Addressing End-of-Life Care in Cancer Patients through “Ubuntu”: Lessons Learned from Rwanda in Global Health Perspective of Humanity

Multi-disciplinary palliative care is rarely integrated into the public health care system at all levels in Africa. In Kigali, Rwanda, we have developed palliative care services for cancer patients and other incurable diseases, such as renal and heart failure, progressive neurologic diseases, and late stage HIV/AIDS for pediatric and adult patients in a district hospital and linked these services to home care. This article aims to describe palliative care in Rwanda and to address end-of-life care issues in a post-genocide society.     

Ethical Decision Making in the Resuscitation of Extremely Premature Infants: The Health Care Professional’s Perspective

Across Canada, the rate of preterm birth (i.e., at < 37 weeks’ gestation) has been steadily increasing. Advances in perinatal medicine and neonatal intensive care have resulted in an increased capacity to intervene at the extremes of prematurity, leading to an increase in the overall survival of infants born at early gestations. There has been little corresponding decrease in long-term complications. As a result, additional stresses are placed on neonatal intensive care units across the country, impacting families, health care professionals, and society as a whole. Moral distress and moral residue are often cited in the neonatal-perinatal literature as stressors experienced by those who participate in the resuscitation decision-making process. They are directly related to the challenge of making a concrete decision about life and death at extremely early gestations in the context of longterm uncertainty. In this review, we performed a systematic search of medical and ethics literature pertaining to resuscitation at the extremes of prematurity. The perspective of health care professionals is explored, including how definitions of viability and parental perspectives contribute to the decision-making process. We argue for the necessity of further research exploring the inter-professional context of ethical decision making at the extremes of prematurity.     

Difficulties in Transition of Care from Pediatric to Adult Gynecology Providers: Should We Maintain Care into Adulthood?

There is evidence that transfer of care for older adolescent patients to adult care is associated with a deterioration in health, especially in those with chronic conditions. Because several specific conditions in pediatric and adolescent gynecology continue into adulthood, it is important that patients have a seamless healthcare transition. In this commentary, it is argued that instead of arranging transfer, long-term retention of patients by the same physician or physician team may be the more caring, patient-centered approach.     

The creation of “monsters”: the discourse of opposition to in vitro fertilization in Poland

In Poland, there is a campaign to criminalise in vitro fertilization, led by the Catholic church. This article explores how this campaign makes “monsters” of IVF children in its discourse, that is, embodiments of “the other” in the sense of Frankenstein's monster. Basing the analysis primarily on Catholic mass media publications, the article investigates the discursive strategies employed to oppose IVF, most notably by the Catholic clergy and activists and journalists associated with the Church. They attribute “monstrosity” to the children in the following ways: physical (possible bodily deformity), psychological (survivor syndrome, identity crisis), social (loneliness, uncertain place in family relations), and ethical (a life burdened with the deaths of many embryos). Although the world of families with IVF does not provide examples of children who could be considered monsters in any of these terms, these arguments have become the primary reasons given for banning IVF.     

The Risks and Benefits of Being “Early to Bed: Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood

BackgroundA younger age at sexual intercourse has frequently been linked to adverse sexual health outcomes. Yet, little is known about its associations with healthy sexual function, and less still about the timing of pre-coital sexual debuts and adult sexual health.AimWe examined associations between an earlier sexual debut and subsequent sexual health, using broad operationalizations of each that capture pre-coital experiences and positive outcomes. Connections to sexual health risk and healthy sexual function were assessed through the lens of the dual-control model of sexual response.MethodsData on age at first sexual intercourse, first sexual contact, first sexual stimulation, and first orgasm, as well as sexual health risk and healthy sexual function were gathered from 3,139 adults.OutcomesAdverse sexual events (reproductive illness, infection, or injury affecting sexual activity; pregnancy termination and/or loss; non-volitional sex) and current sexual difficulties (Female [FSFI] and/or Male Sexual Function Index [MSFI] scores; Sexual Excitation and/or Sexual Inhibition Inventory for Women and Men [SESII-W/M] scores).ResultsWhen defined narrowly as first sexual intercourse, earlier sexual debut was associated with adverse sexual events, including non-volitional sex, pregnancy termination and/or loss, and reproductive illness, infection, or injury affecting sexual activity. However, it was also related to healthier sexual function, including less pain during vaginal penetration, better orgasmic functioning, and lower sexual inhibition. When sexual debut was broadened to include pre-coital experiences, earlier sexual contact, like earlier sexual intercourse, was associated with non-volitional sex. However, earlier sexual stimulation and orgasm were unrelated to adverse outcomes. Rather, these related to fewer sexual desire difficulties, and greater sexual excitation. Exploratory mediation analyses revealed later sexual intercourse and orgasm were connected to sexual difficulties through higher sexual inhibition and lower sexual excitation, respectively.Clinical ImplicationsWhen sexual functioning is impaired, delay of both coital and noncoital debuts may warrant assessment, and sexual excitation and inhibition may be targets for intervention. To facilitate healthy sexual development of young people, non-coital debuts with and without a partner may warrant inclusion in risk management and health promotion strategies, respectively.Strengths & LimitationsAlthough this research operationalized sexual debut and sexual health broadly, and examined associations between them, it is limited by its cross-sectional retrospective design and non-clinical convenience sample.ConclusionFrom a risk-based perspective, earlier sexual intercourse is adversely related to sexual health. Yet, it is also associated with healthy sexual function. Indeed, earlier sexual initiation may confer more benefits than risks when sexual debuts beyond intercourse are considered.Peragine DE, Skorska MN, Maxwell JA, et al. The Risks and Benefits of Being “Early to Bed”: Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood. J Sex Med 2022;19:1343–1358.