Asian Journal of Medicine and Health

Mechanisms of Recovery in Cervicogenic Headache: Mediating Effects of Cervical Mobility on Pain, Disability, and Quality of Life Following Manual Therapy

Mallika Pradhan Sharma, Kanika Jain — Thu, 06 Aug 2026 00:00:00 +0000

Background: Cervicogenic headache is a disorder arising from dysfunction of the upper cervical spine. It is characterised by restricted cervical range of motion (ROM), neck pain, functional disability, and reduced quality of life. Although manual therapy has been shown to alleviate headache symptoms effectively, the mechanisms underlying its therapeutic effects remain poorly understood.

Objective: This study aimed to investigate whether improvements in cervical ROM mediated the effects of manual therapy on pain intensity, neck disability, headache impact, and health-related quality of life in patients with cervicogenic headache. A secondary objective was to compare the mediating effect of cervical mobility between upper cervical manipulation alone and upper cervical manipulation combined with upper thoracic manipulation.

Methods: This prospective, assessor-blinded, randomised controlled trial included 76 individuals with cervicogenic headache, who were randomly assigned to either Group A (upper cervical manipulation with conventional physiotherapy; n = 38) or Group B (upper cervical manipulation with upper thoracic manipulation plus conventional physiotherapy; n = 38). The primary outcomes were pain intensity, assessed using the Visual Analogue Scale (VAS), and neck disability, assessed using the Neck Disability Index (NDI). Secondary outcomes included the HIT-6, headache frequency, headache duration, the Short Form Health Survey (SF-36), patient satisfaction, and cervical ROM. Statistical analyses included repeated-measures ANOVA, correlation analysis, and mediation analysis.

Results: Following treatment, all clinical outcomes improved significantly in both intervention groups. However, Group B achieved significantly greater reductions in pain, disability, headache impact, frequency, and duration, together with larger improvements in cervical ROM, quality of life, and patient satisfaction, than Group A. Mediation analysis indicated that manual therapy restored cervical ROM, which significantly mediated the association between manual therapy and improvements in pain, disability, and quality of life, supporting the interpretation that restoration of cervical mobility is a principal mechanism of clinical recovery.

Conclusion: Manual therapy is effective for cervicogenic headache. In particular, combining upper cervical and upper thoracic manipulation produced superior clinical outcomes compared with upper cervical manipulation alone. Recovery of cervical range of motion appears to be a major biomechanical pathway through which manual therapy may reduce pain and disability while improving recovery and quality of life. The findings suggest that mechanism-based rehabilitation strategies aimed at enhancing cervical mobility should be considered an important component of cervicogenic headache management.

Reproductive and Maternal Health among Indigenous Women in Guatemala: A Cross-Sectional Study of Healthcare Access, Reproductive Autonomy, and Social Determinants

Thu, 06 Aug 2026 00:00:00 +0000

Background: Indigenous women in Guatemala experience persistent reproductive and maternal health inequities shaped by geographic, economic, social, and cultural conditions.

Aims: To characterize reproductive and maternal health experiences among Indigenous women attending mobile medical clinics in Guatemala, with emphasis on healthcare utilization, family planning, reproductive decision-making, access barriers, and women’s health education.

Study Design: Cross-sectional descriptive survey.

Place and Duration of Study: Humanitarian mobile medical clinics in communities in the Chimaltenango region of Guatemala during a field medical mission. Methodology: An anonymous 10-item questionnaire was administered to 100 Indigenous female participants. Responses were summarized using descriptive statistics (frequencies and percentages) across reproductive history, maternal healthcare utilization, family planning, household decision-making, travel time, financial barriers, and prior health education.

Results: Most participants had children, and 25 reported first childbirth before 18 years of age. Sixty-six reported receiving pregnancy care primarily in a clinic or hospital; 53 reported prior use of family-planning or contraceptive methods. Forty-seven reported making reproductive decisions independently, while others reported partner, elder, or shared decision-making. Cost and transportation were each identified as the leading barrier by 32 participants, followed by distance (n = 21). Thirty-six reported avoiding reproductive or maternal healthcare because of cost, and 38 reported no previous women’s health education.

Conclusion: Maternal healthcare utilization among participants was shaped by more than service availability. Affordability, transportation, geographic accessibility, household decision-making, and education remained important components of reproductive and maternal health equity. Community-based and culturally responsive strategies should address these interconnected barriers while supporting informed reproductive decision-making.

Exploration of Policy and Regulatory Frameworks for Dual Clinical Practice toward Universal Health Coverage: Evidence from South Sudan

Fri, 07 Aug 2026 00:00:00 +0000

Background: Dual clinical practice (DCP) is prevalent among healthcare workers in South Sudan, yet no specific, legally binding regulatory framework governs the practice. This study assessed the socio-demographic profiles of participants, examined existing policy frameworks, and proposed context-appropriate regulatory options for managing DCP in Juba, South Sudan.

Methods: A mixed-methods, cross-sectional, sequential study was conducted in Juba, South Sudan, from March to April 2026 among 288 healthcare workers selected through multistage stratified random sampling from 20 public and private health facilities. Qualitative data were obtained through 22 purposively selected key informant interviews and three focus group discussions involving policymakers, academics, professional bodies, health service users, and community members. Quantitative data were analysed using descriptive statistics (frequencies, proportions, and 95% confidence intervals), while qualitative data were analysed thematically using ATLAS.ti version 7.

Results: Among the participants, 52.8% were male, and approximately 40% were aged 20–29 years. Regulatory awareness was critically low: only 15.6% (95% CI: 11.5–20.1) reported knowledge of existing DCP policies, 33.7% (95% CI: 28.5–38.9) reported no awareness, and 50.7% (95% CI: 44.8–56.3) were uncertain. Only 14.9% believed that the current framework adequately regulated DCP, while 66% considered DCP acceptable under appropriate regulation. Qualitative findings consistently indicated strong opposition to outright prohibition, with participants advocating a regulatory approach incorporating salary reform, improved working conditions, conflict-of-interest management, and accountability mechanisms. A desk review of South Sudanese policy documents further indicated that, although the 2011–2015 human resources for health policy recommended establishing a DCP governance framework, subsequent national health policies remain silent on the practice and provide no explicit regulatory guidance.

Conclusion: South Sudan faces a substantial health-policy and regulatory gap in governing DCP. The findings support the development of a permissive, context-specific, and politically feasible regulatory framework that combines financial incentives for healthcare workers, improved working conditions, conflict-of-interest disclosure, and accountability mechanisms rather than prohibition. Policymakers should prioritise multisectoral stakeholder involvement in co-designing and implementing evidence-informed DCP governance policies that strengthen health-worker performance and support progress towards Universal Health Coverage (UHC).

Occupational Safety and Health Awareness and Compliance with Safe Work Practices among Morgue Workers in Kiambu County, Kenya

Lucy Mithu, Matthews Ciira Kiiyukia, Benson Karanja — Tue, 11 Aug 2026 00:00:00 +0000

Background: Morgue workers are routinely exposed to biological, chemical, physical, ergonomic, and psychosocial hazards while handling human remains. Although Kenya's Occupational Safety and Health Act (OSHA), 2007, provides a legal framework for workplace safety, limited evidence exists on occupational safety and health (OSH) awareness and compliance with safe work practices among morgue workers. Understanding these factors is important for improving workplace safety and reducing occupational injuries.

Aim: This study assessed occupational safety and health awareness and compliance with safe work practices among morgue workers in Kiambu County, Kenya.

Study Design: Descriptive cross-sectional study.

Methodology: The study was conducted among morgue workers employed in selected public and private mortuary facilities in Kiambu County. A census approach yielded 195 respondents. Data were collected using a structured questionnaire developed from the Occupational Safety and Health Act (2007), Ministry of Health guidelines, and relevant literature. Descriptive statistics, chi-square tests, independent-samples t-tests, Pearson's correlation, and multiple linear regression were used to analyse the data at a significance level of p < 0.05.

Results: Occupational safety awareness was moderate, with mean scores of 6.3 ± 1.32 for workplace hazards, 6.3 ± 1.29 for toxic products, and 6.1 ± 1.16 for hazardous materials information systems. Only 13.2% of respondents reported full implementation of universal precautions, while 34.7% indicated that these measures were hardly implemented. Partial use of personal protective equipment (PPE) was reported by 71.6% of respondents, whereas only 21.0% reported full compliance. Additional PPE during high-risk procedures was inadequately used, with 46.5% reporting that it was hardly in place. Occupational safety awareness was strongly associated with overall OSH performance (r = 0.85, p < 0.001). Awareness (β = 0.43), training (β = 0.38), and workers' attitudes (β = 0.24) were significant predictors of occupational safety performance (p < 0.001).

Conclusion: Morgue workers demonstrated moderate occupational safety awareness but suboptimal compliance with recommended safe work practices. Strengthening occupational safety training, enforcing safety regulations, ensuring adequate PPE, and promoting a positive safety culture may improve occupational safety in mortuary facilities.

Assessment of Cardiometabolic Risk Factors among Adults with Symptoms of Depression and Anxiety in South-Western Nigeria: A Cross-sectional Study

Fri, 14 Aug 2026 00:00:00 +0000

Background: Cardiometabolic risk factors (hypertension, diabetes mellitus and obesity), together with symptoms of depression and anxiety constitute a growing public health challenge in Nigeria. These conditions are increasingly prevalent among adults in peri-urban communities undergoing rapid urbanisation, where limited access to preventive healthcare and mental health services further exacerbates their combined burden. The study assessed the pattern of cardiometabolic risk factors and their association with symptoms of depression and anxiety among adults in South-Western Nigeria.

Methods: A community-based, descriptive, cross-sectional study was conducted among 554 adults aged ≥18 years in Ogun Central Senatorial District. Sociodemographic data were collected using a structured questionnaire. Symptoms of depression and anxiety were assessed using the validated Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Anthropometric measurements, blood pressure and random blood glucose levels were obtained. Data were analysed using SPSS version 25. Associations were assessed using the chi-square test, with statistical significance set at p < 0.05.

Results: The prevalence of overweight-obesity, hypertension, diabetes mellitus and impaired glucose regulation was 42.8%, 22.6%, 3.2% and 4.9%, respectively. Mild depressive symptoms were observed in 75.1% of the participants. Mild anxiety symptoms were present in 83.6% of the participants. Symptoms of depression were significantly associated with town of residence (p < 0.001), while anxiety symptoms showed significant associations with town of residence, educational attainment and blood pressure category (p < 0.05).

Conclusion: This study demonstrates a substantial burden of cardiometabolic risk factors and symptoms of depression and anxiety among adults in South-Western Nigeria. The observed associations, particularly between anxiety symptoms and blood pressure, underscore the need for integrated community-based screening and interventions that address both physical and mental health, especially in underserved peri-urban communities.

Impact of ART Adherence on Liver and Kidney Function in HIV-infected Individuals in Nigeria

Chibuzo, Olachi Lilian, Bob-Chile Agada, Adaeze — Mon, 17 Aug 2026 00:00:00 +0000

Background: Poor adherence to antiretroviral therapy (ART) may worsen organ impairment in persons living with HIV (PLHIV).

Objective: To assess the effect of ART adherence on hepatic and renal functions in patients with HIV.

Methods: A cross-sectional comparative study was conducted among 90 participants (30 ART-adherent HIV-positive participants, 30 ART-non-adherent HIV-positive participants, and 30 HIV-negative controls). Serum biochemical parameters (liver enzymes: AST, ALT, and ALP; bilirubin; kidney function: urea, creatinine, and electrolytes) were determined using standard colorimetric methods. Data were analysed using one-way ANOVA followed by post-hoc LSD and Student’s t-tests in SPSS version 25 (p < 0.05).

Results: ART-non-adherent participants had significantly higher liver enzymes (AST, ALT, and ALP), total and conjugated bilirubin, urea, creatinine, sodium and potassium levels compared with adherent participants and controls (p < 0.05). The profiles of adherent participants were akin to those of HIV-negative controls. Among non-adherent patients, sodium levels differed significantly among regimens (p < 0.05), and longer interruption (7–12 months) was associated with worse biochemical derangements than shorter interruption (3–6 months) (p < 0.05).

Conclusion: Non-adherence to ART is strongly associated with hepatic and renal dysfunction. Long-term adherence preserves organ function. Routine monitoring, adherence counselling and re-engagement strategies are recommended.

Does Maternal Carbon Monoxide Exposure Determine Birth Outcomes? A Hospital Based Study in South-South Nigeria

Mon, 17 Aug 2026 00:00:00 +0000

Background: Neonatal outcomes, such as birth weight and Apgar scores, are key indicators of intrauterine health and immediate postnatal adaptation. Several maternal and obstetric factors influence these outcomes; however, the role of environmental exposures, such as carbon monoxide (CO), remains insufficiently characterised.

Aim: This study aimed to explore the association between maternal carbon monoxide exposure and neonatal outcomes.

Methodology: This cross-sectional analytical study was conducted among 240 pregnant women at Rivers State University Teaching Hospital, Port Harcourt, between 2024 and 2025. Using consecutive sampling, maternal carbon monoxide exposure was measured with a Smokerlyzer® device, and neonatal outcomes, including birth weight and Apgar scores at 1 and 5 minutes, were recorded at delivery. Data were analysed using descriptive and inferential statistical methods, with significance set at p < 0.05.

Results: The mean maternal CO level was low across the study population. Maternal CO was not significantly correlated with birth weight (p = 0.140) or Apgar scores (p > 0.05), and it was not significantly associated with birth weight in the regression analysis (p = 0.097).

Conclusion: Maternal carbon monoxide exposure at the levels observed was not associated with adverse neonatal outcomes. This study was unable to detect effects within the narrow exposure range.

Effectiveness of Habituation Exercises Versus Gaze Stability Exercises in the Management of Migraine-Related Dizziness: A Comparative Study

P. O. Beena, K. Kotteeswaran — Mon, 17 Aug 2026 00:00:00 +0000

Aims: To compare the effects of habituation exercises versus gaze stability exercises on dizziness severity using the Dizziness Handicap Inventory in patients with migraine-related dizziness.

Study Design: Participants were allocated to groups by simple randomisation in a two-arm parallel-group randomised controlled trial. A comparative study with a pre- and post-test design was conducted.

Place and Duration of Study: The study was conducted over a period of 6 months among subjects selected from physiotherapy and rehabilitation centres across Bangalore between June 2025 and June 2026.

Methodology: Forty subjects of both sexes, aged 20-40 years, with a history of migraine-related dizziness lasting from more than 2 weeks to 6 months were selected. After demographic data were collected, the subjects underwent clinical evaluation using the dynamic visual acuity test, Motion Sensitivity Quotient, and Dizziness Handicap Inventory scale. Testing was performed for all 40 subjects over a period of 10 months, after which a post-test was conducted and the results were compared.

Results: There was no significant difference between the two groups at baseline. Following the 6-week intervention, there was an overall improvement in the Dizziness Handicap Inventory scale, Motion Sensitivity Quotient, and dynamic visual acuity test between the pre- and post-test assessments. The results showed a significant between-group difference for the Motion Sensitivity Quotient value [p < 0.0001], whereas the dynamic visual acuity test value [p > 0.290] and Dizziness Handicap Inventory value [p > 0.443] were not statistically significant.

Conclusion: The pre- and post-test scores for the dynamic visual acuity test, Motion Sensitivity Quotient, and Dizziness Handicap Inventory scale showed significant improvement in the rehabilitation of subjects with migraine-related dizziness in both groups. Hence, based on the results, both therapies were equally effective in improving the Dizziness Handicap Inventory and dynamic visual acuity test scores; however, habituation exercises were more effective than gaze stability exercises in improving the Motion Sensitivity Quotient scores in the treatment of migraine-related dizziness.

Comparative Evaluation of Different Impression Materials for Recording Tongue Morphology and Their Influence on Sex Determination: A Cross-sectional Forensic Odontology Study

Annu Gurjar, Monika Sharma, Radhika Saini — Sat, 22 Aug 2026 00:00:00 +0000

Background: Tongue morphology has potential as an adjunctive forensic marker, but the influence of impression material on the quality of tongue-morphology recording and subsequent sex determination requires comparative evaluation.

Aim: To compare alginate, addition silicone, condensation silicone and polyether for recording tongue morphology and to assess their influence on sex-determination accuracy.

Materials and Methods: This cross-sectional comparative observational study included 120 healthy adults (60 males and 60 females) aged 18–40 years. Each participant underwent tongue impression recording with the four materials. Two calibrated blinded observers assessed morphological reproduction, detail reproduction and dimensional stability. Participant comfort was rated on a 10-cm visual analogue scale. Sex-determination performance was evaluated using sensitivity, specificity and accuracy. Categorical variables were compared using the chi-square test, and continuous variables using one-way analysis of variance; p < 0.05 was considered statistically significant.

Results: Addition silicone yielded the highest proportion of excellent detail reproduction (73.3%), followed by polyether (61.7%), condensation silicone (30.0%) and alginate (18.3%) (p < 0.001). Addition silicone showed the lowest dimensional change (0.24 ± 0.08%), whereas alginate had the highest comfort score (8.45 ± 0.82; p = 0.003). Sex-determination accuracy was highest with addition silicone (90.8%), followed by polyether (88.8%), condensation silicone (82.5%) and alginate (74.2%) (p < 0.001).

Conclusion: Addition silicone provided the most favourable overall combination of detail reproduction, dimensional stability and sex-determination accuracy, while alginate offered greater participant comfort.

Comparing Effect of Mat Exercise and Gym Ball Exercise Regime on Trunk Control and Functional Balance in Patients with Chronic Stroke

Pritesh Prajapat, Himanshu Rajeev Sharma — Sat, 08 Aug 2026 00:00:00 +0000

Persistent impairment of trunk control is an important constraint on balance, mobility and independence after stroke. Selective trunk exercise performed on a stable mat or plinth and on an unstable gym ball has therefore been proposed to extend task-specific practice beyond conventional limb-focused rehabilitation. This critical narrative review evaluates the comparative effects, plausible mechanisms, methodological quality and clinical applicability of mat- and gym-ball-based trunk exercise for adults with chronic stroke. Searches of PubMed/MEDLINE, the Cochrane Library and the Physiotherapy Evidence Database were supplemented by citation searching and verification through publisher, PubMed and Digital Object Identifier records; eligible evidence available up to 23 April 2026 was considered. Direct comparative evidence remains limited. In an acute pilot trial, the between-group change favoured physio-ball training by 3.06 points on the total Trunk Impairment Scale. In a 108-participant chronic-stroke trial, plinth- and Swiss-ball-based programmes produced mean improvements of 3.6 and 4.1 points, respectively, relative to standard physiotherapy, with similar benefits between the two active surfaces. A subsequent 84-participant chronic-stroke trial likewise found that stable- and unstable-support core programmes improved trunk control, strength, weight-bearing symmetry and balance confidence relative to standard physiotherapy, without significant differences between active conditions. Meta-analytic evidence supports trunk training for trunk-specific outcomes and standing balance, although certainty is commonly low and transfer to activities of daily living is attenuated in dose-matched comparisons. The most defensible interpretation is that repeated selective movement, multidirectional weight shift, feedback, progression and sufficient active practice account for much of the benefit, whereas surface instability is an optional method of grading task demand rather than a necessary therapeutic ingredient. Surface selection should therefore reflect impairment, goals, tolerance, supervision and setting. Independent, adequately powered, dose-matched comparative trials with objective biomechanics, prospective falls, participation, fidelity, adverse-event and economic outcomes are required before surface-specific superiority can be established.

Fragmentomics in Pediatric Genetics: A New Frontier for Non-invasive Diagnosis of Rare Congenital and Metabolic Disorders

Stefan Bittmann, Elisabeth Luchter, Elena Moschüring-Alieva — Tue, 11 Aug 2026 00:00:00 +0000

Cell-free DNA (cfDNA) circulating in plasma is fragmented non-randomly, and the resulting patterns carry information about the cells and tissues from which the molecules were released. The analysis of these patterns, termed fragmentomics, includes fragment size distributions, preferred end coordinates, end-motif frequencies, nucleosome and transcription-factor footprints, and sequencing coverage around transcription start sites. Enthusiasm for applying fragmentomics within paediatric genetics has grown alongside proposals that plasma-based assays might shorten the diagnostic pathway for rare congenital and inherited metabolic disorders. The present review examines whether the accessible evidence supports that expectation. Literature was identified through Europe PMC and Crossref Metadata Search, supplemented by targeted retrieval of works cited in recent reviews and by verification against digital object identifier landing pages, covering January 2004 to 1 June 2026. Studies were appraised for design adequacy, cohort composition, analytical validation, and the correspondence between the claim advanced and the data presented. Three observations dominate the synthesis. The mechanistic foundations of fragmentomics are comparatively secure, since nuclease activity, chromatin accessibility, and hepatic clearance jointly govern fragment length and terminal characteristics, and genome-wide association analysis has linked end-motif phenotypes to specific nuclease loci. The strongest clinical evidence nevertheless remains obstetric rather than paediatric, concerning fetal fraction estimation, aneuploidy screening, and placental phenotypes, where fragmentomic features operate as quantitative adjuncts rather than as primary determinants of a molecular diagnosis. Direct evidence in postnatal paediatric rare and metabolic disease is sparse, derives largely from small single-centre cohorts, and has been generated principally in graft-injury monitoring rather than in primary diagnosis. Paediatric normative fragmentomic reference data are largely absent, pre-analytical standardisation remains inconsistent, and cohort sizes attainable for individual rare disorders are incompatible with the sample requirements of the statistical learning methods commonly applied. Fragmentomics is best characterised at present as a biologically well-grounded measurement framework whose diagnostic utility in paediatric rare disease remains largely unevaluated rather than established.

Sleep Duration, Quality, and Timing as Modifiable Determinants of Growth and Endocrine Health in Children and Adolescents: A Critical Narrative Review

Mon, 17 Aug 2026 00:00:00 +0000

Adequate sleep is increasingly recognised as a modifiable determinant of somatic growth and endocrine function during childhood and adolescence, yet the strength and consistency of this relationship across different sleep dimensions remain incompletely resolved. This critical narrative review synthesises evidence on how sleep duration, sleep quality, and sleep timing relate to linear growth, pubertal maturation, and metabolic-endocrine regulation in paediatric populations. Literature was drawn from peer-reviewed biomedical and life-science sources, general and specialist scholarly indexes, and citation tracking of recent reviews, covering mechanistic, cohort, cross-sectional, and intervention studies published predominantly since 2000, with foundational older work retained where historically necessary. The relationship between slow-wave sleep and pulsatile growth hormone release is well established physiologically, but its translation into measurable differences in childhood height remains inconsistent across cohort studies, with nighttime sleep duration showing more reproducible associations with linear growth than total sleep time. Evidence linking sleep quality, particularly obstructive sleep-disordered breathing, to growth faltering and post-surgical catch-up growth is comparatively robust. The association between sleep duration and pubertal timing is bidirectional and modest in magnitude, with genetic and observational data suggesting that later menarche modestly lengthens habitual sleep, while shorter sleep in mid-childhood may be associated with earlier pubertal onset in some age windows. Sleep curtailment is consistently associated with unfavourable leptin, ghrelin, and insulin-sensitivity profiles, although effect sizes vary by measurement method, pubertal stage, and adiposity status. Sleep timing and circadian misalignment, including social jetlag, appear to influence cardiometabolic risk independently of sleep duration, particularly in female adolescents. Cortisol regulation is sensitive to both sleep duration and sleep architecture in children, although the direction of causation is difficult to establish from existing designs. Across domains, methodological heterogeneity, reliance on subjective sleep measures, and a scarcity of studies spanning the pubertal transition limit the strength of causal inference that can currently be drawn. Priorities for future research include objectively measured, longitudinal cohorts extending across puberty, mechanistic paediatric studies of appetite-regulating hormones, and trials of sleep extension or circadian realignment with endocrine and growth endpoints.

Continuing Medical Anatomy Education: A Critical Narrative Review of Anatomy in Clinical and Surgical Practice

Rotimi S. Ajani — Sat, 22 Aug 2026 00:00:00 +0000

Anatomical knowledge underpins physical examination, image interpretation, procedural intervention and operative decision-making, yet it is acquired predominantly during the earliest phase of professional training and is seldom revisited in any structured manner thereafter. This critical narrative review examines the evidence connecting anatomical education to clinical and surgical practice, with particular attention to the period after undergraduate instruction ends. Literature was identified through searches of open scholarly databases and indexes, supplemented by forward and backward citation searching and bibliographic verification, covering January 2014 to 15 June 2026. Evidence was appraised for design adequacy, outcome validity, transferability and consistency, and was synthesised thematically rather than study by study. Four findings dominate. Consensus-derived core syllabi have brought welcome specificity to curricular content, but they rest on expert judgement rather than on outcome data, and their influence on what learners retain remains largely unmeasured. The proposition that anatomical knowledge determines operative safety is supported by mechanistic reasoning, studies of anatomical variation and medico-legal analysis, yet direct evidence linking measured anatomical competence to patient outcomes is almost entirely absent. Modality comparisons dominate the empirical literature and yield small to moderate, heterogeneous effects on short-term knowledge scores; immersive virtual environments outperform passive comparators more reliably than augmented reality does, and case-specific printed models have not been shown to transfer to cadaveric performance. Continuing anatomical education for qualified practitioners is delivered through cadaveric courses, intraoperative instruction, structured video review and computational anatomical recognition, but almost all supporting evidence comprises single-centre pre-test and post-test designs with self-reported confidence as an outcome. The principal weakness of the field is not scarcity of studies but misalignment between what is measured and what matters, since recognition tests taken days after instruction cannot substantiate claims about intraoperative judgement. Priorities include outcome-anchored definitions of competence, longitudinal retention studies extending into independent practice, standardised operative-interpretation assessments, and pragmatic multicentre trials of continuing anatomical education embedded within surgical training.