Vasectomy reversal in Nepal

Data from 157 men in Nepal who had vasectomy reversal are analysed. Most sought reversal within 5 years of vasectomy. Half of the men sought reversal because of the death of a male child, and about one-fourth because of the loss of a female child. Re-marriage was the primary reason for only 10% of the men. Those having reversal because of the loss of a male child were generally younger, and for almost half of this group, the age of their last child at the time of their vasectomy was under 2 years. The results suggest that the demand for reversal could be considerably reduced by more careful screening of the potential vasectomy acceptors.     

Weak autoantibody reactions to antigens other than sperm after vasectomy.

Autoantibody activity against various antigens was measured by indirect immunofluorescence in 97 men about to undergo vasectomy and 170 men who had undergone the operation up to six years earlier. There was a significantly higher prevalence of weakly positive autoantibody reactions among those who had undergone vasectomy. There was, however, no evidence that vasectomy could induce stronger autoantibody reactions such as those associated with autoimmune disease.     

Farmers’ preferences for result-based schemes for grassland conservation in Slovenia

Government-funded payments for ecosystem services (PES) have increasingly been used to facilitate transactions between users of environmental services and their providers. In order to improve the link between payments and the service provided, some countries in the EU have promoted result-based schemes (RBS), which remunerate farmers for ecological results, as part of their agricultural policy. Since PES programs are voluntary, it is important to understand farmers’ responses before more large-scale implementations of RBS are initiated. Using a choice experiment and a mixed logit model, we elicited the preferences of farmers in two Natura 2000 sites in Slovenia for different design elements of a hypothetical scheme for dry grassland conservation. We found that the majority of farmers preferred the result-based approach over the management-based scheme both in terms of payment conditions and monitoring; one group of farmers preferred the RBS very strongly (average WTA of more than 500 EUR/ha/yr) and another group less strongly (average WTA about 200 EUR/ha/yr). Farmers also showed a higher preference for on-farm advise and training in small groups than for lectures, which would be offered to a larger audience. A collective bonus, which would incentivise coordination and could potentially increase participation rates in the scheme, significantly influenced the farmers’ willingness to adopt the scheme. However, the estimated average WTA was comparable or lower than the 40 EUR/ha annual bonus payment. Older farmers and those who managed small and semi-subsistent farms were significantly more likely to be highly resistant to scheme adoption no matter its design.     

Risk of testicular cancer after vasectomy: cohort study of over 73,000 men.

OBJECTIVE--To confirm or refute reports that vasectomy may increase the risk of cancers of the testis and prostate. DESIGN--Computerised record linkage study of cohort of men with vasectomy and comparison of cancer rates with those in the whole Danish population; manual check of all records of patients with testicular and prostate cancer diagnosed within the first year of follow up. SETTING--Denmark 1977-89. SUBJECTS--Cohort of 73,917 men identified in hospital discharge and pathology registers as having had a vasectomy for any reason during 1977-89. MAIN OUTCOME MEASURES--Observed incidences of testicular, prostate, and other cancers up to the end of 1989. RESULTS--The overall pattern of cancer incidence in the study cohort was similar to that expected nationally. No increased incidence in testicular cancer was observed (70 cases; standardised morbidity ratio 1.01 (95% confidence interval 0.79 to 1.28)). The incidence during the first year of follow up was also close to that expected (nine cases; standardised morbidity ratio 0.80 (0.36 to 1.51)). The incidence of prostate cancer was not increased (165 cases; standardised morbidity ratio 0.98 (0.84 to 1.14)). CONCLUSIONS--The incidence of testicular cancer in men with vasectomy is no higher than in other men. Vasectomy does not cause testicular cancer and does not accelerate the growth or diagnosis of pre-existing testicular neoplasms. Data concerning a causal relation between vasectomy and prostate cancer were inconclusive.     

Contraceptive choice in an urban clinic in Nigeria

Contraceptive choice in the 1st 1075 acceptors at an urban clinic in Lagos, Nigeria is studied using clinical notes of all patients who attended the clinic between September 1, 1980 and August 31, 1983. Details of previous and current contraception, age, parity and level of education are analyzed. The IUD was the most popular choice followed by the injectable contraceptive and the pill. Interval tubal ligation was chosen by some patients. Acceptors of injectables were older women of high parity and lower educational standard while pill acceptors were of lower parity and higher educational level. The IUD was acceptable to all ages and parities except those with only 1 child or none. Loss to follow-up and the wish to plan another pregnancy were the commonest reasons for discontinuing contraception. Medical reasons for discontinuing the IUD were pain, menstrual disorder, accidental pregnancy and expulsion/perforation; for discontinuing injectables the reasons were menstrual disorder, accidental pregnancy and raised blood pressure. Of acceptors of the 3 main methods, former pill and IUD users were more likely to choose the same method again. A strategy should be devised to encourage patients of lower parities and age to use contraceptives, while sterilization in patients of parity 3 and above should be even more actively advocated. Greater effort should be made to support patients through the 1st 6 months after starting any method as this is the time when a large number of discontinuations occur.     

A review of epidemiologic studies of vasectomy

A number of epidemiologic studies of vasectomy have been published in recent years. These studies have been methodologically diverse and have involved several groups of investigators in several countries. The studies are consistent in finding no long-term effects of vasectomy on the risk of cardiovascular disease, cancer, impotence, prostatic disease, or disease related to immune function and dysfunction. Continued follow-up of vasectomized men to evaluate further the possibility of adverse effects of vasectomy is recommended. At this time, epidemiologic studies of vasectomy in man are strongly reassuring. Vasectomy decreases prostatic secretory function. In a study conducted by Sidney, no association was found between vasectomy and benign prostatic hypertrophy or prostatic cancer. Massey et al. found that the incidence of impotence was 1.9/1000 man-years of observation in men with vasectomy and 1.7/1000 man-years in non-vasectomized men, a difference that was not statistically significant. 3 studies examining the risk of malignant and nonmalignant neoplasms in vasectomized and nonvasectomized men revealed that vasectomy was not associated with an increased risk of malignant or nonmalignant neoplasms.     

Who has a vasectomy reversal?

A comparatively small proportion of sterilized men request vasectomy reversals, and the size of the proportion (which UK estimates place between 1% and 1.5%) depends on awareness of the availability of reversal. In this study, the characteristics of 200 cases of vasectomy reversal (the 1st 200 such operations performed in the UK) were analyzed. All 200 had been completed by 1981, the mean time from vasectomy to reversal being 4.8 years. The time figure varied according to the reason for requesting reversal, and was particularly short when the operation had been performed at the time of the partner's pregnancy. General practitioners and friends were particularly important sources of referral. 30% of the men were with the same partner and 70% a new partner. Vasectomy reversal cases tended to be younger than vasectomy patients as a whole but did not differ significantly in social class. Most requesting reversal wanted to have another child. Scattered cases requested the reversal after a partner's pregnancy termination. 12 men requested it for psychosexual reasons. In this series of reversals, spermatozoa were present in the ejaculate throughout the 20-week follow-up time in 80% of the men; the pregnancy rate was 44%. The study demonstrates the need for counselling prior to a vasectomy, especially with regard to the posibility of marital breakdown or pregnancy termination.     

EXPLOITATION IN PAYMENTS TO RESEARCH SUBJECTS

Offering cash payments to research subjects is a common recruiting method but there is significant debate about whether and in what amount such payments are appropriate. This paper is concerned with exploitation and whether there should be a lower limit on the amount researchers can pay their subjects. When subjects participate in research as a way to make money, fairness requires that researchers pay them a fair wage. This call for the establishment of a lower limit meets resistance in two places: (1) denial that the payments offered by researchers are wages for participation; and (2) concern about undue inducement. This paper critically examines these arguments for and against a lower limit. It shows that the need for a lower limit cannot be avoided by adopting a non‐wage payment model and that concerns about undue inducement are unjustified in all trials except those that present greater than minimal risk. This analysis suggests the following compromise position: there should be an unconditional lower limit on payment amounts so that researchers cannot offer less than a fair wage, and when researchers cannot satisfy this limit because fairness requires a problematically large payment, then researchers should offer no payment at all.     

The influence of vasovasostomy on antisperm antibodies in rats

Serum antisperm antibodies were studied in Sprague-Dawley rats after vasectomy and vasovasostomy. Animals received a bilateral vasectomy, a vasectomy followed 3 mo later by vasovasostomy, or sham operations. Blood samples were obtained at 1, 3, 4, and 7 mo, and antisperm antibodies were assayed by an enzyme-linked immunosorbent assay. After vasectomy reversal was performed at 3 mo, antisperm antibodies were significantly higher in rats in the vasovasostomy group at 4 mo than in animals that had a persisting vasectomy or sham operations. At 7 mo, the antisperm antibody level for the vasovasostomy group was approximately double that for the vasectomized rats. Spermatic granulomas occurred in 76% of rats after vasovasostomy. Antisperm antibody levels were higher in vasovasostomized animals with granulomas than in those lacking granulomas. The results suggest that vasovasostomy may stimulate an antibody response to sperm rather than lead to a reduced response, as was anticipated upon removal of the obstruction. Spermatic granulomas may serve as sires for continued antigenic challenge. The observed increase in antisperm antibodies after vasovasostomy in Sprague-Dawley rats may be related to their relatively low immunologic responsiveness to vasectomy, with vasovasostomy serving as a second major immunologic challenge, aided by the formation of an additional granuloma. In the more responsive Lewis strain, we previously observed a rise in antisperm antibodies after the initial vasectomy, with no further increase after vasovasostomy.     

Sterilization in Canberra

The discussion in this article uses data from the 1979 Canberra Population Survey to assess the degree and nature of the resistance to the use of sterilization, particularly male sterilization. In the 1979 Canberra Population Survey, respondents were asked what methods of contraception they would recommend to a couple who had completed their family. About 2/3 recommended sterilization, with vasectomy a more popular 1st choice, particularly for male respondents, than tubal ligation. Compared to 20% of the 1978 sample, 27% of the 1979 sample reported use of sterilization; the increase may reflect not only the increasing popularity of sterilization, but also improved reporting. The 1979 survey provides some confirmation of the forecast that 60% of Australian couples would use contraceptive sterilization as a method of birth control in their fertile lifetime. However, the forecast that the importance of vasectomy may come to equal that of tubal ligation seems highly unlikely, even though there seems to be some recognition by Canberra respondents that vasectomy is simple, safe and reliable. Data from the Canberra survey shows that although a majority of respondents would use sterilization, female sterilization would be preferred largely because men were more resistant to the idea than females. Other researchers have commented on the feeling that fertility decisions and contraception are ultimately the wife's concern. Respondents born outside Australia, the United Kingdom, and Eire were more resistant to the idea of sterilization, but reported higher use of tubal ligation. It is presently suggested that the choice of vasectomy or tubal ligation, or resistance to these methods, may in fact be important indicators of the assimilation of immigrants and of husband-wife communication of Australia. Future studies of sterilization in Australia might profit from focusing on sterilizationas an independent rather than a dependent variable.     

The price of tolerance: wolf damage payments after recovery

The costs of wildlife conservation distribute unequally across society. Compensation can potentially redress inequities and raise local tolerance for endangered wildlife that damage property. However, the rules for payments generate controversy, particularly as costs mount and species recover. In Wisconsin (USA), gray wolf damage payments grew notably over 28 years and eventually undermined budgets for conserving other endangered species. We measured attitudes to compensation among 1,364 state residents, including those who voluntarily contributed funds and those likely to receive compensation, and we interviewed elected officials about the politics of payment rules. Most respondents endorsed compensation for wolf damages to livestock—even when wolves are no longer endangered—but opposed payments for wolf damage to hunting dogs on public land. Most donors opposed killing wolves and over one-fourth unconditionally rejected a wolf hunt. We predict the latter donors would stop contributing funds for compensation if the state were to implement a proposed wolf hunt. Controversy over payment rules reveals clashing values regarding wildlife between those receiving and those paying for compensation. Moreover, the costs of compensation ratchet up as endangered species recover and claims of entitlement expand. Hence we recommend conservationists use sunset clauses and an adaptive management of compensation programs.     

Who asks for vasectomy reversal and why?

Of the 76 men requesting reversal of vasectomy who were interviewed at Charing Cross Hospital between June 1978 and September 1981, 31 were still married. These men had decided to have a vasectomy during a crisis-a recent pregnancy or financial stress being the commonest reason. Most wanted another child but others wished to be "put back to normal," and a few hoped reversal would help their marriage. Forty-five (59%) were divorced or separated and felt disadvantaged in courtship or remarriage by being infertile, many wives or partners being "desperate" for a pregnancy. A greater number of requests for reversal came from men who had been under 35 at the time of vasectomy and who were more likely to have been divorced, especially if there had been a teenage pregnancy. The risks of regret after sterilisation appear to relate to immaturity at the time of the vasectomy and to be as great for young men as for young women.     

Male contraception: Another holy grail

The idea that men should participate in family planning by playing an active role in contraception has become more acceptable in recent years. Up to the present the condom and vasectomy have been the main methods of male contraception. There have been and continue to be efforts to develop an acceptable hormonal contraceptive involving testosterone (T) suppression. However the off target affects, delivery of the analogs and the need for T replacement have proven difficult obstacles to this technology. Research into the development of non-hormonal contraception for men is progressing in several laboratories and this will be the subject of the present review. A number of promising targets for the male pill are being investigated. These involve disruption of spermatogenesis by compromising the integrity of the germinal epithelium, interfering with sperm production at the level of meiosis, attacking specific sperm proteins to disrupt fertilizing ability, or interfering with the assembly of seminal fluid components required by ejaculated sperm for acquisition of motility. Blocking contractility of the vas deferens smooth muscle vasculature to prevent ejaculation is a unique approach that prevents sperm from reaching the egg. We shall note the lack of interest by big pharma with most of the support for male contraception provided by the NIH.     

Incidence of disease after vasectomy: a record linkage retrospective cohort study.

OBJECTIVE--To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation. DESIGN--Retrospective cohort study using linked medical record abstracts. SETTING--Six health districts in Oxford region. SUBJECTS--13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for one of three specified elective operations, appendicitis, or injuries. MAIN OUTCOME MEASURES--Hospital admission and death after vasectomy or comparison event. RESULTS--The mean durations of follow up were 6.6 years for men with a vasectomy and 7.5 years for men with a comparison condition. The relative risk of cancer of the testis in the vasectomy cohort (4 cases) compared with that in the other cohorts (17 cases) was 0.46 (95% confidence interval 0.1 to 1.4), that of cancer of the prostate (1 v 5 cases) 0.44 (0.1 to 4.0), and that of myocardial infarction (97 v 226 cases) 1.00 (0.8 to 1.3). There was no evidence of an increase associated with vasectomy in the incidence of a range of other diseases. CONCLUSIONS--Vasectomy was not associated with an increased risk of testicular cancer or the other diseases studied. With respect to prostatic cancer, while we found no cause for concern, longer periods of observation on large numbers of men are required.     

Possible mechanisms of vasectomy-exacerbated atherosclerosis

Our laboratory as well as those of others have demonstrated that in experimental animals vasectomy results in immune-complex deposition not only in the reproductive tract but also in the renal glomerulus. We have shown that in two species of monkeys vasectomy results in a significant increase in atherosclerosis and have postulated that this may be due to circulating immune complexes. We have shown a mild change in arteriolar vessels in a small study of vasectomized men and have found a mild but insignificant increase in systolic blood pressure in vasectomized men over time compared to an age-matched group. One cannot ignore the fact that persistent autoimmune responses to spermatozoal antigens are generated in both vasectomized men and animals. The paucity of direct information about whether vasectomy exacerbates atherosclerosis in human subjects has made reliance on animal studies unavoidable. But to date there is no evidence that vasectomy causes a similar effect in human beings.     

Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer''s claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.     

Perspectives of contraceptive choices for men

Apart from condoms and vasectomy, which have several limitations of their own, no other methods of contraception are available to men. Various chemical, hormonal, vas based and herbal contraceptives have been examined and few of them have reached the stage of clinical testing. Promising leads have been obtained from testosterone buciclate/undecanoate, alone or in combination with levonorgestrel butanoate or cyproterone acetate, RISUG, an injectable intravasal contraceptive and a few herbal products, particularly the seed products of Carica papaya. It is feasible that an ideal male contraceptive, that meets out all the essential criteria will be made available to the community in the near future.     

Third‐way neoliberalism and conditional cash transfers: The paradoxes of empowerment,participation and self‐help among poor Uruguayan women

The Latin American literature on Conditional Cash Transfer (CCT) welfare programs has typically involved the quantitative evaluation of social and economic impact, with fewer studies addressing the qualitative and gendered impacts of CCTs. Drawing from ethnographic fieldwork in poor squatter settlement communities in Uruguay, this article explores the everyday social realities of poor single mothers who have been disconnected from their kinship networks and must rely on CCT payments for survival. I locate these women's experiences within the third‐way neoliberal discourses of ‘empowerment’, ‘participation’ and ‘self‐help’ espoused by the state, and the various structural conditions, including crime, violence and unequal gender relations, that impact negatively on women's abilities to comply with their social and civic duties. I argue that rather than producing responsible and empowered subjects, Uruguay's recent CCT welfare program has paradoxically limited some women's participation in civic and public life and reproduced their dependent relations with men.     

Male attitudes towards family planning in Khartoum, Sudan

Knowledge of, attitudes toward, and use of contraception were investigated in a 1982 survey of 250 men living in Khartoum, Sudan. Interviews were conducted at mosques, marketplaces, a government office building, and a textile factory. 75% of respondents were ages 21-40. 92% of respondents expressed the belief that Khartoum is overcrowded, although this was attributed by 57% to rural-urban migration. Despite the fact that 85-95% linked overpopulation with social problems such as inflation, food shortages, and unemployment, 72% expressed a desire for 5 or more children. Only 30% of the men interviewed supported the concept of family size limitation, largely for economic reasons. The majority of those opposing family size limitation cited religious reasons. Attitudes toward child spacing were more favorable, with 80% indicating approval 59% of the men with wives at risk of pregnancy reported that they were using some form of contraception, but only 21% were using an effective method. Two-thirds of respondents reported that they do not discuss contraception with their spouse. 60% identified either the mass media or friends and relatives as their source of family planning information. Although 64% indicated an awarencess of where to obtain family planning services, only 2.8% had ever received services from a family planning clinic. 79% voiced an interest in more information on family planning, and 59% with wives of reproductive age wanted to use family planning services. Most respondents desired more information on sexual sterilization and, although surgical contraception is not available in Sudan, 10% said they would consider this method when they attained their desired family size. The belief that family size should be limited increased dramatically with education, from 9% among those with no formal schooling to 45% among men with 13 or more years of school. Men under 40 years of age had more favorable attitudes toward family planning than older men. Surprisingly, men interviewed at mosques had the most favorable attitudes whereas government employees were the most conservative. Overall, these fndings suggest that the present family planning clinic system in Sudan may be falling short of meeting the demand for information services.     

Arts students in debt: Concerns,consequences, and interventions

While there are many educational and experiential benefits to attending professional higher arts education programs, students who incur excessive student loan debt during their studies may experience unanticipated or poor professional outcomes either over the course of their artistic careers, shortly after the expiration of a loan grace period, or after they can no longer defer payments. To date, little to no research exists on the effects of an excessive student loan debt burden on professional arts careers. To address this gap in the higher arts education literature, and in an effort to facilitate scholarly discussion on the topic, this article identifies concerns, consequences, and potential interventions.