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Okubo Y, Uda K, Miyairi I, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Nationwide epidemiology and clinical practice patterns of pediatric urinary tract infections: application of multivariate time-series clustering. Pediatr Nephrol 2023; 38:4033-4041. [PMID: 37382710 DOI: 10.1007/s00467-023-06053-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The nationwide epidemiology and clinical practice patterns for younger children hospitalized with urinary tract infections (UTIs) were unclear. METHODS We conducted a retrospective observational study consisting of 32,653 children aged < 36 months who were hospitalized with UTIs from 856 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. We investigated the epidemiology of UTIs and changes in clinical practice patterns (e.g., antibiotic use) over 8 years. A machine learning algorithm of multivariate time-series clustering with dynamic time warping was used to classify the hospitals based on antibiotic use for UTIs. RESULTS We observed marked male predominance among children aged < 6 months, slight female predominance among children aged > 12 months, and summer seasonality among children hospitalized with UTIs. Most physicians selected intravenous second- or third-generation cephalosporins as the empiric therapy for treating UTIs, which was switched to oral antibiotics during hospitalizations for 80% of inpatients. Whereas total antibiotic use was constant over the 8 years, broad-spectrum antibiotic use decreased gradually from 5.4 in 2011 to 2.5 days of therapy per 100 patient-days in 2018. The time-series clustering distinctively classified 5 clusters of hospitals based on antibiotic use patterns and identified hospital clusters that preferred to use broad-spectrum antibiotics (e.g., antipseudomonal penicillin and carbapenem). CONCLUSIONS Our study provided novel insight into the epidemiology and practice patterns for pediatric UTIs. Time-series clustering can be useful to identify the hospitals with aberrant practice patterns to further promote antimicrobial stewardship. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Altunkol A, Abat D, Topuz AN, Alma E, Gürbüz ZG, Verit A. Muslim mothers mainly saw circumcision in terms of religion or tradition but wanted it to be carried out medical professionals. Acta Paediatr 2020; 109:396-403. [PMID: 31755589 DOI: 10.1111/apa.15105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/26/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022]
Abstract
AIM This study assessed the relationship between the education level of Muslim Turkish mothers whose sons had been circumcised and their views on circumcision. METHODS Interviews based on 20 close-ended questions were carried out in the Çukurova region of southern Turkey between June 2015 and September 2016. The participants were 1497 Muslim Turkish mothers whose sons had been circumcised and who were recruited using convenience sampling in schools, hospitals and public spaces. RESULTS Most (82%) of the mothers saw circumcision as a religious and traditional requirement, 64% mentioned the health benefits and 48% mentioned cosmetic appearance. The majority (80%) were performed by health organisations, with two-thirds (66%) expressing this preference. Most circumcisions were at school age (38%), which was about 6 years of age plus at the time of the study, and there were no complications in 79% of cases. Higher education levels were associated with views that circumcision was an important surgical procedure, it decreased the risk of urinary tract infections, it should be performed in hospitals and the foreskin did not prevent sexual intercourse. CONCLUSION Circumcision was mainly seen as a religious and traditional ritual, and more highly educated Turkish Muslim mothers were better informed about the health aspects.
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Affiliation(s)
- Adem Altunkol
- Department of Urology University of Health Sciences Adana City Teaching and Research Hospital Adana Turkey
| | - Deniz Abat
- Department of Urology Ministry of Health Iskenderun State Hospital Hatay Turkey
| | - Ayşe Nur Topuz
- Department of Family Medicine Public Health Institution of Çukurova Adana Turkey
| | - Ergün Alma
- Department of Urology University of Health Sciences Adana City Teaching and Research Hospital Adana Turkey
| | - Zafer Gökhan Gürbüz
- Department of Urology University of Health Sciences Adana City Teaching and Research Hospital Adana Turkey
| | - Ayhan Verit
- Department of Urology University of Health Sciences Fatih Sultan Mehmet Teaching and Research Hospital İstanbul Turkey
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Kato T, Mizuno K, Nishio H, Moritoki Y, Nakane A, Kurokawa S, Kamisawa H, Maruyama T, Yasui T, Hayashi Y. Can lichen sclerosus be diagnosed by preputial appearance or symptoms? Res Rep Urol 2018; 10:89-94. [PMID: 30271758 PMCID: PMC6149835 DOI: 10.2147/rru.s173184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Lichen sclerosus (LS), or balanitis xerotica obliterans, is a chronic, inflammatory disease accompanied by cicatrizing skin conditions resulting in pathologic phimosis. LS can be detected clinically by the whitish appearance of the glans or the foreskin, thickened, nonretractable foreskin, dysuria, and spraying. However, diagnosis is confirmed histopathologically. Purpose The aim of this study was to investigate whether LS can be diagnosed on the basis of clinical manifestation and symptoms. Patients and methods A retrospective analysis was performed, which included boys referred to our institutions for phimosis evaluation between May 2001 and December 2016. Pediatric urologists clinically diagnosed LS preoperatively. Boys with voiding problems, recurrent balanoposthitis, or who were unresponsive to topical steroid treatment underwent surgical treatment. Patients who underwent religious circumcisions were not included. Results Three-hundred twenty boys diagnosed with phimosis were identified, and 71 (22%) boys underwent surgery. Fifty-eight boys underwent complete or partial circumcision, and 13 boys underwent a dorsal slit or preputioplasty. Thirty foreskin samples were sent for histopathologic examination. Histopathologic evaluation showed evidence of LS in 13 of 30 (43%) circumcised boys, chronic inflammation in ten (33%), no abnormality in four (13%), dysplasia in two (7%), and acute inflammation in one (3%). In the 22 boys who were clinically diagnosed with LS, 13 patients had histopathologic evidence of LS (59%). Visually, eleven cases had whitish foreskins and 21 cases had thickened nonretractable foreskins, of which there were seven (64%) (P>0.05) and 12 (57%) (P<0.01) cases, respectively. These cases were histopathologically diagnosed with LS. Both whitish and thickened, nonretractable foreskin was observed in eight patients, of which seven (88%) (P<0.01) were also histologically diagnosed with LS. There was no correlation between histopathologic diagnosis and preoperative symptoms such as dysuria, ballooning, spraying, or penile pain (P>0.2). Conclusion It is difficult to reliably distinguish whether a patient has histopathological LS by clinical findings alone.
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Affiliation(s)
- Taiki Kato
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan,
| | - Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan,
| | - Yoshinobu Moritoki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Akihiro Nakane
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Satoshi Kurokawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Hideyuki Kamisawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Tetsuji Maruyama
- Department of Urology, Nagoya City East Medical Center, Wakamizu, Chikusa-ku, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan,
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Abstract
The American Academy of Pediatrics recently issued a statement that the health benefits of newborn male circumcision exceed the risks and therefore justify access to the procedure for families who choose it. Further, clinicians are charged with providing factually correct information that communicates the risks and benefits of elective newborn male circumcision in a nonbiased manner. However, many clinicians lack adequate information to discuss the risks and benefits of male circumcision. The purpose of this review is to highlight evidence on the risks and benefits of newborn male circumcision and provide clinicians with counseling points that can be used to guide discussion with parents considering newborn male circumcision.
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Castro-Vázquez G. Paediatric male circumcision and penile hygiene: a Japanese mothers' view. Anthropol Med 2013; 20:299-310. [PMID: 24152018 DOI: 10.1080/13648470.2013.850468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper analyses the views of 20 Japanese mothers concerning paediatric male circumcision and penile hygiene. In Japan, routine male circumcision has never been implemented for newborns and children, and adult males are mostly circumcised at aesthetic clinics. However, media reports indicate a trend of Japanese mothers willing to have their sons circumcised. In discussing penile hygiene and male circumcision, the construct of a 'sexual script' becomes relevant to understanding how linguistic and gender barriers made references to male genitalia and penile hygiene largely appear as 'vulgar' and 'unfeminine' in daily life conversations. Peers were often identified as the main source of information and only mothers who have struggled with their children's penile infections have learnt about male genital hygiene, a domain of knowledge largely transmitted by men. Male circumcision becomes a double-edged sword that could help prevent penile infections but also an embarrassing conversational topic that could elicit discrimination because most Japanese children are uncircumcised.
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Hayashi Y, Kohri K. Re: Editorial Comment to Circumcision related to urinary tract infections, sexually transmitted infections, human immunodeficiency virus infections, and penile and cervical cancer. Int J Urol 2013. [DOI: 10.1111/iju.12202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yutaro Hayashi
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya; Japan
| | - Kenjiro Kohri
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya; Japan
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