BACKGROUND: Cystography is a common genitourinary imaging study performed in the evaluation of children and can result in iatrogenic infection. OBJECTIVE: We sought to determine the incidence of and factors associated with post-cystography urinary tract infection (PCUTI) in a contemporary population. STUDY DESIGN: A single-institution, retrospective review was performed for 913 patients who underwent cystography (voiding cystourethrogram, radionuclide cystography, and contrast-enhanced voiding urosonography). PCUTI was defined as strict (fever or symptoms + pyuria + positive urine culture) or pragmatic (met strict criteria or high clinical suspicion prompting treatment) within 30 days of cystography. A multivariate logistic regression model was used to adjust for the propensity of being on antibiotic prophylaxis. RESULTS: By strict criteria, 1.0 % and 2.2 % of patients developed PCUTI within 7 and 30 days of cystography, respectively. An additional 13 patients (33 total, 3.6 %) met pragmatic criteria for 30-day PCUTI. Circumcised males were less likely than females (OR 0.24, 95 % CI 0.05-0.76, p = 0.030) and patients with kidney stones on ultrasound were more likely than those without stones (OR 12.2, 95 % CI 3.04-42.34, p < 0.001) to have PCUTI. Being on antibiotic prophylaxis was not associated with decreased odds for post-cystography urinary tract infection. DISCUSSION: Based on our results, we can reasonably counsel families that circumcised males have lower likelihood of PCUTI, children with kidney stones on their ultrasound have higher likelihood of PCUTI, and prophylactic antibiotics did not reduce the likelihood of developing a PCUTI. This study is limited by our pragmatic definition of UTI and the variables included in our multivariate model. CONCLUSIONS: There is a relatively small but noteworthy risk for urinary tract infection after cystography. Sex, circumcision status, and presence of kidney stones on ultrasound were significantly associated with the likelihood of PCUTI, while antibiotic prophylaxis was not. Further investigation is necessary to determine interventions that may reduce PCUTI in high-risk patients.
Peter Y Cai, Tanya Logvinenko, Caitlynn Feng et al.
Globally, the burden of hepatitis B virus (HBV) infection is a serious health problem for women that could be transmitted to their newborn infants. Screening and treating at an early stage help prevent the spread of this infection and its complications. Therefore, the study aimed to assess the seroprevalence and associated risk factors of HBV infection among mothers attending public health facilities in Bahir Dar, Northwest Ethiopia. A cross-sectional study was conducted in a total of 325 mothers attending Bahir Dar city public health facilities from December 2023 to June 2024. Data on sociodemographic characteristics and possible risk factors were collected using a structured questionnaire, and serum samples were screened for hepatitis B surface antigen (HBsAg) using sandwich enzyme-linked immunosorbent assays (ELISA). Data were entered and analyzed using SPSS version 23 software. Logistic regression was used to check the association between variables with an odds ratio (OR) at 95% confidence intervals (CI). P-value ≤ 0.05 was considered statistically significant. The overall seroprevalence of HBV infection was 3.4% (95% CI; 1.0-5.0). The history of sexually transmitted diseases (STDs) (AOR = 7.60; 95% CI: 1.84-31.34, p = 0.005), history of contact with chronic hepatitis B virus-infected (CHB) family members (AOR = 20.86; 95% CI: 2.48-175.03, p = 0.005), and female circumcision (AOR = 13.76; 95% CI: 1.63-116.80, p = 0.016) were significantly associated risk factors with HBV infection. Generally, an intermediate seroprevalence of HBV infection was reported in this study. This showed that HBV infection is still a critical public health concern among mothers in the study area. History of contact with CHB family members, history of STDs, and female circumcision were significantly associated risk factors with HBV infection. These findings call for enhanced public health strategies to effectively reduce HBV infection in mothers.
Mekuanint Geta, Endalew Yizengaw, Kefale Ejigu et al.
Peer-reviewed article·PubMed (US National Library of Medicine)·
INTRODUCTION: Children require extra care and attention during healthcare procedures. Therefore, it is crucial for healthcare providers to implement appropriate interventions to manage the negative effects of pain and anxiety that may arise in medical settings. MATERIALS AND METHODS: This quasi-experimental pretest-posttest study aimed to determine the effect of video games played during circumcision on children's pain, anxiety, and physiological parameters. The study population consisted of children aged 6-12 years who were scheduled to undergo circumcision with local anesthesia in a private Pediatric Surgery Clinic. The study was completed with a total of 42 children. Data were collected using a parental information form, a physiological measurement chart, the Faces Pain Scale-Revised (FPS-R), and the Children's Emotional Manifestation Scale (CEMS). Assessments were conducted three times: before the procedure, during the procedure, and at the end of the procedure. Statistical analyses included frequency (n), percentage (%), and mean values. The Friedman test was used to determine differences between measurements. RESULTS: The mean age of the children in the study was 7.33 ± 1.20 years. Heart rate and respiratory rate significantly decreased in the second and third assessments compared to the first measurement (p < .05). The FPS-R scores in the second and third assessments were significantly lower compared to the first assessment. Similarly, CEMS scores in the second and third assessments were significantly lower than in the first assessment (p < .05). CONCLUSION AND RECOMMENDATIONS: The use of video games during circumcision provides a novel, easily accessible, and cost-effective intervention to manage pain, anxiety, and the physiological effects of stress in children. Additionally, it facilitates the safe completion of the procedure.
IMPORTANCE: Child and adolescent members of marginalized racial groups have poorer surgical outcomes compared with White children and adolescents. Clinical communication may contribute to these disparities. OBJECTIVE: To explore racial differences in parent-clinician communication during initial consultations for elective surgical procedures in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS: This cohort study investigated communication during consultations between parent-clinician dyads: surgical clinicians and parents of children and adolescents ages 2 to 17 years referred for initial evaluation for tonsillectomy or adenoidectomy, hernia repair, and circumcision between 2016 and 2023 at academically affiliated outpatient clinics in the Baltimore, Maryland, region. MAIN OUTCOMES AND MEASURES: Visits were audio-recorded and coded using the Roter Interaction Analysis System, a quantitative communication coding system developed to analyze medical interactions. Outcomes included visit-level measures (parent vs clinician verbal dominance and patient-centeredness ratio), clinician communication (facilitation and activation statements to encourage parent participation, emotional statements, social chitchat, and normalized positive affect Z scores), and parent communication (emotional statements, social chitchat, and normalized positive affect Z scores). Generalized estimating equations were used to test associations of parent race with visit communication, accounting for nesting of visits within clinicians and adjusting for parent sociodemographic variables. RESULTS: A total of 153 parents (63 Black [41.2%] and 90 White [58.8%]; mean [SD] age, 35.1 [6.7] years; 135 female [88.2%]) and 22 clinicians (2 Asian [9.1%], 1 Hispanic or Latino [4.5%], 13 White [59.1%], 3 another race or ethnicity [13.6%], and 3 multiple races or ethnicities [13.6%]; 12 female [54.5%]) were included. In unadjusted models, visits with Black parents had higher clinician verbal dominance (0.4 more clinician statements [95% CI, 0.1-0.8 statements] per parent statement) but no difference in overall patient-centeredness scores compared with visits with White parents. However, visits with Black parents had 2.3 fewer clinician chitchat statements (95% CI, 3.3 to 1.3 statements), 26.6 fewer total parent statements (95% CI, 46.0 to 7.2 statements), 2.1 fewer parent emotional statements (95% CI, 3.6 to 0.7 statements), and 1.7 fewer parent chitchat statements (95% CI, 2.8 to 0.55 statements) per visit and lower parent positive affect (Z score = -0.6; 95% CI, -1.0 to -0.2) compared with visits with White parents. After adjustment for parent sociodemographic variables, clinician verbal dominance remained significantly higher, with clinicians making 0.4 more statements (95% CI, 0.1-0.7 statements) per parent statement. CONCLUSIONS AND RELEVANCE: In this study, parent race was associated with differences in clinician, parent, and interactive visit communication, although some differences appeared to be mediated by sociodemographic factors and most were due to differences in parent rather than clinician communication. These findings suggest that application of patient-centered communication and engagement strategies may help bridge social distance in pediatric surgical care.
Peer-reviewed article·PubMed (US National Library of Medicine)·
IMPORTANCE: Since 2021, there have been growing calls in the US to prohibit gender-affirming medical care (GAMC) for transgender and gender-diverse (TGD) minors (ie, <18 years). Supporters of these bans have argued the restrictions are necessary to protect TGD minors from potentially risky or unproven medical interventions; however, the same bans include exceptions for similar procedures when performed on presumptively non-TGD minors: primarily, infants and children with variations in sex characteristics, or intersex traits. OBJECTIVE: To comprehensively describe US legislation seeking to prohibit GAMC for TGD individuals and determine the extent to which such legislation contains exceptions for similar interventions performed on presumptively non-TGD minors. EVIDENCE REVIEW: All US jurisdictions with statutes restricting GAMC across 4 full legislative sessions (January 1, 2021, to December 31, 2024) were searched. For each statute, the authors identified descriptions of sex, gender, and GAMC; restricted health care services; stated purpose(s) for which services are restricted; exceptions to restrictions; and penalties for statutory violations. FINDINGS: All US states with legislation restricting voluntarily sought TGD-related health care contain statutory exceptions that allow for physically comparable, but typically nonvoluntary interventions to "normalize" the benign bodily attributes of children with intersex traits. Some statutes also explicitly permit medically unnecessary procedures like penile circumcision on presumptively non-TGD minors. CONCLUSIONS AND RELEVANCE: Inconsistent statutory rules appear to be applied to TGD and presumptively non-TGD minors. Furthermore, these findings suggest such rules are shaped by definitions of sex and gender that conflict with current scientific understanding. Sound health policy ought to afford equal access to health care services affecting sexual anatomy, without discrimination based on sex traits or gender.
Sara A Mar, Brian D Earp, Gnendy Indig et al.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: This meta-ethnographic review synthesised qualitative evidence on the lived experiences and impacts of female genital mutilation/cutting (FGM/C). By incorporating insights from individuals who have undergone FGM/C, men and healthcare providers caring for affected populations, the study enriches understanding of the practice and its multifaceted consequences. METHODS: Using Noblit and Hare's seven-stage meta-ethnographic framework, an inductive and interpretive synthesis was conducted. A comprehensive search of electronic databases, including PubMed/Medline, ScienceDirect, Google Scholar, ResearchGate, African Journals Online (AJOL) and the WHO website, identified qualitative and mixed-method studies that captured in-depth perspectives on FGM/C. The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies, and Ames et al's 5-point scale was applied to evaluate the conceptual richness of each study. RESULTS: Fifty-three qualitative studies spanning diverse geographical and cultural contexts, both in traditionally practising regions and migrant communities, were included. Through rigorous analysis of first-order constructs (participant quotes) and second-order constructs (study authors' themes), five overarching themes were developed: (1) the onset: inherited tradition and gendered expectations; (2) ramifications on health and well-being; (3) inadequate health-seeking behaviours and lack of comprehensive healthcare services; (4) the psychosocial toll and (5) the perceived benefits of FGM/C. Each overarching theme comprises second-order constructs, along with participants' quotes. CONCLUSION: This synthesis demonstrates how FGM/C is deeply intertwined with sociocultural norms and functions as a bidirectional bridge, presenting a complex dilemma for the health of women and girls, healthcare systems and broader society. On one hand, it serves as a pivotal gateway to sociocultural belonging and a source of social capital, shaping women's and girls' lives long after the practice itself. On the other hand, it inflicts immediate, short-term and long-term health impacts and poses considerable challenges for healthcare systems due to its diverse and interconnected consequences. This complexity makes it challenging to address all related issues within a single setting or with a single specialist, often leaving affected individuals behind in accessing the highest attainable quality of care and support, while simultaneously complicating elimination efforts. PROSPERO REGISTRATION NUMBER: CRD42023387750.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Pediatric opioid prescribing has received heightened scrutiny following legislative and professional efforts to curb excess supply. In Michigan, multiple statewide opioid stewardship policies-including informed consent for minors, expanded prescription monitoring, and prescribing duration limits-were implemented in June 2018. We evaluated changes in opioid prescribing for common pediatric surgical procedures following these statewide initiatives. METHODS: A retrospective review of children <18 years undergoing surgery at a single tertiary children's hospital between June 1, 2015, and June 1, 2021. Procedures included circumcision, tympanostomy, adenoidectomy, tonsillectomy, and inguinal or umbilical hernia repair. Patient demographics, surgical specialty, insurance status, and discharge opioid prescriptions were abstracted. Morphine milligram equivalents (MME) were calculated for all prescriptions. Outcomes included mean MME prescribed and the frequency of patients receiving no opioid prescription before and after June 2018, coinciding with implementation of statewide opioid stewardship policies. Multivariable regression adjusted for patient age, surgery type, and insurance. RESULTS: Among 7280 patients (3512 before, 3768 after), mean prescribed MME declined significantly following implementation of statewide opioid stewardship policies (7.7 vs 3.2 mg, p < 0.0001). Reductions were observed across specialties and procedures, with the largest decreases in circumcision and tonsillectomy. The proportion of patients who received no opioids remained stable (60.8 % before vs 59.7 % after, p = 0.35). CONCLUSIONS: Prescribed opioid dosages decreased significantly following implementation of Michigan's coordinated statewide opioid stewardship policies. These reductions coincided with overlapping legislative, monitoring, and educational efforts, suggesting that multi-level stewardship initiatives collectively contributed to safer prescribing practices in pediatric surgery.
Madison Saunders, Ryan T Davis, Nathan M Novotny et al.
Peer-reviewed article·PubMed (US National Library of Medicine)·
Male circumcision is an accepted HIV prevention measure in high-incidence countries and is now part of global HIV prevention programs. We interviewed 63 mothers at four major hospitals in Bunia, North-Eastern Democratic Republic of Congo (DRC) between February and March 2014, about their circumcision practices for their sons, including reasons and timing. All participants indicated that their son's father was circumcised and that they have or will circumcise their son. The most common reason given was adherence to social norms. Only 12.7% mentioned prevention of sexually transmitted infections, including HIV. The mean age of circumcision was 2.5 ± 1.8 years, with reasons including greater strength to tolerate surgery (34.9%) and better pain tolerance (27.0%). All responses were recorded, entered into Microsoft Excel, and analyzed to calculate the mean, average, and standard deviation statistics. Few mothers planned circumcision in the newborn period. These findings suggest that circumcision in the DRC is culturally driven rather than motivated by HIV prevention and typically occurs after the newborn period. Parental education on optimal timing is needed to reduce surgical risks and maximize health benefits.
Vanessa Dochynets, Angela E Schellenberg, Philip Wood
SurvivalDevelopmentCD
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: HIV incidence among adolescent girls and young women (AGYW) in eastern and southern Africa has declined substantially over the past two decades. These declines are often attributed to biomedical HIV prevention strategies, though concurrent changes in sexual behavior may also contribute. We evaluated the contributions of biomedical and behavioral drivers to historical incidence decline in AGYW and projected their impact on incidence trajectories over the next 30 years. METHODS AND FINDINGS: We conducted a mathematical modeling study using data from the Rakai Community Cohort Study (RCCS), an open, population-based cohort of adults aged 15-49 years in 30 communities in Rakai, Uganda. We used an agent-based HIV-1 transmission model calibrated to cohort data to estimate HIV incidence trends among AGYW, aged 15-24, and to quantify the independent and combined effects of antiretroviral therapy (ART), voluntary medical male circumcision (VMMC), and changes in age at first sex (AFS). HIV incidence among women aged 15-24 declined by 71% between 2000 and 2019, from 1.57 to 0.45 per 100 person-years, representing the largest decline across female age groups in the cohort. Increasing AFS over the study period (by approximately 3 years in women and 2 years in men) was the largest contributor to incidence declines among adolescent women aged 15-19, averting 17% of cumulative infections between 2000 and 2020 and 37% between 2000 and 2050. Among women aged 20-24, ART scale-up had the greatest impact, averting 13% of infections by 2020 and 43% by 2050. VMMC contributed modestly to historical declines but had larger projected effects over longer time horizons. ART, VMMC, and delays in AFS acted additively to reduce HIV incidence among AGYW. Study limitations include reliance on self-reported sexual behavior and the use of a mathematical model that cannot capture all real-world sexual network dynamics. CONCLUSIONS: Both biomedical HIV interventions and broader behavioral changes contributed to declines in HIV incidence among AGYW. Sustaining continued incidence declines in young women will require maintaining both the protective changes in sexual behaviors and effective biomedical interventions.
Peer-reviewed article·PubMed (US National Library of Medicine)·
Violence and abuse against women and children remain prominent issues in Lebanon, resulting in dire psychological consequences. The aims of the current study are to evaluate the moderating role of child abuse in the relationship between (1) domestic violence and suicidal ideation, and (2) domestic violence and self-harm. This cross-sectional study was conducted between January and May 2023. Women between the ages of 18 and 50 were recruited to participate using a snowball sampling technique. 915 women consented to take an online questionnaire that collected information about sociodemographic characteristics. It also included the following scales: Composite Abuse Scale (Revised)-Short Form, Columbia Suicide Severity Rating Scale, Child Abuse Self-Report Scale (CASRS-12), and Self-Harm Inventory (SHI). Older age (aOR = 0.96) was significantly associated with lower odds of having suicidal ideation, whereas higher domestic violence (aOR = 1.09), psychological child abuse (aOR = 1.36) and child neglect (aOR = 1.09) were significantly associated with higher odds of having suicidal ideation. The interaction domestic violence by sexual abuse (aOR = 1.04) was significantly associated with suicidal ideation in the binary model. In an additional ordinal logistic regression analysis of suicidal ideation severity, older age remained protective, while child neglect and physical abuse were associated with greater severity of suicidal ideation. The interaction domestic violence by child neglect was significantly associated with self-harm. At low (Beta= 0.01; p = .013), moderate (Beta= 0.022; p < .001), and high (Beta= 0.035; p < .001) levels of child neglect, higher domestic violence was significantly associated with more self-harm. The current study results have the potential to guide mental health professionals in implementing further interventions for child abuse and domestic violence. It can encourage a multidisciplinary approach starting with Lebanese community-based programs that combine the efforts of researchers and practitioners in order to reduce the burden of child abuse and domestic violence.
Emmanuelle Awad, Perla Moubarak, Diana Malaeb et al.
