bir insanlık ayıbı sünnet

following on from the guidelines already drawn up by the european councils in lisbon (june 1992), corfu (june 1994) and essen (december 1994) and the commission proposals, the european union (eu) decided to establish a new framework for its relations with the countries of the mediterranean basis with a view to forming a partnership. this partnership became a reality at the barcelona conference of 27 and 28 november 1995, which brought together the ministers for foreign affairs of the 15 eu member states and the following 12 mediterranean non-member countries (mncs): algeria, cyprus, egypt, israel, jordan, lebanon, malta, morocco, the palestinian authority, syria, tunisia and turkey. the league of arab states and the arab maghreb union (amu) were also invited, as was mauritania (as a member of the uma).

this conference laid the foundations of a process designed to build a multilateral framework for dialogue and cooperation between the eu and its mediterranean partners. at the meeting, a declaration and a work programme were unanimously adopted by the 27 participating countries. this euro-mediterranean declaration establishes a multilateral framework bringing together economic and security aspects and also comprises a social, human and cultural dimension.

in the preamble, the participants affirm their desire to go beyond the traditional bilateralism that has long characterised euro-mediterranean relations and to give these relations a new dimension, based on comprehensive cooperation and solidarity. this lasting multilateral framework is based on a spirit of partnership, with due regard for the characteristics peculiar to each of the participants. the new multilateral framework is also the counterpart to a strengthening of bilateral relations.

the euro-mediterranean partnership is not intended to replace the other activities and initiatives undertaken in the interests of the peace, stability and development of the region. the participants support the realisation of a just, comprehensive and lasting peace settlement in the middle east based on the relevant united nations security council resolutions and principles mentioned in the letter of invitation to the madrid middle east peace conference, including the land for peace principle.

the new, comprehensive euro-mediterranean partnership focuses on three key aspects:

• the political and security aspect aims to establish a common area of peace and stability;
• the economic and financial aspect hopes to allow the creation of an area of shared prosperity;
• the social, cultural and human aspect aims to develop human resources and promote understanding between cultures and exchanges between civil societies.

political and security partnership

the participants in the barcelona conference decided to establish comprehensive, regular political dialogue to complement the bilateral dialogue provided for in the association agreements. in addition, the declaration sets out a number of common objectives in matters of internal and external stability. the parties undertook to act in accordance with the united nations charter and the universal declaration of human rights as well as other obligations under international law, in particular those arising out of regional and international instruments. respect for human rights and fundamental freedoms (including freedom of expression, freedom of association and freedom of thought, conscience and religion) is reaffirmed on several occasions. the declaration stipulates that it is important to give favourable consideration, through dialogue between the parties, to exchanges of information on matters relating to human rights, fundamental freedoms, racism and xenophobia.

the parties agree to develop the rule of law and democracy in their political systems, while recognising in this framework the right of each of them to choose and freely develop its own political, socio-cultural, economic and judicial system.

the signatories also undertake to respect their sovereign equality and the equal rights of peoples and their right to self-determination. respect for territorial integrity, the principles of non-intervention in the internal affairs of another partner and the peaceful settlement of disputes were highlighted as key elements of the relations between the conference participants.

the parties also agreed to combat terrorism and organised crime and to combat the drugs problem in all its aspects.

moreover, the participants undertook to promote regional security and to work to prevent the proliferation of nuclear, chemical and biological weapons through adherence to and compliance with international and regional non-proliferation regimes and the various arms control and disarmament agreements. the parties will also pursue a middle east zone free of weapons of mass destruction.

economic and financial partnership

the creation of an area of shared prosperity in the mediterranean requires sustainable and balanced socio-economic development and an improvement of the living conditions of the populations, an increase in the employment level and the encouragement of regional cooperation and integration. with a view to achieving these objectives, the eu and its partners agreed to establish an economic and financial partnership based on:

• the progressive establishment of a free trade area;
• the implementation of appropriate economic cooperation and concerted action in the relevant areas;
• a substantial increase in the european union's financial assistance to its partners.

the free trade area (fta) is to be set up by means of the new euro mediterranean agreements and free trade agreements to be concluded between the mncs themselves. the parties have set 2010 as the target date for the gradual establishment of this area which will cover most trade in compliance with the world trade organisation (wto) obligations. tariff and non tariff barriers to trade in manufactured products will be progressively eliminated in accordance with timetables to be negotiated between the partners. trade in agricultural products will be liberalised in stages, as will trade in services.

to facilitate the establishment of the euro-mediterranean fta, the eu and mncs defined four priority areas:

• the adoption of suitable measures as regards rules of origin (progressive introduction of cumulation of origin), certification, protection of intellectual and industrial property rights, and competition;
• the pursuit and the development of policies based on the principles of market economy and the integration of their economies taking into account their respective needs and levels of development;
• the adjustment and modernisation of economic and social structures, giving priority to the promotion and development of the private sector, the upgrading of the productive sector and the establishment of an appropriate institutional and regulatory framework for a market economy. they will likewise endeavour to mitigate the negative social consequences which may result from this adjustment, by promoting programmes for the benefit of the neediest populations;
• the promotion of mechanisms to foster transfers of technology.

the work programme sets out some practical measures designed to promote free trade, such as the harmonisation of customs rules and procedures, the harmonisation of standards and the elimination of unwarranted technical barriers to trade in agricultural products.

the increase in economic cooperation and concerted action between the eu and the mncs relates primarily to a number of important areas:

• investment and internal savings: mncs must progressively eliminate obstacles to direct foreign investment and encourage internal savings in order to support economic development. the creation of an environment conducive to investment could, according to the declaration, lead to the transfer of technology and increase production and exports. the work programme highlights the importance of giving greater thought to the definition of these obstacles to investment and to means, including in the banking sector, of promoting such investment;
• regional cooperation as a key factor in promoting the creation of an fta;
• industrial cooperation and support for small and medium-sized enterprises (smes);
• stepping up environmental cooperation;
• promoting the role of women in development;
• creating joint instruments for the conservation and rational management of fish stocks;
• developing dialogue and cooperation in the energy sector;
• developing cooperation in the area of water resource management;
• modernising and restructuring agriculture

al sabaha kadar oku. copy-paste ise buda copy-paste. hemde kaynaklarıyla

Erkeklerin sünnet olmasının penis kanserini önleme gibi bilinen bazı faydaları dışında, diğer bazı yararları giderek artan sıklıkta belirtilmektedir. Sünnet ve çeşitli patolojik durumlar arasındaki ilişkiler aşağıda açıklanmaktadır.

A- Fimozis (prepisyumun darlığı), parafimozis (prepisyumun glansın altında bir boğum yaparak glansı boğması), balanit (glansın inflamasyonu). postit (prepisyumun
inflamasyonu) gibi hastalıkları sünnet önlemektedir (6). Sünnet olmamış çocuklarda, penisle ilgili bu problemlere, olanlara göre 2.5
misli fazla rastlanmaktadır (9). Bir başka araştırmada da yenidoğan döneminde sünnet edilmiş çocuklar, edilmemiş olanlarla 8 yıl boyunca karşılaştırıl-mış ve sünnetli olanlarda bu problemlerin daha az olduğu tesbit edilmiştir (10).

B- Prepisyumun kesilmesi bölgenin temiz kal- masını sağlamaktadır. ABD’de fakir ailelere bilhassa bu sebeple çocuklarım sünnet ettirmeleri tavsiye edilmektedir (11). Fakat bu
ülkede sünnet zengin, yüksek eğitim yapmış ve beyaz ırktan olanlar ara-sında daha yaygındır (12).

C- Üriner sistem enfeskiyonları ile sünnet arasındaki ilişki son yıllarda üzerinde durulan bir konudur (14). Bu konuda yapılmış bir araştırmada sünnetli çocuklarda üriner enfeksiyonların daha az olduğu gösterilmiştir (15). ABD’de sünnet sıklığının yukarda bahsedilen sebeplerle azalması üriner enfeksiyonları artırmıştır (5). Sünnetsiz çocuklarda üriner enfeksiyonların sık görülmesi, prepisyumun bu enfeksiyonlara yol
açan barsak bakterilerinin üremesi için uygun
bir ortam sağlamasıyla açıklanmıştır (16). Aynı sebep sünnet olmamış yenidoğanlarda daha sık rastlanan menenjit, bakteriemi gibi patolojik durumları da açıklayabilir (17). Hayatın ilk 3 yılı içinde bilhassa ilk yılında olan üriner enfeksiyonlarda böbrekte nedbe dokusu
geli-şebilmesi ve bunun kronik böbrek yetmezliğine ilerleyebilecek olması, konunun önemini artırmaktadır (18).

D- Penis kanseri çoğunlukla sünnet olmamış topluluklarda görülür. Sünnet olma yaşı küçüldükçe penis kanserinin görülme sıklığı azalmaktadır. Bu kanser Yahudiler arasında hiç görülmezken, Paraguay’da en sık görülen genitoüriner kanser olarak bildirilmiştir (19). Türk tıp liiteratüründe şimdiye kadar yayınlanan penis kanserli vakaların sayışı 41′dir. Bunların da 30′unu sünnetsiz gayrimüslimler teşkil etmektedir. Penis kanserinin gelişme-sinde genital bölgenin kötü hijyeninin, herpes simpleks virüs tip II, "insan
paopilloma virüs tip 16 ve 18 ile olan
enfeksiyonların rol oynayabileceği ileri sürülmüştür (20).

E- Kadınlarda serviksin yassı hücreli kanserinin, penis kanseri ile ilgili çekici ortak
özellikleri vardır. Penis kanseri olan erkeklerin eşlerinde ser-viks kanseri sıklığı 3-8 misli fazladır (19). Serviks kanseriyle cinsel temasla geçen hastalıklar arasında kuvvetli bir ilgi vardır. insan papilloma virüs tip 16 ve 18, herpes simpleks virüs tip 11 bu kanserin olu-
şumunda suçlanmaktadır. Yukarda belirtildiği gibi aynı mikroorganizmalar penis kanserinin de so-rumlusu olabilir (6, 19, 20).

F- Sünnet olmamış erkeklerin cinsel temasla geçen hastalıklara daha çok yakalandığı bildirilmiştir. Bir araştırıcı grubu sünnetsiz erkeklerde bu hastalıklardan herpes genitalis ve gonorenin 2, sifilis ve kandidiazisin 5 kat
fazla görüldüğünü rapor etmiştir (21). Sünnetin belirtilen bu faydaları sonucu Amerikan Pediatri Akademisi Sünnet Komitesi
son rapo-runda, daha önce açıkladığı "Yenidoğan dönemin-de sünnet yapmayı gerektiren kesinleşmiş tıbbî bir gerekçe yoktur" ifadesin! "Yenidoğanda sünnet, potansiyel fayda ve avantajları ile riskleri ve dezavantajları olan bir işlemdir" şeklinde değiştirmiştir (6). Sünnetin Yapılmadığı Durumlar: 1- Sünnet vücut ısısını koruyamayan, beslen- meye aktif katılamayan bebeklere veya hasta ço-cuklara yapılmaz. 2- Hipospadias veya bir başka ürogenital ano- malisi olanlara, bu anomaliler için düzeltici
ameliyat yapılmadan önce sünnet yapılmamalıdır. Çünki prepisyum bu anomalilerin düzeltilmesi sırasında kullanılabilir. 3- Kanama hastalığı olabilecek kişilere (aşırı kanaması veya ailesinde kanama hastalığı olan gibi) gerekli tetkikler yapılıp kesin teşhis konulmadan sünnet yapılmamalıdır (l, 6).

Kaynaklar: 6- American Academy af Pediatrics Task Force
on Cir-cumcision. Report of the task force on
circumcision Pediatrics 1989; 84: 388-391
7- Wiswell TE, Geschke DW. Risks from
circumcision du-ring the first month of life
compared with those for uncircumci-sed boy. Pediatrics 1989; 83: 1011-1015
8- Kirya C, Werthmann MW. Neonatal
circumcision and penile dorsal nerve block-a
painless procedure. J Pediatr
1978-92:998-1000.
9- Herzog LW, Alvarez SR. The frequency of foreckin problems in uncircumsised children.
Am J Diş Child 1986; 140: 254-256
10- Fergusson DM, Lawton JM, Shannon FT.
Neonatal circumcision and penile problems:
An 8- year longitudinal study. Pediatrics 1988;
81:537-541.
11- Preston EN. Circumcision and genital hygiene. Am J Diş Child 1986; 140:969. 12- Slaby AR, Drizd T. Circumcision in the
United States. Am J Public Healt 1985;
75:878-880.
13- Ginsburg CM, McCracken GH Jr. Urinary
tract infec-tions in youg infants Pediatrics
1982; 69:409-412. 14- Wiswell TE, Smith FR, Si -s JW.
Decreased incidence of urinary tract infections
in circumcised malc infants. Pediatrics 1985;
75: 901-903.
15- Herzog LW. Urinary tract infections and
circumcision, a case-control study. Am J Diş Child 1989; 143: 348-350.
16- Wiswell TE, Miller GM, Gelston HM, et al.
Effcct of circumcision status on periurethral
bacterial flora during the first year of life. J
Pediatr 1988; 113: 442-446.
17-Amir J, Varsana I, Mimouni M. Circumcision and urinary tract infection in
infants. Am J Diş Child 1986; 140:1092.
18- Robcrts JA. Does circumcision prcvent
urinary traci infection. J Urol 1986; 135:
991-992.
19- Schelihamı-ner PF, Grabstald H. Tumors o the penis. in: Walsh PC, Gittes RF, Perimutter
AD, Stamey TA, cds. Cambell’s Urology. Philadeiphia: WB Saunders, 1986: 1583-1606.
20- Sufrin G. Huben R. Benign and malignant
lesisons of the penis, in; GiIIenwater JY,
Grayhack JT, Howards SS, Du-kett JW, eds.
Auit and Pediatric Urology. Chicago: Year
Book Medical Publishers 1987: 1448-1483.

ps: bu da mı gol değil?