Sociodemographic predictors of postvasectomy noncompliance

BackgroundPostvasectomy semen analysis (PVSA) is critical to establish the success of the vasectomy but the rate of compliance with PVSA is notoriously low. We determined various sociodemographic predictors of high noncompliance rate.Study designRetrospective chart review of 214 patients who have undergone vasectomy by one surgeon was performed. All men had similar preoperative consultation with written instruction to provide two PVSA 2 and 4 months after vasectomy. Noncompliance was defined as a failure to provide PVSA. Sociodemographic data including age, marital status, number of children, level of education and smoking history were analyzed.ResultsOf 214 patients, 99 (46.2%) provided no PVSA. Rate of noncompliance was independently higher in men with four or more children, smokers and those with lower educational level. Marital status and age had no impact on postoperative complianceConclusionObjective sociodemographic variables were associated with a higher risk of PVSA noncompliance. A more thorough approach to vasectomy counseling and timely reminder of upcoming PVSA in a preoperatively defined group of patients will help to improve compliance and prevent possible medical and legal repercussions.     

Vasectomy effectiveness in Nepal: a retrospective study

The main purpose of this retrospective, cross-sectional study was to evaluate the effectiveness of vasectomy in an ongoing public sector program in Nepal. We evaluated semen samples from men who had previously had a vasectomy, and asked about the occurrence of pregnancies in the men's partners. In addition, the surgeons who performed the vasectomies completed a questionnaire about their techniques. A two-stage stratified sampling procedure was used to select 1263 men from among over 30,000 men, who had previously undergone a no-scalpel vasectomy, mostly by ligation and excision, in 32 districts between July 1996 and June 1999. Semen samples were preserved and analyzed at a central laboratory. A US andrology laboratory validated the lab results. Twenty-three men (2.3%, 95% confidence interval [CI] 1.1-3.6) had >/=500,000 sperm/mL in their semen. Fifteen of those men reported pregnancies conceived after their vasectomy. In addition, six men with azoospermia reported pregnancies for which conception occurred within 3 months after vasectomy. Eleven men with azoospermia reported pregnancies for which conception occurred more than 3 months after vasectomy. Reported pregnancy was more likely in younger partners. The life table pregnancy rates for all men interviewed were 0.7 (95% CI 0.2-1.1), 1.7 (95% CI 1.4-2.1) and 4.2% (95% CI 3.2-5.2) at 3, 12 and 36 months, respectively. In low-resource, programmatic settings, vasectomy failure rates may be higher than commonly cited rates, especially in younger populations. Additional research is needed to determine if other occlusion techniques could reduce failure rates. Counseling on vasectomy should always convey the possibility of failure and partner pregnancy.     

Communicating information to patients. Patient satisfaction and adherence as associated with resident skill

A study investigated the degree to which residents' communication of specific information about medications and follow-up appointments had an impact on patient recall, satisfaction, and adherence. Twenty-nine interactions between patients and residents were taped and analyzed by two trained observers. Patients were interviewed immediately after their interactions with residents to assess their ability to recall instructions and to assess their levels of satisfaction with the visit. Patients' overall global satisfaction with their interactions was highly correlated with their ratings of resident information giving (Pearson r = .90, P less than .001). Patients who expressed higher levels of satisfaction also had higher recall rates (Pearson r = .39, P less than .01), although overall patient recall rate was only slightly above 50 percent. Observers' analysis of residents giving information reveals a mean performance rating of 40 percent. Only 31 percent of patients returned for their follow-up appointments. The study suggests that information itself may not be so important in determining patient satisfaction as are patients' perceptions that physicians attempt to give them information. Such information may, however, have greater impact on patient adherence with physician recommendations.     

Sociodemographic predictors of postvasectomy noncompliance

Background

Postvasectomy semen analysis (PVSA) is critical to establish the success of the vasectomy but the rate of compliance with PVSA is notoriously low. We determined various sociodemographic predictors of high noncompliance rate.

Study design

Retrospective chart review of 214 patients who have undergone vasectomy by one surgeon was performed. All men had similar preoperative consultation with written instruction to provide two PVSA 2 and 4 months after vasectomy. Noncompliance was defined as a failure to provide PVSA. Sociodemographic data including age, marital status, number of children, level of education and smoking history were analyzed.

Results

Of 214 patients, 99 (46.2%) provided no PVSA. Rate of noncompliance was independently higher in men with four or more children, smokers and those with lower educational level. Marital status and age had no impact on postoperative compliance

Conclusion

Objective sociodemographic variables were associated with a higher risk of PVSA noncompliance. A more thorough approach to vasectomy counseling and timely reminder of upcoming PVSA in a preoperatively defined group of patients will help to improve compliance and prevent possible medical and legal repercussions.     

Employment changes among patients following coronary bypass surgery: social,medical, and psychological correlates.

The relations of socioeconomic and psychological factors to resumption of employment following coronary artery bypass surgery were studied using a questionnaire returned by a sample of 426 men and 70 women. The sample was drawn from the membership of Mended Hearts, Inc., a nationwide voluntary organization of persons who have had heart surgery. Preoperatively, more men (92 percent) than women (59 percent) were employed. Return to work rates were high for men (81 percent) and much lower for women (58 percent). The 395 men tended to return to work an average of 3.7 months after surgery whereas the 41 women took an average of 4.8 months. Return to work following surgery was most clearly related to socioeconomic level for both sexes. In addition, for men, those most likely to return had less postoperative morbidity and held jobs requiring little physical exertion. Patients who reported that they were forced into an early retirement represent a particularly vulnerable group in that they were more likely to experience the most postoperative morbidity. As a group, they believed that their physicians had least prepared them to return to work, and they experienced the poorest emotional adjustment. Thus, women and those forced into early retirement represent two potentially high-risk groups of patients who would seem to require additional clinical and psychological management following surgery.     

Revised guideline 'Vasectomy' from the Dutch Urological Association

Vasectomy is a simple and reliable method of contraception. Problems associated with vasectomy include inadequate patient information, complications of the procedure e.g. infection and scrotal bleeding (4-22%), chronic scrotal pain after the procedure (2-5%) and spontaneous recanalisation with return of fertility (0.03-I12%). Later in life a substantial number of men come to regret having a vasectomy, notably those who underwent it at a young age and those without children of their own. After 10 years 2.4% of vasectomised Dutch men have a refertilisation procedure (usually a vasovasostomy) because of the wish for children in a new relationship. Since vasectomy is an elective procedure and not done on medical indication, it requires an extensive informed-consent procedure for the patient. Insufficient information may result in inadequate follow-up, omission of semen analysis, and consequent legal procedures should complications or pregnancy ensue. Clearance after the first semen analysis at 3 months can be given if azoospermia is seen or if less than 100,000 non-motile spermatozoa are present in the ejaculate.     

Vasectomy in India

Experience with vasectomy at the Kohinoor Mills Family Planning Centre in Bombay since 1963 is reviewed. 923 vasectomies were performed. The average age of the patients was 40-42. The average number of children per patient was in excess of 4. All the men were textile workers whose average monthly income was about 200 rupees. Most of the patients were well-motivated toward family planning. In some cases, motivation to vasectomy was made easier because of the good results of 1 of the doctors with resnastomosis. Although there were a few immediate complications, with the passage of time it was demonstrated that the operation had no adverse effect on the health or sexual habits of the patients. The patient was sent home soon after the operation and was told to rest for 2 days. The skin sutures were removed on the third day, and the patient resumed work on the fourth. He was told to have 4 or 5 ejaculations of semen (using adequate contraception) before returning for a semen examination 8 weeks after the operation. Another semen examination was carried out 6 months after the operation.     

Does vasectomy cause prostate cancer?

Vasectomy is the process in which a man's vas deferens are severed, with the cut ends folded back and tied off to prevent the release of sperm from his testicles to the urethra and out of the penis. The procedure may be conducted in a doctor's office under local anesthesia, is almost 100% effective in preventing pregnancy, and leaves sexual function fully intact. Since sperm comprise less than 5% of semen, even the amount of ejaculated fluid does not change noticeably. 20% of American men over age 35 years have had a vasectomy. Despite vasectomy's simplicity and effectiveness, debate exists over whether vasectomy may increase the risk of prostate cancer, the most common malignancy in men. Two large, well-designed Harvard studies were published in 1993 in the Journal of the American Medical Association which suggest that such a relationship may exist. The two studies compared the number of prostate-cancer diagnoses in almost 25,000 men who had undergone vasectomy with nearly 50,000 men who had not. Men who had undergone vasectomy more than 20 years earlier were almost twice as likely as their unsterilized counterparts to have been diagnosed with prostate cancer. Overall, the rate of such diagnoses was about 60% higher among the men who had been sterilized. These widely-reported studies rekindled earlier fears of a possible prostate-cancer risk and no doubt convinced some men to avoid the operation or to have it reversed if they had already gone through with it. Four earlier studies also suggested a link between prostate cancer and vasectomy. Seven other reports, however, have found no connection. Several studies even indicate that men who undergo vasectomy live longer than other men. Many researchers believe that the Harvard studies' findings are simply the result of earlier and better diagnosis of prostate cancer among sterilized men rather than due to an actual increased risk of the cancer.     

Characteristics of candidates for surgical sterilization and factors associated with type of procedure

In 1999 the Municipal Health Department in Ribeir?o Preto, S?o Paulo, Brazil, implemented the provision of surgical contraceptive methods according to prevailing legal requirements. This study aimed to characterize the candidates for surgical sterilization and study the variables associated with the type of procedure. A total of 95 candidate patient records were studied, and statistical logistic regression analysis and Fisher's exact test were performed considering a significance level of ? = 0.05. Most candidates had stable partners, low schooling, and low income, were satisfied with their number of children, and had already tried to limit the number of children using reversible contraceptives. Mean age was 34.2 years, 45.3% underwent female sterilization, 35.8% underwent vasectomy, and 18.9% did not submit to any procedure. The odds of a man older than 35 having a vasectomy were 6.1 times that of a younger man (OR = 6.1; 95%CI: 2.4-16.4). More married men submitted to vasectomy than men who cohabited (OR = 4.0; 95%CI: 1.5-12.4). Women with four or more children were more likely to undergo sterilization than those with fewer children (OR = 3.1; 95%CI: 1.1-8.5).     

The relationship between vasectomy and angiographically determined atherosclerosis in men

Long-term prospective studies in monkeys have shown that vasectomy is associated with an increase in atherosclerotic disease. The purpose of the present investigation is to evaluate whether vasectomy in men is associated with atherosclerotic disease in the coronary arteries. In this study information was obtained on the vasectomy status in a series of 7,420 men who had previously been referred for coronary angiography because of cardiovascular symptomatology and have been followed for as long as 9 years to evaluate coronary artery bypass surgery and the natural history of the disease. It was found that 5.0% had a vasectomy prior to angiography. Two different data analysis procedures were used to determine whether the vasectomized men had a greater degree of angiographically determined coronary occlusive disease than the nonvasectomized men. Subgroups with minimal and extensive coronary artery disease were also analyzed. Results of all analyses show that the vasectomized men did not have more coronary occlusive disease. Possible patient selection biases in this study are discussed.     

Vasectomy: views of Latinos and white men

Vasectomy has gained wide acceptance as a safe, effective, and efficient method of birth control. Knowledge regarding the satisfaction of patients who have undergone the procedure has been well documented. In contrast, there is little data examining the attitude of men in general to the procedure or attempting to interpret these attitudes in a cultural context. Moreover, there appears to be widespread belief by providers that acceptance of the operation is poor among ethnic minorities such as Latinos and blacks. A questionnaire was distributed to 50 white and 50 Latino men at a large county hospital to determine ethnic differences in attitudes toward vasectomy. Only 54 percent of the Latino respondents stated they knew what a vasectomy was compared with 96 percent of the white respondents. Among respondents who knew what a vasectomy was, 50 percent of Latinos and 61 percent of whites stated they would not consider vasectomy in the event that they did not want more children. There was little support for the hypothesis that machismo played an important part in the negative responses by the Latino men or that fears of impotence played a role in the attitudes of both groups. This study suggests that a stronger emphasis on education regarding this procedure should be directed to the Latino male population.     

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.1, 6.1). The adjusted odds ratio of AMI for subjects having had a vasectomy less than or equal to 9 years ago was the same as those who had a vasectomy greater than or equal to 15 years (OR = 2.5), although those who had had a vasectomy 10-14 years ago were associated with a higher odds ratio of 4.2. Among those subjects with vasectomies who were also cigarette-smokers and/or hypertensive, the risk of development of AMI increased multiplicatively compared with those with none of these conditions. We suspect that our finding of this positive association may be spurious due to possible bias introduced during selection of controls and during the process of data collection. Cancer patients may have been less likely to undergo an elective surgical procedure such as vasectomy prior to the admission. When multivariate analysis included only controls who were non-cancer patients (N = 241 controls), the adjusted odds ratio between vasectomy and hospitalization for AMI was reduced to 2.1, (95% CL: 0.8, 5.7), which is no longer statistically significant. When the analysis was further limited to only those control subjects admitted with a diagnosis of digestive system problems, the adjusted odds ratio was reduced to close to unity (1.1). Recognizing the importance of the study topic and the fact that all previous epidemiological studies showed no association between vasectomy and cardiovascular diseases, we urge further studies. A historical cohort study in the Korean setting is considered feasible and is recommended.     

男性年龄对精子氧化应激水平、核DNA损伤的影响

目的:研究男性年龄对人精子氧化应激水平、核DNA损伤的影响。方法:选择因女方原因行体外受精-胚胎移植的男性精液标本95例,按男方年龄分为3组,年龄<35岁组40例、35～39岁组34例,≥40岁组21例,观察不同年龄对人精子氧化应激水平、核DNA损伤情况。结果:3组精液量、精子浓度、精子正常形态差异均无统计学意义(P>0.05),≥40岁组的a+b级精子的百分率低于<35岁组(P<0.05),精浆活性氧水平为(17.66±7.73)%,高于<35岁组和35～39岁组(均P<0.05),精子DNA损伤率为(21.12±11.01)%高于<35岁组(P<0.05)。经Pearson相关系数分析,精子氧化应激水平、核DNA损伤与男性年龄均呈正相关(r分别为0.43和0.27,P<0.05)。结论:男性年龄增加可能导致前向运动精子比率降低,精子氧化应激水平、核DNA损伤升高。精子氧化应激水平、核DNA损伤与男性年龄存在正相关。在生育过程中,男性年龄因素应引起临床关注。     

Stool submission by general practitioners in SW England ¿ when, why and how? A qualitative study

ABSTRACT: BACKGROUND: We know little about when and why general practitioners (GPs) submit stool specimens in patients with diarrhoea. The recent UK-wide intestinal infectious disease (IID2) study found ten GP consultations for every case reported to national surveillance. We aimed to explore what factors influence GP's decisions to send stool specimens for laboratory investigation, and what guidance, if any, informs them. METHODS: We used qualitative methods that enabled us to explore opinions and ask open questions through 20 telephone interviews with GPs with a range of stool submission rates in England, and a discussion group with 24 GPs. Interviews were transcribed and subjected to content analysis. RESULTS: Interviews: GPs only sent stool specimens to microbiology if diarrhoea persisted for over one week, after recent travel, or the patient was very unwell. Very few had a systematic approach to determine the clinical or public health need for a stool specimen. Only two GPs specifically asked patients about blood in their stool; only half asked about recent antibiotics, or potential food poisoning, and few asked about patients' occupations. Few GPs gave patients advice on how to collect specimens.Results from interviews and discussion group in relation to guidance: All reported that the HPA stool guidance and patient collection instructions would be useful in their clinical work, but only one GP (an interviewee) had previously accessed them. The majority of GPs would value links to guidance on electronic requests. Most GPs were surprised that a negative stool report did not exclude all the common causes of IID. CONCLUSIONS: GPs value stool culture and laboratories should continue to provide it. Patient instructions on how to collect stool specimens should be within stool collection kits. Through readily accessible guidance and education, GPs need to be encouraged to develop a more systematic approach to eliciting and recording details in the patient's history that indicate greater risk of severe infection or public health consequences. Mild or short duration IID (under one week) due to any cause is less likely to be picked up in national surveillance as GPs do not routinely submit specimens in these cases.     

Return to work following back surgery: a review

Nineteen articles published between 1980 and 1986 were reviewed to determine the prognosis for returning to previous employment following back surgery. Seventy-seven percent of the cases reviewed returned to their previous level of employment. Nearly 11% of cases had additional back surgery during the period of follow-up. Data from three articles suggest that 82% of patients are able to return to their previous level of employment following primary back surgery compared to 59% of patients who have had multiple back surgeries. Recommendations for work activity following back surgery should be individualized for each patient. A work-hardening program including assessment of cardiovascular fitness and task performance can be used to progressively increase activity to the highest achievable level. Prevention of back injuries in the workplace will increase employee morale and reduce employee turnover and workers' compensation costs.     

Healthcare workers' risk of contact with body fluids in a hospital: the effect of complying with the universal precautions policy.

OBJECTIVE: To test whether healthcare workers' knowledge of and compliance with the basic principle of the Universal Precautions policy (i.e., that all patients should be treated equally regarding contact with body fluids) influenced the rate of contact with patient blood. DESIGN: Survey based on anonymous questionnaires. SETTING: A 380-bed secondary and tertiary care hospital receiving emergency and elective patients. PARTICIPANTS: All employees having any contact with patients. Nine hundred one of 1,308 (69%) of the questionnaires were returned. RESULTS: Twelve percent of the respondents (95% confidence interval [CI95] = 10.0%-14.4%) had experienced any contact with patient blood in the week preceding their answer. Physicians had the highest rate of contact with blood followed by nurses. In the five groups--physicians, nurses, laboratory technicians and phlebotomists, nursing aides, and student nurses--contact with blood was less frequent in the subgroup that did know and comply with the basic principle of the Universal Precautions policy, compared with the subgroup that did not. When adding the results for the 5 groups, contact with blood was experienced by 91 of 571 (15.9%, CI95 = 13%-19%) of the personnel who did not know and comply with Universal Precautions. The personnel who did know and comply with Universal Precautions had a significantly lower (9 of 111 [8.1%], p < .05, CI95 = 3.8%-15%) rate of contact with blood. CONCLUSIONS: The healthcare workers who knew and complied with Universal Precautions had a significant lower rate of contact with patient blood than those who did not.     

Vasectomy and subsequent cardiovascular disease in US physicians.

Due to previous animal research suggesting accelerated atherosclerosis following vasectomy, we examined whether vasectomy increases the risk of subsequent cardiovascular disease (CVD), including myocardial infarction (MI), angina pectoris, coronary revascularization, and stroke, in the US Physicians' Health Study. Of 22,071 US male physicians participating in the study, aged 40 to 84 years at entry and free from cardiovascular disease and cancer, 21,028 reported on the 60-month questionnaire whether they had undergone vasectomy prior to randomization. Of the 4546 physicians with vasectomy, 1159 had undergone the procedure at least 15 years before entry. During 258,892 person-years of follow-up, we documented 773 cases of MI (719 nonfatal and 54 fatal), 1907 cases of angina pectoris or coronary revascularization, and 604 confirmed cases of ischemic or hemorrhagic stroke (566 nonfatal and 38 fatal). When compared to men without prior vasectomy, the multivariate relative risk (RR) of total MI adjusted for age and other coronary risk factors was 0.94 (95% confidence interval [CI], 0.77-1.14) among men with vasectomy. Risk estimates for fatal and nonfatal events did not appreciably differ from each other. For angina or coronary revascularization or both, the multivariate relative risk was 0.99 (0.88-1.12) and for total stroke the RR was 0.95 (0.75-1.21). For men who had undergone vasectomy 15 or more years previously, the multivariate relative risks were 0.98 (0.73-1.32) for total MI, 1.17 (0.87-1.57) for total stroke, and 1.12 (0.94-1.35) for angina/revascularization. These results provide reassuring evidence that vasectomy does not materially increase the risk of subsequent cardiovascular disease, even 15 or more years following the procedure.     

输精管吻合术后精子超微结构观察

目的:观察输精管吻合术后精子超微结构的变化。方法:采用光学显微镜、扫描和透射电子显微镜对20例接受输精管吻合术者和10例正常生育男性精子的形态和超微结构改变进行观察、统计、分析。结果:①光镜和扫描电镜分析显示吻合术后精液中正常形态精子显著减低;②两组精子尾畸在光镜下有明显差异,在扫描电镜下无差异;③两组精子头畸在扫描电镜下有显著性差异;④在透射电镜下吻合术后精子多数均属于复合型精子结构异常,大部分均有多个部位和多个细胞器结构异常。结论:吻合术后精子有多种类型和复合型的异常改变,这些改变与不育男子精子的改变相似。提示:输精管结扎术后精子形态学的改变,是使吻合术后生育能力降低的主要原因之一。