Introduction of non-scalpel vasectomy at the Mexican Social Security Institute.

Since government approval of the Mexican Family Planning Program in 1977, the Mexican Social Security Institute (IMSS) has been one of the major family planning service providers in Mexico. No-scalpel vasectomy, a refined surgical vasectomy technique developed and widely used in China, has been introduced in 20 countries, including Mexico. This paper will describe the experience of the IMSS in introducing the no-scalpel vasectomy technique into its service delivery system, and will review the clinical and programmatic experience, and the impact of no-scalpel vasectomy on client and provider attitudes toward vasectomy.

Comparative parameters of fertility regulation as related to STD / HIV infections. An overview.

PIP: The sexually transmitted disease (STD), chancroid, is the greatest factor for HIV infections in Africa like syphilis is in the US. 3 physicians suggest that reducing the incidence of STDs may reduce the spread of HIV. Risk factors for HIV include current or history of STD in women and bisexual men, pelvic inflammatory disease, semen, copper releasing IUDs, contraceptive dermatitis, malnutrition/food allergy, environmental pollutants, genetic make up, and prostitutes. HIV infected persons should use condoms to not only protect partners but to prevent repeated contact with HIV which influences the clinical outcome. Condom use for contraception is not widely practiced in some areas, however, including Central Africa and Haiti. Condom use has increased in the US because IUDs have been removed from the market, fear of HIV infection, and discontinued use of oral contraceptives in older women. Urticarial reactions secondary to a copper IUD often occur in adolescent women, but clears when the IUD is removed. Traces of nickel in the copper wire used in IUDs often induce an allergic reaction. Allergic reactions are cofactors of HIV which can be made worse if coupled with excessive menstrual bleeding and HIV infected semen cells entering the uterus via the IUD tail. Many countries have integrated family planning services with other public health services, such as STD clinics that address AIDS. Integrated services should provide STD services and contraception and involve males and be accessible to them. Comprehensive school based clinical model should be implemented into schools and colleges. Counselors should advice HIV infected women not to have any more children. These women should get top priority to family planning services. HIV antibody testing for women should be done at any center where women may be including family planning centers and prisons.^ieng

Supervising Community health Workers in Community-Based Delivery of Primary Health/Family Planning Services: Experiences in Mexico, 1977-1982.

The supervision of CHWs in the Mexican Rural Health Program (1977-82) illustrates a wide range of problems and strengths because it was developed within a program based on a strong political mandate to deliver services to an extremely large, as well as culturally and geographically diverse population. This article presents an in-depth perspective on the issues involved in the supervision of community health workers with a focus on the myriad roles and responsibilities which are expected from supervisory personnel. The information and observations which are offered come from program evaluation materials as well as the long-term, first hand experience of the authors with the program discussed.

[Secretion of growth hormone in men and women during the reproductive age, in aged men and menopausal women with or without estrogens or progesterone]. / Secreción de hormona del crecimiento en hombres y mujeres en edad fértil, hombres seniles y mujeres postmenopáusicas con y sin estrógenos o progesterona.

PIP: Apomorphine hydrochloride 0.75 mcg subcutaneously was given to 39 men and 36 women, 18-66 years of age, and the seric concentration of growth hormone was measured. All the men showed a maximal concentration over 6 mcg/l in a total of 61 tests; while in 16 of 58 tests in women, maximal concentration was less than 6 mcg/1. Senile men had a significantly greater response of growth hormone than premenopausal and postmenopausal women. There was no significant correlation between maximal concentration and the age in men and women. There was no significant difference in maximal growth hormone concentration for men ages 24-42 and men 45-66 years of age. However, there was a trend for high levels in young men and a significantly greater concentration 60 minutes after apomorphine administration (but not at 30 and 45 minutes) in young men as compared with older men. There was no difference in secretory response to apomorphine in premenopausal and postmenopausal women. After mestranol administration (0.08 mcg orally, 3 times/day for 3 days) to 6 postmenopausal women, there was a significant increase in the secretory response of growth hormone to apomorphine. Progesterone (250 mg intramuscularly for 3 days) does not antagonize growth hormone secretion induced by apomorphine in postmenopausal women. (author's)^ieng

The impact of organization of family planning clinics on waiting time.

Mathematical simulations and structured observations were used to assess factors in family planning clinic procedures responsible for long waiting times for clients. Principal causes of unnecessarily long waiting times in selected clinics of a Mexican program included: inflexibilty of client's routes within the clinic and of staff functions, late arrival of staff, patterns of client arrival times, and the proportion of clients seen by the doctor.

PIP: Waiting times for patients were studied in 6 Mexican clinics. Waiting times were recorded for each step through which the client had to pass, as were the amounts of time spent acutally receiving services at each step. Simulation techniques were employed to estimate the effects altering certain clinic conditions would have on the average total time spent in the clinic. The clinics whose actual waiting times exceed the simulated times are characterized by 1 or more of the following: late arrivals of personnel, wasted time, inflexibility of routes and staff activities, and an inefficient filing system. 3 basic functions are necessary at all clinics--education, medical services, and record keeping. Rigidity in the order of these 3 elements appears to result in increased waiting time.

[Rate and reasons of desertion of patients who visit the family planning clinics]. / Tasas y razones de deserción de pacientes que acuden a clínicas de planificación familiar

PIP: The frequency and reasons for women abandoning family planning program were studies in 84 clinics in Mexico in terms of the ages, the number of children, the educational level, the method or methods utilized during her attendance at the clinic, the total number of months attended, and birth control measures employed after terminating the program. Women who used oral contraceptives were more inclined toward terminating the program than those who were using an IUD or a trimestral injection. Younger women with less children were more inclined to quit than women with more children. The majority of women who used the pills and the injections abandoned contraceptive measures within a short time after their last visit to the clinic, and the frequency of pregnancy was significant. The ones who had used the IUD, however, tended to continue with the same method and usually kept the same IUD. Among women who were using the IUD, the most common reasons for quitting the program were: no problems with the method ( so no reasons to go back), the necessity to leave town, and the lack of time. None of these reasons were directly related to the use of the method.^ieng