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.
Asteray Assmie Ayenew, Ben Mol, Gedefaw Abeje Fekadu et al.
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.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Adverse childhood experiences (ACEs) and bullying victimization are prevalent psychosocial stressors associated with adolescent depressive symptoms. However, less is understood about their co-occurrence, whether distinct exposure profiles confer differential risk, and the role of perceived social support in moderating the impact of ACEs and bullying on depression. This study addresses these gaps within a large cohort of Chinese adolescents. METHODS: A cross-sectional survey was conducted with 5,724 middle school students (mean age = 13.5 years) in Anhui Province, China. Participants completed self-report measures on ACEs, peer victimization, depressive symptoms, and perceived social support. Linear regression analyses explored the relationships between ACEs, bullying victimization, and depressive symptoms, as well as the moderating effect of perceived social support. Latent class analysis (LCA) identified patterns of co-occurring ACEs and victimization, with subsequent regression models examining associations with depressive symptoms and the moderating effect of social support. RESULTS: Among the participants, 65.5% reported experiencing at least one ACE, and 30.0% reported bullying victimization. Linear regression indicated that both ACEs and bullying victimization significantly elevated the risk of depressive symptoms, with emotional abuse and relational bullying showing the strongest associations. LCA revealed four distinct exposure profiles: a low-risk group with minimal exposure to ACEs and victimization; a family adversity group with high household adversity but low victimization; a victimization group with high peer victimization but relatively low ACE exposure; and a high-risk group with elevated probabilities of both ACEs and bullying victimization. Linear regression further showed that the combined ACEs and bullying victimization group had the highest depressive symptom scores, and LCA identified a high-risk subgroup with both ACEs and victimization, which also exhibited high depressive symptoms. Perceived social support significantly moderated the relationship between ACEs and depressive symptoms, but did not moderate the relationship between bullying victimization and depressive symptoms. CONCLUSIONS: Both ACEs and bullying victimization independently and cumulatively contribute to adolescent depressive symptoms. Perceived social support may serve as a protective factor against ACE-related depressive symptoms, though its role in buffering the effects of bullying victimization is less pronounced. Interventions should be tailored to specific risk profiles, addressing both familial and peer-related adversities to mitigate adolescent depression.
Peer-reviewed article·PubMed (US National Library of Medicine)·
We examined how masculine honor beliefs (MHBs, beliefs that violence is sometimes necessary for a man to protect himself, his family, or his reputation; Cohen & Nisbett, 1994; Saucier et al., 2015) relate to perceptions of parental retaliation against their child's sexual abusers. Participants (N = 203) read a hypothetical scenario about a father who learned that his child was molested by a male daycare worker and then violently retaliated against the male abuser. Participants completed the Masculine Honor Beliefs Scale (MHBS; Saucier et al., 2016) and rated their perceptions of the father, the male abuser, the actions they believed the father should take after learning about the sexual abuse (e.g., legal, social retaliation) before reading that he retaliated violently, and his decision to retaliate violently. Consistent with hypotheses, higher levels of MHBs were related to greater desires for harsher punishment for the male abuser and greater desired retaliation (social, legal, and violent) toward the male abuser. Higher levels of MHBs were also related to lighter punishment for the father's violent retaliation and more favorable perceptions of the father due to his violent retaliation. However, MHBs were negatively correlated with support for the father enacting child-focused (e.g., get the child therapy) and self-focused responses (e.g., talk to his wife about it). Our results are consistent with an important foundational concept of MHBs: It is important for a man to respond aggressively against insults and threats to protect his family and their reputation. Our findings suggest that those who more endorse MHBs focus more on punishing sexual offenders and less on supporting survivors of their offenses. When cases of parental retaliation against a child's sexual abuser occur in real life, the public is often divided on whether this violent retaliation is justified. Our research indicates that MHBs help explain these perceptions.
Svyatoslav Slava Prokhorets, Donald A Saucier
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND/OBJECTIVES: Empowered mothers are more likely to adopt recommended childcare practices, thereby contributing to reduced childhood undernutrition. However, the magnitude of the association between maternal empowerment and childhood undernutrition in Bangladesh has not been comprehensively assessed. This study aims to address this research gap. METHODS: The Bangladesh Demographic and Health Survey (BDHS) 2017-18 and BDHS 2022 served as data sources. Maternal empowerment was assessed across three domains, e.g., attitude to violence, social independence, and decision making, using the Survey-based Women's Empowerment (SWPER) index. The undernutrition status of children was assessed through z-score based indicators, including stunting (height-for-age z-score < -2 SD), wasting (weight-for-height z-score < -2 SD), and underweight (weight-for-age < -2 SD). Children with at least two and any of these undernutrition conditions were categorized as multiple undernutrition and any undernutrition, respectively. Multivariable logistic regression models were utilized to observe the survey-specific and pooled association between maternal empowerment and childhood undernutrition. RESULTS: The analysis includes 11,647 mother-child pairs. The association between maternal empowerment and childhood undernutrition was consistent across individual surveys and the pooled sample, although the significance level varied by empowerment domains and undernutrition categories. Maternal social independence was found to be a significant protective factor against both multiple and any childhood undernutrition status in individual surveys and the pooled sample. For example, in the pooled sample, high maternal empowerment in the social independence domain was significantly associated with 18% (AOR: 0.82; 95% CI: 0.69, 0.98; p = 0.026) lower odds of multiple undernutrition statuses and 18% (AOR: 0.82; 95% CI: 0.71, 0.95; p = 0.009) lower odds of any undernutrition statuses than those of low maternal empowerment. CONCLUSIONS: Improving the status of maternal social independence can potentially result in reduced childhood undernutrition. The scope remains to cascade the benefits of the other two maternal empowerment domains, e.g., attitude to violence and decision making, to child nutrition in Bangladesh.
Peer-reviewed article·PubMed (US National Library of Medicine)·
Forensic psychological and psychiatric evaluations-understood here as assessments addressing legally operative questions such as, for instance, competency to stand trial, criminal responsibility (sanity), violence risk, but also those on legal capacity and child custody-must meet stringent standards of scientific rigor, transparency, and replicability, yet the reasoning processes underlying clinical formulation require further theoretical articulation. This paper operates at an explicitly metatheoretical level: it does not propose a new clinical procedure, but an epistemological framework grounded in C. S. Peirce's theory of abduction. Abduction designates a third form of inference, irreducible to both induction and deduction: whereas deduction derives a necessary conclusion from a rule, and induction generalizes a rule from observed cases, abduction moves from a surprising fact to the most plausible explanatory hypothesis-a provisional conjecture that requires deductive and inductive testing. Within this framework, forensic case formulation is reconceptualized as an iterative, multi-level abductive process in which idiographic formulations must be systematically anchored to nomothetic data, safeguarded by dual-process reasoning and multimethod and Process-Focused assessment against distortions such as forensic confirmation bias, first-impression effects, and malingering. A novel theoretical contribution is a fractal model of abductive reasoning: clinical inference replicates its structure from micro-abductions on individual signs, through meso-abductions on diagnostic patterns, to macro-abductive formulations. Diagnostic errors can be understood as a "collapse of the fractal." Three vignettes from Italian proceedings illustrate the framework. The paper concludes with methodological and ethical recommendations, arguing that diagnostic error in forensic contexts carries both epistemic and ethical consequences.
Mothers in low-income households face an increased risk for intimate partner violence (IPV). The high costs of raising young children can create household conflict that makes violence more likely to occur. Furthermore, a lack of formal childcare can force women out of the workforce, rendering them financially dependent on partners. Childcare subsidies, which cover a portion of the expenses associated with center-based or in-home care for young children, can alleviate household economic strain and allow mothers to work, potentially reducing relationship conflict and promoting women's financial independence to leave abusive partners. The present study investigated the link between mothers' receipt of government childcare subsidies and IPV victimization. Data came from the Future of Families and Child Wellbeing Study, a large longitudinal birth cohort study that sampled families from 20 large American cities. The analytic sample for the present study was limited to mothers who were income-eligible for a childcare subsidy in their home state and were in an intimate relationship at the year 3 interview when children were approximately 3 years old (N = 1,987). Path analysis with a latent dependent variable found that receipt of a childcare subsidy was associated with a significant decrease in IPV victimization (β = -.18, p < .05), controlling for a number of maternal and household characteristics. Maternal employment, parenting stress, and housing insecurity were associated with increased IPV, regardless of subsidy receipt. Findings suggest childcare subsidies are an important policy tool for targeting violence against women. Expansion of federal childcare subsidies may have additional unintended benefits for families.
Katherine Marçal, Kathryn Showalter, Yanghyun Park et al.
