cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.1283852
title: NATIONAL SUMMARY DATA

description: This file contains summaries of data around circumcision practice and complications in England and Scotland. The A&E datasets are without denominator but there are also datasets from hospitals which have provided full admission details from their own circumcisions (including therapeutic coded and Z412 Ritual/Routine coded) in some cases for up to 90 days. Readmission diagnosis has allowed the weeding out of non relevant readmissions. All this data is important - it reveals that NHS Choices is not telling the truth in saying that complications of male circumcision are 'rare'. My data suggests that even within 30 days you can expect a relevant readmissions rate in children of &gt;4% following circumcision - it can run much higher.The data is from freedom of info requests, mostly generated through queries of hospital/funder databases - it's good quality and it's useful to note it matches findings from more mainstream/commercial sources such as Dr Foster, as well as many published series. The widely varying incidence of therapeutic circumcision indicates there is a real problem with bad practice in this area - admitted verbally by paediatric urologists and in print by urology associations. The complication rates simply underline how important it is that this gets addressed: unnecessary surgery has a financial toll on the NHS as well as a presumed personal toll on the child and their family. A concern of mine is why does the NHS lie about the complication rates on NHS Choices? I was first concerned about this some years ago when making a complaint about their assertion (via Leeds urologist Benjamiin Squires) that child circumcision does not require anaesthetic. This concern was taken seriously and the claim removed - but the question remains in my mind (and I hope will in yours) about whether there is bias being allowed to creep into NHS Choices editorial? PS my use of the phrase 't or not t coding' on the 2011 dataset on child circumcisions could be misleading. 'T' diagnostic coding would normally refer to a complication of a procedure - here I mean it to stand for 'therapeutic'. Normally the diagnostic coding for a non therapeutic procedure begins with 'Z' and so I should probably have used that terminology. The point remains that there is a significant issue either a/ with non therapeutic genital cutting being hidden (and thus possibly being made fundable) by a false therapeutic diagnosis or b/ wilful ignorance of issues around the normal development of the male body in childhood.
DOI: 10.6084/m9.figshare.1283855
title: WEST MIDLANDS CIRCUMCISION REPORTS & SUMMARIES

description: This folder contains files on circumcisions performed and complications treated following circumcision in the West Midlands area of England. It includes verified data from Birmingham Children's Hospital on 104 boys seen in their A&E with confirmed circumcision complications, and also detailed and useful data on the HUGE incidence of NHS funded infant NTC in the West Midlands: one commissioner alone (Heart of Birmingham PCC as was) funded 8,212 baby circumcisions between April 2005 and March 2012 at a total cost of £757,125 - with data suggesting the cost of treating complications in this period would take the total cost of forced religious circumcions in Heart of Birmingham area to around £1 million over 7 years. Most other PCCs in the West Mids area funded some NTCs with particularly large numbers in South Birmingham, Walsall and Sandwell. For the national picture on which PCCs funded religious child circumcision in 2009 (and its cost) see the file Primary Care Trusts NTC stats 2009.
DOI: 10.6084/m9.figshare.1283870.v1
title: Heart of Birmingham hospital admissions within 30d of NHS NTC in F/Y 2011/12

description: A file provided by Heart of Birmingham PCT (as was) under freedom of information legislation. It was prepared for the author of this research and the information does not seem to have been collated or reviewed otherwise (although Birmingham Children's Hospital had raised the alarm some 2 y previously regarding significant complications seen in A&E, mainly infants). This file shows the early (up to 30 day) readmissions from religious infant circumcisions in financial year 2011-12 (N=1,359). It was generated by asking them to perform a query using the unique patient ID as a pivot. The data includes days between op and admission, primary and secondary diagnosis, primary and secondary procedure codes (where relevant), length of stay and the cost of the spell. It's difficult to analyse in pdf but HOB PCT refused the excel version so I have partially retyped into excel to make analysis possible. See in the West Midlands folder. We can say that 8 cases are almost definately circ complications (the're coded as urinary issue or 'complications of a procedure') but there are many more that may have been. It's useful to remember in analysing this data that Birmingham Children's Hospital verified data shows infant circumcision complications may present initially as something else - some verified cases presented with, for example, respiratory or gastric issues. The same things has been observed in data from Leeds. Researchers need therefore to be wary of assuming that analysis of presenting issue gives a full picture of NTC adverse effects. It doesn't.
DOI: 10.6084/m9.figshare.1283853
title: Circumcision complications 2009 in A&E at Birmingham Children

description: This is a list provided by Birmingham Children's Hospital in response to a request for a list of the child complications seen in A&E in 2009 from male circumcision. This was the only hospital to provide a comprehensive verified dataset - it seems they had conducted this audit prior to my asking. When I asked why, they advised that due to the "volume of attendances at ED, the department wanted to investigate to ensure that appropriate aftercare was being provided to patients." Pressed to advise what this meant - were the concerns regarding NHS NTC - they eventually admitted in 2013 that "an internal report which was sent to the commissioners and still to date we have had no communication from them." So it would appear that BCH were concerned about the quality of local religious cutting schemes, but up to 2 years after raising this concern, the local commissioners with responsibility for those schemes had still failed to respond. It's perhaps important to note that correspondence with Heart of Birmingham PCT and South Birmingham PCT - which collectively operated the biggest scheme, cutting &gt;1,500 babies in one year via a local GP, appear not to have enforced the terms of the contract which required the circumcision contractor to provide monthly details of adverse events treated in primary care or referred to A&E. Both commissioners advised me they didn't have information readily available on complications - one then asked the contractor if any complications had been seen (in a series of &gt;250 infant NTCs) to which he replied 'zero'. If you have read any of the information I've uploaded from hospital/commissioner datasets or even the range of reports into acute complications of neonatal circumcision you'll know this is a non credible response. I hope you'll also be asking the question, can someone with a cultural and financial vested interest in male circumcision be trusted to monitor his own complications?? I investigate this issue further on my commentary site via an analysis of what Milah UK say publicly about ritual circumcisions and what UK doctor mohels actually recorded at audit. See http://emperorsnewcock.blogspot.co.uk/2014/12/complications.html
DOI: 10.6084/m9.figshare.1283854
title: LONDON CIRCUMCISION REPORTS AND SUMMARIES

description: Folder contains files received from London NHS funders and hospital trusts with data on circumcisions performed and complications treated. Includes data from the large and long running circumcision scheme in Tower Hamlets, contracted to a GP in the area, showing the rate of early complications and later recircumcisions (no data on other surgical follow ups such as for meatal stenosis). 16/290 babies cut in 2009 in this scheme had experienced a complication within 7 days of which 10 visited the GP and 6 went to A&E. Excluding the 2 who went to the GP and did not get treatment this would be a 4.8% complication rate in one week, trouncing the American assertion that infant circumcision complications affect only 2 per thousand and also the NHS Choice claim that circumcision complications are 'rare' (which would also mean &lt;1%). Tower Hamlets advise that 2005-2009 1492 baby boys were cut religiously by the NHS but apparently none got meatal stenosis treatment as a result. With Iranian research showing 20% of boys will suffer undiagnosed severe meatal stenosis post infant cutting (see link) this indicates a poor attitude to the safety of religious circumcision on the NHS. Or maybe it was just an untruth - Tower Hamlets also said no one got meatal stenosis treatment in the borough in 2009 ...which is vanishingly unlikely. They did admit that of the 1492 cut babies (2005-2009) 11 suffered a second circumcision, a rate of just over 0.7%.
DOI: 10.6084/m9.figshare.1283849
title: child circumcisions in 2011 at 91 English hospital trusts

description: This table is a collation of returns I received from hospital trusts showing their number of child circumcisions in 2011 with age and whether therapeutically coded or not. I think it is a useful snapshot of practice across England - it shows how circumcisions were performed in age groups 0-4, 5-9 and 10-17 and how many were explicitly coded as non medically necessary. Note regarding non therapeutic circumcision (NTC) that this is frequently performed in the NHS as an outpatient operation so the figures for NTC ops in this table are only a partial picture (there are some 130 or so Hospital trusts so they don't even represent all the inpatient operations). Not all trusts replied to my questions and not all gave responses in the same format, hence the partial picture. Aside the issue of non therapeutic circumcisions on unconsenting subjects the data also suggests a potentially significant issue of the false coding of unnecessary circumcisions as necessary. Note for example that Su Anna Boddy of BAPS (a member of working group which formulated the 2007 policy on foreskin conditions) has stated publicly that therapeutic circumcision is 'virtually never' necessary in a child under five. BAPS also state that non-retractability (developmental phimosis) can be normal even in the late teens. Danish and Japanese researchers have both shown in fact that full natural retraction tends to happen sometime after the tenth birthday. So with that knowledge, and also the huge variation in numbers we can assume that many of the therapeutic operations shown here were not therapeutic, particularly as most were coded with the ICD 10 diagnosis code N47X (Redundant prepuce, phimosis and paraphimosis). Detailed returns from individual hospitals are available on request (covering mainly 2009 and 2011 - some a longer period). I won't upload everything as it's just too much.
DOI: 10.6084/m9.figshare.1283853.v1
title: Circumcision complications 2009 in A&E at Birmingham Children

description: This is a list provided by Birmingham Children's Hospital in response to a request for a list of the child complications seen in A&E in 2009 from male circumcision. This was the only hospital to provide a comprehensive verified dataset - it seems they had conducted this audit prior to my asking. When I asked why, they advised that due to the "volume of attendances at ED, the department wanted to investigate to ensure that appropriate aftercare was being provided to patients." Pressed to advise what this meant - were the concerns regarding NHS NTC - they eventually admitted in 2013 that "an internal report which was sent to the commissioners and still to date we have had no communication from them." So it would appear that BCH were concerned about the quality of local religious cutting schemes, but up to 2 years after raising this concern, the local commissioners with responsibility for those schemes had still failed to respond. It's perhaps important to note that correspondence with Heart of Birmingham PCT and South Birmingham PCT - which collectively operated the biggest scheme, cutting &gt;1,500 babies in one year via a local GP, appear not to have enforced the terms of the contract which required the circumcision contractor to provide monthly details of adverse events treated in primary care or referred to A&E. Both commissioners advised me they didn't have information readily available on complications - one then asked the contractor if any complications had been seen (in a series of &gt;250 infant NTCs) to which he replied 'zero'. If you have read any of the information I've uploaded from hospital/commissioner datasets or even the range of reports into acute complications of neonatal circumcision you'll know this is a non credible response. I hope you'll also be asking the question, can someone with a cultural and financial vested interest in male circumcision be trusted to monitor his own complications?? I investigate this issue further on my commentary site via an analysis of what Milah UK say publicly about ritual circumcisions and what UK doctor mohels actually recorded at audit. See http://emperorsnewcock.blogspot.co.uk/2014/12/complications.html
DOI: 10.6084/m9.figshare.1283852.v1
title: NATIONAL SUMMARY DATA

description: This file contains summaries of data around circumcision practice and complications in England and Scotland.
DOI: 10.6084/m9.figshare.1283855.v1
title: West Midlands circumcisions and complications

description: This folder contains files on circumcisions performed and complications treated following circumcision in the West Midlands area of England. It includes verified data from Birmingham Children's Hospital on 104 boys seen in their A&E with confirmed circumcision complications, and also detailed and useful data on the HUGE incidence of NHS funded infant NTC in the West Midlands: one commissioner alone (Heart of Birmingham PCC as was) funded 8,212 baby circumcisions between April 2005 and March 2012 at a total cost of £757,125 - with data suggesting the cost of treating complications in this period would take the total cost of forced religious circumcions in Heart of Birmingham area to around £1 million over 7 years. Most other PCCs in the West Mids area funded some NTCs with particularly large numbers in South Birmingham, Walsall and Sandwell. For the national picture on which PCCs funded religious child circumcision in 2009 (and its cost) see the file Primary Care Trusts NTC stats 2009.
DOI: 10.6084/m9.figshare.1283855.v3
title: WEST MIDLANDS CIRCUMCISION REPORTS & SUMMARIES

description: This folder contains files on circumcisions performed and complications treated following circumcision in the West Midlands area of England. It includes verified data from Birmingham Children's Hospital on 104 boys seen in their A&E with confirmed circumcision complications, and also detailed and useful data on the HUGE incidence of NHS funded infant NTC in the West Midlands: one commissioner alone (Heart of Birmingham PCC as was) funded 8,212 baby circumcisions between April 2005 and March 2012 at a total cost of £757,125 - with data suggesting the cost of treating complications in this period would take the total cost of forced religious circumcions in Heart of Birmingham area to around £1 million over 7 years. Most other PCCs in the West Mids area funded some NTCs with particularly large numbers in South Birmingham, Walsall and Sandwell. For the national picture on which PCCs funded religious child circumcision in 2009 (and its cost) see the file Primary Care Trusts NTC stats 2009.
DOI: 10.6084/m9.figshare.1283854.v1
title: London circumcision and complication reports

description: Folder contains files received from London NHS funders and hospital trusts with data on circumcisions performed and complications treated. Includes data from the large and long running circumcision scheme in Tower Hamlets, contracted to a GP in the area, showing the rate of early complications and later recircumcisions (no data on other surgical follow ups such as for meatal stenosis)..
DOI: 10.6084/m9.figshare.1283849.v2
title: child circumcisions in 2011 at 91 English hospital trusts

description: This table is a collation of returns I received from hospital trusts showing their number of child circumcisions in 2011 with age and whether therapeutically coded or not. I think it is a useful snapshot of practice across England - it shows how circumcisions were performed in age groups 0-4, 5-9 and 10-17 and how many were explicitly coded as non medically necessary. Note regarding non therapeutic circumcision (NTC) that this is frequently performed in the NHS as an outpatient operation so the figures for NTC ops in this table are only a partial picture (there are some 130 or so Hospital trusts so they don't even represent all the inpatient operations). Not all trusts replied to my questions and not all gave responses in the same format, hence the partial picture. Aside the issue of non therapeutic circumcisions on unconsenting subjects the data also suggests a potentially significant issue of the false coding of unnecessary circumcisions as necessary. Note for example that Su Anna Boddy of BAPS (a member of working group which formulated the 2007 policy on foreskin conditions) has stated publicly that therapeutic circumcision is 'virtually never' necessary in a child under five. BAPS also state that non-retractability (developmental phimosis) can be normal even in the late teens. Danish and Japanese researchers have both shown in fact that full natural retraction tends to happen sometime after the tenth birthday. So with that knowledge, and also the huge variation in numbers we can assume that many of the therapeutic operations shown here were not therapeutic, particularly as most were coded with the ICD 10 diagnosis code N47X (Redundant prepuce, phimosis and paraphimosis). Detailed returns from individual hospitals are available on request (covering mainly 2009 and 2011 - some a longer period). I won't upload everything as it's just too much.
DOI: 10.6084/m9.figshare.1283852.v2
title: NATIONAL SUMMARY DATA

description: This file contains summaries of data around circumcision practice and complications in England and Scotland.
DOI: 10.6084/m9.figshare.1283855.v2
title: West Midlands circumcisions and complications

description: This folder contains files on circumcisions performed and complications treated following circumcision in the West Midlands area of England. It includes verified data from Birmingham Children's Hospital on 104 boys seen in their A&E with confirmed circumcision complications, and also detailed and useful data on the HUGE incidence of NHS funded infant NTC in the West Midlands: one commissioner alone (Heart of Birmingham PCC as was) funded 8,212 baby circumcisions between April 2005 and March 2012 at a total cost of £757,125 - with data suggesting the cost of treating complications in this period would take the total cost of forced religious circumcions in Heart of Birmingham area to around £1 million over 7 years. Most other PCCs in the West Mids area funded some NTCs with particularly large numbers in South Birmingham, Walsall and Sandwell. For the national picture on which PCCs funded religious child circumcision in 2009 (and its cost) see the file Primary Care Trusts NTC stats 2009.
DOI: 10.6084/m9.figshare.1282594
title: Effects of fine particles on children’s hospital admissions for respiratory health in Seville, Spain

description: This study analyzes the influence of fine particles PM<sub>2.5</sub> on nonprogrammed children’s hospital admissions that occurred in the city of Seville between 2007 and 2011, and makes an economic assessment of the cost of the children’s hospital admissions for respiratory causes due to particle pollution. The PM<sub>2.5</sub> dose-response functions for each type of hospital admission were used to quantify the cost of the hospital admissions. It can be concluded that the PM<sub>2.5</sub> concentrations have negative effects on bronchiolitis, pneumonia, asthma, and bronchitis and other causes. A reduction of the daily average annual PM<sub>2.5</sub> concentration from the existing levels to 10 µg/m<sup>3</sup> would show an annual average reduction of children’s hospital admissions due to respiratory diseases of 0.09 cases. This paper shows that the daily average cost for children hospital admissions due to respiratory reasons in the city of Seville, associated with daily average annual levels of PM<sub>2.5</sub> above 10 µg/m<sup>3</sup>, was almost 200€.Implications: <i>Elevated PM<sub>2.5</sub> concentrations in Seville have negative effects on children’s bronchiolitis, pneumonia, asthma, and bronchitis and other causes. A reduction of the daily average annual PM<sub>2.5</sub> concentration from the existing levels to 10 μg/m<sup>3</sup> would suppose an annual mean reduction of children’s hospital admissions due to respiratory diseases of 0.09 cases.</i>
DOI: 10.6084/m9.figshare.1283849.v1
title: child circumcisions in 2011 at 91 English hosptital trusts

description: This table is a collation of returns I received from hospital trusts showing their number of child circumcisions in 2011 with age and whether therapeutically coded or not. I think it is a useful snapshot of practice across England - it shows how circumcisions were performed in age groups 0-4, 5-9 and 10-17 and how many were explicitly coded as non medically necessary. Aside the issue of non therapeutic circumcisions on unconsenting subjects it also suggests a potentially huge issue of the false coding of unnecessary circumcisions as necessary. Note for example that Su Anna Boddy of BAPS (a member of working group which formulated the 2007 policy on foreskin conditions) has stated publicly that therapeutic circumcision is 'virtually never' necessary in a child under five. BAPS also state that non-retractability (developmental phimosis) can be normal even in the late teens. Danish and Japanese researchers have both shown in fact that full natural retraction tends to happen sometime after the tenth birthday. So with that knowledge, and also the huge variation in numbers we can assume that many of the therapeutic operations shown here were not therapeutic, particularly as most were coded with the ICD 10 diagnosis code N47X (Redundant prepuce, phimosis and paraphimosis). Perhaps it's actually the use of this coding in childhood that is redundant...not the foreskin.
DOI: 10.6084/m9.figshare.1283854.v2
title: LONDON CIRCUMCISION REPORTS AND SUMMARIES

description: Folder will contain files received from London NHS funders and hospital trusts with data on circumcisions performed and complications treated. Includes data from the large and long running circumcision scheme in Tower Hamlets, contracted to a GP in the area, showing the rate of early complications and later recircumcisions (no data on other surgical follow ups such as for meatal stenosis)..
DOI: 10.6084/m9.figshare.1283852.v3
title: NATIONAL SUMMARY DATA

description: This file contains summaries of data around circumcision practice and complications in England and Scotland.
DOI: 10.6084/m9.figshare.1283854.v3
title: LONDON CIRCUMCISION REPORTS AND SUMMARIES

description: Folder contains files received from London NHS funders and hospital trusts with data on circumcisions performed and complications treated. Includes data from the large and long running circumcision scheme in Tower Hamlets, contracted to a GP in the area, showing the rate of early complications and later recircumcisions (no data on other surgical follow ups such as for meatal stenosis)..