Notat om omskæring af drenge - Sundhedsstyrelsen

FROM THE AMERICAN ACADEMY OF PEDIATRICSparents complete would assist in thedecision of whether to circumcise ornot. To this end, the Task Force recommendsthat key professionalorganizations (AAP, ACOG, AAFP, AmericanSociety of Anesthesiologists,American College of Nurse Midwives,and other entities supporting midlevelclinicians) work together to developa consensus plan about which groupsare best suited to perform circumcisionsin newborn males; teach theprocedure and analgesic techniquesduring postgraduate training programs;and develop standards oftrainee proficiency. In addition, healthdepartments should be involved in thedissemination of educational materialsand coordinating educational effortswith professional organizations.Financing Newborn MaleCircumcision Task Force recommendation:1. The preventive and publichealth benefits associated withnewborn male circumcisionwarrant third-party reimbursementof the procedure.The CDC estimates that, from 2005 to2006, the average cost of providingnewborn male circumcision (includingphysician- and facility-related costs)ranged from $216 to $601 across thenation. 60 Hospitals in states whereMedicaid covers routine newbornmale circumcision have circumcisionrates that are 24% higher than hospitalsin states without such coverage.23 As of 2009, 15 states did notcover newborn male circumcision intheir Medicaid programs; 2 additionalstates had variable coverage dependenton the enrollment plan. 245There seems to be a relationship betweencircumcision incidence andthird-party payment.Circumcised newborns are more likelyto be privately insured than publiclyinsured infants. 246 The weighted ratesof circumcision over the 13-year periodfrom 1991 to 2005 were 40.8% forMedicaid clients versus 43.3% for theuninsured and 64.4% for insurednewborns. 5 The associations with insurancestatus were independent ofrace/ethnicity and socioeconomicstatus in this study. 246As noted, a recent cost-effectivenessanalysis by the CDC concluded thatnewborn circumcision is a societalcost-saving HIV prevention intervention.60 African-American and Hispanicmales in the United States aredisproportionately affected by HIVand other STIs, and thus would derivethe greatest benefit from circumcision;the HIV prevention evidencefor non-Hispanic white males was notas strong as for African-American andHispanic males. However, the African-American and Hispanic populationsare the most likely to have Medicaidcoverage. 247 In 2010, 50% of Hispanicchildren (up to age 18 years) and 54%of African-American children werecovered by Medicaid, compared with23% of white children. 248 Thus, recentefforts by state Medicaid programs tocurb payment for newborn male circumcisionaffect those populations thatcould benefit the most from the procedure.60 The CDC authors recommendedthat: “Financial barriers thatprevent parents from having the choiceto circumcise their male newbornsshould be reduced or eliminated.”AREAS FOR FUTURE RESEARCHIn the course of its work, the TaskForce identified important gaps in ourknowledge of male circumcision andurges the research community to seriouslyconsider these gaps as futureresearch agendas are developed. Althoughit is clear that there is goodevidence on the risks and benefits ofmale circumcision, it will be useful forthis benefit to be more precisely definedin a US setting and to monitoradverse events. Specifically, the TaskForce recommends additional studiesto better understand: The performance of elective malecircumcisions in the United States,including those that are hospitalbasedand nonhospital-based, ininfancy and subsequently in life. Parental decision-making to developuseful tools for communication betweenproviders and parents on theissueofmalecircumcision. The impact of male circumcision ontransmission of HIV and other STIs inthe United States because key studiesto date have been performed inAfrican populations with HIV burdensthat are epidemiologically differentfrom HIV in the United States. The risk of acquisition of HIV andother STIs in 0- to 18-year-olds, tohelp inform the acceptance of theprocedure during infancy versusdeferring the decision to performcircumcision (and thus the procedure’sbenefits) until the child canprovide his own assent/consent.Because newborn male circumcisionis less expensive and morewidely available, a delay often meansthat circumcision does not occur. Itwill be useful to more precisely definethe prevention benefits conferredby male circumcision toinform parental decision-makingand to evaluate cost-effectivenessand benefits of circumcision, especiallyin terms of numbers needed totreat to prevent specific outcomes. The population-based incidence ofcomplications of newborn malecircumcision (including stratificationsaccording to timing of procedure,type of procedure, providertype, setting, and timing of complications[especially severe and nonacutecomplications]). The impact of the AAP Male Circumcisionpolicy on newborn malePEDIATRICS Volume 130, Number 3, September 2012Downloaded from pediatrics.aappublications.org by guest on June 19, 2013e777