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Hygieia
  1. Michael Muir
  1. mmuirbmjgroup.com

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    CIRCUMCISION AND HIV

    Debate rages as to the suitability of male circumcision as a preventative public health measure despite strong evidence suggesting it can be protective against HIV infection. Bearing this in mind, researchers elected to study the social acceptability of circumcision in Botswana, Southern Africa, which has a high rate of the disease. They found that it was highly acceptable to the study group and that the vast majority would definitely or probably circumcise a male child if the service was offered for free at a hospital. The authors now recommend “shifting the discussion to the medical realm”, to best serve those who would like circumcision services available to them or their children. (

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    CHLAMYDIA TESTING DIFFERS FROM EPIDEMIOLOGY

    The known epidemiology of genital chlamydia infection is not reflected by current testing practice at primary care level in the UK. Researchers gathered the number of tests and results for each general practice in Nottingham Health District and matched them to practice characteristics. They found that most tests were performed in women over the age of 25 but the most positive results were found in 15–19 year olds, followed by 19–24 year olds. Incidence was highest in more socioeconomically deprived areas, which could not be explained by lower testing rates. Practices with lower doctor to patient ratios did less testing, and the authors suggest that “measures to enable their active participation… will be important in reaching all at-risk groups”. (

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    SOUTH KOREAN SYPHILIS SLOWDOWN

    Syphilis prevalence in South Korea has decreased rapidly since 1977 but now appears to have reached a plateau. Researchers examined over 15 000 adults for the disease and found that the overall prevalence in the country was 0.2%, with a consistently decreasing trend until 1995 when numbers stabilised and remained much the same until 2000. Economic development and public education are credited with reducing syphilis prevalence, and the authors suggest that further progress can only be made by use of a specific and definite syphilis management strategy that takes risk factors into account and includes data on all syphilis patients nationwide. (

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    CHLAMYDIA: ATTITUDES AND ACTION

    Men take chlamydia less seriously than women, are less willing to tell partners that they are infected, and are more likely to blame their partners for infections. Semistructured interviews were held with 12 men and 12 women diagnosed with genital chlamydia infection in a bid to explore attitudes and behaviour towards the disease. There were significant gender differences; women were more worried about the implications of infection on future reproductive health, feared stigmatisation, and blamed themselves for contracting the disease. Male perception of chlamydia as a minor infection was a major reason for delaying seeking care, and men in general had a worryingly laissez-faire attitude to the disease and its consequences. (

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    STI IN RURAL CAMBODIA

    There is a high burden of HIV and syphilis among female sex workers (FSWs) in rural Cambodia, home of Asia’s fastest growing HIV epidemic. Interviews and samples were taken from 114 FSWs and were tested for HIV and syphilis. The results (42% infected with HIV and 22% with current or past syphilis) were merged with data from a similar study on urban FSWs, and showed that rural FSWs tended to be older, have fewer daily clients, lower monthly income, and longer duration of sex work than their urban counterparts. These findings suggest that FSWs move into less competitive rural areas as they age or contract HIV and other STIs, their high mobility contributing in large to the expansion of disease into lower risk populations. (

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    CHLAMYDIA SCREENING IN BELGIUM

    Convincing people to take a test for Chlamydia trachomatosis (CT) can prove difficult, but a recent paper from Belgium shows that targeted screening is possible in primary care. In 2001–2, every woman attending a general practice in Antwerp for routine gynaecological care (mostly for pill prescriptions or PAP smear) was offered opportunistic screening for CT through a home sample kit. Over 750 samples were returned and each woman filled in a standard questionnaire. The authors are hopeful that this model, if validated, could become an important intervention for STI control in the general population, but acknowledge that it is labour intensive in practice and requires considerable communication skills. (

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    FAMILIAL RISK FOR LIVER AND BILIARY CANCER

    There is a strong familial risk in gallbladder cancer and a significant one in primary liver cancer. The authors are the first to report familial clustering of liver and biliary cancers, and the risk is so high (SIR 5.21 for gallbladder cancer) that heritable factors are likely to contribute, with possible modification by environmental factors. All cancers in the liver and biliary system showed a familial SIR of 1.65 and the authors suggest that the next step is to identify candidate genes to permit further characterisation of the familial risks. (

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    TRIUMPH FOR DANISH POLYPOSIS REGISTER

    Both the prevalence and prognosis of colorectal cancer has improved considerably in Denmark since the establishment of the Danish Polyposis Register in 1975. Familial adenomatous polyposis (FAP) is a rare autosomal dominant disease caused by a genetic defect that, if left untreated, will result in death from colorectal cancer for almost all affected patients. Since 1975, every Danish person diagnosed with FAP has been placed on the register, together with their relatives, who were then also screened for the disease. Treatment was delivered where necessary. A 55% reduction in prevalence has resulted, with similarly pronounced improvements witnessed in the survival rate. (

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    UNDETECTED COELIAC DISEASE IN ENGLAND

    Undetected coeliac disease is likely to affect about 1% of English people aged between 45 and 76, a value similar to comparable countries. Screening for coeliac disease is now a realistic possibility after the development of serological tests, and previous studies have suggested that many people may have the disease without knowing it. The authors took serum samples from over 7500 people aged 45–76 in Cambridgeshire, UK, and found that the seroprevalence of undetected coeliac disease was 1.2%. Those affected have an increased risk of osteoperosis and mild anaemia, but also report “better health” and have a good cardiovascular risk profile that may even protect against ischaemic heart disease and stroke. (

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