Christian Graugaard

Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

High Linkage to Care in a Community-Based Rapid HIV Testing and Counseling Project Among Men Who Have Sex With Men in Copenhagen

Introduction The aim of the study was to evaluate a community-based human immunodeficiency virus (HIV) testing program for its capacity to reach men who have sex with men (MSM) and successfully refer HIV-positive patients to treatment. Methods A walk-in clinic placed in the heart of the Copenhagen MSM community provided sexually transmitted infection counseling and rapid HIV testing. In addition, syphilis testing and hepatitis B vaccination were offered. The clinic was staffed with specially trained, predominantly non–health care personnel, and services were anonymous and free of charge. Results A total of 3012 HIV tests with concomitant counseling were performed between 2008 and 2012. The median age of users was 33 years (range, 16–73 years), 18% were non-Danish citizens, and 12% reported that this was their first HIV test. Thirty-eight individuals tested positive; however, 1 was found to be false positive by routine confirmatory testing. The remaining 37 users were true positive. All but 1 user was successfully linked to care at an infectious disease department and achieved full viral suppression after a median of 8 months (interquartile range, 5–19 months). The 37 positive patients accounted for 11% of all newly diagnosed HIV cases among MSM in Copenhagen in the period covered. Patients diagnosed in Checkpoint were younger than other newly diagnosed MSM, but had similar median CD4 counts at the time of diagnosis (420 [interquartile range, 260–590]). Seventy-six MSM (3%) were found syphilis positive in rapid testing and referred for confirmatory testing. Furthermore, 264 MSM completed a 3-shot hepatitis B vaccination program. Conclusions Easily accessible, community walk-in clinics and targeted testing in high-risk settings are convenient for populations of MSM less likely to seek out the established health care system. Checkpoint diagnosed 37 new HIV cases, posed no barrier to successful linkage to care, was noninferior in quickly reducing community viral load, was cost-effective, reached younger MSM, and proved an ideal platform for trying out new interventions and test forms, which conventional health care providers have not yet embraced.

Multifactorial intervention to prevent cardiovascular disease in patients with early rheumatoid arthritis: protocol for a multicentre randomised controlled trial

Introduction Cardiovascular morbidity is a major burden in patients with rheumatoid arthritis (RA). In this study, we compare the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment of modifiable risk factors for cardiovascular disease (CVD) in patients with early RA fulfilling the 2010 American College of Rheumatology European League Against Rheumatism (ACR/EULAR) criteria. Methods and analysis The study is a prospective, randomised, open label trial with blinded end point assessment and balanced randomisation (1:1) conducted in 10 outpatient clinics in Denmark. The primary end point after 5 years of follow-up is a composite of death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke and cardiac revascularisation. Secondary outcomes are: the proportion of patients achieving low-density lipoprotein cholesterol <2.5 mmol/L, glycated haemoglobin <48 mmol/mol, blood pressure <140/90 mm  Hg for patients without diabetes and <130/80 mm Hg for patients with diabetes and normoalbuminuria (urinary albumin creatinine ratio <30 mg/g) after 1 year of follow-up and the proportion of patients in each treatment group achieving low RA disease activity after 1 year, defined as a disease activity score C-reactive protein (DAS28-CRP) <3.2 and a DAS28-CRP score <2.6 after 12, 24 and 60 months. Furthermore, all hospitalisations for acute and elective reasons will be adjudicated by the event committee after 12, 24 and 60 months. Three hundred treatment-naive patients with early RA will be randomly assigned (1:1) to receive either conventional treatment administered and monitored by their general practitioner according to national guidelines (control group) or a stepwise implementation administered and monitored in a quarterly rheumatological nurse-administered set-up of behaviour modification and pharmacological therapy targeting (1) hyperlipidaemia, (2) hypertension, (3) hyperglycaemia and (4) microalbuminuria (intervention group). Ethics and dissemination This protocol is approved by the local ethics committee (DK-S-2014007) and The Danish Health and Medicines Authority. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals. Trial registration number NCT02246257

Sexuality as a health-promoting factor — theoretical and clinical considerations

Sexuality is an important aspect of existence and a fulfilling intimate life can be a facilitator of well-being, self-esteem, and general resilience. Moreover, it can strengthen coping, adherence, and survivorship skills of chronically ill patients. Health-care professionals should, therefore, routinely address issues of sex and intimacy.

What Do Danish Youth Want to Know About Sex? Twenty Years of Telephone Counseling on Sexual and Reproductive Issues

Young peoples need for sexual counseling is well documented, and both website and hotline-based services have been established as means of health promotion in this field. Such measures, however, are rarely evaluated, so this article offers data from the worlds presumably oldest sexuality helpline aimed at young people. With an observation time of two decades and a total of 42,325 questions asked, the study provides a unique glance into the sexual landscapes of Danish youth. It shows an overall male predominance among callers and reveals that the counseling themes change over time and differ between both age groups and genders. The article suggests that telephone counseling—although more resource demanding than online alternatives—provides a secure, anonymous, and dialogue-based arena for discussing delicate sexual issues and therefore may constitute a viable supplement to web-based media for young people with the need to talk rather than just chat.

Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies

Introduction The leading cause of erectile dysfunction (ED) is arterial dysfunction, with cardiovascular disease as the most common comorbidity. Therefore, ED is typically linked to a web of closely interrelated cardiovascular risk factors such as physical inactivity, obesity, hypertension, and metabolic syndrome. Physical activity (PA) has proved to be a protective factor against erectile problems, and it has been shown to improve erectile function for men affected by vascular ED. This systematic review estimated the levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular diseases. Aim To provide recommendations of levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases. Methods In accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed of research articles specifically investigating PA as a possible treatment of ED. The review included research on ED from physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases. All available studies from 2006 through 2016 were checked for the predetermined inclusion and exclusion criteria to analyze the levels of PA needed to decrease ED. Results 10 articles met the inclusion criteria, all suggesting various levels of PA needed to decrease ED for men with relevant risk factors for ED. The results of the review provided sufficient research evidence for conclusions regarding the levels of PA necessary to decrease ED. Conclusion Recommendations of PA to decrease ED should include supervised training consisting of 40 minutes of aerobic exercise of moderate to vigorous intensity 4 times per week. Overall, weekly exercise of 160 minutes for 6 months contributes to decreasing erectile problems in men with ED caused by physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases. Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med 2018;6:75–89.

Self-reported sexual and psychosocial health among non-heterosexual Danes

Introduction: Little is known about the sexual and psychosocial health of non-heterosexual Danes. Based on a large population study, the aim of this article was to compare quality-of-life-related key variables of heterosexual and non-heterosexual men and women, aged 16–66. Materials and methods: Cross-sectional data from the nationwide, representative Health and Morbidity Survey (n = 8496) were used to compare variables concerning both general and sexual well-being of self-identified heterosexual and non-heterosexual respondents. Results: Nearly twice as many non-heterosexual than heterosexual men rated their sexual life as bad or very bad (22.5% versus 12.8%), while no statistical difference was seen among women (13.6% versus 10.6%). For both genders, significantly more non-heterosexuals than heterosexuals stated that their sexual needs were not met (17.9% versus 7.7% for men and 14.8% versus 6.9% for women), and significantly more non-heterosexuals reported acts of sexual violence (8.3% versus 2.1% for men and 35.8% versus 13.0% for women). Finally, non-heterosexual respondents had contemplated suicide more than twice as often as heterosexuals (15.9% versus 7.4% for men and 19.7% versus 8.3% for women). Actual suicide attempts were roughly three times more frequent in the non-heterosexual groups (8.3% versus 2.6 % for men and 11.8% versus 4.2% for women). Conclusions: Overall, non-heterosexual Danes reported higher degrees of sexual and/or psychosocial distress than heterosexuals. Further research is needed; but scientists, clinicians and public health workers should be aware that non-heterosexuals may pose specific health-related challenges and requirements.

Sexual and romantic challenges among young Danes diagnosed with cancer: Results from a cross-sectional nationwide questionnaire study

The negative impact of malignant disease on sexual and relational functioning is well documented among adults but scarcely investigated among adolescents and young adults. This study explored the body image, self‐perceived attractiveness, and sexual/romantic experiences of Danes diagnosed with cancer at the age of 15 to 29 years. It also aimed to clarify whether self‐perceived needs for counseling were in fact met by health care providers.

The Research Landscape of School-Based Sexuality Education: Systematic Mapping of the Literature.

Purpose The purpose of this paper is to map and discuss the overall characteristics of international research on school-based sexuality education, published in academic journals, with a particular focus on the framing of non-conservative approaches including sexuality education research targeting young pupils 6-12 years of age. Design/methodology/approach The paper draws upon the methodology of systematic research mapping and presents a broad overview of research on sexuality education in a school setting for pupils aged 6-16. The authors searched the leading bibliographic databases in the field, i.e., ERIC, PsycINFO, PubMed, Scopus, Australian Education Index, British Education Index and Education Research Complete, using the search terms “sexuality education” and “school” and “children” or “adolescents.” The mapping focused on articles published in peer-reviewed journals in English, German, Danish, Swedish or Norwegian, in the period 2000-2016. Findings Out of 3,769 papers identified in the search process, a total of 576 papers were found to meet the inclusion criteria of the mapping. The mapping portrays a research landscape that is diverse and nuanced in terms of contextual, theoretical and methodological approaches, but also characterized by limitations. The findings point to the clear dominance of research on schools in English-speaking countries, conceptual research is scarce, and school-based sexuality education aimed at the youngest children seems to be neglected. The mapping identifies gaps in the literature that justify a call for more research from diverse sociocultural, political and geographical contexts, more conceptual research using social theory, and more research focusing on the potentials and challenges linked to sexuality education for younger pupils. Originality/value This paper offers a rare, if not the first, comprehensive overview of research on school-based sexuality education including a focus on younger school children 6-12 years of age.

Preben Hertoft (1928-2017)

This is an online talk about professor Preben Hertoft between Graugaard and Schmidt. Graugaard. Let’s talk about our old friend, Preben Hertoft, who died in February at the age of 89. After all, it was Preben who brought you and me together, and while he was my sexological mentor, I know that he was also a source of great inspiration toyou.Personally, Ifirst metPreben at the medical school of Copenhagen sometime in the late 1980s. I had begun studying medicine, because I wanted to come as close to the mysteries of human existence as possible. But to my grave disappointment, I soon discovered that there was not much human about all the body partsand cell morphologieswe were expected to learn by heart. In consequence, I was increasingly frustrated and had a nagging feeling of wasting my time. By chance, I signed up for a voluntary course on basic sexology, and far away at the bottom of the huge auditorium I saw this petite and distinguished man sitting smilingly and relaxed on the lectern saying:‘‘Human above all!’’ Thiswas thefirst timeIheardanybodyat themedical faculty say‘‘human’’without referring to organs or cellular processes. Finally! An esteemed teacher who talked so naturally about whole human beings with dreams, feelings, and desires. I fell a little in love with Preben right there, and my feeling for him never faded, although he could be demanding at times. After the lecture, I contacted Preben’s legendary secretary, Ellen Magrethe Geleff, and requested a meeting. I was soon invited to Preben’s office, and he pulled a bottle of sherry out of the bottom drawer of his archive cabinet and started interviewing me about who I was and how I envisioned my future life as a doctor. I was in my early 20s, and a celebrated chief physician from Rigshospitalet (the University Hospital of Copenhagen) was curious about my background and aspirations. What a shock! Atrainee period was soon arranged, and I & Christian Graugaard chgr@rn.dk