David A. Grimes, MD. Herbert B. Peterson ... George P. Taylor, MD, MPH. Kevin F. Smith, MD ... Brender JD, Weiss NS, Koepsell TD, Marcuse. EK: Fiber intake ...
0
__
U
Letters are welcomed and will be published, iffound suitable, as space permits. The editors reserve the right to edit and abridge letters, to publish replies, and to solicit responses from authors and others. Letters should be submitted in duplicate, double-spaced (including references), and generally should not exceed 400 words.
On Risks, Costs of Sterilization We are writing to update information in the excellent overview of surgical sterilization, Comparative Risks and Costs of Male and Female Sterilization.' In this article, Dr. Smith and his co-authors report that Potts, et al,2 "in reviewing relative risks of sterilization in lesser developed countries quote a rate [of death from vasectomy] of 0.1/100,000 procedures in India, with most of the deaths attributable to tetanus or sepsis. This is the only value that exceeds zero in the available literature. " ' In 1982, we reported a mortality rate of 31.1 deaths per 100,000 vasectomies (95% confidence interval 12.5-64.0) in a population-based study in Bangladesh.3 Paradoxically, the risk of death from vasectomy in this study was 1.6 times higher than that from tubal sterilization. Each of the seven vasectomy deaths reported in our study was due to scrotal infection, which appeared to be related to poor aseptic technique. Corrective measures were taken, and a follow-up study4 identified no further deaths from vasectomy. REFERENCES 1. Smith GL, Taylor GP, Smith KF: Comparative risks and costs of male and female sterilization. Am J Public Health 1985; 75:370-374. 2. Potts M, Speidel JJ, Kessel E: Relative risks of various means of fertility control when used in lesser developed countries. In: Sciarra JJ, Zatuchni GI, Speidel JJ (eds): Risks, Benefits, and Controversies in Fertility Control.
1230
Letters to the Editor Hagerstown, MD: Harper and Row, 1977. 3. Grimes DA, Peterson HB, Rosenberg MJ, et al: Sterilization-attributable deaths in Bangladesh. Int J Gynaecol Obstet 1982; 20:149-154. 4. Grimes DA, Satterthwaite AP, Rochat RW, et al: Deaths from contraceptive sterilization in Bangladesh: rates, causes, and prevention. Obstet Gynecol 1982; 60:635-640. David A. Grimes, MD Herbert B. Peterson, MD DHHS, Public Health Service, Centers for Disease Control, Atlanta, GA 30333
Response from Smith, et al. None of the mortality rates from the lesser developed nations were used in estimating the risks of surgical sterilization in the US. Although we were aware of this population-based study with seven deaths secondary to complications of vasectomy in Bangladesh, we felt that the data were not typical and elected to use a similar populationbased study from India. The fact that simple corrective measures effectively eliminated deaths from scrotal infection in Bangladesh may validate this reasoning. Gregory L. Smith, MD, MPH Captain, Medical Corps, Division of Preventive Medicine George P. Taylor, MD, MPH Kevin F. Smith, MD Department of the Army, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Washington, DC 20012
On Childhood Fiber Intake The Journal has recently advised' us of the desirability of keeping our 7 to 18 year old children in the upper 50th percentile with respect to bran intake. Since only 1 per cent of the children can get into any percentile, there is likely to be strong competition for the 50th one. But it will be even harder to make the
upper 50th one. Could you advise the readers just where the upper 50th percentile is in the distribution. Evidently it is safer than the lower 50th percentile, but how does it compare with the 49th and 51st percentiles? Are there also an upper and lower 49th and 51st? If there are 200 percentiles altogether, the competition will be even stronger to make the upper 50th. Your guidance will be greatly appreciated. REFERENCE 1. Brender JD, Weiss NS, Koepsell TD, Marcuse EK: Fiber intake and childhood appendicitis. Am J Public Health 1985; 75:399-400. George B. Hutchison, MD Professor, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 © 1985 American Journal of Public Health
Response from Weiss and Brender Most of us with children of our own realize that they, little conformists that they are, will be striving to be in the 50th percentile for virtually every characteristic. Perhaps our most realistic goal for a dietary recommendation is to ask only that, within that percentile, they advance to the upper portion. Any stronger suggestion may run the risk of inciting rebellion against parental authority. Being capable of facing only so many such rebellions, we'd rather choose a non-dietary issue over which to draw the line. Noel S. Weiss, MD, DrPH Jean D. Brender, PhD Department of Epidemiology, University of Washington, School of Public Health and Community Medicine, Seattle, WA 98195 © 1985 American Journal of Public Health
