Correlates of female sterilization regret in the southern states of India

This study analyses factors associated with the incidence of sterilization regret in the four south Indian states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Using data from the National Family Health Surveys, in all four states the incidence of regret was found to be less than 10% and the factors significantly associated with it were child loss experience and quality of services. Hence, there is a need to improve the quality of services, both in terms of counselling and service provision, and women need to be counselled about the permanent nature of sterilization in order to avoid future regret.     

Poststerilization regret among women: methodological considerations for the next decade

The literature concerning regret among women following voluntary sterilization shows a lack of methodological rigor. This paper reviews the 7 prospective studies of voluntary sterilization conducted since 1973 that are judged to have adequate design and measurement standards, and suggests methodological considerations for future research. 3 of the studies were conducted in the US, 2 in the UK, 1 in Thailand, and 1 in Pakistan. Only 3 of the 7 studies used control groups and only 3 used standardized pre- and posttest psychological measures. Subjects in all the studies requested sterilization on a voluntary basis. 4 of the 7 studies evaluated contraceptive and menstrual histories before and after sterilization. All the studies varied in their poststerilization follow-up intervals ranging from 2 months and 1 year to 18 months and 2 years. Attrition rates also varied widely across the studies. Although none of these studies presented percentages for precise measures of regret, the overall effect of the sterilization procedure was found to be positive. The relationship between regret and purported indicators of regret, such as depression, anxiety, menstrual difficulties, and desire for reversal, should be documented in prospective, controlled studies. Longer poststerilization follow-up periods are recommended. Responses of childless women and male partners to sterilization should also be considered in future studies. Finally, since repeated references are made to menstrual problems following voluntary sterilization, it is important that studies assessing poststerilization responses control for oral contraceptive (OC) use because OCs reduce menstrual flow and their discontinuation results in a return to normal, although heavier, menstrual flow.     

Regret on Choice of Colorectal Cancer Screening Modality Was Associated with Poorer Screening Compliance: A 4-Year Prospective Cohort Study

Purpose

Very few studies examined the issue of regret on choosing colorectal cancer (CRC) screening tests. We evaluated the determinants of regret and tested the hypothesis that regret over screening choices was associated with poorer screening compliance.

Methods

A bowel cancer screening centre invited all Hong Kong citizens aged 50-70 years who were asymptomatic of CRC to participate in free-of-charge screening programmes. Upon attendance they attended health seminars on CRC and its screening, and were offered an option to choose yearly faecal immunochemical test (FIT) for up to four years vs. one direct colonoscopy. They were not allowed to switch the screening option after decision. A self-administered, four-item validated survey was used to assess whether they regretted over their choice (> 2 = regretful from a scale of 0 [no regret]-5 [extreme regret]). A binary logistic regression model evaluated if initial regret over their choice was associated with poorer programme compliance.

Results

From 4,341 screening participants who have chosen FIT or colonoscopy, 120 (2.8%) regretted over their decision and 1,029 (23.7%) were non-compliant with the screening programme. Younger subjects and people who felt pressure when making their decision were associated with regret. People who regretted their decision were 2.189 (95% C.I. 1.361-3.521, p = 0.001) times more likely to be non-compliant with the programme.

Conclusions

This study is the first to show that regret over the initial CRC screening choice was associated with later non-compliance. Screening participants who expressed regret over their choice should receive additional reminders to improve their programmatic compliance.     

Regret,shame, and denials of women's voluntary sterilization

Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well‐studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men's decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern in the voluntary sterilization of women? I argue that regret is centered in women's voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret.     

Associations between anticipated reactions to genetic test results and interest in genetic testing: will self-selection reduce the potential for harm?

The proliferation of genetic susceptibility tests for complex diseases away from clinic settings increases the potential for harm. This study assessed whether people are likely to self-select themselves into or out of genetic testing depending on whether they believe they could cope with the results. Associations between anticipated reactions to adverse genetic test results and interest in taking genetic tests for cancer and heart disease were examined in a community sample of English adults (n = 1,024). Interest in genetic testing overall was 78% for cancer risk and 80% for heart disease risk. As predicted, there were differences by anticipated reactions. People who anticipated regret about having taken a genetic test for cancer risk expressed lower interest than those who did not anticipate regret (46% vs. 89%), and people who anticipated being glad to know of increased risk status (i.e., reduced uncertainty) were more interested than those who did not look forward to reduced uncertainty (91% vs. 22%). Patterns were similar for heart disease ("regret" 66% vs. 87%; "reduced uncertainty" 87% vs. 38%). The potential for harm from future genetic susceptibility tests may be less than feared if people who anticipate adverse reactions self-select themselves out of testing. However, given that a significant proportion of people who anticipated adverse reactions also expressed interest in testing, there is still a concern about safety. It remains to be seen whether the same patterns emerge in studies that actually offer genetic tests for common gene variants in community settings.     

Sterilization of Companion Animals: Exploring the Attitudes and Behaviors of Latino Students in South Texas

A sample of 131 Latino students attending a university in south Texas near the United States–Mexico border completed a self-administered questionnaire regarding their companion animals (pets). Compared with dog caregivers (owners) (n = 106), cat caregivers (n = 25) were significantly more likely to favor early spay/neuter of pets and to report that the primary benefit received from their own pet was relational (for example, companionship) rather than functional (for example, sense of safety). The rate of sterilization was significantly higher for cats (60%) than for dogs (26.4%). Sterilization rates were significantly higher for cats whose owners favored early spay/neuter and had accurate knowledge about sterilization of female cats and dogs. Sterilization rates were significantly higher for dogs whose owners had a veterinarian, favored early spay/neuter, and valued relational benefits of guardianship more than functional benefits. Approximately 41% of owners whose pets were not sterilized reported that they wanted puppies or kittens, and 25% reported that the cost of the procedure was the primary barrier. Sterilization programs must include both education about the benefits of sterilization and low-cost spay/neuter services.     

Satisfactions and dissatisfactions of patients with augmentation mammaplasty.

In the study group, the augmentation with silicone gel prostheses had a high rate (64%) of firmness (as felt by the patients), which seems not greatly affected by the surgeon or by patient exercises or manipulations. In the group, augmentations with saline-filled inflatable prostheses had a much lower incidence of firmness (40%, as felt by the patients). No deflations of the Heyer-Schulte R.T.V. "Jenny" prosthesis were found during the follow-up period. Augmentation mammaplasty by a certified plastic surgeon has a low rate of physical complications (in the range of one to two percent). However there were unfavorable cosmetic results causing patient dissatisfaction with part of the result in about 15%. The incidence of emotional dissatisfaction with the procedure as a whole, as judged by those who would not choose to repeat the operation, was less than 4%.     

IMPACT OF NIGHT-FLOAT ROTATION ON SLEEP,MOOD, AND ALERTNESS: THE RESIDENT'S PERCEPTION

Night-float rotations were designed to alleviate the workload of residents on night call and thereby improve patient safety. However, the impact of the night float on residents is yet to be surveyed. We assessed the impact of the night-float rotation on pediatric residents using an anonymous questionnaire that covered topics, based on recall, about sleep, mood, alertness, adjustment, and others. The study was conducted in a major tertiary pediatric teaching hospital in the United States. Participants were pediatric residents who had completed one or two night-float rotations and were in active training at our teaching hospital at the time of the study. Fifty-two of 60 eligible residents (87%) responded. Sleep duration during the night-float rotation was shorter than during day-shift work in 24 residents (46%), longer in 20 (38%), and unchanged in eight (15%). A higher proportion of residents took longer to fall asleep, had more difficulty falling asleep, had more sleep interruptions, and felt less rested upon awakening. Twenty-four residents (46%) felt that their bodies never adjusted to the night shift. Also, 22 residents (43%) felt moody or depressed in contrast to seven (14%) who felt depressed during the daytime rotation (p=0.0001). Twenty-one residents (41%) felt they were slower in their thinking during the night float than daytime rotations. The results suggest that disturbances of sleep and mood and decreased alertness, typical of night shift, are present in the night-float rotation. Residency programs should monitor closely the impact of the night-float rotation on resident well being and patient safety. The impact of night-shift work should be considered in the design of night-float schedules, and teaching should be provided for residents to learn coping strategies for night-shift work.     

Impact of night-float rotation on sleep,mood, and alertness: the resident's perception

Night-float rotations were designed to alleviate the workload of residents on night call and thereby improve patient safety. However, the impact of the night float on residents is yet to be surveyed. We assessed the impact of the night-float rotation on pediatric residents using an anonymous questionnaire that covered topics, based on recall, about sleep, mood, alertness, adjustment, and others. The study was conducted in a major tertiary pediatric teaching hospital in the United States. Participants were pediatric residents who had completed one or two night-float rotations and were in active training at our teaching hospital at the time of the study. Fifty-two of 60 eligible residents (87%) responded. Sleep duration during the night-float rotation was shorter than during day-shift work in 24 residents (46%), longer in 20 (38%), and unchanged in eight (15%). A higher proportion of residents took longer to fall asleep, had more difficulty falling asleep, had more sleep interruptions, and felt less rested upon awakening. Twenty-four residents (46%) felt that their bodies never adjusted to the night shift. Also, 22 residents (43%) felt moody or depressed in contrast to seven (14%) who felt depressed during the daytime rotation (p=0.0001). Twenty-one residents (41%) felt they were slower in their thinking during the night float than daytime rotations. The results suggest that disturbances of sleep and mood and decreased alertness, typical of night shift, are present in the night-float rotation. Residency programs should monitor closely the impact of the night-float rotation on resident well being and patient safety. The impact of night-shift work should be considered in the design of night-float schedules, and teaching should be provided for residents to learn coping strategies for night-shift work.     

Psychological sequelae to elective sterilisation: a prospective study.

A total of 201 women were interviewed four weeks before elective interval tubal sterilisation, of whom 190 (94.5%) were assessed again six months postoperatively and 193 (96.0%) 18 months postoperatively. Before sterilisation the prevalence of psychiatric morbidity as measured by the present state examination was 10.4% (21 patients), no greater than might be expected in a general population sample; six months after the operation the prevalence was significantly reduced to 4.7% (nine patients); and 18 months postoperatively it had returned almost to the preoperative value (9.3%; 18 patients). Postoperative psychosexual disturbance was rare, only 3% of patients reporting reduced enjoyment of sexual intercourse at either follow-up. Considerable regret was reported by only five patients (2.6%) six months after the operation and by eight (4.1%) 18 months after the operation; however, some dissatisfaction was reported by 15 patients (7.9%) at six months and 21 patients (10.9%) at 18 months. Postoperative psychiatric disturbance and dissatisfaction were largely associated with preoperative psychiatric disturbance. Thus there was no evidence that elective interval sterilisation increased the risk of psychiatric disturbance up to 18 months after the operation.     

Extent of regretted sexual intercourse among young teenagers in Scotland: a cross sectional survey

This cross sectional survey determined the extent of regretted sexual intercourse among young teenagers in Scotland. Using a questionnaire, data were obtained from 7395 third-year pupils (3365 boys and 3730 girls) aged 13 years and 6 months to 14 years and 9 months in 24 nondenominational state secondary schools. Regretted sexual intercourse, measured on a three-point scale, was analyzed by ordinal logistic regression. The data revealed that 18% (661) of boys and 15.4% (576) of girls had experienced sexual intercourse, of which 74.8% occurred since their 13th birthday. Boys, compared with girls, reported higher levels of regret. For boys, higher levels of regret were significantly associated with having exerted pressure to have sex. On multivariate analysis, reports of being pressured, exerting pressure, not having planned sexual intercourse with partner, and high levels of parental monitoring were significantly related to girls' regret. For women, regret seemed to be related to lack of control. Sex education should focus on assisting young people to develop relationship and negotiation skills. In addition, making teenagers aware of potential emotional and relationship consequences of early sexual intercourse may delay first intercourse.     

Knowledge based diagnosis of inoculum properties and sterilization time in lactic acid fermentation

Summary A knowledge based system has been shown to be a powerful tool for diagnosing microbial activities during a fermentation process. Knowledge about lactic acid fermentation was collected by an experimental study ofLactobacillus casei. The effects of the inoculum properties and sterilization time on the cultivation were expressed in a form of a fuzzy rule-based knowledge network. The system was able to detect abnormal inoculum or sterilization conditions which caused malfunctions in the cultivations.     

Children and Adolescents with Gender Dysphoria in Israel: Increasing Referral and Fertility Preservation Rates

Objective: To describe patient characteristics at presentation, management, and fertility preservation rates among a cohort of Israeli children and adolescents with gender dysphoria (GD).Methods: We performed a retrospective chart review of 106 consecutive children and adolescents with GD (<18 years) referred to and followed at the multidisciplinary Israeli Pediatric Gender Dysphoria Clinic from March 2013 through December 2018.Results: Of the 106 patients, 10 were prepubertal (9 prepubertal transgender females), and 96 were pubertal (38 pubertal transgender females). The GD population increased 11-fold since the establishment of our clinic in 2013. The subject's median age at referral was 15.5 years (range, 4.6 to 18 years). At the time of referral, 91 (95%) of the pubertal group had completed sexual maturation in their assigned gender at birth. Thirteen (13.5%) patients had attempted suicide, and 11 (11.5%) reported having had suicidal thoughts. Fourteen (45%) pubertal transgender females and 3 (6.5%) pubertal transgender males completed fertility preservation. Gonadotropin-releasing hormone analog treatment was prescribed in 77 (80%) patients at a mean age of 15.9 ± 1.6 years. Gender-affirming hormones were prescribed in 61 (64%) patients at a mean age of 16.5 ± 1.3 years. No severe side effects were recorded. Two (2%) of the pubertal group expressed regret about medical treatment.Conclusion: Children and adolescents with GD are presenting for medical attention at increasing rates. Israeli adolescents with GD have high fertility preservation rates, perhaps attributable to cultural perspectives. Taking advantage of the option to preserve fertility can be achieved when proper counseling is both available and promoted by medical personnel.Abbreviations: GAH = gender-affirming hormone; GD = gender dysphoria; GnRHa = gonadotropin-releasing hormone analog; MHP = mental health professional     

Patient-physician sexual involvement: a Canadian survey of obstetrician-gynecologists.

OBJECTIVE: To determine obstetrician-gynecologists'' (ob-gyns'') awareness of and experience with sexual abuse of patients and former patients and their opinions about appropriate consequences. DESIGN: Mailed survey. SETTING: Canada. PARTICIPANTS: All 792 members of the Society of Obstetricians and Gynaecologists of Canada (SOGC); 618 (78%) responded. Approximately half of all ob-gyns in Canada belong to the SOGC. MAIN OUTCOME MEASURES: Knowledge of sexual involvement by an ob-gyn colleague with a patient or former patient (as defined by the respondents and by the College of Physicians and Surgeons of Ontario [CPSO]), self-report of such involvement, attitudes toward physician sexual abuse, desirable length of time a physician should wait before seeing a former patient in a situation that could lead to a sexual encounter, suggested consequences of sexual abuse. RESULTS: Overall, 10% of the respondents indicated that they knew about another ob-gyn who at some time had been sexually involved with a patient. In all, 3% of the male respondents and 1% of the female respondents reported sexual involvement with a patient; the corresponding proportions of those who reported having been accused of sexual abuse by a patient were 4% and 2%. Significantly more of the female ob-gyns than of their male counterparts (37% v. 19%) reported awareness of a colleague''s sexual involvement with a patient that would meet the CPSO''s definition of sexual impropriety, transgression or violation. Most of the respondents felt that the consequence of proven sexual impropriety should be reprimand and fine (chosen by 33%) or rehabilitation without loss of licence (28%). Most of the physicians supported loss of licence for proven sexual transgression (57%) or proven sexual violation (74%), but fewer felt that loss of licence should be permanent for these types of abuse (4% and 24% respectively). The female ob-gyns supported stronger sanctions against sexual transgression and sexual violation than the male ob-gyns. A wide range of opinion was seen regarding the propriety of sexual relationships with former patients. CONCLUSIONS: Ob-gyns have varied opinions about how sexual abuse of patients should be defined and how it should be sanctioned. There is a discrepancy between proposed public policy and the beliefs of physicians to whom the policy is to be applied.     

Decision-making for long-term tube-feeding in cognitively impaired elderly people

BACKGROUND: The decision to start long-term tube-feeding in elderly people is complex. The process by which such decisions are made is not well understood. The authors examined the factors involved in the decision to start long-term tube-feeding in cognitively impaired older people from the perspective of the substitute decision-maker. METHODS: A telephone survey was administered to the substitute decision-makers of tube-fed patients over 65 years old in chronic care facilities in Ottawa. Subjects were recruited from September 1997 to March 1998. Patients were incapable of making their own decisions about tube-feeding. Data were collected on sociodemographic factors, patients'' health status, advance directives, communication between the substitute decision-maker and the health care team, and the decision-maker''s perceived goals of tube-feeding and satisfaction with the decision regarding tube-feeding. RESULTS: Among the 57 cases in which the patient was eligible for inclusion in the study, 46 substitute decision-makers agreed to participate. Most of the patients had not given advance directives, and only 26 substitute decision-makers (56.5%) were confident that the patient would want to be tube-fed. A physician spoke with the substitute decision-maker about tube-feeding for 15 minutes or less in 17 cases (37.0%) and not at all in 13 cases (28.3%). Most of the substitute decision-makers (39 [84.8%]) felt that they understood the benefits of tube-feeding, but less than half (21 [45.7%]) felt that they understood the risks. The prevention of aspiration and the prolongation of life were the medical benefits most often cited as reasons for tube-feeding. Just over half (24 [52.2%]) of the substitute decision-makers felt that they had received adequate support from the health care team in making the decision. Substitute decision-makers of patients less than 75 years old were more likely than those of older patients to feel supported (odds ratio [OR] 4.2, 95% confidence interval [CI] 1.0-17.9). Compared with the physician''s making the decision independently, substitute decision-makers felt more supported if they primarily made the decision (OR 16.5, 95% CI 2.7-101.4) or if they made the decision together with the physician (OR 5.3, 95% CI 1.0-27.9). Most (20 [43.5%]) of the substitute decision-makers did not feel that tube-feeding improved the patient''s quality of life, and less than half (21 [45.7%]) indicated that they would choose the intervention for themselves. INTERPRETATION: The substitute decision-making process for tube-feeding in cognitively impaired elderly people is limited by a need for advance directives, lack of confidence in substituted judgement and poor communication of information to the substitute decision-maker by the health care team.     

Perceptions of Private Medical Practitioners on Tuberculosis Notification: A Study from Chennai,South India

Background

The Government of India declared TB as a notifiable disease in 2012. There is a paucity of information on the government''s mandatory TB notification order from the perspective of private medical practitioners (PPs).

Objective

To understand the awareness, perception and barriers on TB notification among PPs in Chennai, India.

Methods

Total of 190 PPs were approached in their clinics by trained field staff who collected data using a semi-structured and pre-coded questionnaire after getting informed consent. The data collected included PPs'' specialization, TB management practices, awareness about the TB notification order, barriers in its implementation and their suggestions to improve notification.

Results

Of 190 PPs from varied specializations, 138 (73%) had diagnosed TB cases in the prior three months, of whom 78% referred these patients to government facilities. Of 138 PPs, 73% were aware of the order on mandatory TB notification, of whom 46 (33%) had ever notified a TB case. Of 120 PPs, 63% reported reasons for not notifying TB cases. The main reasons reported for not notifying were lack of time (50%), concerns regarding patients'' confidentiality (24%) and fear of offending patients (11%). Of 145 PPs, 76% provided feedback about information they felt uncomfortable reporting during notification. PPs felt most uncomfortable reporting patient''s government-issued Aadhar number (77%), followed by patient''s phone number (37%) and residential address (26%). The preferred means of notification was through mobile phone communication (24%), SMS (18%) and e-mail (17%).

Conclusion

This study highlights that one-fourth of PPs were not aware of the TB notification order and not all those who were aware were notifying. While it is important to sensitize PPs on the importance of TB notification it is also important to understand the barriers faced by PPs and to make the process user-friendly in order to increase TB notification.     

Results of a Free Spay/Neuter Program in a Hispanic Colonia on the Texas-Mexico Border

The purpose of this study, conducted in a small, impoverished Hispanic community on the Texas-Mexico border, was to evaluate the level of participation in a bilingual spay/neuter program offered free of charge to residents with companion animals. Prior to the sterilization project, approximately 11% of dogs and about 27% of cats with guardians underwent surgical sterilization. Over an 8-month period, the spay/neuter program sterilized about 47% of dogs and 38% of cats who had guardians in the community. In spite of residents' early reluctance to neuter their dogs, the project sterilized nearly equal numbers of male and female dogs (200 male; 201 female).     

Results of a free spay/neuter program in a Hispanic colonia on the Texas-Mexico border

The purpose of this study, conducted in a small, impoverished Hispanic community on the Texas-Mexico border, was to evaluate the level of participation in a bilingual spay/neuter program offered free of charge to residents with companion animals. Prior to the sterilization project, approximately 11% of dogs and about 27% of cats with guardians underwent surgical sterilization. Over an 8-month period, the spay/neuter program sterilized about 47% of dogs and 38% of cats who had guardians in the community. In spite of residents' early reluctance to neuter their dogs, the project sterilized nearly equal numbers of male and female dogs (200 male; 201 female).     

Insulin therapy for inpatients with diabetes: Perceptions of resident physicians from disparate geographic training programs

Background: Improving diabetes management in hospitalized patients will require educational efforts for all practitioners, particularly resident physicians. Thus, a better understanding of residents' beliefs about diabetes in the hospital must be obtained.Objective: The purpose of this article was to compare and contrast perceptions of resident physicians from 2 geographically distinct training programs regarding management of inpatients with diabetes.Methods: Residents from training programs in the southwestern and southeastern United States were surveyed in 2006 and 2007 about their views on the importance of inpatient glucose control, their perceptions about desirable target glucose ranges, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.Results: Responses were obtained from 52 of 66 residents at site 1 and from 65 of 85 residents at site 2 (N = 117 total respondents; total response, 77%; mean age, 31 years; 48% men; 61% primary care). Combined analyses revealed that respondents believed that glucose control was “very important” in critically ill patients (96%), perioperative patients (82%), and noncritically ill patients (66%). Most residents indicated that they would target a therapeutic glucose range within published recommendations. Less than half felt “very comfortable” managing inpatient hyperglycemia, hypoglycemia, subcutaneous insulin, or insulin drips. Respondents were not very familiar with existing institutional policies or preprinted order sets for insulin therapy. The most commonly reported barrier to management of inpatient hyper-glycemia was lack of knowledge about appropriate insulin regimens and their use.Conclusions: Trainees from 2 very different educational programs shared common beliefs, knowledge deficits, and perceived barriers about inpatient glucose management. Our findings indicate that trainees were uncertain about how to use insulin therapy in the hospital. Future inpatient diabetes quality-improvement efforts should focus on development of uniform educational programs targeting the management of inpatient diabetes, particularly as it relates to insulin use.