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Nabavizadeh B, Li KD, Hakam N, Shaw NM, Leapman MS, Breyer BN. Incidence of circumcision among insured adults in the United States. PLoS One 2022; 17:e0275207. [PMID: 36251658 PMCID: PMC9576047 DOI: 10.1371/journal.pone.0275207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to present the incidence of adult circumcision across the United States. Methods Using IBM MarketScan® Commercial Database from 2015 to 2018, we obtained claims for circumcision in men between 18 and 64 years of age. We calculated the incidence of adult circumcision over the study period and across the United States. We also collected data on indications for surgery using International Classification of Diseases codes. Results We identified a total of 12,298 claims for adult circumcisions. The mean age was 39 (±12.9) years. The average incidence rates remained relatively constant from 98.1 per 100,000 person-years in 2015 to 98.2 per 100,000 person-years in 2018 (Δ+0.1%). The age-standardized incidence rates varied significantly across the United States (from 0 to 194.8 per 100,000 person-years) with South Dakota having the highest rate. The most common indications for adult circumcision were phimosis (52.5%), routine/ritual circumcision (28.7%), phimosis + balanitis/balanoposthitis (6.8%), balanitis (3.8%) and balanoposthitis (2.6%), and significantly varied by age groups. Conclusion This study suggested a wide geographic variation in rates of adult circumcision between states with highest incidences in the Northeast United States. Future studies can identify the underlying causes for the observed variations.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, Weill Cornell Medicine, New York, New York, United States of America
| | - Kevin D. Li
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nathan M. Shaw
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Michael S. Leapman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Ihediwa CG, Bode CO, Alakaloko FM, Elebute OA, Seyi-Olajide JO, Ladipo-Ajayi OA, Ademuyiwa AO. Evaluation of the effect of nutritive versus non-nutritive pacifiers as adjuncts to local anaesthesia in male neonatal circumcision using the plastibell technique - A prospective randomised controlled study. Niger Postgrad Med J 2022; 29:310-316. [PMID: 36308260 DOI: 10.4103/npmj.npmj_189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Male circumcision is the most common surgical procedure worldwide and is often carried out for religious, cultural, medical and public health reasons. It is commonly performed during the neonatal period. Many studies have now shown that pain is a common intra- and post-operative complication. To ensure proper analgesia during the procedure, many surgeons opt for the use of pacifiers as an adjunct to anaesthesia during neonatal circumcision. The aim of this study is to compare nutritive pacifiers (NPs) versus non-NPs (NNPs) as adjuncts to local anaesthesia in male neonatal circumcision using the Plastibell technique. METHODS A prospective randomised controlled study was carried out between October 2019 and March 2020. A total of 100 neonates were circumcised using the Plastibell technique and randomised into NP (Group A, n = 33), NNP (Group B, n = 33) and controls (Group C, n = 34), respectively. The differences in pain scores using the Neonatal Infant Pain Scale, total crying time and heart rate during circumcision were recorded and assessed. RESULTS The age of participants ranged from 5 to 28 days and the weight ranged from 2.5 to 5.0 kg. The overall mean age, birth weight and current weight of the participants were 15.5 ± 6.1 days, 3.4 ± 0.4 kg and 3.5 ± 0.6 kg, respectively. The control group had the highest average pain score of 5.5 (4.5-5.8) compared to the intervention groups with median pain score (NP: 3.3 [1.3-4.3] and (NNP: 4.3 [3.1-5.1], respectively). NPs had significantly lower pain scores (P = 0.023) and reduced total crying time (P = 0.019) at all stages of the circumcision compared to those given NNPs and controls. CONCLUSION This study showed that NPs were superior to NNPs in providing additional pain control during male neonatal circumcision.
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Affiliation(s)
- Chibuike George Ihediwa
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Christopher O Bode
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital; Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Felix M Alakaloko
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olumide A Elebute
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital; Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Justina O Seyi-Olajide
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Adesoji O Ademuyiwa
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital; Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
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Parwez A, Singh S, Kumar R, Kumari R, Kumar V, Prakash V, Ali M. Determination and evaluation of HR-HPV genotype in different communities of Bihar, India. Int J Health Sci (Qassim) 2022; 16:40-48. [PMID: 36101850 PMCID: PMC9441651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV)-associated uteri cervix carcinoma continues to be the 2nd highest cause of death among women in India. This study aims to identify the mode of HPV transmission in different communities such as Hindu, Muslim, Christian and Banjaran women of Bihar, India. Different patterns of life and cultural variations exist among Muslims, Hindus, Christians, and Banjarans. For example, Muslim wash their genital parts after urination and maintain genital hygiene, whereas Banjaran tribes, Christians, and Hindu communities do not maintain hygiene. Thus, the present study was undertaken to evaluate high-risk HPV (HR-HPV) infection among healthy women. We access to genuine reason for the cause of HPV transmission in women. METHODS Ethical clearance was obtained from MCS and RC Patna, India. A total 154 urine samples have been used for the detection of HR-HPV through a real-time PCR technique. The DNA extraction was done from collected non-invasive urine samples. The estimation and purification of DNA purity was performed by QuantiFluor® dsDNA system and detected HPV-16 and HPV-18. RESULTS Overall, the prevalence of HR-HPV infection was detected to be 12.34% (19/154) whereas HPV-16 was found to be 9.9% (14/154) and HPV-18 was found to be 3.25% (5/154) in women. The lowest (2%; 1/50) prevalence of HR-HPV was observed in the Muslim community, while higher (25%, 16%, and 14.71%) prevalence was found in the Banjaran, Christian, and Hindu communities, respectively. CONCLUSION Our study indicates that personal hygiene possibly reduces HPV infection in women and the evidence suggests that male circumcision has a protective role of HPV infection in Muslim community. Therefore, personal hygiene and circumcision may reduce the risk of HPV acquisition and transmission as well as cervical cancer development in women.
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Affiliation(s)
- Akhtar Parwez
- Department of Biotechnology, Magadh University Bodh-Gaya, Bihar, India
| | - Sunit Singh
- Department of Zoology, B.D. College, Patna, Patliputra University, Patna, Bihar, India,Address for correspondence: Dr. Sunit Singh, Department of Zoology, B.D. College, Patna, Bihar, India. E-mail:
| | - Rahul Kumar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - Roushan Kumari
- Department of Biotechnology, Magadh University Bodh-Gaya, Bihar, India
| | - Vikas Kumar
- Department of Biotechnology, Magadh University Bodh-Gaya, Bihar, India
| | - Vidyut Prakash
- Department of Microbiology, Indira Gandhi Institute of Medical Sciences Patna, India
| | - Mohammad Ali
- Mahavir Cancer Sansthan and Research Centre, Patna, Bihar, India
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Bawazir OA, Alhallaq OA, Albayhani B, Bawazir A. Is the simple webbed penis a contraindication to circumcision? AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical correction of the webbed penis is challenging. We presented the safety and feasibility of webbed penis correction for neonates under local anesthesia using a simple principle of leaving equal cylindrical shaft skin.
Methods
This retrospective study included 530 patients who presented for circumcision to three pediatric surgery centers between May 2017 and January 2020. We included male patients aged less than four weeks old who had circumcision with a minimum of 6 months follow-up. We compared patients with normal penile anatomy (n = 451, Group 1) to a simple webbed penis (n = 79, Group 2).
Results
There were no differences in age and weight between groups. The procedure time was significantly longer in Group 2 (8.05 ± 3.11 vs. 7.48 ± 2.07 min; P = 0.04). There were no differences in bleeding (P = 0.38), redundant foreskin (P > 0.99), need for corrective surgery (P = 0.38), and re-suturing (P = 0.28) between groups. The procedure success was significantly higher in Group 1 (449 (99.56%) vs. 70 (88.6%); P < 0.001). Parents' satisfaction was measured at two weeks with no difference between both groups.
Conclusion
Simple penoscrotal web is not a contraindication for neonatal circumcision. Circumcision of the penoscrotal web had good esthetic results with comparable outcomes to those with a normal penis without a web.
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Circumcision in Hemophilia: A Multicenter Experience. J Pediatr Hematol Oncol 2021; 43:e33-e36. [PMID: 33003145 DOI: 10.1097/mph.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemophiliac patients and their families have social pressure to undergo circumcision, despite the potential complications. The objective of this study was to report our experience in the circumcision of hemophilia patients. MATERIALS AND METHODS We included 35 patients with hemophilia who had circumcision in 3 centers from January 2010 to August 2019. Their age ranged between 0.3 months and 8 years. Hemophilia a was classified as mild (n=3), moderate (n=4), and severe (n=28). Patients received 2 doses of factor VIII concentrate 50μ/kg, 1 hour before the procedure and 12 hours after it. RESULTS Four neonates were diagnosed with hemophilia after circumcision because of prolonged bleeding. Two patients with severe hemophilia A had bleeding after hospital discharge (6.5%). They received additional factor concentrate, and 1 patient had an extra stitch. Two patients had wound gaping (6.5%), and 1 patient had a wound infection (3.2%). CONCLUSION Hemophilia is not an absolute contraindication for circumcision. Circumcision of hemophilic children should be performed under appropriate conditions in hemophilia centers. Bleeding is not frequent but could be serious.
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Heras A, Vallejo V, Pineda MI, Jacobs AJ, Cohen L. Immediate Complications of Elective Newborn Circumcision. Hosp Pediatr 2019; 8:615-619. [PMID: 30262594 DOI: 10.1542/hpeds.2018-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the incidence of immediate complications of elective newborn circumcision in 2 community teaching hospitals. METHODS We performed a retrospective chart review of all term neonates who had circumcision performed between August 2011 and December 2014 at 2 community hospitals in New York. Neonatal hospital records and subsequent inpatient and outpatient records were reviewed. We classified complications as minor, intermediate, and major. RESULTS Out of a total of 1115 circumcisions, 1064 met inclusion criteria. There were 41 complications (3.9%), all involving hemorrhage. Sutures were used to control hemorrhage in 3 patients (0.3%). Local pressure or application of hemostatic chemical agents controlled bleeding in the remainder of patients. Bleeding was more common with the use of the Gomco clamp than with the Mogen clamp. Circumcisions performed with Gomco clamp represented 73.2% of the total complications compared with 26.8% with the Mogen clamp. There were no injuries to structures outside the prepuce or problems requiring medical treatment after discharge from the neonatal hospitalization. CONCLUSIONS The most common immediate complication encountered during an elective neonatal circumcision was bleeding that required only pressure or topical thrombin to achieve hemostasis. Bleeding was more common with the use of the Gomco versus the Mogen clamp. To conclude, our data support the theory that elective infant circumcision can be performed safely in a hospital setting.
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Affiliation(s)
| | | | | | | | - Lourdes Cohen
- Flushing Hospital Medical Center, Flushing, New York;
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Outcome of circumcision for newborns with penoscrotal web: oblique skin incision followed by penis shaft skin physical therapy shows success. J Pediatr Urol 2019; 15:404.e1-404.e8. [PMID: 31337533 DOI: 10.1016/j.jpurol.2019.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/20/2019] [Indexed: 11/22/2022]
Abstract
UNLABELLED SHORT INTRODUCTION/BACKGROUND: and objectives: Although it is widely agreed that newborn circumcision complications are low when the penile anatomy is normal, outcomes are uncertain when a web of skin attaches the penis to the scrotum. This anomaly, called a penoscrotal web or webbed penis, often leads to surgical reconstruction instead of newborn circumcision. OBJECTIVE With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. STUDY DESIGN Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the 'normal' group if they had no penile anomalies or the 'web' group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as 'push down' the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. RESULTS Of 828 boys who presented for circumcision, 652 (79%) were enrolled as they were suitable for circumcision: 355 (43%) in the normal group and 297 (36%) in the web group. The remaining 176 (21%) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89%) cases, with 261 of 263 (99%) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92%) cases, with all 327 (100%) showing success. The two web group cases (0.7%) who failed had surgical reconstruction. DISCUSSION It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. CONCLUSION It was found that newborns with a penoscrotal web and straight shaft show 99% success for circumcision, which is not different from boys without any penile anomalies (p = not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.
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Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). Can Urol Assoc J 2018; 12:18-28. [PMID: 29381455 PMCID: PMC5937397 DOI: 10.5489/cuaj.5034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
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Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J 2018; 12:E76-E99. [PMID: 29381458 PMCID: PMC5937400 DOI: 10.5489/cuaj.5033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
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Krishnaratne S, Hensen B, Cordes J, Enstone J, Hargreaves JR. Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. Lancet HIV 2017; 3:e307-17. [PMID: 27365205 DOI: 10.1016/s2352-3018(16)30038-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/22/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Much progress has been made in interventions to prevent HIV infection. However, development of evidence-informed prevention programmes that translate the efficacy of these strategies into population effect remain a challenge. In this systematic review, we map current evidence for HIV prevention against a new classification system, the HIV prevention cascade. METHODS We searched for systematic reviews on the effectiveness of HIV prevention interventions published in English from Jan 1, 1995, to July, 2015. From eligible reviews, we identified primary studies that assessed at least one of: HIV incidence, HIV prevalence, condom use, and uptake of HIV testing. We categorised interventions as those seeking to increase demand for HIV prevention, improve supply of HIV prevention methods, support adherence to prevention behaviours, or directly prevent HIV. For each specific intervention, we assigned a rating based on the number of randomised trials and the strength of evidence. FINDINGS From 88 eligible reviews, we identified 1964 primary studies, of which 292 were eligible for inclusion. Primary studies of direct prevention mechanisms showed strong evidence for the efficacy of pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision. Evidence suggests that interventions to increase supply of prevention methods such as condoms or clean needles can be effective. Evidence arising from demand-side interventions and interventions to promote use of or adherence to prevention tools was less clear, with some strategies likely to be effective and others showing no effect. The quality of the evidence varied across categories. INTERPRETATION There is growing evidence to support a number of efficacious HIV prevention behaviours, products, and procedures. Translating this evidence into population impact will require interventions that strengthen demand for HIV prevention, supply of HIV prevention technologies, and use of and adherence to HIV prevention methods. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Shari Krishnaratne
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK; Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bernadette Hensen
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jillian Cordes
- Department of Global Health, Emory University, Atlanta, GA, USA
| | - Joanne Enstone
- Public Health and Epidemiology, School of Medicine, Nottingham University, Nottingham, UK
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Seck M, Sagna A, Guéye MS, Faye BF, Sy D, Touré SA, Sall A, Touré AO, Diop S. Circumcision in hemophilia using low quantity of factor concentrates: experience from Dakar, Senegal. BMC HEMATOLOGY 2017; 17:8. [PMID: 28451435 PMCID: PMC5402675 DOI: 10.1186/s12878-017-0080-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
Background Circumcision in hemophiliacs is a delicate surgery because of bleeding risks that could be avoided by adequate substitution of coagulation factor. This practice is very challenging in countries where anti hemophilic treatment is inaccessible. The study aimed to evaluate a circumcision protocol in hemophilia A using low quantities of factor concentrates. Methods This prospective study included 26 hemophiliacs A who underwent circumcision in 2014. Medical treatment protocol using low quantity of factor concentrates was drafted by physicians of the Hemophilia Treatment Center and the surgical protocol by experienced surgeons. Assessment criteria were: number of hospitalization days, number of exposure days to factor concentrates, delay to healing and occurrence of bleeding events. Results Mean age was 9.6 years (1–30). Hemophiliacs patients were classified as severe (n = 8), moderate (n = 9) and mild form (n = 9). Mean number of exposure days to factor VIII concentrates was 6.9 days (5–12) in children and 10.75 days (7–16) in adults (p = 0.0049); mean number of hospitalization days was 3.68 days (2–10) in children and 13.5 days (13–15) in adults (p = 0.0000); delay to healing was 26.47 days (20–35) in children and 25.25 days (22–30) in adults (p = 0.697); five haemophiliacs (19.2%) presented bleeding events after the circumcision. The mean amount of FIII concentrates used per patient was 1743 IU (810–2340). Conclusion The study shows treatment protocol using low quantity of factor concentrates is efficient in hemophilia patients who underwent circumcision.
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Affiliation(s)
- Moussa Seck
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Aloïse Sagna
- Pediatric Surgical Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Mame Sokhna Guéye
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Blaise Félix Faye
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Diariétou Sy
- Hematology Service, National Blood Transfusion Center, Dakar, BP 5005 Senegal
| | | | - Abibatou Sall
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Awa Oumar Touré
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Saliou Diop
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
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Lama JR, Karuna ST, Grant SP, Swann EM, Ganoza C, Segura P, Montano SM, Lacherre M, De Rosa SC, Buchbinder S, Sanchez J, McElrath MJ, Lemos MP. Transient Peripheral Immune Activation follows Elective Sigmoidoscopy or Circumcision in a Cohort Study of MSM at Risk of HIV Infection. PLoS One 2016; 11:e0160487. [PMID: 27536938 PMCID: PMC4990246 DOI: 10.1371/journal.pone.0160487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/20/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Rectal and genital sampling in HIV prevention trials permits assessments at the site of HIV entry. Yet the safety and acceptability of circumcision and sigmoidoscopy (and associated abstinence recommendations) are unknown in uncircumcised men who have sex with men (MSM) at high risk of HIV infection. METHODS Twenty-nine HIV-seronegative high-risk Peruvian MSM agreed to elective sigmoidoscopy biopsy collections (weeks 2 and 27) and circumcision (week 4) in a 28-week cohort study designed to mimic an HIV vaccine study mucosal collection protocol. We monitored adherence to abstinence recommendations, procedure-related complications, HIV infections, peripheral immune activation, and retention. RESULTS Twenty-three (79.3%) underwent a first sigmoidoscopy, 21 (72.4%) were circumcised, and 16 (55.2%) completed a second sigmoidoscopy during the study period. All who underwent procedures completed the associated follow-up safety visits. Those completing the procedures reported they were well tolerated, and complication rates were similar to those reported in the literature. Immune activation was detected during the healing period (1 week post-sigmoidoscopy, 6 weeks post-circumcision), including increases in CCR5+CD4+T cells and α4β7+CD4+T cells. Most participants adhered to post-circumcision abstinence recommendations whereas reduced adherence occurred post-sigmoidoscopy. CONCLUSION Rectosigmoid mucosal and genital tissue collections were safe in high-risk MSM. Although the clinical implications of the post-procedure increase in peripheral immune activation markers are unknown, they reinforce the need to provide ongoing risk reduction counseling and support for post-procedure abstinence recommendations. Future HIV vaccine studies should also consider the effects of mucosal and tissue collections on peripheral blood endpoints in trial design and analysis. TRIAL REGISTRATION ClinicalTrials.gov NCT02630082.
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Affiliation(s)
| | - Shelly T. Karuna
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Shannon P. Grant
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Edith M. Swann
- Vaccine Clinical Research Branch, Division of AIDS, National Institutes of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, United States of America
| | | | | | | | | | - Stephen C. De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Susan Buchbinder
- San Francisco Department of Health, San Francisco, California, United States of America
| | - Jorge Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Maria P. Lemos
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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Firestone R, Rowe CJ, Modi SN, Sievers D. The effectiveness of social marketing in global health: a systematic review. Health Policy Plan 2016; 32:110-124. [DOI: 10.1093/heapol/czw088] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 12/30/2022] Open
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Gyan T, Strobel N, McAuley K, Shannon C, Newton S, Tawiah-Agyemang C, Amenga-Etego S, Owusu-Agyei S, Forbes D, Edmond K. Health service provider education and/or training in infant male circumcision to improve short- and long-term morbidity outcomes: protocol for systematic review. Syst Rev 2016; 5:41. [PMID: 26931106 PMCID: PMC4774100 DOI: 10.1186/s13643-016-0216-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/22/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There has been an expansion of circumcision services in Africa as part of a long-term HIV prevention strategy. However, the effect of infant male circumcision on morbidity and mortality still remains unclear. Acute morbidities associated with circumcision include pain, bleeding, swelling, infection, tetanus or inadequate skin removal. Scale-up of circumcision services could lead to a rise in these associated morbidities that could have significant impact on health service delivery and the safety of infants. Multidisciplinary training programmes have been developed to improve skills of health service providers, but very little is known about the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. This review aims to evaluate the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. METHODS/DESIGN The review will include studies comparing health service providers who have received education and/or training to improve their skills for infant male circumcision with those who have not received education and/or training. Randomised controlled trials (RCTs) and cluster RCTs will be included. The outcomes of interest are short-term morbidities of the male infant including pain, infection, tetanus, bleeding, excess skin removal, glans amputation and fistula. Long-term morbidities include urinary tract infection (UTI), HIV infection and abnormalities of urination. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library (including CENTRAL and DARE), WHO databases and reference list of papers will be searched for relevant articles. Study selection, data extraction and synthesis and risk of bias assessment using the Cochrane risk of bias assessment tool will be conducted. We will calculate the pooled estimates of the difference in means and risk ratios using random effects models. If insufficient data are available, we will present results descriptively. DISCUSSION This review appears to be the first to be conducted in this area. The findings will have important implications for infant male circumcision programmes and policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015029345.
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Affiliation(s)
- Thomas Gyan
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. .,Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
| | - Natalie Strobel
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| | - Kimberley McAuley
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| | | | - Sam Newton
- School of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
| | - David Forbes
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| | - Karen Edmond
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
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Chikutsa A, Maharaj P. Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe. BMC Public Health 2015; 15:603. [PMID: 26133368 PMCID: PMC4489047 DOI: 10.1186/s12889-015-1967-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 06/25/2015] [Indexed: 11/14/2022] Open
Abstract
Background The World Health Organisation recommended the scale-up of voluntary medical male circumcision (VMMC) as an additional HIV prevention method in 2007 and several countries with high HIV prevalence rates including Zimbabwe have since adopted the procedure. Since then researchers have been preoccupied with establishing the level of knowledge and acceptability of circumcision in communities that did not traditionally circumcise. Despite evidence to suggest that knowledge and acceptability of voluntary medical male circumcision is high, there is also emerging evidence that suggest that uptake of circumcision among men has been below expectations. The purpose of this study was thus to investigate people’s representations of male circumcision that may influence its uptake. Methods Data for this study was collected through focus group discussions with men and women aged between 18 and 49 years. This age group was selected because they are still very sexually active and are within the target population of the upscale of voluntary medical male circumcision programme. Women were included in the study because they would be directly involved in a decision to have their son(s) get circumcised for HIV prevention. The study was carried out in Harare, Zimbabwe. Obtained qualitative data was analysed using thematic content analysis. Results Results suggest that circumcision is perceived as an alien culture or something for “younger” men or “boys” who are not yet married. The findings also suggest that there are beliefs that circumcision maybe associated with satanic rituals. The issue of condom use after circumcision was also discussed and it was found that some men do not see the need for using condoms after getting circumcised. Conclusions There is an urgent need for the development of communications that directly address the misconceptions about voluntary medical male circumcision. There is need for communication that encourages circumcised men to continue using condoms.
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Affiliation(s)
- Antony Chikutsa
- School of Built Environment and Development Studies, University of KwaZulu Natal, Durban, South Africa. .,Department of Development Studies, Zimbabwe Open University, Harare, Zimbabwe.
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu Natal, Durban, South Africa
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Karaman K, Akbayram S, Garipardıç M, Öner AF. Diagnostic evaluation of our patients with hemophilia A: 17-year experience. Turk Arch Pediatr 2015; 50:96-101. [PMID: 26265893 DOI: 10.5152/tpa.2015.2516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
AIM Hemophilia A is a rare inherited bleeding disorder resulting from factor VIII deficiency and is a group of diseases characterized by intra-articular and intramuscular bleeding. In this study, we aimed to retrospectively evaluate the treatment outcomes, demographic and clinical characteristics of our patients who were treated and followed up for last 17 years in our pediatric hematology unit with a diagnosis of Hemophilia A. MATERIAL AND METHODS The medical records of 83 patients who were diagnosed with Hemophilia A and followed up between 1997 and 2014 in our hospital's pediatric hematology clinic were reviewed retrospectively. The demographic data, prophylaxis state, development of inhibitors and clinical characteristics of the patients were evaluated. RESULTS When the complaints at presentation were examined, it was found that 27 (32%) patients had hemarthrosis, 24 (29%) patients had ecchymosis and hematoma, 13 (16%) patients had prolonged bleeding after trauma or cut, 10 (12%) patients had gingival, mouth or nose bleeding, 4 (5%) patients had prolonged bleeding after circumcision, 4 (5%) patients had gastrointestinal bleeding, 1 (1%) patient had hematuria. Fifty (60%) patients were considered severe hemophilia A, 20 (24%) patients were considered moderate hemophilia A and 13 (16%) patients were considered mild hemophilia A according to factor activity. Among severe hemophilia A patients, primary prophylaxis was being administered in 2 (2%) patients and secondary prophylaxis was being administered in 40 (48%) patients. Inhibitor positivity was found in 8 (10%) of these patients. It is found that hemophilic artropathy developed in 17 patients and 8 of these 17 patients had undergone radioisotope synovectomy. CONCLUSIONS Treatment of severe bleeding in hemophilia A patients should be performed in hospital and the presence of inhibitor must be investigated in cases of uncontrolled bleeding where adequate doses of factor concentrates have been administered for treatment. In order to decrease the development of inhibitor, prophlaxis should be suggested to patients rather than repetetive treatment when bleeding occurs. The radioactive synovectomy should not be overlooked in countries like ours in which factors can not be used adequately.
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Affiliation(s)
- Kamuran Karaman
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Sinan Akbayram
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Mesut Garipardıç
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Ahmet Fayik Öner
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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Ashengo TA, Grund J, Mhlanga M, Hlophe T, Mirira M, Bock N, Njeuhmeli E, Curran K, Mallas E, Fitzgerald L, Shoshore R, Moyo K, Bicego G. Feasibility and validity of telephone triage for adverse events during a voluntary medical male circumcision campaign in Swaziland. BMC Public Health 2014; 14:858. [PMID: 25134856 PMCID: PMC4150954 DOI: 10.1186/1471-2458-14-858] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/04/2014] [Indexed: 12/28/2022] Open
Abstract
Background Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual men by approximately 60%. VMMC is a surgical procedure and some adverse events (AEs) are expected. Swaziland’s Ministry of Health established a toll-free hotline to provide general information about VMMC and to manage post-operative clinical AEs through telephone triage. Methods We retrospectively analyzed a dataset of telephone calls logged by the VMMC hotline during a VMMC campaign. The objectives were to determine reasons clients called the VMMC hotline and to ascertain the accuracy of telephone-based triage for VMMC AEs. We then analyzed VMMC service delivery data that included date of surgery, AE type and severity, as diagnosed by a VMMC clinician as part of routine post-operative follow-up. Both datasets were de-identified and did not contain any personal identifiers. Proportions of AEs were calculated from the call data and from VMMC service delivery data recorded by health facilities. Sensitivity analyses were performed to assess the accuracy of phone-based triage compared to clinically confirmed AEs. Results A total of 17,059 calls were registered by the triage nurses from April to December 2011. Calls requesting VMMC education and counseling totaled 12,492 (73.2%) and were most common. Triage nurses diagnosed 384 clients with 420 (2.5%) AEs. According to the predefined clinical algorithms, all moderate and severe AEs (153) diagnosed through telephone-triage were referred for clinical management at a health facility. Clinicians at the VMMC sites diagnosed 341 (4.1%) total clients as having a mild (46.0%), moderate (47.8%), or severe (6.2%) AE. Eighty-nine (26%) of the 341 clients who were diagnosed with AEs by clinicians at a VMMC site had initially called the VMMC hotline. The telephone-based triage system had a sensitivity of 69%, a positive predictive value of 83%, and a negative predictive value of 48% for screening moderate or severe AEs of all the AEs. Conclusions The use of a telephone-based triage system may be an appropriate first step to identify life-threatening and urgent complications following VMMC surgery.
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Affiliation(s)
- Tigistu Adamu Ashengo
- Maternal and Child Health Integrated Program (MCHIP), and Jhpiego-an affiliate of the Johns Hopkins University, Washington, DC, USA.
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Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: a systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014; 66 Suppl 2:S154-69. [PMID: 24918591 DOI: 10.1097/qai.0000000000000178] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2012, an estimated 2.1 million adolescents were living with HIV. Though there are effective interventions to prevent and treat HIV infection, adolescents face specific barriers in accessing them. As a result, new infections and poor outcomes among HIV-infected adolescents are common. HIV programming for adolescents should focus on interventions of proven effectiveness and address underlying factors driving incidence and lack of effective treatment and care in this age group. METHODS We conducted a systematic review of systematic reviews to summarize the global data on effectiveness of 20 intervention types, to identify characteristics of effective interventions, and to explore evidence of how adolescents can access interventions with proven effectiveness. Interventions were in 2 broad categories: those designed primarily for adults and those designed specifically for adolescents. Where available, we evaluated the evidence of impact on the key outcomes: HIV risk, HIV transmission, and HIV morbidity and mortality. RESULTS Among the interventions designed for adolescents, there was high-quality evidence that in-school interventions and some interventions in geographically defined communities can positively impact important HIV-related outcomes, such as self-reported sexual risk behaviors. Interventions designed primarily for adults that had high-quality, consistent biological evidence of efficacy included voluntary medical male circumcision (VMMC), antiretrovirals for the prevention of mother-to-child transmission, HIV testing and counseling, HIV treatment, condom use, and provision of sterile injecting equipment to people who inject drugs. There was also an evidence of potential efficacy for oral preexposure prophylaxis and behavior change interventions among certain populations. There was a dearth of systematic review data on how best to enable adolescents to access the intervention types identified as having proven effectiveness among adults. CONCLUSIONS This series of reviews allowed us to rigorously and systematically review a large number of intervention types at once using a standard, transparent methodology. Eight key interventions showed clear evidence of effectiveness, with evidence of potential efficacy for some additional interventions among certain populations. DISCUSSION These priority interventions with proven effectiveness should be included in all HIV prevention programming for adolescents. There is a pressing need for more rigorous research on how best to enable adolescents to access these effective interventions.
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Xi RC, Sheng YR, Chen WH, Sheng L, Gang JJ, Tong Z, Shan Z, Shuo YF, Gang ZZ, Sheng YG, Ling XJ, Ying GH, Dong LC, Ju ZK. Male circumcision performed with 8-figure non-absorbable suture technique. Can Urol Assoc J 2014; 8:E142-7. [PMID: 24678353 DOI: 10.5489/cuaj.1521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We analyze the outcome of circumcisions performed with 8-figure non-absorbable suture (8FNS) and assess the feasibility of using the technique in male circumcision. METHODS We randomly divided 317 patients who would undergo circumcision between February 2009 and January 2012 into 2 groups. Each group was subdivided into children (age range: 7 to 15 years) and adult (range: 16 to 85 years). In the experiment group (n =166), we used 8FNS and in control group (n = 151), commonly absorbable suture (CAS) were used for the circumcised wound closure. The results of 2 groups were compared. We also performed a cost analysis and a mean 6-month follow-up (range: 1-12). Chi-square and Student's t-test were used in statistical analysis. Differences were considered significant (p < 0.05). RESULTS No patients were required to remove their sutures postoperatively. Among them, the sutures of the 8FNS for circumcision fell off spontaneously within 9 days (6.2 ± 1.57). There was no statistically significant difference between the 2 groups in surgical duration (16.2 ± 1.73 vs. 15.8 ± 2.01) and follow-up time (6.4 ± 3.82 vs. 6.2 ± 2.39). The overall complication rate of the 2 groups was 6.63% and 10.53% (p = 0.15), respectively. In addition, the complication rate among the adults was significantly lower in the 8FNS group compared to children (2.53% vs. 10.34%, p = 0.04). Also, the average cost (in US dollars) of 8FNS for circumcision was $20.7 ± $3.83 less than $35.8 ± $5.02 of CAS, which is a very significant difference (p < 0.0001). CONCLUSIONS 8FNS for circumcision is feasible, easy, safe and cost-effective, especially for adult males.
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Affiliation(s)
- Ren Chong Xi
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Yin Rui Sheng
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Wang Hong Chen
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Li Sheng
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Ji Jing Gang
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhou Tong
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhang Shan
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Yang Feng Shuo
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhang Zhi Gang
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Yu Guo Sheng
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Xu Jun Ling
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Guo Hong Ying
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Liu Chun Dong
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhu Kun Ju
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
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Macipe-Costa RM, García-Sanchez N, Gimeno-Feliu LA, Navarra-Vicente B, Jiménez-Hereza JM, Moneo-Hernández I, Castillo-Laita JA, Lobera-Navaz P. Non-therapeutic male circumcision performed on immigrant children from Africa in Spain. Int J Public Health 2013; 59:351-8. [PMID: 24212325 DOI: 10.1007/s00038-013-0522-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 09/17/2013] [Accepted: 10/03/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To study the frequency, characteristics, and complications of non-therapeutic male circumcision on immigrant children from Africa in Spain. METHODS This descriptive study focused on primary care consultations conducted at 21 Aragon health centres during 2010 and 2011. The data were gathered through interviewer-administered questionnaires to the parents of African children. Sociodemographic variables were studied, along with others related to the practice of circumcision. RESULTS 283 questionnaires were obtained. 98.93 % of the children had undergone or were planning to undergo circumcision. 68.2 % were circumcised. Circumcisions were most frequently performed during a vacation to the country of origin (67.04 %), especially so for the Maghreb population. The remaining circumcisions had been performed in Spain. Half of the circumcisions practiced in Spain were performed at home, and 84 % of these were performed on Gambian children. CONCLUSIONS The current study demonstrates that, in Aragon, Spain, almost all immigrant children from Africa have been or will be circumcised and that a considerable proportion has been circumcised at home by unqualified individuals. Gambians are particularly at risk of performing unsafe circumcision.
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Affiliation(s)
- Rosa Maria Macipe-Costa
- Fuentes de Ebro Health Centre (Centro de Salud Fuentes de Ebro), Aragon Health Service (Servicio Aragonés de la Salud), Paseo de la Justicia, 69 Fuentes de Ebro, Saragossa, Spain,
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Darby RJL. The child's right to an open future: is the principle applicable to non-therapeutic circumcision? JOURNAL OF MEDICAL ETHICS 2013; 39:463-468. [PMID: 23365468 DOI: 10.1136/medethics-2012-101182] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The principle of the child's right to an open future was first proposed by the legal philosopher Joel Feinberg and developed further by bioethicist Dena Davis. The principle holds that children possess a unique class of rights called rights in trust-rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity. Parents should not, therefore, take actions that permanently foreclose on or pre-empt the future options of their children, but leave them the greatest possible scope for exercising personal life choices in adulthood. Davis particularly applies the principle to genetic counselling, arguing that parents should not take deliberate steps to create physically abnormal children, and to religion, arguing that while parents are entitled to bring their children up in accordance with their own values, they are not entitled to inflict physical or mental harm, neither by omission nor commission. In this paper, I aim to elucidate the open future principle, and consider whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. I argue that the principle is highly applicable to non-therapeutic circumcision, and conclude that non-therapeutic circumcision would be a violation of the child's right to an open future, and thus objectionable from both an ethical and a human rights perspective.
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Robinson JD, Ortega G, Carrol JA, Townsend A, Carnegie DA, Rice D, Bennett N. Circumcision in the United States: where are we? J Natl Med Assoc 2013; 104:455-8. [PMID: 23342820 DOI: 10.1016/s0027-9684(15)30200-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Circumcision is one of the most common surgical procedures performed on males in the United States. Ethical considerations of the procedure have been considered for many years and, recently, research on the topic has shed more light on the debate. The purpose of this study was to review the history and emergence, current demographics, and practices of male circumcision, specifically, nonreligious, nonmedically indicated routine neonatal circumcision. A review of the current literature was conducted using PubMed and current practices from guidelines of major professional societies. Physicians should consider the various ethical concerns and provide the patient's guardians with unbiased counsel. There is a lack of evidence both in favor of and against recommending routine neonatal circumcisions in the United States. The question remains whether we should continue unwarranted male circumcisions, especially when the major tenet of medical ethics is "do no harm."
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Affiliation(s)
- John D Robinson
- Department of Surgery , Howard University Hospital/College of Medicine, 2041 Georgia Ave NW Washington, DC 20060, USA.
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Mass safe male circumcision: early lessons from a Ugandan urban site - a case study. Pan Afr Med J 2012; 13:88. [PMID: 23396906 PMCID: PMC3567401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/20/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach. METHODS A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented. RESULTS A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs. CONCLUSION Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.
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Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N. EAU Guidelines on Iatrogenic Trauma. Eur Urol 2012; 62:628-39. [DOI: 10.1016/j.eururo.2012.05.058] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022]
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Dauendorffer JN, Renaud-Vilmer C, Bagot M, Cavelier-Balloy B. [Circumcision-induced penodynia]. Ann Dermatol Venereol 2012; 139:566-7. [PMID: 22963969 DOI: 10.1016/j.annder.2012.04.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 03/03/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022]
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Bitega JP, Ngeruka ML, Hategekimana T, Asiimwe A, Binagwaho A. Safety and efficacy of the PrePex device for rapid scale-up of male circumcision for HIV prevention in resource-limited settings. J Acquir Immune Defic Syndr 2012; 58:e127-34. [PMID: 21909032 DOI: 10.1097/qai.0b013e3182354e65] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of the PrePex device for nonsurgical circumcision in adult males as part of a comprehensive HIV prevention program in Rwanda. METHODS Single-center 6-week noncontrolled study in which healthy men underwent circumcision using the PrePex device, which employs fitted rings to clamp the foreskin, leading to distal necrosis. In the first phase of the study, the feasibility of the procedure was tested on 5 subjects in a sterile environment; in the main phase, an additional 50 subjects were circumcised in a nonsterile setting by physicians or a nurse. Outcome measures included the rate of successful circumcision, time to complete healing, pain, and adverse events. RESULTS In the feasibility phase, all 5 subjects achieved complete circumcision without adverse events. In the main phase, all 50 subjects achieved circumcision with 1 case of diffuse edema after device removal, which resolved with minimal intervention. Pain was minimal except briefly during device removal (day 7 after placement in most cases). The entire procedure was bloodless, requiring no anesthesia, no suturing, and no sterile settings. Subjects had no sick/absent days associated with the procedure. Median time for complete healing was 21 days after device removal. There were no instances of erroneous placement and no mechanical problems with the device. CONCLUSION The PrePex device was safe and effective for nonsurgical adult male circumcision without anesthesia or sterile settings and may be useful in mass circumcision programs to reduce the risk of HIV infection, particularly in resource-limited settings.
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SASMAZ I, ANTMEN B, LEBLEBISATAN G, ŞAHIN KARAGÜN B, KILINÇ Y, TUNCER R. Circumcision and complications in patients with haemophilia in southern part of Turkey: Çukurova experience. Haemophilia 2011; 18:426-30. [DOI: 10.1111/j.1365-2516.2011.02706.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Darby R, Van Howe R. Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. Aust N Z J Public Health 2011; 35:459-65. [PMID: 21973253 DOI: 10.1111/j.1753-6405.2011.00761.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To conduct a critical review of recent proposals that widespread circumcision of male infants be introduced in Australia as a means of combating heterosexually transmitted HIV infection. APPROACH These arguments are evaluated in terms of their logic, coherence and fidelity to the principles of evidence-based medicine; the extent to which they take account of the evidence for circumcision having a protective effect against HIV and the practicality of circumcision as an HIV control strategy; the extent of its applicability to the specifics of Australia's HIV epidemic; the benefits, harms and risks of circumcision; and the associated human rights, bioethical and legal issues. CONCLUSION Our conclusion is that such proposals ignore doubts about the robustness of the evidence from the African random-controlled trials as to the protective effect of circumcision and the practical value of circumcision as a means of HIV control; misrepresent the nature of Australia's HIV epidemic and exaggerate the relevance of the African random-controlled trials findings to it; underestimate the risks and harm of circumcision; and ignore questions of medical ethics and human rights. The notion of circumcision as a 'surgical vaccine' is criticised as polemical and unscientific. IMPLICATIONS Circumcision of infants or other minors has no place among HIV control measures in the Australian and New Zealand context; proposals such as these should be rejected.
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Darby R. Routine peripubertal circumcision? CMAJ 2011; 183:1283-4. [PMID: 21825054 DOI: 10.1503/cmaj.111-2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int J Epidemiol 2011; 40:1367-81. [PMID: 21672947 DOI: 10.1093/ije/dyr104] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (~5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes. METHODS Participants in a national health survey (n = 5552) provided information about their own (men) or their spouse's (women) circumcision status and details about their sex lives. Logistic regression-derived odds ratios (ORs) measured associations of circumcision status with sexual experiences and current difficulties with sexual desire, sexual needs fulfilment and sexual functioning. RESULTS Age at first intercourse, perceived importance of a good sex life and current sexual activity differed little between circumcised and uncircumcised men or between women with circumcised and uncircumcised spouses. However, circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors [11 vs 4%, OR(adj) = 3.26; 95% confidence interval (CI) 1.42-7.47], and women with circumcised spouses more often reported incomplete sexual needs fulfilment (38 vs 28%, OR(adj) = 2.09; 95% CI 1.05-4.16) and frequent sexual function difficulties overall (31 vs 22%, OR(adj) = 3.26; 95% CI 1.15-9.27), notably orgasm difficulties (19 vs 14%, OR(adj) = 2.66; 95% CI 1.07-6.66) and dyspareunia (12 vs 3%, OR(adj) = 8.45; 95% CI 3.01-23.74). Findings were stable in several robustness analyses, including one restricted to non-Jews and non-Moslems. CONCLUSIONS Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted.
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Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen S, Denmark.
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Forbes DA. "The case for boosting infant male circumcision in the face of rising heterosexual transmission of HIV" ... and now the case against. Comment. Med J Aust 2011; 194:97-8; author reply 101. [PMID: 21241226 DOI: 10.5694/j.1326-5377.2011.tb04179.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/05/2010] [Indexed: 01/17/2023]
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Abstract
PURPOSE OF REVIEW Three large trials among African heterosexual men in the last decade have confirmed that male circumcision reduces HIV acquisition. This review summarizes recent data regarding circumcision performed primarily to reduce HIV in high-prevalence settings. RECENT FINDINGS Male circumcision more than halved the acquisition of HIV in the trials, and was associated with few adverse events and high levels of satisfaction. An additional trial found no direct reduction in HIV risk for female partners of circumcised men. Evidence for an HIV-protective effect of circumcision in men who have sex with men is weak and inconclusive. Acquisition of HSV-2 and high-risk human papillomavirus are both reduced in circumcised heterosexual men, whereas acquisition of common male urethral pathogens are not. Concerns exist that behavioural disinhibition could offset benefits of this intervention, and it remains to be seen whether the low rate of adverse events and adoption of safer sexual practices observed in the trials will be maintained in circumcision programmes outside trial settings. SUMMARY The evidence that circumcision reduces HIV in African heterosexual men is clear. The impedance of political, cultural and logistic factors on expansion of much-needed African circumcision services requires urgent attention.
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