Advances in Orthopedics

BackgroundWhile migration studies have boomed, little is mentioned about internal displacement of queer persons. In Kenya, internal displacement of sexual and gender minorities is often overlooked and not well understood, which results in increased marginalization and vulnerabilities. The article provides an in-depth analysis of forced serial internal displacement trajectories of sexual and gender minorities, and its effect on navigating socialites and livelihoods.MethodsWe draw on qualitative data conducted between 2010 and 2023 using participant observations, in-depth interviews, case histories, and focus group discussions with LGBTQ+ persons, as well as mothers and fathers of gay men in Kenya. We used a thematic approach and principles of interpretive anthropology to organize and describe the meaning of the data as a continuous process. Broader themes were identified from the beginning of the first study, resulting in the development of a codebook framework that was reiterated over time.FindingsOur findings show that sexual and gender minorities are forced into internal migration. Factors informing are located at the individual, interpersonal, institutional, and communal levels. We identified three main themes with eight subthemes. The main themes were (1) reasons for migration, which were often related to stigma, violence and oppression, (2) patterns of migration, which primarily had rural to urban patterns and instability, and (3) kinship, networks, and social systems, which required rebuilding, and gaining “respectability” from kin.ConclusionThere can be little doubt that sexual and gender minorities face stigma and discrimination across levels of the socioecological model, and that in most cases, there has been multiplied grievances and anti- LGBTQ+ activities instigating serial forced migration. Forced serial displacement of sexual and gender minorities in Kenya requires research attention, and it might be better served if examined through the lens of “forced migration,” given the non-voluntary aspects of fleeing and displacement. Rethinking LGBTQ+ IDPs through the lens of coercion may better capture the lived experiences given the structural stigma and violence in which they live and cannot escape.

This article explores the sociological and ethical implications of redefining disease in the era of advanced diagnostic technologies, with a focus on blood-based biomarkers. Drawing from Foucault's concept of medicalization and Illich's critique of disease mongering, it highlights how diagnostic expansions, driven by corporate and institutional influences, are reshaping the boundaries of health and disease. Advances such as blood assays for Alzheimer's and Parkinson's diseases, liquid biopsies in oncology, and biomarkers for depression and diabetes, while promising, raise concerns about premature diagnoses and overtreatment. The influence of pharmaceutical and insurance industries on diagnostic criteria, as seen in the ICD updates, underscores the need to address conflicts of interest and regulatory gaps. Case studies on Alzheimer's and Parkinson's reveal how these changes could benefit stakeholders at the expense of patient welfare. The article calls for ethical oversight, stricter regulation, and research into the population-level efficacy of diagnostic and treatment protocols.

The social and cultural understanding of disability has indicated that it is primarily a consequence of attributional processes, idealized and generalized conceptions of ability, and structural discrimination. Assuming the validity of these conceptualizations, the focus shifts to relational dynamics that determine how and if disability is ‘felt.’ This study explores this relationality in the context of couples parenting a child with disabilities. Intersections of gender and disability associated with self-positioning as ‘special parents’ include specific affective couple arrangements. This study reports on a qualitative study using in-depth interviews with couples who were interviewed first together and then individually. The results indicate a subjectivation of couples as ‘special parents,’ which is difficult to reject and includes affective aspects as well as gendered inequalities in care. Disabling affects are delegated to and felt by the female partner, leading to affective inequalities in the partnership. The couple positions the mother as the one who ‘suffers,’ which is part of a well-known affective repertoire that is implied by ableism to feel. The theoretical implications of these empirical results will be discussed as twofold: first, as an entry point to understanding disability via affection—how to be affected by disability along intersected cultural attributions; and second, as a suggestion to bridge cognitive and behavioral approaches to emotion by elaborating on how disabling affects become felt and enacted in subjectivation and relation.

ObjectivesThe primary aim of this study was to examine the level of trust male residents in urban areas of Bangladesh have in the police. Additionally, the study sought to explore the various factors that influence this trust.MethodThis study employed a robust cross-sectional research design. Utilizing multi-stage sampling techniques, the survey was conducted among male respondents (aged 18 or over) through in-person interviews, and the data was collected using the Kobo Toolbox. A total of 1,108 data were collected from four city corporation areas in Dhaka, Sylhet, Khulna, and Rangpur districts, ensuring a comprehensive representation of urban areas in Bangladesh.ResultsThe study revealed that male citizens in urban areas of Bangladesh have a moderate level of trust in the police. Trust in neighbors was found to be a significant and positive factor influencing trust in police. The study also found that neighborhood relative safety was positively associated with trust in police, while the perceived crime problem in the locality had a negative impact on trust in police. Furthermore, middle-aged (39–49 years old) and older men (over 50 years old) were found to have significantly lower trust in police than young adult (19–39 years old) respondents. Location was also a crucial factor, with respondents from Khulna City exhibiting substantially higher trust in the police than male residents of other cities.ConclusionThe study underscores the need for the law enforcement agency to address the current situation. To improve public trust in the police, it is crucial that the agency increases its social media presence and launches campaigns to highlight its recent successes.

This article addressed digital racism and exclusion from the decolonial perspective, explicitly concerning the possibilities of resistance to colonial structures. This argument was based on the discussion of intersectionality as a reference to the multiple combinations of exclusionary experiences expressed here through new forms of hierarchizing difference, understood from the perspective of social classification, as taught by Aníbal Quijano. We theoretically rehearsed the topic to broaden dialogs, conducting a reflective exercise that invites debate. Based on the notions of subjectivation processes emerging from this elaboration, we performed a propositional reflection, pointing to plural and collective solutions that rescue the memory and knowledge denied by coloniality. Furthermore, we suggest the rediscovery of local practices and values, as opposed to the adherence to standards established by remnants of colonization that are transmitted and reverberated in contemporary daily life.

For many decades, the large part of developed countries has been experiencing the progressive ageing of their populations. This quantitative change is also accompanied by a qualitative shift in social representations of the third age. Within these changes, a fundamental role is played by the desire to experience opportunities for socializing, leisure, and culture that can shape a new and more complex concept of well-being. Within this context, tourism experience plays a crucial role. The focus is therefore on the new characteristics of senior tourism and the conditions under which it can represent a full and satisfying experience, going beyond the classic offerings of “sun, sand, and sea” or medical tourism. To this end, a qualitative study was conducted, revealing a typology of individuals that can serve as a useful reference for the tourism market to diversifying its offerings.

This article argues that there is a close relationship between individuals’ understandings of specific incidents of racism, their ideas of how racism operates, and their (repertoires of) responses to such incidents. The argument is based on a qualitative interview study with 21 highly educated Black Germans with at least one parent born outside Germany, and draws on both the extant literature on responses to experiences of ethnoracial exclusion and research into how people make sense of such experiences. The analysis specifically explores two contrasting types of interviewees: Type 1 felt that they were constantly and potentially always affected by racism and had a broad knowledge of racism. These interviewees recounted many different incidents, many of which they clearly labelled as “racist.” Type 1 interviewees reported a variety of response options, with direct confrontation being one of them. In stark contrast, Type 2 respondents tended to normalise the relatively few incidents they mentioned or indicate only feelings of unease. They also believed that they were largely unaffected by racism, had a less deep understanding of racism and tended to respond to incidents of exclusion in ways that allowed the encounter to continue without disruption. Overall, the study calls for greater attention to racialised people’s meaning-making in relation to concrete incidents of exclusion and to their knowledge of racism. This requires methodological adaptations to qualitative interview research, which remains the most popular method for exploring experiences of racism. In particular, the study highlights the importance of understanding the ways in which respondents talk about their experiences (categorisation, indication of feelings of unease, and normalisation). It also emphasises the need to go beyond considering only interviewees’ responses to direct questions about their experiences of racism and/or discrimination and/or incidents clearly categorised by interviewees as, for example, “racist.” Moreover, reconstructing interviewees’ knowledge about racism offers a path towards understanding not only their sense-making but also their repertoires of responses. This, in turn, provides insight into why individuals of comparable class position and educational background respond to racism in different ways.

IntroductionThere is an increasing attention for the role of military chaplains (MCs) in supporting veterans with moral injury. However, research into how veterans experience the support of MCs remains scarce. Moreover, no studies to date have explored this question in a Dutch contex, while this is relevant as it can offer insight into what forms of care are helpful in predominantly secular societies.MethodsThis article presents a study from the Netherlands, involving 12 veterans. Using a longitudinal qualitative approach, we explored how the one-on-one conversations with MCs unfold over time.ResultsOur study shows that three types of moral questions underly experiences of moral injury. Veterans see the conversations with MCs as an opportunity to exchange thoughts and perspectives concerning these ongoing moral struggles, a process that we conceptualize as ‘moral learning’. Over time, we found 5 types of change in veterans’ experience of moral injury. The conversations with MCs helped veterans to: share their stories, thoughts and worries; grow personally; better understand and accept certain events; feel a stronger connection with others; critically engage with the Dutch Ministry of Defence.DiscussionThis study raises questions about the centrality of the morally injurious events in chaplaincy interventions that are described in the literature. It suggests that supporting veterans in dealing with questions about the good life and about the conduct of the military may be just as or even more important as reflecting on morally injurious events. Moreover, the study highlights the importance of engaging with seemingly mundane, everyday issues when addressing the moral dimensions of veterans’ struggles. This counters the focus on grand concepts like “forgiveness,” “acceptance,” “reconciliation,” “restitution” and “vindication” which are usually emphasized in the literature about chaplaincy in the context of moral injury. The study shows that it is through reflection on the everyday that these larger concepts gain relevance and meaning within veterans’ lives.

IntroductionGiven the lack of academic literature on colorism within the Cambodian community and the lack of focus on how colorism influences experiences in this context, this study seeks to analyze how Khmer women’s perceptions of colorism are shaped by their family and community environments.MethodsThe data and methods consist of 40 in-depth qualitative interviews with Khmer women, primarily those living in the United States and Cambodia, with their experiences of colorism analyzed through thematic analysis.ResultsFindings reveal that factors such as family support and cultural connections to Khmer identity interact with relative skin tone within families and broader communities to shape self-esteem and experiences with colorism. Women with darker skin did not necessarily have the lowest self-esteem, especially when they had supportive families and lived in communities where darker skin tones were more prevalent. Conversely, women with lighter skin did not necessarily have the highest self-esteem, especially when their families reinforced color hierarchies and they lived in communities dominated by White or East Asian Americans.DiscussionBy further examining this structural issue, colorism, the study highlights how communities of color can work toward racial and ethnic justice while developing strategies for future generations to challenge and move beyond colorism.

Alterations to the clinical, social, and economic landscape have made palliative care an increasingly challenging sector in which to work; COVID-19 introduced further changes that pushed palliative care professionals to the breaking point. Their struggles at work are exacerbated by the fact that specialists in this field tend to ignore their own needs, instead centring and prioritising those of their patients—a situation that is not tenable. Within this community case study we describe how our team, comprising clinical and university staff, sought to address this by co-creating a suite of resources to support the physical, psychological, social, and spiritual health of palliative care workers. The result was the Creative Toolkit©, which is both an overall approach and a suite of materials that uses creative, arts-based intervention to facilitate reflection, relaxation, and rejuvenation—and to ensure that clinical staff feel connected and valued. Although participants sometimes initially hesitate due to their limited prior exposure to art-based methods, feedback on our sessions has been unanimously positive, revealing the value of creative activities for, among other things, aiding in processing difficult feelings and creating community amongst staff. While initial results are promising, we acknowledge the need for an expanded evidence base to encourage more widespread uptake of our method.

IntroductionCross-cultural research measuring how women perceive their sense of agency and catalyze social innovation has been limited. We conducted a mixed-methods study to learn about women’s agency and life satisfaction, while evaluating the perceived benefits of a social innovation program (We Love Reading), in the UAE which, in 2022, launched a nationwide reading promotion strategy.Methods and resultsWe implemented the Sense of Agency (SoA) scale and Cantril Ladder of Life Scale with a sample of 78 female Emirati students, then conducted two Fuzzy Cognitive Mapping (FCM) sessions with 13 respondents. The FCM sessions helped to develop local definitions of agency and life satisfaction, map causal relationships, and run scenarios to identify program benefits. This highlighted 6 core dimensions of personal and relational agency—ability, control, strength, authority, freedom of action, and responsibility. We Love Reading boosted several aspects of agency and life satisfaction.DiscussionOur findings suggest that We Love Reading can help change mindsets and meet a fundamental policy goal related to reading habits and knowledge empowerment in the Arab World. They show the need for mapping causal reasoning in systematic ways, taking into account different dimensions of agency in environments where social innovation can flourish.

BackgroundPersonal care attendants (PCAs) provided essential care and support to home care clients during the COVID-19 pandemic and thus were a vital part of the pandemic response in helping to keep older adults and individuals with disabilities out of nursing homes. Furthermore, they are one of the largest and fastest growing workforces in the United States. Yet this essential workforce received little attention during the pandemic. Guided by feminist theories on caregiving and the principles of community-based participatory research, this study examined the experiences of PCAs during the COVID-19 pandemic.MethodsData from 78 in-depth interview participants representing Medicaid-Funded Home and Community-Based Services (HCBS) PCAs, clients, family caregivers, and service providers in Kansas, United States, as well as additional data from 176 PCA survey participants were analyzed. Findings from this interactive, convergent, mixed-methods study were integrated by theme using the weaving approach.ResultsFour major themes emerged from the analysis: (1) PCAs remained in this field during the pandemic out of a commitment to their clients; (2) PCAs were undervalued and invisible as an essential workforce; (3) direct care work had an emotional toll on PCAs during the pandemic; and (4) PCAs have mixed feelings about their satisfaction with the job, and, as good workers quit, they were difficult to replace.DiscussionPCAs held professional-level responsibilities without the recognition or pay of a professional. The pandemic had mixed impacts on job stress and satisfaction, suggesting that the intrinsic rewards of the job and social support had a protective impact. However, intrinsic rewards are not enough to retain this workforce, and the growing PCA workforce shortage leaves many clients having to choose between no care and poor care. Our findings indicate that institutions and systems must better support and recognize this essential workforce to build and maintain a quality in-home care services system.

This study examines the phenomenon of violence towards gay men in South Africa, focusing on its portrayal and understanding within online media. Using a qualitative approach, it explores how online reports construct, interpret, and contest narratives surrounding these attacks. The investigation aims to highlight the portrayal of the victimology of gay men and the societal dynamics, including gender-based violence, abduction, victimisation, and queercide, in the South African context. The research analysed online reports, between 2022 and 2024, by a community organisation on cases of violence perpetrated against gay men. The research found that media frames about the circumstances of violence, the role of social media or hookup apps, and demographic details of gay men can provide insights into their victimhood. This contributes to the understanding of the challenges gay men face in navigating their identities and safety in South Africa. The findings show that Gauteng, Cape Town, and Durban remain the most affected by attacks against gay men and provide more insight into the strata of the age of victims, their movement, and the nature of attacks. By identifying how online community media frames these cases, the study offers insights into the emergence of gangsterism and the use of mobile technologies to target these men. It can inform strategies for social change and foster inclusive environments for marginalised communities. The findings have implications for advocacy, policy making, and community empowerment efforts addressing queercide and promoting LGBTIQ+ rights and safety.