Background: Dog bites represent a significant global public health concern, particularly among children and adolescents. Approximately 330,000 emergency department visits occur annually in the United States alone due to dog-bite injuries, with pediatric populations bearing a disproportionate burden. Despite this, existing systematic reviews remain fragmented, focusing on isolated aspects such as breed-specific risk, educational interventions, or legislative measures, without comprehensively addressing the global incidence, prevalence, and multifactorial risk profile in pediatric cohorts. Objective: This protocol describes a planned systematic review aimed at synthesizing international evidence on the incidence and prevalence of dog bites in pediatric populations (aged ≤18 y), with concurrent analysis of demographic, behavioral, and environmental risk and protective factors. Secondary objectives are to characterize the clinical severity, psychological sequelae, and health economic consequences of pediatric dog-bite injury as reported in the eligible literature. Methods: This protocol is reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement. A comprehensive search of PubMed, Embase, Web of Science, Scopus, CINAHL, and the World Health Organization Global Index Medicus, supplemented by forward and backward citation tracking and gray literature sources, will be conducted with no date restrictions and limited to English-language observational studies (cross-sectional, case-control, and cohort) and population-based surveys. The PECOS (population, exposure, comparator, outcome, and study design) framework will guide inclusion and exclusion criteria. Two independent reviewers will screen records and extract data using a standardized codebook, with discrepancies resolved by consensus or by a third reviewer. Study quality will be assessed using validated tools appropriate for each study design. Findings will be synthesized narratively with descriptive statistics. When studies are sufficiently homogeneous, prevalence and incidence will be pooled using random-effects meta-analysis of Freeman-Tukey double arcsine–transformed proportions, with prediction intervals reported alongside pooled estimates. The certainty of evidence for each outcome will be rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: The systematic database search across PubMed, Embase, and Web of Science was conducted on August 1, 2025. At the time of manuscript submission, study screening and data extraction are ongoing. The anticipated completion of data extraction and evidence synthesis is in December 2026, with submission of the completed systematic review for publication expected thereafter. As this manuscript describes the review protocol, no study findings are available at this time. Conclusions: By aggregating data across diverse populations and settings, this systematic review will deliver the most comprehensive global assessment of pediatric dog-bite epidemiology to date, stratified by age group, geographic region, sex, and socioeconomic context, with direct implications for reducing the burden of these preventable injuries worldwide.

Background and Objectives: Postoperative pain and opioid requirements can vary widely, even among patients undergoing similar procedures. This narrative review examines how biological sex, age, frailty, chronic pain, preoperative opioid exposure, and psychological factors may affect postoperative pain, opioid response, and recovery. Materials and Methods: PubMed and Google Scholar were searched from database inception through 18 June 2026. Relevant systematic reviews, meta-analyses, clinical guidelines, randomized trials, and observational studies involving adult surgical patients were included, with a focus on postoperative pain, opioid use, adverse effects, persistent pain, and functional recovery. Human perioperative evidence was prioritized, while experimental and preclinical evidence was used selectively to explain relevant biological mechanisms. Results: The available evidence was heterogeneous across patient populations, surgical procedures, analgesic techniques, and outcome definitions. No single patient characteristic consistently predicts postoperative pain or opioid requirements. Female sex is associated with a greater risk of postoperative nausea and vomiting, but reported differences in pain and opioid efficacy are inconsistent. Older and frail patients may be more susceptible to sedation, respiratory depression, delirium, and other opioid-related adverse effects. Patients with chronic pain or prior opioid exposure often have more difficult postoperative pain control because of tolerance, dependence, or possible opioid-induced hyperalgesia. Anxiety, depression, and pain catastrophizing may also contribute to greater pain and poorer recovery, although their relationship with opioid consumption is less consistent. Conclusions: Perioperative analgesia should be based on the patient’s overall clinical picture rather than any single risk factor. The proposed framework is conceptual and has not been clinically validated. Considering these characteristics together may help clinicians select appropriate multimodal treatments, anticipate analgesic needs, monitor for adverse effects, and support recovery.

Purpose: Childhood myopia is a growing global health concern, associated with serious vision complications later in life, including retinal detachment and myopic macular degeneration. While behavioral factors such as screen time and reduced outdoor exposure have been studied, the potential contribution of environmental light pollution, particularly artificial light at night (ALAN), remains underexplored at the population level. Methods: We analyzed 2019 data from 46 US states to examine the association between ALAN and the prevalence of childhood myopia (ages 0– 17). VIIRS satellite-derived nighttime radiance was used as a proxy for outdoor ambient lighting. Using generalized additive modeling (GAM), we examined nonlinear associations while adjusting for behavioral (screen time, insufficient sleep) and structural (Medicaid coverage, uninsured children, vision screening, optometrist density, urbanization) factors. Multicollinearity was assessed using Spearman correlation and variance inflation factors. Results: The final GAM explained 65.3% of the deviance in childhood myopia prevalence (adjusted R² = 0.509). Higher ALAN was significantly associated with higher myopia prevalence (F = 8.39, p = 0.0068). Screen time showed a nonlinear relationship, whereas sleep deprivation showed an unexpected inverse association, potentially reflecting detection disparities. Medicaid coverage showed a U-shaped association, with both low and high coverage associated with higher prevalence. Vision screening rates were positively associated with myopia prevalence, likely reflecting improved detection. Urbanization, optometrist density, and the number of Asian children were not statistically significant. Conclusion: ALAN is a population-level correlate of childhood myopia in the US. Although not indicative of individual-level risk, its association warrants further ecological investigation and may merit consideration in environmental health and urban planning discussions. These findings highlight the multifactorial nature of pediatric refractive error and the value of integrating environmental exposure data into public health vision surveillance. Further individual-level research is needed to assess causal mechanisms.