Exploration into the microstructural, mechanical, and biological characteristics of the functionally graded 3Y-TZP/Ti6Al4V system as a potential material for dental implants

This study investigated the mechanical, microstructural, and biological properties of 3Y-TZP/Ti6Al4V functionally graded material (FGM) fabricated by the spark plasma sintering (SPS) method. For this purpose, 11 layers of 100-x vol% Ti6Al4V/x vol% Yttria stabilized zirconia (YSZ) (x = 0 to 100) were sintered at 1450 °C and a pressure of 30 MPa for 8 min. To investigate the properties of each layer in more detail, 11 batches of 100-x vol% (Ti6Al4V)/x vol% YSZ (x = 0 to 100) composites were sintered separately with the same sintering conditions mentioned for the FGM sample. Phase identification of the FGM sample showed the formation of Ti3O, c-ZrO2, and Zr3O phases as by-products. A schematic model was proposed for the formation of the mentioned phases with the aid of thermodynamic calculations. The formation of these phases was confirmed by microstructural and elemental tests. The results of the relative density of the samples showed that these values were obtained for each layer above 99%. The microhardness of 590 ± 18 Vickers was obtained for Ti6Al4V; by increasing the amount of 3Y-TZP, this value reached 1510 ± 24 Vickers for the YSZ sample. The fracture toughness value for Ti6Al4V was 39.2 ± 2 MPa m0.5, which was significantly reduced to 4.84 ± 1 MPa m0.5 by adding 10 vol% YSZ. After that, with the further increase of YSZ, this value increased slowly. A similar trend was observed for the bending strength of the samples. By increasing 3Y-TZP from 0 to 30 vol%, the bending strength was decreased from 1556 ± 32 to 272 ± 62 MPa. By further increasing the amount of 3Y-TZP from 30 to 100 vol%, an increase in the bending strength was observed in the samples, which reached 1180 ± 71 MPa for the YSZ sample. The FGM sample showed a brittle fracture despite a metal layer, but a higher bending strength (982 ± 44 MPa) was obtained for this structure than the composite samples. The biological results show that increasing YSZ content leads to a decrease in antimicrobial activity. Additionally, all samples demonstrated high biocompatibility based on MTT cytotoxicity tests after 1 and 7 days of culture.

A thermo-mechanically loaded rotating FGM cylindrical pressure vessels under parabolic changing properties: An analytical and numerical analysis

This study aims to develop an exact analytical solution for steady-state thermo-mechanical stress in a functionally graded (FG) thick-walled cylindrical vessel. The cylinder is subjected to combined rotational speed and internal pressures while the thermal load is with convective and radiative boundary conditions. The dimensionless governing equations and boundary conditions, represented as a quartic equation, are derived and solved using Ferrari's method. The temperature, displacement, and stress fields across the thick-walled cylindrical vessel are calculated by finding the roots of the quartic equation. In order to investigate the accuracy of the exact analytical solution, a numerical model is constructed based on a standard Galerkin discretization approach of the finite element method (FEM). The analytical solutions and the results obtained through FEM show a high level of agreement. Furthermore, the study analyzes the effects of material parameters on temperature, displacement, and stress fields. Displacement, temperature, and stress fields are presented in the form of dimensionless graphs along the radial direction. For the considered parametric studies, results revealed that parabolic grading is beneficial than conventional grading. This study reveals that for the thermal loading, the maximum temperature, displacement, and tangential stress decrease for the parabolic grading. A similar but lower value of temperature, displacement, and tangential stress is also observed in the case of thermomechanical loading. This study is expected to assist in the assessment of the reliability of load calculations and contribute to the overall durability of pressure vessels. The results obtained from this study can provide valuable insights into thermo-elasticity and the thermo-mechanical behavior of thick-walled cylindrical vessels and can aid in the design and optimization of such systems.

Female Circumcision and Sexual Negotiation Ability of Ethiopian Women

The following study attempts to assess the link between the circumcision status of Ethiopian women and their ability to negotiate sex. From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 3,445 women aged 15 to 49. Women's sexual negotiation ability was measured by their ability to ask for condom and their ability to refuse sex. We performed a univariate, bivariate, and multiple logistic regression analysis. In the final analysis, only education, residence, media access, and sexually transmitted infections knowledge were independently associated with the sexual negotiation ability of women. Circumcision status was not associated with sexual negotiation ability.

Female Genital Mutilation and Sexual Risk Behaviors of Adolescent Girls and Young Women Aged 15-24 Years: Evidence From Sierra Leone

PURPOSE

Considering the high levels of female genital mutilation (FGM) in Sierra Leone with over 83% of girls and young women aged 15-24 years having undergone the practice, the study explores the potential influence of FGM on sexual behaviors of adolescent girls and young women (AGYW) in Sierra Leone.

METHODS

Cross-sectional data from the 2019 Demographic Health Survey were utilized to examine the association between FGM and three sexual behaviors; sexual debut before 18 years, child marriage and adolescent motherhood. To model this association, a generalized estimation equation technique was employed, while controlling for socio-demographic characteristics. Additionally, the study corrected for multiple-hypothesis testing using the Benjamini-Hochberg procedure with a specified false discovery rate of 0.05. Finally, percentage predicted probabilities of occurrence of the sexual risk behaviors in the presence of FGM were also calculated.

RESULTS

Of the 5524 AGYW, 76% had undergone FGM. FGM was associated with all three sexual risk behaviors. Sexual debut before 18 years had the highest predicted probability increase (+18.00 ppt, 95% CI: 14.41 to -21.59), followed by adolescent motherhood (+13.38 ppt, 95% CI: 10.16-16.60) and child marriage (+12.61 ppt; 95% CI: 10.22-15.01). Education was found to be protective against all three sexual risk behaviors.

DISCUSSION

The findings of this study demonstrate that FGM remains a prevalent practice in Sierra Leone, even among the younger generation. This practice is strongly associated with sexual behaviors that pose a significant risk to the health outcomes of AGYW. Investments in education by removing barriers to access for AGYW could lead to multiple gains.

Female genital mutilation - An overview for forensic practitioners

Female genital mutilation (FGM) refers to all procedures that partially or totally remove the external female genitalia, or to all other deliberate injuries to the female genital organs for non-medical reasons. It is thought that over 200 million girls and women have had some form of FGM, with more than three million girls being at risk annually. The procedure varies in severity from partial or complete removal of the clitoris (Type 1) to oversewing of the vaginal opening, so-called infibulation (Type 3). There are no medical benefits from FGM, with complications increasing with the amount of tissue damage that has been inflicted. Side effects may be psychological and physical including excessive scarring, pain, infections, sexual dysfunction with significant obstetrical complications such as fistulas and increased risks of stillbirth, as well as increased neonatal and maternal morbidity and mortality. Although primarily originating in countries in Africa, the Middle East and Asia, mass migrations in recent years have made FGM a feature in most societies. For this reason, forensic practitioners and pathologists should be aware of the anatomical features of FGM and the potential medical and psychological side effects. Accurate recording of cases is required to enable appropriate resources to be allocated for instituting preventive measures.

Postpartum depressive symptoms in women with female genital mutilation in Somalia

OBJECTIVES

This study aimed to identify associated factors for postpartum depression (PPD) among women with female genital mutilation (FGM) in Somalia.

METHODS

This was a cross-sectional study conducted between February and May 2021 in Somalia Mogadishu-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia. Mothers with any known chronic disease, or psychiatric disorders and who refused to participate were excluded from the study. The cutoff point for depression was defined as ≥13 points according to the Edinburgh Postnatal Depression Scale.

RESULTS

Out of 446 postpartum mothers, 267 (59.9%) had increased depressive symptoms in the early postpartum period. PPD scale scores of mothers who were very poor were significantly higher depression scores than their counterparts (p = .002). Education level, place of residence, occupational status, number of children, type of FGM, and the presence of perineal tear did not differ significantly between depressed and non-depressed groups.

CONCLUSIONS

Women with FGM had increased depressive symptoms in the early postpartum period in Somalia. In addition, women who had lower income had higher PPD scores than their counterparts. Further studies are needed to develop a deeper understanding of the relationships between FGM and PPD and its causes.

Female genital mutilation/cutting: going beyond urogynecologic complications and obstetric outcomes

PURPOSE OF REVIEW

Female genital mutilation/cutting (FGM/C or FGM) are procedures that involve partial or total removal of external female genitalia and other injuries to the female genital organs for non-medical reasons. Over 4 million girls are at risk of FGM annually. Since urogynecologic and obstetric complications of FGM have been extensively described and characterized, the aim of this review is to shift the focus on other aspects like perception of women, awareness of community, and knowledge of health workers. Our purpose is to highlight those aspects and understand how their grasp might help to eradicate this practice.

RECENT FINDINGS

Self-perception of women with FGM changes when they emigrate to western countries; awareness of complications and awareness of their rights are factors that make women reject the practice. Women from rural areas, already circumcised, or without a secondary level education are more likely to have a circumcised daughter. Women with at least a secondary education are more likely to agree with the eradication of the practice. Lack of education and poor wealth index are factors associated with men's support of FGM. Although aware of FGM, healthcare professionals need to be trained on this topic. General practitioners play a central role in addressing patients with FGM to the right path of diagnosis and treatment and psychologists in helping them with psychological sequelae.

CONCLUSION

These findings point out the future area of intervention, stressing the need of higher standard of care and global effort to eradicate this practice.

Exploring the risk of glycemic variability in non-diabetic depressive individuals: a cross-sectional GlyDep pilot study

Background

Data on the correlation between glycemic variability and depression in nondiabetic patients remain limited. Considering the link between increased glycemic variability and cardiovascular risks, this relationship could be significant in depressed patients.

Methods

In this single-center pilot study, we utilized Flash Glucose Monitoring (Abbott Libre Pro) to study glycemic variability. The CES-D (Center for Epidemiological Studies- Depression) scale was employed to measure depression levels. Based on CES-D scores, patients were classified into two groups: those with scores ≥ 33 and those with scores < 33. We analyzed various glycemic variability indices, including HBGI, CONGA, ADDR, MAGE, MAG, LI, and J-Index, employing the EasyGV version 9.0 software. SPSS (version 28) facilitated the data analysis.

Results

We screened patients with depression visiting the department of psychiatry, FGM was inserted in eligible patients of both the groups which yielded a data of 196 patient-days (98 patient-days for CES-D ≥ 33 and 98 patient-days for CES-D < 33). The glycemic variability indices CONGA (mg/dl), (76.48 ± 11.9 vs. 65.08 ± 7.12) (p = 0.048), MAGE (mg/dl) (262.50 ± 25.65 vs. 227.54 ± 17.72) (p = 0.012), MODD (mg/dl) (18.59 ± 2.77 vs. 13.14 ± 2.39) (p = 0.002), MAG(mg/dl) (92.07 ± 6.24vs. 63.86 ± 9.38) (p = <0.001) were found to be significantly higher in the CES-D ≥ 33 group.

Conclusion

Patients with more severe depressive symptoms, as suggested by CES-D ≥ 33, had higher glycemic variability.

Knowledge, attitudes, and practice of female genital mutilation and cutting: an observational cross-sectional study in English primary care (FGM/C Study)

BACKGROUND

Female genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practised. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C.

AIM

To explore the knowledge, attitudes, and practice of primary care GPs and practice nurses (PNs) regarding FGM/C.

DESIGN & SETTING

An observational cross-sectional study with GPs and PNs working in primary care in the West Midlands, UK.

METHOD

An online survey was circulated to GPs and PNs between September 2019 and December 2019.

RESULTS

A total of 137 survey responses were received. Study participants were predominantly female (81.8%) and GPs (59.9%), with a mean age of 47.3 years (standard deviation [SD] 9.1). The survey found 19.7% of responders reported seeing >1 patient with FGM/C in the past 12 months. It also found 91.3% of responders had received some form of FGM/C training; however, the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C.

CONCLUSION

The results have suggested varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that patients with FGM/C typically present in primary care, it is important that clinicians can provide appropriate support underpinned by up-to-date training.

The Blossom Gang: co-producing research on FGM with second-generation young people in the UK

BACKGROUND

Female genital mutilation (FGM) is a practice that involves the removal of external female genitalia and is widely known as a violation of human rights. The custom is illegal in the United Kingdom (UK) and carries a sentence of up to 14 years in prison. This prohibition, along with the secretive nature of the practice, has led to limited research on the awareness of FGM on young people in the UK. Little is known about the process of involving young people in research about the topic.

METHODS

This paper is based on the findings of a Ph.D. project that used a community-based participatory research approach (CBPR). The research took a two-stage approach: stage one aimed to recruit nine young people aged 15-18, from the Southwest of England, who attended a 10-day training workshop to prepare them for stage two-data collection with young people aged 13-15. This paper focuses on the 10-day creative, collaborative workshops. The data collected from the collaborative workshops were analysed using thematic analysis.

RESULTS

Undertaking CBPR enhanced the quality and relevance of this research. Engaging young people as co-researchers was vital for the success of this project. By developing a collaborative learning environment, young people were able to build trusting relationships which flourished beyond the research project. In addition, the creative workshops enabled peer learning about FGM and inspired young people to learn new skills that was useful in their daily lives.

CONCLUSION

The collaborative environment created in this project enabled an insightful learning experience for young people and researchers alike. Participants and facilitators formed relationships; participants learned new marketable skills and researchers gained new insights about FGM, from a young person's perspective.

Using flash glucose monitoring in pregnancies in routine care of patients with gestational diabetes mellitus: a pilot study

AIM

Flash glucose monitoring (FGM) has been approved for the care of pregnant women with preexisting diabetes since 2017. However, its use in gestational diabetes (GDM) has been critically discussed. Inaccuracy and missing recommendations for target values are the main arguments against the use of FGM in GDM. To date, there is a lack of data to justify routine use of FGM in GDM pregnancies. Consequently, this new technology has been withheld from GDM-patients. Aim of our pilot study was to analyze the impact of FGM use on pregnancy outcomes, patient's satisfaction and to confirm the safe use in GDM pregnancies.

METHODS

Cohort study of 37 FGM-managed GDM pregnancies compared with 74 matched women using self-monitoring of blood glucose (SMBG). Group comparison using nonparametric testing concerning patients characteristic and perinatal outcome focusing on adverse outcomes (preeclampsia, preterm delivery, large for gestational age, C-sections, neonatal intensive care unit admission, hyperbilirubinemia and hypoglycemia). Evaluation of patient's treatment satisfaction using the "Diabetes Treatment Satisfaction Questionnaire change" (DTSQc) and patient interviews.

RESULTS

No significant differences in patient's characteristics despite gestational age at diagnosis (FGM with 20 vs. SMBG with 25 weeks). No difference in gestational weight gain, HbA1c progression and perinatal outcome. Treatment satisfaction obtained by the DTSQc revealed a high level of satisfaction with FGM use.

CONCLUSION

FGM use was well accepted and did not affect perinatal outcome. Use of FGM during pregnancy is safe and non-inferior to the management with SBGM. FGM should be considered as an option in the management of GDM patients.

Legal Awareness and Practices of Female Genital Mutilation/Cutting (FGM/C) among United Arab Emirates Medical Practitioners

Female genital mutilation/cutting (FGM/C), due to its regional occurrence, is a marginalized issue in the international arena. The aim of the study was to verify reasons for performing a procedure prohibited by international and domestic law. A cross-sectional study was conducted among nurses and doctors practicing in the UAE. The study was conducted from the 1 of January 2020 to the 31 of December 2021. The total number of recruited individuals who agreed to participate was 120, with the rate of return being 82%. About half of the participants (n = 59, 49.2%) have seen FGM/C patients in their UAE practice. Regarding medical staff, the total knowledge score concerning possible complications of the performed procedure was assessed at 64%, i.e., at a moderate level. None of our study participants had previously performed any type of FGM/C. However, 6.7% were willing to do it upon a mother's or guardian's request. About 83% of study participants stated that FGM/C should be halted internationally. Only 26.7% of the medical practitioners were aware of UAE law concerning FGM/C, while 50% had no knowledge concerning this issue. The present study reveals that cultural conditions take priority over medical knowledge, making medical practitioners inclined to accept the circumcision of girls and women. The crucial goals of future activities should focus on sensitizing society and the medical community, the need to create clear laws penalizing the practice, and the legal obligation to report the circumcision of a girl or woman.

Systematic Review of Obstetric and Neonatal Complications Associated With Female Genital Mutilation

OBJECTIVE

To assess the prevalence of obstetric and neonatal complications in women with female genital mutilation (FGM) compared to women without FGM.

DATA SOURCES

Literature searches carried out on three scientific databases (CINAHL, ScienceDirect, and PubMed).

STUDY SELECTION

Selected observational studies published from 2010 to 2021 that assessed prolonged second phase of labor, vaginal outlet obstruction, emergency cesarean birth, perineal tear, instrumental births, episiotomy, and postpartum hemorrhage in women with and without FGM, as well as Apgar score and resuscitation of their newborns.

RESULTS

Nine studies were selected, including case-control, cohort, and cross-sectional studies. There were associations between FGM and vaginal outlet obstruction, emergency cesarean birth, and perineal tears.

CONCLUSION

For obstetric and neonatal complications other than those listed in the "Results" section, researchers' conclusions remain divided. Still, there is some evidence to support the impact of FGM on obstetric and neonatal harm, particularly in cases of FGM Types II and III.

Postoperative Course of Reconstructive Procedures in FGM Type III-Proposal for a Modified Classification of Type III Female Genital Mutilation

BACKGROUND

Reconstruction after female genital mutilation (FGM) has developed from being merely a therapy for complications to addressing body perception and sexuality. However, evidence regarding a direct correlation between FGM and sexual dysfunction is scarce. The present WHO classification provides an imprecise grading system, which makes it difficult to compare present studies with treatment outcomes. The aim of this study was to develop a new grading system based on a retrospective study of Type III FGM, evaluating operative time and postoperative results.

METHODS

The extent of clitoral involvement, operative time of prepuce reconstruction and lack of prepuce reconstruction, and postoperative complications of 85 patients with FGM-Type III were retrospectively analyzed at the Desert Flower Center (Waldfriede Hospital, Berlin).

RESULTS

Even though universally graded by the WHO, large differences in the degree of damage were found after deinfibulation. In only 42% of patients, a partly resected clitoral glans was found after deinfibulation. There was no significant difference in operative time when comparing patients who required prepuce reconstruction and patients who did not (p = 0.1693). However, we found significantly longer operative time in patients who presented with a completely or partly resected clitoral glans when compared to patients with an intact clitoral glans underneath the infibulating scar (p < 0.0001). Two of the 34 patients (5.9%) who had a partly resected clitoris required revision surgery, while none of the patients in whom an intact clitoris was discovered under the infibulation required revision. However, these differences in the complication rates between patients with and without a partly resected clitoris were not statistically significant (p = 0.1571).

CONCLUSIONS

A significantly longer operative time was found in patients who presented with a completely or partly resected clitoral glans when compared with patients with an intact clitoral glans underneath the infibulating scar. Furthermore, we found a higher, though not significantly significant, complication rate in patients with a mutilated clitoral glans. In contrast to Type I and II mutilations, the presence of an intact or mutilated clitoral glans underneath the infibulation scar is not addressed in the present WHO classification. We have developed a more precise classification, which may serve as a useful tool when conducting and comparing research studies.

Views of female genital mutilation survivors, men and health-care professionals on timing of deinfibulation surgery and NHS service provision: qualitative FGM Sister Study

Background

Female genital mutilation is an important UK health-care challenge. There are no health benefits of female genital mutilation, and it is associated with lifelong physical, psychological and sexual impacts. The annual cost to the NHS to care for survivors is £100M. Deinfibulation may improve the health and well-being of some women, but there is no consensus on the optimal timing of surgery for type 3 survivors. UK care provision is reportedly suboptimal.

Objectives

We aimed to explore the views of survivors, men and health-care professionals on the timing of deinfibulation surgery and NHS service provision.

Methods

This was a qualitative study informed by the Sound of Silence framework. This framework is useful for researching sensitive issues and the health-care needs of marginalised populations. A total of 101 interviews with 44 survivors, 13 men and 44 health-care professionals were conducted, supplemented by two workshops with affected communities (participants, n = 10) and one workshop with stakeholders (participants, n = 30). Data were analysed using a hybrid framework method.

Results

There was no clear consensus between groups on the optimal timing of deinfibulation. However, within groups, survivors expressed a preference for deinfibulation pre pregnancy; health-care professionals preferred antenatal deinfibulation, with the caveat that it should be the survivor's choice. There was no consensus among men. There was agreement that deinfibulation should take place in a hospital setting and be undertaken by a suitable health-care professional. Decision-making around deinfibulation was complex. Deficiencies in professionals' awareness, knowledge and understanding resulted in impacts on the provision of appropriate care. Although there were examples of good practice and positive care interactions, in general, service provision was opaque and remains suboptimal, with deficiencies most notable in mental health. Deinfibulation reportedly helps to mitigate some of the impacts of female genital mutilation. Interactions between survivors and health-care professionals were disproportionately framed around the law. The way in which services are planned and provided often silences the perspectives and preferences of survivors and their families.

Limitations

Only a minority of the interviews were conducted in a language other than English, and the recruitment of survivors was predominantly through maternity settings, which meant that some voices may not have been heard. The sample of men was relatively small, limiting interpretation.

Conclusions

In general, service provision remains suboptimal and can silence the perspectives and preferences of survivors. Deinfibulation services need to be widely advertised and information should highlight that the procedure will be carried out in hospital by suitable health-care professionals and that a range of time points will be offered to facilitate choice. Future services should be developed with survivors to ensure that they are clinically and culturally appropriate. Guidelines should be updated to better reflect the needs of survivors and to ensure consistency in service provision.

Future work

Research is needed to (1) map female genital mutilation service provision; (2) develop and test effective education to address deficits in awareness and knowledge for affected communities and health-care professionals; and (3) develop, monitor and evaluate clinically and culturally competent female genital mutilation services.

Trial registration

Current Controlled Trials ISRCTN14710507.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 27, No. 3. See the NIHR Journals Library website for further project information.

Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis

There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa. This study employed a narrative synthesis to collate evidence on mental and sexual health outcomes. A systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C. Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions. The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C.

FUNDING

This work was self-funded.

Girls at risk: FGM intentions among in-school adolescents of a rural community in Osun State, Nigeria

PURPOSE

Knowledge of adolescents' intention to sustain female genital mutilation (FGM) practice is required to guide efforts to eradicate FGM in Africa and Asia where about 200 million women are affected. Nigeria has one of the highest FGM cases in the world. The study sought to determine the knowledge, attitude, and intentions of adolescents to sustain FGM practice when they become parents.

MATERIALS AND METHODS

This study is a cross-sectional descriptive survey of 195 in-school adolescents aged 14-19 years, in Imesi-Ile, a rural town in South-west Nigeria selected through a multistage sampling method.

RESULTS

Overall, 44.6% of adolescents had good knowledge of FGM, while 44.6% had a positive attitude and 55.4% had a negative attitude towards FGM. More females (57.4%) have a negative attitude towards FGM. About 42.1% of adolescents intend to continue the practice of FGM, while 47% have no intentions and 10.8% remain undecided. Gender, age group and family affluence were not statistically associated with intention to continue FGM.

CONCLUSION

Intention to continue FGM practice is high among adolescents in the rural community. FGM eradication campaign among adolescents should seek to improve knowledge, attitude and intentions towards FGM practice.

Maternal Risk Factors Associated with Preterm Births among Pregnant Women in Mogadishu, Somalia

Background: Premature birth impacts millions of newborns annually. Sixty percent of the world’s preterm births occur in Sub-Saharan Africa and South Asia. Somalia’s premature birth rates and maternal risk factors are poorly studied; hence, this study aims to identify maternal risk factors related to premature births in Mogadishu, Somalia. Methods: This unmatched case-control study was conducted at four maternity hospitals in Mogadishu, Somalia. The cases were newborns with gestational ages of less than 37 weeks; controls were newborns with gestational ages of 37 to 42 weeks. All were live singletons. Cross-tabulation and binary logistic regression were used to analyze the data; a p-value of 0.05 was deemed statistically significant. Result: Of the total of 499 newborns, 70 were cases, and 429 were controls. Adequate prenatal care, maternal urine analysis, tetanus toxoid (TT) vaccination, hemoglobin (Hb) measurement, ultrasound monitoring, intake of iron + folic acid (IFA) supplement, blood pressure (BP) measurement during the current pregnancy, as well as partograph usage during labor all significantly decreased risk of having premature births. A prior history of preterm delivery and preeclampsia, obstetric complications, and female genital mutilation (FGM) significantly increased the risk of preterm births. Conclusion: The utilization of antenatal care services, use of a partograph, obstetric complications, and prior history of premature birth and preeclampsia had a substantial effect on preterm birth rates. This study identifies female genital mutilation (FGM) as a previously unidentified risk factor for preterm birth that needs additional investigation.

Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation

We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14-55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia.Impact statementWhat is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data.What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia.What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.

Gender, migration and violence among third country nationals accessing the sexual health clinic in Malta

BACKGROUND

In 2020 the number of displaced people worldwide reached 41.3 million (IOM, 2020). Among them, are many migrants and refugees at risk of sexual and gender-based violence (SGBV). Healthcare providers have a key role to play in identifying migrant victims/survivors of violence.

OBJECTIVES

This paper seeks to assess STIs prevalence, sexual health and sexual violence among third country nationals (TCNs) attending the GUC in Malta.

METHODS

This is a mixed methods study carried out at the Genitourinary Clinic (GUC), which is the only public sexual health clinic in Malta. Demographic data, sexual history and diagnoses of patients attending the GUC between January 2018 and December 2019 were collected and retrospectively analysed. A SGBV risk assessment was performed through a semi-structured questionnaire.

RESULTS

In the 24-month study period, a total of 12,654 patients accessed the GUC in Malta. Demographic data was collected on age, gender, nationality, marital status, and sexual orientation. 16.4% (n=2,064) of these were extra-European migrants, predominantly male. 80 different nationalities were recorded, with the 5 most common being Nigerian, Filipino, Libyan, Syrian and Brazilian. The average age was 32.6 years. Over 110 sex workers were visited at the GUC in the study period - 20 were foreign, primarily from China. The presence of a "massage parlour owner" during consultation, lack of control over passports and other factors were identified as warning signs of trafficking. 5 cases of sexual violence and forced prostitution involving girls from Sub-Saharan Africa and, in 2 cases, boys recently arrived in Malta by boat, were encountered. 6 African women accessing the service exhibited a type of female genital mutilation (FGM).

CONCLUSIONS

Migration, sexual health and SGBV overlap in important ways. Further research and training in SGBV and migration in the healthcare setting and awareness-raising about existing services among the migrant population are required.

Cognitive-Emotional Aspects of Post-Traumatic Stress Disorder in the Context of Female Genital Mutilation

Around 200 million women and girls worldwide are affected by female genital mutilation/cutting (FGM/C). FGM/C is a procedure that harms or alters the external female genitals for non-medical reasons, and is usually performed on children. Often, this procedure leads to severe consequences for the women's physical and mental health. In a cross-sectional sample of 112 women seeking medical counseling, physical and mental health characteristics associated with FGM/C were examined and possible predictors for the development of post-traumatic stress disorder (PTSD) in women affected by FGM/C were identified. A total of 55.4% (n = 66) of the women reported symptom levels of probable PTSD. Predictors for higher PTSD symptomology were an older age at the time of the FGM/C procedure, feelings of guilt and the centrality of the event in the woman's life. Thus, cognitive-emotional processing was found to play an important role in the emergence of PTSD in women suffering from FGM/C. However, interventions taking into consideration these characteristics are mostly lacking and need to be investigated further in the context of FGM/C.

The Exergy Losses Analysis in Adiabatic Combustion Systems including the Exhaust Gas Exergy

The entropy generation analysis of adiabatic combustion systems was performed to quantify the exergy losses which are mainly the exergy destroyed during combustion inside the chamber and in the exhaust gases. The purpose of the present work was therefore: (a) to extend the exergy destruction analysis by including the exhaust gas exergy while applying the hybrid filtered Eulerian stochastic field (ESF) method coupled with the FGM chemistry tabulation strategy; (b) to introduce a novel method for evaluating the exergy content of exhaust gases; and (c) to highlight a link between exhaust gas exergy and combustion emissions. In this work, the adiabatic Sandia flames E and F were chosen as application combustion systems. First, the numerical results of the flow and scalar fields were validated by comparison with the experimental data. The under-utilization of eight stochastic fields (SFs), the flow field results and the associated scalar fields for the flame E show excellent agreement contrary to flame F. Then, the different exergy losses were calculated and analyzed. The heat transfer and chemical reaction are the main factors responsible for the exergy destruction during combustion. The chemical exergy of the exhaust gases shows a strong relation between the exergy losses and combustion emission as well as the gas exhaust temperature.

Combining Theory and Research to Validate a Social Norms Framework Addressing Female Genital Mutilation

Female Genital Mutilation (FGM) is a harmful practice with no benefits and considerable harm to girls and women who undergo it. In 2016, the United Nations Joint Program to Eliminate FGM, funded the development and subsequent validation of a monitoring and evaluation framework to understand the relationship between social norms and practicing FGM. Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalize the framework and determine what factors are associated with practicing FGM. A total of 554 and 481 participants answered the question "Have you undergone FGM?" and "Do you know a family member who has undergone FGM?" respectively. Overall, 65% of participants said they had undergone FGM and 32% said they knew someone in their family who had undergone FGM. Predictors of not undergoing FGM included most progressive attitudes vs. less progressive attitudes about FGM and relationship to identity [OR: 1.9 (95% CI: 1.1-3.3)]; region [Afar vs. Addis Ababa: OR: 0.09 (95% CI: 0.02-0.5); Southern Nations Nationalities and People's Regions vs. Addis Ababa: OR: 0.1 (95% CI: 0.05-0.3)], being 36 years old and above vs. 10-19 years (OR: 0.2 (95% CI: 0.1 to 0.7)) and being single, never married vs. married or engaged (OR: 2.8 (95% CI: 1.1-7.0)]. Predictors of knowing a family member who has not undergone FGM included: Higher knowledge vs. lower knowledge [OR: 0.3 (95% CI: 0.1-0.5)]; if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% CI: 2.7-687.8)]; coming from Southern Nations, Nationalities and People's Region was associated with a lower odds of knowing a family member who had not undergone FGM [0.3 (95% CI: 0.1-0.6)]. Being a female influential vs. female caregiver was associated with a higher odds of knowing a family member who had not undergone FGM [2.9 (95% CI: 1.01-5.2)]. This paper has allowed us to validate a theory and research based social norms framework, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice. Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM.

Fabrication and Characterization of New Functional Graded Material Based on Ti, Ta, and Zr by Powder Metallurgy Method

In view of the aging population and various diseases worldwide, the demand for implants has been rapidly increasing. Despite the efforts of doctors, engineers, and medical companies, the fabrication of and procedures associated with implants have not yet been perfected. Therefore, a high percentage of premature implantations has been observed. The main problem with metal implants is the mechanical mismatch between human bone and the implant material. Zirconium/titanium-based materials with graded porosity and composition were prepared by powder metallurgy. The whole samples are comprised of three zones, with a radial gradient in the phase composition, microstructure, and pore structure. The samples were prepared by a three-step powder metallurgy method. The microstructure and properties were observed to change gradually with the distance from the center of the sample. The x-ray diffraction analysis and microstructure observation confirmed the formation of diffusive connections between the particular areas. Additionally, the mechanical properties of the obtained materials were checked, with respect to the distance from the center of the sample. An analysis of the corrosion properties of the obtained materials was also carried out.

Reduction of hypoglycaemia, lifestyle modifications and psychological distress during lockdown following SARS-CoV-2 outbreak in type 1 diabetes

AIMS

To assess changes in glucose metrics and their association with psychological distress and lifestyle changes in patients with type 1 diabetes (T1D) using flash glucose monitoring (FGM) during lockdown following severe acute respiratory syndrome coronavirus 2 outbreak.

MATERIALS AND METHODS

Single-centre, observational, retrospective study enrolling T1D patients who attended a remote visit on April 2020 at the Endocrinology division of the University Hospital Policlinico Consorziale, Bari, Italy. Lockdown-related changes in physical activity level and dietary habits were assessed on a semi-quantitative basis. Changes in general well-being were assessed by the General Health Questionnaire-12 items with a binary scoring system. Glucose metrics were obtained from the Libreview platform for the first 2 weeks of February 2020 (T0) and the last 2 weeks before the phone visit (T1).

RESULTS

Out of 84 patients assessed for eligibility, 48 had sufficient FGM data to be included in the analysis. FGM data analysis revealed significant reductions in coefficient of variation, number of hypoglycaemic events, and time below range, while no changes were found in time in range, time above range, mean sensor glucose, and glucose management indicator. Moreover, the frequency of sweets consumption was inversely related to the occurrence of hypoglycaemic events during lockdown.

CONCLUSIONS

Lockdown-related lifestyle changes, albeit unhealthy, may lead to reduction in FGM-derived measures of hypoglycaemia and glycaemic variability in patients with T1D.

The Consequences of Female Genital Mutilation on Psycho-Social Well-Being: A Systematic Review of Qualitative Research

The health consequences of female genital mutilation (FGM) have been described previously; however, evidence of the social consequences is more intangible. To date, few systematic reviews have addressed the impact of the practice on psycho-social well-being, and there is limited understanding of what these consequences might consist. To complement knowledge on the known health consequences, this article systematically reviewed qualitative evidence of the psycho-social impact of FGM in countries where it is originally practiced (Africa, the Middle East, and Asia) and in countries of the diaspora. Twenty-three qualitative studies describing the psycho-social impact of FGM on women's lives were selected after screening. This review provides a framework for understanding the less visible ways in which women and girls with FGM experience adverse effects that may affect their sense of identity, their self-esteem, and well-being as well as their participation in society.

The experiences and psychological outcomes for pregnant women who have had FGM: A systematic review

Female genital mutilation (FGM) is a global issue, with 200 million women and girls thought to be affected. FGM is defined as removal of female external genitalia, either partial or total, for non-medical purposes. FGM is embedded in tradition, including cultural beliefs about sexual behaviour. Associated risks include haemorrhage, infection, death, dyspareunia, childbirth complications and psychological issues. Although FGM negatively impacts on women's psychological wellbeing, little is known about the impact on pregnancy experiences. Psychological consequences of FGM are likely to be intensified during pregnancy when women have concerns about their own and their baby's wellbeing. This mixed-method systematic review aimed to provide insight into the psychological impact of FGM on women who subsequently become pregnant. Nine electronic databases were searched, using a search strategy to identify relevant studies. Studies were considered for inclusion if they were primary studies (qualitative, quantitative or mixed-method) involving pregnant women of any age who have previously undergone FGM. Relevant studies were evaluated using the MMAT appraisal tool. Analysis was guided by the review questions and the evidence identified. One quantitative and 9 qualitative papers were included. Qualitative data were analysed using meta-ethnography. Narrative analysis of the quantitative study was conducted. Findings relate to power of choice linked to reinfibulation, deinfibulation, birth procedures and pain management; importance of knowledgeable and sensitive health care professionals; and relived trauma experienced during childbirth. These findings could inform the development of supportive interventions for women with FGM within maternity services.

An experimental philosophical bioethical study of how human rights are applied to clitorectomy on infants identified as female and as intersex

Clitorectomies performed on the genitals of infants identified as female and as intersex have been described both as similar procedures and as different procedures. The former types of surgery have been recognised more consistently as human rights abuses than the latter in recent decades. We tested social psychological explanations of why human rights are differently recognised when infants are described as 'intersex' or 'female'; 122 laypeople in the UK read one of two near-identical descriptions of clitorectomies performed on intersex or female infants and reported their agreement with 22 items about the human rights of such infants. Clitorectomies were perceived as violating human rights more by women than by men, and more so when infants were described as female than intersex. Endorsement of human rights was better predicted by several psychological variables when infants were described as female than as intersex. Less politically conservative participants, as assessed by a Right-Wing Authoritarianism measure, and participants who trusted medical authority more recognised human rights violations of female infants more than intersex infants. Results are discussed with respect to human rights efforts to protect infants from medically non-necessary genital surgery on the basis of membership in identity categories or possession of sex characteristics.

Trends and Determinants of Female Genital Mutilation in Ethiopia: Multilevel Analysis of 2000, 2005 and 2016 Ethiopian Demographic and Health Surveys

Background

Female genital mutilation (FGM) is a harmful practice that causes health-related problems in the life of the affected women and girls. Though FGM is declared as a human right violation, studies revealed it is being practiced throughout Ethiopia. Therefore, this study was conducted to assess the prevalence, trends, and predictors of FGM among reproductive-aged (1549 years) women in Ethiopia.

Methods

Trends of FGM among reproductive-age women were estimated using the three Ethiopian Demographic and Health Survey (EDHS): 2000 (n=15,367), 2005 (n=14,070) and 2016 (n=7248) data. Multilevel logistic regression analysis was conducted to identify both individual- and community-level factors of FGM using the latest (2016) EDHS. To adjust potential confounders, the analysis was conducted considering sample weighting, clustering, and stratifications using STATA-14 software.

Results

The prevalence of FGM among women of reproductive age in Ethiopia decreased from 79.91% in 2000 to 70.37% in 2016. Similarly, FGM among daughters of circumcised mothers decreased from 56.16% in 2000 to 16.76% in 2016. Being Muslim (adjusted odds ratio [AOR] 5.48; 95% confidence interval [CI]: 4.23, 7.09), attending higher education (AOR 0.40; 95% CI: 0.29, 0.54), 45–49 years old (AOR 5.06; 95% CI: 3.38, 7.57), marriage at ≥ 18 years (AOR 0.80; 95% CI: 0.66, 0.96), not working (AOR 1.20; 95% CI: 1.02, 1.41), married (AOR 1.41; 95% CI: 1.12, 1.77) and residing in peripheral region (AOR 3.0.4; 95% CI: 1.96, 4.70) were determinants of FGM.

Conclusion

Though the reduction of FGM among women of reproductive age in Ethiopia was minimal, it was encouraging among daughters of circumcised women over the last 16 years. Education, religion, age, age at marriage, occupation, marital status, and geographical regions were determinants of FGM. Combined and integrated interventions based on the identified factors are recommended to abandon FGM in Ethiopia.

New Innovation: Use of Flash Glucose Monitoring for Evaluating Glycaemic Variability, Patient Satisfaction and Clinical Utility in Pregnant Women with Diabetes

Aim

Application of Flash glucose monitoring (FGM) system to evaluate glycaemic variability (GV), patient satisfaction and clinical utility in pregnant women with diabetes.

Methods

This prospective study was conducted in a tertiary care teaching hospital on 70 pregnant women with diabetes where blood sugar levels were monitored by FGM and self-monitoring of blood glucose (SMBG).

Results

FGM generated 19,950 readings versus 1470 readings by SMBG over 3 days. Glucose values measured by FGM and SMBG had significant positive correlation (r > 0.89; p < 0.001). Significant difference (p < 0.001) was present between minimum glucose values by FGM (52.49 ± 15.42 mg/dl) and SMBG (72.74 ± 18.30 mg/dl). FGM (20.9%) was able to pick exact duration of hypoglycaemia, while one-third of this duration was missed by conventional SMBG (14.7%; p < 0.05). Hypoglycaemic episodes were observed in 92.9% women by FGM as compared to 45.7% by SMBG (p < 0.001). No significant difference was observed in maximum glucose level or duration of hyperglycaemia by both methods. FGM identified hyperglycaemia in 74% women vs. 52% by SMBG (p < 0.001). GV calculated by using MODD by FGM was 118.4 ± 52.4 mg/dl and by SMBG was 83.2 ± 53.2 mg/dl (p < 0.001). 100% women preferred AGP vs. SMBG.

Conclusion

This is the first study to evaluate FGM for GV and patient satisfaction in women with GDM. Significant correlation was observed in glucose values by FGM and SMBG. FGM was more sensitive in detecting GV and hypoglycaemic excursions as compared to SMBG. All women preferred FGM over SMBG. Use of FGM gave new insights in clinical management of challenging cases.

Female genital mutilation (FGM) in UK children: a review of a dedicated paediatric service for FGM

OBJECTIVE

To describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic.

METHODS

Data collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification.

RESULTS

Between September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution.

CONCLUSIONS

The number of children with FGM was significantly lower than expected based on UK prevalence estimates. Most children had undergone FGM prior to UK entry, and the majority of cases were initially disclosed by the child or family themselves. These results reflect the lack of large-scale proof of the practice of FGM in the UK and are consistent with growing evidence of the abandonment of FGM among communities after migration.

Socio-economic and demographic determinants of female genital mutilation in sub-Saharan Africa: analysis of data from demographic and health surveys

Background

Owing to the severe repercussions associated with female genital mutilation (FGM) and its illicit status in many countries, the WHO, human rights organisations and governments of most sub-Saharan African countries have garnered concerted efforts to end the practice. This study examined the socioeconomic and demographic factors associated with FGM among women and their daughters in sub-Saharan Africa (SSA).

Methods

We used pooled data from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 12 countries in SSA. In this study, two different samples were considered. The first sample was made up of women aged 15–49 who responded to questions on whether they had undergone FGM. The second sample was made up of women aged 15–49 who had at least one daughter and responded to questions on whether their daughter(s) had undergone FGM. Both bivariate and multivariable analyses were performed using STATA version 13.0.

Results

The results showed that FGM among women and their daughters are significantly associated with household wealth index, with women in the richest wealth quintile (AOR, 0.51 CI 0.48–0.55) and their daughters (AOR, 0.64 CI 0.59–0.70) less likely to undergo FGM compared to those in the poorest wealth quintile. Across education, the odds of women and their daughters undergoing FGM decreased with increasing level of education as women with higher level of education had the lowest propensity of undergoing FGM (AOR, 0.62 CI 0.57–0.68) as well as their daughters (AOR, 0.32 CI 0.24–0.38). FGM among women and their daughters increased with age, with women aged 45–49 (AOR = 1.85, CI 1.73–1.99) and their daughters (AOR = 12.61, CI 10.86–14.64) more likely to undergo FGM. Whiles women in rural areas were less likely to undergo FGM (AOR = 0.81, CI 0.78–0.84), their daughters were more likely to undergo FGM (AOR = 1.09, CI 1.03–1.15). Married women (AOR = 1.67, CI 1.59–1.75) and their daughters (AOR = 8.24, CI 6.88–9.87) had the highest odds of undergoing FGM.

Conclusion

Based on the findings, there is the need to implement multifaceted interventions such as advocacy and educational strategies like focus group discussions, peer teaching, mentor–mentee programmes at both national and community levels in countries in SSA where FGM is practiced. Other legislative instruments, women capacity-building (e.g., entrepreneurial training), media advocacy and community dialogue could help address the challenges associated with FGM. Future studies could consider the determinants of intention to discontinue or continue the practice using more accurate measures in countries identified with low to high FGM prevalence.

Transcultural influence on female genital mutilation done in late pregnancy: A case report

A complicated case of female genital mutilation (FGM) type 2b done in late-pregnancy is presented and the interplay of Yoruba and Kwale culture, in this case, is discussed. A Yoruba who grew up among Kwales/Urhobos had FGM at 38 weeks and 4 days gestation (to assure vaginal delivery) and presented with vulvar hematoma, septicemia, obstructed labor, and a distressed fetus. 5 days after FGM procedure, she had an emergency cesarean section (EmCS), repair of FGM site and baby was admitted in special care. There was the obvious synergy of the Yoruba culture of FGM in infancy and Kwale/Urhobo culture of FGM in pregnancy. The patient and her fetus/baby almost became mortalities but for prompt intervention. The role of sociocultural factors in the practice of FGM is recommended to be further investigated as FGM even in educated women and at the dangerous stage of term pregnancy is still prevalent.

Material-Oriented Shape Functions for FGM Plate Finite Element Formulation

A four-noded finite element of a moderately thick plate made of functionally graded material (FGM) is presented. The base element is rectangular and can be extended to any shape using a transformation based on NURBS functions. The proposed 2D shape functions are consistent with the physical interpretation and describe the states of element displacement caused by unit displacements of nodes. These functions depend on the FGM’s material parameters and are called material-oriented. The shape function matrix is based on a superposition displacement field of two plate strips with 1D exact shape functions. A characteristic feature of the proposed formulation is full coupling of the membrane and bending states in the plate. The analytical form of the stiffness matrix and the nodal load vector was obtained, which leads to the numerical efficiency of the formulation. The element has been incorporated into Abaqus software with the use of Maple program. The finite element shows good convergence properties for different FGM models in the transverse direction to the middle plane of the plate. During derivation of the 2D plate element the formally exact 1D finite element for transverse nonhomogeneous FGM plate strip was developed.

Impact of technology on glycaemic control in type 2 diabetes: A meta-analysis of randomized trials on continuous glucose monitoring and continuous subcutaneous insulin infusion

AIM

To conduct a meta-analysis to assess the effect of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and the combination of the two, on glycaemic control in type 2 diabetes.

MATERIALS AND METHODS

The analysis included randomized clinical trials comparing CSII with multiple daily injections (MDI) in people with type 2 diabetes, as well as studies comparing CGM or flash glucose monitoring (FGM) with self-monitoring of blood glucose (SMBG), with a duration of at least 12 weeks, identified in Medline or clinicaltrials.gov. The principal endpoint was glycated haemoglobin (HbA1c) at the end of the trial. Mean and 95% confidence intervals (CIs) for HbA1c and Mantel-Haenzel odds ratios for severe hypoglycaemia were calculated, using random-effect models.

RESULTS

The retrieved trials showed a significant heterogeneity (I² = 90%). The difference in HbA1c between CSII and MDI was not statistically significant (-0.26% [95% CI -0.74;0.22]; P = .29). The difference in endpoint HbA1c between CGM and SMBG was marginally significant (-0.24 [95% CI -0.49;0.00]; P = .05), and CGM was possibly associated with a lower hypoglycaemic risk. Only one trial explored the effect of FGM, as compared with SMBG, on HbA1c in type 2 diabetes, finding no difference across groups (at study end: 8.4% ± 0.8% vs 8.3% ± 1.1% with FGM and SMBG, respectively). Conversely, FGM was associated with an improvement in quality of life and with a lower incidence of hypoglycaemic events. The small number of retrieved trials indicates that the results should be interpreted with caution.

CONCLUSIONS

The analysis showed that CSII, CGM and FGM provide only small benefits compared with MDI (on either HbA1c, hypoglycaemic risk or quality of life) in insulin-treated people with type 2 diabetes.

Effects of school-based health education on attitudes of female students towards female genital mutilation in Sudan

Background

The practice of female genital mutilation (FGM) is widespread in Sudan. Over the years, the government, civil society and the international community implemented multiple interventions to address the issue. However, due to a number of cultural and educational factors, this harmful practice continues.

Aims

This study aimed to assess the effects of a secondary school-based health education intervention on the knowledge and attitude of female students towards FGM in Sudan.

Methods

We conducted a quasi-experimental study in Karary Locality, Khartoum State, Sudan. A multistage sampling technique was used to determine targeted schools. Within the schools, students of two randomly selected classes received the intervention. The study included three phases; in the pre-intervention phase, data were collected from the totality of students (154 students) using a pre-tested questionnaire, after which students received health education sessions. The same questionnaire was used to re-collect the data in a post-intervention phase 6 weeks later.

Results

The participants were between 14 to 17 years old, 30.3% of which were subjected to FGM. The main source of information about FGM was family and friends (41.1%). The majority of participants had a negative attitude towards FGM. The means of knowledge and attitude scores increased from 8.63 (SD=2.562) and 5.76 pre-intervention (SD=1.937) to 11.99 (SD=2.264) and 6.53 post-intervention (SD=1.164), respectively.

Conclusions

School-based health education has a positive impact on both knowledge and attitude of female students towards FGM in Sudan. As such, introducing health education about the complications of FGM in curricula of secondary schools in Sudan has the potential to improve students' knowledge and attitude. Ultimately, such interventions can help reduce the prevalence of the practice when students become responsible for future families.

Twelve tips for teaching medical students about female genital mutilation (FGM)

This article was migrated. The article was marked as recommended. Background: Seeing women or girls from FGM practising communities can be a challenge for healthcare professionals, involving a complex interplay of professional duties, legal requirements, social and cultural understanding, and sensitive, skilled communication. Aims and methods: Robust training on how to identify and support women and girlswho have undergone or who are at risk of FGM , including fulfilling FGM-related legal duties,is essential for healthcare professionals. We believe it is important that this training begins in medical school so that junior doctors feel prepared to talk to women and girls from FGM practising communities as soon as they qualify and start work. Results: We have reviewed the limited existing literature on teaching medical and other healthcare students about FGM and have drawn on our many years of providing well-evaluated teaching sessions on FGM at UCL Medical School to design twelve tips as a blueprint for running sensitive and effective undergraduate teaching on FGM. Conclusions: Effective teaching for medical students on FGM is important and feasible . Curricula leads and individual teachers will benefit from a structured, comprehensive and culturally sensitive approach outlined in the twelve tips.

Research on the Buckling Behavior of Functionally Graded Plates with Stiffeners Based on the Third-Order Shear Deformation Theory

This paper presents a finite element formulation to study the mechanical buckling of stiffened functionally graded material (FGM) plates. The approach is based on a third-order shear deformation theory (TSDT) introduced by Guangyu Shi. The material properties of the plate were assumed to be varied in the thickness direction by a power law distribution, but the material of the stiffener was the same as that of the one of the bottom surface where the stiffener was placed. A parametric study was carried out to highlight the effect of material distribution, the thickness-to-width ratio, and stiffener parameters on the buckling characteristics of the stiffened FGM plates. Numerical results showed that the addition of stiffener to the FGM plate could significantly reduce the weight of the FGM plate but that both the FGM plates with and without stiffener had equally high strength in the same boundary condition and compression loading.

A New Beam Model for Simulation of the Mechanical Behaviour of Variable Thickness Functionally Graded Material Beams Based on Modified First Order Shear Deformation Theory

There are many beam models to simulate the variable thickness functionally graded material (FGM) beam, each model has advantages and disadvantages in computer aided engineering of the mechanical behavior of this beam. In this work, a new model of beam is presented to study the mechanical static bending, free vibration, and buckling behavior of the variable thickness functionally graded material beams. The formulations are based on modified first order shear deformation theory and interpolating polynomials. This new beam model is free of shear-locking for both thick and thin beams, is easy to apply in computation, and has efficiency in simulating the variable thickness beams. The effects of some parameters, such as the power-law material index, degree of non-uniformity index, and the length-to-height ratio, on the mechanical behavior of the variable thickness FGM beam are considered.

Female genital mutilation and obstetric outcome: A cross-sectional comparative study in a tertiary hospital in Abakaliki South East Nigeria

Background

Female genital mutilation (FGM) is an assault on womanhood.

Objective

To compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation.

Materials and methods

This cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of < 0.05.

Results

The mean age and gestational age of the women were 27.9 ± 4.8 years and 38.9 ± 1.5 weeks respectively. Majority of the women, 308 or 77.0%, belonged to social class 4 and 82.0% had Type 2 FGM. More than 90.0% of the women had a vaginal delivery and the 2nd stage of labour lasted more than 2 h in 13.4% of the women (OR = 0.78 95% CI 0.64-0.97). Parturient with FGM had increased odd of perineal tear (OR = 0.76 95% CI 0.63 - 0.91) and episiotomy (OR = 1.69 95% CI 1.17–2.45). The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM (P > 0.05).

Conclusion

The study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.

False beliefs predict increased circumcision satisfaction in a sample of US American men

Critics of non-therapeutic male and female childhood genital cutting claim that such cutting is harmful. It is therefore puzzling that 'circumcised' women and men do not typically regard themselves as having been harmed by the cutting, notwithstanding the loss of sensitive, prima facie valuable tissue. For female genital cutting (FGC), a commonly proposed solution to this puzzle is that women who had part(s) of their vulvae removed before sexual debut 'do not know what they are missing' and may 'justify' their genitally-altered state by adopting false beliefs about the benefits of FGC, while simultaneously stigmatising unmodified genitalia as unattractive or unclean. Might a similar phenomenon apply to neonatally circumcised men? In this survey of 999 US American men, greater endorsement of false beliefs concerning circumcision and penile anatomy predicted greater satisfaction with being circumcised, while among genitally intact men, the opposite trend occurred: greater endorsement of false beliefs predicted less satisfaction with being genitally intact. These findings provide tentative support for the hypothesis that the lack-of-harm reported by many circumcised men, like the lack-of-harm reported by their female counterparts in societies that practice FGC, may be related to holding inaccurate beliefs concerning unaltered genitalia and the consequences of childhood genital modification.

Sequela of female genital mutilation on birth outcomes in Jijiga town, Ethiopian Somali region: a prospective cohort study

Background

In Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. Even though FGM is reported to be associated with a range of obstetric complications, little is known about its effects on childbirth in the region. Therefore, the objective of this study was to test the hypothesis that FGM is a contributing factor to the increased risk of complication during childbirth.

Methods

Facility based cohort study, involving 142 parturients with FGM and 139 parturients without FGM, was conducted in Jijiga town from October to December, 2014. The study participants were recruited by consecutive sampling technique. Data were collected using a structured interviewer administered questionnaire and observational checklists. Data were analyzed using SPSS version 16 and STATA version 11.

Results

The existence of FGM was significantly associated with perinealtear [RR = 2.52 (95% CI 1.26–5.02)], postpartum blood loss [RR = 3.14 (95% CI 1.27–7.78)], outlet obstruction [RR = 1.83 (95% CI 1.19–2.79)] and emergency caesarean section [RR = 1.52 (95% CI 1.04–2.22)]. FGM type I and FGM type II did not demonstrate any association with prolonged 2nd stage of labour, emergency caesarean section, postpartum blood loss, and APGAR score < 7. FGM type III however was significantly associated with prolonged 2nd stage of labour [RR = 2.47 (95% CI 1.06–5.76)], emergency caesarean section [RR = 3.60 (95% CI 1.65–7.86)], postpartum blood loss [RR = 6.37 (95% CI 2.11–19.20] and APGAR score < 7 [RR = 4.41 (95% CI, 1.84–10.60)]. FGM type II and type III were significantly associated with perinealtear [RR = 2.45(95% CI 1.03–5.83)], [RR = 4.91(95% CI 2.46–9.77)] and outlet obstruction [RR = 2.38(95% CI 1.39–4.08)], [RR = 2.94(95% CI 1.84–4.71)] respectively.

Conclusion

Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive form of FGM. Adverse obstetric outcomes can therefore be added to the known harmful immediate and long-term effects of FGM.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1937-4) contains supplementary material, which is available to authorized users.

Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations

BACKGROUND

Anecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). At present, systematic research on the psychological sequelae of this tradition has remained limited. The study provides preliminary, high-quality psychodiagnostic data on potential psychopathological consequences of FGM, with a focus on posttraumatic stress disorder (PTSD), shutdown dissociation and other stress-related variables.

METHODS

We investigated a convenience sample of N = 167 women, supported by the women's affairs headquarters in Jijiga (capital of the Ethiopian Somali Region) and a local Ethiopian non-governmental organization. Our main outcome measures were PTSD (PSS-I) and shutdown dissociation (ShuD). We also assessed depression and anxiety (HSCL-25), major depression, substance abuse and dependence, suicidality and psychotic disorders (M.I.N.I.; sub-scales A., B., K., and L.). In addition, we collected hair samples to assess hair cortisol concentrations (HCC) as a neuroendocrinological measure.

RESULTS

The majority of women endured FGM (FGM I: 36%, FGM II/III: 52%) and, regardless of the level of the physical invasiveness, almost all women reported having felt intense fear and/or helplessness. FGM II/III, the more invasive form, was associated with a greater vulnerability to PTSD symptoms (p < .001) and shutdown dissociation (p < .001). Symptoms of depression (p < .05) and anxiety (p < .01) were also elevated. Random forest regression with conditional inference trees revealed evidence of an alteration of the cortisol levels in relation to the age when FGM was experienced (< 1 year) and the invasiveness of the procedure.

CONCLUSION

More extensive forms of FGM are associated with more severe psychopathological symptoms - particularly with an increased vulnerability to PTSD. Higher hair cortisol levels in women who experienced FGM before their first year of age or had more severe forms of FGM indicate long-term neuroendocrinological consequences of FGM and trauma in general on the stress system.

Further Evidence of Severe Allergic Contact Dermatitis From Isobornyl Acrylate While Using a Continuous Glucose Monitoring System

In the past decade, new diabetes technologies, including continuous glucose monitoring (CGM) systems, support patients with diabetes in their daily struggle with achieving a good glucose control. However, shortly after the first CGM systems appeared on the market, also the first concerns about adverse skin reactions were raised. Most patients claimed to suffer from (sometimes severe) skin irritation, or even allergy, which they related to the (acrylate-based) adhesive part of the device. For a long time the actual substance that caused these skin reactions with, for example, the Flash Glucose Monitoring system (iscCGM; Freestyle® Libre) could not be identified; however, recently Belgian and Swedish dermatologists reported that the majority of their patients that have developed a contact-allergic while using iscCGM react sensitively to a specific acrylate, that is, isobornyl acrylate (IBOA). Subsequently they showed by means of gas chromatography-mass spectrometry that this substance is present in the case of the glucose sensor attached by an adhesive to the skin. We report three additional cases from Germany, including a 10-year-old boy, suffering from severe allergic contact dermatitis to IBOA.

Addressing female genital mutilation in Europe: a scoping review of approaches to participation, prevention, protection, and provision of services

BACKGROUND

Public and policy attention to female genital mutilation (FGM) in diaspora communities has increased in Europe, but research remains limited and misinformation abounds. As a first step to addressing these issues, this study explored FGM prevention and response interventions in Europe, using a scoping literature review and key informant interviews.

METHODS

A scoping study design was selected, using Arksey and O'Malley's six-stage scoping framework to review identified sources. Key informant interviews were used to inform and add depth to literature findings. Findings were summarised thematically, guided by the Scottish Government's '4Ps' framework for tackling violence against women (i.e. participation, prevention, protection, providing services).

RESULTS

Seventy literature sources, of 1095 screened, plus 16 individual and 3 group interview sources were included. Several countries have developed promising interventions supporting FGM resistance and recovery. However, gaps remain including community participation, professional knowledge and linkages, and evaluation of approaches.

CONCLUSIONS

This scoping review is an initial attempt to describe available primary evidence on European initiatives responding to FGM. Further research is required to determine whether interventions are effective, while policy and practice development must be shaped and driven by the experiences, needs, and views of affected communities.

What do we know about assessing healthcare students and professionals' knowledge, attitude and practice regarding female genital mutilation? A systematic review

Introduction

Improving healthcare providers’ capacities of prevention and treatment of female genital mutilation (FGM) is important given the fact that 200 million women and girls globally are living with FGM. However, training programs are lacking and often not evaluated. Validated and standardized tools to assess providers’ knowledge, attitude and practice (KAP) regarding FGM are lacking. Therefore, little evidence exists on the impact of training efforts on healthcare providers’ KAP on FGM. The aim of our paper is to systematically review the available published and grey literature on the existing quantitative tools (e.g. scales, questionnaires) measuring healthcare students’ and providers’ KAP on FGM.

Main body

We systematically reviewed the published and grey literature on any quantitative assessment/measurement/evaluation of KAP of healthcare students and providers about FGM from January 1^st, 1995 to July 12^th, 2016. Twenty-nine papers met our inclusion criteria. We reviewed 18 full text questionnaires implemented and administered to healthcare professionals (students, nurses, midwives and physicians) in high and low income countries. The questionnaires assessed basic KAP on FGM. Some included personal and cultural beliefs, past clinical experiences, personal awareness of available clinical guidelines and laws, previous training on FGM, training needs, caregiver’s confidence in management of women with FGM, communication and personal perceptions. Identified gaps included the medical, psychological or surgical treatments indicated to improve girls and women’s health; correct diagnosis, recording ad reporting capacities; clitoral reconstruction and psychosexual care of circumcised women. Cultural and personal beliefs on FGM were investigated only in high prevalence countries. Few questionnaires addressed care of children, child protection strategies, treatment of short-term complications, and prevention.

Conclusion

There is a need for implementation and testing of interventions aimed at improving healthcare professionals’ and students’ capacities of diagnosis, care and prevention of FGM. Designing tools for measuring the outcomes of such interventions is a critical aspect. A unique, reproducible and standardized questionnaire could be created to measure the effect of a particular training program. Such a tool would also allow comparisons between settings, countries and interventions. An ideal tool would test the clinical capacities of providers in managing complications and communicating with clients with FGM as well as changes in KAP.

The Origins and Maintenance of Female Genital Modification across Africa : Bayesian Phylogenetic Modeling of Cultural Evolution under the Influence of Selection

We present formal evolutionary models for the origins and persistence of the practice of Female Genital Modification (FGMo). We then test the implications of these models using normative cross-cultural data on FGMo in Africa and Bayesian phylogenetic methods that explicitly model adaptive evolution. Empirical evidence provides some support for the findings of our evolutionary models that the de novo origins of the FGMo practice should be associated with social stratification, and that social stratification should place selective pressures on the adoption of FGMo; these results, however, are tempered by the finding that FGMo has arisen in many cultures that have no social stratification, and that forces operating orthogonally to stratification appear to play a more important role in the cross-cultural distribution of FGMo. To explain these cases, one must consider cultural evolutionary explanations in conjunction with behavioral ecological ones. We conclude with a discussion of the implications of our study for policies designed to end the practice of FGMo.