Nutritional composition of ultra-processed plant-based foods in the out-of-home environment: a multi-country survey with plant-based burgers.

Ultra-processed plant-based foods, such as plant-based burgers, have gained in popularity. Particularly in the out-of-home (OOH) environment, evidence regarding their nutritional profile and environmental sustainability is still evolving. Plant-based burgers available at selected OOH sites were randomly sampled in Amsterdam, Copenhagen, Lisbon and London. Plant-based burgers (patty, bread and condiment) (n 41) were lab analysed for their energy, macronutrients, amino acids and minerals content per 100 g and serving and were compared with reference values. For the plant-based burgers, the median values per 100 g were 234 kcal, 20·8 g carbohydrates, 3·5 g dietary fibre and 12·0 g fat, including 0·08 g TFS and 2·2 g SFA. Protein content was 8·9 g/100 g, with low protein quality according to amino acid composition. Median Na content was 389 mg/100 g, equivalent to 1 g salt. Compared with references, the median serving provided 31% of energy intake based on a 2000 kcal per day and contributed to carbohydrates (17-28%), dietary fibre (42%), protein (40%), total fat (48%), SFA (26%) and Na (54%). One serving provided 15-23% of the reference values for Ca, K and Mg, while higher contributions were found for Zn, Mn, P and Fe (30-67%). The ultra-processed plant-based burgers provide protein, dietary fibre and essential minerals and contain relatively high levels of energy, Na and total fats. The amino acid composition indicated low protein quality. The multifaceted nutritional profile of plant-based burgers highlights the need for manufacturers to implement improvements to better support healthy dietary habits, including reducing energy, Na and total fats.

Prevalence and risk factors related to anovular phenotypes in dairy cows.

The objective of the current study was to evaluate the relationship of body condition score (BCS) at 35 d in milk (DIM), milk production, diseases, and duration of the dry period with prevalence of anovulation at 49 DIM and then, specifically, with the prevalence of each anovular phenotype. We hypothesized that anovular follicular phenotypes, classified based on maximal size of the anovular follicle, have different etiologies. A total of 942 lactating Holstein cows (357 primiparous and 585 multiparous) from 1 herd had ovaries evaluated by ultrasonography at 35 ± 3 and 49 ± 3 DIM to detect the absence of a corpus luteum (CL), and to measure the diameter of the largest follicle. Cows were classified as cyclic at 49 DIM if a CL was observed in at least 1 of the 2 examinations, or anovular if no CL was observed at either examination. Cows considered anovular were divided into 3 groups based on the largest diameter of the largest follicle as follows: ranging from 8 to 13 mm, 14 to 17 mm, or ≥18 mm. Cows were evaluated for the following diseases: retained placenta, metritis, hyperketonemia, mastitis, lameness, respiratory problem, and digestive problem. At 35 DIM, BCS was determined, and milk yield for individual cows was recorded. A total of 28.5% (268/942) of cows were classified as anovular. Anovular cows had longer dry periods (90 vs. 71 d) and smaller BCS than cyclic cows (2.83 vs. 2.99). Cows with a single disease or multiple diseases had 2 and 3-fold increase in odds of being anovular, respectively. Anovular cows had follicles that ranged from 4 to 50 mm. The prevalence of anovular phenotype, among anovular cows, that had the diameter of the largest follicle ranging from 8 to 13 mm, 14 to 17 mm, and ≥18 mm was 29.9 (79/264), 37.5 (99/264), and 32.6% (86/264), respectively. Anovular cows with follicles of 8 to 13 mm had longer dry periods than those with follicles ≥18 mm (104 vs. 74 d), whereas anovular cows with medium size follicles had intermediate days dry (99 d). Cows with small and medium anovular follicles had smaller BCS and greater prevalence of multiple diseases than cyclic cows. For almost all risk factors, the cows with large anovular follicles (≥18 mm) were similar to cyclic cows and different from cows with smaller anovular follicles (8-13 mm). Thus, longer dry periods, less BCS at 35 DIM, and diseases were risk factors for anovulation. Moreover, the risk factors for the 3 distinct anovular follicle phenotypes differed.

Self-paced cycling performance and recovery under a hot and highly humid environment after cooling.

AIM: This study investigated the effects of pre- and post-cooling on self-paced time-trial cycling performance and recovery of cyclists exercising under a hot and highly humid environment (29.92 °C-78.52% RH). METHODS: Ten male cyclists performed a self-paced 20-min time trial test (TT20) on a cyclo-ergometer while being cooled by a cooling vest and a refrigerating headband during the warm-up and the recovery period. Heart rate, power output, perceived exertion, thermal comfort, skin and rectal temperatures were recorded. RESULTS: Compared to control condition (222.78 ± 47 W), a significant increase (P<0.05) in the mean power output during the TT20 (239.07 ± 45 W; +7.31%) was recorded with a significant (P<0.05) decrease in skin temperature without affecting perceived exertion, heart rate, or rectal temperature at the end of the TT20. However, pace changes occurred independently of skin or rectal temperatures variations but a significant difference (P<0.05) in the body's heat storage was observed between both conditions. This result suggests that a central programmer using body's heat storage as an input may influence self-paced time-trial performance. During the recovery period, post-cooling significantly decreased heart rate, skin and rectal temperatures, and improved significantly (P<0.05) thermal comfort. CONCLUSION: Therefore, in hot and humid environments, wearing a cooling vest and a refrigerating headband during warm-up improves self-paced performance, and appears to be an effective mean of reaching skin rest temperatures more rapidly during recovery.

Ankylosing spondylitis in nonhuman primates: the drill and the siamang.

Nonhuman primates are known to be susceptible to many of the arthritides that afflict humans. Psoriatic like spondyloarthropathies have been reported in gorillas and skeletal hyperostosis in gibbons, rhesus monkeys, and gorillas, and additional cases of both of these conditions occurring in drills (baboons) are noted in this report. One western lowland gorilla and two rhesus monkeys with clinical features consistent with ankylosing spondylitis have been documented previously. Two additional nonhuman primate species with radiographic evidence of ankylosing spondylitis are described. A siamang (gibbon) and two drills (baboons) with the classic radiographic features of ankylosing spondylitis, namely a bamboo spine and sacroiliac joint fusion, are reported.

A survey of prescribing practice of antipsychotic maintenance treatment for manic-depressive outpatients.

Survey questionnaires were mailed to public hospital psychiatrists practising in a French region to obtain information on the manic-depressive outpatients they personally followed up. Data were collected on 222 manic-depressive outpatients managed by 43 separate psychiatrists. More than two thirds were receiving at least one antipsychotic, and 17% were prescribed a depot-neuroleptic. Predictors of antipsychotic prescription were a history of psychotic features (OR = 3.4; 95%CI 1.7-6.9), early age at onset (OR = 2.1; 95%CI 1.0-4.8) and low educational level (OR = 3.1; 95%CI 1.5-6.3). Similar predictors were found for depot-neuroleptic prescription. Although these indicate that the prescription of antipsychotic for manic-depressive outpatients is not random, only 14% of patients were receiving mood stabilizers only. Owing to the potential side effects of antipsychotics, the benefit-to-risk ratio of antipsychotic use in the maintenance treatment of manic-depressive patients has to be carefully taken into account.

Seasonal patterns of strongyle infections in grazing sheep under the traditional production system in the region of Trikala, Greece.

Ten 4-month-old female sheep of the Karagouniko dairy breed were used to monitor the seasonal fluctuations of strongyle infections in sheep during the first year of grazing under the traditional production system in the region of Trikala, Greece, where control of nematodes is currently based exclusively on the frequent use of anthelmintics which might contribute to the appearance of anthelmintic resistance. The sheep grazed communal pasture plots and did not receive any anthelmintic treatment during the entire study period. Faecal egg counts (epg), plasma pepsinogen levels, blood values, and genera of parasitic strongyles recovered from coprocultures were recorded monthly. Mean epg for strongyle-type eggs were significantly higher during summer. Mean plasma pepsinogen levels were significantly higher during spring and summer. The genera of parasitic strongyles recovered from the faecal cultures were Haemonchus, Ostertagia, Trichostrongylus, Cooperia, Nematodirus, Oesophagostomum, and Chabertia. The percentages of larvae for Haemonchus, Ostertagia, Cooperia, and Oesophagostomum were significantly higher during winter. The percentages of larvae for Trichostrongylus were significantly higher during summer. During summer, levels of RBC, HGB, and HCT were depressed and levels of MCV, MCH, and MCHC were elevated. Mean epg for strongyle-type eggs had a significant inverse correlation with RBC, HGB, HCT, and positive correlation with MCH, MCHC, and percentages of eosinophils in differential leucocyte counts. The seasonal pattern of infection observed in the present study indicates that it is possible to decrease the number of treatments to one per year, thus, reducing the possibility for the appearance of anthelmintic resistance.

Prediction of duration of psychosis before first admission.

SUMMARY OBJECTIVE: To assess the factors predicting the delay between onset of psychotic symptoms and first admission in a population-based sample. METHOD: The duration of psychosis before admission was ascertained in a standardised way for 59 consecutively first-admitted patients presenting with psychotic symptoms. RESULTS: The median of the duration of psychosis before admission was 3 months (interquartile range 0.5-14). A delay ? 3 months was independently predicted by family history of psychiatric hospitalisation (odds ratio [OR] = 12.1, 95% confidence interval [CI] 1.15-97.0, P = 0.02), low educational level (OR = 7.7, 95% CI 1.0-50.0, P = 0.05), poor global adjustment in the preceding year (OR = 0.93, 95% CI 0.86-0.99, P = 0.04), and by greater global seventy of illness at admission (OR = 4.0, 95% CI 0.87-18.3, P = 0.07). CONCLUSION: As these factors are also known to predict poor outcome, our results suggest that the association between duration of untreated psychosis and poor prognosis may be mediated, at least in part, by such demographic and clinical variables. (c) 1998 Elsevier, Paris.

Declining mortality in international sterilization services.

Between 1973 and 1988, AVSC supported 1,516,478 female sterilizations and 401,856 vasectomies in 50 countries. Overall, 73 deaths were attributable to voluntary sterilization procedures (yielding mortality rates of 4.7 deaths per 100,000 female sterilizations and 0.5 per 100,000 vasectomies). Causes of death, in order of frequency, were anesthesia (22), intestinal injury (20), infection (19), intra-abdominal hemorrhage (6) and other (6). The female sterilization mortality rate declined from 7.1 per 100,000 procedures in 1973-1981 to 3.7 per 100,000 in 1982-1988. Safer anesthesia practices and improved infection control contributed most to this decline. The mortality rate related to surgical errors declined proportionately less than the rates related to anesthesia and infection. Contraceptive sterilization has become a very safe procedure in these 50 countries, where anesthesia (local and general), surgical technique (minilaparotomy and laparoscopy) and timing of the procedure (interval and postpartum) vary substantially. Future deaths will probably be rare. However, expert surgeons should review each case because identifying the most likely cause of death is always complex and these analyses help shape surgical contraception practices.

EPA in the prevention of restenosis post PTCA.

The effect of fish oil on restenosis was evaluated in patients undergoing coronary balloon angioplasty. In addition to routine pharmacotherapy, subjects were given 2.8 g of eicosapentanoic acid (EPA) daily. Treatment was started within twenty-four hours after successful percutaneous transluminal coronary angioplasty (PTCA). After six months of therapy, participants were subjected to coronary arteriography, exercise scintigraphy, exercise electrocardiography, or clinical evaluation. Follow-up evaluation involved 97 coronary lesions in 85 patients. Partial or significant restenosis occurred in 36.5% of patients and 33% of vessels. The presence of severe stenosis before PTCA, dissection, thrombus, multilesion PTCA, and template bleeding time values were not correlated with restenosis. Dilation of the left anterior descending (LAD) and a residual stenosis greater than or equal to 35% were associated with restenosis. Approximately 20% of the patients related difficulty in taking the fish oil. Furthermore, these results show no advantage over expected restenosis rates.

The international medicolegal status of sterilization for mentally handicapped people.

PIP: Civil libertarians and other conservatives who are interested only in protection against involuntary sterilization argue that a mentally incompetent individual is incapable of ever giving an informed consent. Yet, other liberal thinkers and those who are interested in reproductive freedom for all sexually mature persons maintain that no group of persons should be categorically denied the benefits of sterilization. Rather than clarify, the laws tend to confuse. In most countries, legislation pertaining to voluntary sterilization is nonexistent or nonspecific. Where laws exist, they appear to fall into 3 groups: one group permits consent for surgical treatment to be given by the parents or guardians of incompetent persons without apparent regard to the wishes of the individual; another group considers eugenic sterilization to be legal; and the 3rd group takes into account the probability that there is serious limitation in the capacity of the person concerned to care for a child. In the U.S. 24 states have laws providing for some form of sterilization of persons suffering from mental disorders. The statutes vary in their provisions with some distinguishing between mental illness and mental retardation and others failing to do so. Some laws allow relatives, guardians, physicians, welfare boards or others to initiate sterilization proceedings. Only Colorado allows the mentally retarded individual to petition for his/her own sterilization. The U.S. Department of Health and Human Services was unable satisfactorily to come to terms with the difficult question of sterilization for mentally incompetent persons. The department was not willing to establish a mechanism that would permit some sterilizations under proper safeguards. It chose, instead, to ban all federal funds for programs or projects that would provide sterilization for persons who have been declared mentally incompetent by a court. The department's intention was to protect people from involuntary sterilization, but the unintended effect is also to deny others access to sterilization. From the legal perspective, the most pressing issue is how to ensure that any decision to be sterilized is both informed and unpressured. The purpose and effect of a voluntary sterilization law should be to permit sterilization to be used by all adults who are capable of giving informed consent and who request the procedure. Consent is the central legal issue, and the Association for Voluntary Sterilization model statute authorizes only voluntary sterilization. This model statute permits sterilization after the person requesting it has received counseling and has given consent in writing.^ieng

Counseling for sterilization.

PIP: The standards of the Department of Health and Human Services (DHHS) regarding the provision of sterilization services fail to deal with the need for professionally trained sterilization counselors to present the medical, social, and related information in a manner that prospective patients can understand and retain. Sterilization patients require counseling by a person who is competent, experienced, warm, and supportive of their decision. A good counselor will remain non-judgmental and objective. A counseling session with a prospective sterilization patient should have the following specific objectives: help the woman understand her feelings about birth control, pregnancy, abortion, and possible relationships between sexuality and reproductive capacity; help her understand her own reproductive anatomy and physiology; help her understand the sterilization procedure and what she can expect to experience; help her project her thoughts to the future to see if she can think of any life situation in which she might want to become pregnant; and fulfill the legal requirements for obtaining informed consent. The direction and consent of any interview will be influenced by several factors, such as marital status or lifestyle of the prospective candidate. The ideal situation for postpartum sterilization would include counseling and arrangements made long before the onset of labor. Specialized counseling is also valuable when delivery is to be by cesarean section, for in these instances a last minute change of plan is not possible. If female sterilization is to be performed under local anesthesia, the patient should be prepared for the possible discomfort or actual pain that might occur. The counselor also needs to be alert to indications of a special need for in-depth discussion. Such indications include the individual who has a physical, mental, or emotional condition that would be improved by sterilization. Any evidence of coercion should be regarded as a contraindication to sterilization. Those persons depending on possible reversal of sterilization require special attention, but old restrictions on voluntary sterilization based on age and parity should be discarded. A counselor is obligated to present the arguments against successful reversal in individual cases while making it clear that reversals are increasingly successful. Good counseling does much to eliminate regret or at least reduces it to an absolute minimum.^ieng

A serologic survey of the island fox (Urocyon littoralis) on the Channel Islands, California.

The island fox is listed as a threatened species in California. A serologic survey of 194 island foxes (Urocyon littoralis) was conducted over the entire range of the species on the Channel Islands (California, USA). Antibody prevalence against canine adenovirus and canine parvovirus reached 97% and 59%, respectively, in some populations sampled. Antibody prevalence of canine herpesvirus, canine coronavirus, leptospirosis and toxoplasmosis were low. Antibodies against canine distemper virus were not detected.

Epidemiologic and pathologic aspects of an epizootic of malignant catarrhal fever in exotic hoofstock.

An epizootic of malignant catarrhal fever (MCF) occurred at the Los Angeles Zoological Park which resulted in the deaths of four exotic ungulates. The source of infection was considered to be a newly purchased wildebeest bull (Connochaetes taurinus taurinus) that had been negative for antibody to MCF virus by an indirect immunofluorescent test. The need to re-evaluate regulations for the transportation and housing of young wildebeest is emphasized by this MCF outbreak. The diagnostic technology now available for identifying asymptomatic carriers of MCF virus and the present understanding of the behavior and pathogenesis of this highly cell-associated herpesvirus in exotic ruminants should provide a basis for the prevention and control of MCF in zoological parks.

Immobilization and physiological parameters associated with chemical restraint of wild pigs with Telazol and xylazine hydrochloride.

We used a combination of Telazol (3.3 mg/kg) and xylazine hydrochloride (1.6 mg/kg to immobilize 144 wild pigs (Sus scrofa) with blow darts. This drug combination was safe and effective for rapidly immobilizing animals ranging in size from 34 to > 170 kg and avoided difficulties associated with hand injections. For 123 single injection immobilizations, mean (+/- SD) induction times and effective handling periods averaged 5 (+/- 2.5) and 52 (+/- 18) min, respectively, and animals generally recovered for release within 120 min of initial injections. Animals that required two injections to immobilize (n = 21) received lower initial doses of Telazol and xylazine hydrochloride than those immobilized with a single injection because of errors in estimating body sizes; we found that there was a threshold dose required to immobilize wild pigs from 2.8 to 3.3 mg/kg Telazol and 1.4 to 1.6 mg/kg xylazine. Although neither age or sex influenced immobilization parameters, animals in good condition required longer to recover than those in poor condition. However, animals immobilized with two injections recovered as rapidly as those immobilized with a single injection. Heart rates and body temperatures declined slightly during the immobilization period, but respiration rates and blood oxygen saturation levels remained stable. In general, single injection immobilizations were preferable because they minimized problems associated with injecting partially immobilized animals. because it was difficult to accurately estimate the sizes of large wild pigs (> or = 90 kg), and because wild pigs that were partially immobilized were difficult to handle, we recommend increasing the drug doses to 4 mg/kg Telazol and 2 mg/kg xylazine hydrochloride when injecting relatively large animals to assure single injection immobilizations. Although recovery periods may be prolonged, higher doses of Telazol and xylazine should be safe based on data from domestic pigs.

A digital image analysis and neural network based system for identification of third-stage parasitic strongyle larvae from domestic animals.

A competitive learning vector quantization artificial neural network (ANN) was trained to identify third-stage parasitic strongyle larvae from domestic animals on the basis of quantitative data obtained from processed digital images of larvae. For this reason, various quantitative features obtained from processed digital images of larvae were tested as to whether they are variant or invariant to the shape taken by the motile larvae during image recording. A total of 255 images of 57 individual larvae in various shapes belonging to five genera were recorded. Following image processing, 16 features were measured, of which seven were selected as invariant to larva shape. By trial and error, two of those features, 'area' and 'perimeter', along with the quantitative features used in conventional identification, 'overall body length', 'width' and 'extension of sheath' (tip of larva to tip of sheath), were used as an effective training data set for the ANN. This ANN coupled with an image analysis facility and a knowledge relational database became the basis for developing a computer-based larva identification system whose overall identification performance was 91.9%. The advantages of this system are its speed and objectivity. The objectivity of the system is based on the fact that it is not subject to inter- and intra-observer variability arising from the user's profile of competency in interpreting subjective and non-quantifiable descriptions. The limitations of the system are that it cannot handle raw images but only data extracted from images, its performance depends on the reliability of the input vectors used as training data for the ANN, and its use is restricted only to well-equipped laboratories due to its requirement for expensive instrumentation.

[Predictive factors of suicide? an 8-year-long prospective longitudinal study of 200 psychiatric inpatients]. / Les facteurs prédictifs du suicide: étude prospective sur 8 ans de 200 patients hospitalisés en psychiatrie.

Suicide is the most dramatic complication of psychiatric disorders. Certain risk factors are generally accepted by practitioners. Mental disorders increase (tenfold) suicidal risk. However, this "statistically rare event" renders very difficult the definition of predictive factors. A personal prospective longitudinal study of 200 psychiatric inpatients followed up during an 8-year period found 5% of deaths by suicide. Amongst the various risk factors reputed predictive for suicide, only 2 were found statistically more frequent in the suicidal group: familial antecedents (1st degree relatives) of suicide and hospitalization in psychiatry. Impulsivity was also more frequent but could be imputed to the younger age of the suicide victims. Therefore, it was impossible to find determinants of suicide. This makes difficult preventive measures, excepted that psychiatric patients are at a much greater risk and should be diagnosed and correctly treated. There are also increasing legal aspects of responsibility for psychiatrists and psychiatric institutions in charge of these patients.

[Prognosis of short-term outcome in the first admission for psychosis]. / Pronostic à court terme lors de la première hospitalisation pour trouble psychotique.

The aim of the study was to assess the factors predicting the clinical and therapeutic outcome at discharge of first hospitalization in a population-based sample of patients presenting with psychotic symptoms. Factors predicting duration of the first hospital stay were examined using Cox proportional hazard regression. A family history of psychiatric hospitalization was the only variable independently predicting at trend level a longer hospitalization (HR = 0.54, 95% CI 0.28-1.07, p = 0.08). Since most subjects (92.5%) returned to an independent place of residence in the community after the hospital stay, factors predicting residential outcome were not assessed. Factors associated with persistence of psychotic symptoms, or prescription of antipsychotic drugs, at discharge, were examined using logistic regression models. Persistence of psychotic symptoms (whatever their intensity) was associated with a diagnosis of schizophrenia broadly defined (OR = 23.9, 95% CI 2.8-201.7, p = 0.003), with poor adjustment in the preceding year as measured by the Global Assessment of Functioning (GAF) scale (OR = 0.93, 95% CI 0.87-0.99, p = 0.04), and, at trend level, with older age at admission (OR = 1.1, 95% CI 0.99-1.21, p = 0.07). Prescription of antipsychotic drugs at discharge was independently predicted by low educational level (OR = 5.5, 95% CI 1.2-25.4, p = 0.03), low GAF score (OR = 0.94, 95% CI 0.90-0.99, p = 0.05), and, at trend level, by a diagnosis of schizophrenia broadly defined (OR = 4.1, 95% CI 0.80-23.4, p = 0.09). Univariate analyses showed that duration of psychosis before first admission was strongly associated with persistence of psychotic symptoms and with prescription of antipsychotic drugs at discharge. However, no association was found between duration of psychosis and outcome after adjustment.

[Evaluation of the incidence of hospitalization of patients with psychotic disorders]. / Evaluation de l'incidence hospitalière des troubles psychotiques.

The aim of this study was to assess the administrative incidence of psychotic disorders, i.e. the incidence of first hospitalization for such disorders. Consecutively first-admitted patients hospitalized in 4 departments of Bordeaux's psychiatric hospital were included. Patients fulfilled the following inclusion criteria: no previous psychiatric hospitalization; aged 60 years or less; at least one overt psychotic symptom; clear consciousness. Patients were drawn from a 250,000 inhabitants urban catchment area, with an at risk population of 161,698 inhabitants. DSM IV diagnoses were made using the Mini International Neuropsychiatric Instrument (MINI) as well as all available information collected from the patient, the relatives, and from any other informant. A complementary study was performed in the private psychiatric institutions and in the military Hospital of Bordeaux in order to assess the representativeness of the patients hospitalized in the state hospital. 59 patients were included during one year in the state hospital. The raw incidence rate was 0.37 per 1,000 (95% CI; 0.28-0.46). We used a direct standardization on age to calculate the incidence rates ratio to gender. Men were over-representated in the sample, with a standardized incidence ratio in men compared to women equal to 1.87 (95% CI; 1.25-2.8). Psychotic mood disorders had the highest incidence, with an incidence rate equal to 0.15 per 1,000 inhabitants (95% CI; 0.09-0.21). The incidence rate of DSM IV schizophrenia was lower than that of psychotic mood disorders, and was equal to 0.13 per 1,000 (95% CI; 0.08-0.18). Several studies conducted in European and North-American countries have recently suggested that the incidence of schizophrenia may have decreased in the past decades. Since few French studies on the incidence of such disorders have been carried out, it is not possible to assess whether the incidence of schizophrenia is or not decreasing in France. Further studies on the incidence of psychotic disorders are required in other French regions in order to assess the reproductibility of our results, and to have reference data on the incidence of psychotic disorders in the nineties.

Complications of vasectomies in the United States.

Physicians in the United States were surveyed in 1983 to gather information concerning the number of vasectomies they performed in 1982 as well as their use of anesthesia and complications of those vasectomies. Most urologists performed vasectomies, whereas family physicians and general surgeons were less likely to do so. As expected, most physicians used local anesthesia, occasionally in combination with a sedative; however, 22 percent of physicians reported using general anesthesia for at least some vasectomies. Complication rates were in the ranges reported by previous case series. Physicians who performed between one and ten vasectomies in 1982 had higher rates of hematoma and hospitalization for treatment of a complication than physicians who performed more vasectomies. Maintenance of surgical skills appears to be important in preventing complications of this usually low-risk procedure.