[Labor migration in Venezuela]
This report, which is concerned with labor migration affecting Venezuela, is one in a series done under a joint project of the Organization of American States (OAS), the Spanish government, and the Intergovernmental Committee on Migration. The first part of the present study covers Venezuelan migration from colonization to the end of the nineteenth century. The second part deals with 1900-1945, a period of oil boom, agricultural stagnation, and rural exodus. The third part covers 1946-1959 and the massive postwar immigration. The fourth section deals with internal and international migration during the 1960s. In the fifth part, the situation during the 1970s is discussed, including the impact of changes in oil prices, the effects of alien immigrants on Venezuelan society, and labor migration policy.
This report, which is concerned with labor migration affecting Colombia, is one in a series done under a joint project of the Organization of American States (OAS), the Spanish government, and the Intergovernmental committee on Migration. The first part deals with immigration into Colombia. The second part concerns internal migration, urbanization, the rural exodus, unemployment, and the emigration of Colombians to Venezuela and the United States. The third part deals with frontier migration and labor markets for frontier colonization, commercial cultivation, and urbanization. The fourth part concerns policies affecting labor migration.
This report, which is concerned with labor migration affecting Chile, is one in a series done under a joint project of the Organization of American States (OAS), the Spanish government, and the Intergovernmental Committee on Migration. The first part deals with socioeconomic development and regional demographic comparisons. The second part concerns internal migration. The third part deals with immigration into Chile between 1800 and 1970. The fourth part covers emigration from Chile, especially to Argentina and the United States, and includes information on occupational characteristics and the labor force.
[Labor migration in Argentina]
This report, which is concerned with labor migration affecting Argentina, is one in a series done under a joint project of the Organization of American States (OAS), the Spanish government, and the Intergovernmental Committee on Migration. The first part is concerned with the two main sources of immigration into Argentina--Europe and neighboring countries in Latin America. The rest of the report deals with immigration from neighboring countries and includes consideration of the role of immigrants in the labor force in Argentina and in their countries of origin. Present-day Argentine immigration policy is briefly considered. Finally, the overall situation in the 1970s is discussed, and projections for the 1980s are offered.
This report, which is concerned with labor migration affecting Peru, is one in a series done under a joint project of the Organization of American States (OAS), the Spanish government, and the Intergovernmental Committee on Migration. The first part deals with immigration into Peru between 1849 and 1972. The second part concerns emigration from Peru. Peruvian emigration is compared with that from other Latin American countries, with particular emphasis on occupations and destinations. (ANNOTATION)
[Census of population of Ireland, 1981. Vol. 6: Irish language]
Final results from the 1981 census of Ireland are presented concerning the Irish language. Retrospective data from 1861 are included. The data are presented by province, county, and county borough. Special data are included for the Gaeltacht areas, where the language has a special status. (ANNOTATION)
The Arab population of Israel, 1950-1980
Some basic demographic information concerning the Arab population of Israel is presented. Consideration is given to trends over the past 30 years and to forecasts for the future. Data are from official Israeli sources. (ANNOTATION)
The decline in coronary heart disease (CHD) mortality that occurred in the United States between 1968 and 1981 is analyzed. The author notes that CHD mortality declined over this period at a rate averaging about three percent annually and involved all sectors of the population defined by age, sex, race, and region. The author attributes this decline to the successful development of public health policy that has brought about changes in life-style affecting diet, smoking behavior, and exercise, particularly among the more affluent sectors of the population. The impact of improved medical and surgical techniques is also considered.
Coronary heart disease mortality trends and related factors in Australia
"Coronary heart disease (CHD) has been the greatest single cause of mortality in Australia over the past 30 years. For most age and sex groups CHD mortality rates peaked in 1965-67. Since that time, rates have decreased by nearly 40% and are currently the lowest for 30 years." Variations in CHD mortality by region, place of birth, and socioeconomic status are noted. The impact of changes in life-style, including diet and smoking, and in medical techniques are analyzed. (EXCERPT)
Coronary heart disease mortality, morbidity, and risk factor trends in New Zealand
"Coronary heart disease (CHD) mortality rates [in New Zealand] declined by 22 and 13% for European men and women respectively between 1968 and 1981. Data from two methodologically identical population-based registers indicate that in the period 1974-1981 there was no change in either the event rates or case fatality rates of definite myocardial infarction. In the same period there was a significant 17% decline in the sudden death event rates." The factors associated with these declines are considered, including a decrease in consumption of dairy products, a reduction in cigarette smoking, improved control of hypertension, and possibly a lowering of cholesterol levels and an increase in physical activity. "There have also been improvements in the medical management of patients with CHD although this appears to be of secondary importance in contributing to the decline in CHD mortality." (EXCERPT)
Trends in coronary heart disease mortality and morbidity and related factors in Finland
"A marked increase in the coronary heart disease (CHD) mortality of working-age men and women occurred in Finland from the 1950s until the 1960s. Around the year 1970, CHD mortality started to decline and this decline still continues. In the age group 35-64 years the average annual decline of CHD mortality in the 1970s was 1.8% for men and 3.4% for women. Limited data available on trends in CHD morbidity show that the decline in CHD mortality is accompanied by a decline in the incidence of non-fatal myocardial infarction." Geographical variations in CHD mortality are discussed. The authors note parallel changes in fat consumption, cholesterol levels, smoking among men, control of hypertension, and medical care. They suggest that changes in life-style and medical care are jointly responsible for the downward trend in CHD mortality. (EXCERPT)
Evolution of coronary heart disease mortality from 1958 in Belgium
"Coronary heart disease (CHD) mortality [in Belgium] increased during the 1950s and 1960s but then showed a steady decline over time, starting in 1970. The author reviews the evidence relating this decline in CHD mortality to a favourable evolution of the major coronary risk factors." (EXCERPT)
Trends in coronary heart disease mortality and related factors in Israel
Changes in mortality from coronary heart disease (CHD) among Jews in Israel between 1975 and 1979 are analyzed. The authors note a sharp decline in mortality from this cause among both males and females. These changes have been associated with changes in medical technology and health care, but no changes in serum cholesterol levels, cigarette smoking, or dietary habits are noted. There is, therefore, no evidence that changes in life-style have affected CHD mortality. (ANNOTATION)
Coronary heart disease mortality trends and related factors in Poland
"The reported data point to a clear trend of increasing coronary heart disease (CHD) mortality in Poland with a tendency toward its reduction in recent years. The mortality is higher in urban than rural areas, but the increase has been greater in the rural population, especially in males. Recent reduction in the trend of increasing mortality has not been found in middle-aged men and women. The trend showed a correlation with changes in the levels of risk factors, especially in the usual diet consumed by the population. The authors suggest that the increased mortality is due to an increased incidence of CHD." (EXCERPT)
An enquiry into the two basic assumptions of multistate increment-decrement life tables
The two basic assumptions of population homogeneity and Markovian behavior on which multistate methodology is based, including that used in increment-decrement life tables, are examined. "This paper enquires into the nature of the Markovian condition from the point of view of Stochastic Processes and brings into focus an important point: In order to make the multistate model more realistic, one has necessarily to take into account the distinction between the two concepts of population homegeneity and the Markovian condition and consequently distinguish between the implications of relaxing the one as opposed to the other." The authors then relax the homegeneity assumption and categorize the population, "with each category following its own Markov process. And it is shown that the sum of the categorized state transition probability matrices, when weighted by status-wise population proportions, yields the probability matrix of the total population. Two complementary procedures are given to illustrate that the sum of Markov processes could yield another Markov process." Finally, the authors suggest a line of distinction between the two conceptually overlapping assumptions. (EXCERPT)
Handbook of indirect methods for mortality estimation
"This Handbook aims at providing detailed operational steps in the application of four of the indirect methods of mortality estimation: Orphanhood, Widowhood, Census survivorship and Deaths Distribution methods. Each of these is dealt with in a separate chapter giving details of data required, underlying assumption, and operational steps involved." (EXCERPT)
Mortality, survivorship and longevity in American Samoa, 1950 to 1981
The relationship between changes in life-styles and cause-specific mortality in American Samoa from 1950 to 1981 is examined. The emphasis is on the effects on mortality of a growing reliance on manufactured products and Western health products. The data are from official sources and a six-year longitudinal study of approximately 5,800 individuals. The results indicate that changes in Samoan life-styles have been associated with only moderate changes in mortality from cardiovascular disease and cancer. A relationship between modernization and mortality from infections, diabetes, and trauma is also noted. The author concludes, however, that body weight and obesity are not risk factors for death among American Samoans. This work was prepared as a doctoral dissertation at Pennsylvania State University, University Park, Pennsylvania.
The results of a study on the relationships among maternal age, parity, and perinatal mortality are presented. The data concern all singleton live births and fetal deaths of 24 completed weeks of gestation or greater in New York City from 1976 to 1978 and are from vital statistics kept by the Department of Health. Perinatal mortality is divided into four components "late fetal deaths that occurred before labor (late antepartum fetal deaths), fetal deaths during labor (intrapartum fetal deaths), neonatal deaths, and perinatal deaths attributed to congenital anomalies, and...the relation of each of these to maternal age and parity [is assessed], controlling for relevant confounding factors." The results indicate that "1) increasing maternal age was strongly associated with antepartum fetal deaths but not with intrapartum fetal deaths, while older maternal age was also associated with perinatal deaths attributed to congenital anomalies; 2) high parity bore a strong relationship to intrapartum fetal deaths, but none to antepartum fetal deaths, neonatal deaths, or congenital anomaly deaths; and 3) for neonatal death, there was a statistically significant...interaction between parity and age such that mothers over 34 years old having their first birth were at especially high risk." (EXCERPT)
Neonatal and postneonatal mortality rates: are we sacrificing quality for simplicity?
Official data concerning period- and cause-specific infant mortality rates for U.S. whites for the years 1941-1979 are analyzed in order to show that neonatal and postneonatal mortality rates are not accurate approximations of endogenous and exogenous infant mortality rates. "Use of cause-specific rates [is] shown to be more accurate than period-specific rates....Reasons behind the reduced dominance of endogenous causes and the increased dominance of unknown causes of death are explored, and possible future contributions of preventive versus curative health care are presented." (EXCERPT)
An annotated bibliography of U.S. scholarship on the history of the family
This is an annotated bibliography of selected works by U.S. scholars on family history. It includes journal articles, books, and unpublished papers. The material covered is primarily published since 1970, with emphasis on the period since 1975, and is organized by subject. Sections are included on family and household structure and composition; marriage; the life cycle; and sexuality, birth, death, and migration. The works cited are from a variety of fields of study, including history, sociology, anthropology, economics, and women's studies. The primary geographical focus is on the United States; however, items on other countries are included. There is an author index.
[Naturalization in the Netherlands, 1860-1984]
Trends in naturalization in the Netherlands from 1860 to 1984 are reviewed. The procedures for obtaining Dutch nationality are described, and the nationalities of those obtaining Dutch nationality in the period since World War II are examined. (summary in ENG) (ANNOTATION)
Estimates of the population of Canada are provided by age, sex, marital status, and province or territory. Data are also included by age and sex on the components of population growth, including births, deaths, and international and internal migration. The data on marriage and divorce provide an insight into current structural changes in marital status. (ANNOTATION)
Mortality in Italy: contours of a century of evolution
The authors construct contour maps of Italian male and female mortality rates for ages 0-79 for the years 1870-1979 using life table data from published sources. The maps "display persistent global and prominent local patterns of mortality, simultaneously over age, by period, and for cohorts." Previously documented aspects of the evolution of Italian mortality are highlighted graphically, and new areas for study are indicated. (summary in FRE, ITA) (EXCERPT)
[Some aspects of recent trends in mortality in Algeria (1965-1981)]
Using data from the official vital statistics register and from a three-round survey that was conducted in 1969-1970, the author calculates mortality estimates for Algeria for the years 1965-1981. The findings show "a period of fluctuations between 1965 and 1975, [during which] mortality between the age of five and young adult age experienced a deterioration which could [have been] the result of an increase of deaths due to accidents. Since 1976, mortality has decreased spectacularly, although all ages do not benefit from this decrease in the same way." (summary in ENG, ITA) (EXCERPT)
[The status of women and fertility: the experience of developed countries]
The author critically examines recent studies that have cited various changes in women's status in developed countries as the cause of changes in the number of children desired. It is suggested that "the number has decreased as a consequence of the social pressures tending to limit the total fertility of women so as to be compatible with the new behaviour patterns of an industrialized society." (summary in ENG, ITA) (EXCERPT)
[Census of population, October 20, 1985. Preliminary cable results]
Preliminary results are presented from the 1985 census of Turkey. Data are included on population by province and district for 1980 and 1985 and on rates of population growth. Data for provincial and district capitals are also included. (ANNOTATION)
Population and housing census 1980. Vol. VI: fertility, union status, marriage
This is one in a series of reports presenting the final results of the 1980 census of Trinidad and Tobago. This report includes data on population 14 years and over by sex, age group, and marital status; women aged 14-64 by union status, age group, and number of children ever born; and women with children born in the year preceding the census. The data are presented for major and minor administrative divisions. (ANNOTATION)
Report on the results of the 1981 Demographic Survey
These are the results of a national demographic survey carried out in 12 regions of Ethiopia in 1981. Data are presented on total population estimates by sex, sex ratio, age and sex distribution, and reported and adjusted vital rates. (ANNOTATION)
[Territory of French Polynesia: results of the population census, October 15, 1983]
Results from the 1983 census of French Polynesia are presented. The report consists of an analysis of the data, followed by statistical tables. Separate consideration is given to the overall results, housing, residence characteristics, households, and population characteristics. (ANNOTATION)
Results from the 1981 census of Belgium concerning nationality are presented. Separate sections are included on a general overview; foreigners by nationality, sex, and place of residence; age distribution; and marital status. The data are presented for the whole country, regions, provinces, and smaller administrative districts, excluding communes. (ANNOTATION)
Results from the 1981 census of Belgium concerning nationality are presented. Data are included on the foreign population by sex, marital status, age group, and country of origin, and are presented by commune. (ANNOTATION)
Private organizations in the population field
This is a selective list of private organizations active around the world in various aspects of population issues. "It includes those private organizations with a primary focus on U.S. or international population trends, family planning programs, and reproductive rights, as well as some health, environmental, and development organizations which have significant population components." The list is arranged alphabetically and includes addresses and a one-paragraph description of activities and areas of interest. (EXCERPT)
Recent changes in the U.S. age at death distribution: further observations
This article is a response to a critique by J. F. Fries of an earlier article by the same authors on changes in the distribution of ages at death in the United States. The focus is on the relationship between life expectancy and the biological bounds on the human life span. (ANNOTATION)
[Regional trends in modern cohabitation: methodology and results]
This is one in a series of progress reports from a research project on the life cycle of women in modern Sweden from 1936 to 1960. In the present paper, regional variations in the frequency of consensual union in Sweden are reviewed, and changes over time are described. The author notes that consensual unions have played an important role in Sweden, particularly in the past few decades. Regional data are presented on cohabitation, marriage, adolescent childbearing, and cohabitation leading to marriage. (ANNOTATION)
[The population of Western Europe: reproduction, migration, settlement, and occupations]
Population developments in Western Europe during the second half of the twentieth century are reviewed. Topics covered include trends in population growth, internal and international migration, the development of settlement systems, and utilization of labor resources. The analysis is conducted at three levels: for the region as a whole, for individual countries, and for regions within countries. (ANNOTATION)
[The stability of the family: social and demographic aspects]
Recent developments concerning the family in the USSR are reviewed. The characteristics of the contemporary family are analyzed, with a focus on the urban family. The central role of the relationship between husband and wife is stressed. Consideration is given to how the society can influence the process of human reproduction through policy measures. (ANNOTATION)
[Male nuptiality by real cohorts]
Trends in male nuptiality in the USSR over the past 30 years are analyzed. Male nuptiality is compared with female nuptiality using nuptiality indexes derived from real cohorts. A trend toward lower age at marriage over time is noted, and the impact of this trend on marital stability is considered. (ANNOTATION)
This is a report on the population situation in Poland in 1983 and on likely future developments. It consists of extracts from a longer report prepared by a government commission charged with the coordination of research on population policy issues. (ANNOTATION)
This book consists of a selection of items on aspects of population trends in developed market-economy countries. It was commissioned by the Soviet authorities as preparation for the International Population Conference held in Mexico in 1984. Topics covered include the socioeconomic consequences of the slowing of population growth, demographic aging, the social impact of increasing longevity, the relationship between demographic factors and economic problems in the United States, changes in age at retirement, the economic consequences of a declining population, and the problems posed by large numbers of foreign workers in Europe.
The means to marry: population and economy in pre-industrial England
The relationship between marriage trends and long-term economic trends in preindustrial England is explored using data developed through aggregative back projection by the Cambridge Group for the History of Population and Social Structure. The results show that marriage became more difficult and therefore less frequent in worsening economic conditions, and easier and therefore more frequent when the economic climate was improving. The author speculates on the links between this relationship and the creation of conditions favorable to the industrial revolution.
Illegal immigration: the host-country problem
Some theoretical aspects of international migration are explored, with a focus on the illegal migration of unskilled workers to the United States. The emphasis is on the implications for U.S. immigration policy. (ANNOTATION)
Subjective relative affluence and expected family size
"This paper explores some of the microlevel implications of the Easterlin hypothesis using [U.S.] data from the NORC General Social Science Surveys [for the period 1972-1983]. Questions are answered surrounding the extent to which perceived changes in affluence from the family of origin to the present affect the expected family sizes (in the short- and long-term) of men and women. The results of this analysis provide evidence for both skeptics and believers of the hypothesis." (EXCERPT)
Reasons why people migrate are examined by questioning prospective migrants about future moves. Reasons reported before the move are compared with reasons reported after the move. Consideration is also given to reasons for not moving. The data concern 167 U.S. households, 42 of which were migrants. (ANNOTATION)
Trends in total mortality and mortality from heart disease in 26 countries from 1950 to 1978
The authors calculate rates for total mortality and heart disease mortality for men and women aged 45-64 in 26 developed countries for six time periods during the years 1950-1978. Data are from official sources, and the results are presented separately by sex and country. Changes in the proportion of total mortality attributable to heart disease and the impact of changes in heart disease mortality on total mortality are compared among countries over time. While the analysis indicates the significance of percentage changes in heart disease mortality over the observed period, the authors also show that "absolute changes in heart disease mortality rates since 1950 have had, from the point of view of international differences, little effect on the relative position of a given country along the scale of descending mortality." (EXCERPT)
The demographic situation in Luxembourg in 1984 is reviewed. Significant developments include a continuation of the decline in the number of marriages, a record number of divorces, and an increase in the number of births to those of Luxembourg nationality coupled with a decline in the foreign population. (ANNOTATION)
[Historical demography: an introduction to the methods]
This is an introductory textbook for the study of historical demography. The book, written in New Norwegian, includes sections on developments in historical demographic methods, the census as a source of data, data contained in parish registers, demographic crises and their effects, and family roots. The geographic focus is on Norway. (ANNOTATION)
The decline in occupational sex segregation during the 1970s: census and CPS comparisons
"An assessment of changes in occupational sex segregation during the 1970s, as measured by the [U.S.] Census and the Current Population Survey, is complicated by the recent reclassification of occupations. Once this is taken into account, it is apparent from both the Census and the CPS that there was a decline in occupational sex segregation in the 1970s and that the decline was probably more substantial than in the 1960s." This is a revised version of a paper originally presented at the 1984 Annual Meeting of the Population Association of America (see Population Index, Vol. 50, No. 3, Fall 1984, p. 416). (EXCERPT)
[Mortality among young people in the countries of the European Community (from birth to age 24)]
The authors examine mortality among the population of the European Community aged 0-24. The data are from official sources in the 10 member countries and concern the period 1960-1980. The primary objective of the study "is the critical analysis of these mortality statistics and the comparison of the level of mortality and causes of death for various age-groups in the countries of the Community during the past 20 years." Chapters are included on registration and analysis of causes of death; mortality in the first year of life; the principal causes of infant death; sudden infant death; mortality for ages 1-4, 5-14, and 15-24; and mortality due to accidents. (summary in ENG) (EXCERPT)
New settlement pattern of rural blacks in the American South
"Microscale redistribution has accompanied the severing of rural blacks from agriculture in the plantation regions of the American South. Since 1960 a nucleated pattern has superseded the dispersed one that developed after the Civil War. The new pattern is interpreted in context of three eras of settlement for rural blacks." (EXCERPT)
[Stages of women's lives: 18 Swedish female cohorts and their life cycle history]
Changing life cycle experiences among 18 female birth cohorts in Sweden between 1750 and the 1920s are reviewed. The focus is on the factors that prevented women from experiencing an "ideal" life cycle, including survival of self and husband to age 50. Five factors influencing the life course are considered, namely, mortality, emigration, nuptiality, widowhood, and divorce. The author notes that as mortality declined over time, factors preventing marriage played an increasingly important role. Consideration is also given to the family structure of Scandinavian immigrants in the American Midwest. (summary in ENG)
The results of a study of emigration and return migration, conducted in the rural district of Esme, Turkey, are presented. Consideration is given to the impact of migrant savings and returning migrants' skills on economic development in the region of origin. (summary in ENG) (ANNOTATION)
[Urban traditional sector and rural-urban migration in developing countries]
The effect of the urban traditional sector on rural-urban migration in developing countries is examined. The author constructs a three-sector model along the lines of a model developed by Harris and Todaro, which also includes the urban traditional sector. The implications for social welfare policy and urban wages are considered. (summary in ENG) (ANNOTATION)
An indirect method of mortality estimation developed by Y. Courbage and P. Fargues is evaluated using incomplete data from a demographic survey carried out in Togo in 1971. The author concludes that the method gives good results in this case. The method is used to estimate life expectancy at birth to be 40.51 for men and 43.12 for women. (ANNOTATION)
ASEAN directory of demography and family planning research and training institutions
An attempt is made to list all English-language facilities and resources available for training and research in family planning and demography in the ASEAN region of southeastern Asia. The research institutions are first listed by country and by biomedical or socio-demographic field of interest. The second part lists the institutions and the types of courses they offer, with details of content, duration, criteria for admission, and officer to be contacted. (ANNOTATION)
Migration between rural peripheral areas and urban central areas is analyzed using the city of Nairobi, Kenya, as an example. The study is based on official Kenyan data for 1969-1979. The role of Nairobi as a focal point for both centripetal and centrifugal migration is discussed, and the volume, intensity, and direction of migration streams are examined. An attempt is also made to evaluate this migration in terms of modernization and dependency theories. (ANNOTATION)
[New roots: 50 years of immigration of German-speaking Jews to Israel]
This book focuses on the immigration of German-speaking Jews to Israel, their problems of adaptation, and their contributions to Israeli society. The emphasis is on Jewish emigration from Germany, Austria, and Czechoslovakia between 1919 and 1951, with particular reference to the mass emigration that began when the Nazi movement came to power in 1933. The book is based on various written sources and personal interviews. Topics discussed include the contribution of German-speaking Jews in areas such as academic life, medicine, the press, and politics. (ANNOTATION)
Compression of mortality: myth or reality?
"The concept of the rectangularization of the human survival curve has received considerable attention in discussions of the past and future course of life expectancy and survival changes for the United States population, especially at later ages. Surprisingly, few empirical studies of rectangularization have been made. In this article, [the authors] examine several aspects of this issue as they relate to changes in life expectancy, survival, and compression of ages at death during the twentieth century and specifically during the period 1962-1979. These studies provide evidence that rectangularization has had little impact on the population or mortality dynamics of the elderly." (EXCERPT)
The compression of morbidity: miscellaneous comments about a theme
"The Compression of Morbidity hypothesis maintains that the age of onset of significant disability may be moved upward more rapidly than life expectancy, thus compressing morbidity into a shorter period at the end of life, by using a strategy primarily directed at postponement of chronic illness and improvement in vitality through increased physical, psychological and social exercise, particularly in the later years. Objections to the thesis are examined in this paper, a series of qualitative and quantitative confusions are discussed, and predictions for the future offered." The primary geographic focus is on the United States. (EXCERPT)
Cause specific mortality patterns among the oldest old: multiple cause of death trends 1968 to 1980
"Trends in sex specific mortality from six conditions (hip fracture, septicemia, pneumonia, cancer, heart disease, and stroke) were examined for the period 1968 to 1980 to determine if recent increases in life expectancy at advanced ages were associated with significant shifts in the pattern of cause specific mortality at those ages. Changes in life table parameters were assessed both at birth and age 85 to determine if the relative significance of certain conditions had increased or decreased at advanced ages." The data are from the U.S. multiple cause of death mortality statistics, which contain all medical conditions listed by the physician on the death certificate for each death occurring in the United States. The results provide little evidence that mortality for conditions associated with a debilitation has increased markedly at later ages. (EXCERPT)
The development of migration expectations: changes throughout the lifecourse
The relative influence of factors that determine the expectations of individuals concerning migration over the course of their lives is examined using data collected in Chicago, Illinois, in 1982. "Factors representing personal characteristics, ties to origin, and ties to potential destinations were used to discriminate between expected migrants and nonmigrants in three population subgroups representing different stages of life. These subgroups included a general adult population, a preretirement population, and an elderly population." The findings show "that personal characteristics are most influential among preretirement persons, ties to origin are most influential among the general and elderly populations, and ties to potential destinations are influential among all population subgroups." (EXCERPT)
Migration differentials in the Philippines, 1983
Data from the 1983 National Demographic Survey for the Philippines and from earlier published sources are used in bivariate and multivariate analyses in order to examine differential internal migration rates according to region, place of residence, and other selected characteristics. The significance of the associations between different variables and propensity to migrate is discussed. (ANNOTATION)
Characteristics of mothers whose children have died in infancy
Data from the 1983 National Demographic Survey for the Philippines and from earlier published sources are analyzed in order to examine the relationships between selected maternal characteristics and infant mortality. Among the characteristics considered are place of residence, number of pregnancies, number of live-born children, number of times married, age at marriage, and family planning use. Regional differences in the findings are noted. (ANNOTATION)
[Compendium of human settlements statistics, 1983]
This is the fourth edition of a quinquennial compendium of statistics previously published by the United Nations under the title Compendium of Housing Statistics. The purpose of the compendium is to provide data relevant to the formulation of policies and programs concerning urbanization and human settlements. Sections are included on population, land use, housing, and infrastructure and services. The section on population includes data on population by sex, rate of growth, density, and country; estimates and projections from 1960 to 2010 by region, country, and urban or rural area; age distribution; household size; residence characteristics; economic activity; population in localities; and population of the world's 35 largest agglomerations, 1960-2000.
[Population history of Japan's 2000 years]
Population trends in Japan over 2,000 years are reviewed. The focus is on the relationship between socioeconomic and demographic change. The first three chapters cover the period up to the nineteenth century. The final three chapters are concerned with the Edo period, for which considerably more data are available. In these, the author attempts to reconstruct the demographic outline of a preindustrial population. (ANNOTATION)
[Urbanization and natural population growth in Poland]
The impact of urbanization on population characteristics and trends in Poland since World War II is explored. Three time periods are analyzed separately: 1948-1965, 1966-1974, and the period since 1975. The focus of the study is on the effect of urban residence on the components of natural increase, namely, marriages, births, and deaths. The results of correlation analysis of data from small administrative areas show clear differences in demographic indicators among areas at different levels of urbanization. (summary in ENG, RUS) (ANNOTATION)
Possible effects of transportation on mortality differentials in central Taiwan
The author develops the hypothesis that transportation systems may affect mortality differentials in developing countries by facilitating or retarding accessibility to medical services. The hypothesis is tested using data for 39 townships in central Taiwan for the years 1980-1982. The results suggest that while transportation may be significant in explaining child mortality differentials, it does not significantly affect infant or neonatal mortality rates. (summary in CHI) (ANNOTATION)
The aim of this publication is to describe the methodology used in a panel study of family formation in the Federal Republic of Germany. The study, which was carried out between 1975 and 1984 by the Federal Institute for Demographic Research, involved five rounds of interviews as well as three supplementary surveys. Two cross-sectional surveys of different samples were also conducted for comparative purposes. The focus was on the factors influencing desired and actual family size. The original sample for the panel study included about 4,000 married German women who were born after 1945 and were still in first marriages; later interview rounds covered smaller samples. An extensive appendix contains the questionnaires used in each part of the study.
A perspective on linking SIPP to administrative and statistical records
"This paper examines ways in which the new [U.S.] Survey of Income and Program Participation (SIPP) can be improved at reasonable cost by augmenting it with administrative and statistical records. One reason for linking SIPP and other data sets is to assess the quality of SIPP and to improve imputation algorithms for missing data....Administrative and statistical data sets maintained by federal and state agencies as well as the Bureau of the Census are identified and examples given of the benefits to be gained from linking them to SIPP. The problem of maintaining the confidentiality of the data in a linked file and ways of making the data available to the research community are also discussed." (EXCERPT)
Skills and the pattern of international migration
"This paper develops a simple two-country model of international migration. By distinguishing individuals in terms of their ability and age, the model enables us to examine not only the equilibrium flow of migrants and the pattern of factor rewards in the two economies, but also the factors which determine the skill and age profile of those who migrate. In addition, the effects of both qualitative and quantitative restrictions on immigration are analysed within a general-equilibrium framework. The role of an emigration tax and how it interacts with the immigration policy of the labor-importing country is also considered." (EXCERPT)
"The purpose of this report is to provide the most comprehensive survey possible of morbidity statistics published regularly in Council of Europe member states. To be included, they had to be indisputably comprehensive or representative at national level and concern serious or disabling diseases placing a heavy burden on the health systems of the countries concerned or life-threatening diseases." (EXCERPT)
This report is a result of the work of an expert committee set up at the recommendation of the Council of Europe's Steering Committee on Population to examine issues related to divorce, judicial separation, and remarriage in member countries. The report examines the frequency of divorce, the characteristics of those divorcing, divorced couples and their children, and remarriage. Numerous statistical data on divorce are included in an appendix. (ANNOTATION)
The changing age structure of the population and future policy
This report was prepared during the course of work of an expert committee set up at the recommendation of the Council of Europe's Steering Committee on Population to examine the changing age distribution of the population of member countries and the associated policy implications. Consideration is also given to the impact of these changes on fertility. Among the consequences of change that are considered are the impact on the provision of balanced educational resources, the effect on the labor force, and the growing number of the aged and very old. (ANNOTATION)
Factors affecting suicide in young, middle-aged and elderly men
"The effects of socioeconomic and geographical factors on age-specific mortality by suicide in men were assessed in 46 Japanese prefectures (counties) by stepwise regression analysis...." The study is based on official data for 1970 and 1975, years preceding and following the onset of the world oil crisis. Factors significantly related to mortality included "(1) the proportion of old and young men in the population for young men; (2) low income for middle-aged men; and (3) rural residence for elderly men. The mortality significantly increased after the crisis in young and middle-aged men, while no significant alteration was observed in elderly men." (EXCERPT)
Evaluation of selected Soviet population statistics
The author first notes that the limited publication of results from the 1979 census of the USSR does not include the basic data on age composition essential for demographic analysis. An evaluation of unofficial Soviet age distributions presented in a recent article by Murray Feshbach is attempted. These distributions are compared with distributions from previous Soviet censuses and vital statistics. The results indicate that Feshbach's age distributions for 1979 are compatible with the evidence from earlier official sources. These 1979 estimates are used to analyze recent trends in mortality and completeness of birth registration. Consideration is also given to the quality of available Soviet data.
[The movement of the Yugoslav population: volume, directions, factors]
An analysis of internal migration trends in Yugoslavia is presented. The economic characteristics of the population are first described. Next, regions of in-migration and out-migration are identified. The factors affecting migration are then analyzed separately for each republic and autonomous region. Finally, the socioeconomic characteristics of migration zones are considered. (ANNOTATION)
[Population of Japan. Final report of the 1980 population census]
This is part of the final report on the 1980 census of Japan. The present volume contains an analysis of the statistical data, which are published in a separate volume. Chapters are included on population, population characteristics, social characteristics, economic characteristics, migration, and families and housing. (ANNOTATION)
This collection of essays by various authors is concerned with census mapping around the world. The papers, except for one in French, are in English. The book is the result of a survey carried out under the joint auspices of the International Geographical Union's Commission on Population Geography and the International Cartographic Association's Commission on Census Mapping. The focus of the collection is on progress in mapping during the 1980 census round. Following an introductory chapter, reports are included on 21 countries, representing approximately 43 percent of the world's population. A retrospective or summary chapter is also included. Countries included are Argentina, Australia, Bangladesh, Brazil, Cameroon, the Federal Republic of Germany, Hungary, India, Italy, Japan, Kenya, Malaysia, Nepal, Nigeria, Sweden, Tanzania, Uganda, United Kingdom, United States, Zambia, and Zimbabwe. Topics covered include the use of census districts for mapping population, the use of automation to produce maps, the importance of post-censal mapping, and the use of census maps as tools by planners.
Population, disease, and land in early Japan, 645-900
"This book examines population, disease, land clearance, agricultural technology, and rural settlement in Japan between 645 and 900." A chapter on fertility, mortality, and life expectancy in the early eighth century includes a description of available data sources and an assessment of the quality of the data they contain. A chapter is also included on the relationship between population trends and epidemic disease. The final chapter is devoted to rural settlement, including migration. (EXCERPT)
[Innovation and parental behavior in an urban environment (fifteenth to nineteenth centuries)]
The author examines the reasons why putting children out to wet-nurse became prevalent in French cities by the eighteenth century, given that the risks to the child of such a practice were known. The obstacles to nursing by the natural mother are reviewed, and the attitude of fathers is identified as critical. Fathers encouraged the practice of putting children out to nurse in order to protect their conjugal life. The process by which these changes led to a reduction in the number of pregnancies and the emergence of a new model of the family are reviewed. Consideration is also given to the possible effect on such practices of the European habit of carrying children in the arms rather than on the back. (summary in ENG)
The age structure of Soviet population: preliminary analysis of unpublished data
"This article presents and analyzes hitherto unpublished data on the age structure of the population of the USSR and four of its republics. Analysis of the patterns revealed by these newly available data provides a basis for understanding why they had not been published in the USSR in the six years since the census date. The implications of the data for the analysis of Soviet society, its economic potential, and military draft pools are discussed." (EXCERPT)
Estimated population by age, sex, and counties, 1970-1982
"This report presents 1970 to 1979 intercensal estimates and 1980 to 1982 postcensal provisional estimates of the resident population of Hawaii by age, sex, and county. The estimates, prepared by the Population Division of the U.S. Bureau of the Census, are for five-year age groups to age 85 and over." (EXCERPT)
A descriptive analysis of the population growth that occurred in the metropolitan area of San Jose, Costa Rica, between 1950 and 1980 is presented. The first part describes changes in the pace of growth and urban spatial distribution over time. The second part examines the components of growth, including fertility, mortality, and migration. (ANNOTATION)
Circulation and migration in third world settings: a comparison in Ecuador
This study is concerned with circulation, defined as temporary and repetitive migration that lacks any declared intention of a permanent or long-lasting change in residence. "The first section of the paper reviews pertinent circulation literature. Attention then turns to describing circulation and migration patterns in Ecuador, and identifying relationships between these patterns and regional differentials in economic development, both through cartographic and statistical analyses. A summary and conclusions comprise the last section." (EXCERPT)
Census of Population, 1980: Inter-County Migrant File [MRDF]
This file contains 534,762 logical records (with a record length of 34 characters) and has accompanying technical documentation. "The file provides a count of persons living in a specified county in 1980 who were residents of a different specified county in 1975. (Movers from abroad are not included.)" Summary statistics are provided for all U.S. counties and county equivalents and for the District of Columbia. (EXCERPT)
[Changes in the population of Kuwait and their socioeconomic and political consequences]
The evolution of the population of Kuwait since the beginning of the exploitation of oil in 1946 is examined, with particular emphasis on the years 1957-1975. Official statistics are presented concerning the structure of the population by native or nonative status, nationality, and sex. The data show that since 1965 foreigners have constituted a majority of the country's population. Figures are also included concerning the distribution of the native and nonnative labor force among the various types of economic activity. The economic, social, and political consequences for Kuwait of this recent immigration are then considered.
Alternative dual system network estimators
"When there are two or more data systems and none of them enumerates the population at an acceptable completeness level, concern about the bias due to underenumeration suggests an estimator which makes joint use of data compiled by the combined imperfect data systems. Conventional dual system estimators are based on the existence of two separate data collection systems. Dual system network estimators assume a main survey and a follow-up quality check survey. The main survey adopts a multiplicity counting rule that combines two mutually exclusive partial counting rules." Three dual system network estimators are presented. "One was previously proposed by Sirken (1979) and is the natural analogue of the conventional dual system estimator. The two other estimators are proposed as potential improvements, although neither of them is the natural analogue of the conventional dual system estimator. The design effects of the three estimators are compared analytically and empirically with one another, and with those of the single system conventional and network estimators." (summary in FRE) (EXCERPT)
Recent and prospective population trends in Malaysia
Recent population trends in Malaysia are reviewed, with the focus on Peninsular Malaysia. Separate consideration is given to population growth between 1970 and 1980; mortality trends; period and cohort fertility trends; factors affecting fertility, including changes in age structure, nuptiality, and other socioeconomic and demographic changes; and the recent development of a pro-natalist policy involving a goal of a population of 70 million by 2050. (ANNOTATION)
Fertility and mortality in Vanuatu. The demographic analysis of the 1979 census
A demographic analysis of data from the 1979 census of Vanuatu is presented. Available data sources, including the 1967 census, vital statistics, and hospital records, are first reviewed. Next, consideration is given to the quality of the 1979 census data. Chapters are then presented on the estimation of mortality and fertility. It is noted that, contrary to the situation in most populations, female mortality appears to be higher than male mortality. The study concludes by presenting actual estimates of mortality and fertility. (summary in FRE) (ANNOTATION)
An overlapping generations model with endogenous fertility and intergenerational transfers
"The one sector two factor growth model with a representative agent solving a life cycle control problem is extended by allowing the altruistic agent to choose not only an intergenerational transfer optimally, either bequests or gifts, but the number of children produced as well. As a result the family's decisions regarding fertility and the transfer are interlinked through the respective shadow prices." The effect on fertility of changes in policy concerning social security, government debt, land rent taxation, and consumption taxation is explored. This work was prepared as a doctoral dissertation at the University of Minnesota. (EXCERPT)
The parameters of death: a proposed parameterisation of the mortality curve.
"A method is sought to express the pattern of mortality depicted by a life table in a minimal number of parameters. The survivorship...columns of 360 empirical life tables...are fitted by a fifth degree polynomial, and it is shown that six parameters are adequate to reproduce these curves almost flawlessly. However, of these six parameters four are collinear. As all four represent various dimensions of the scale, or level of mortality, it is proposed that one parameter may be taken to represent all four." The remaining two parameters "express dimensions of the shape of the mortality curve: its tilt, or the skewness of the distribution of deaths over the life span; and its flatness, or the kurtosis of this distribution." A preliminary investigation is presented concerning the changing relationship between male and female mortality as the level of mortality declines, and the clustering of the life table shapes is compared with that implied by model life table assignments. "It is shown that, consistent with previous findings, male-female mortality differences grow to give females a clear advantage as mortality declines, though the use of the three parameter scheme enables some new interpretations to be made of these differences....A concluding chapter discusses possible uses of the three parameter representation in the demographic and sociological analysis of mortality." This work was prepared as a doctoral dissertation at Brown University. (EXCERPT)
"The aim of this dissertation is to examine the impact of nonmarital cohabitation on the sequence and timing of some important life-course events, including marriage and marital dissolution....The effect of cohabitation on the probability of entry into marriage is...explored in detail using a multivariate hazard model. Finally, some of the social and legal implications of cohabitation are discussed. Data from the 1980 Women in Sweden Survey and the 1977 Norwegian Fertility Survey are used in the analyses." The results indicate that "the traditional sequence of relatively early entry into legal marriage followed by childbearing is no longer the course followed by the majority of women in Sweden. Among recent Swedish cohorts, the overwhelming majority of women cohabit before marriage and these nonmarital unions are less likely to result in marriage than such unions in earlier cohorts. In addition, the association of legal marriage with childbearing has become weaker....In Norway, similar trends are observed but are less extreme and seem to have begun somewhat later." This work was prepared as a doctoral dissertation at Princeton University. (EXCERPT)
[Mortality and medical services in the Netherlands around 1870-1900]
The relationship beteen use of medical services and the decline in mortality that occurred in the Netherlands from 1870 to 1900 is considered, with particular reference to regional differences in mortality. The data are from cause of death statistics kept at the provincial level. The importance of preventive medicine in reducing mortality is stressed. (ANNOTATION)
Data are presented on international migration to and from the Netherlands in 1984. The data concern those persons added to or subtracted from the country's population register. Migrant characteristics are analyzed by age, marital status, and province of arrival or departure. (summary in ENG) (ANNOTATION)
"This article analyzes the causes of divorce among a cohort of couples married in Geneva [Switzerland] between 1974 and 1975, from information based on interviews and other data collected at four different points [in] time." The classical factors associated with divorce, including its acceptability, financial constraints, and differences in social class between spouses, do not seem to be major determinants of divorce. The authors conclude that the main factor concerns changes in attitude toward marriage and that divorce is more frequent among couples who stress the importance of individual rights and equality between the sexes. (summary in ENG, SPA) (EXCERPT)
[The aged in the Soviet Union]
Demographic aging in the USSR is analyzed using data from a variety of Soviet sources. The author notes that although the number of people aged 65 and above has risen to over nine percent of the total population since 1975, significant differences exist among republics, between urban and rural areas, and between sexes. The relationship between pension levels and labor force participation of the elderly is discussed. The provision of services for the elderly is also reviewed. (summary in ENG, SPA) (ANNOTATION)
An attempt is made to estimate population levels in sub-Saharan Africa before the coming of the slave-trade in the seventeenth century using data primarily from archaeological sources. The author develops the hypothesis that the African population of the fifteenth and sixteenth centuries was both of considerable size and growing. A commentary by Jean-Noel Biraben (pp. 884-8) argues that the data to support such a hypothesis are inadequate and that environmental conditions in Africa have always prevented the development of large and dense population concentrations. (summary in ENG, SPA)
[Population growth and the housing market in France since 1954]
A model of the relationship between population trends in France and developments in the housing market since 1954 is presented. The model is used to project future trends in the building industry and to show that there will be no sharp increase in the demand for new houses in the foreseeable future. The impact of changes in standard of living and types of household, as well as changes in overall population numbers, is taken into consideration in the model. (summary in ENG, SPA) (ANNOTATION)
[Regional mortality differences in Italy]
Regional mortality differentials in Italy are analyzed using data from official sources. Consideration is given to differences in mean length of life, life expectancy at age 65, mortality by sex, and infant mortality. (ANNOTATION)
Immigration and the future U.S. black population
The author first briefly reviews the history of black migration to the United States from the initiation of the slave trade in the mid-1600s to the present. Projections are then presented for the total U.S. black population and for total black immigration through 2030. Particular attention is given to the emergence of a "multicultural" black society and potential problems of assimilation. (ANNOTATION)
Nativity, intermarriage, and mother-tongue shift
This study is concerned with the process of the continuation of unique language among native-born generations of immigrants in the United States. The author examines changes in language between generations in relation to linguistic and ethnic intermarriage. "The analysis, based on 1976 Survey of Income and Education data, shows that non-English languages disappear between generations as patterns of social interaction widen to include intimate associations outside of the non-English-language community, and outside of the ethnic descent group." (EXCERPT)
The aging of the suburbs, 1960-1980
"The suburban population in the United States has aged more rapidly than the population as a whole. This paper examines the suburbanization of the elderly during 1960-1980 for a national sample of metropolitan regions. The increasing proportion of residents age 65 and over has been accompanied by declining segregation of the elderly among suburbs in most metropolitan regions. During this period suburbs with older populations were relatively poor but had higher municipal expenditures....Increases in proportion elderly are greater in slow-growing inner suburbs, but are linked to lower proportions of black residents, more trade employment, and a stronger tax base." (EXCERPT)
Projection of mortality rates for the elderly
"This article considers past and future mortality rates for three of the main causes of death affecting persons living in England and Wales and aged 60-84. The reason for concentrating on this age-group in particular is that the majority of deaths occur to people within this range (over 80 per cent of all the men and nearly 90 per cent of all the women who died in 1984.)" The projections take into account not only past trends and the factors that have affected them, but also assumptions of the effect that future changes in life-styles and health care will have on mortality. (EXCERPT)
Area mortality comparisons and institutional deaths
The impact of mortality among residents of long-stay institutions on mortality in the area in which the institution is located is explored using official data for England and Wales. "This paper examines the effectiveness of the method of adjustment for institutions in use until 1982 against a more suitable method using 1981 Census based populations and deaths registered in 1981. It is shown that the old method was inappropriate and that a simple standardised mortality ratio, which adjusts for age and sex distribution of the population only, is adequate for most areas." (EXCERPT)
Ward population trends 1971 to 1981
"Wards are relatively small areas for which inter-censal population changes are readily available; they give a detailed, country-wide insight into patterns and trends. This article shows that although the total population of England and Wales changed only slightly from 1971 to 1981 there were appreciable shifts at the ward level and analysing these adds considerably to local authority analyses." (EXCERPT)
[The process of aging of Poland's population and the urbanization process]
The relationship between demographic aging and urbanization in Poland since 1950 is examined, with a focus on the impact of urban development on aging. "The first chapter deals with methodological problems; the second chapter describes the demographic determinants in the process of the aging of the population; the third chapter contains an assessment of the process of the aging of Poland's population in 1950-1978; on the basis of projection data information on the years 1980-2060 has also been included." (summary in ENG, RUS) (EXCERPT)
Concepts and issues in family planning: guidelines for nurses, midwives, and other health personnel.
These guidelines on family planning services have been prepared for nurses, midwives, and other primary health and health-related personnel in Africa and the Near East to help them with family planning services and problems of service delivery, infertility, sexually transmitted diseases, family life education, contraceptive choice, and standards of service delivery. Unit I covers family planning--concepts and definitions, traditional methods of contraception, cultural and social influences on contraceptive practice, and the role of government and nongovernment agencies in family planning programs. Unit II discusses the benefits of family planning. Health benefits include declines in maternal and child mortality, fewer pregnancy and delivery complications, maternal replenishment, prevention of genetic and communicable diseases, improved nutrition for infants and mothers, and better mental health and family adjustment. Unit III deals with reproduction and different contraceptive methods and contains a case study of family planning during the reproductive years. Unit IV describes services and facilities, basic equipment, personnel and staffing, and the importance of record keeping and how to do it. Unit V on care and counseling covers case finding, client visits to a family planning program, laboratory tests, physical examinations, contraceptive selection, return visit responsibilities, and referral to outside resources. Special attention is given to clients' decision making, avoiding coercion, the effect of health personnel's disapproval, adolescents, infertility, and customs affecting health.
The Planned Parenthood and Women's Development (PPWD) workshop, held in Mombasa, Africa in 1983, was designed so that participants would: 1) acquire additional knowledge of the PPWD program, 2) develop skills to initiate, plan, manage, and evaluate PPWD projects, 3) identify constraints and problems affecting project management, 4) assess the viability of the projects they have formulated in their countries, 5) acquire skills in integrating family planning components into development activities, and 6) develop plans to improve their PPWD projects back home. Some of the common problems were: 1) problems and needs addressed by women's groups--such as women's economic and social status; 2) current problems of project development, implementation, and management; 3) factors which lead to success; 4) operational, financial, and leadership problems in organizations; 5) collaboration; 6) integration of family planning into the project; and 7) problems of monitoring and evaluation. The major needs identified were health, water, sanitation, housing, and education. In addition, the social factors such as communication, beliefs, influential groups, religious influences, relations and conflicts, language problems, and types of resources available are also part of the factors involved in participatory development. The workshop discussed the steps of project planning and prepared participants for the group encounters which facilitate the testing of some of the concepts discussed. Therefore, 2 women's groups were selected for the case studies, one in Makiwo, and one in Kibuyuni. The main objective of the visit was to give the participants a chance to study an on-going project, exchange ideas with the group, and test some of the concepts learned against real life situations in the community. Group members discussed at length the problem of leadership--identified as being key to group project success: 5 types of leaders were identified. It was concluded that training could help alleviate some of the prevalent leadership problems; rotating leadership would also be an alternative. A checklist for monitoring and evaluation of projects was drawn up and could also be used to assess project proposals. Workshop evaluation, issues raised and recommendations, and general comments are given.
A decade of partnership, 1974-1984.
The East and South East Asia and Oceania Region (ESEAO) of the International Planned Parenthood Federation (IPPF) is a partnership formed a decade ago between 2 former regions. This partnership includes many other partnerships--those between volunteers and professional staff and those between family planning associations and the IPPF. The ESEAO region is a varied and widely dispersed one. In 1983, its 15 countries contained 465 million people. The ESEAO region must design seminars and training classes that cover very basic information for new and tiny associations with virtually no resources as well as seminars that cover more advanced training for more developed associations. IPPF is a nonprofit international organization of voluntary family planning organizations dedicated to the belief that knowledge of family planning is a basic human right and that the world's population and natural resources must be balanced for human well-being. Family planning associations are grassroots organizations that quite often make use of volunteers. Because they are in touch with people's needs, these associations have pioneered many new initiatives in service delivery. The major role of the associations in the ESEAO region is to provide information and education about the benefits of family planning. The associations also provide services and training. Each association holds that family planning is a fundamental human right. Country association reports are included for Australia, Hong Kong, Indonesia, Japan, the Republic of Korea, Malaysia, New Zealand, Fiji, Papua New Guinea, the Solomon Islands, Tonga, West Samoa, the Philippines, Singapore, and Thailand.
Urbanization in China: new insights from the 1982 Census.
The Chinese government's concerted efforts to control population growth through its one child family policy has understandably received worldwide attention. Less well known outside China is the considerable attention given by Chinese government officials at all levels to problems related to rural-urban population distribution, urban growth rates, and the relationships between employment opportunities and rural and urban development. These concerns have led to the emergence of a policy to strictly control the growth of big cities while encouraging the growth of small cities and the developnent of towns and commune centers into new urban centers. Data from the 1982 Chinese Census provides a unique opportunity to assess urbanization patterns in China and the changes that have occurred since the 1953 census. The author documents that in the 3 1/2 decades since the establishment of the People's Republic, urbanization has risen slowly. Moreover, despite some changes in the urban hierarchy and some evidence of success in controlling big city growth, almost 2/3 of the total urban population remains concentrated in big cities, with almost 40% living in metropolises of 1 million or more. China's urban population also remains imbalanced in its geographic distribution, although the extent of the imbalance has diminished somewhat through efforts to achieve higher industrialization rates and urbanization and city development in the inland provinces. The 1982 populations of cities, towns, and countryside are compared on a range of socio-demographic characteristics, including age and sex, labor force structure, and literacy. The analysis suggests that the 2,664 towns have already assumed a more urban character and that they are likely to play a key role in China's future urbanization. Their development is assessed within the larger efforts at modernization and urbanization and in light of policy developments in the 1980s, including institution of the responsibility system in agriculture and the establishment of economic development zones. (author's modified)
This workshop report covers the 2 categories of maternal and child health/family planning (MCH/FP) program practices and problems in the South Pacific: mangement/administrative, and technical/operational. Participants concluded that 1) maternal nutrition and health during pregnancy influence babies' hemoglobin levels and weight at birth, therefore family health workers need more training in these areas and in infant care; 2) immunization programs are only as successful as the overall health system of which they are a part; and 3) there are widespread policy/management related problems in family planning, such as lack of full time supervisors in MCH programs. There are 12 global and 7 regional indicators to achieve health for all by the year 2000, of which the MCH/FP ones are: 1) global indicators: primary health care for all, adequate child nutrition, and an infant mortality rate below 50 per 1000 live births; and 2) regional indicators: daily per capita calorie and protein availability, maternal mortality, number of cases of common diseases, and population growth rate. Also identified were 7 main sources of information for constructing MCH/FP indicators, including government and donor agencies and survey data. The report also covered the classification of these indicators, the criteria for their selection and guidelines for their generation and analysis, a minimum list of indicators and related data, and their analysis and uses. To implement program improvements as soon as possible, a modest start was recommended, with the understanding that each country's list of indicators need to be expanded over time to meet international standards. Training, education, and suitable supplies and equipment would be essential for the institutionalization of indigenous management capability. Additional workshops and visits by experts were also recommended.
Issues in contraceptive development.
Contraceptive technology development in the last 25 years has made choices about childbearing possible for millions of women and has had far-reaching social and economic implications; however, the present selection of methods is limited and all have drawbacks. Only 325 million (41%) of the world's 800 million reproductive age, married couples use an effective modern contraceptive method. Most of the worlds 325 million unprotected couples live in developing countries where contraceptive prevalence is 10-30%, and many people lack access to affordable family planning services or fail to find an acceptable method. In Africa, Asia, and Latin America, pregnancy complications, childbirth, and illegal abortion are a leading cause of death among reproductive age women; effective contraception can reduce high risk pregnancies and improve women's and children's health. The author discusses steroidal contraceptives such as oral contraceptives, injectable contraceptives, contraceptive implants, and vaginal rings, IUDs, voluntary sterilization, barrier methods such as vaginal sponges, cervical caps, and spermicides, and periodic abstinence, in terms of each method's worldwide use, characteristics, side effects, and research possibilities. New methods currently under development include menstrual inducers, new hormonal preparations, contraceptives for men, and anti-fertility vaccines. Contraceptive users are most concerned with reliability, safety, reversibility, cost, convenience, consumer control, and cultural acceptability; family planning programs are most concerned with medical supervision requirements, cost, and requirements for maintenance, storage, and handling. Greater financial investments and more highly concentrated cooperative research efforts are needed to meet the contraceptive needs of the world's population.
This article examines the relationship between rural fertility and rural-urban migration and land holding patterns, using data for 26 developing countries. A 2-equation stochastic model is developed with variables for the rural total fertility rate, the average annual rate of rural-urban migration, the gross domestic product per agricultural worker, the small holder index, the concentration index, the land ownership index, agricultural density, the literacy rate, and life expectancy at birth. Regression results for the rural fertility and migration equations show that the coefficient for lagged migration is positive, as expected. The lack of an effect of literacy is surprising, and may indicate that urban-rural differentials in literacy rates vary widely across countries. The positive coefficient for rural income provides evidence of a positive income effect on fertility in rural areas. The 3 land holding variables receive strong statistical support. The urbanization variable is very powerful; studies that do not take this into account may be seriously biased. The smallholding variable is significant and positive, but the diffusion of land ownership raises fertility and rural-urban migration rates. The reduced form equation highlights both opportunities and obstacles. The statistical results provide strong support for the major hypotheses of the effects of land holding patterns on rural fertility and rural-urban migration: higher fertility is positively related to higher rates of out-migration. Higher out-migration in the previous decade means higher subsequent fertility.
In 1979, after 6 years of research, development, and testing, the Research Triangle Institue (RTI) was awarded a patent for the contraceptive implant, Capronor. The implant's inch long tube is filled with levonorgestrel, a synthetic progestogen, and is injected into a woman's upper arm or hip. It delivers a steady levonorgestrel dose for 1 year, then begins to decompose. Its advantages include 1) user ease, and 2) steady drug release levels. 1 month trials show no discomfort and constant hormone level maintenance. This initial trial will be followed by month long clinical studies in London, Bangkok, and Rome, and by 1 year long tests by 400 women at 20 research centers around the world. The capsule's polymer is ideally suited for implant use, unlike some nonbiodegradable implants in use, since it slowly disintegrates after a year and is excreted from the body. Clinical trials since 1980 show Capronor to be safe and effective; after future tests, Capronor can be submitted to the US Federal Drug Administration for approval. Controlled drug release systems work in 1 of 3 ways: 1) diffusion through a semipermeable polymer membrane (which is how Capronor works), 2) use of a porous polymer, and 3) biodegradation. Some researchers are now working on self-regulated systems which release drugs in response to biological need, instead of a steady, predetermined, unchangeable rate. Biological delivery systems differ from synthetic devices because they can target specific tissues and automatically regulate the supply of the active agent in proportion to the biological need. RTI researchers are currently testing 2 approaches to self-regulated drug delivery: 1) using antibodies and binding proteins to control polymer membrane permeability and biodegradability, and 2) using chelation (a process that forms a ring structure containing a metal ion) functioning drugs whose release is controlled by a target metal. Continuing research will allow existing drugs to be delivered in new, different, more effective, and safer ways.
Recent fertility studies show that specific contraceptive attitudes and intentions can significantly predict contraceptive behavior. This paper examines the effect of contraceptive intentions in 3 distinctly different cultures, and the relative effects of contraceptive intention and selected nonattitudinal factors on contraception. Family planning program evaluations suggest that 2 sets of factors determine program outcome as measured by effective contraception: 1) social settings, such as supportive, cultural, and political conditions; and 2) program effort, such as infrastructure, delivery systems, and resource allocations. The authors' previous work in Venezuela and Kenya suggests that specific contraceptive intentions, social support, services' accessibility, parity, and conjugal power and communication predict contraception. This paper also tests these findings in the Philippines. Women, aged 15-45, in these 3 countries supply survey responses for over 125 socioeconomic and demographic characteristics. Multivariate analysis was performed on 1) personal intention to use contraception, 2) perceived support for contraceptive use, 3) information and services' accessibility, and 4) parity. Personal intention to use contraceptives has the strongest effect on contraceptive use in all 3 countries, although its relative impact varies considerable between and within the cultures. The other variables also have variable impacts; strong effects on contraceptive use result when the variables are combined. The research implications from this study include the need to 1) understand the the extent and process through which culture influences the consistency between attitudes and behavior, 2) research how intentions influence behavior, 3) test whether attitudes and intentions are central action determinants in cross-cultural studies, and 4) determine whether all other variables affect behavior only indirectly through intentions. In light of these findings, the promotion of positive intentions, social support, and improved accessibility, even in an unfavorable social setting, can influence the contraception rate, and improvement of these factors is the best policy options now available.
Methods of monitoring ovarian function and predicting ovulation: summary of a meeting.
This report summarizes the proceedings of an international meeting sponsored by Family Health International on methods of monitoring ovarian function and predicting ovulation. The imprecision of current indirect methods for predicting the timing of ovulation, as well as pressures from natural family planning, artificial insemination, and in vitro fertilization programs, have provided impetus for advances in this field. Among the purposes of the meeting were to identify the limitations and potential of available methods of monitoring ovarian function and predicting ovulation, define those approaches requiring further development, and stimulate the collaboration necessary for production of a new generation of techniques. This report highlights the current status of indicators that have been used to predict the limits of the fertile period and the time of ovulation. Natural family planning indices reviewed include cervical mucus, basal body temperature (BBT), algorithms for prospectively interpreting BBT, the symptothermal method (STM), and cervical changes. Other indices discussed include ultrasound monitoring, gonadotropin measurement, steroid metabolites, enzymes and ions, pregnancy, and prolactin in lactating women. Combinations of 2 or more methods can delineate the fertile period in over 95% of cycles. If the exact timing of ovulation needs to be predicted, cervical mucus or STM should be augmented by indices such as increase in follicle size, the rise or peak in luteinizing hormone levels, attainment of peak estradiol, or the initial rise in progesterone. Technological improvements in the endpoints used in immunoassays could lead to development of self-tests and reduce costs. Research in 3 areas might improve the effectiveness of physiologic and biochemical indicators: 1) the fertile spans of gametes within the female tract, 2) spontaneous early embryonic loss; and 3) lactational amenorrhea. Close collaboration between laboratory scientists and directors of family planning programs would facilitate this research.
Strangers and changers: consulting roles in social development. III. Module Manager's Guide.
This module manager's guide is part of a series of development modules designed and produced at the East-West Communication Institute for professionals working in population and family planning IEC programs. This module espouses a process approach to consulting and views students as co-workers and participants. The consultant's stranger-changer role is based on the application of expertise without resort to coercion and control. Among the goals of this module are to teach participants to organize consulting roles into a consulting role model, write a plan for establishing common expectations between consultant and client, develop ideas for the introduction of an innovation in the participant's own organization, and develop a list of general principles involved in improving an organization's ability to solve its own problems. The module uses a Criterion Referenced Instruction approach to learning, which is based on behavioral objectives. Getting ready for your own work (GROW) sessions, involving 15-minute presentations on a subject of the participant's choosing, are a part of this approach. The module is highly structured, listing activities and materials for numerous objectives.
On the basis of detailed study of Chinese agriculture, the author of this article concludes that the country is at present doing well in terms of feeding its population. Whether this achievement continues into the 21st century will depend on factors such as a shift toward a private enterprise economy, the loss of farmland to erosion, and management of the negative effects of pollution. China's agricultural output rose by an average of 8%/year between 1978-84. The increase in food availability is attributed to new policies that brought farmers increased inputs, wider markets, and higher prices and to the de facto privatization of Chinese farming embodied in the baogan daohu (full responsibility to households) system. The rising productivity associated with baogan has released millions of farm workers who are being absorbed into service and industrial enterprises. Baogan is not merely an expedient policy to solve the problem of feeding the population; it represents a fundamental reform of the rural economic system. Since 1982, China is considered to have provided enough food to cover the energy needs that are compatible with normal growth and health. The situation with regard to protein is similar. However, regional, local, and individual disparities in the standard of living persist. In the long run, neither the communes nor baogan farming will be able to support sustained growth in production if they remain confronted with restricted markets and distorted prices. An additional challenge is that of maintaining a sustainable agricultural ecosystem through conservation of farmland. A fundamental question is how much control is the Chinese leadership willing to give up in exchange for continued rises in agricultural productivity.
A study on problems associated with the use of drugs and drug education in Ghana.
This study on drug abuse and drug education in Ghana had 3 components: 1) identification of legal and illegal drugs currently in use in Ghana; 2) a survey of the attitudes of various population groups (e.g., students, teachers, and parents) toward drugs; and 3) assessment of educational programs aimed at reducing Ghana's drug problem. Among the 4216 student respondents surveyed, 50% claimed to be regular (at least once/week) users of drugs, primarily alcohol, cigarettes, and marijuana. Most frequently cited reasons for drug use were: to enable students to study hard (65%), to get along with peers (21%), and to induce a sense of well-being (9%). Only 30% of students surveyed indicated they felt narcotic drugs should be legalized in Ghana. Of the 250 teachers surveyed, 49% indicated they were regular users of alcohol and 31% cited regular cigarette use: only 1% claimed marijuana use. When asked to suggest ways the drug abuse problem could be ameliorated, 32% mentioned intensification of antidrug education and 21% proposed stricter controls on drug sales. Finally, 150 parents were interviewed, 43% of whom claimed to be regular users of alcohol. Parents blamed drug use among students on the influence of peers and teachers, broken homes, and curiosity. 37% of parents favor education as a way of controlling drug abuse. Laws and regulations governing drug consumption in Ghana are lax and rarely enforced. Although there are periodic campaigns in the media against drugs, these have been largely ineffective. Recommended is a behavioral approach in drug education centered on knowledge, attitudes, and practice. Such education must cover more than the effect of drugs on the body; it must also take account of students' feelings, values, and actions in this area. It must provide students with alternatives to drug use and permit them to form their own opinions and decisions.
World Fertility Survey Report: Nigeria [memorandum]
This brief report highlights some of the findings of a World Fertility Survey conducted in Nigeria between October 1981 and August 1982. The sample was comprised of 9736 women 15-49 years of age, 85% of whom lived in rural areas. The weighted average household size was 5.83 persons. 56% of respondents' households consisted of only a married couple with or without their unmarried children while 24% of households were extended and 22% were polygynous. 97% of women under 30 years of age were married or in consensual unions, and 71% had married between 12-18 years of age. The average age difference between spouses was 12.6 years. The data indicated that both infant and child mortality have declined dramatically in recent years. The total fertility rate for the 5-year period preceding this survey was 6.3. Overall, the average number of children ever born to women 15-49 years of age was 3.1. The average number of children ever born to women aged 45-49 years at the time fo the survey was 5.8. Only 5% of currently married women expressed a desire to have no more children. The mean number of children desired was 8.4. Only 1/3 of respondents had ever heard of a method of family planning. Abstinence, oral contraception, and injection were the most commonly known methods. Ever use of contraception was 15%, and only 3% of respondents had ever used an efficient method. 6% of respondents exposed to the risk of pregnancy were currently using a family planning method. Current use was highest among older women and varied by education, religion, and region. Respondents breastfed their children for an average of 17 months. 70% of women surveys were illiterate. Piped water was available to 21% of households and electricity to 20%. Finally, 49% of households reported ownership of a radio or television.
Population: Norplant subdermal contraceptive implant--update.
This memorandum updates the position of the US Agency for International Development (AID) on the Norplant subdermal contraceptive implant. This system provides protection from pregnancy for 5 years by means of low-dose, progestin-only implants inserted beneath the skin in a woman's arm. To date, this method has been used by over 30,000 women in 25 countries. The contraceptive effectiveness and continuation rates have proved equal or superior to those obtained with other reversible methods of contraception. Pregnancy rates are generally below .5%/year after up to 5 years of continuous use and continuation rates as high as 96% have been reported after 1 year of use. This method might be particularly appropriate for women over 35 years of age who should not take estrogen. However, because of the potential for disturbances in menstrual patterns, careful counseling is essential. The Norplant system is currently on the market in Sweden and Finland. During the next 3 years, drug regulatory approval will be sought in over 40 additional countries. USAID believes that this contraceptive method offers major safety, efficacy, and acceptability advantages over currently available temporary methods and has a clear potential for providing a significant positive impact on family planning programs in developed and developing countries. Once approval is obtained from the US Food and Drug Administration, USAID plans to include Norplant implants in the range of contraceptives provided by the Agency.
Spermatic cord arteriovenous fistula: an unusual complication of vasectomy.
This paper reports the case of a large, symptomatic spermatic cord arteriovenous fistula following routine vasectomy in a 39-year old white man. This complication has not been noted previously. The patient underwent bilateral partial vasectomy for sterilization in 1963. A right scrotal hematoma developed and was treated in the immediate postoperative period. In 1973 the patient was evaluated for a nontender right posterior scrotal mass and spermatic cord arteriovenous fistula was diagnosed. The patient was asymptomatic and declined surgical intervention at this time. In 1976 right groin pain developed and surgical exploration revealed a large arteriovenous fistula in the right spermatic cord. The fistula was ligated on the arterial and venous side and the symptoms resolved. The anatomic findings in this case suggest that the deferential artery and a vein of the pampinoform plexus were penetrated with a suture at vasectomy. Careful placement of ligating sutures to avoid vessel perforation is recommended to prevent this complication.
Clinical trial of 19-nortestosterone-hexoxyphenylpropionate (Anadur) for male fertility regulation.
To test the effectiveness of 19-nortestosterone (19NT) as an antifertility agent, 12 normal men (age, 24.0 + or - 2.2 years) received 19NT-hexoxyphenylpropionate (19NT-HPP), 200 mg/week intramuscularly for 7 weeks. After this initial phase, 2 groups were formed that received injections at different intervals. Except for the 19NT serum levels, there was no difference in treatment effects between both groups. 19NT-HPP administration in general suppressed gonadotropins below detection limits, accompanied by testosterone levels well in the castrate range. At the end of the treatment phase, azoospermia or severe oligozoospermia was present in 10 volunteers. No loss of libido or potency was reported. Administration of 19NT-HPP did not affect liver enzymes, creatinine, uric acid, serum electrolytes, or serum lipids. The presented data demonstrate that 19NT-HPP as a single entity given every 3 weeks can suppress sperm output in a high proportion of men and simultaneously maintain virility. (author's)
The majority of the world's 65 million oral contraceptive (OC) users are in developed countries. In Kenya, however, 70% of all clients requesting contraception select OCs. The most commonly used OCs in Africa are combined preparations containing ethynodiol diacetate and ethynylestradiol, in doses of 1 mg of the progestagen and .05 mg of the estrogen. The sequential and continuous progestagens have not been widely used in African family planning programs. Although detailed studies of OC risks have not been conducted in Africa, circulatory system diseases resulting from OC use seem to be uncommon. This is attributed to the young age of the majority of African OC users (20-34 years), the fact that predisposing factors such as obesity and smoking are uncommon, and an average duration of use of under 5 years. Nor do African OC users seem to have experienced major metabolic changes. Continuation rates are low among OC users in Kenya, and 70% are lost to follow up within the 1st 3 months. Experience in Zimbabwe suggests that OC resupply could be handled safely by trained nonmedical community-based health workers, following initial counseling and medical examination by a physician. Overall, the experience in Kenya and in Africa in general indicates that OCs are an effective and safe method of fertility control. With better screening of patients and staff supervision, OCs can be made more widely available.
A large proportion of reproductive health services in Africa are consumed by complaints of infertility. However, infertility remains a problem characterized by a lack of standard definitions, insufficient understanding of etiologic factors, questionable diagnostic procedures, and dubious therapies. The social implications of infertility in a country such as Africa where fertility is highly valued include marital instability, divorce, polygamy, prostitution, and suicide. In developing countries like Africa, there are extensive regional, ethnic, and geographic variations in infertility. Sociocultural factors considered to have led to the spread of sexually transmitted diseases, a major cause of infertility in Africa, include self-treatment, inadequate treatment, poor medical infrastructure, and the young age of African populations. Other causes of infertility and pregnancy wastage in Africa are tuberculosis, toxic agents, parasitic disease, nutritional deficiencies, and immunologic incompatibility between partners. Efforts to solve Africa's infertility problem should be focused on prevention. This effort should promote sex education, public health, and hygiene; control of nonvenereal infections; correction of nutritional deficiencies and blood disorders; early treatment of abnormal conditions; prevention of damage from trauma, heat, chemicals, and x-ray exposure; early investigation when marriages are childless; improvements in obstetric practices; avoidance of unnecessary operations or procedures; and proper contraceptive counseling.
Land tenure and development problems in Mali: the case of the Niger delta.
The chapter's objective is to identify the distinctive features of 1 geographical area of Mali, the inner delta of the Niger. In both the distant and recent past, this area has seen several waves of settlers. It is the focus of a number of development schemes whose degree of success or failure is attributable to their awareness of traditional tenure rights. Several different modes of acquiring land exist based on 3 groups of factors: the productive system employed (farmers till the soil, herders graze the vegetation, and fishermen exploit the waters); the historical role of the settlers; and the social and historic dynamics of the groups. The Delta is divided into pastoral zones or transhumance routes dominated by certain groups: by Fulani pastoralists; by permanent occupants based in villages; or by fishermen. Farmers (Rimaibe or Marka) or fishermen (Bozo) dominate the zones where they can control production according to village demands, but these are not always the same for pastoral groups. The contradition inherent in this situation is resolved by the partitioning of the Delta into 3 divisions for each of the different societies. Reform of land rights as viewed by the modern state of Mali and the socioeconomic disasters since 1970 are the 2 factors which have led to the establishment of a number of major schemes in the Delta. Until the development schemes were established, the system of traditional tenure rights was the only system prevailing in the Delta. It had the advantage of being known by all and was respected in the main every time a part of the Delta was brought into production. The arrival of the development schemes and their system of organization of the land had a 2-fold impact on land rights in general and on the Delta in particular. First, the schemes produced a disorganized and anarchic extension of economic activity in the area. Peasants who had lost their traditional rights resented new conditions offered or imposed on them, despite the advantages of controlled irrigation and easier work. Consequently, the development schemes often found themselves managing larger and larger areas without the labor needed to bring them into production. This expropriation of land from the peasants was not wholly responsible for the sense of resignation associated with the development schemes. Other factors also explain their lack of success, including the high cost of participation, the charges levied for irrigation and flood control, and the redistribution of land without universal agreement.
Nutrition amongst a group of Wodaabe (Bororo) pastoralists in Niger.
A longitudinal survey was conducted to establish the nutritional profile of a nomadic herding group in "normal" conditions, to measure the impact of seasonal variations on nutritional status, and to see what extent the dry season is the critical period of the year, comparable to the rainy season among Sahelian farmers. From August 1980 to September 1981, 54 families of WoDaaBe herders were visited at 3-monthly intervals. The sample chosen consisted of 3 groups of related families (family defined as a food consumption unit) which tended to move in the same area, thus allowing them to be more easily reinterviewed. On average, 366 herders were interviewed with a standard questionnaire on a family level on food consumption and water supply and the individual level concerning the occurrence of illness, limitations on work capacity, and infant feeding. Anthropometric measurements were made. All interviews and measurements were carried out by the same 2 Nigerian assistants. Milk and cereals (millet and sorghum) are the basis of the WoDaaBe diet. If enough milk is available during the rainy season, the diet consists entirely of milk. As pastures degrade and water becomes scarce in the dry season, milk production declines and the herders increase the proportion of cereals in their diet. By the end of the dry season, they eat almost only cereals. The herders have most milk at their disposal at the end of the rainy season (September) and least during the dry season. As the standard deviations show, there are large variations among families. Based on the estimates from 40 families of the sample during 1981, the quantity of cereals eaten per person per annum as in the range of 130-180 kg. Meat is not a basic food for the herders. Among the 40 families questioned every 3 months, an average of 2.5 sheep and goats and 1 calf had been slaughtered per family a year. These animals are not eaten by a single family. The meat is distributed among all the guests invited to the celebration. 2 cohorts of adult men and women (aged 18 and older) pregnant women excluded, were weighed every 3 months, to quantify weight changes over a year. Peak weights were in February, at the end of the cold season, following a steady weight gain during the preceding rainy season. Between February and May (the hot and dry season), a sharp drop in weight of about 5% was observed.
A detailed household socioeconomic study was conducted among selected communities of the inner Niger Delta of central Mali between June 1981 and December 1982. 1 part of this longitudinal survey was a detailed examination of the nutritional status (anthropometry) and dietary habits of 2 groups -- purely pastoral Kel Tamasheq and the agropastoral Fulani. 1 of the aims of the larger socioeconomic survey was to identify seasonal periods of stress, since for most of the Sahel, especially for the pastoral groups, little is known about nutritional status, energy expenditure, and food intake on a seasonal basis. 2 different types of survey were used to obtain the nutritional information for the populations under study. The 1st survey of food intake consisted simply of a retrospective interview conducted fortnightly, later monthly, but on different days, concerning food consumption in a 24-hour reference period. The 2nd survey on nutritional status consisted of a monthly survey of heights and weights of all individuals, adults and children, in the study population. Data on both anthrompometry and food intake are presented for the Kel Tamasheq; data on anthropometry alone are presented for the Fulani. For the Kel Tamasheq, it seems that food consumption is highest between November and April. The main period of stress for everyone begins in may and ends in August. The balance between the consumption of milk and cereals in both camps is very different with milk assuming a much greater importance amongst the cattle-herding Ineslemen of Camp A. The figures indicate a much lower dependence on meat than anticipated for a pastoral society. In regard to anthropometry, in Camp A seasonal changes in body weights are pronounced, possibly due to dietary deficiencies. Adults are lightest at the end of the dry season, reaching a low point in August. In Camp B, adult changes were much smaller, and it is tentatively suggested that the changes observed are due to differences in energy expenditure by season rather than to changes in food intake. There was no evidence of malnutrition among children under 5 years in either social class. The Fulani chosen for the larger study were located in 2 sizeable vilalges. The Fulani also have a complex system of castes and social classes. Only 2 categories are distinguished -- the descendants of the pastoral Fulani or the Fulbe and the agricultural descendants, the Rimaibe. Throughout the year, changes in adult body weights for Fulbe and Rimaibe were quite similar, except during the September-October period when the body weights of Rimaibe adults increased, while this increase was delayed until November for the Fulbe. More Fulbe than Rimaibe children age 5 to 15 fell below 80% of standard, although the seasonal pattern of weight changes was the same for both groups.
Assessing the components of seasonal stress amongst Fulani of the Seno-Mango, central Mali.
The objective of this study of the Fulani, an agropastoral population in the Seno-Mango, Central Mali, was to attempt to understand 1 of the major problems of the Sahelian world, i.e., the nutrition and health of the pastoral and agropastoral populations. A complementary goal was to stimulate an interest and action in further research among the populations of Doosu, Gabana, and Kinya. From the outset, the populations was divided into 2 groups: Rimaibe and Fulbe. This division was considered necessary because variations in agricultural and herding practices, in type of settlement, in ethnic origin, and in the economic and social effects of past history could result in significant differences in nutrition and health status. Both groups live in the same zone, speak the same language, and have numerous economic and social ties. The Fulbe practice a system of semi-transhumant herding with associated millet cultivation. The Rimaibe primarily cultivate millet with associated breeding of small ruminants. The year is divided into 4 main seasons: a rainy season from June-July to September; a short hot season from September to mid-November; a cold dry season from November until the end of February; and a hot dry season from March until the beginning of the rains. Despite the small sample numbers, the nutritional status, as judged by mean monthly weights and percentages falling below 90% of Harvard Standards (weight/height), appears to indicate a more favorable position of the Rimaibe. There does not appear to be a great difference between the classes in health status except for the Guinea-worm eruptions of the Rimaibe and malarial bouts for the Fulbe. The Rimaibe also appear better off economically than the Fulbe. This is evident at the village, household, and individual levels. 1 of the original hypotheses was that the periods of seasonal stress would be different for the Fulbe and Rimaibe. For the Fulbe, with their emphasis on pastoral activities, it was expected that the dry season would be the most critical time of the year. This is the season during which the shortage of water and pasture demands high levels of energy expenditure for cattle husbandry, at a time when food intake is low and the climate particularly harsh. The data support this hypothesis. For the Rimaibe who are primarily agriculturalists it was expected that the period of rains would be the most critical. This was regarded as the time in the year of most intense activity, with food reserves still low, and a high disease incidence due to the rains. The data support this hypothesis for the Rimaibe women only. The Rimaibe men appear to follow the Fulbe pattern of seasonal weight loss. The shortage of water, demanding high levels of energy expenditure during the dry season, was cited as a possible reason for the weight loss at this time. The data do not support the hypothesis that in regions of unimodal rainfall, where the period from 1 harvest to the next is long, herders have an advantage over farmers because of milk production.
The objectives of the broader study of which this project forms a part were: to describe the nutritional status of the sample population by means of regular measures of anthropometric status, food intake, disease and energy expenditure (with an emphasis on seasonal variation); to identify the components of seasonal stress and the risk of stress among different groups of people; and to compare the findings with those from parallel studies in other regions of Mali amongst Fulani and Tamasheq populations. This chapter covers just 1 of the areas involved: food intake. Measurement of food intake itself is analyzed, concentrating on millet, which provides over 90% of nutrient intake. Dofinena and Dalonguebougou, the 2 villages studied, are in the Doura Arrondisement of the Cercle of Segou, Mali. Subsistence farming is based on dry land millet cultivation. There are 2 millet crops: early millet, harvested October to November, and late millet, which is harvested between December to January. Peanuts, Bambara groundnuts, cowpeas, maize, fonio, and a very few vegetables also are cultivated. Dalonguebougou has sandy soils, and water is available from a large number of wells about 20 meters deep. Dofinea has heavier, clay soils, and there is only 1 major well 40 meters deep. The population of Dalonguebougou is approximately 550 and of Dofinena almost 200. This analysis of millet consumption covers the April-October 1982 period for Dalonguebougou and the May-October 1982 period for Dofinena. This means 2 or 3 months of the hot season, when millet was still available from household granaries in Dalonguebougou but not in all cases in Dofinena, followed by 2 months of the rainy season, during which time household supplies were getting low for some households in both villages; plus 2 months of the late rainy season, when household millet supplies were finished for the majority of households in Dofinena, and low or finished for about 2/3 of households in Dalonguebougou. 25 of the 28 households under study in Dalonguebougou were included in the analysis; all of the 22 households in Dofinena were included in this analysis. In Dalonguebougou 9 of the 25 households were in Group 1 -- surplus millet, that is, did not show any constant pattern of increased or decreased millet consumption in the 3 periods; 7 of the 25 were in the enough millet category, i.e., similar to households in Group 1 except in the July to August period when they are on the whole a little lower in their supply; and 9 of 25 were in the deficit millet category, that is, the average intakes for this group were not substantially different than for Groups 1 and 2, and the intake in July and August was greater than for Group 2 even though Group 3's millet supplies were very low at that time. In Dofinena 4 of 22 families were in Group 1, 3 in Group 2, and 9 in Group 3, and 6 were in Group 4 -- early millet deficit. It appears that the daily millet allocation for adults averaged about 1.5 kilograms when supplies are good. Households vary in their ability to maintain this level from their annual millet harvests.
Comments on sterilization methods in China [letter]
Bullough and Bullough draw attention to the non-surgical transcervical method of female sterilization developed in China. All methods of fertility regulation raise important medical and ethical issues. Approximately 95 million couples worldwide are currently protected from unwanted pregnancy by voluntary sterilization, and about half of them live in the Peoples Republic of China. Between 1975 and June 1983, the transcervical phenol mucilage instillation technique developed in China was used in an estimated 50,000 to 100,000 sterilizations in that country. In 1983, 200 medical units in China offered the procedure. 2 of the authors (Chi and Lippes), at different visits to China, have personally observed the procedure performed on a total of about 20 women. Most of them requested this non-surgical procedure because their friends had a satisfactory experience with it. The procedure sometimes causes pain, but the authors did not see any of these women leave the clinic "clutching their abdomen." Presently, a nationwide follow-up study is being conducted to examine the possible long-term sequelae, including the incidence of ectopic pregnancies, of this procedure (Qiu SH, principal investigator, Personal Communication). In China and in the United States, male and female sterilizations have become the single most important method of fertility regulation. Many countries have a medical infrastructure much weaker than that of China but, like China, face the same problem of making very large numbers of sterilizations available in a safe and acceptable way. The alternative of minilaparotomy or laproscopy is not always easy to provide where medical facilities are few and highly burdened with problems of curative medicine. Male sterilization is relatively easy to perform under local anesthesia. However, there seems a genuine need for simplification of female sterilization and the transcervical route is the most obvious option for improvements. In addition to the Chinese use of phenol, some experience has been accumulated in Chile with the use of quinacrine. Family Health International has records and follow-up on 450 women who have undergone transcervical sterilization with quinacrine pellets. The 4 year cumulative life table pregnancy rate is about 4.0 per 100 women. No serious complications, other than failure to block the fallopian tubes, has attended the use of quinacrine pellets. Phase I clinical trials are now being conducted on the use of tetracycline as a possible sclerosing agent. (full text)
Evaluation of intramuscular sulprostone and vacuum aspiration for termination of early pregnancy.
The results of a comparative study of the efficacy and acceptability of sulprostone administered intramuscularly and vacuum aspiration for termination of very early pregnancy is reported. The period of amenorrhea varied from 35 to 45 days with a positive pregnancy test. Group A (20 cases) received intramuscular sulprostone in doses of 500 mcg and 1000 mcg 4 hours apart without any pretreatment. The success rate was 85%. Group B (20 cases) underwent vacuum aspiration with 100% success rate. Incidence of vomiting was comparable in both groups. Severe abdominal cramps/pain occurred in 11% following sulprostone administration. No immediate serious complication occurred. Estimation of serum HCG was done before sulprostone administration and 2 weeks later. A decline was noted 2 weeks post-treatment in successful cases, thus confirming the effectiveness of the therapy. (author's)
A case of breast enlargement in an 18-month-old breastfed girl whose mother was using a combination pill containing 150 mcg d-norgestrel and 30 mcg ethinyl estradiol for 3 months is reported. Physical examination and endocrinological investigations in the girl did not reveal any abnormality. Breast enlargement subsided slowly over the next 6 months after discontinuation of breastfeeding. (author's)
Pharmacokinetic and pharmacodynamic studies of vaginal rings releasing low-dose levonorgestrel.
Pharmacokinetic and pharmacodynamic effects of a vaginal ring releasing 20 mcg/day levonorgestrel (L-NOG) have been studied in 15 women. Serum levels of L-NOG, estradiol, and progesterone were measured 3 times a week in a control menstrual cycle and a treatment period of 3 months after the insertion of the 1st vaginal ring. All control cycles were normal ovulatory. Among the 36 treatment cycles 13 were ovulatory (36%), 5 ovulatory with inadequate luteal function (14%), 14 anovulatory but with marked follicle activity (39%), and 4 anovulatory (11%). In the groups with ovulatory reaction the serum levels of L-NOG showed a decline of 54% of the initial level at the end of the treatment period, calculated according to the linear regression equation of Y=0.903-0.0142X, while in the groups without ovulation the L-NOG levels were higher and the decline was 24% of the initial level (Y=1.034-0.0086X). There were distinct individual differences in the levels of L-NOG and ovarian reactions. Marked follicle activity with very high estradiol levels were found in correlation with high L-NOG in 7 treatment cycles, particularly in the B type of reaction (B=anovulatory cycle with marked follicle activity). More intermenstrual bleeding and spotting occurred in the 2nd treatment cycles, particularly in those with anovulatory reactions. (author's)
Copper intrauterine contraceptive device insertion 6 weeks after caesarean section.
A total of 214 women had copper T 200 IUDs inserted at 6 weeks postpartum. Half of these women had had a cesarean section while the other half had a vaginal delivery. No accidental pregnancy or perforation was observed in either of the groups. However, the event rates for expulsion and removals for bleeding and pain were slightly higher in postcesarean section women as compared to those who had delivered normally. (author's)
Chlamydia trachomatis infection at a family planning clinic.
Endocervical samples were taken for the detection of Chlamydia trachomatis from 500 consecutive patients attending a family planning clinic. The Microtrak direct specimen immunofluorescence test was used. Swabs from 79 patients (15.8%) were positive for chlamydia. 71 (95%) of these patients were symptom free, and 39.8% were under 20 years old. 21 patients were pregnant, 7 (33%) had chlamydia. Those positive for chlamydia had twice the frequency of abnormal smears and other sexually transmitted infections as those who were negative. Contraceptive use was similar except that intrauterine devices were used less frequently by patients with chlamydia infection. This report indicates the frequent occurrence of Chlamydia trachomatis infection in New Zealand and that newly developed methods of diagnosis enable us to identify and treat those with this infection. Characteristically these patients are under 20, have multiple partners, and a high incidence of abnormal smears and other sexually transmitted infections. (author's)
An epidemiologic surveillance program for evaluating occupational reproductive hazards.
A noninvasive and inexpensive epidemiologic program for evaluating the possible effects of occupational exposures on fertility is proposed. This suveillance program utilizes reproductive information obtainable from a short questionnaire (1-2 pages in length) or directly from existing medical, employment, or insurance records, and results can be generated readily on a routine basis. This program examines the reproductive experience of the exposed workers in terms of live births compared with that of the US general population with the proper statistical adjustments. It calculates the standardized birth ratios (SBR), adjusting for maternal age, parity, calendar time, and race. Such an analysis will detect whether there is a significant decrease in fertility among a group of employees, and is, therefore, a useful surveillance tool. The proposed method should be viewed as a mechanism to provide an early signal for any potential hazard and to direct priority for other more in-depth epidemiologic or physiologic studies. The procedure is illustrated with data from individuals exposed to EDB, DBCP, and waste-water treatment plant processes. The method can be modified to compare the reproductive performance of an exposed group to that of an internal control group. With an internal control group, additional confounding factors can be taken into consideration. The relative merits of this approach compared to another method of fertility evaluation, semen analysis, are discussed. (author's)
The delivery of primary health care (PHC) services is now recognized as a crucial element in the development of low-income regions. Effective delivery of these services requires the ability to solve a variety of policy decision problems. Research has demonstrated the utility of operations research/management science (OR/MS) models and methodologies in the analysis and solution of such problems. However, this approach may be limited in some regions by the data and computational requirements of the models. Intuitive approaches in the spirit of OR/MS models, termed heuristics, can provide an effective alternative in such cases. The current paper proposes a general heuristic procedure for solving problems of PHC delivery in developing regions. The heuristic is applied, in detail, to the problem of identifying "best" community financing schemes for PHC services in low-income sections of Rio de Janeiro, Brazil. (author's)
Vecuronium bromide in anaesthesia for laparoscopic sterilization.
Vecuronium bromide 70 mcg kg-1 was used to facilitate tracheal intubation and provide neuromuscular blockade in 52 patients undergoing laparoscopic sterilization. Anesthesia was maintained with 67% nitrous oxide in oxygen. Patients were monitored clinically and by tactile assessment of the evoked response of the adductor pollicis to a supramaximal train-of-four stimulation. Intubating conditions were assessed at 90s in the 1st 33 patients, and were poor. They improved significantly in the subsequent 19 patients when intubation was delayed until 150 s (P0.05). Operating conditions were good in all except 2 patients. Residual neuromuscular blockade was antagonized rapidly at completion of surgery by neostigmine 2.5 mg i.v., which was administered provided there was at least 1 twitch response. The mean duration of the procedure was 14.3 minutes (SD 2.5 minutes). The mean time from injection of neostigmine to satisfactory spontaneous breathing and neuromuscular recovery was 1.6 minutes (SD 0.7 minutes). (author's)
Effect of theophylline F2-alpha-induced contractile activity of the uterus.
Prostaglandins are now extensively used for abortions and for inducing labor in all 3 trimesters of pregnancy. Owing to the side effects associated with parenteral administration, preference is now given to local application. This, however, may also give rise to an extreme or inadequate stimulation of the uterus. Therefore, therapeutic procedures capable of effectively influencing exogenous PGF2-alpha induced uterine contractions and even spontaneous hyperergic uterine contractions are of clinical importance. Theoretically, methylxanthine derivatives may be used in view of their well-known smooth muscle relaxant effect. (author's)
Cell-mediated immunity to spermatozoal antigens after vasectomy: recent developments.
Vasectomy has rapidly become the most popular male sterilization technique in man in recent years. However, little is known about its long-term physiological, anatomical, endocrinological, and immunological consequences. This report summarizes recent developments in investigations into the immune response to spermatozoa after vasectomy. The review deals with those aspects that bear directly on clinical problems. Animal data is used where necessary to supplement inadequate knowledge of events occurring in man. The review reveals that the main obstacles to major progress in this area of research include: 1) unavailability of purified sperm antigens, 2) unavailability of a suitable animal model for such studies, and 3) inadequacy of the techniques currently in use. These are suggested as major avenues for future exploration. (author's modified)
Significantly for this International Planned Parenthood Federation/UNESCO Meeting on Clearing House Facilities for Audiovisual Aids and Teaching Materials, the proportion of work and of funding devoted to education, information, and training is steadily increasing. Program activities in need of audiovisual aids and teaching materials include: components designed to motivate people to practice family planning and to persuade opinion leaders to support program objectives (face-to-face communication and mass media outlets); training courses; and the education of government officials, opinion leaders, the community, young people both in and out of school, and family planning acceptors. Discussion of the present state of clearing house facilities for audiovisual aids and teaching materials covers the following: UN agencies, government activities, nongovernment organizations. UNESCO, WHO, FAO, ILO, AND UNICEF have services in audiovisual materials, including the production and distribution of films, photographs, and printed materials. These services illustrate the broad areas of activity of each agency and until the present time family planning and population problems have not featured very prominently in these materials. Many of them are used extensively in family planning programs because they demonstrate the health and socioeconomic development aspects to which family planning is related. Materials produced by the specialized agencies circulate through regional and national offices and are at the disposal of other agencies for loan usually without charge. Donor governments vary in the emphasis they place on educational materials. The Population Council is a nongovernmental organization which has been particularly active in the past in the production and distribution of audiovisual aids and teaching mterials. Among the universities, the Carolina Population Center has established an educational materials unit which produces audiovisual aids for use at home and overseas. The IPPF houses a rapidly growing collection of films, slides, and filmstrips, printed materials, nonprojected aids, and models relating to family planning motivation, training, population, and sex education. Some factors to be taken into account in considering the feasibility of establishing an international clearing house for audiovisual aids and teaching materials include: means of assessing levels of expressed demand; possibility of stimulating demand for audiovisual aids and teaching materials in family planning information and education programs; possiblity of promoting knowledge and understanding of the proposed clearing house at all levels of operation; extent of personnel equipped and trained to utilize audiovisual aids and teaching materials; adaptability of materials to local situations; desirability of a central, regional, or combination structure; and funding. Factors to be considered in formulating a blueprint for an international clearing house include: scope of materials to be handled by clearing house; problems inherent in identification and collection of materials; need for services to support circulation of materials; international transportation of materials; storage; need for a reporting system and evaluation; and policy with regard to meeting clients' equipment requirements and to payment by client.
Some thoughts on Contraceptive Prevalence Surveys.
This paper presents the views of the Agency for International Development (AID) on Contraceptive Prevalence Surveys, focusing on why the agency supports them, what the agency wants to get out of them, and how they fit into the AID program. Both the developing countries and the donor community needed data bases that serve several purposes. There was a clear need for data on what was happening in countries with active family planning programs. Fairly substantial resources were being programmed into efforts to slow population growth, and it was important to ensure that these resources were used effectively and efficiently. There were also obvious time pressures. The longer the delay before slowing population growth, the more serious the problem would become. Clearly, timely data were needed. To respond to the varied data needs, early in its history AID's Population Office initiated a broad program of support for data collection, including censuses, surveys, civil registration systems, and family planning program statistics. There was also support for efforts to ensure that these data were evaluated, analyzed, and interpreted to facilitate their use. In 1971, AID along with the UN and the International Statistical Institute, began to develop what became the World Fertility Survey (WFS). The effort was launched more as a research than an administrative tool. During the course of developing the WFS, there was much reluctance on the part of many demographers and social scientists to clarify the link between fertility change and family planning action programs. In 1976, WFS carried out some field trials on a series of questions on perceived family planning availability and accessibility and thereafter developed a set of questions on availability, which were added to the core questionnaire. When the Contraceptive Prevalence Survey (CPS) project was initiated with Westinghouse, AID asked that availability information be collected for all methods requiring a source. These data have been very valuable as a means of gaining insight into the role of availability in contraceptive use. The CPS was specifically designed to collect a limited set of highly program-relevant data quickly and to make these data available to program administrators and policy makers. First, CPS has been an important data source for documenting trends in contraceptive knowledge and use. Second, since many of the WFS, as well as the CPS, have included questions on perceived availability of family planning, it is possible to examine trends in availability. Regarding how the CPS might be improved, the CPS Workshop provides a good opportunity for an exchange of ideas. A description of the Workshop objectives are outlined.
This article reports the results of phase I multicenter clinical studies of subcutaneous norethindrone (NET) contraceptive implants. 10 female volunteers from each of 5 centers were studied for 6-12 months and the effects of the NET implants on ovulation, bleeding patterns, cycle length, and other parameters were noted. Mean serum NET levels remained sustained and steady to levels of .54 + or - .12 ng/ml up to day 200. The incidence of ovulation was decreased to 20-50% of controls in the 1st 3 cycles and gradually returned to a normal pattern. Subjects tended to experience a marked increase in bleeding days during the cycles right after implantation but returned to a normal pattern after 3 months. No major adverse local reaction was noted at the implant site following either implantation or removal. The rate of pellet breakage was 20% at implantation and 80% at removal. This study provides evidence that the ovarian effect of 300 mcg of NET in oral dose is equivalent to that produced by the much lower dose of 110.6 + or - 20 mcg of NET/day administered subcutaneously from the 2 NET pellets. The most important feature of the pellet implant method is that the minimal effective dose of progestin can be administered subcutaneously at a fairly constant level for inhibition of conception over several months. Moreover, the daily dose of progestin can be precisely controlled to modulate the ovulatory and bleeding patterns. Study subjects reported alleviation of dysmenorrhea and improvement of skin conditions. The few side effects observed (headache, nausea, abdominal discomfort, and hematoma at the implant site) were minor. More clinical studies involving larger numbers of subjects are needed to evaluate the number of pellets and the NET concentration that will provide maximum contraceptive effects with minimal side effects.
Managing patients on oral contraceptives.
This article presents guidelines on the selection and management of oral contraceptive (OC) users and provides a balanced view of the risks and benefits of the class of drugs. The risk-benefit ratio is best conceptualized as the risk of this method versus the risk of pregnancy and of other contraceptive methods. Age and smoking are the most critical risk factors in OC use. It is not until a woman is over 35 years of age and smokes that the risk of mortality due to OC use approaches and then surpasses that due to pregnancy. Since OCs are believed to challenge a woman's physiologic reserve, it is recommended that physicians obtain a general health as well as a reproductive history, perform a general physical examination, and order laboratory tests such as urinalysis, hematocrit, and Pap test before OCs are prescribed. The initial choice of OC estrogen content is 30-35 mcg of ethinyl estradiol. It is essential that physicians inform patients how to take OCs, recommend a back-up method of contraception for situations such as missed pills, review common side effects as well as danger signals, and encourage the patient to stop smoking if applicable. With adolescents or patients whose understanding or motivation is questionable, the patient should be seen again by the physician after 1-2 cycles. A 3-month evaluation allows early reassessment of the patient's physiologic reserve. After this visit, the patient should be seen every 6 months. About 40% of OC users experience minor side effects such as decreased menstrual flow, weight gain, and vaginal discharge during the 1st 3 months. More difficult problems include persistent breakthrough bleeding, absence of withdrawal bleeding, and hypertension. Headaches, severe leg pain, chest pain, visual symptoms, and abdominal pain are considered serious complications.
Emergency urinary HCG testing with the Tandem ICON [letter]
The authors of this letter compared the performance of Tandem ICON and Sensitex urine human choriogonadotropin (hCG) assays with that of hCG in the corresponding serum through use of a qualitative serum radioimmunoassay (RIA) test. Fresh urine samples were analyzed by both the Tandem and the Sensitex assays (412 specimens over 64 days), and a total of 348 corresponding serum samples were analyzed with the RIA serum assay. Compared with the RIA, the sensitivity of the Tandem assay was 94.7% and that of the Sensitex assay was 83.2%. Concentrations of serum hCG not detected by the Tandem assay were less than 40 IU/L, whereas those undetected by the Sensitex assay were as high as 450 IU/L. On the basis of the observed false positive rate of 0%, true positive rate of 95%, and apparent freedom from interference by protein, hemoglobin, follitropin, and lutropin, the authors recommend the Tandem ICON assay for use in routine screening of pregnancy in outpatient settings. On the other hand, the false positive rate of 5% may not be acceptable for emergency situations where early pregnancy must be ruled out.
Rural-urban mobility in Thailand: a decision-making approach.
This paper analyzes a theoretical model of mobility decision making, which is developed in a context dominated by circular rural-urban movement. Focus on the individual level permits closer examination of why, given an overall objective context, some people move while others do not. This theoretical model of mobility behavior uses 5 explanatory variables: past mobility experience, urban social contacts, information about urban areas, evaluations of alternative destinations, and mobility plans. The data presented were collected in 6 villages in northeast Thailand during 2 waves of interviews -- July-September 1978 and July-August 1979. The northeast region of Thailand has been characterized by substantial outmigration for decades, much of it directed toward Bangkok. The 6 villages -- which range in population from just under 500 persons to just over 1000 -- are relatively poor. They are neither immediately adjacent to an urban area nor excessively remote, and they are broadly representative of many areas supplying migrants to Bangkok and other urban centers. The model is represented as a system of linear structural equations. For purposes of analysis, the theoretical model is represented as 2 models, 1 for Bangkok and 1 for northeast urban destinations, each having 2 submodels -- 1 for each commune. The 2 submodels for each destination were analyzed simultaneously, producing effect coefficients similar to regression coefficients. Although certain differences were found among the 4 submodels, the overwhelming feature was their similarity. Where differences were evident, they generally reflected differences in the effectiveness of prior mobility as a predictor of other variables in the process. A villager's previous history of movement was a key factor affecting subsequent movement and the entire decisionmaking process. The primary effect of having friends and relatives in a particular urban center was to increase the amount of information a villager had about that urban center. Information had a significant effect on evaluations and plans. Except in 1 submodel, evaluations had a significant effect on plans. The existence of plans, which to some extent represent a culmination of social contacts, information, and evaluations, was the only factor other than previous mobility which had a significant effect on subsequent movement. To stimulate the growth of regional urban growth centers and reduce the growth of Bangkok, the most feasible approach seems to be to introduce appropriate information into the village to alternate subsequent mobility patterns.
The 5 sections of this 15th volume of the Salus annotated bibliography on low-cost rural health care and manpower training, with special emphasis on developing countries, covers the following: reference works; organization and planning (health workers; organization and administration; planning; geographical distribution of health services and workers; financial aspects; cultural aspects; and epidemiological, family planning, maternal child health, nutrition, and disease control studies); health care implementation (inpatient care, outpatient care, mobile units and services, health education, and appropriate technology); health workers -- training and utilization (medical personnel, nursing personnel, midwives and family planning workers, dental personnel, laboratory and X-ray technicians, environmental health workers, occupational and physical therapists, health educators, and teaching aids); and formal evaluative studies (health workers, organization and administration, planning, geographical distribution of health services and workers, financial aspects, cultural aspects, and epidemiological, family planning, maternal and child health, nutrition, and disease control studies).
The 5 sections of this Salus annotated bibliography on low-cost rural health care and manpower training, with special emphasis on developing countries, covers the following: reference works; organization and planning (health workers; organization and administration; planning; geographical distribution of health services and workers; financial aspects; cultural aspects; and epidemiological, family planning, maternal child health, nutrition, and disease control studies); health care implementation (inpatient care, outpatient care, mobile units and services, health education, and appropriate technology); health workers -- training and utilization (medical personnel, nursing personnel, midwives and family planning workers, dental personnel, laboratory and X-ray technicians, environmental health workers, occupational and physical therapists, health educators, and teaching aids); and formal evaluative studies (health workers, organization and administration, planning, geographical distribution of health services and workers, financial aspects, cultural aspects, and epidemiological, family planning, maternal child health, nutrition, and disease control studies).
The pregnant adolescent: problems of premature parenthood.
This book's objective is to describe the circumstances surrounding adolescent pregnancy, demonstrate the need for social support, and describe how these supports might be offered. It contains 2 basic thrusts. The early chapters describe the adolescent pregnancy problem and the parallels between the development of the adolescent pregnancy and the potential child maltreater. What follows from this description is the author's sense of methods which will help to reduce the risks generated by participation in either, or both, of these environments. The information presented in this volume suggests that the time for joint study of child maltreatment and adolescent pregnancy has arrived. The demand for correlational study of these 2 social situations is viable for 4 interrelated reasons: both child maltreatment and adolescent pregnancy are social phenomena which demonstrate a dramatic increase in reported incidence in the past 25 years; both child maltreaters and adolescents who have experienced pregnancy appear to share multiple demographic or situational variables, i.e., minority overrepresentation, low income, low education, and high unemployment; the development of the maltreating event and the adolescent pregnancy reveal an unusual similarity, and the intergenerational aspects of both problems could well be strongly related to the snowball effect that these problems have on each other; and if the problems of child maltreatment and adolescent pregnancy are found to be symbiotic in their support of each other, rather than independent responses to a uniform social context, the direction of prevention efforts in these 2 areas could produce beneficial reductions in the rates of both problems. The best hope for the provision of prevention services in adolescent pregnancy rests within an alteration in public fears and misconceptions related to welfare dependency, contraceptive use, sexual education and information, and possibly even a general view of the adolescent in society. There is no question that contraceptive programming for the adolescent can serve as a vital preventive measure. The cornerstone of this service returns the perspective to education. Preventive services must include education for contraception, education for appropriate decision making, and education for survival of a parent and child. The community-based multidisciplinary system for the adolescent pregnancy or parent has been demonstrated to be the most effective model for programming today. It is also the most difficult program to find or or develop. Services to adolescents must begin as soon as community standards will permit them to be initiated to prevent the occurrence of the problem. Only when a collage of services in the prevention, treatment, and rehabilitation realms is available for the individual adolescent can it be said that a meaningful program exists.
International family planning: the reasons for the program.
For some time there has been an active debate centering on the relationship between population growth and economic growth and the relationship, if any, between abortion and family planning programs. This debate has been characterized by strongly held and often polarized convictions, yet the debate usually fails to consider a most important set of reasons for family planning programs. Specifically, there has been little attention directed to the interests of families and individuals. This is unfortunate since the availability or lack of family planning services is of enormous consequences to some families and individuals. These family and individual interests fall into 3 categories: the desire of couples to determine the size and spacing of their family; mother and child survival; and reduction of abortion. The right of the family to choose the number and spacing of their children was strongly reaffirmed by international consensus at the International Conference on Population in Mexico City in 1984. Governments should not dictate the number of children couples can have, but family planning services should be encouraged so that people really do have the option, if they desire, of fewer children. Families make decisions in their own interest based upon their social and economic and religious situation. Change, including urbanization and lower child mortality, has created a new situation for millions of families throughout the developing world. One can debate the impact of population growth on economic growth in a family, but there is no question that many families feel they can do more for each child if they have fewer children. The unfulfilled desire of 3rd world families to have fewer children is not just Western speculation. Surveys show a large number of women who would like to space or limit their family size but cannot because no services are available. The health and survival of mothers and children provides a 2nd important reason for family planning. 1 of the most serious consequences of women having many children in quick succession is that more children and mothers die. There are dramatic statistics that family planning saves lives. Sound economic policies and various development efforts are critical to economic growth, but family planning has been part of successful packages in some key countries in recent years. Based upon that, sound economic and population policies are mutually supportive components of a country's plans for economic growth. This was the position taken by the Agency for International Development and remains its position. Strong family planning programs should be supported in the interests of families and individuals.
[Spermicidal effect of organic and non-organic substances]
This article deals with a comparative study in vitro of spermicidal activity of superficially active substances, of organic and non-organic acids and conservans which are usually combined with local contraceptive preparations. Spermicidity was determined according to a modified IPPF test. The strongest spermicidal activity was registered in non-ion superficially active nonoxynol-9. The 1:18,000 solution of this substance completely immobilized human spermatozoa in 20 seconds. Cation active benzalkonium-chloride was spermicidal only in a 1:1500 solution and anion active substance sodium natrium laurilsulphate in a 1:1500 solution. The spermicidal activity of acids depended on anion hydrogens concentration and on the nature of anion. Thus, the milk acid was spermicidal in a 1:5000 solution, whilst borate acid was not spermicidally active. Concentration of methyl and propyl hydroxybenzoates used in the prevention of microorganism growth did not immobilize human spermatozoa. (author's)
AIDS and cancer in Nigerians [letter]
According to the author of this letter, broadening of the Centers for Disease Control (CDC) clinical definition of acquired immunodeficiency syndrome (AIDS) to include any case of non-Hodgkin's lymphoma of B-cell origin in an individual positive for human T-cell lymphotropic virus type III (HTLV-III) has led to the identification of AIDS cases in Nigeria. A surveillance program has targeted healthy young blood donors and urban schoolchildren, hemophiliacs, cancer patients, and patients with lymphadenopathy, typical African cancers, and tropical disorders. 15% of the adult blood donors and 13% of the schoolchildren were HTLV-I seropositive, while only 6% of the former and none of the latter individuals were HTLV-III seropositive. None of the hemophiliacs were positive for HTLV-III. HTLV-III seropositivity was detected, however, in a wide variety of patients with hematologic and other malignancies or nonmalignant diseases such as tropical splenomegaly syndrome and reactive lymphadenopathy. HTLV-III infection, like HTLV-I infection, may have a different natural history in Nigeria than in Europe and the US. Homosexuality is believed to be uncommon in Nigeria. Adjustment to the virus through long exposure is possible.
Acquired immunodeficiency syndrome in Saudi Arabia: the American-Saudi connection.
This paper reports 2 cases of acquired immunodeficiency syndrome (AIDS) that developed in a 42-year old Saudi man and a 5 1/2-year old Saudi boy 3 1/2 and 2 1/2 years, respectively, after blood transfusion. These are the 1st cases to be reported from Saudi Arabia, a country in which most of the risk factors for AIDS (homosexuality, promiscuity, and drug abuse) are not prevalent. The blood received by both patients was imported from the US by a commercial company. Both patients were completely healthy, with no history or clinical evidence of malignant disorders, poor nutrition, or other causes of immune suppression before they received the blood transfusions. The transfusions were received in January 1981, coinciding with the emergence of AIDS as a unique clinical entity in the US. An outbreak of AIDS might prove to be a serious health problem in the near future in Saudi Arabia for several reasons: 1) as a result of the long incubation period, AIDS victims can transmit the disease to others before a diagnosis is reached; 2) the number of patients who received imported blood transfusion is unknown, making it impossible to survey potential victims; 3) many physicians and health providers in Saudi Arabia are not familiar with AIDS; and 4) no methods for reporting AIDS cases to public health authorities have been established. Measures such as limiting the importation of blood products from countries with a high incidence of AIDS and screening blood bank samples for human T-cell lymphotropic virus type III are recommended to stop the spread of this fatal disease.
Catholics and abortion: authority vs. dissent.
A paid advertisement, appearing in "The New York Times" on October 4, 1984 under the sponsorship of a group called Catholics for a Free Choice, contended that there is more than 1 legitimate, i.e., theologically and ethically defensible, viewpoint on abortion within the Roman Catholic tradition. The advertisement called for a dialogue on abortion among Catholics; a dialogue that would acknowledge this situation of pluralism, not only in regard to practice (Catholics have about the same proportion of abortions as Protestants in the US) but in regard to the ethical state of the question. The ad explicitly asked for the cessation of institutional sanctions against those with dissenting positions on abortion. In the months following the ad's appearance, its admonition that dissenters should not be penalized has not been heeded. The chief initiative in this repression has come from the Vatican. In early December 1984 there arrived in the mailboxes of the religious superiors or bishops of the 4 priests and brothers and most of the 24 nuns who signed the statement a letter from the head of the Vatican's Sacred Congregation for Religious and Secular Institutes. This letter, dated November 30, 1984, stated that the position taken in "The New York Times" advertisement was "in contradiction to the teachings of the Church" and that the ad's signers were "seriously lacking in religious submission to the mind of the Magisterium." Any signer who declined to make a public retraction was to be warned by the superior with an explicit threat of dismissal from his/her religious community. The 2 priests and the 2 brothers made "pro forma" statements of retraction. None of the nuns who signed was willing to do so. When the nun-signers, through their religious superiors, indicated that they would not retract the statement nor would the superiors threaten them with dismissal, the Sacred Congregation appeared to back off. To date, none of the nuns has fully complied with the request to affirm the church's teaching authority on abortion, and none has been dismissed from her order. Yet, the Vatican clearly is not pleased with this insubordination. By January 1985 it was evident that reprisals against the lay signers were beginning also. Various incidents directed against the signers have led the signers and their supporters to redirect their attention from the question of pluralism on abortion to the right of dissent itself. A network calling itself the Committee of Concerned Catholics is gathering signatures for a new "New York Times" ad. The new ad will repeat the 1st ad's statement on pluralism in regard to abortion, adding to it a statement of solidarity with the original signers and a defense of the right to dissent.
[Retrospective study of ectopic pregnancy after IUD insertion]
190 cases of ectopic pregnancy were encountered in the Hospital of Tianjin Medical College from January 1972 to December 1982. 31 (16.3%) of them were to women using intrauterine devices (IUDs). Some investigators believe the probability of ectopic pregnancy is increased by using an IUD. Others, based on epidemiological statistics, have found that IUD use reduces the probability of intrauterine pregnancy effectively, but not ectopic pregnancy, resulting in a relatively higher percentage of the latter. A conclusion cannot be reached on the basis of this study as the sample was too small. It is worthwhile to point out, however, that the probability of ectopic pregnancy is higher during a short period after removal of the IUD. Additionally, one should be alerted to the possibility of ectopic pregnancy if the villi cannot be found in induced abortion, or a woman presents with abdominal pain or with vaginal bleeding. (author's modified)
Preexisting data were used to investigate patterns of infant mortality among shantytown and nonshantytown residents in Porto Alegre, Brazil, in 1980. The results show sharply differing mortality patterns among these 2 groups -- even within the same limited study areas -- and suggest that the recently favorable downward trend of infant mortality in Porto Alegre could be reversed by rising numbers of shantytown deaths unless concerted action is taken to combat shantytown health hazards. (author's)
Toxic shock syndrome and the vaginal contraceptive sponge.
13 confirmed cases of toxic shock syndrome temporally related to use of the vaginal contraceptive sponge have been reported. The observed risk of toxic shock syndrome in sponge users may be elevated above estimated background rates, but this risk remains very low. Traumatic manipulation of the sponge, use during menstruation or the puerperium, and prolonged retention of the sponge may additionally increase toxic shock syndrome risk. As with all contraceptives, risks must be balanced against benefits. (author's)
Famines in historical perspective.
This paper presents a challenge to the Malthusian view that, historically, famines have been a consequence of overpopulation relative to available resources. The Malthusian paradigm has been used to explain periods of population stability in the past and to account for modern population growth once subsistence crises were no longer a threat. Using premodern Asian populations as a model, the sequence of demographic changes that could be expected to have accompanied and followed famines in the past are simulated in this paper. Critical to an assessment of the demographic importance of famine is an understanding of the time it takes for a population to recover: the shorter the time to achieve prefamine population size, the more frequent famines would have to be to serve as a check to population growth. The information used in this simulation of the consequences of famine includes the age composition of the population at the time the crisis began and the magnitude, duration, and age pattern of changes in fertility and mortality rates when the crisis was over. The simulation results suggest that the only way famines and other mortality crises could have been a major deterrent to longterm population growth is if they occurred with frequency and severity far exceeding that recorded in history. The simulations indicate that the low rate of natural increase set by normal levels of fertility and mortality constitutes a more plausible explanation for the longterm slow growth of large populations in the past. Moreover, the control of normal mortality is most likely responsible for the onset of modern population growth. In general, famines were sufficiently localized and brief that their demographic impact was modest, and even relatively low rates of natural increase quickly erased their impact. Unless famine intensities increase greatly, there is little likelihood that famines will be a major determinant of population growth in the future. Overall, the social and economic effects of famines have probably been more farreaching than their demographic impact.
Reproductive mortality in two developing countries.
This study examined reproductive mortality (mortality attributable to pregnancy, pregnancy termination, childbirth and its sequelae, and contraception) in Indonesia's Bali Province and Egypt's Menoufia Governorate. The study sample included 1691 married women in Menoufia aged 15-49 years who died in 1980-83 and 1241 Bali women who died in 1980-82. All deaths were coded by cause, and surviving family members were interviewed regarding the cases' reproductive and contraceptive histories. Reproductive mortality was 46/100,000 women in Menoufia and 70/100,000 women in Bali. Complications of pregnancy, childbirth, and the puerperium comprised 23% of total deaths to married women aged 15-49 in both areas. Reproductive mortality rates were similar for older and younger women in Menoufia. In Bali, on the other hand, older women had a reproductive mortality rate 28% lower than younger women due to the former's lower fertility rates. Deaths related to contraceptive use were rare in this series, accounting for only 2.2% of reproductive mortality in Menoufia and 1.4% in Bali. All these deaths in Menoufia were associated with oral contraception, whereas most of the Bali deaths were linked to IUD use. The overall contraceptive prevalence rate was 24% in Menoufia and 48% in Bali during the study period. However, among women who died from causes unrelated to pregnancy, only 9% in Menoufia and 34% in Bali were using contraception. This study draws attention to the high maternal mortality in these 2 areas. Menoufia has 48 times as many maternal deaths and Bali 77 times as many matternal deaths as occurred in the US in 1981. It is important to note that the vast majority of these deaths are due to pregnancy and childbirth, not contraception. The increased use of prenatal care and the training of traditional birth attendants to identify and refer high-risk patients could prevent many of these deaths.
Gonococcal urethral stricture and watering-can perineum.
A total of 16 patients with urethral stricture and/or perineal urinary fistulae (watering-can perineum) complicating gonorrhea were seen at the Special Treatment Clinic, University College Hospital, Ibadan, Nigeria. The patients were aged between 25 and 80 years, and the latent period between the time of original attack of gonococcal infection and the development of complications varied from 4 to 50 years. The rate of divorce or marital separation is high among these patients with late sequelae of gonorrhea. The factors responsible for the present higher incidence of early and late complications of gonorrhea among patients in Nigeria and other tropical countries compared with their counterparts in Europe and North America include: 1) lack of medical facilities in most rural areas; 2) inadequate treatment of venereal diseases, including the urban areas where self-medication is practised on a large scale by the general population; 3) illiteracy and ignorance of venereal diseases. The cases of watering-can perineum reported here, and the subsequent chronic pyelonephritis and hypertension, reinforce the plea for early and energetic treatment of acute gonorrhea by health authorities. (author's)
Adolescent sexual activities and fertility in Japan.
In recent years, the public as well as the educational profession in Japan have become increasingly concerned about the issues of teenage pregnancy. During the past 5 years abortions to teenagers have increased by 40% and live births have declined only slightly. The overall condition on the sexual attitudes and behavior of young people were shown here. Several major surveys conducted between 1971 and 1981 formed the basis for discussion in the text. A 1971 survey by the Prime Minister's Office reported that young people tend to view sex in a positive way, they are more open-minded about sex than their parents' generation, and young people are becoming conscious of sex at earlier ages. Comparison of the duplicate surveys conducted in 1974 and 1981 revealed that girls have become more active in sexual experiences than boys over this period, resulting in a convergence and cross-over phenomenon in favor of girls. Clearly, the changes in the sexual behavior of Japanese adolescents have created an urgency in providing sex education; meanwhile, immediate countermeasures need to be taken in dealing with unwanted pregnancies among teenagers which potentially may result in serious social consequences. (author's modified)
WHO seeks global program against viral hepatitis.
A World Health Organization (WHO) Consultative Group on Hepatitis met during July 1983 to draft a global program for viral hepatitis control. At this time, hepatitis viruses infects tens of millions of people every year. These viruses can be transmitted by the fecal-oral route, in blood or certain blood products, and through intimate personal contact. Of the various forms (heptitis A, hepatitis B, and hepatitis non-A, non-B) hepatitis B arouses particular concern because it can produce chronic liver disease and premature death. Currently, there are over 200 million persistent carriers of this virus, many of whom will die of chronic liver damage. Firm evidence recently shows a clear cause and effect relationship between infection with hepatitis B virus and primary liver cancer, a common cancer that claims hundreds of thousands of lives a year. The July meeting made recommendations to improve the situation. One of the most important recommendations was to strengthen national capabilities to control viral hepatitis. The group also reviewed available diagnosis and control methods and suggested areas where action by the WHO would be most effective. The group agreed that the availability of safe and effective vaccines against hepatitis B provides a unique opportunity to break the chain of transmission and to prevent acute and chronic liver disease, including primary liver cancer. There has been concern that the plasma-derived hepatitis B vaccines could contain transmissible agents that might be implicated in the acquired immune deficiency syndrome (AIDS). It was felt that much care needs to be taken in selecting plasma donors and in purifying the immunizing component of the vaccine, known as hepatitis B surface antigen, so as to ensure a very high degree of purity and freedom from all infectious agencts. No evidence exists at this time of AIDS transmission by any hepatitis B vaccine.
Formative evaluation of a sex education course for young adolescents.
The study was done to demonstrate the use of objective instruments to evaluate a sex education course for 8th graders. Results indicated that knowledge scores increased and attitudes toward premarital sexual permissiveness changed to show a greater acceptance of premarital sexual behavior in relationships involving affection or commitment for marriage. Students tended to become less permissive in accepting premarital sexual behavior in relationships not involving affection or commitment for marriage. A sex-concerns check list measured no overall change in the number of concerns, but there were significant changes in 4 of the 24 items. Evaluation questionnaires completed by the students, together with the diaries kept by group leaders, provided useful information to evaluate process and to implement program revisions. The experience of using a variety of evaluation instruments led to a greater awareness of types of data needed to measure the effectiveness of the instructional program. (author's)
Sudden infant death syndrome and maternal age: etiologic implications.
During a 12-year period (1969 through 1980), 431 episodes of sudden infant death syndrome (SIDS) occurred in King County, Washington. Longitudinal analysis of these data confirms the inverse association of SIDS occurrence with maternal age, which has been reported repeatedly from previous cross-sectional analyses. Risk of SIDS increases with increasing birth order, but the inverse maternal age gradient remains constant within each birth-order category. Available evidence suggests that maternal age may be a more important clue to SIDS causation than previously supposed. Assessment of established SIDS risk factors in relation to maternal age deserves further attention. The role of nutrition in pregnancy in relation to maternal age and SIDS risk may also be a productive avenue for future investigation. (author's)
Smoking habits in east Denmark at October 1979.
In October 1979 an Omnibus Interview Survey was carried out covering 2308 persons living in Denmark east of the Great Belt. Type and amount of tobacco consumption was examined by the use of a log linear model for the pinpointing of sufficient marginals among multiple contingency tables. An important finding was that among today's teenagers, more have started smoking before the age of 14 than ever before, namely, 64% of males and 77% of females. The outlines for a person-oriented antitobacco intervention program mediated by medical and dental personnel is outlined. Apart from humanitarian aspects, a cost-benefit analysis may well show that an intervention program may save money in the long run. (author's)
[Survey of smoking habits of Africans in Abidjan]
An investigation of the smoking habits of Africans in Abidjan, Ivory Coast, was made in 1977, surveying a sample of 500 people. Subjects lived in 4 different districts of the city, determined after careful choice to be characteristic of the most important socioeconomic levels. The results show specific traits different from well-known facts in Western countries: only 24.4% of the persons tested are smokers, they smoke cigarettes most frequently. They are almost exclusively men and few of them inhale the smoke. The great majority of smokers is found among the lower socioeconomic classes. (author's modified)
Drugs and youth: a review of the problem.
Recent research concerning motives for alcohol and drug use is summarized and reviewed in the context of seeking common reasons for using alcohol and other drugs. Common motives were found which correlated with both drinking and other drug-taking behavior, and specific motives were also found which were related to use of alcohol, marijuana, and other drugs. The implication of these findings for both primary and secondary prevention efforts is discussed. (author's)
The adolescent's first pregnancy: a controlled study.
The records of 1021 primigravida women who delivered single infants from 1973 to 1976 and who were in the adolescent (ages 20-24) and mature (ages 20-24) age groups were reviewed. It was found that the adolescent patient is more often black and unmarried, and has less prenatal care than the mature woman. There was a higher frequency of hypertensive disorders in the adolescents but this was related to race. The adolescent had fewer breech deliveries and more postpartum endometritis and premature deliveries. There was no significant difference in the fetal, neonatal, and perinatal mortality in the adolescent pregnancies. (author's)
Teenage mothering, admission to hospital, and accidents during the first 5 years.
1031 singleton children of teenage mothers were compared with 10,950 children of older mothers in a national longitudinal cohort study. Children born to teenage mothers and living with them during the first 5 years were more liable to hospital admissions, especially after accidents and for gastroenteritis, than were children born to and living with older mothers. Frequent accidents, poisoning, burns, and superficial injuries or lacerations were more often reported by teenage mothers. The association of teenage mothering with greater likelihood that children would have accidents or be admitted to hospital remained highly significant even after controlling for social and biological confounding influences. Although in part a marker for adverse socioeconomic circumstances, low maternal age appears to be a health hazard for children. (author's)
Drinking habits and alcohol-related beliefs of Australian, Papua New Guinean and American youth.
Results are reported from a cross-national investigation of the drinking habits and beliefs about alcohol of 793 male and 365 female high school students in Australia, Papua New Guinea, and the United States. Only 1/3 of the Papua New Guinean males and 1/10 of the Papua New Guinean females had drunk alcohol. In contrast, almost all Australian and American students had drunk alcohol, with about 1/2 the males and Australian females having a drink in the previous week. Across cultures students were against drinking and driving, and the majority agreed that alcohol was detrimental to the healthy development of children and to one's own health. (author's)
Patterns of drug use from adolescence to young adulthood: II. Sequences of progression.
Major pathways of progression among legal, illegal, and medically prescribed psychoactive drugs from adolescence to young adulthood are described. The data are based on a follow-up cohort of former adolescents representative of high school students in grades 10 and 11 in New York State who were reinterviewed 9 years later at ages 24-25. Various models of progression are tested for their goodness of fit. The patterns formerly observed in adolescence involving progression from 1 class of legal drug (either alcohol or cigarettes) to marijuana to the use of other illicit drugs appear in the transitional period into young adult, with an additional stage, that of prescribed psychoactive drugs. Some differences appear between men and women, with cigarettes more important for women than for men in the total progression. (author's)
Patterns of drug use from adolescence to young adulthood: III. predictors of progression.
Possible linkages of influence among classes of drugs in the observed sequential progression from adolescence to young adulthood are investigated through event history analyses. 3 stages are examined; initiation to marijuana, to the use of other illicit drugs, and to prescribed psychoactive drugs. The data are based on a follow-up cohort of former adolescents representative of high school students in grades 10 and 11 in New York State who were reinterviewed 9 years later at ages 24-25. The sequential order between alcohol and/or cigarettes and marijuana reflects not only the effect of the use of legal drugs on marijuana initiation, but also the effects on onset of these drugs, controlling for individual characteristics measured in adolescence; marijuana use by one's friends in adolescence is an additional important predictor of marijuana initiation. Prior use of marijuana is necessary for progression to other illicit drugs. Multiple factors are involved in the progression to prescribed drugs, with adolescent depressive symptomatology and use of other illicit drugs important for both sexes, and maternal use of psychoactive drugs, dropping out of school, and and prior use of marijuana of additional importance for women. Although licit drugs influence initiation into marijuana independently of age effects, it is especially for the progression from marijuana to other illicit drugs that the earlier drug is associated with the progression to a higher stage drug. (author's)
Changes in the use of drugs, tobacco, and alcohol among Norwegian youth from 1968-1979.
In order to provide information on the way in which use of drugs, and of alcohol and tobacco, among young people changes over a period of time, the Norwegian National Institute for Alcohol Research has each spring, since 1968, conducted a survey of the youth of Oslo to determine their use of these drugs. The results are of significance not only from a scientific point of view but also from the point of view of policy making. For instance, since 1974 there does not seem to have been any increase in alcohol consumption among the youth of Oslo, a fact which may reflect the measures which were introduced at that time in order to curb alcohol consumption among young people in Norway. (author's)
Experience with teenage pregnancy.
A retrospective study of 4224 deliveries to women age 19 or younger was conducted. The purpose of the study was to evaluate the characteristics of teenage pregnancy in an urban, predominantly nonwhite, socioeconomically depressed population. A total of 10,011 infants were delivered during the study period, with 42% (4224) of the infants born to teenagers. It is concluded that teenage pregnancy among the urban, nonwhite poor is characterized by poor outcome, primarily as a reflection of the high-risk obstetric population from which it derives, and only secondarily due to any risk inherent to maternal age. In addition, a striking characteristic of pregnancy in this age group is its tendency to repeat itself. Teenage pregnancy is a sociologic problem with medical consequences, and medical programs as they presently exist are incapable of bringing about the ultimate solution -- prevention. (author's)
Over 1000 teenagers participated in the field test of an educational series designed to help them resist the social and peer pressures that can lead to early sexual involvement. A companion program for parents was designed to help adults better understand the pressures experienced by adolescents and aid the parents in reinforcing the information given to their children. Initial findings indicate skill building may be an important addition to the knowledge-based curriculum commonly used to prevent the spread of sexually transmitted disease among teenagers today. (author's)
Emission of spermatozoa: age of onset.
The determination of the age at which the 1st release of spermatoza takes place in boys, spermarche, has been hampered by social and ethical considerations. Based on observation by Baldwin (1928) that spermatozoa can be detected in urine specimens after emission of spermatozoa, the authors conducted a cross-sectional study on 429 Israeli school boys aged 11 to 16, in order to estimate the age of spermarche. Based on the collection of at least 3 consecutive urine samples from most of the boys, the median age of spermache was estimated to be 14.5. These findings confirm previous assumptions based on retrospective questionnaires and correlate well with histological findings at the age of onset spermatogenesis. Among the boys with spermaturia, the frequency of positive findings was 1 out of 2 days in the age group of 12 years, while it was 1 out of 3 days in the 15-16 year old older boys, with an intermediate frequency in those 13 years old. (author's)
Psychological aspects of female sterilisation--assessment of subsequent regret.
In order to study subsequent regret as a complication of female sterilization, hospital records of women requesting reversal of their sterilization were compared with women who had not requested a reversal. Regret was more likely in women sterilized at a younger age, but was not associated with lower parity. Women requesting reversal were interviewed to determine the psychosocial factors likely to produce later regret. The clinical implications are discussed. (author's)
Studies of diarrhoea in Quindio (Colombia): problems related to water treatment.
This paper studies the association between fluctuations in rates of diarrhea among children less than 5 years old in Armenia (Quindio) and variations in the application of chlorine in the aqueduct of the city. The study shows that to a great extent diarrhea morbidity can be explained by the application of chlorine which does not reach useful levels of concentration during the required time. The article concluded by recommending the improvement of existing treatment plants and investing the necessary resources in new plants to insure the quality of water. (author's)
Relationships between tissue plasminogen activator, steroid hormones and deep vein thrombosis.
The plasma concentrations of tissue plasminogen activator (t-PA) antigen, cortisol, testosterone, dehydroepiandrosterone sulphate, FSH and LH were studied in 33 men undergoing major abdominal surgery. Significant positive correlation was found between the concentrations of t-PA antigen and cortisol, suggesting that the adrenal cortex has a role in the regulation of extrinsic fibrinolysis. These 2 variables, however, did not distinguish between patients with postoperative deep vein thrombosis (diagnosed by 125I-fibronogen uptake test) and those without this complication. Such distinction was possible, however, with another steroid hormone of the adrenal cortex, dehydroepiandrosterone sulphate. At present, no explanation in terms of hemostatic mechanisms can be offered for this finding. (author's)
Nonprescription contraceptives: increasing in popularity.
The nonprescription forms of birth control now receive much attention due to the ongoing controversy about the prescription contraceptive methods. Condoms, 1 of these nonprescription methods, are the most effective nonprescription contraceptives available and among the most widely used. They are simple to use, inexpensive, and not associated with any major adverse effects. Condoms are unique in that they are a reliable contraceptive for males. It is estimated that 1 of 3 people who use contraception worldwide will rely on a male method. In the US this figure is somewhat lower, 18%. In other countries, such as Japan, condoms are the chief contraceptive method. If properly used, the failure rate for condoms is quite low; the lowest observed failure rate is 2%. In contrast, with typical users, the failure rate approaches 10%. The industry has taken several quality control measures to produce a safe and reliable condom. The principal material tested is usually either of the 2 ingredients used to make them, latex or collagenous tissue taken from the lamb cecum. Condoms definitely can protect against sexually transmitted diseases, simply because they prevent the infecting organisms from being transferred across the condom wall. The contraceptive efficacy of the condom is greatly enhanced when a spermicide is used at the same time. In terms of effectiveness, of 100 users that start the year using foams, creams, jellies, or vaginal suppositories containing nonoxynol 9 and used them consistently, the lowest observed rate of failure has been 3-5%. In actual use, the pregnancy rate is probably closer to 18%. Few side effects have been reported with spermicides. The most common of these is a burning sensation. The foaming suppository has been widely promoted as an effective vaginal contraceptive. It does not really offer any advantage over any of the other dosage forms except for convenience. It is the combination of foam and condom that pharmacists need to pay particular attention to because it is these 2 nonprescription methods that, used concurrently and correctly, can rival the efficacy of oral contraceptives. 1 of the newest dosage forms for a vaginal spermicide is a disposable polyurethane foam sponge which is impregnated with nonoxynol 9, but vaginal irritation has been reported frequently as an adverse effect.
Fertility and mortality differences in relation to maternal body size.
The relationship between maternal stature, number of conceptions, offspring mortality and number of surviving children was studied in 291 Jalari women. Maternal stature averaged 150.98 cm, maternal age 35 years, number of conceptions 5.1 and number of surviving children 4.2. Adjusting for age and number of conceptions, the relationship between maternal stature and surviving children is significantly negative. Shorter women show significantly higher number of conceptions and surviving children than taller women (p0.05). Intensity of natural selection is computed for height and weight. (author's)
Ischemic strokes and oral contraception.
The authors describe the epidemiology and the physiopathological aspects of ischemic strokes in patients with a history of estroprogestogen use. They then study their main radiological correlates: arterial infarcts at CT scan and angiographic non-specific lesions which can be included in the extremely wide framework of arteritis and, much more rarely, venous thrombophlebitis. (author's)
[AIDS: situation today and current knowledge]
Until the end of September 1985, more than 15,000 cases of AIDS have been reported worldwide, and the incidence rate is still rising in the United States, Europe, and equatorial Africa. The newly discovered agent, a pathogenic human retrovirus HTLV-III/LAV, was discovered 1 year ago, and the genome is already known in detail. Until now no definite success has been reported in preliminary therapeutic clinical trials. The following paper summarizes the current knowledge about etiology, pathogenesis, diagnosis, and therapeutic procedures in this new disease. (author's)
Differences in excretory-secretory products and surface antigens among 19 isolates of Giardia.
The excretory-secretory (E-S) products and surface antigens of 19 isolates of Giardia were compared by reactivity of E-S products with antisera to homologous and heterologous organisms and by acrylamide gel electrophoresis of surface-labeled Giardia. Isolates could be divided into 3 broad groups on the basis of the previously reported DNA studies and the present studies. Group 1 consisted of 5 isolates with similar or highly crossreactive E-S. These showed identical DNA banding patterns after endonuclease restriction analysis; 4 of 5 had identical surface antigens, and the remaining isolate showed a similar but different major surface antigen. Group 2 consisted of 11 isolates with moderate reactivity amongst themselves. DNA patterns showed some bands in common with Group 1 organisms and themselves, but the surface-antigen molecular weight patterns were different. Group 3 consisted of 3 isolates with reactivity only amongst themselves. There were no DNA bands in common with Group 1, and the molecular weights of the surface antigens were diverse. Surface-antigen differences are common among isolates of Giardia lamblia. These differences correlated to some degree with the DNA banking patterns observed after endonuclease restriction analysis and may result in altered virulence and host response. (author's)
Low endemicity and low pathogenicity of rotaviruses among rural children in Costa Rica.
Rotaviruses were prospectively studied in 51 rural Costa Rican children from birth to 2 years. Samples of feces were collected weekly over a 33-month period. Rotavirus was detected in 45 (1.04%) of 4317 fecal specimens; 39 infections were documented (an incidence of 0.5 infections per child-year), only 5 of which were associated with diarrhea (a pathogenicity of 12.8%). Secretory antibody in fecal extracts, detected in 6 of 39 infections, was short lived and did not protect against reinfection. Serum antibody was present in 69.6% of 2-year-old children, but was not detected in 18.8% with documented infections. On the other hand, serum antibody was present in 6 of 14 children in whom rotavirus was not detected, thus increasing the overall incidene to 0.6 infection per child-year. The combination of prolonged breast-feeding, exposure to a lower infecting dose (compared with urban children), and a higher standard of hygiene than expected may explain low incidence and low pathogenicity of rotavirus among these rural children. (author's)
Effects of drugs on the male and female reproductive systems.
Infertility, permanent or temporary, resulting from drug-induced injury is an important clinical problem. Many commonly used drugs are potentially toxic to gonads. It is well known that estrogens are toxic to the male genital system, but androgens may also produce infertility. Anovulation may also be a consequence of exposure to sex steriods. Cimetidine regularly produced hypospermia in men; phenytoin does so occasionally. Marijuana has been shown to be a gonadal toxin, while the effects of lysergic acid diethylamide (LSD) remain controversial. The most significant group of drugs that may injure the gonads is the cancer chemotherapeutic agents, of which the alkylating agents are the worst offenders. Prediction of infertility induced by these agents may be possible based on the duration of therapy and the patient's age and sex. (author's)
Gonadal steroids in athletic women: contraception, complications and performance.
Gonadal steriods are altered by the reproductive system's adaptation to conditioning exercise. Contraceptive options for the athletic woman include all measures appropriate for the sedentary women. Barrier methods (always with spermicidal jelly) are the preferred choice. The cardiovascular risks, decreased aerobic performance, and shorter time to muscular exhaustion related to oral contraceptives make this a less desirable option. Potential complications from the steroid changes of intense exercise include: low estrogen and progesterone with risk of loss of trabecular bone and early osteoporosis, and absent progesterone with low normal estrogen levels associated with risk of endometrial or breast cancer. Therapeutic options for the amenorrhoeic or young athlete include supplemental oral calcium, cyclic oral progesterone, or possible cyclic physiological estrogen and progesterone. The anovulatory (usually older) athlete with regular menses needs cyclic progesterone. Medroxyprogesterone 10 mg on days 16 to 25 of the cycle or for 10 days monthly can potentially prevent endometrial and breast cancer, give predictable cycles, improve trabecular bone balance and stimulate the return of ovulatory cycles. A practical approach to anovulatory infertility in the athlete includes a 10% reduction in exercise intensity and/or an increase in percentage body fat to 18 to 20%. Cyclic vaginal progesterone (25 mg bid) can then treat short luteal phase cycles. With improved understanding of the hormonal adaptations to conditioning exercise, we will be better able to outline contraceptive and therapeutic options in the future. (author's)
Trends in self-reported marijuana use among teenagers--Canada, 1981-1983.
In February 1983, the Canadian Gallup Poll conducted a national survey of 12-19-year-old Canadians to determine their use of marijuana. The questions were identical to those used in earlier surveys. The sampling design incorporated stratification by 6 community-sized groups based on 1976 census data. The population was arrayed in geographic order by community size and, within these classifications, by enumeration area. Approximately 200 enumeration areas were selected. The overall sample was designed to be representative of 12-19-year-olds living in Canada, although the number of 18-19-year-olds was augmented using the monthly Gallup Poll Omnibus Survey. Within the selected enumeration areas, Gallup administered 7 questionnaires according to the following quotas: 3 with 12-14-year-olds; 3 with 15-17-year-olds; and 1 with 15-19-year-olds. 3 were to be male, and 4, female. A total of 1419 youths 12-19 years completed a self-administered questionnaire. In addition to cannabis use, the questionnaire covered perceptions of the risks and benefits of cannabis use, perceptions of the prevalence and changes in the use of marijuana in Canada, attitudes toward use, and awareness of messages regarding marijuana use. Similar topics were covered for alcohol and tobacco. The earlier studies with which the 1983 survey was compared were carried out in 1981 and 1982 for Health and Welfare Canada by Gallup using Gallup's Young Omnibus Survey, which is conducted in May of each year. The sampling procedures used were similar to those used in the 1983 study, except that the sample of 18-19-year-olds was not augmented. The 1982 survey covered alcohol and tobacco as well as marijuana, but the 1981 survey dealt only with marijuana. There were statistically significant declines in all frequencies of self-reported marijuana use between 1981-83, with the exception of daily use, where the decline was not statistically significant. There also were statistically significant declines from 1981-82 in all frequencies except daily use, and a significant decline in use in the last 30 days between 1982-83. Greater declines appeared to take place between 1981-82 than between 1982-83, although it is possible that greater differences would have appeared between the 2 latter years had the 1983 survey been carried out in May rather than in February. In sum, the findings strongly suggest that there has been a recent decline in marijuana use among Canadian teenagers.
Aspects of smoking in developing countries in Africa.
This discussion of smoking in developing countries in Africa focuses on the cultivation of tobacco and the economics of tobacco smoking. The cultivation of tobacco in Africa has been encouraged in recent years by multinational companies, especially British American Tobacco and Rothmans, thus avoiding import duty on raw materials and conservation of scarce foreign exchange. In Nigeria, 60,000 farmers now grow tobacco on 120,000 acres. The 3 major deleterious effects of cultivating tobacco are: competition with cultivation of staple food crops, such as rice, millet, cassava, and guinea corn; displacement of necessary cash crops, such as cotton; and loss of timber through tree felling and bush fires due to ignited cigarette stubs and promotion of erosion and Sahelian migration in areas with already sparse vegetation. In the Sokoto region of Nigeria, tobacco thrives in the flood plains where rice would normally be expected to grow. Because tobacco provides ready cash, rice is a 2nd choice for cultivation. The net result of such displacement of staple food crops is that rice is now imported into Nigeria. Any development economist would rather cultivate rice than tobacco. Forest reserve has been lost from clearing bush to promote cultivation of tobacco and using wood fuel in flue-curing of tobacco. The ecologic consequences in areas bordering on the desert are disastrous. Yet, the spinoffs to the grower of tobacco cannot be dismissed. Most obvious is that cash returns for cultivating tobacco are better than for food crops. Because tobacco growers are relatively prosperous, they tend to stay on during periods of drought whereas food growers tend to migrate to the urban areas. The acquisition of modern skills is associated with growing tobacco. The multinational tobacco companies take pains to teach local farmers modern methods of land preparation. The fight against cultivation of tobacco can be won only by planned action. Recently, tobacco companies introduced programs such as block farms among tobacco growers. Farmers are now encouraged to grow other crops as well as tobacco, especially those related to food, in small land holdings. In the past 5 years, the tobacco industry has begun active reforestation programs since 3.5% of wood-fuel consumption is devoted to flue-curing of tobacco. Governments in the 3rd world have been slow to arrest the tobacco smoking habit because of large government revenues derivable from sales and manufacture of cigareetes. The consumption of cigarettes is underestimated in government or commercial statistics because smuggling accounts for 25% of total cigarette consumption.
Teen theaters grapple with issues.
At this time there are about 20 Planned Parenthood teen theater groups throughout the US. The idea originated in New York in 1973, when the staff of the Family Planning Division of the New York Medical College needed an effective way to reach adolescents about important issues. FOCUS, a teen family life theater sponsored by Planned Parenthood of Greater Charlotte, performs skits about life as seen from the teenager's perspective. The teenagers do not use a script but create their performances from their own experiences, expressed through carefully learned improvisational techniques. This approach gives the presentations an authentic flavor that enables the troupe to connect with the audience. The topics dealt with vary. For example, 1982-83 shows included peer pressure, divorce, teenage pregnancy, drinking, teenage suicide, parent-teen relationships, and loneliness. The performances do not offer absolute answers but rather pose important questions to the audience. Following the performance the actors and actresses return to the stage, still portraying their characters, and invite the audience to ask questions and discuss possible alternatives for the characters. THE SOURCE is the Teen Council of Planned Parenthood of Southwest Florida. It works to inform the community of problems teenagers face by presenting short plays, written, directed, and cast by teens themselves. Through education, honest answers, healthy building of self esteem, and parent support, SOURCE members reach a higher level of self awareness. They then share what they learn with their families, peers, and the community through performance and special events. THE SOURCE, formed in October 1980, grew out of Planned Parenthood's belief that if teens feel self worth, their decision-making process will be affected less by peer pressure and negative social influences. The Youth Expression Theater (YET) of Cambridge is an education outreach project of the Planned Parenthood League of Massachusetts (PPLM). It grew out of the belief that improvisational drama, by permitting teens to portray their conflicts, is a more creative educational tool than a lecture series by adult professionals. YET productions deal with teen pregnancy, parenting, sexual responsibility, and decision making, alcohol and drug abuse, birth control, homosexuality, divorce, abortion, suicide, and sex-role stereotyping. In Dallas, Texas, Elena Love and Jim Roderick established the Teen Perspective Theater (TPT) as an arm of the Planned Parenthood of Greater Dalls education program. An acting company of 11 students aged 13-18 was drawn from public and private schools. Rehearsals began the end of July and included educational sessions as well as performance skill workshops. The presentation follows the format established by other Planned Parenthood theater groups: brief improvisational skits, in-character exchange with the audience, and personal exchange with the audience.
Smoking among schoolchildren in metropolitan Manila.
A total of 2000 school children aged 8-20 years from 3 sets of elementary and secondary schools in Metropolitan Manila (Philippines) were surveyed to determine the prevalence of smoking among them and to learn the factors affecting the acquisition of the habit. The students were chosen to represent each of the 3 socioeconomic classes of school children in Metropolitan Manila -- 500 each came from socioeconomic class 1 and socioeconomic class 2, and 1000 came from socioeconomic class 3. Cluster random sampling was used in the selection of study subjects. The necessary information was obtained by self-administered questionnaires. The students ranged in age from 8 years to over 20 years with a mean of 14 years for both males and females. The proportion of boys was the same as girls among the ever-smokers. Their mean age was likely comparable. The same result was noted among the nonsmokers. The mean age of ever-smokers was 15 + or - 1.75 years; the mean age of nonsmokers was 13 + or - 2.11. The age differences were significantly different, with ever-smokers being generally older than the nonsmokers. The prevalence of ever-smokers in the class 1 school was 34.4%. The proportion of boy ever-smokers was not significantly different from the girl ever-smokers. In class 2 school, the prevalence rate was 23.4%, and the proportion of boys and girls was not significantly different. Among class 3 school children, boy ever-smokers were significantly more prevalent than girl ever-smokers, and the combined prevalence of ever-smokers in this social class was 29.2%. A regular smoker among school children is defined as one who smokes at least 1 cigarette per week. The overall prevalence rate of regular smokers in the 3 schools was 6.6% for both sexes (11.6% for males and 1.7% for females). The proportion of boy ever-smokers was about the same or slightly higher than the girl ever-smokers except among the 15-year-olds where the proportion of girl ever-smokers was much higher than those of boy ever-smokers. The older the boy ever-smoker is, the higher the probability of him being a regular smoker. This trend was not observed among the girl ever-smokers and girl regular smokers. The male smokers were most prevalent in class 1 school (14.7%), followed by class 3 (11.0%) and class 2 (9.2%). For the female regular smokers, class 1 had a rate of 6.3% and class 3, 0.6%. Class 2 school did not have any regular female smokers. The most surprising observation was that the smoking habit of the school children, male or female, was not influenced at all by either parent, but the habit of the girl ever-smoker was affected by the brother.
The message of the International Nongovernmental Organization (NGO) Consultation on population and Development, held in Geneva during September 1983, was that there should be a global effort to at least double family planning services and to raise funding to a minimum of $1 billion. WAY has been actively associated with the preparation of this Consultation and emphasizes the need for a separate working group on youth and population in this consultation. An interesting recommendation of the Working Group is to inform and educate teenagers and adolescents about the negative emotional and physical effects of having very early sexual activity resulting in pregnancy, along with providing family planning services for them. Other recommendations of the youth group accepted by the Consultation include: family life education (FLE) in schools, colleges, and for out-of-school youth; the inclusion of adolescent development, human reproduction, hygiene, sexually transmitted diseases, personal relationships, reasons to delay sexual activity, and demographic concepts and environment implications in the FLE curriculum; and the encouragement of youth leaders and youth organizations to include family life education in their existing programs.
Shows with explicit sexual content are accessible to teenagers, yet the major networks will not show a public service announcement from the American College of Obstetricians and Gynecologists that would tell them something about sexual responsibility. The ad features 3 young women. The 1st young woman says she intends to be President, the 2nd that she intends to go back to school, and the 3rd, who is pregnant, that she intended to have a family, "but not this soon." An announcer states that nothing changes intentions faster than unintended pregnancy, and that these have risks greater than any of today's contraceptives. He then gives a number to call for an informational booklet. ABC and and CBS claim that the content is too controversial, and NBC is not sure it meets the network's criteria for public service announcements. Yet, it meets every standard of public decency. More than a million teenagers get pregnant every year. Nearly half of them have abortions; nearly 150,000 miscarry; and those who give birth often end up on welfare. Although television does not make them pregnant, it clearly played a part in setting their attitudes about sex. The networks make fortunes selling sex. By running the physicians' 30-second spot, they would be meeting a public responsibility.
Sex on the soap operas: afternoon delight.
To examine the portrayal of intimate sexual behavior on soap operas, 65 hours of programming over 3 seasons was sampled. During 1 week in the winter of 1976, 2 episodes of 12 different soap operas (15.5 hours) were videotaped. In the summer of 1979, 2 episodes of 13 different soap operas (21 hours) were videotaped. In 1980, 3 episodes of each of 11 soap operas (28.5 hours) were coded off the air. In all 3 seasons, 10 of the same soap operas were coded. Intimate sexual behavior was defined as explicit or implied acts of sexual intercourse, any type of illicit sexual behavior, homosexuality, or petting. The unit of analysis was the physical or verbal act, or reference to 1 of these intimate sexual behavior categories. A unit began with either a physical or verbal display of a category and ended with the completion of the act category, a new character entering the scene, or a scene change. In addition to coding instances of these content variables, the physical and verbal explicitness of each incident was judged as high, low, or absent. The net changes in rate of occurrence are an increase from 2.00 to 2.28 acts per hour between 1976 and 1979, and a decrease to 1.80 acts per hour in 1980. Petting acts were the most frequently occurring activity overall, and the predominant activity in the first 2 analyses. Unmarried partners outnumbered married partners in incidents of and references to intercourse by a ratio of 4 to 1. For the remaining analyses, the distribution of petting acts was compared with a collapsed category of the remaining acts, labeled "intercourse/all other sexual acts." CBS had comparable rates of petting and all other activity; NBC and ABC had higher rates of the latter. 30-minute shows contained more than 1 additional intimate sexual act or reference overall in each hour of programming than did 60-minute shows, and that addition came from increased occurrences of both petting and intercourse/all other sexual acts. Shows broadcast earlier in the afternoon (before 1 p.m. EST) had higher rates in both categories than did shows broadcast later in the afternoon. The intimate sexual acts categories of petting and intercourse did not differ by sex of the participants, or by age, occupation, or marital status, either for the initiators or for the targets. Of the petting incidents, 35% involved marital partners and 45% involved lovers, with the remainder distributed equally among work partners, strangers, and those planning to marry. Of the incidents of intercourse, 49% involved lovers, 29% involved strangers, and only 6% involved marital partners. A comparison of these results with those from prime-time analysis shows that there is more sex activity and reference to such activity in afternoon programming, but the content of the intimacies differs greatly in the afternoon and evening programs.
School health-clinic movement is spreading across the nation.
In response to increasing concern about teenage pregnancies in the US, a movement to place health and birth control clinics in public schools, introduced in a few midwestern cities nationwide, has begun to spread nationwide. Despite vehement opposition from those who fear that the clinics encourage sexual activity among teenagers, the facilities have been established in 35 schools across the US and 75 more are planned. Last month, Los Angeles became the largest US city to approve a pilot clinic after a report that high school pregnancy rates dropped 64% in the first 3 years of a similar program in St. Paul, Minnesota. The school-based health clinic movement appears to be an example of experimental social programs born in communities far from Washington but converging on the nation's capital. A public hearing is scheduled Wednesday to consider placing such a clinic at Washington's Anacostia High School, and some suburban Washington communities are expressing interest. The clinics have been established independently by various private groups and funded by a mix of public and private funds. Most of the clinics have been set up in schools serving low-income, usually predominantly black neighborhoods where teenage pregnancy rates are highest. Most clinics require parental consent before distributing birth control devices. Organizers maintain that parents offer little or no resistance and some support. The publicity surrounding opposition to a new clinic established at Chicago's Dusable High School led to the proposal for the Los Angeles clinic, which was approved 6 to 1. Lawyers are studying the proposed requirement for a parental consent form. Jackie Goldman, school Board member, says she and other board members were particularly moved by evidence of potential teenage health problems not related to birth control. A West Dallas clinic found that up to 30% of its patients had undiagnosed health problems, including 100 heart murmurs. Still, much of the interest in the clinics has been stimulated by statistics from the pro-birth control Alan Guttmacher Institute indicating US girls 15-19 years old have a 1-in-10 pregnancy rate, one of the highest in the world. The St. Paul clinics, as well as others, report that a majority of patients seek help unrelated to birth control, but the St. Paul pregnancy figures have done much to sell the program.
Let's run birth control ads during Dallas and Dynasty. End this TV taboo.
Birth control continues to be a taboo on television in the US despite the fact in an average year American television viewers are exposed to some 9230 scenes of suggested sexual intercourse, sexual comment, or innuendo. That is the reason for the protest last summer when ABC and CBS rejected a simple public service announcmenet submitted by the American College of Obstetricians and Gynecologists. The announcement presented 3 young women: "I intend to be President," said one. "I intend to go back to school," said another. A third, obviously pregnant, said: "I intended to have a family...but not this soon." An announcer noted that "unintended pregnancies have risks, greater risks than any of today's contraceptives," and offered an information booklet. CBS and ABC initially termed the announcement "controversial," yet 90% of American couples use some form of birth control. Networks claim responsibility to viewers. There is an explosion of teenage pregnancies in the US. The rate is higher here than in any other industrialized country. 2 of every five 14-year-old girls in the US today will become pregnant at least once before the age of 20. More than 1/3 will have abortions, and those who become teen parents will tend to sacrifice education, earnings, and even stable marriages. Television shows the lure and adventure of sex but shows nothing of the consequences. If public service spots must wage an uphill battle, contraceptive ads have hit a total barrier. Researchers at Johns Hopkins University say that sex education does not increase sexual activity; it decreases unplanned pregnancies. Birth control messages on French, English, Swedish, and Dutch television were part of broad campaigns that brought their teen pregnancy rates down. Keeping people ignorant to keep them virtuous appears to be a peculiarly American concept. If these ads so offend, why not run them during those "sexy" programs -- like "Dallas" and "Dynasty" -- that audiences already have chosen to watch. The 35 local and 2 cable television stations that ran the Today sponge ad reported few complaints. This is not really about chastity and sensitivity but about dollars and cents. Groups like the American Life Lobby would certainly fight contraceptive messages, but other groups have been fighting beer ads and television violence for a long time. The network never complied on those fronts, and that is simply because that is where the money is. While the diversity of views about sex and contraception must be recognized and respected, it is also necessary to acknowledge that more than half of all teens are already sexually active and to recognize the need to promote sexual responsibility.
Korea includes sex education in its curriculum for middle and high school students, but progress with this program has been slow due to a limited number of trained teachers. Consequently, the Young Women's Christian Association is becoming involved and organizing seminars and lectures in major cities. The Seoul Youth Guidance Society gives sexual guidance lectures for working youths. The Daehwa Christian Social Welfare Association runs an office to counsel girls and boys about sexual relationships. This increased emphasis comes as a response to the rising incidence of cases of rape, which numbered 800 in 1974 but rose to 3642 in 1982. Kim Suk-hi, director of the Seoul YMCA sex education counseling office, emphasizes the urgency of the sex education programs. She advises parents to answer their children's questions about sex. The Ministry of Education recently began to provide training for teachers and to develop educational materials.
Irish FPA opens telephone service for adolescents.
On January 22, 1985 the Irish Family Planning Association launched a confidential telephone service run by young people for young people as part of a contribution to International Youth Year. 10 young volunteers will take calls during Saturday afernoons for the duration of 1985. The service was operated as a pilot project from October to December 1984, and an average of 12 calls was made to it, even though advertising of the service was limited. Most callers wanted basic information on conception and on sexually transmitted diseases.
Argentinian FPA expands communication and services programme.
In 1983 the Asociacion Argentina de Proteccion Familiar (AAPF) sponsored a 25-minute radio tape, "Dulce Espesa", produced by adolescents for adolescents on the theme of unwanted pregnancy. This Association is now at work on a proposal with the same film director, Javier Szerman, to make a series of 16 mm films on subjects such as the consequences of unwanted children and adolescent sexuality. Also in 1983 the Association saw an increased interest in the media regarding its work. "Mujer," a weekly magazine, now provides free coverage of the Association's activities and advertises its clinic session. Unfortunately, the radio program "Quienes Somos," had to be discontinued because the municipal radio station which aired it was taken over by an extremely conservative Roman Catholic group. The Association expanded its work with the poor northeastern provinces especially Formosa, Resistencia, Misiones, Santa Fe, and Corrientes. The Association signed an agreement with the Medical School of the University of Tucuman to train teachers and provide films. It has also expanded its clinical services, not only at the Buenos Aires headquarters but also at government facilities in 6 municipalities in the Greater Buenos Aires area. The Adolescent Center opened in 1983 was closed after the bombing, and there are plans to reopen it.
Factors seen as possible links to posttubal ligation syndrome.
Dr. Herbert B. Peterson of the Center for Disease Control (CDC) recently reported at a conference at Emory University in Atlanta that research now indicates 2 new hypotheses for the genesis of posttubal ligation syndrome. When 2 groups of women, both with histories of menstrual problems, were compared over time, those who had not undergone tubal ligation had fewer menstrual problems than women who had. That fact suggests that preexisting menstrual problems can be aggravated by tubal sterilization. In addition, posttubal ligation syndrome could be related to performance of sterilization shortly after delivery. 3 primary types of evidence -- clinical, laboratory, and epidemiologic -- used to support the conclusion that posttubal ligation syndrome does exist deserve further investigation. Clinical evidence is the most easily observable by health care providers but may be unreliable. The relationship between age and posttubal ligation syndrome has not been strictly established. According to Peterson, 10 years following sterilization, women may be experiencing mesntrual problems because of time passage alone. Additionally, about 30% of American women have used oral contraceptives (OCs) up to the time of the procedure. Possibly mesntrual complaints after sterilization in such cases can be attributed to cessation of OC use rather than to tubal ligation. Laboratory data documenting functional, anatomic, and hormonal changes after posttubal ligation are vague. Several recent studies involving such data do add "biologic plausibility" to certain hypotheses. A unifying hypothesis to account for disturbances in ovarian function is that tubal ligation results in destruction of the uterovarian blood supply. Different methods of fallopian tube occlusion destroy different parts of the tube and the tube's blood supply. A 2nd hypothesis is that certain types of tubal occlusion are more likely than others to result in endometriosis, which can affect menstrual function. The 3rd hypothesis is that tubal sterilization may cause an estrogen-progesterone imbalance. Epidemiologic data obtained from shortterm studies fail to support the existence of posttubal ligation syndrome. According to Peterson, women who did not have adverse bleeding before sterilization were more likely to have adverse bleeding problems than the unsterilized women. Adverse bleeding was even more pervasive among the sterilized group in the longterm results. Further studies should investigate 2 possibilities: that posttubal ligation syndrome is related to a preexisting adverse menstrual condition that fails to improve and that symptom severity may be pregnancy related.
This discussion of Antigua and Barbuda focuses on the following: the people and history; geography; government and political conditions; the economy; foreign relations; and relations between the US and Antigua and Barbuda. The population of Antigua was estimated at 78,240 in June 1983; the 1984 estimate for Barbuda was 1200. The annual growth rate in 1983 was 1.3%. In 1970 the life expectancy was 70 years. The infant mortality rate is 31.5/1000 live births. Today's population is almost entirely of Black African origin, some of British, Portuguese, Lebanese, and Syrian origin. The sister islands of Antigua and Barbuda are located in the northeastern part of the Lesser Antilles, about 650 kilometers southeast of Puerto Rico in the eastern Leeward group separating the Caribbean Sea and the Atlantic Ocean. As head of the Commonwealth, Queen Elizabeth II is represented in Antigua and Barbuda by a governor general, who acts on the advice of the prime minister and the Cabinet. The prime minister is the leader of the majority party of the House, and the Cabinet conducts affairs of state. Antigua and Barbuda has a bicameral legislature. Antiguans have enjoyed a long history of free and fair elections in which, from time to time, the government changes peacefully. Constitutional safeguards include freedom of speech, press, worship, movement, and association. By 1972 the sugar industry was largely dismantled. The current government has taken steps to revive the industry to meet local demand for sugar, thus saving import costs, and to produce ethanol from sugar products for export. Yet, agriculture remains important contributing about 8.2% to the gross domestic product. At this time, the economy is based upon services rather than manufacturing. Since Antigua's independence in 1981, US relations with the island nation have been friendly. The US seeks to help Antigua develop economically and to help strengthen its moderate, democratic, parliamentary form of government.