Present situation and prospects of China's population.
For a very long time China has been the most populous country in the world. Throughout the last 15-16 years China has achieved great success in checking the excessively rapid growth of its population. However, due to historical reasons as well as current changes, China is still facing a serious situation. As a result of historical evolution, a great number of contradictions exist in China between population on the 1 hand and arable land, food, natural resources, the environment, employment, education, and support of the aged on the other hand. Per capita arable land is now only about .1 hectare. Restricted by the area of arable land, the food supply in China has always been a source of tension. People are reclaiming land on hills and from lakes in ways that are not good for the environment. With rapid population growth, large numbers of young people are reaching working age every year. The ultimate goal of modernization is to promote the well-being of the people. Although the achievements of economic development have been remarkable, the level of goods per person remains low. This has made people realize that population growth must be controlled. The main causes of the rapid fertility decline are 1) socioeconomic development, 2) state guidance, and 3) a strong government policy. Beginning in 1979 in China, the focal point of work has been shifted to economic construction. China's strategic goal of population control is to attain the stationary state through rapid fertility decline. Prospects for the 21st century include 1) an aging population, 2) a more abundant labor force, 3) the further development of cultural and educational undertakings, 4) rapid urbanization, and 5) environmental pollution and resource shortages.
A study of standards for the differentiation of the urban population in China.
In China, the recent reclassification of the country into urban areas has led to an increase of urban population that is to a large extent purely administrative. To set a standard for differentiating the population into urban and rural, it is necessary to formulate a scientific standard. The author considers the problems and contradictions created by the differentiation of population according to cities and towns which are administratively established. Newly established cities and towns are comparatively large in number and their sizes are much expanded because a certain amount of agricultural population is included in the urban population. A survey of 347 cities revealed that on the average, the agricultural population accounted for 47% of the total. It is important to set the principles for standards of differentiation of the urban population with a view to the origin of the city. All the economic, social, and administrative principles have limitations, and no one set of principles can be used by itself to decide whether or not an area is urban. The standards should be based on actual conditions within China itself. (author's)
The 1990 U.S. census: how good is good enough?
The 1990 US census is likely to be the most accurate in the nation's history, but it may miss 2 or 3 million people, most of them poor and many of them black or Hispanic. Because the population census is the basis for political apportionment and determines the allocation of a growing share of federal funds to localities and public programs, undercoverage is of great concern to cities, states, and the groups most affected. The statistical methods developed to measure the extent of undercounting in the census have become increasingly reliable, but the official census count has never before been adjusted on the basis of these methods. This article describes plans for the 1990 census and examines a growing controversy over adjustment for an undercount. (author's)
City size, economic development, and quality of life in China: new empirical evidence.
The dearth of case studies on Third World urbanization and city size is unfortunate because, in contrast to cross-national research, these studies can explain special patterns of development. This study utilizes the recently published POPULATION ATLAS OF CHINA to analyze the relationship among city size, economic development, and physical quality of life. These data are unusually complete, covering most of China's counties, districts, cities, and other administrative units (N=2306). The data analysis produces 3 major results. 1st, all-sized cities enjoy higher levels of economic development and physical quality of life relative to nonurban areas. 2nd, externally oriented coastal cities possess higher levels of economic development but not a better quality of life. 3rd, education and industrial employment contribute to both economic development and physical quality of life. Overall, these findings support modernization theories and some aspects of the dependency/world-systems perspective. (author's)
Villages as contexts for contraceptive behavior in rural Egypt.
This research joins sociological and demographic traditions in a study of villages as contexts for contraceptive behavior in rural Egypt. Using survey data collected in the early 1980s, the authors explore the effects of village, household, and individual characteristics on contraceptive use and expectations about future use. Primary interest centers on the effects of the village variables, including the structure of the village economy, modernization of agriculture, level of school participation, and family planning service environment. The analysis demonstrates clearly that contraceptive behavior in rural Egypt varies systematically with these features of the village setting. In addition, village effects appear to vary according to characteristics of individual respondents: women respond differently depending on the stage in their reproductive career and their motivation to regulate fertility. (author's)
The basic ideas underlying the analysis in this paper are that family size can be viewed as an economic life cycle decision and that there are decision trade-offs among fertility, consumption, and leisure. A micro-model of life cycle choice is developed and embedded in an economic-demographic macro-model. The macro-model is then used in a series of computer experiments to assess the effects on the population and the economy of changes in household preferences for children. The experiments include factual and counterfactual simulations of Canadian historical demographic experience and simulations of alternative future scenarios. The analysis and conclusions have general relevance for countries that have been through a fertility boom-and-bust sequence. (author's)
Population growth and economic development: a case study of Yugoslavia.
The paper deals with the relationship between the population growth and economic development in Yugoslavia and its republics, covering the period after the 2nd World War. Yugoslavia is a developing country with a specific demographic and economic structure which makes it unique in Europe. Its territory is comprised of both relatively developed regions where demographic transition is over, and underdeveloped regions with high natural increase of population where the demographic transition is only just beginning. Correlation and regression methods were used to quantify this relationship. The economic development and structural changes are discussed, relating to human factor. An adequate population policy through family planning is stressed as important in obtaining an increased return to scale with a more positive role of demographic factor. (author's)
The marriage premium and compensating wage differentials.
This paper proposes and tests an alternative explanation of the marriage premium that relies upon differences in workers' tastes and compensating wage differentials. A key assumption is that marital status proxies for the consumption of family goods, such as children, and that these are costly. Workers whose greater demands for family goods are taste- generated and shown to choose jobs that offer greater wage, and less non-pecuniary compensation. This creates an observed wage premium that has nothing to do with differences in workers' productivities. Supporting empirical evidence for this hypothesis is presented, including a reevaluation of previous studies. (author's)
Self-generated fertility waves in a non-linear continuous overlapping generations model.
In this paper, Samuelson's simplified version of the Easterlin theory is extended to a continuous-time model with 3 age groups. This approach enables one to apply the qualitative theory of nonlinear differential equations to show the existence of Easterlin-type cycles. In contrast to the discrete time model we obtain information about the period length of the cycle. (author's)
International factor mobility and production technology.
This paper systematically investigates the pattern and effect of international factor mobility caused by international differences of production technology in an endogenous-population-growth and overlapping-generations model. It is shown here that if the autarkic steady state in each country is characterized by under-investment relative to the Golden Rule, international labor migration will take place to the country with a more capital-saving or neutrally superior technology, and then the capital-labor ratio and the demand for children per family in that country will be lower. On the other hand, international capital will move to the country with a more labor-saving or a neutrally superior technology and will decrease the per worker domestic capital stock in that country. (author's)
Subsidy policies with capital accumulation: maintaining employment levels.
The authors study a dual economy model of growth and unemployment in the presence of Harris-Todaro type labor migration. The model is a discrete time model of economic growth with a given population but endogenous migration of labor. The economy tries to reach development in the quickest possible time while not allowing unemployment to rise above a socially acceptable level. The authors also characterize situations under which maximizing the accumulation of capital in each period is optimal and study how particular taxes and subsidies affect unemployment and capital accumulation. Finally, they show that a higher initial capital stock does not necessarily mean a quicker attainment of self- sustained full employment. (author's)
Pre-migration differences in anthropometry and blood pressure are examined for evidence of selective migration for biological characteristics. The authors conducted a 5-year follow-up of the migration status of 99 American Samoans 15-30 years old who had been previously examined in 1981 and found that 33 had migrated. Analysis of covariance of the baseline anthropometry and blood pressures of the nonmigrants (n=58) and those who subsequently migrated (n=29) indicates that selective migration does occur among young American Samoan adults. Migrants of both sexes tend to be younger and leaner and have significantly lower mean blood pressures than nonmigrants even before migration. Selective migration of lean individuals with lower blood pressures may contribute to the lower blood pressures of migrants from American Samoa living in Hawaii or to the heterogeneity in other Samoan populations. These results are 1 of the few examples of biological selectivity demonstrated to date and illustrate the dangers of assuming that the effects of selective migration are negligible in studies of migration and health. (author's)
This is the preface to a collection of papers presented in 2 symposia: Biological Anthropology and Aging: Cross-Cultural and Biomedical Studies, held at the Fortieth Annual Scientific Meeting of the Gerontological Society of America, November 18-22, 1987 in Washington, D.C.; and the Nutritional and Dietary Status of the Elderly, held at the Fifty-Sixth Annual Meeting of the American Association of Physical Anthropologists, April 2-5, 1987. Because of the traditional emphasis on evolutionary processes and the causes of variability, human biologists have contributed to the understanding of variability in human biological aging. The shared interests of human biologists and gerontologists are evident in the observation that human aging is characterized by increased phenotypic variation in later stages of life and by reduced adaptive capacity. The papers in this issue illustrate the unique blend of evolutionary, biosocial, and cross-cultural perspectives used by human biologists to study the variation in biological aging. The papers present examples of common methodological paradigms such as theoretical/mathematical models, epidemiological studies, natural experiments, and studies of isolated foci of diseases. The principles of human adaptability and the premises of the life-course perspective may provide the foundation for a conceptual framework that integrates the study of biological, behavioral, and social aspects of human aging. Human biologists can play an important role in refining the theoretical and methodological tools that will be needed to understand the variability in human aging in populations throughout the world. (author's modified)
The authors examine the influence of 2 measures of maternal nutritional status: prepregnant body mass and weight gain during pregnancy (adjusted for duration of gestation) on spontaneous preterm delivery (<37 completed weeks' gestation) and duration of gestation, as well as on low birthweight (<2500 grams) and small-for-gestational-age in pregnant adolescents. Inadequate weight gain for gestation increased the risk of spontaneous preterm delivery when prematurity was reckoned by the obstetric estimate or from the mother's last menstrual period. In linear models, gestation duration was significantly reduced by more than 1/2 a week when reckoned from either estimate of gestation. However, the association between preterm birth or gestation duration and prepregnancy body mass was not consistent and depended on the method of estimating gestation. Low birthweight and small-for-gestational age were each significantly associated with inadequate weight gain during pregnancy as well as with prepregnant body mass. These results suggest that current maternal nutritional status, as measured by weight gain during pregnancy, may influence preterm delivery and gestation duration. The inconsistent results obtained with prepregnancy body mass may reflect a size bias inherent in the obstetric estimate of gestation, rather than effects of prepregnant maternal nutritional status on gestation. (author's)
Growth of Filipino infants who differ in body proportions at birth.
Growth of infants who differ in body proportions at birth is followed during the 1st 12 months of life. The sample of 2695 infants from Metropolitan Cebu, in the Central Philippines, was divided into 5 groups based on a cross tabulation of low-birth-weight status (2500 grams or less) with low (<10th percentile), adequate (10th-90th percentile) or high (>90th percentile) Rohrer's Index. The groups exhibited significant differences in growth patterns. The importance of these groups, which reflect weight and body proportions of the infant at birth as a determinant of attained size at 2, 6, and 12 months of age, was evaluated by using multivariate techniques which took into consideration other factors known to affect growth. Results show that intergroup differences in growth patterns and attained size occur because of 1) differences in postnatal growth potential represented by weight and body proportions at birth, 2) differences in the important biological inputs that affect postnatal growth (such as feeding practices and morbidity), and 3) differences in the effects of inputs on growth. Infants who are of low birth weight status but are well proportioned are most likely to remain small during the 1st year of life, while those with a low Rohrer's Index at birth are more capable of catch-up growth. (author's)
Oral contraceptive failure secondary to dentally prescribed drugs: fact or fiction?
Drug interactions likely to occur with dentally prescribed drugs and oral contraceptives include 2 broad mechanisms: reduced reabsorption of contraceptive steroids and stimulation of liver metabolism of the steroids. The antibiotics ampicillin and tetracycline are often reported to cause failure of oral contraceptives, now that pills contain such low doses. These medications destroy bacteria in the gut that normally hydrolyze conjugated steroids, re-releasing them into the circulation. Thus reduced entero-hepatic recirculation lowers active levels of the contraceptive steroids. Drugs that induce hepatic enzymes such as barbiturates and sedatives, enhance elimination of steroids. Other drugs, such as rifampin the anti-tubercular antibiotic, and barbiturates, phenobarbital meperidine, penicillin V, phenylbutazone, phenytoin sodium, sulfonamides and chloramphenicol have also been implicated in failures of the pill. Dentists should take a detailed history of drug intake, specifically mentioning oral contraceptives, and counsel patients accordingly. They are ultimately responsible for unintended pregnancy in the event of pill failure when writing prescriptions for their patients.
Relationship of simian T-lymphotropic virus type III to human retroviruses in Africa.
HTLV-I has common characteristics of a simian retrovirus (STLV-I), such as extremely cross reactive major viral antigens. Further, the major proteins of HTLV-III/HIV are similar to and cross react with those of STLV-III which causes an immunodeficiency syndrome similar to AIDS in macaque monkeys. It appears, however, that, even though STLV-III has been found in green monkeys, it does not adversely affect them. These similarities suggest that these viruses have a common ancestry. In their quest for more information on commonality between simian lymphotropic viruses and human retroviruses, researchers found that antibodies of healthy prostitutes in West Africa reacted with related antigens of STLV-III, e.g., the p24, p55, and gp 120/160 antigens. Researchers then isolated this human retrovirus and called it HTLV-IV. The prostitutes were healthy at the time of examination and 15 months later continued to show no symptoms of AIDS. This differs from global seroepidemiologic data of individuals with HTLV-III/HIV who, upon exposure, eventually develops AIDS related complex or AIDS. Present evidence shows that a number of related T-lymphotropic viruses affect their respective hosts pathogenically different. Further research may lead to the identification of distinctive structural and mechanistic differences responsible for the pathogenicity of the AIDS virus (HTLV- III/HIV). Research has shown that env-related antigens of HTLV-III/HIV, STLV-III, and HTLV-IV all cross react which means that common conserved regions of these viruses are immunogenic. Additional research marking these cross-reactive epitopes can provide the basis for the development of an AIDS vaccine.
Profile of Liberia on IEC management in population programs.
Only about 5% of women in Liberia of child-bearing age who need family planning services have access to such services. A recent study on adolescent sexuality in Monrovia, the capital city of Liberia, revealed that lack of information and unavailability of services accounted for 90% of contraceptive nonuse. In rural areas of the country, there is a belief that a large number of children have high economic value-- daughters bring dowries while sons help with farm work. There is a high infant mortality rate, and parents tend to have many children with the hope that some will survive to adulthood. The society looks with disfavor on those sought to be infertile or unable to have children as often as other persons of similar age. And political leaders are reluctant to advocate any policies on family planning. Given this cultural environment, communications components are essential to any effective family planning programs. Radio and television would be ideal media for publicizing family planning information, but commercial broadcasting is expensive and public service spots are limited. The press cannot be utilized effectively in a country with a literacy rate of 25%. The only communications tool utilized to any extent by family planning programs in Liberia is interpersonal contact through clinic and home visits, lectures, and counseling. But there is little supervision of such contacts and a virtual absence of systematic evaluation to determine the impact of these contacts on family planning services. Agencies in Liberia providing family planning services such as the Family Planning Association of Liberia (funded by IPPF) and the government's Ministry of Health and Social Welfare should build effective communications programs to improve their services.
Programs in religious settings.
The Center for Population Options' Program to Expand Sexuality Education in Cooperation with Youth Serving Agencies was initiated in 1977 to encourage and assist youth-concerned organizations in their efforts to provide sex education to young people and/or their parents. The Youth Serving Agencies Program has worked with 20 national organizations that share a concern for the quality of life of young people. The program has focussed on training and technical assistance that facilitate provision of sex education. One of the earliest activities of the program was to conduct demonstration projects in 3 pilot communities-- Cleveland, Des Moines, and Seattle. In each pilot site, youth workers from the 20 participating agencies were trained to develop and implement sex education programs. A number of religious group members received training and established programs. This pamphlet describes in some detail 3 successful sex education programs established by churches, and discusses program goals, content, curricula material, structure, and content. It also provides summary descriptions of 12 other programs established by religious groups. The pamphlet provides information to assist in the design and establishment of religious-based programs, including listings of instructional books, articles, films, videotapes, and recorded tapes. An analysis of Christian curricular materials on premarital sex, homosexuality, contraception, masturbation, and abortion is included.
Training in management of population communication programmes.
Communication is a basic part of population and development programs and is necessary to ensure that people participate and improve their quality of life. The management of the communication process in these programs requires not only knowledge and comprehension of the process, but also the structure of media and local organizations. The direction of management has shifted from a vertical to a horizontal communication structure. To be an effective manager, the following traits are needed: The ability to understand policy, develop strategies, provide and seek support, produce unique messages, make media choices, mobilize personnel, prepare training activities and work plans, and be able to implement research. The skills needed are the ability to foresee and act on problems, communicate and listen effectively, motivate and persuade, and adapt to changing demands of a program. Based on these and other needs a 2 week pilot training program was developed containing 3 modules. After evaluation of the pilot program the course was lengthened to 3 weeks with additional time for special needs asked for by the students. Unesco together with the Asia-Pacific Institute for Broadcasting Development developed courses in the management of population communication programs and also with the Arab States Broadcasting Union. These programs are the beginning of an integrated effort for population and development management training.
Trip report: AIDSCOM technical assistance in the Eastern Caribbean.
From April 4-April 17, 1988, AIDSCOM personnel visited the Eastern Caribbean countries of Barbados, Trinidad and Tobago, St. Vincent and the Grenadines to provide technical assistance to health care officials and to continue with development of an AIDSCOM regional base and additional satellite sites. In addition, the program officer met with the regional USAID health officer and health officials in these countries to draft preliminary plans and letters of understanding and to specify support and financial responsibilities among the parties. AIDSCOM conducted its 1st needs assessment of St. Vincent and the Grenadines on this trip. Needs assessments for the other 2 nations have previously been completed. AIDSCOM is hoping to hire 2 resident expatriate advisors to work on AIDS communication, operations research, and training activities and 2 local communications, education, and counseling specialists to work from a regional base at the Caribbean Epidemiology Center in Port of Spain, Trinidad. AIDSCOM has proposed additional satellite sites for smaller islands to test pilot AIDSCOM programs and to ensure a regional range in proposed programs. 1 site may be on a smaller island in the northern end of the Eastern Caribbean and the other on the southern end. AIDSCOM would employ local specialists at each of these sites and they would work with the resident advisors in Trinidad. The Trinidad and Tobago National AIDS Control Plan has placed the national AIDS information hotline in Trinidad as 1 of its priorities. During this visit, AIDSCOM tested the effectiveness of the hotline.
Major activities of 1986, training programs, and management development projects are described and progress reports given for projects and programs of the January-December 1986 period. The International Council on Management of Population Programs (ICOMP) International Conference on Management of IEC in Population Programs was devoted totally to information, education and communication, indicating increasing recognition of IEC as a vital program component. Training workshops were held in 1986 for sub-Saharan Africa, for Asia and Middle East, and for Latin America. 7 projects were initiated to assist nongovernmental organizations and institutions in exploring ways to conduct appropriate management training for women in the social sector, particularly health and family planning activities. A South Asian Management Program was funded to assist government initiatives in the area of management improvement of health and population programs. Case studies on management of information, education, and communication in population programs have been undertaken in 20 countries. Publications include the bimonthly newsletter and a reprint of the ICOMP brochure.
Efforts of the World Resources Institute (WRI), the World Bank, the United Nations Development Programme, and the Food and Agriculture Organization have resulted in a common framework to save tropical forests--the Tropical Forestry Action Plan. A 1st step includes national forestry sector reviews to coordinate aid agency and government involvement in identifying investment priorities and significant policy reforms to reverse deforestation and promote sustainable development and then incorporating them into their national development plans. This represents a shift from the focus of national government and aid agency forestry programs of the late 1970s, which was on commercial or industrial forestry, to forestry which provides for people's basic needs. To be successful, this plan requires the involvement of farmers and local communities. Involving NGOs and their capabilities can complement government and development assistance programs. NGOs' greatest contribution is the promotion of community based, participatory forestry programs that benefit economically or socially disadvantaged groups. WRI and the Environment Liaison Centre hosted 3 regional workshops to discuss NGOs roles in reforestation. Participants agreed that, to establish a basis for constructive collaboration, NGOs, governments, and aid agencies must mutually understand their complementary roles. Further governments and aid agencies must change policies and procedures to assist and enhance NGO involvement in policymaking and the project cycle. This includes finding new mechanisms to direct funds to NGOs, and for governments and aid agencies to respect the autonomy of the NGO and therefore enable it to achieve its goals.
India's Institute for Research in Reproduction's annual report covers its activities during the period from April 1986 to March 1987. To further its goals of better understanding the biology of reproduction and clarify the ways different physiological mechanisms are integrated, the institute develops diagnostic tools, applies contraceptive technology at the individual and community levels, and attempts to understand infertility-related problems. In addition to summarizing the status of projects under way in reproductive immunology, neuroendocrinology, hormone assays, improving contraceptive acceptance, nonhuman primates, and 5 other research areas, the report highlights the institute's activities in support of research. A conference convened by the institute on biologically active proteins and peptides brought together the major investigators in protein chemistry to present current findings and develop a program integrating the synthesis, testing, and manufacture of biologically active proteins for research purposes. The institute isolated and identified a number of proteins that play a key role in regulating reproductive processes. It also organized 2 training courses in radioimmunoassay and held a symposium on endocrinology. The report concludes with a list of published studies and papers presented at conferences by institute members.
A study was recently conducted in New Zealand on 3 types of IUDs--The Nova-T, the Multiload Copper 375, and the Multiload Silver Copper 250. The IUDs were compared for termination rates and for complications presented during insertion and removal. All insertions were grouped into 1 of 5 categories: easy, difficult, patient fainting, patient fitting, or impossible to insert. Removals were analyzed in 3 categories: easy, difficult, or impossible to remove without administration of a general anesthetic. In analyzing terminations, expulsions included complete expulsions into or from the vagina and partial expulsions protruding from the cervix; medical removals included removal for bleeding and/or pain; and other medical removals included pregnancies prior to insertion, perforation of the uterus, vaginal discharge, and physical complaints by wives or husbands attributed to IUD use. The study revealed that at insertion, there were 12 Multiload Copper 375, 6 Multiload Silver Copper 250, and 2 Nova-T devices that could only be removed under general anesthetic. After a period of 1 year of use, the Multiloads had lower net rates for accidental pregnancy, expulsion, medical removals, and infections, than the Nova-T. There were no significant differences between the multiloads, but the Nova-T had a significantly lower continuation rate.
Trip report: Focus Group Training Workshop, Accra, Ghana.
A 3-phase focus group (FG) training workshop was held for the core training staff of the Ministry of Health/Health Education Division, Ghana, in September-October 1986. The goals of the workshop were to teach FG techniques, to use FG to conduct a KAP survey of Level B health providers, and to use the results to develop a IEC training curriculum for these providers. During the classroom phase, participants practiced FG methods and developed 3 instruments for field use. They then conducted FGs at 25 sites throughout the country. The resulting data showed that Level B health providers are generally knowledgeable and favorable to family planning, but are skeptical about method effectiveness, safety, reversibility (sterilization) and acceptability (sexual pleasure). Their clinics are handicapped by lack of contraceptive supplies, logistic support, clinic equipment, and IEC materials, especially audiovisuals. Many workers want more training in family planning, IEC and use of IEC materials beyond posters. It was recommended that lack of contraceptive supplies and clinic equipment be addressed 1st, and priority be placed on family planning and IEC training of both nursing students and current health workers.
Risk factors for HIV seropositivity in selected urban-based Rwandese adults.
In January 1987, HIV antibodies were detected by means of an immunoenzymatic assay, indirect immunofluorescence, and Western blot in 52 of 302 male urban-based professionals and in 28 of 150 healthworkers in Kigali, Rwanda. Univariate analysis showed an association between HIV seropositivity and a history of sexually transmitted diseases (STD), blood transfusion, medical injections for treatment of STD, and medical injections for treatment of febrile illnesses. However, injection related to treatment of other conditions were not associated with HIV seropositivity. Among healthworkers, no association between HIV seropositivity and professional or accidental exposure to HIV-infected patients or to their body fluids was identified. Discriminant analysis showed that HIV seropositivity was associated only with a history of STD and with a history of blood transfusion. In central Africa, a history of blood transfusion should be considered as risk factors for HIV seropositivity. Medical or accidental injections do not seem to play a major role in the transmission of HIV among adults in central Africa. (author's)
Smoking and reproductive health.
The effect of smoking on reproductive health is examined from the social and public health perspectives, and in a series of epidemiologic studies on topics such as oral contraception, tubal infertility, fecundity, ectopic pregnancy, spontaneous abortion, birth weight, pregnancy outcome, cancer of the endometrium, breast, ovary, and cervix. The incidence of smoking is still increasing among girls in the U.S., and among many developing countries. The consequences of low birth weight attributed to maternal smoking, reported to be 0.5-0.9 lb., are estimated to cost the U.S., $175 million annually in excess neonatal intensive care alone. Other effects of smoking on health for which there are available explanations include: dramatically increased risk of atherosclerotic disease among oral contraceptors, increased rates of pelvic inflammatory disease leading to ectopic pregnancy, effects on cancer and osteoporosis attributed to lower estrogen levels, increased incidence of cervical cancer--even in those exposed to sidestream smoke- -due to both concentration of tobacco ingredients in cervical mucus and to potentiation of the oncogenic action of human papilloma virus. It is generally agreed that smoking is an addictive process, that scare tactics will not make pregnant women stop smoking, but supportive interventions have a moderate chance of success, even if only temporary.
Clinical trials procedures: a summary of requirements in thirty-three countries.
Greater standardization of the requirements countries impose before clinical trials may be performed would help ensure that worthwhile new drugs are made available at the earliest opportunity. A review of the requirements needed for setting up clinical trials found no uniformity and although some discussion has been under way, it appears unlikely that agreement will be reached in the foreseeable future. 33 countries were surveyed, including Australia and countries in North America, South America, Europe, Africa, and Asia. The review sought each country's pharmacological and toxicological requirements; need for registration of drugs prior to clinical trials; information required by health authorities; requirements related to investigators; requirements for importation of clinical trial materials; and package labeling requirements. Although the U.S. was not surveyed, it is noted that registration of new drugs is restricted by Food and Drug Administration regulations. Of 50 drugs under research, 31 are already marketed abroad, some for a considerable time.
The development and regulation of new medications.
The unmet needs of many patients make the successful search for new and better drugs an urgent goal. Increasing regulatory demands in the U.S. have generated delays in the availability of new drugs and concerns about the long-term profitability of the pharmaceutical industry. It now takes an American firm about 8 years and $54 million to bring one of its new drugs to the U.S. market. A rational and flexible approach to drug regulation could ease some of the most worrisome constraints without jeopardizing the public welfare. Over-the-counter drugs and old and proven drugs should not be subject to the same rigid testing requirements as new prescription drugs. Money saved in this area could be put to use in expediting the search for new drugs. The Food and Drug Administration requires that 2 controlled trials of new drugs be conducted, regardless of the number and quality of foreign trials already available. This requirement should be eliminated. Changes in our national drug regulatory policy will serve our society better than legislative proposals intended either to emasculate the Food and Drug Administration or to grant the agency broad new powers. (author's modified)
This article reviews regulatory requirements for the import, export, transport, and clinical study of investigational new drugs in those countries that make up the major pharmaceutical markets of the world. Regulations governing both human and veterinary drugs are discussed. The author states that the regulatory requirements on the extent and acceptability of clinical trial data are as diverse as the countries in which trials are conducted. He divides major pharmaceutical market countries into 3 groups. The 1st is made up of countries that accept foreign clinical studies for regulatory review; the 2nd of countries where local clinical trials are usually necessary for compliance with local regulatory requirements; and the 3rd (which includes India, Japan, and France) of countries where foreign data are not accepted and severe restrictions are placed on the importation of formulated clinical supplies for use in local clinical trials. The types of data that are required for investigational new drug approval are summarized for selected countries. Regulations on the transport of clinical drug supplies are discussed with a focus on whether countries require pretransport notification or documentation, the time factors involved in receiving approvals, whether authorized personnel or institutions are required to conduct clinical trials, and customs considerations. Particular attention is given to transport requirements in the U.S., the world's leader in controlling and regulating the transport and investigation of clinical drug supplies.
Can government regulate fertility? An assessment of pronatalist policy in Eastern Europe.
The authoritarian governments in Eastern Europe have played an active role in the fertility regulation of their citizenry. This article examines government attempts to encourage population growth in Eastern Europe, with particular attention given to Romania, Hungary, and the German Democratic Republic. Governments attempting to influence reproductive behavior can utilize 3 types of policies--the moral-propagandistic, the economic, and the legal-administrative. Romania has focused on the latter, issuing a decree in 1966 banning abortion for women under age 45 with less than 4 children. Hungary has pursued a policy with some legal-administrative aspects, but it has included more positive economic incentives for families to have children. Allowances were raised for a second child and monthly maternity payments were increased through the third offspring. Hungary also expanded its network of family planning centers and offered more courses on sex education and family life. The German Democratic Republic has emphatically followed an economic incentive approach in its pronatalist policy. In 1976, the government adopted regulations that raised paid maternity leave to 26 weeks, provided cash allowances during the time of unpaid leave for 2nd and 3rd births, gave working mothers a fully paid work week of 40 hours, raised the value of birth grants, and provided newly married couples with loans to buy and furnish homes. The population growth policy followed by Romania is likely to fail--abortion is deeply engrained in Romanian culture. Hungary's mixed administrative-economic approach should be effective. But the purely economic incentives of the German Democratic Republic should work permanently.
Population: problems and policies.
Sri Lanka's population policies, which the government has promoted since 1977, have achieved positive results. The policies are directed at the country's rapid population growth (an increase of 500% in the last 100 years), population distribution (concentration in the western coastal belt), population composition (46% are younger than age 20), and attendant health problems, especially for women and children. The government provides family planning services to all who seek such services. It educates the people on the implications of population growth for national development and the health implications of having too many children without adequate spacing. The government is developing the country's dry zone and suburban towns to reduce population pressures in urban areas. Conditions for women have improved with equal education and employment opportunities. Underlying the policy of improved education for women is the belief that women's age at marriage will thereby be increased, fertility rates will be reduced, and the health of children and mothers will be promoted. The government also aims to further reduce infant and child mortality rates through a program promoting child immunization, growth weight monitoring, and breast-feeding. Achievements of the government's policies include a 5% decline in total number of births from 1982 to 1985, a decline in the crude birth rate from 30/1000 in the late 1970s to 24.6/1000 in 1985, and an increase in acceptance rates for all family planning methods from 34% in 1975 to 55% in 1982.
Vaginal spermicides and congenital disorders: study reassessed, not retracted [letter]
In 1981, an article by H. Jick and others appeared in The Journal of the American Medical Association concerning a purported link between spermicides and congenital malformations in offspring. 2 of the authors recently retracted their positions taken in the article, but Jick and 2 other authors persist in claiming that despite the lack of definitive proof, evidence points to a link between vaginal spermicides and trisomies, chromosomal abnormalities resulting in such disorders as Down Syndrome. Studies using chromosome bonding indicate that approximately 25% of trisomies are due to meiotic errors in male gametogenesis, which occurs prior to ejaculation and before any possible contact between sperm and spermicides. Among female meiotic errors, 75% (56% of all trisomies) occur during meiosis 1, which is completed prior to ovulation and before direct contact with spermicides. Maternal meiosis 2, errors in which account for about 19% of all trisomies, starts before the sperm fuses with the ovum and continues through development of the female pronucleus, after the sperm has contacted the ovum. In light of the dozens of biochemical changes that occur in the ovum once contact with a sperm has been achieved, it is difficult to understand why meiosis 2 should be selectively interfered with by spermicides, or how such exposure might happen. Virtually no trisomies occur at fertilization itself, and even if a sperm could survive contact with spermicide, a spermicide-damaged sperm would be highly unlikely to achieve fertilization. The biologic basis for an association of spermicides with chromosome anomalies is quite small. (author's modified)
Indonesia's great frontier and migration policy.
The population of Indonesia is 175 million, of which 65% live in Java. Java has only 7% of the land area, causing a population density of 2,000/square mile. This has lead the government to introduce a policy of transmigration which encourages people to move from Java to the larger outer islands. In the last 35 years 4.3 million people have moved from Java to Sumatra, Borneo, Celebes, and Irian Jaya. The total area of Indonesia stretches over 3,200 miles and has 16,000 islands of which 1,000 are inhabited. It has vast resources of oil, lumber, rubber, tin, palm oil, copra, coffee, tea, pepper, cloves, nutmeg, and quinine. Indonesia is also rich in minerals, including coal, bauxite, iron ore, and gold. Even with a national family planning program, population growth has reached 2.1% a year. 3 other islands that people are induced to move from are Madura, Bali, and Lombok, although their population densities are less then Java. The small islands near Singapore are being developed and Batam will be a free port to compete with Hong Kong. The most intense migration has been to Kalimantan (Borneo) which has 4 provinces. The migration policy began in 1905 and by 1930 100,000 people, had moved to other islands; 600,000 people were relocated to plantations in Java for labor needs. In 1979-84, a more ambitious program costing 2.3 billion moved 1.5 million people. In the most recent 1984-89 plan, a goal of 3.1 million were to be relocated but due to budgetary restrictions only 150,000 families have moved. The main social issue addresses the domination of other people by Javanese, not only in numbers but cultural differences. Some observers say the real reason for migration is political in ensuring the boundaries and geographic integrity of Indonesia.
A UN Development Programme (UNDP) report covering the 1972-1981 period states that because funding declined sharply in 1981, UNDP projects will be severely cut back. The report notes, for example, that the UNDP's goals aimed at developing the Senegal River Basin will not be reached. The project, begun in 1972, was designed to increase and improve food production, industrialization, power generation, transportation, trade, employment, earnings, environmental health protection, and regional self-sufficiency. The project entailed an assessment of hydroelectric sites, introduction of new crops and agricultural techniques, river flow control, mineral exploitation and irrigation. By the end of 1981, an irrigation and hydropower dam was under construction, and plans for an anti-salt barrier and harbor were ready. But without voluntary contributions from governments to support UNDP, the projects cannot be realized. The report also details UNDP's performance record for projects in other countries and regions, as well as its achievements in addressing problems related to energy, water supply and sanitation, women in development, and the environment. Charts are included that show distribution of UNDP expenditures by region and sector, delivery of services by function, and investments related to the group's activities.
Annual report 1987. (April-December).
The 1987 annual report of India's National Institute of Cholera and Enteric Diseases outlines the activities and achievements of the agency from April through December. The institute undertook 29 research projects during the year and continued to support the implementation of the National Diarrhoeal Diseases Control Programme with a special emphasis on the training of health care delivery personnel. A community-based longitudinal study conducted by the institute to determine the various risk factors responsible for severe life- threatening diarrhea resulted in the collection of valuable data. In the training area, the institute conducted several intercountry training courses and national workshops and prepared training modules and programs. In addition, institute staff contributed to and participated in a number of educational seminars and had their work published. Further progress was made in the development of bilateral collaborative research studies with biomedical scientists from the U.S., Soviet Union, and Great Britain.
Family planning and the health of women and children.
Each year, over 14 million infants and children and more than 1/2 a million women die as an effect of pregnancy: 98% and 99% of these deaths, child and maternal deaths respectively, happen in developing countries. Maternal mortality figures prominently in the number of deaths of young women per year. 1 in every 8 children born alive in a developing country dies before its 5th birthday. Family planning, therefore, could be a very effective means of reducing infant and maternal mortality rates if targeted correctly. A general decline in fertility would help reduce mortality rates, but attention to specific risk areas would also be effective. It known that first births and births to very young mothers produce exceptional risks. Risks are also inherent with closely spaced births. Family services can inform their clients of such risks. However, although family planning can play a significant part in the improvement of women's and children's health status, it is not the sole answer to a complex problem. The maximum benefit of family planning intervention in relationship to maternal and infant mortality is 10-20%, but practical application will probably produce a smaller percentage.
Trip report: the Hashemite Kingdom of Jordan.
A trip was made to the Hashemite Kingdom of Jordan during February 1987 to conduct a clinical family planning survey of institutions providing family planning training and/or services; and to assist in developing a family planning training sub-project with the Ministry of Health. The 219 primary health care centers in Jordan fall into 3 categories: about 54 maternal and child health (MCH) centers, with resident midwives, provide some family planning services; about 50 MCH centers, staffed by MCH doctors and practical nurses, do not provide family planning services: and 115 health centers provide non-MCH/FP services. Service providers generally lack knowledge and skills about contraception necessary to provide safe and effective family planning services. The following were among the recommendations proposed to RONCO for consideration: advise the Ministry of Health to obtain funds for the provision of contraceptive equipment and commodity; provide training materials to the proposed training centers in Amman, Karak, Salt, Zarka, and Irbid; provide technical assistance in contraceptive technology to physicians and midwives; and assist in developing guidelines for a family planning training curriculum.
Mass media and human services: getting the message across.
An attempt is made to demonstrate how human service public relations, public education, and prevention activities can be carried out through the media. Initially, the book presents some evidence that more public education efforts on the part of human service workers are necessary and what kinds are possible. It then provides specific guidelines, strategies, and tools for carrying out a variety of public education activities, all of which are within the capabilities of the average human service practitioner, either as an individual or as a member of a human service organization or group. Attention is directed to organizing for action and planning media resources as well as working with the print media and opportunities in radio and television. A chapter is devoted to evaluation mechanisms, documenting success in achieving media coverage as well as evaluating the quality and impact of the media messages. Any effort to promote public understanding of social issues, community problems, human service programs, and the concerns and activities of human service workers can be enhanced significantly by the appropriate use of the mass media.
The spermicide nonoxynol-9 does not inhibit Chlamydia trachomatis in vitro.
The antimicrobial effects of the active ingredient, nonoxynol-9, and the base component of a commercially available spermicide were tested in vitro against Chlamydia trachomatis. The infectivity cell-free elementary bodies was not affected by nonoxynol-9 or the base after incubation for 30, 60, or 180 minutes in direct contact with serial 2- fold dilutions of each agent. The spermicide's effect on the in vitro growth of C. trachomatis was evaluated after exposure of C. trachomatis- infected McCoy cells to serial dilutions of each agent for 2 hours and for 72 hours. A significant cytopathic effect of nonoxynol-9 on the host cell membrane was observed at concentrations of spermicide between 100% and 0.0014%. However neither agent was effective in inhibiting the intracellular growth of C. trachomatis at concentrations (0.0014- 0.0004%) of nonoxynol-9 that produced no evident cytopathic effect on McCoy cells. Thus, nonoxynol-9 was found to be ineffective in inhibiting infectivity or subsequent growth of C. trachomatis. (author's)
The ultrarapid method for determining serum hCG, time-resolved fluoroimmunoassay, was employed to measure hCG in 41 women having vacuum aspiration procedures, to validate its reliability for clinical applications. The method is a direct immunologic sandwich assay involving 2 monoclonal antibodies, 1 against hCG beta subunit, and the other, slow-decay fluorescent labeled, against the alpha subunit. Commercial kits were from Delfia (LKB-Wallac, Turku, Finland). The subjects were aged 15-43 (mean 25.3), 6-18 weeks gestation. Suspected abnormal pregnancy of those with abnormal evacuation products were excluded. Disappearance of hCG was followed in 35 women. Baseline hCG ranged from 20,800-185,000 IU/1. Mean levels declined from 106,700 IU/1 at 0800 before evacuation, to 98,500 4 hours later. Within 2 days it fell to mean 9600 IU/1. The level of 10 IU/1 was reached in 21 days on average. These results are essentially similar to levels found with standard radioimmunoassay techniques.
Bangladesh: promoting higher growth and human development.
A 1987 World Bank report on Bangladesh explores the economic progress the country made 2 years into its 3rd 5-year development plan. The report also assesses the feasibility and effect of accelerating development in the country. In addition to summarizing recent economic developments, the report examines medium-term growth options but suggests that policy reforms and more generous foreign assistance are required to achieve optimum growth. Policy reforms should target agricultural issues, trade and industry, the jute market and manufacturing sector, and the domestic financial system. Although Bangladesh has made progress in alleviating poverty, it can improve programs that would promote economic opportunities among the poor and women, as well as better address education, health, population management, and nutrition. The report includes charts and tables detailing economic, budgetary, and agricultural production trends and indicators. A statistical appendix provides data on the country's human resources, national accounts, balance of payments, external debt, public financing, wages and prices, industry, transportation, and energy.
Natural family planning: fact sheet for family planning providers.
In 1987, the Los Angeles Regional Family Planning Council issued a fact sheet for family planning providers on natural family planning methods which provide safe and effective, non-chemical means to prevent pregnancy. The fact sheet explains the menstrual cycle and the naturally occurring bodily changes that a women can observe during the cycle. There are 2 commonly used natural family planning methods: the cervical mucus method, under which a woman observes her mucus changes to know when she might become pregnant; and the sympto-thermal method, under which the temperature of the body at rest and other bodily changes are observed along with cervical mucus changes. The fact sheet also points out that, contrary to myth, natural family planning methods can be effectively used within 2 weeks of receiving proper instructions and fertility signs need not be monitored every day of a woman's menstrual cycle.
Serving the neediest at home and abroad. Annual report 1987.
Planned Parenthood Federation of America (PPFA), in its 1987 annual report, summarizes its operations for the year against the backdrop of a political climate in which restrictions on abortion and access to family planning activities were attempted. Major efforts were directed against the Reagan administration's "Mexico City policy," restricting nongovernmental foreign recipients of U.S. government family planning funds from using privately raised money to underwrite any program that performs, advocates, refers, or counsels for abortions, and against a Title X regulatory proposal forbidding family planning clinics from counseling on abortion. The report also details the national and affiliate offices' activities on sexuality education, public education, the AIDS crisis, public affairs, and on the legal front. A PPFA/Louis Harris poll, "Attitudes About Television, Sex, and Contraceptive Advertising" showed that adults, by a 4 to 1 margin, think that sexually active teens would be encouraged to use contraceptives if their use was depicted on television shows starring popular performers: over 80% believe that television advertisements promoting contraceptives would lead to an increase in contraceptive usage among adolescents. 72% of adult respondents would not be offended by contraceptive advertising. Although only 53% of adult respondents approve of beer and wine advertisements, 60% support contraceptive advertising. The report closes with a 5-year plan (1987-91) and summary information on the group's financial activities in 1987.
Contraceptive steroids increase cholesterol in bile: mechanisms of action.
Contraceptive steroids increase the risk of acquiring cholesterol gallstones. The factors responsible include an increase in cholesterol saturation of bile and an increase in rate of secretion of cholesterol into bile. The goal of this study was to investigate the mechanism(s) of these increases in biliary cholesterol. During the use of contraceptives, cholesterol saturation of gallbladder bile and the amount of cholesterol secreted/mole of bile acid increased (P<0.05 and P<0.02, respectively). Cholesterol absorption, cholesterol synthesis, chylomicron remnant clearance, and the concentration of plasma and lipoprotein lipids were not altered by contraceptives. Despite this apparent lack of effect, important correlations were present during steroid use. Low density lipoprotein (LDL) cholesterol increased as dietary cholesterol increased (r=-0.58, P<0.025). Cholesterol synthesis correlated directly with VLDL cholesterol concentration (r=-0.64, P<0.01), biliary cholesterol secretion (r=0.68, P<0.01), and with molar % cholesterol in bile (r=0.49, P=0.06). Chylomicron remnant clearance also correlated with cholesterol secretion (r=0.85, P<0.001). As either remnant uptake or synthesis increased, the effect of the other source of hepatic cholesterol on biliary cholesterol secretion diminished. These relationships were not observed in the same subjects when they were not taking the hormones. These findings suggest both newly synthesized and dietary cholesterol contribute to the cholesterol secreted in bile. This is consistent with the hypothesis that cholesterol for secretion into bile and VLDL is derived from a common metabolic pool of free cholesterol. It is proposed that contraceptives exert their effect on biliary cholesterol by increasing cholesterol entering the pool and/or by inhibiting hepatic acylcoenzyme A:cholesterol acyltransferase activity, a known effect of progesterone, so that an increase in free cholesterol entering the pool leads to an increase in output. (author's)
The excretion of ethynyl steroids in milk from a lactating woman taking a daily dose of an oral contraceptive (Conlumin) containing 1 mg norethindrone + 50 mcg mestranol has been studied. Milk was diluted with aq. triethylamine sulphate and steroids were extracted on a Sep-Pak C18 cartridge at 60-64 degrees Celsius. Groups of unconjugated steroids, glucuronides, mono- and disulphates were separated on triethylaminohydroxypropyl Sephadex LH-20. Following hydrolysis and further purification, steroids possessing an ethynyl-substituent were isolated by chromatography on sulphohydroxypropyl Sephadex LH-20 in silver form. Gas chromatographic-mass spectrometric analysis of the O- methyloxime-trimethylsilyl ether derivatives of these steroids, showed the presence of norethindrone and mestranol in the free fraction and of tetrahydro metabolites of norethindrone with 3x, 5x, 3x,5beta, and 3beta,5x configurations in the mono- and disulphate fractions. The disulphate of the 3x,5x isomer was the most abundant ethynyl steroid in milk after 13 days of administration. The site of conjugation of the monosulphates was established by acetylation prior to solvolysis and analysis by gas chromatography-mass spectrometry. This showed that the 3x,5x isomer was conjugated mainly in the 17beta-position while the 3x,5beta isomer was conjugated at C-3. (author's)
The recovery of ovarian function during breast-feeding.
The pattern of breastfeeding was daily recorded and the serum concentrations of prolactin (PRL), FSH, LH, estradiol (E2), and progesterone (P) were measured at weekly intervals in 26 breastfeeding mothers from the time of delivery and up to the resumption of regular ovulation or to the end of the 1st postpartum year. 12 postpartum non- breast feeding women were similarly studied as controls. An algorithm was used to characterize ovulatory events into 3 types: the 1st, with evidence highly suggestive of normal ovulation (EHSO), the 2nd, with evidence of probable ovulation (EPO), and the 3rd with evidence indicating questionable ovulation or deficient corpus luteum function (QO/DCT). Pregnancy preceded the 1st menstruation in 1 woman in each of the breastfeeding and control groups. Of the 19 breastfeeding women who started to menstruate during the 1st postpartum year, 5 had EHSO, 1 had EPO, 5 had EQO/DCL, and 7 had anovulatory (AO) menstruation. The corresponding figures in the 11 controls were 6, 2, 3, and 0. Pregnancy occurred before a 2nd menstruation in 1 woman in both the study group and the controls. In 18 breastfeeding women observed, the 2nd menstruation was preceded by EHSO in 7, by EPO in 3, by EQO/DCL in 1, and AO in 7. In 10 controls the corresponding figures were 7, 3, 0, and 0. Out of a total of 79 menstruations observed during breastfeeding, the incidence of AO was 30% and of QO/DCL was 15%. In actively breastfeeding mothers, hyperprolactinemia persisted for more than 1 year. However, menstruation and ovulation occasionally occurred before the drop of PRL to concentrations seen during the normal menstrual cycle. In the majority of women, low E2 levels were present during lactational amenorrhea, but with occasional spikes in some. A few women maintained somewhat high values of E2 for several weeks before the resumption of menstruation. The implications of these hormonal findings to the attempts to improve on the contraceptive effect of breastfeeding are discussed. (author's)
The antiprogestins: a recent advance in fertility regulation.
Ru 486 (mifepristone) is the 1st antiprogestin available for clinical purposes. Its pharmacological properties are presented. It possesses antiprogestin and antiglucocorticoid activities. It is now in phase II- III clinical studies as a fertility control agent. The drug appears useful per se in 4 situations: for early pregnancy (amenorrhea of less than 5 weeks' duration), for late occasional luteal contraception when given as a single dose on the date of the expected period in women at risk for a pregnancy, for dead fetus expulsion in the 2nd or 3rd trimester of pregnancy, and for cervical ripening before such obstetrical procedures in pregnant women as vacuum aspiration or D and C. During early pregnancy, complete interruption is obtained in approximately 90% of the women participating with a single dose of 600 mg. For this stage of pregnancy, RU 486 appears to be an interesting alternative to vacuum aspiration. The antiglucocorticoid activity of the molecule can be demonstrated in humans by a rise in plasma cortisol, ACTH, and LPH after RU 486 intake, and by blockade of some peripheral effects of cortisol. Results obtained in more than 1000 women undergoing shortterm treatment with RU 486 (600 or 800 mg once) clearly indicate that the antiglucocorticoid activity of the molecule has no clinical relevance at the doses used for fertility control purposes. In conclusion, RU 486 appears to be a promising new tool for fertility control, but largescale trials are necessary to confirm for each indication. (author's)
The effects of bilharziasis in Rhodesia.
Bilharziasis, a parasitic infection resulting from the deposition of snail ova, is a serious problem in Rhodesia. The severity of disease and the likelihood of complications are directly related to infection intensity. Mild infections tend to be self-limiting, while severely infected individuals can progress to hydronephrotic atrophy with renal failure. Most common in African populations is a diffuse fibrosis of the lower ureter and bladder, liver, and lung. Less frequent is massive bilharzial granuloma in the colon, vulva, and clitoris. Of concern is growing evidence linking severe infestations with malignant changes in the mucosa of the bladder; in fact, bladder cancer is the 3rd most frequently reported type of cancer in Rhodesia. Bilharziasis appears to have no effect on pregnancy or future fertility. The most common presenting symptoms are dysuria, suprapubic pain, hematuria, and acute urinary retention or incontinence. Fatigue, the most widely reported clinical symptom in Europeans with Bilharziasis, is rarely mentioned by African patients; however, African children with this infection have been shown to have impaired intellectual ability that can be improved by a 1-dose hycanthone treatment.
Psychological and related characteristics of smokers and nonsmokers.
Smoking prevention and cessation programs would be aided by more knowledge about the personal attributes of smokers versus nonsmokers. A review of major studies by Haenszel et al (1956), Sackrin and Conover (1957), and Lilienfeld (1959)--as well as other studies appearing in the literature--suggests that there are significant differences between these 2 groups in terms of psychological, social, and behavioral characteristics. Concerning personal-situational variables, smokers are more likely than nonsmokers to be male, divorced or widowed, urban residents, unemployed, veterans, participants in sports, and to have been in a driving accident; generally, there are no consistent differences in socioeconomic status, education, or income. On the psychological dimension, studies have shown smokers to have high anxiety scores, higher than average scores on psychological tension, a neurotic personality constellation, and more psychosomatic symptoms than nonsmokers; however, no "smoker's personality" can be delineated. There are some indications that the factors that motivate people to initiate smoking (e.g., parental smoking, peer pressure) differ from those that perpetuate the habit (e.g., reduction of anxiety, tension, and loneliness). The fact that a 1958 study found no significant differences in the proportion of quitters between psychologists and scientists studying lung cancer, despite the latter's presumed greater knowledge of the harmful effects of smoking, shows the importance of noncognitive factors in the maintenance of smoking.
The majority of cases of pediatric acquired immunodeficiency syndrome (AIDS) are transmitted perinatally. 165 (76%) of the cases of AIDS in children under 13 years of age reported as of December 1, 1985, in the US had as the only known risk factor a mother from a high-risk group. However, perinatal transmission from an infected mother to her infant is not automatic; studies have placed the rate of transmission from 0%-65%. A concern in addition to the risk posed to infants born to infected mothers is evidence of an increased likelihood of developing full-blown AIDS when infection with the AIDS virus occurs in association in pregnancy. Target groups for counseling and testing for antibodies to the AIDS virus should include pregnant women or those who may become pregnant who already have evidence of AIDS infection, are intravenous drug abusers, were born in countries where there is a high rate of heterosexual transmission of AIDS, are prostitutes, or are the sexual partners of men in high-risk groups. Such counseling and testing should be made available through the settings that women at increased risk frequent, including drug abuse treatment programs and sexually transmitted diseases clinics. Infected women should be advised to delay pregnancy until more is known about the perinatal transmission of AIDS. Pregnancy infected women should be closely monitored for the development of opportunistic infections as well as psychosocial difficulties. Although these recommendations pertain to women, men who are infected with the AIDS virus also should be counseled about risks of perinatal transmission.
This document includes detailed recommendations for precautions to prevent the transmission of the acquired immunodeficiency syndrome (AIDS) virus and other blood-borne infectious diseases (e.g., hepatitis B) in the workplace. Since the type of nonsexual contact that generally takes place between workers and their clients or consumers has been documented to pose no risk of transmitting the AIDS virus, routine antibody screening is not recommended for groups such as health care workers and food preparers and servers. Health care workers are at potential risk of contracting the AIDS virus only through parenteral exposure to a needle of other sharp instrument contaminated with the blood of an infected patient; thus, protocols should be developed for the safe handling and disposal of all sharp instruments. In cases where a health care worker is possibly exposed, the source patient should be evaluated clinically and epidemiologically for the likelihood of AIDS infection. If AIDS infection is possible, the patient should be requested to undergo serologic testing. To prevent worker-patient transmission, all health care personnel should wear gloves when in direct contact with mucous membranes or nonintact skin of patients and should avoid direct patient care if they have exudative lesions or weeping dermatitis. Routine serologic testing of health care workers who do not perform invasive procedures is discouraged. Sterilization, disinfection, housekeeping, and waste disposal procedures currently in place in health and dental facilities are adequate to protect against infection. In general, recommendations designed to prevent the spread of hepatitis B--a hardier and more infectious virus--will be adequate to prevent workplace transmission of the AIDS virus.
This technical manual is based on the guidelines following the Bucharest Conference to integrate population and demographic factors into development plans. Based on those guidelines the United Nations Economic and Social Council requested the preparation of a technical manual on methods to incorporate demographic factors into the development planning process. Development planning may take a number of different forms: it's scope can be comprehensive or sectoral; geographically it can be national or regional; and with regard to time it can be short, medium or long-term. Organizationally it can be centralized or decentralized and from the point of view of implementation it can be mandatory or indicative. This manual is designed for national comprehensive and sectoral planning over the medium and long term, and should be used by planners in mixed or market economies practicing decentralized indicative planning. The material is useful to planners in socialist countries practicing central planning. The manual is a "how to" publication presenting techniques for plan preparation and application. There are 3 methodological chapters aimed at planners in the development of quantitative national and sectoral plans: (I) A Conceptual Framework for Development Planning; (II) The Cohort Component Method for Making Population Projections; and (III) The Headship Rate Method for Making Household Projections. The materials on the rationale and conceptual issues in integration are aimed at planners coordinating the planning process and responsible for the technical work on the plans. When integrating demographic factors in planning, a distinction should be made between planning that is population-accommodating (takes demographic variables into account to accommodate prospective demographic change) and planning that is population-influencing (uses demographic processes to attain specific development objectives). (Author's modified).
Fertility regulation today and tomorrow.
This volume includes an introduction and 24 papers given in Stockholm at the 1986 symposium, Fertility Regulation Today and Tomorrow. The meeting was organized and co-sponsored by the Karolinska Institute and Serono-Ares Symposia. The symposium is mainly devoted to the medical aspects of fertility regulation methods in both the male and the female. The main emphasis is on new methods currently under clinical testing or on new leads which are being evaluated in phase 1 and phase 2 studies. The program also covers established methods, especially with regard to the longterm effect. The volume is divided into 8 sections: Opening Sessions, Postovulatory Methods I, Postovulatory Methods II, Long-Acting Antifertility Agents, Medical Benefits and Risks of Contraception, Regulation of Male Fertility, Diagnosis and Treatment of Infertility, and Closing Session.
Components of the international research system include political commitment, international cooperation, and financial factors. The author discusses each of these factors. 2 examples show a markedly changed degree of political commitment by government from 2 areas of the developing world, Latin America, and Africa, where family planning activities of the public sector have been clearly lagging behind. First, in October 1984, the Ministers of Health of the Americas unanimously approved a resolution at the World Health Organization Regional Committee meeting recognizing the close relationship of health, development, and population and reaffirming the basic human right of parents to decide freely and in a well-informed and responsible way the number and spacing of their children. Secondly, in May 1986, African parliamentarians from 29 countries and representatives from another 9 countries met in Zimbabwe to discuss population and development issues. They pledged to provide leadership and support to their governments to improve the quality of life of their people by promoting a number of measures, including family planning programs, and national population policies and programs that attempt to decrease the high rates of population growth in Africa. International cooperation in scientific research is undoubtedly a sine qua non for accelerating the development of new contraceptive technologies. Use-effectiveness is 1 of the greatest problems. An important element of international cooperation is close interaction between the leaders of family planning programs to get a better feel for the needs and constraints of both groups. International cooperation is also essential to respond to a new challenge posed by a resurgence of opposition to family planning. Another weak point in international cooperation and which restrains research efforts is the state of the safety requirements of regulatory agencies. Developing countries are confused by the different requirements of the most sophisticated agencies of developed countries and particularly by the wide differences among them as to which products are and are not authorized for use as contraceptives. Worldwide expenditures for research in human reproduction peaked in 1973 at close to $120 million U S dollars. Funding has decreased since then in constant dollar value. It seems quite likely that the reduced support for research in fertility regulation may continue unless special efforts to increase funding are undertaken.
Postcoital contraception: a cover-up story.
Since 1983, there have been few advances made in the search for a postcoital agent suitable for repeated use. The criteria to be fulfilled by such an agent are formidable. The ideal postcoital drug should have the ability to interfere with pre-embryonic development or with implantation, a fairly long duration of action, the capacity to provide full interceptive protection even when taken only once, and a high selectivity of action so that menstrual cyclicity is not disturbed. Such a drug should be safe, cheap, and active in an oral or other easily self-administrable form. Current postcoital methods for emergency use involve either administration of steroid hormones (estrogens or estrogen/progestogen combinations), or insertion of a copper-releasing IUD. No major side effects have been reported following postcoital steroid treatment, except for 1 case of acute pulmonary edema. Side effects include nausea, vomiting, headache, dizziness, breast tenderness, and disturbances of the menstrual cycle. Advantages of the IUD as a postcoital method are its high efficacy and the fact that it can be used up to 5 days after coital exposure (48 hours beyond hormonal methods). Side effects include pain and bleeding, and the risk of pelvic inflammatory disease. Also, if this method failed and the IUD were to remain in place, or if an IUD were inserted into the gravid uterus of a pregnant woman, the woman would be subject to an increased risk of spontaneous abortion and of septic mid-trimester abortion.
Contragestion by antiprogestin RU 486: a novel approach to human fertility control.
The steroidal derivative RU 486 is the 1st potent antiprogestin useful medically. Acting reversibly at the molecular level of receptor binding, RU 486 interrupts progesterone action while allowing endocrine functions to return quickly to normal afterwards. However, target cells dynamics that depend upon a continuity of progesterone action will be irreversibly disrupted. In cycled women, RU 486 acts during the luteal phase in the endometrium, provoking bleeding, and via a decrease in luteinizing hormone resulting in a secondary luteolysis. In pregnant women, it affects mainly the decidualized mucosa, increases myometrial contractility and maturation of the cervix, leading to termination of pregnancy. Luteolysis, brought on by secondary alteration or detachment of the trophoblast, is secondary to the decrease in chorionic gonadotrophin. Clinical studies thus far indicate that RU 486 can be a very efficient and safe contragestive agent, especially for the medical termination of early pregnancy, as a postcoital menses inducer, or menstrual regulator. The failure observed when RU 486 is given alone may be overcome when efficient form(s) of RU 486 are administered and/or when uterotonics are used in combination with the RU 486. A small amount of prostaglandin, which by itself is inefficient, when given at the end of RU 486 treatment, yields highly satisfactory results up to 8 weeks of amenorrhea. The treatment with the antiprogestin RU 486 does not expose women to a hormonal drug continuously, and no significant systemic side-effects have been observed, including those which seemed possible because of the compound's antiglucocorticosteroid activity. Based upon physiological and molecular understanding of RU 486 actions, this antiprogestin may be a 2nd generation agent to achieve a safe and effective control of human fertility. (author's)
After reviewing the literature and their own experiences, the authors draw a number of conclusions about postpartum contraception. They conclude that the inhibitory influence of lactation upon fertility varies between individuals and populations. It is not a reliable method for all women since the risk of pregnancy increases steadily as time elapses since delivery, and more abruptly after the end of amenorrhea or when supplementary feeds are started. Nonhormonal methods have no influence upon lactation. The IUD seems particularly advantages for this period because of its high efficacy, but present models are not suitable for early postpartum insertion. The main problem is related to the timing of their insertion and to the local side effects. Spermicides should be viewed with caution because the drug may be excreted in milk. Combined oral contraceptives should not be used by women who want to breastfeed because of their negative effects on infant growth. Pure progestins administered by the oral or parenteral route do not interfere with lactation, but the passage of an orally active steroid to the milk is a limitation for their use in nursing women. Among methods still in the developmental stage, progesterone administration by other than oral routes inhibits fertility during breastfeeding, presumably with less risk of affecting the infant.
The potential and limitations of epidemiological studies.
Full evaluation of a contraceptive method involves prolonged observation of large numbers of subjects to assess benefits and risks. This requires epidemiological evaluation. Such studies are limited by many considerations with regard to design, conduct, and interpretation. The 2 main epidemiological approaches are the experimental approach in which the subjects are allocated at random to the birth control method under evaluation or to a comparison group, and the observational approach in which subjects who have themselves chosen their contraceptive method are studied. Experimental approaches have major limitations. For example, randomized studies often deal with very highly selected populations. Thus, every participant must give informed consent and none can have contraindications to any of the contraceptive methods included in the trial. In practice, researchers have to depend on observational studies of which there are 2 main kinds--the case-control study and the cohort study. 1 important basic limitation of case-control studies is that they provide a direct estimate only of relative risk, not of absolute risk. Cohort studies are, in general, much easier to understand than case-control studies. Case-control studies are usually quick, cheap, and easy to do. They may be the only way to study rare diseases and each is concerned with only a single disease. Case-control studies often permit study in great depth, are subject to bias in selecting cases and controls, provide an estimate only of relative risk, cannot study variables that may be altered by the disease event, and may present recall and bias problems in measuring exposure. Cohort studies are usually slow, expensive and difficult to do. They are usually only practicable for fairly common diseases. Numbers usually preclude collection of highly detailed information on each subject. Cohort studies enable many different diseases to be studied at once, are generally less subject to bias, and provide information on both relative and absolute risk. With cohort studies, one can study variables altered by the disease event, and problems with recall and bias in measuring exposure are avoided.
The benefits and risks of hormonal contraceptives: an epidemiologist's view.
Epidemiologic studies over the past 25 years have identified several benefits and risks of hormonal contraception. The short and long-term health effects of oral contraceptives, the most widely used hormonal contraceptive, have been studied in detail since their introduction in the early 1960s. Oral contraceptives are currently used by more than 50 million women worldwide. 1 of the reasons for the Pill's popularity is its high effectiveness, with an annual pregnancy rate of less than 1%. Oral contraceptive (OC) use may produce lighter and more regular periods and relief from dysmenorrhea and premenstrual tension. It may substantially reduce menstrual blood loss and protect against iron-deficiency anemia. OCs also protect against severe pelvic inflammatory disease, benign breast disease, and a may result in a reduced risk of developing ovarian and endometrial cancer. However, a number of studies suggest that OCs may increase the risk of lower genital tract chlamydial infection. Other widely proclaimed risks are those associated with circulatory system disease. Thromboembolism, ischemic heart disease, myocardial infarction, cerebrovascular disease, and hypertension continue to be a major cause of Pill-associated morbidity and mortality. OCs may increase cardiovascular disease risks by altering blood coagulation systems, serum cholesterol, blood pressure, or cardiac output. About 4 million women in more than 100 countries currently use the 2 available long-acting injectable contraceptives, depot medroxyprogesterone acetate (DMPA) and norethindrone enanthate. Both have a pregnancy rate of less than 1%. They may cause oligomenorrhea and amenorrhea, which may protect against iron deficiency anemia. Injectables may also decrease the risk of severe acute pelvic infection. They do not appear to reduce the duration or volume of lactation, as combination OCs might. However, menstrual irregularities resulting from injectables may be regarded as disadvantages. They may also be associated with a slightly delayed return of fertility. Compared with users of OCs or IUDs, former users of DMPA require an average of 1-3 months longer to conceive after the contraceptive effect has ceased. Evidence that other high-dose progestins might harm the fetus raised concerns that injectable progestins might cause teratogenic effects if used during pregnancy, though no case reports show excess risk of congenital malformations or prematurity. Remarkably few metabolic changes have been reported in users of injectables. Whether long-acting injectables affect the risks of cancer is a continuing source of controversy that calls for further study.
Chemical vas occlusion in the People's Republic of China.
In various provinces of China, such as Shanxi, Sichuan, Hebei, Shannxi, Hubei, and Heilongjiang, methods of vas occlusion have been investigated since the 1970s. Li's method of percutaneous chemical vas occlusion has been the most successful and Shao Shen-cai's reversible percutaneous vas occlusion seems to be a promising method. This paper reviews the clinical trials of these 2 methods. The author points out that over the last 2 years, there has been an increasing trend in male sterilization in China. With the development of simpler, more effective and safer non-surgical methods of sterilization, the adoption of male contraception would be extended to a wider population. Epidemiological studies of a large number of volunteers of chemical vas occlusion with a mixture of carbolic acid and n-butyl alpha cyanoacrylate in Sichuan Province of China will give a clearer picture of the complications, follow-up of failure cases, and long term safety of the method. The possibility of reanastomosis and recanalization of the vas after chemical occlusion needs to be explored. The reversible percutaneous occlusion method with polyurethane elastomer is still in the early stage of development. Long term follow-up studies are necessary before it could be claimed to be an effective and safe reversible method of male sterilization.
Contraceptive choices: who, what, why.
With reproductive freedom comes opportunities for women to participate in the affairs of family and society that are otherwise closed off to them. The major breakthrough in fertility control came with the development of oral contraceptives in 1960 and modern intrauterine devices shortly thereafter. These discoveries were international, cooperative, scientific achievements in which developing countries' scientists played a major role. Mexico's scientists began bulk steroid synthesis in the 1st steps needed to manufacture both norethynodrel and norethisterone - the 1st 2 synthetic progestins used for contraception. The impetus for research on IUDs came from clinical research reports emanating from Japan and Israel in the late 1950s. It was also in Mexico that continuous, low-dose progestin contraception was 1st demonstrated. Scientists in Bahia, Brazil contributed the 1st publication of the contraceptive effectiveness of the injectable progestin medroxy-progesterone acetate (Depo Provera), and the 1st clinical report of the effectiveness of norethisterone acetate as an injectable contraceptive came from Lima, Peru. The importance of copper in IUDs was discovered 1st in Santiago by a Chilean scientist; the manufacturing knowledge was primarily that of metalurgists in Finland. The 1st clinical studies on the new, long-acting contraceptive implant systems were done by physicians in Chile, Brazil, and India. The rhythm method was 1st described by physicians from Japan and Austria, the 1st birth control procedure to be based on a scientific understanding of the cyclical monthly changes that a woman normally experiences. Vacuum aspiration of the uterus was developed in China. By the early 1960s, Indian surgeons had shifted from conventional laparotomy with general anesthesia to mini-laparotomy with local anesthesia. It was in India, also, that scientists developed the 1st contraceptive vaccine brought to clinical trials. Improving the safety of contraceptive methods remains an issue and should continue to receive high priority. Glimpses of the future show that a 5-year contraceptive implant is now a reality and promises to be the most effective, reversible contraceptive the world has known. A pill for men is being tested in China. Indian scientists are studying contraceptive vaccine to be used by either men or women. A totally new concept for women's fertility regulation is being developed under the leadership of French scientists.
Interregional migration: dynamic theory and comparative analysis.
This book investigates interregional migration in quantitative detail. It includes 16 chapters divided into 1) General Theory, 2) Interregional Migration in Individual Countries, 3) Comparative Studies, and 4) Mathematical Methods. The volume treats 3 main aspects: 1) The development of a dynamic migratory model connecting the microlevel of individual decisions with the macrolevel of the migratory process and making use of the Master Equation method well known in statistical physics; 2) the quantitative description and evaluation of interregional migration in different countries in terms of dynamic regional utilities and mobilities; and 3) the interpretative and quantitative correlation of interregional migration with the socioeconomic situation in these countries.
Concepts of the dynamic migration model.
Migration theory consists of a microlevel and a macrolevel of consideration, and it is decisive to understand how these levels are linked. In this case, the microlevel consists of single individuals moving from an origin to a destination region at certain times, and the macrolevel is defined by a few aggregate variables: regional population numbers and interregional population flows. The authors discuss population configuration and migration matrix, the decision process, and transition probabilities as functions of dynamic utilities and mobilities.
The migratory equations of motion.
The authors derive equations of motion for the dynamics of the population configuration. The description of the dynamics takes place on 2 levels: the stochastic and the quasideterministic level. Only the stochastic or probabilistic level is the fully consistent one for simple reasons. Since the individual decision process is described in probabilistic terms, the evolution on the macrolevel can only be a probabilistic one, too. Therefore, only the fully probabilistic treatment gives the insight into how the decision on the microlevel of individuals induce probabilistic fluctuations on the macrolevel. The mean square deviations on the macrolevel can, however, be very small because of mutual cancellations of fluctuations. The equation describing the full probabilistic evolution including the probability of deviations from the mean path is the master equation. On both the statistical and the quasideterministic level it is simple to generalize the equations so that they include migration as well as birth/death processes. It is shown how birth/death processes can be formally separated off in the mean value equation.
The authors develop the methods for applying the theory of the 1st 2 chapters in the book to concrete migratory systems. This regression analysis consists of 2 parts. In the 1st part, all parameters of the theory which directly relate to the migration process are estimated by comparison with empirical data. The explicit form of the probability transition rates consisting of mobilities and utilities turn out to be functions of the regions involved and of time. The 2nd part provides insights into the dependence of the migratory process on socioeconomic key factors. It is well known that it is difficult to establish a direct and unique causal relationship between the socioeconomic situation and migratory dynamics. Instead, the authors expect that many influences merge with different intensities in producing the migratory behavior. Therefore, they take the degree of the regional and temporal correlation between the socioeconomic variables and the migratory variables as an indirect measure of their relevance in generating or influencing migration.
The author applies a mathematical model to the case of Canada, enabling him to establish some interesting features of interprovincial migration through a proper interpretation of the levels of and changes in the observed values of the model's main indices (global mobility, regional preferences). By contrast, it has been somewhat less successful in identifying the socioeconomic variables that are responsible for these features. It can be conjectured that the latter finding follows less from the unrealistic assumption of homogeneous growth rates (which underlies implementation of the model) than from the lack of consideration of relevant socioeconomic factors which have been found to have a significant effect on Canadian interprovincial migration. It is suggested that the global mobility and regional utility indices estimated earlier in this chapter be fitted to a more complete set of explanatory factors in future runs of the socioeconomic analysis.
Comparative analysis of population evolution models.
The economic causes of population redistribution are essentially captured as functions of a set of determinants. This chapter shows that cost of the economic models of population distribution and migration are based on 3 principles: 1) the effect of the population as a pool of labor upon production and income and the effect of income on demographic behavior, 2) the effect of migration distances between pairs of regions (as a migration cost item) upon migration propensities and thus upon migration flow patterns, and 3) the consequences of regional natural resources or public good capacity endowments for the attractiveness of a region, its effect upon population distribution, and its change by migration. These 3 factors have been observed in this book's model, in particular by the specification and estimation procedures employed in the country studies.
Comparative analysis of interregional migration.
This chapter compares the interregional migration processes within the 6 countries (Federal Republic of Germany, Canada, France, Israel, Italy, Sweden) described earlier in this book. The comparison explores analogies and/or differences in the migratory process between these countries and correspondence or disagreement between the interpretations of the migratory process. This kind of investigation is facilitated by having used the same migratory model, and hence immediately comparable methods of evaluation, in all 6 cases. Some general problems arising in a comparative study of interregional migration are discussed in a qualitative manner. The authors also analyze and compare earlier chapters' quantitative results obtained with the model used in this book.
Derivation of the master equation.
This chapter provides a self-contained derivation of the master equation approach in general, complementary to that given in Part I. Starting from a general comparison of the deterministic and probabilistic evolution of systems, some constitutive concepts of probability theory are introduced. The general master equation is derived from these. The latter can easily be specialized to assume the form appropriate for the migratory system. Finally, the relation between individual and configurational transition probabilities is derived.
Solutions of the master equation.
Weidlich considers the solutions of the general and the migratory master equation. At first he assumes that the probability transition rates do not depend on time. Furthermore, he assumes that the transition rates satisfy the condition of detailed balance. This condition is fulfilled in the case of his migratory model. Whereas the stationary solution has a very complicated form in general, a simple representation can be given to it in the case of detailed balance; the unique stationary solution of the migratory master equation is derived. Its importance derives from the fact that all time dependent solutions of the master equation must finally evolve into the stationary solution. This property is shown by deriving the master equation version of the famous H-Theorem of L. Boltzmann. Finally, the author goes over to time dependent solutions of the master equation. The general method of solution leads to an eigen value problem which in general can only be solved numerically. For the special case of the migratory master equation with probability transition rates linear in the population numbers, he finds an easily interpretable exact time dependent solution of analytical form. This special case also serves for demonstrating the relation between solutions of the master equation and the mean value equations.
Tests of significance in the ranking regression analysis.
It is necessary to introduce statistical tests to quantify how far the estimated trend parameters are able to explain the variation of the empirical migration data. A 1st impression of the quality adjustment is already given by the graphical representation of theoretical versus empirical migration flows as shown in figures in chapter 3. It is obvious that there is a high significance of the estimate trend parameters. In these figures, deviations of single flows may optically lead to a wrong impression of the quality of the estimation. However, the relative frequency of these deviations has to be considered, too. In this chapter, the relative frequency of events is plotted versus the difference between the empirical and theoretical migration rates. Small deviations are more frequent than large ones. Because this behavior is tacitly presumed as a necessary basis for all analyzing procedures, it has to be verified in order to substantiate the functional form of the theoretical transition rates. Comparing the different assumptions for the mobility matrix, it can be seen that the best result is obtained using the most general mobility matrix. The number of parameters is considerably reduced by introducing the reduced matrix. The most unsatisfactory result of this investigation is obtained by using the geographical distance in the deterrence function. In this case, the distribution function of the residuals is not symmetric; this means the deterrence function introduces a bias in the residuals of the migration flows. Therefore, regarding both the number of parameters and the width of the distribution of residuals, the reduced mobility matrix seems to be the most appropriate one.
Ranking regression analysis of the global mobility.
In this regression analysis of the regional utilities, global time trends of the variables are eliminated by normalizing the utilities and the socioeconomic variables. But this procedure cannot be adapted to the analysis of the global mobility. Instead, the authors use a slightly modified procedure which enables them to introduce separate trends in time if necessary. Such separate trends, having no deeper explanatory value of their own, should only be taken into account if there exist no explanatory variables automatically implying the trend of the global mobility. Thus, the authors present a procedure allowing for both pure trend variables and socioeconomic variables implying trends.
A computer program for the estimation of utilities and mobilities.
Munz and Reiner list a computer program written in Fortran 77 for the estimation of the utilities and mobilities. For simplicity, the log-linear estimation procedure is used. A program for the non-linear estimation procedure is obtained from the listed program by substituting the subroutine ESTIMA by a more complicated one for solving the nonlinear equations arising in this case. The program enables one to perform a decomposition of the total mobility matrix to a time-dependent global mobility function and a time-independent deterrence matrix. Statistical tests including the correlation coefficient, the adjusted correlation and Fishers F-value, are computed using the total mobility and the reduced mobility.
This 1986 edition of the ANNUAL REVIEW OF POPULATION LAW was prepared by the Harvard Law School Library under a joint agreement between the UN Population Fund and Harvard University. Laws are listed by subject--general population policy, family planning in general, contraception, sterilization, termination of pregnancy, assisted reproduction, marriage, termination of marriage, rights and duties of spouses within marriage, family support in general, family allowances, parental leaves and benefits, housing, support and protection of children in general, parental and family responsibilities, filiation and adoption, support and protection of women in general, status of women, employment of women, economic and property rights of women, support and protection of the aged in general, immigration and emigration in general, refugees, migrant workers, internal migration, primary health care, health care of women and children, regulation of non-physician medical personnel, free and compulsory education, literacy programs; family, population, and sex education; land tenure and agrarian reform; famine, drought, and desertification; census, and vital registration. Within each subject, laws are listed by country or organization. Laws are then listed by country name or organization subdivided into selected topics. This volume draws from various sources of law: legislation, international resolutions, constitutional provisions, regulations, judicial decisions, legal pronouncements of ministries, departments, government statements, and official documents such as development plans.
Vital statistics of the United States, 1987, volume 2--mortality, part B.
This annual volume of US mortality statistics presents data on total number of deaths, deaths from selected causes, infant deaths, neonatal deaths, fetal deaths, and selected rates and ratios. Tabulations are shown by each state and county, specified urban places, metropolitan and nonmetropolitan counties, population-size groups, and standard metropolitan statistical areas. A separate section on Puerto Rico, the US Virgin Islands, and Guam contains data on the trend of the crude death rate as well as frequency tabulations for most of the characteristics shown in the other sections of volume II.
This 1st volume of the 3-volume set of conference papers includes 32 papers grouped into 9 categories: 1) Patterns of fertility change in Asia, 2) Demography of China, 3) Data collection systems in South Asia, 4) Population growth policies in South-East Asia, 5) Social structure and fertility change, 6) Emerging issues in fertility control, 7) Fertility analysis, 8) The conditions of child survival, and 9) Biomedical and demographic aspects of health. The 2nd volume contains papers in the areas of 1) fertility change in Asia, 2) the demography of China, 3) data collection systems in South Asia, 4) population growth policies in South-East Asia, 5) social structure and fertility change, 6) emerging issues in fertility control, 7) fertility analysis, 8) the conditions of child survival, 9) biomedical and demographic aspects of health, 10) non-traditional approaches to demographic data collection, 11) indirect methods of demographic analysis, 12) international migration systems, 13) mega-cities, 14) changing patterns of migratory flows, 15) population and rural development, 16) population and economic development, and 17) changing family structure. Volume 3 contains papers in the areas of 1) demographic planning, 2) ageing, 3) changing family structures, 4) marriage systems, 5) population policy, 6) demographic trends in developed countries, 7) demographic issues in developed counties, 8) case studies in anthropological demography, 9) peopling the continents, and 10) priority needs in demography. The International Population Conference was held in New Delhi on September 20-27, 1989.
During the past 3 decades there have been important shifts in the marriage formation system in the US. Marriage rates have fallen, age at marriage has increased, premarital sex has become more common, non-marital cohabitation has become a frequent occurrence, and divorce rates have increased. These behavioral changes have been accompanied by value and normative transformation. Most importantly, there has been a substantial weakening of the norms to marry, to stay married, and to refrain from sexual relations outside marriage. However, at the same time, Americans remain positive towards family life, marriage, and parenthood. Since the family is a major determinant of demographic behavior and economic well-being, these changes in marital behavior have important ramifications for many dimensions of American life. Increases in age at marriage and a higher prevalence of divorce have decreased the portion of the life course spent married, which could lead to smaller families and higher ages at childbirth. Both out-of-wedlock childbearing and marital dissolution have increased the prevalence of single-parent families, with their lower levels of economic well-being and physical and mental health. New patterns of marriage, divorce, and remarriage also have implications household composition and geographical mobility. Finally, high levels of divorce in American society may have led to a questioning of the institution of marriage and a decline in people's willingness to invest in marriage as a way of life, which may have contributed to the decline in marriage, the increase in cohabitation, and increased involvement of women with careers, and reduced fertility within marriage. While this paper emphasizes the importance of marriage and divorce trends for several dimensions of American life, the determinants of these other behaviors are numerous, and changing marital behavior is only 1 of their many causes.
Brazil: changes in nuptiality and their fertility implications.
This paper investigates in Brazil 1) recent changes in nuptiality, 2) whether these nuptiality changes have played a role in fertility changes, and 3) long range implications of the current union system. This paper deals with 3 data sources: population censuses, national annual household surveys, and the 1986 Brazilian Demographic Health Survey. Religious-only marriages have declined in popularity, but legal unions are still considered advantageous. Consensual unions are on an upward swing, having grown from 6.5% in 1960 to 11.8% in 1980 of all marriage forms. It may be that reporting of consensual unions has improved due to the liberalization of customs. On the other hand, the recent legalization of divorce and the overall increase in the number of separations from legal marriages--from 1.75 in 1970 to 7.38 in 1980 per 10,000 persons aged 15 and over--might have led people to use consensual unions to test their compatibility before moving on to marriage. The rural-urban distribution of legal and consensual marriages is quite similar. Women in consensual unions are on average less educated than those in legal unions. Women in consensual unions are less likely to use contraception. Fertility levels are similar; the largest difference is .4-.5 children in women aged 20-34. The recent increase in the preference of women for consensual unions seems to be strongest in 2 specific groups within the population: 1) the younger age cohorts (under age 25), and 2) the urban sector. It is likely that the trend toward consensual unions will increase.
The key to economic development.
This paper shows that the coincidences of the demarcations of poverty and prosperity with national borders, and the experiences of migrants crossing these borders, offer insights for both economists and demographers interested in economic development and the alleviation of poverty. The author begins with the idea of diminishing returns of labor. Migration from poor to rich countries greatly increases total income; world income obviously goes up by the difference between the wage the migrant worker receives in the rich country and what he earned in the poor country. Obviously, free immigration across national borders is not now politically feasible. Many believe that the high incomes of the populations in rich countries are due to cultural traits that make the individuals in these cultural groups adept at responding to economic opportunities. Yet migrants from countries where the per capita incomes are only a tiny fraction of US levels earn, even promptly after their arrival, wages that are only about 2/5 less than native workers of comparable demographic characteristics and years of schooling. The conspicuous differences in the rate of economic progress between areas with the same cultural inheritance--such as Hong Kong, Taiwan, and China--show that cultural traits are far from sufficient to explain international differences. Even a casual inspection of population densities tells us that many of the most densely settled countries also have high per capita incomes and that many poor countries are sparsely settled. Many kinds of manufacture and services need not be closely tied to natural resources. The population-to-resources and population-to-capital factors fail to explain the historical as well as the cross-country variation in economic development. If natural resource endowments, exogenous differences in capital stocks, cultural differences in individual responses to economic incentives, and the features of the international system are not sufficient to explain economic development, it would by elimination seem that the institutions and policies of countries would have to be important. The institutions and policies that are required cannot be adequately described in terms of the familiar ideological labels, but the classes of institutions and policies that have been associated with all of the most striking examples of economics development are clear. For most developing countries, improvements in institutions and economic policies can have more impact on per capita income than fertility-repressing policies.
A sequence of events in fertility and family formation?
This paper investigates whether industrialized countries arrived at their current low fertility and nuptiality levels through essentially the same route. Each country has followed the same sequence of demographic events, although from different starting points, at different speeds, and with occasional false starts and reversals. Fertility fell 1st, most notably marital fertility. Marriage rates fell later, but after divorce rates had begun to rise. Cohabiting unions are a recent development in some western countries. The choice of a time-frame is critical to an appreciation of the sequence of events through which each country has passed. 1 link in the long chain of cause and effect is female labor force participation. The proportion of women employed outside the home has been growing since before the turn of the century. Employment outside the home is incompatible with the rearing of large numbers of children within it, and for much of the earlier period fertility was indeed steadily falling. The strong fertility decline was facilitated, but not produced, by the introduction of the pill, particularly in North America and Australasia, but the precise contraceptive strategy differed from country to country. Economic independence and sexual activity free from the fear of pregnancy led to delayed marriage, and probably also contributed to a loss of patience with bad existing marriages. Demographically, this was reflected in falling marriage rates and rising divorce rates. In some countries informal unions seem to have taken over the functions of marriage; in others they are primarily preludes to marriage. Cohabitation is not common in all countries; it is more common where divorce rates are high. An appreciation of non-demographic movements, such as in female labor force participation, helps to clarify the links between behavioral change and normative change.
Contrasts in mortality trends.
People born in the 1980s can expect to survive 73.1 years if they were born in developed countries, but only 57.3 years if they were born in developing countries. Mortality contrasts can also be observed in industrialized countries. Life expectancy at birth is 78.1 years in Japan (1986) but only 69 years in the Soviet Union (1985-1986). The period after World War II was among the most successful in terms of increases in longevity, but these were uneven. Life expectancy increased 15 years in Japan, but only 4 years in the Soviet Union. It is noteworthy how much socioeconomic development and mortality decline are interrelated. The most remarkable mortality decline can be observed in Japan which also made the most spectacular progress in economic development after World War II. On the other hand, the Soviet Union which met unexpected difficulties in socioeconomic development over the last 2 decades or so also experienced increases in mortality which had nothing to do with aging. The increase in life expectancy has been more favorable to females than to males. There is no consensus on the contribution of medicine to the recent decline in mortality. It is thought that medicine is unable to cure most neoplasms and that it cannot reverse the process of chronic degenerative diseases if they have already caused anatomical damage. However, if medicine is considered in a broad sense as also promoting healthful practices, its relevance in decreasing mortality grows substantially.
Although most long-term population projections predict a continuing below-replacement level fertility and a slow improvement of mortality, neither the possibility of a new baby boom nor a further important fertility decline can be ruled out. However, the author believes that without population policy interventions cohort fertility will remain below replacement level and that mortality will continue to improve or remain at the present level. The consequences of these trends will be a decline in the numbers of people and the aging of the population in these societies. Governments may try to moderate these population tendencies due to 1) difficulties in financing pension systems, 2) increased demands for manpower in services, and 3) high levels of immigration pressure from developing countries. 3 types of policies are considered: 1) pronatal policies, 2) allowing adequate immigration, and 3) the growth of women and the elderly in the work force. Pronatal policies are basically 2 types: 1) coercive policies which prohibit abortion and cost very little, and 2) incentives which encourage having more children and are expensive. Pronatal social benefits may not increase fertility very much, but they could possibly raise fertility to replacement level. The author favors a combination of a pronatal policy and a liberal immigration policy. In industrialized countries 3 tendencies can be discerned in labor force trends: 1) the participation of the young declines due to increased education, 2) the participation rates of the elderly decline due to the enlarging of pension plans, and 3) the participation rates of adult women increase in most countries. Increased growth in the participation of women might lead to even lower fertility rates. The author recommends non-coercive pronatal policy measures consisting of social benefits, plus a liberal immigration policy, plus policies aimed at the growth of participation rates of women and the elderly.
Quality of care at the household level: the field worker's perspective.
Analysis of the determinants of the quality of care provided at the household level in rural Bangladesh examined several areas where changes have been and are being made to increase the family welfare assistant's (FWA) ability to give quality care within the existing system in which she works. As seen in Appendix 1, some interventions such as increasing worker density and testing of domiciliary provision of injectable contraceptives involve policy decisions at national level while others are lower-level interventions from the upazila. Most of the changes discussed fall within the 2 major interventions of the worker density study and development of national training materials. Recruiting and training 10,000 new FWA's will eventually have its effect on decreasing the worker-to-population ratio, and FWA's will have smaller target populations to visit. These new FWA's will have field-based training conducted by both upazila officials as well as regular training staff. The manuals being used are based on field experience in rural Bangladesh and emphasize the importance of set standards of practice and promotion of linkages with technical and administrative supervisors. As the FWA continues to be the critical link between rural Bangladesh women and the outside world for health care, maximum use of her routine household visits should be made, after careful assessment of her ability to do all the tasks in her job description. It is recommended that there be clarification of the tasks falling under each duty in the FWA's present job description to guide her in her work as well as examination of the level of effort needed for each duty. The feasibility of the FWA providing a mix of preventive and curative services and education should be determined in a pilot project. (Author's)
Hmong demography: an anthropological case study.
This paper describes features of Hmong culture relevant to demographic behavior, and discusses results from demographic studies of Hmong minority people living in Thailand and Laotian Hmong refugees in the US. The Hmong are a very young, high fertility population with rapid growth and a large household size. The young age structure, early age at marriage, and high population growth rate of the Hmong make it possible for them to adhere to their ideals of extended family households. High fertility is supported by numerous beliefs and customs, such as the need for children of both sexes for household labor, and the desire for sons to support parents in their old age and to carry on family ancestral rituals. Stated ideals of household economy and household composition are consistent with attitudes and behavior about marriage and fertility. There are, however, indications of change related both to perceptions of constraints on land resources in rural areas and to urban (non-farm) economic conditions. The anthropological approach of controlled comparisons has been used in this analysis to identify 3 sub-groups for comparison and has allowed the authors to show major differences in demographic behavior despite negligible differences in such socioeconomic indices as distance to health facilities and low overall degree of female education. Women in the transitional and especially the urban communities want few children, marry later, are more likely to use family planning, and have fewer children. Sex preferences associated with traditional household economy and composition are beginning to change. Some women said that they wanted fewer children than they already