We developed the Quality of Contraceptive Counseling (QCC) Scale to improve measurement of client experiences with providers in the era of rights‐based service delivery. We generated scale items drawing on the previously published QCC Framework and qualitative research on women's preferences for counseling in Mexico, and refined them through cognitive interviews (n = 29) in two Mexican states. The item pool was reduced from 35 to 22 items after pilot testing using exit interviews in San Luis Potosí (n = 257). Exploratory Factor Analysis revealed three underlying dimensions (Information Exchange, Interpersonal Relationship, Disrespect and Abuse); this dimensionality was reproduced in Mexico City (n = 242) using Confirmatory Factor Analysis. Item Response Theory analyses confirmed acceptable item properties in both states, and correlation analyses established convergent, predictive, and divergent validity. The QCC Scale and subscales fill a gap in measurement tools for ensuring high quality of care and fulfillment of human rights in contraceptive services, and should be evaluated and adapted in other contexts.

BackgroundClient-centered contraceptive counseling is critical to meeting demand for contraception and protecting human rights. However, despite various efforts to optimize counseling, little is known outside of the United States about what individuals themselves value in counseling. In the present study we investigate women’s preferences for contraceptive counseling in Mexico to inform efforts to improve service quality.MethodsWe conducted applied qualitative research, using six focus group discussions with 43 women in two cities in Mexico with distinct sizes and sociocultural contexts (Mexico City and Tepeji del Río, Hidalgo) to assess contraceptive counseling preferences. We used a framework approach to thematically code and analyze the transcriptions from focus groups.ResultsConsistent with quality of care and human rights frameworks for family planning service delivery, participants expressed a desire for privacy, confidentiality, informed choice, and respectful treatment. They expanded on usual concepts of respectful care within family planning to include avoidance of sexual assault or harassment—in line with definitions of respectful care in maternal health. In contrast to counseling approaches with method effectiveness as the organizing principle, participants preferred counseling centered on personalized assessments of needs and preferences. Many, particularly older, less educated women, highly valued hearing provider opinions about what method they should use, based on those personalized assessments. Participants highlighted the necessity of clinical assessments or physical exams to inform provider recommendations for appropriate methods. This desire was largely due to beliefs that more exhaustive medical exams could help prevent negative contraceptive outcomes perceived to be common, in particular expulsion of intra-uterine devices (IUDs), by identifying methods compatible with a woman's body. Trust in provider, built in various ways, was seen as essential to women's contraceptive needs being met.ConclusionsFindings shed light on under-represented perspectives of clients related to counseling preferences. They highlight specific avenues for service delivery improvement in Mexico to ensure clients experience privacy, confidentiality, informed choice, respectful treatment, and personalized counseling—including around reasons for higher IUD expulsion rates postpartum—during contraceptive visits. Findings suggest interventions to improve provider counseling should prioritize a focus on relationship-building to foster trust, and needs assessment skills to facilitate personalization of decision-making support without imposition of a provider's personal opinions. Trust is particularly important to address in family planning given historical abuses against women’s autonomy that may still influence perspectives on contraceptive programs. Findings can also be used to improve quantitative client experience measures.

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IntroductionJourneys have been considered life-changing experiences since the first chronicles of humanity. Interest towards the relationship between travels and mental illness started off with the publication, in 1897, of Les aliénés voyageurs.Case reportWe report the case of a 52-year-old gentleman, married and without children, who works as a couch driver and has no past medical records. During a holiday trip, at his arrival to Saint Petersburg, he first experienced haze and cognitive and memory failures, along with malaise and sweating. The day after, while visiting the Hermitage museum, he underwent forthright auditive hallucinations, diffusion of thought phenomena and harm delusions. After ruling out diagnosable organic causes through CT scan, MRI and blood analyses including immunologic studies, he was put on olanzapine 10 mg/day with total symptomatic remission within 2 weeks.DiscussionStendhal syndrome, described back in 1989 by Dr. Magherini, refers to anxious, somatic and psychotic symptoms affecting tourists who visit Florence. The celebrated author, himself, experienced intense emotions due to an overdose of beauty at the Italian city. Further clinical pictures related to journeys include Jerusalem Syndrome and Way of Saint James Syndrome. Another entity, Paris Syndrome, differentially affects Japanese visitors, disappointed with the actual experience of visiting the French city.ConclusionDuring journeys, people often abandon everyday life in order to open up to unknown sights and feelings. These can eventually, lead to certain sorts of mental illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Catatonia is a rare but potentially lethal neuropsychiatric syndrome. Despite its historical association with schizophrenic disorders, it is more frequent in affective ones, and is currently considered an independent pathological entity. The basis of the treatment, regardless of the cause, is the use of benzodiazepines and electroconvulsive therapy (ECT), without a clear consensus on the combined treatment. Regarding ECT, the frequency and number of effective sessions has not been clearly established. Therefore, clinical evolution is the main factor to be considered in order to determinate the appropriate treatment regimen, although the daily application of ECT is preferred, at least for the first week. We report the case of a 41-year-old patient with paranoid schizophrenia, who presented with a benzodiazepine resistant catatonic syndrome. The clinical picture included stupor, mutism, negativism, severe stiffness, catalepsy, waxy flexibility and diaphoresis, with slight CPK increase but with no other extrapyramidal symptoms, fever more than 39 and hemodynamic instability, which allowed to exclude a neuroleptic malignant syndrome. A blood analysis, lumbar puncture, CT, EEG and viral serologies were performed with inconclusive results. The patient required ICU admission and ECT treatment and we used the Bush-Francis Catatonia Rating Scale to evaluate the evolution of symptoms. Six daily treatments with ECT led to an almost full recovery of the patient. Further case series regarding the clinical management of this syndrome are needed, in order to reach consensus on an effective ECT regimen.Disclosure of interestThe authors have not supplied their declaration of competing interest.