New York Times
Circumcision Benefits Outweigh Risks, Study Reports
By NICHOLAS BAKALAR
April 7, 2014, 10:38 am
As well as the New York Times, the article in Mayo Clinic Proceedings below also led to over 50 other news reports, including NBC and CBS television in the USA and in newspapers and online news services in the USA and other countries.
Mayo Clin Proc.
2014 Mar 28. pii: S0025-6196(14)00036-6. doi: 10.1016/j.mayocp.2014.01.001. [Epub ahead of print]
Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?
- 1School of Medical Sciences, University of Sydney, Sydney, NSW, Australia. Electronic address: email@example.com.
- 2People Incorporated, St Paul, MN.
- 3Center for Neonatal Care, Orlando, FL.
The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision.
Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
[PubMed - as supplied by publisher]
Primary Strategies for HPV Infection and Cervical Cancer Prevention.
- 1*Departments of Family and Geriatric Medicine, Obstetrics and Gynecology, Bioengineering, Epidemiology and Population Health, Health Promotion and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky; †Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Counseling messages for tobacco cessation, condom use, circumcision, and selective choice in the number of sexual partners can help reduce the risk of cervical cancer. Other sexual behavioral and reproductive risk factors for cervical cancer are a younger age at first intercourse and at first full-term pregnancy as well as increasing duration of combined hormonal oral contraceptive use. Micronutrients and supplements can reduce the risk of human papillomavirus infection, persistence, progression, and regression. Some human papillomavirus infections can be prevented by vaccination. Cervical cancer is best prevented by screening.
[PubMed - as supplied by publisher]
This article appeared under “male circumcision” as a keyword
Making the cut: evidence-based lessons for improving the informed consent process for voluntary medical male circumcision in Swaziland and Zambia.
The informed consent (IC) process for voluntary medical male circumcision (VMMC) was evaluated in Zambia and Swaziland as VMMC programs scaled up. In-depth interviews (IDIs) were conducted with clients 1 week after surgery to explore understanding of IC and gauge how expectations of MC surgery compared to actual experiences. In Zambia, key opinion leaders (KOLs) were also interviewed. Some clients equated written IC with releasing the clinic from liability. Most clients felt well prepared for the procedure, although many were surprised by the level of pain experienced during anesthesia and postsurgery. Clients were highly motivated to adhere to wound care, but some were overwhelmed by extensive instructions. Adolescents described barriers to accessing follow-up care and the need for support in overcoming adult gatekeepers. KOLs indicated that IC is not well understood in poorly educated communities. Results led to concrete programmatic changes, including revised patient education materials and more effective anesthesia for longer-lasting pain relief.
[PubMed - in process]
2014 Apr 4;9(4):e92015. doi: 10.1371/journal.pone.0092015. eCollection 2014.
Indices to Measure Risk of HIV Acquisition in Rakai, Uganda.
, Gray RH2
, Whalen C3
, Fu P4
, Neuhauser D4
, McGrath JW5
, Sewankambo NK6
, Serwadda D6
, Kigozi G4
, Nalugoda F4
, Reynolds SJ7
, Wawer MJ2
, Singer ME4
- 1Rakai Health Sciences Program, Entebbe, Uganda; Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
- 3Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America.
- 4Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
- 5Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America.
- 6Makerere University College of Health Sciences, Kampala, Uganda.
- 7Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America; Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender-specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda.
We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike’s information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell’s concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models.
We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner’s HIV status and community HIV prevalence. The Model’s optimism-corrected c index was 69.1 percent (95% CI?=?0.66, 0.73). The final women’s model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI?=?0.64, 0.70). Both models were well calibrated.
These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.
[PubMed - in process]