Anogenital warts and relationship to child sexual abuse: Systematic review and meta-analysis

BACKGROUND/OBJECTIVES

In children, distinguishing anogenital warts (AGW) acquired innocently from those acquired by child sexual abuse (CSA) is challenging. High-quality studies examining this relationship are sparse. Here, we sought to evaluate the association between AGW and sexual abuse in children 12 years of age and younger with respect to wart location, age, and gender.

METHODS

A systematic review of Ovid MEDLINE, Embase, and Web of Science was performed for studies published on or before 2/16/2018. Studies were eligible for inclusion if they contained at least 10 patients 12 years old and younger and reported the number of patients who were sexually abused. The principal summary measures were the odds ratios (OR) of reported CSA with respect to subject age, wart location, and gender.

RESULTS

Three hundred twenty-seven studies were identified through record search. Twenty five were included in a summary synthesis (791 subjects); 10 were included in the final statistical analysis (199 subjects). In our overall review, 102 of 468 (21%) females and 36 of 204 (18%) males with AGW were abused or probably abused. Overlapping HPV types were found in abused and non-abused subjects. Perianal location and gender were not significant predictors of abuse. Both age and genital wart location (penis, vulva) did significantly predict CSA (α = .05). The odds ratio for sexual abuse of children aged 3-4 years was 7.45; 6.52 for ages 5-8 years; and 6.93 for ages 9-12 years compared to those 0-2 years of age. Genital location was associated with an OR of CSA of 5.93.

CONCLUSIONS

Our systematic review supports a significant association between AGW in a child greater than 2 years of age and odds of CSA. Genital wart location significantly predicts CSA as well. HPV typing is not a reliable method to ascertain CSA. Male family members and acquaintances were the most likely perpetrators of abuse.

Europeans’ willingness to pay for ending homelessness: a contingent valuation study

Objective

In Europe, 4 million people were homeless in 2009. The Staircase model of care targeted mental health, drug rehabilitation and housing readiness yields poor long-term housing results. Western countries are investing in a new model, Housing First (HF), which yields better clinical and social results. We aim to explore how much the European citizens are willing to pay for the HF model and what are the determinants of this valuation.

Methods

A nationally representative telephone survey conducted in 2017, targeted European adult citizens from France, Ireland, Italy, Netherlands, Portugal, Spain, Poland and Sweden. Respondent’s willingness-to-pay (WTP) (n = 5,631) for HF model was assessed through a contingent valuation method with bidding algorithm. Multivariate analyses using two-part models with a cluster and weighted design were conducted to predict: 1/ respondents’ refusal or incapacity to pay for the HF model; 2/ willingness-to-pay (continuum) for the HF model.

Results

42.3% of respondents were willing to pay more taxes to reduce homelessness through HF model; 30.3% were protest zero (don’t want to pay taxes (either contested the payment vehicle-taxes- or the survey instrument); huge differences being observed between countries (P<.001). Respondents were willing to pay €57 (+/- 9) through annual taxes for the HF model. Respondents with higher educational attainment, paying taxes on income, reporting positive attitudes about homelessness or practices to reduce homelessness (donations, volunteering), and those residing in a country with higher share of social protection expenditures on family benefits or higher at-risk-of-poverty rate were more likely to value the HF model.

Perspective

These results provide key stakeholders with an understanding of the level of support from the general population for the Housing First model; especially since the determinants of this valuation were studied according to the social and environmental context of each country.

Key messages

More than 42% of European citizens reported to be willing to pay for reversing homelessness. More than a three quarter of European citizens thought that Government spending on Homelessness is too little.

Knowledge, attitudes, and practices about homelessness and willingness-to-pay for housing-first across 8 European countries: a survey protocol

Background

Most European countries report rising numbers of people experiencing homelessness. For those with mental disorders, interventions are centered on achieving mental health and drug rehabilitation alongside housing readiness, often to the detriment of access to housing. Notwithstanding, more European countries are investing in a new model, Housing First (HF), which postulates immediate access to permanent housing with no initial requirements for treatment. While results of the European HF programs are published on individual-level data, little is known about the opinions of the general population about homelessness and the societal value of the HF model, which can represent barriers to the model's dissemination. Therefore, we present the protocol of a study designed for the following objectives: 1) to explore the knowledge, attitudes, and practices (KAP) about homelessness within the general population of 8 European countries, 2) to assess the valuation of the HF model by European citizens, and 3) to estimate the lifetime prevalence of homelessness in the targeted countries.

Methods

A telephone survey was conducted from March to December 2017 among adults selected from opt-in panels from France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden. A total sample of 5600 interviews was expected, with 700 per country. The interviews included three sections: first, the KAP about homelessness; second, the valuation of the HF model by measuring a respondent's willingness-to-pay (WTP) through the contingent valuation method; and third, an assessment of the lifetime prevalence of homelessness among the general population. Descriptive analyses and comparisons between countries will be conducted. KAP indicators will be created and their psychometric properties assessed. Determinants of WTP will be assessed through regression models.

Discussion

This survey will highlight Europeans' views of homelessness, especially their level of tolerance towards homelessness, potential misconceptions and the most important barriers for the implementation of the HF model. Additionally, the results on the valuation of the HF model by citizens could be instrumental for key stakeholders in understanding the level of support from the general population. Ethics approval has been obtained from the Aix-Marseille University Ethics Committee (n° 2016-01-02-01) for this study, which is part of HOME_EU: Reversing Homelessness in Europe H2O20-SC6-REVINEQUAL-2016/GA726997.

A Report of Two Patients with Darier Disease and Hidradenitis Suppurativa

We report two unique cases of patients with Darier disease and hidradenitis suppurativa. Although it is unknown whether there is a connection between the two diseases, it is possible that an interaction between sarcoendoplasmic reticulum calcium transport ATPase and Notch homolog 1, translocation-associated (Drosophila) caused both diseases in these individuals.

Granuloma inguinale in a 51-year-old man

Granuloma inguinale, or Donovanosis, is a rare, sexually transmitted ulcerative disease primarily affecting the genital area. In this report, we present a case of a 50-year-old man that was diagnosed with granuloma inguinale after a 2-month history of a penile ulcer. Histological analysis demonstrated the presence of Donovan bodies within macrophages, confirming the diagnosis. He was subsequently treated with trimethoprim/sulfamethoxazole with improvement in the ulcer. This case serves as a reminder to clinicians that although granuloma inguinale is rarely encountered in the US, it should still be suspected in patients with non-healing penile ulcers.

Objective assessment of isotretinoin-associated cheilitis: Isotretinoin Cheilitis Grading Scale

IMPORTANCE

Isotretinoin remains an effective treatment for severe acne. Despite its effectiveness, it includes many side effects, of which cheilitis is the most common.

OBJECTIVE

To develop an objective grading scale for assessment of isotretinoin-associated cheilitis.

DESIGN

Cross-sectional clinical grading study.

SETTING

UC Davis Dermatology clinic.

PARTICIPANTS

Subjects were older than 18 years old and actively treated with oral isotretinoin.

EXPOSURES

Oral Isotretinoin.

MAIN OUTCOMES AND MEASURES

We developed an Isotretinoin Cheilitis Grading Scale (ICGS) incorporating the following four characteristics: erythema, scale/crust, fissures and inflammation of the commissures. Three board-certified dermatologists independently graded photographs of the subjects.

RESULTS

The Kendall's coefficient of concordance (KCC) for the ICGS was 0.88 (p < 0.0001). The Kendall's coefficient was ≥0.72 (p < 0.0001) for each of the four characteristics included in the grading scale. An image-based measurement for lip roughness statistically significantly correlated with the lip scale/crusting assessment (r = 0.52, p < 0.05).

CONCLUSION AND RELEVANCE

The ICGS is reproducible and relatively simple to use. It can be incorporated as an objective tool to aid in the assessment of isotretinoin associated cheilitis.

Alopecia as the Presenting Symptom of Syphilis

Alopecia can be one of the many symptoms of secondary syphilis and the clinical presentations include essential syphilitic alopecia or symptomatic syphilitic alopecia. In this report, we present a case of a patient with essential syphilitic alopecia whose sole presenting symptom of syphilis was alopecia. Despite an initial negative rapid plasma reagin (RPR) test, he was ultimately found to have syphilis on scalp biopsy. His alopecia improved following treatment with benzathine penicillin. This presentation serves as a reminder to clinicians to be cognizant of alopecia as a presenting sign of syphilis. A review of the specificity and sensitivity of the typical tests used for the diagnosis is presented.