Should Surgery for Hypospadias Be Performed Before An Age of Consent?

Hypospadias is a relatively common genital condition in which the urethral opening forms on the underside of the penis, as opposed to at the tip of the glans. Patients with hypospadias are typically referred for surgery during infancy or early childhood. Recent evidence, however, indicates that many individuals with hypospadias do not experience the functional or psychosocial difficulties commonly attributed to the condition, and that surgical intervention for hypospadias carries substantial risk of adverse outcomes. In this article, we review published outcomes data and conduct an in-depth analysis of the typical rationales for hypospadias surgery, taking into consideration both the potential benefits and harms of the procedure, as well as the existence of nonsurgical alternatives. We argue, first, that most childhood surgeries for hypospadias are performed for anticipated future problems concerning function and cosmesis, rather than extant physical and/or psychosocial problems that are adversely affecting the child’s well-being. Second, we contend that the surgery can be safely performed after an age of consent without increasing the absolute risk of surgical complications to an ethically meaningful degree. We conclude, therefore, that surgery for hypospadias should be performed only if requested by the affected individual, under conditions of informed consent.     

Spatial Variation of Soil Lead in an Urban Community Garden: Implications for Risk‐Based Sampling

Soil lead pollution is a recalcitrant problem in urban areas resulting from a combination of historical residential, industrial, and transportation practices. The emergence of urban gardening movements in postindustrial cities necessitates accurate assessment of soil lead levels to ensure safe gardening. In this study, we examined small‐scale spatial variability of soil lead within a 15 × 30 m urban garden plot established on two adjacent residential lots located in Detroit, Michigan, USA. Eighty samples collected using a variably spaced sampling grid were analyzed for total, fine fraction (less than 250 μm), and bioaccessible soil lead. Measured concentrations varied at sampling scales of 1–10 m and a hot spot exceeding 400 ppm total soil lead was identified in the northwest portion of the site. An interpolated map of total lead was treated as an exhaustive data set, and random sampling was simulated to generate Monte Carlo distributions and evaluate alternative sampling strategies intended to estimate the average soil lead concentration or detect hot spots. Increasing the number of individual samples decreases the probability of overlooking the hot spot (type II error). However, the practice of compositing and averaging samples decreased the probability of overestimating the mean concentration (type I error) at the expense of increasing the chance for type II error. The results reported here suggest a need to reconsider U.S. Environmental Protection Agency sampling objectives and consequent guidelines for reclaimed city lots where soil lead distributions are expected to be nonuniform.     

The views and attitudes of health professionals providing antenatal care to women with a high BMI: A qualitative research study

BackgroundThe prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m² and over.MethodsA qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n = 10), one with continuity of care midwives (n = 18) and one with obstetricians (n = 5). Data were analysed using Interpretative Phenomenological Analysis (IPA).FindingsSix dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women.ConclusionHealth professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals.     

The Developmental Progression of Understanding of Mind during a Hiding Game

In this longitudinal study, 52 typically developing preschoolers engaged in a hiding game with their mothers when children were 42‐, 54‐, and 66‐months old. Children's understanding of mind, positive affect, and engagement with the task were rated, and mothers' utterances were coded for role and content. Analyses confirmed that some facets of children's understanding of mind developed sequentially; specifically, they expressed an understanding of knowledge access before an understanding of deception and false beliefs, and expressed an understanding of deception before an understanding of false beliefs. Children's understanding of mind increased across visits and positively correlated with false belief task performance. Results suggest that mothers may tailor the content of their utterances to the child's growing expertise, but the role of mothers' utterances did not change. Observing preschoolers engaged in a playful hiding game revealed that children's understanding of mind not only increased with age but also developed sequentially.     

“You're not getting married for the moon and the stars”: The uncertainties of older British widowers about the idea of new romantic relationships

Older widowers are more likely to remarry than older widowed women. However, relatively little is known about the attitudes of older widowers to new romantic relationships and remarriage or repartnering. In this study of 60 widowers, more than half spontaneously discussed their attitudes toward, and experiences of, these relationships. However, none of the widowers had remarried and of those who described themselves as repartnered only one was cohabiting. We examine these data in the light of Lopata's concept of ‘husband sanctification’ (1981). We identify four themes. First, some widowers do sanctify their late wives. Second, we argue that wife sanctification contributes to widowers' uncertainties about repartnering. Third, when widowers make decisions to repartner, wife sanctification does not appear to make an important contribution. Finally, there is evidence to suggest that wife sanctification influences how men refer to their new women friends. Thus, we conclude by arguing that wife sanctification influences widowers' decisions surrounding remarriage/repartnering.     

Parenting Stress and Perceived Family Functioning of Chinese Parents in Hong Kong: Implications for Social Work Practice

This article reports the results of a telephone survey (n = 1002) conducted in November 2008, which aimed to identify parenting stress and perceived family functioning of Chinese parents in Hong Kong; to explore the effects of the parents’ socio‐demographic characteristics (gender, family income, education and family structure) on the aforementioned stress and functioning variables; and to examine the interrelationship among these characteristics and the two variables in question. Results showed that the reported parenting stress was at average level, while the perceived family functioning was slightly below average. The results also indicated that the parenting stress of mothers, single parents, the low‐income and the less‐educated was higher than that of fathers, parents of nuclear and extended families, the high‐income and the better‐educated. Socio‐demographic characteristics except the parent’s gender had similar effects on perceived family functioning. Higher parenting stress was associated with lower family functioning, and explained a larger variance in the perceived family functioning than the socio‐demographic characteristics taken alone. The results of the study have provided empirical support regarding the interrelationships among the vulnerable groups in society, parenting stress and perceived family functioning. Implications of the study for social work practice are discussed.     

Healthcare-Related Financial Burden Among Families in the U.S.: The Role of Childhood Activity Limitations and Income

This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996–2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0–17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p < 0.05), and were 54% more likely to experience relative burden (p < 0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.     

Physical Activity and Physical Self‐Concept in Adolescence: A Comparison of Girls at the Extremes of the Biological Maturation Continuum

This study examined differences in physical activity and physical self‐concept between the least and most biologically mature female adolescents within chronological age and academic year groups. A total of 252 British female adolescents (M age = 12.9 years; SD = .7) in Years 7–9 completed self‐report measures to assess physical activity and physical self‐concept. Percentage of predicted adult (mature) stature served as the index of biological maturation. Univariate analyses of covariance, controlling for decimal age, revealed that the least mature girls generally held higher perceptions of physical self‐concept but were no more, or less, active than the most mature girls. A subsequent meta‐analysis suggested, however, that across age and year groups the least mature girls were more active than the most mature girls.