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German philosopher Hans-Georg Gadamer is best known for his contribution to the development of philosophical hermeneutics, an interpretive approach to knowledge, understanding and meaning-making. It has become a well-established research approach in the health sciences to shed light on the lived experiences of people living with challenging chronic health conditions. Some feminist scholars have gravitated to Gadamer’s hermeneutics for its steadfast rejection of positivism and its intention to uncover preunderstandings and prejudices. However, others have critiqued the approach for its lack of focus on prescribing action for social change and its reluctance to evaluate the prejudices present in its own tradition. In this paper, the authors will demonstrate how using feminist hermeneutics can help health researchers deepen their understanding of illness narratives by examining the power structures contributing to the marginalization of chronically ill people within and outside the healthcare system. They will juxtapose a reflexive investigation of the first author’s experiences with a focused literature review of the dialogue between hermeneutics and feminism. By examining the first author’s experiences with Gadamerian hermeneutics and feminist hermeneutics through self-study, she can in turn unearth her own preunderstandings. This approach will allow the authors to leverage the depth of interpretive understanding generated by hermeneutics while exploring the power structures involved in the complex process that is patient care, particularly that of people with chronic illness. They conclude that this combined approach of feminist hermeneutics allows health researchers to deepen their understanding of illness narratives with issue-specific and effective recommendations to clinicians and public health officials, leading to better-adapted services through a more just approach to chronically ill people.

The space industry has made significant strides, leading to an era of commercial spaceflight. Meanwhile, understanding molecular responses to spaceflight is crucial for astronauts’ safety. To this end, we examined transcriptomic and epigenetic changes in two astronauts’ blood samples at three timepoints: two weeks before spaceflight (T0), 24 hours after spaceflight (T2), and three months after spaceflight (T3). Transcriptomic analysis identified two gene clusters with opposing transient expression trends post-flight (T2), normalized at T3: one upregulated and the other downregulated. Mapped immune cell types through the CIBERSORT coupled with the pathway analysis suggested monocytes’ role in coordinated cellular response. Epigenetic analysis identified four methylation patterns with transient and persistent changes post-flight, enriched in nervous system development and cell apoptosis pathways. Methylation changes implicated genes associated with bone disorders, including FBLIM1, IHH, and SCAMP2. eQTM analysis suggested a link between RNA transcriptional level and DNA methylation through transcriptional regulator ZNF684. In conclusion, our study revealed significant short-term transcriptional and methylation changes as well as long-term methylation changes.

Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.

There is limited information regarding the effects of pediatric chronic pain management on the number and cost of chronic pain-related emergency department (ED) consultations. This retrospective study aimed to evaluate the number and costs of chronic pain-related ED consultations of children and adolescents with chronic pain conditions at the Montreal Children's Hospital (MCH). Charts of patients followed by the Edwards Family Interdisciplinary Center for Complex Pain (CCP) of the MCH between April 2017 and December 2018 were reviewed. ED consultations, specialist consultations, medication prescriptions, hospital admissions, and outpatient consultation referrals were assessed for the period of 1 year before and after the patients' first consultation with the CCP. Associated costs were also calculated. One-hundred sixty-eight patients were included in the analysis. Fifty-one percent consulted the ED and had 151 chronic pain-related ED consultations within 1 year before their initial CCP consultation. In the year following their first CCP consultation, 52 patients (31%) consulted the ED, of which 24 consultations were chronic pain-related (84% reduction). There was an 81% reduction in the costs associated with chronic pain-related ED consultations within 1 year after CCP management. In addition, there was a significant reduction in ED interventions within 1 year after CCP management, though there was no change in medication prescriptions, hospital admissions, or subspecialist consultations. Children and adolescents with chronic pain conditions had fewer chronic pain-related ED consultations within 1 year after the first evaluation by an interdisciplinary center for complex pain, contributing to reduced ED costs.

After surgery, the adverse effects (AEs) of analgesics are common and critical factors influencing the postoperative experience of pediatric patients. Inadequate management of AEs has been found to prolong hospital stay, increase readmission rates and decrease satisfaction with care. The aim of this qualitative descriptive study was to better understand the AEs of analgesics from the perspective of adolescent patients with idiopathic scoliosis after spinal surgery. A total of 7 patients participated in the study. Semistructured interviews were conducted at discharge and 1 week after discharge. Transcribed data were analyzed using qualitative content analysis and themes were identified. Overall, participants most frequently reported gastrointestinal and cognitive AEs, with constipation being the most persistent and bothersome. The pediatric participants used a combination of 3 strategies to mitigate analgesic AEs, namely pharmacologic, nonpharmacologic, and reduction of analgesic intake. Participants demonstrated a lack of understanding of AEs and involvement in their own care. Future studies should be conducted to evaluate the efficacy of nonpharmacological strategies in managing analgesic AEs for pediatric patients after surgery.

Abstract Background The seasonal human coronaviruses (HCoV) NL63, 229E, OC43, and HKU1 are globally endemic, yet the majority of HCoV infections remain undiagnosed. Methods In a cross-sectional study, 2389 serum samples were collected from children and adults in France in 2020. In a longitudinal cohort study, 2520 samples were collected from 898 French individuals followed up between 2020 and 2021. Antibodies to HCoVs were measured using a bead-based multiplex assay. Results The rate of waning of anti-HCoV spike immunoglobulin G antibodies was estimated as 0.22–0.47 year−1 for children, and 0.13–0.27 year−1 for adults. Seroreversion was estimated as 0.31–1.37 year−1 in children and 0.19–0.72 year−1 in adults. The estimated seroconversion rate in children was consistent with 20%–39% of children being infected every year with each HCoV. Conclusions The high force of infection in children indicates that HCoVs may be responsible for a substantial proportion of fever episodes experienced by children.

Introduction: Scoliosis in a condition where a curve develops in the spine. Adolescent girls affected by scoliosis are significantly more likely to require treatment such as bracing or surgery than their male counterparts. Curvy Girls is a peer support group for adolescent girls with scoliosis that allows them to engage with each other in a safe environment.Objectives: This study endeavours to explore the lived experiences of adolescent girls with scoliosis who are Curvy Girls members and understand how this peer support group has affected their experienceApproach: Sixteen participants were recruited through a senior board member of Curvy Girls. Data was gathered through semi-structured interviews with open-ended questions, transcribed verbatim, and analyzed using an applied philosophical hermeneutic approach, a practice of uncovering insights from transformational conversation.Findings: We found that participants perceived to have had their pain, feelings, or scoliosis treatments invalidated by friends, family members, educators, or healthcare professionals. We also found that the participants’ sense of belonging to Curvy Girls did not depend on their level of involvement with the group, and that many of them displayed a strong sense of reflexivity and desire to ‘give back’ to the scoliosis community. Finally, we found that, if participants could make changes to Curvy Girls, they would extend its reach and scope through advertising and including peer support services for boys and non-binary adolescents.Future Directions: These findings may help clinicians, healthcare professionals, and peer support organisations deepen their understanding of the perspectives of this specific population. This transformed understanding could lead to the instauration of care and services that are better adapted to this population’s needs, resulting in lessening the burden of the condition on the individual and their support system.

Juvenile fibromyalgia (JFM) is a condition that presents as chronic widespread musculoskeletal pain and affects children and adolescents. JFM remains a challenging diagnosis, as it is both based on subjective criteria and the pathogenesis is poorly understood. Small fiber neuropathy (SFN) is a distinct condition, which is characterized by pathology of small A-delta and C fibers, and can present similarly to JFM. Small fiber pathology is characterized by reduced intraepidermal nerve fiber density (IENFD) on skin biopsy. Recent studies have found that as many as half of patients with JFM can demonstrate decreased IENFD, in pattern similar to SFN. This phenomenon has been referred to as small fiber pathology. The meaning of these findings was disputed; however, the current consensus remains that fibromyalgia and SFN are distinct conditions. Additionally, among patients with fibromyalgia, there are two phenotypes: those with small fiber pathology and those without. The purpose of this review was to characterize the role assessment of IENFD plays in the clinical context. We conducted a narrative review of pertinent articles pertaining to JFM, SFN and small fiber pathology in fibromyalgia. We concluded that assessment of IENFD should be completed if SFN is suspected either when a patient first presents or in patients who were previously diagnosed with fibromyalgia and SFN is later suspected. Distinguishing between JFM and SFN is important because recommended therapies differ between the two conditions. However, there is no evidence to support the use of skin biopsy to distinguish between the two discussed fibromyalgia phenotypes. More studies are needed to elucidate whether IENFD varies with morbidity and if both fibromyalgia phenotypes vary in their response to different therapeutic regimens.

The purpose of this article is to provide insight into the philosophy and practice of Applied Philosophical Hermeneutics as a unique approach for research in the health sciences. While there are other research approaches grounded in hermeneutics, this article focuses on Gadamer’s modern philosophical hermeneutics. During my 18 years as a hermeneutic researcher, graduate students and I have engaged with people with a wide variety of experiences such as preventable medical error, Indigenous health, adult and adolescent chronic pain, social responsibility in higher education, oral health care for autistic children, and the experiences of people living with Thalassemia. Applied Philosophical Hermeneutics offers an approach to help bring researchers, clinicians, and patients together within a community of active partnerships in research. All these projects employed Applied Philosophical Hermeneutics as an approach to gain a deeper and personal understanding of the unique experiences of these diverse groups of people. Hermeneutics remains somewhat confusing as the unmethod which may lead to a dismissive attitude toward this research approach. Therefore, the intention of this paper is to present a risk-free insight into hermeneutics, which hopefully will open-up conversations and new learning experiences among researchers, students, patients, and colleagues.