The process of opting for female permanent contraception: A qualitative study of women's experiences in Sweden.

OBJECTIVES: We aimed to explore Swedish women's decision-making experiences regarding permanent contraception. STUDY DESIGN: In this study, we included 17 women aged 30-48 who were scheduled to undergo female permanent contraceptive procedures. We conducted semistructured interviews using two broad open-ended questions. We analyzed these data using systematic text condensation based on the principles of psychological phenomenological analysis. RESULTS: The interviewees experienced no counseling or support from health care workers regarding permanent contraception until they specifically asked for it. Participants reported that they themselves place the responsibility of permanent contraception solely on women. Consequently, our participants described feeling hesitancy and ambivalence in the process of deciding to have the procedure. Once the decision was made and the women were on the waiting lists for surgery, they experienced relief and empowerment. CONCLUSIONS: Our findings suggest that health care providers in Sweden miss opportunities to support patient-centered decision-making regarding permanent contraception. This study indicates that women make deliberate and considered decisions regarding permanent contraception and are best positioned to know when the procedure should take place in their reproductive lives. IMPLICATION STATEMENTS: Health care professionals should discuss permanent contraception as an option with all women desiring contraception to allow them to decide if that method is right for them.

IgE cross reactivity between reindeer and bovine milk beta-lactoglobulins in cow's milk allergic patients.

BACKGROUND: Allergic reactions to cow's milk are common in small children. One of the main protein allergens found in cow's milk is beta-lactoglobulin (beta-Lg). Reindeer and bovine milk both contain related beta-Lg proteins, but the allergenicity of reindeer beta-Lg has not previously been studied. The purpose of this study was to analyze the immunological cross-reactivity of IgE antibodies from children with cow's milk allergy to reindeer and bovine beta-Lg. METHODS: Sera from 17 children and a serum pool of 4 patients with elevated cow's milk-specific IgE were investigated. Beta-Lg from bovine and reindeer milk was isolated in native form and an enzyme-linked immunosorbent inhibition assay was developed. Bovine beta-Lg was used as a capturing antigen and the inhibiting effects of reindeer and bovine beta-Lg on the IgE binding were measured. RESULTS: Cross-reactivity patterns of bovine milk beta-Lg specific IgE to reindeer beta-Lg varied among patients. In general, reindeer beta-Lg showed significantly lower inhibition (mean 43%) of IgE binding to the capturing antigen than did bovine beta-Lg (mean 89%). In some patients, even high concentrations of reindeer beta-Lg only partly eliminated the IgE binding to bovine beta-Lg. CONCLUSIONS: The partial cross-reactivity of human anti-bovine IgE with reindeer beta-Lg suggests that it lacks important bovine epitopes and those that are recognized are only weakly bound.

Female and male sterilization and refertilization in Sweden.

In Sweden, approximately 1,500 men and 7,000 women are sterilized yearly. The frequency varies considerably between regions. The reasons for these differences are not fully known. More women than men are sterilized in Sweden, but a higher proportion of sterilized men undergo refertilization. The object of the study was to analyze counselling routines prior to sterilization, presterilization waiting time, the number of refertilizations performed, the attitudes of the operating departments towards refertilization, and the possible relation between frequency of refertilization and incidence of sterilization. A questionnaire was mailed to all units performing refertilizations and/or sterilizations of mean and women in Sweden (n = 161). The response was 93%. Counselling routines and waiting times before sterilization varied, which influenced the operation's availability. The frequency of refertilizations varied considerably between counties from 0.5 to 5.4 per 100,000 inhabitants. There was no correlation between frequency of sterilizations and refertilizations. The rate of refertilization appears to be determined mostly by the local attitudes of the health authority. The Swedish sterilization law has had a heterogeneous impact in the country.

A long-term follow-up of 108 vasectomized men. Good counselling routines are important.

Contraceptive sterilization of men and women was made legal in Sweden in 1976. Males presently account for approximately 20% of the 8-10,000 people sterilized yearly in the country. Only few long-term follow-ups have been performed on Swedish men. Since 1983 preoperative counselling of men has been available in the county of Blekinge at family planning clinics. Prior to this counselling was available only at urologic or surgical departments. To evaluate long term satisfaction and the new counselling possibilities, all men vasectomized in Blekinge during 1985-1986 (n = 108) were investigated by a mailed questionnaire 2 years and 7 years after the operation. Response rates were 98% after 2 years and 96% after 7 years. 93% of the responding men were satisfied with their vasectomy when asked after 2 years. 95% reported satisfaction 5 years later. Problems mentioned concerned sexual performance, long lasting pain, and wanting children in new relationships. Regret was not encountered among the 25% who had been counselled at family planning centers.

PIP: The contraceptive sterilization of men and women in Sweden became legal in 1976. Males presently comprise approximately 20% of the 8000-10,000 people sterilized annually in the country. At Blekinge county family planning clinics, preoperative counseling has been available for men since 1983. Such counseling used to be available only at urologic or surgical departments. To evaluate long-term satisfaction and new counseling possibilities, all 108 men vasectomized in Blekinge during 1985-86 were questioned via mailed survey 2 and 7 years after their operations. The response rates were 98% after 2 years and 96% after 7 years. 93% of the responding men were satisfied with their vasectomy when asked after 2 years, while 95% reported being satisfied after 7 years. Problems mentioned concerned sexual performance, long lasting pain, and wanting children in new relationships. No regret was expressed among the 25% of men who had been counseled at family planning centers.

Two additional glutaredoxins exist in Escherichia coli: glutaredoxin 3 is a hydrogen donor for ribonucleotide reductase in a thioredoxin/glutaredoxin 1 double mutant.

Thioredoxin (Trx) and glutaredoxin (Grx1) are hydrogen donors for ribonucleotide reductase, the key enzyme for deoxyribonucleotide biosynthesis. The viability of a double mutant lacking both Trx and Grx1 implies the presence of a third, unknown hydrogen donor. This paper reports the purification and characterization of two proteins with glutaredoxin activity (using hydroxyethyl disulfide as a substrate) from an Escherichia coli mutant lacking Trx and Grx1 (delta trxA, grx::kan). Affinity chromatography was used to bind glutaredoxin on a glutathione-containing thiol-Sepharose column. The molecular weight of Grx2, 27,000, was atypical for glutaredoxins, whereas Grx3 had a molecular weight of 10,000. Amino acid sequence analysis revealed novel structures with putative active sites typical of glutaredoxins: Cys-Pro-Tyr-Cys. The proteins are therefore referred to as Grx2 and Grx3. The low hydrogen donor activity for ribonucleotide reductase in the crude extract was recovered in the purification of Grx3, whereas Grx2 was inactive. As a hydrogen donor for E. coli ribonucleotide reductase, Grx3 showed approximately the same Km value (0.35 microM) as Grx1, whereas its Vmax value was only 5% that of Grx1. The combination of the Grx3 hydrogen donor activity and a 25-fold induction of ribonucleotide reductase activity in a delta trxA, grx double mutant provides an explanation for its viability and deoxyribonucleotide biosynthesis. The physiological functions of Grx2 and Grx3 remain to be determined.

Experiences of legal sterilization in Scandinavia.

The three Scandinavian countries--Denmark, Norway and Sweden--all legalized voluntary sterilization in the 1970s. Previous legislation had been very restrictive, limiting access to certain defined minority groups. During the two decades with this new possibility, sterilization has been accepted as a good contraceptive alternative, equally accessible for men and women above age 25 years. The sterilization frequency varies considerably between the three countries, being most popular in Norway and Denmark. The proportion of sterilization in males versus females is 40% in Denmark, 25% in Norway and 20% in Sweden. Published follow-up studies point out risk groups for regret of the intervention, and underline the need for good preoperative counseling. The overall results are very positive.

PIP: 2 obstetrician-gynecologists from Central Hospital in Karlskrona, Sweden, analyzed official sterilization data and reviewed the literature to determine the development of sterilization in Denmark, Norway, and Sweden. National registration of sterilizations were available from Norway as far back as 1984 and from Sweden as far back as the early 1940s. It is not required in Denmark, so the researchers had to use hospital registrations. New sterilization laws in the 1970s allowed contraceptive sterilization for everyone at least 25 years old; prior to the 1970s, sterilizations were allowed mainly for hereditary or eugenic indications, mentally ill, severely retarded persons, ill women needing to avoid a life-threatening pregnancy, and sometimes people determined to not be able to care for children. Vasectomies are more common in Denmark than Norway and Sweden (in the 1980s: about 40% vs. about 20-25%, respectively), but vasectomy was already somewhat popular in Norway before enactment of its new law. The sharpest increase in female sterilizations after enactment of the new law occurred in Denmark. Either the husband or wife is sterilized by the end of the reproductive years among 10-15% of all couples in Sweden. There were marked differences in sterilization rates between regions in Sweden. 90-95% of sterilized men and women from all 3 Scandinavian countries were satisfied with the operation. Postoperative hematoma or infection were the most frequent short-term complications for sterilized men and women. Men also reported postoperative pain. Some women noted trauma to intra-abdominal organs. Longterm effects were regret/desire for reversal, pregnancy, and negative effects on sexuality. Women also reported bleeding disturbances and pain. Pregnancy rates are .54-1.6% for women and 0.5% for men. These findings suggested that surgeons should pay more attention to preoperative counseling to reduce the likelihood of later regret, especially among young applicants. High quality counseling and accessible services should minimize complications and continue to provide contraceptive sterilization.

[Significant difference in sterilization frequency in different counties 15 years after the introduction of the new legislation]. / Stor skillnad i steriliseringsfrekvens mellan landstingen 15 år efter nya lagen.

PIP: The 1976 sterilization law in Sweden allowed sterilization for both sexes over the age of 25, while for under 25 official permission was required. In the 1st 1/2 of the 1900's sterilization was used in a large measure for the mentally ill. In the US 19% of married couples got sterilized in 1981; at present there are at least 10 million sterilized couples of fertile age. In the 2nd part of the 1980's about 7000 sterilizations were carried out; 10-15% of Swedish couples chose sterilization as a contraceptive method. During 1976-79 men had 48-31% of sterilizations, in the last 5 years it has stabilized around 19%. At present the sterilization rate is 2.6% in the 25-39 age group in the country of Blekinge contrasted with 1.1% in the county of Kalmar. More than 90% of those sterilized were satisfied with the results. 25-60% did not experience any change or improved sexual life. 10-15% of men reported complications of hematoma, infections, and pain. Women had postoperative infections and bleedings, even damage to internal organs. Long-term negative complications include regret (about 5%), unplanned pregnancy, negative effect on sexual life, and bleeding and pain in women. 1/3 of those sterilized under age 30 admit having regretted the operation at one time or another. Every 6th seriously considers refertilization. Among women the pregnancy rate is .5-1% after the operation, while .5% of men stay fertile after vasectomy. 4-7% of women complained of negative effects on sex life vs. 3% of men. Bleeding disorders occurred in about 17% of sterilized women, 15% had dysmenorrhea, and up to 18% complained of abdominal pain. Easily accessible preoperative counselling increased male sterilization to over 30% in 1 country. Yet 4 out of 5 sterilization seekers are women because of their shorter fertility period, pregnancy complications experienced, and high probability of refertilization.^ieng

[Reactions of men after sterilization. All satisfied with the consultation at the Maternal Health Center]. / Mäns reaktioner efter sterilisering. Alla nöjda med MVC-rådgivning.

PIP: Before 1976 there was little opportunity for voluntary sterilization for men in Sweden, although it had been possible for some time for women to be sterilized for medical reasons with the approval for 2 physicians. When the law on abortion was introduced in 1975, men and women were placed on the same status and any man over 25 years of age could be sterilized after appropriate counseling. In the province of Blekinge in southern Sweden this counseling was normally provided by urologists or surgeons until 1983. After then, men could receive counseling on vasectomy from a gynecologist at any maternal health center. The gynecologist carried out a physical examination, including urogenital status and then referred him to a polyclinic for an operation by a surgeon or urologist. For this study, 107 men who had undergone vasectomy between 1985 and 1986 were surveyed. 94 patients replied. Median age at vasectomy was 39 years with a spread from 28-58. 66% of the men had been counseled by a surgeon or urologist, 25% by a gynecologist at a maternal health center, and 6% by a general practitioner. 90% considered that the counseling had been good, 24% reported pain during the operation, and 55% had local pains postoperatively. 67% of the men were home from work 0-2 days, 16% 3-5 days, 14% 6-14 days, and 3% 2-4 weeks. Postoperative bleeding occurred in 28% of the cases and 10% reported postoperative infection. 27% of the men reported that their sexual life had improved after sterilization and 3% had noted diminished potency. In all, 95% of the men were pleased with the operation and did not regret their decision.^ieng