutic procedures across surgical disciplines. Drawing on decades of evidence across gynecology, general surgery, and urology, we show that MIS is associated with substantial reductions in perioperative mortality, major complications, blood loss, infections, thromboembolic events, postoperative pain, and length of hospital stay, while maintaining oncologic equivalence and improving functional and quality-of-life outcomes. Beyond these technical advances, MIS catalyzed a broader reimagining of surgery itself, challenging long-standing norms rooted in large-incision approaches and shifting the field toward precision, organ preservation, and pathology-directed intervention. These changes were accompanied by parallel advances in multiple domains, including in imaging, intraoperative visualization technologies, surgical anatomy, instrumentation, and nerve- and organ-sparing techniques—developments that collectively established the foundation for contemporary minimally invasive and robotic-assisted surgery. Collectively, these advances have contributed to the prevention of an estimated 10–20 million surgery-related deaths that would likely have occurred under the large-incision approaches of the past. Full article

Despite the global movement toward sustainable mobility, the adoption of electric and autonomous vehicles (EVs/AVs) in Gulf Cooperation Council (GCC) countries is shaped by unique socio-cultural and structural contingencies. This study provides a significant theoretical contribution by exploring market entry strategies through a multidimensional value framework that captures symbolic and contextual dimensions overlooked by traditional models such as TAM and UTAUT. Drawing on in-depth interviews, focus groups, and participant observations, the research utilizes Kuwait as a case study to delineate the multidimensional construct of perceived value through Osterwalder’s Value Proposition Canvas (VPC). The findings reveal that consumer adoption is influenced not only by utility and efficiency but also by social, emotional, epistemic, conditional, and cost values. Dealers, in turn, demonstrate how these values guide entry strategies for non-conventional vehicles by aligning product offerings with specific “Pain relievers”, “Gain creators”, and “Jobs to be done” (JTBD). The study identifies distinct encroachment pathways: high-end entry for battery electric vehicles (BEVs) and low-end entry for hybrid electric vehicles (HEVs). Notably, a dual-encroachment strategy is identified for high-tech Chinese brands, which are aggressively disrupting emerging markets by leveraging manufacturing efficiencies to dominate the mid-market while simultaneously deploying premium models to challenge luxury incumbents. Finally, despite the structural constraints on public AV deployment, the research highlights vital applications for autonomous systems within “industrial sandboxes” such as aviation, seaports, military, and oil sectors. While centered on Kuwait, the findings offer potentially transferable strategic insights for the broader GCC region. Full article

This qualitative study examines how menstruation structures the lives and futures of married adolescent girls in the Centre for Girls’ Education’s Married Adolescent Safe Spaces (MAS) program in rural northern Nigeria. It addresses a key gap by focusing on married adolescents and treating menstruation as a social process linked to early marriage, schooling, mobility, and sexual and reproductive health, rather than only a hygiene issue. Guided by an intersectional social ecological and menstrual health-and-rights framework, the study draws on three years of ethnographic fieldwork. Methods include participant observation in MAS clubs, in-depth interviews, informal group discussions, and Hausa field notes from multiple rural communities, analyzed through iterative thematic coding and collaborative memoing. Findings show that menstruation operates as a “catalyst of constraint.” Menarche signals sexual maturity, intensifying moral surveillance, prompting threats or realities of school withdrawal, and accelerating pressure toward marriage. Girls describe menstruation as a “joy killer” and becoming “a shadow of myself,” as stains, pain, and shaming by teachers and peers lead to absenteeism and, at times, permanent dropout. Silence and stigma mean that asking questions can be read as promiscuity, pushing girls away from parents, religious leaders, and male teachers and toward sisters, peers, and mentors for incomplete guidance. Structural deprivation further individualizes the burden of menstrual management. Poverty, lack of affordable pads and underwear, and inadequate WASH facilities compel girls to “make do” with cloths and other unsafe materials, restrict movement during bleeding, and engage in small income-generating activities or kin negotiations to obtain basic supplies. MAS safe spaces partially disrupt these patterns by offering rare venues to discuss menstruation openly, learn cycle tracking and hygiene, and build peer solidarity and self-advocacy. However, the analysis underscores that program benefits remain constrained when poverty, weak school infrastructure, and restrictive gender norms remain intact. The study highlights how equitable sexual and reproductive health interventions must integrate menstrual health centrally, combining safe-space programming with subsidized products, improved WASH infrastructure, protective school policies, and norm change efforts. Full article

Background: Prolonged extubation and pain following cardiac surgery remain significant clinical challenges. The pecto-intercostal fascial plane block (PIFB) is an emerging regional anesthesia technique incorporated into multimodal analgesia protocols to reduce opioid consumption and facilitate early extubation. This study retrospectively evaluated extubation times, perioperative opioid consumption, and postoperative analgesic requirements in patients who underwent isolated open-heart surgery via median sternotomy, comparing those who received PIFB with those who did not. Methods: This retrospective single-center study included ninety-nine patients who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy between 1 June 2023 and 25 March 2024. The study included 46 patients who received PIFB (Group 1) and 53 patients who received no block (Group 2). Ultrasound-guided bilateral PIFB was performed after anesthesia induction, with a total of 40 mL administered to each side (30 mL 0.25% bupivacaine + 10 mL normal saline). Demographic data, perioperative data, extubation times, analgesic consumption, and complications were compared between groups. Results: Demographic data, EuroSCORE, body mass index, and ejection fraction were similar between groups. Perioperative opioid (fentanyl) consumption was statistically significantly higher in Group 2 (median 450 [IQR: 350–600] μg vs. 400 [IQR: 350–450] μg; p = 0.037). Extubation time was statistically significantly shorter in Group 1 compared to Group 2 (median 340 [IQR: 265–490] min vs. 495 [IQR: 420–555] min; p < 0.001). The number of patients requiring postoperative paracetamol and tramadol was statistically significantly lower in Group 1 (p = 0.015 and p < 0.001, respectively). No statistically significant difference was found between groups regarding chest drain removal, length of hospital stay, or ICU length of stay (p > 0.05). Mortality occurred in 1 patient in Group 1 and 2 patients in Group 2. Conclusions: PIFB application in isolated open-heart surgery performed via median sternotomy was associated with shorter extubation time and reduced perioperative fentanyl and postoperative analgesic consumption, without a statistically significant effect on hospital length of stay. Complication and mortality data are reported descriptively; the study does not have sufficient statistical power to draw inferences regarding safety outcomes. Full article

Endometriosis is a chronic, estrogen-dependent disorder defined by ectopic endometrial-like tissue growth, persistent inflammation, and aberrant innervation. Emerging evidence indicates that disease progression and symptom severity are driven by a reciprocal interaction between hormonal dysregulation and neuroinflammatory signaling. This narrative review synthesizes human-based mechanistic and clinical evidence on the hormonal–neuroinflammatory interface in endometriosis, drawing on peer-reviewed publications retrieved from PubMed and Scopus through November 2025. The publications comprised studies using data from patient-derived tissues, primary endometriotic cells, and clinical cohorts. Several convergent molecular nodes at this interface were identified: the prostaglandin E₂–prostaglandin E receptor 2/prostaglandin E receptor 4–aromatase axis, estrogen receptor beta—nuclear factor kappa B signaling, interleukin-6/signal transducer and activator of transcription 3-mediated fibrosis, neurotrophin pathways, transient receptor potential channels (TRPV1/TRPA1), and neurokinin 1 receptor signaling. In this integrated model, endocrine dysfunction fuels neuroinflammation, which in turn impairs steroid responsiveness. This cycle explains the frequent pain–lesion mismatch and the persistence of symptoms despite standard hormonal suppression. Targeting these druggable interface pathways enables better patient stratification and more effective combination therapies for endometriosis. Full article