Difficulties Faced by Physicians in the Diagnosis of Endometriosis in the Brazilian Public Health System

Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.

Reacting to Epidemics:The Innovative Imperial Public Health System during the Late Northern Song Dynasty

Song China was a period in which China experienced a great increase in its population.Concurrently,the Song dynasty also experienced a rise in the frequency of epidemics and two major wars with the Western Xia and Liao dynasties during the 1000s and 1040s.The consequences of these changes were exacerbated by the increased geographical mobility of certain social groups such as traders and examinees attending civil service examinations.Thus,casualties of wars,epidemics,or disease,especially of people whose families were far away and could not care for them were left without care and“their corpses often lay bare along the roads.”This new social environment created a need for general relief.The Northern Song government(960-1127 CE),especially during the reign of Emperor Huizong,established an innovative public health system to address this issue.The public health system included poorhouses,public hospitals,and pauper’s cemeteries.The first were more of charity organizations,whereas the latter two promoted public health by providing medical services for the poor and burial for those that nobody cared for.In terms of rationale behind these institutions,on the one hand,they constituted an attempt to get the poor and homeless off the streets while providing them relief or burial.On the other hand,it seems that Huizong’s deep concern with medicine propelled him to design and implement a comprehensive public health system oriented to prevent contagion and outbreak of epidemics.This article depicts the background,the organization,and the functions of the system.The article also discusses the conditions and reasons that gave rise to such a unique undertaking by the Northern Song government.

History and Logical Progression of China's Public Health System——From the Perspective of the Protection of the Right to Health

A public health system generally refers to public utilities oriented toward protecting and improving health. It is intended to protect the health of the general public. Since the founding of the People’s Republic of China, China has constructed the largest healthcare system in the world. The 20th National Congress of the Communist Party of China(CPC), stressed that China will improve its public health system. Looking back at the history of China’s public health system from its inception to the reform and development and then improvement, it can be found that its development has always revolved around the theoretical logic of unifying rights and obligations and the practical logic of balancing the protection of the right to health and the regulation of state power. The fundamental goal is to protect the right to health of the people. The increasing health risks in modern society have changed require that efforts be made to construct a crisscrossing legal framework for public health, improve early-warning and emergency response mechanisms for public health emergencies,and integrate the health concept into all policies to further improve the public health system.

Characteristics of Organizational Leadership and Motivation as a Factor of Change in the Public Health System

The purpose of this study is to investigate the characteristics of organizational leaders in the health system and the factors that motivate health workers, in order to improve health care. The research was conducted in the public health institutions in Montenegro. The objectives of the research were to investigate whether leaders affect the motivation of employees in order to implement changes in the health system. The study was implemented through the interview method on the representative sample of 603 employees in public health institutions. The factor analysis revealed the latent characteristics of the organizational leader and the factors that motivate employees in public health institutions. The result of study indicates that employees in public health perceive organizational leadership to have a good quality. Result also exposes that the strongest motivation factor is a financial incentive. Financial incentive is the main motivator for employees in the public health sector, while the participation in decision-making was the least important motivational factor. The results obtained indicate that employees are primarily focused on individual goals, which influence the acceptance of change within the health system. The role of organizational leaders in motivating is poor because obtained factor scores are not correlated. The research has shown that organizational leaders do not have a great impact on the motivation of employees in the public health sector. This has effect on the process of accepting changes, where the roles of leaders are very important, especially in providing support to employees.

Therapeutic Approach in Female Sexual Dysfunctions in an Outpatient Clinic of Sexology in the Public Health System: A Longitudinal and Prospective Study

INTRODUCTION: Sexuality is one of the parameters of quality of life, and it is essential to include care for sexual dysfunctions in primary health care. OBJECTIVE: To evaluate the therapeutic approach in female sexual dysfunction in a public health outpatient clinic. DESIGN: A prospective cohort of women with sexual dysfunctions in an outpatient clinic of sexology in the Public Health System. The Female Sexual Function Index (FSFI) and scored 0 - 10 their sexual satisfaction were applied at the beginning and end of the follow-up. RESULTS: Eighty-nine women were included with a median age of 45 years, 69 (77.5%) had less than 11 years of schooling and 95.5% lived with a partner. The main reasons for referral for follow-up at the outpatient clinic of sexuality were dysfunction of hypoactive sexual desire disorder in 67.4% and pain related to sexual function in 46%. The average number of consultations was five and the main therapeutic interventions were guidance and clarification on sexuality (86.5%), use of topical estrogen (56.2%), and relaxation techniques (37.1%). All FSFI-19 domains had better post-intervention rates (p ≤ 0.005). Considering the domains of the FSFI-19, the medians of desire, arousal, lubrication, orgasm, pleasure and pain were higher in the post-intervention period in relation to the pre-intervention period (p ≤ 0.0001 for all analysis). In addition, the score given by the participant on their sexual satisfaction was higher at the post-intervention time compared to the pre-intervention period (p ≤ 0.0001). CONCLUSION: In public health, even with the care being performed by different professionals in each consultation, we conclude that through simple interventions, it is possible to improve the sexualities of the women attended. Still, offering care in sexuality is fundamental as part of primary health care and the training of medical professionals.

Greenway Non-mortorized System Planning from the Perspective of Public Health

The important role of greenway non-mortorized systems in urban sustainable development was summarized,pointing out their potential value in improving the ecological environment,promoting healthy living,and enhancing community connections.Based on the analysis on some cases of urban greenway construction in China,specific transformation models and strategies were proposed for greenway construction,which could integrate green spaces with non-mortorized system,so as to enhance the comprehensive efficiency of urban linear spaces.

Ancylostoma ceylanicum and other zoonotic canine hookworms:neglected public and animal health risks in the Asia-Pacific region

Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.

Dynamic analysis of major public health emergency transmission considering the dual-layer coupling of community–resident complex networks

We construct a dual-layer coupled complex network of communities and residents to represent the interconnected risk transmission network between communities and the disease transmission network among residents. It characterizes the process of infectious disease transmission among residents between communities through the SE2IHR model considering two types of infectors. By depicting a more fine-grained social structure and combining further simulation experiments, the study validates the crucial role of various prevention and control measures implemented by communities as primary executors in controlling the epidemic. Research shows that the geographical boundaries of communities and the social interaction patterns of residents have a significant impact on the spread of the epidemic, where early detection, isolation and treatment strategies at community level are essential for controlling the spread of the epidemic. In addition, the study explores the collaborative governance model and institutional advantages of communities and residents in epidemic prevention and control.

Linking Perceived Risk of Public Health Emergency to Psychological Distress among Chinese College Students: The Chain Mediation Role of Balanced Time Perspective and Negative Coping Styles

Background:With public health emergencies(PHE)worldwide increasing,the perceived risk of PHE has been one of the critical factors influencing college students’psychological distress.However,the mechanisms by which the perceived risk of PHE affects college students’psychological distress are not clear.The study’s purpose was to investigate the mediation roles of deviation from a balanced time perspective(DBTP)and negative coping styles between the perceived risk of PHE and psychological distress.Methods:A convenience sampling method was used to survey 1054 Chinese college students with self-reporting.Data was collected using the Public Risk Perception Scale(PRPS),the Zimbardo Time Perspective Inventory(ZTPI),the Simplified Coping Style Questionnaire(SCSQ),the PHE Anxiety Scale,and the Chinese version of the Patient Health Questionnaire(PHQ).The associations between the perceived risk of PHE,DBTP,negative coping styles,and psychological distress were clarified using the correlation analysis.Additionally,the mediating roles of DBTP and negative coping styles between the perceived risk of PHE and psychological distress were investigated using a structural equation model.Results:The findings revealed low to moderate correlations between the variables studied.Students’perceived risk of PHE was a positive predictor of their psychological distress(b=0.219,p<0.01).DBTP and negative coping styles played chain mediation roles between them with the effect being 0.009 and a 95%Boot CI of[0.003,0.023].This chain mediation model had an excellent fit index(χ^(2)/df=4.732,CFI=0.973,TLI=0.930,RMSEA=0.048,SRMR=0.047).Conclusion:These findings showed how the perceived risk of PHE affected college students’psychological distress.Specifically,these results suggested that improving students’mental ability to switch effectively among different time perspectives depending on task features and situational considerations and reducing their negative coping styles might be effective ways to promote their mental health.

Identification and Optimisation of Cycling Life Circle in High Density Communities with Public Health Support: A Case Study of Tiantongyuan in Beijing

In recent years,the compact development of high-density cities has sparked ongoing interest in healthy urban environments and public well-being.This study examines the relationship between cycling behaviors and the built environment of streets in Tiantongyuan Community,a typical high-density area in Beijing,China.By observing street spaces and summarizing residents’travel modes and behaviors,the study evaluates the impact of street design on cycling habits.In order to reveal the riding behavior characteristics of residents in different time periods and different street spaces,tools such as track recording APPs and the Gopro Motion Camera are employed to collect street view pictures and riding track data comprehensively,analyzing the various travel purposes of residents in Tiantongyuan community and the riding OD activity tracks of the main entrances and exits of the community.Meanwhile,by conducting the questionnaire survey of residents’travel demands and OD data of Baidu,and utilizing geographic information system(GIS)for data visualization,this study further investigates the distribution characteristics of cycling hotspots,cycling paths and cycling space,accurately identifies the cycling life circle of this community based on the spatial and temporal scales,and further puts forward the optimization strategy of the cycling network.Some cycling-friendly street space optimization strategies are suggested to deeply analyze the mechanism of the built environment of street space in high-density communities on the cycling activities and health of urban residents,with a view to provide accurate data support for the renewal of street cycling space.

Principle for the Installation of Accommodation for Sick guards in Public Health Establishments in Brazzaville in the Republic of Congo

The results of scientific studies of human social facts in the field of health show that the management of a patient should involve the patient’s entourage,whatever the status or size of the health establishment.In healthcare establishments in the Congo,the following are recognised as being responsible for medical care:specialist doctors,doctors,midwives,nurses and care assistants.The patient’s family and close friends are responsible for looking after the patient and financing care.The hospital infrastructure does not provide any space for the patient warden who accompany the patient during reception and hospitalisation.This makes Congolese hospitals inefficient for patient care.How can we integrate the function of the Sick guard and the assistance of the family,in order to reduce the mortality rate and repair the harm caused to patients requiring the presence of relatives during their stay in hospital,which is considered to be a dangerous place?This article examines the functional principles for configuring the space that patient warden would occupy in the patient care system.On the basis of a documentary analysis of sociological and architectural studies of existing facilities,this article proposes a typical accommodation model with the spaces needed to ensure the well-being and effectiveness of the patient warden with the patient.These are rooms with minimum space for 2 to 4 individual beds,equipped with toilets and showers.The accommodation has a dining area,kitchen and laundry facilities.In the future,this accommodation will become part of the hospital estate and may be occupied by orderlies and patient warden recruited by the hospital administration.

Comprehensive Analysis of Cancer Incidence and Mortality Trends in Costa Rica: Implications for Public Health

This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.

REDISSE in Benin and Lessons Learned for the Management of Public Health Emergencies after Five Years of Implementation

Introduction: Benin was embarked on phase 3 of the REDISSE Benin project (Regional Disease Surveillance Systems Enhancement) which began in 2018. The objectives were in five key components namely, Surveillance and health information;Laboratory capacity building;Emergency preparedness and response;Human resources management for effective disease surveillance and epidemic preparedness;and Institutional Capacity Building, Project Management, Coordination and Advocacy. After five years of implementation, this study aimed at the documentation of lessons learned and best practices. Methods: A descriptive cross-sectional study. Apart from individual semi-structured interviews, a thematic workshops bringing together the project’s main stakeholders recruited on an exhaustive way by component to identify and validate lessons learned, good practices and propose improvement mechanisms to be taken into account by the sector. Criteria were set up and used to validate best practices and lessons learned. Results: A total 54 (Surveillance workshop), 47 (Preparedness & response workshop), 53 (Human Resources workshop), 26 (Laboratories workshop) participated to the thematic workshops, and five interviews. The good practices (33: 9 for animal health, 7 for human health and 17 crosscutting) and lessons learned (10: 3 for animal health and 7 for human health) have been identified and have been the subject, depending on the case, of proposals for improvement or conditions necessary for their maintenance. Discussion: The richness of a project lies not only in the immediate achievement of its results, but also and above all, in its usefulness for similar interventions, whether in the local, regional, national or international context. It is in this context that the REDISSE project has set out to make public the various lessons learned and best practices from the implementation of its activities over a period of some five consecutive years.

Work experience of special workers returning to work after the public health emergency:taking ICU nurses who have been infected with COVID-19 as example

Objective:The occurrence of some public health events inevitably endangers medical personnel,and medical personnel,as a special group,have to resume work on time to treat patients.This coronavirus disease-2019(COVID-19)infection is a good example,and what intensive care unit(ICU)nurses experience as the primary caregivers of critically ill patients after COVID-19 infection is our focus.To explore the work experience of ICU nurses after recovery from COVID-19,and to provide a theoretical basis for the intervention to improve the physical and mental health level and work experience of special workers in public health emergencies.Methods:We conducted an explorative descriptive study using an inductive thematic analysis.Using the maximum differential sampling method,a semi-structured interview was conducted among 13 ICU nurses suffered from COVID-19 in a tertiary grade A hospital in Qingdao,Shandong Province.This study carried on the theme analysis according to the inductive content analysis method and used MAXQDA 2020 Analytics Pro(VERBI Software GmbH,Berlin,Germany)to manage and summarize the interview data.Results:After being infected by the virus,SARS-Coronavirus-2(SARS-CoV-2),the pathogen of COVID-19,the work experience of ICU nurses was extracted from the following 5 themes:(1)Stress and challenge caused by the change of work focus;(2)downsizing,overtime,taking up work with illness,and physical discomfort;(3)dedication and family debt;(4)unknown fear and helplessness;and(5)professional responsibility and sense of benefit.Conclusions:Under the pressure of COVID-19,ICU nurses face multiple pressures and challenges,and their emotions are complex.We suggest that nursing managers should take corresponding measures to alleviate nurses'physical and psychological pressure and improve their work experience.

Weighing in on monkeypox against the criteria of public health emergency

The monkeypox,a viral zoonotic disease usually found in forest areas of Central and Western Africa,has spread worldwide through new modes of transmission little understood.The WHO on 23 July 2022,declared the virus a Public Health Emergency of International Concern(PHEIC).The declaration has stirred criticism from leading scientists that the criteria for PHEIC as defined by International Health Regulation have not been met and it is non-transparent and contradictory.This paper reviews the criteria of PHEIC and weighs the rationales behind the declaration to increase the clarity of the WHO's decision,justifications,and legitimacy in the ongoing outbreak.

Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.

Leadership,communication,and science:three pillars essential to public health emergency response and closing the gap in the HIV response among key populations

Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has significantly increased morbidity and mortality worldwide is the human immunodeficiency virus(HIV)and acquired immune deficiency syndrome(AIDS)pandemic.HIV has a disproportionately negative impact on key populations.Strong leadership,effective communication,and sound science are necessary for public health emergency(PHE)responses to be successful.These three PHE response pllars are also essential for bridging the HIV response gap among key populations in the setting of restrictive laws.In this review,we explored the importance of these three pillars of successful PHEs responses,and how they are essential to closing the gap in the HIV response among key populations.Leaders must make decisions and instil a sense of authority in the populace during PHEs to foster trust and confidence.Leaders should base their choices on scientific evidence.Effective communication during PHEs should be proactive,polite,imaginative,innovative,and constructive.To address gaps in the HIV response among key populations,leaders must create a supportive environment for effective communication and scientific research,communication should be used to raise awareness of HIV and to dispel stigma and discrimination,while science should provide evidence of efficacy and effectiveness of interventions amongkey populations.

Does higher tax rate affect tobacco usage?Unravelling the nexus between tobacco regulatory control and public health concern

Objectives:Bangladesh stands as a prominent global consumer of tobacco,with alarming consequences on public health.The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126000 lives in 2018,contributing to 13.5%of all deaths in the country.This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden,with a particular emphasis on its implications for public health.Methods:This study is based on the annual time series data over the period 2000-2020.The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level.This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden.Results:The study finds a negative relationship between tobacco tax rate and tobacco consumption.More specifically,the higher tax rate of tobacco(low(β=-0.3495),medium(β=-0.2319),high(β=-0.9033),premium(β=-0.7322),filtered(β=-0.2114),and non-filtered(β=-0.3452)categories)is significant to reduce tobacco use at 1%level of significance.The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable.Finally,the study investigates the impact on health care cost through tobacco consumption,tobacco control law,growth rate,export-import,and tobacco production.The results indicate that tobacco consumption,export-import,and tobacco production increases health care cost burden while tobacco use regulatory decreases it.By reducing tobacco consumption,higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system,promoting healthier lifestyles,and aligning with global health objectives.Conclusions:Higher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco.Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands.Tobacco control laws need to revised and proper implementation should be ensured as well,to achieve the goal of tobacco free Bangladesh by 2040.Tobacco-related diseases,responsible for a significant proportion of deaths in the country,could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation.This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

Adolescent health issues:The role of publich health nurses

Adolescent health(AH)is an integral part of public health with the goal of improving the healthy development,safety,and well‑being of adolescents because the behavioral patterns established during this period influence the health status of the adolescents and the risk of developing chronic diseases during adulthood.Adolescence being a time of great physical and psychological change,many social and physical conditions as well as behavioral pattern can impact AH and heighten the risk of illness and diseases.This makes adolescents to be susceptible to various health issues by nature because of their stages of development,which affects their ability to make safe decisions,and the need to rely on significant others for support.Other factors like desire for greater autonomy,pressure to conform to peers,exploration of sexual identity,increased access to and use of technology,violence and sexual abuse,social and cultural norms,family circumstances,emotional and physical environment of the adolescents contribute significantly to adolescents’health issues.Therefore,nurses have significant roles to play to ensure optimal growth and development of the adolescents and to prevent and reduce the impact of changes associated with adolescence on the health and well‑being of the adolescents.This article presents the concept of adolescence,components of AH,health‑related challenges associated with adolescence,and role of public health nurses.

Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.