New ferocity marks ancient debate over humanity's relationship to nature.
The great minds of the world are currently engaged in a debate over the environment that will ultimately establish the course of the environmental movement in the future. The ecocentric side of the debate insists that wilderness areas should be fenced off and left alone so that they can manage themselves. The anthrocentric side of the debate claims that there is no area untouched by humans, so we should manage all areas of the globe, including the wilderness. The ecocentricists believe that it is evil to define away wilderness and therefore allow the entire world to be covered in concrete, steel, and toxic waste. The anthrocentricists believe that nature cannot manage itself in a way that is compatible with how we want to live. Forest fires are seen as destructive of valuable resources by the anthrocentricists and part of the food chain by ecocentricists. Radical groups like Earth First view the Earth as an Ark in which all living things should be left alone to function as they normally would. At the Earth Summit the concept of sustainable development will be vigorously debated because the future prosperity of all the developing countries hangs in the balance. These countries do not want environmental restrictions to deny them the things that the developed nations have achieved. Some feel that sustainable development is a fraud because growth cannot be infinite in a finite system like the Earth. Others feel that we should look to the inhabitants of rural areas in order to learn how to live in concert with nature rather than trying to micromanage it from a distance. The Nature Conservancy has started a new program called the Last Great Places in which they will use their own land as core areas and try to recruit their neighbors as volunteers to conduct their business in a way that will not harm the core area.
HIV-1 and HIV-2 in Spain [letter]
Human immunodeficiency virus type 1 (HIV-1) is common in central Africa, but very few cases have been identified in west Africa where HIV-2 is common. HIV-1 and HIV-2 combined infection has been found among drug abusers in Spain. Recently HIV-2 infection was isolated among west African immigrants living in Barcelona. 604 such African and north African immigrants were treated between 1984-July 1991 at the dermatological clinic of a Barcelona general hospital. Serum samples were screened by enzyme linked immunosorbent assay (ELISA), Western blot 1-2, and Pepti-Lav for HIV-1 and HIV-2 infection incidence. All were blacks, most of them from Gambia except for 45 Moroccans. 25 were females, the rest were males aged 16-42 years having lived in Spain for 4 years. Heterosexual intercourse with prostitutes was the source of infection for HIV-1. 43 (7%) were HIV-1 positive, 10 (2.1%) of 462 patients were positive for HIV-2. In 1 case concomitant HIV-1 and HIV-2 infection was detected. The Moroccans had neither of these infections. The rate of infection with HIV-1 increased from zero in 1988 to 10% by 1991. The most likely source of infections was prostitutes in Spain. 5 patients eventually developed AIDS, and 3 of them died. 7 other patients had opportunistic infections and/or AIDS related complex (ARC). No one with the HIV-2 infection had AIDS, but they had minor immunological abnormalities.
An economist's view of natural resource and environmental problems.
A distinction between exhaustible (of geologic origin) and self-renewing resources (biological) has to be made. Exhaustible resources are never totally exhausted but it becomes expensive to extract time. On the other hand, self-renewing resources can be annihilated as the case of the American buffalo amply demonstrates. A theory for the use of exhaustible resources attributed to Harold Hotelling but originally presented by Lewis Gray holds that the market for exhaustible resources will generate a path of gradually increasing prices. However, problems present themselves regarding deferred costs, discounting, the concept of reserves, and future costs depending on the rate of extraction. Most of the critical exhaustible resources are traded on the world market. The problems of self-renewing resources center around the maximum sustainable yield theory on the maximum carrying capacity for a species, as it neglects the costs of harvesting fur-bearing animals or fish, the decrease of the social value of a commodity with increased supplies, and socially optimal sustainable yield. Environmental problems concern terrestrial, aquatic, and atmospheric surroundings. The planning of environmental programs has to tackle the absence of standards, the neglect of distributional effects by cost-benefit analyses (impact on population groups), unpersuasive treatment of monetary effects (protection of health, air quality, noise), neglect of uncertainty (future effects of environmental interventions), inadequate attention to alternatives, superficial treatment of costs (benefits of environmental measures predominate), and false assumption of 100% effectiveness. Implementation problems stemming from the choice of administrative instruments affect both developed and developing countries when controlling global pollution.
Population the key to saving Nepal's disappearing forests.
Nepal's forests are threatened with extinction in the next 20-25 years, according to a new report, as the current population of 19.5 million is growing at an annual rate of 2.6% with total fertility rate of 6.3 children/woman. Population density/unit of agricultural land has increased by about 2 1/2 times over the last 2 generations. IUCN-Nepal and the National Planning Commission commenting on Nepal's National Conservation Strategy stated that hill slopes and poor land on the mountain flanks were being used for cultivation. According to a 1990 World Bank report the availability of agricultural land declined from .6 hectares/persons in 1950 to .24 in 1990. About 40% of the predominantly rural population is living in absolute poverty. The forests of the thin strip of fertile plains along Nepal's southern borders, called the Tarai, are also receding fast. About 1.2 million migrants from the hills moved to the Tarai between 1960-70. At present growth and migration rates the land would have 8 persons/hectare in 20 years, a population density similar to China's. The use of cattle dung (normally reserved for improving soil fertility) for fuel when firewood becomes scarce lowers agricultural productivity. The report suggests that family planning user groups could be formed in the villages to motivate others to practice contraception. Another proposal is to raise the legal age of marriage of girls from the present 16 with parental consent and 18 without parental consent to 20 years. Legalization of abortion is another option. Other suggestions include incentives, such as free education for their children and education of the Nepalese population about the problem.
Manufacturers on the fence regarding PPI revisions.
Oral contraceptive (OC) manufacturers stated that they would comply with the US Food and Drug Administration's (USFDA's) new labeling, as not responding might cause an unwanted delay in the new drug applications. New instructions on how to handle missed pills and what day to start a new cycle package concerns both manufacturers and family planning clinicians. The final version of the instructions was very different from those that Organon Inc. had drafted: the new instructions include 2 options for start days. Several confusing scenarios exist concerning missed pills, dependent upon the day a woman decided to start her package and in which week she missed the pills. A senior research associate at Family Health International in Research Triangle Park, N.C., who helped develop the guidelines, said the manufacturers' suggestions were taken into account and incorporated into a message at then end of the section on missed pills. The vice president for clinical affairs at Ortho Pharmaceuticals in Raritan, N.J., deemed the recommended approach reasonable. However, the new instructions of patient package inserts (PPIs) relating to missed pill scenarios may be too complex for some women because of USFDA's scientific thoroughness. Most individuals involved with the new guidelines believe these instructions can be amended without time-consuming problems as new information on pill use becomes available.
In June 1990, a US cable TV drama, A Private Matter, addressed the emotional pain a woman from Scottsdale, Arizona endured when a newspaper made publish her decision to abort a deformed fetus in 1962. She was a local TV personality who hosted an educational program for children. She had taken her husband's thalidomide pills early in her pregnancy. Later she learned that thalidomide was linked to serious deformities in infants. Her physician suggested she terminate the pregnancy and arranged for an abortion at a Phoenix hospital even though abortion was illegal then in Arizona. Before the procedure, she spoke to a newspaper reporter, who promised anonymity, to inform other women about the drug. A reporter from a competing newspaper looked through court documents allowing the woman to have an abortion to reveal her identity. This act placed her and her family in legal and ethical chaos. This forced her to go to Sweden to abort the fetus which had no legs and only 1 arm. The drama did not center around abortion, but instead addressed privacy, media intrusion, and abortion and drugs. The TV networks believed the story too controversial to air since in 1989 NBC lost US$1 million in advertising revenue from airing the movie Roe vs. Wade. The 1991-92 season of a weekly network drama, Murphy Brown, took a chance and had the unmarried pregnant star struggle with her options yet she did not mention the word abortion. Antiabortion groups argue that TV almost always have women who experience an unplanned or unwanted pregnancy choose abortion. They want the characters to consider that the child deserves to live. A spokes person for the Center for Population Options contends that TV viewers appreciate dramas that deal with difficult issues in a responsible manner. TV networks also shy away from other controversial issues including AIDS, date rate, child abuse, domestic violence, and substance abuse.
IUDs are rigid and heavy thus irritating the endometrium. Their design accounts for many side effects and encourages pelvic infections. IUDs may even facilitate transmission of HIV. Since some health professionals and patients consider some IUDs to be harmful or unacceptable, researchers have worked on developing a newly designed IUD which meets the criteria for and ideal IUD. Some criteria include soft and flexible in nature and inside the uterus, safe, no migration, and light in weight. Taiwanese researchers have developed such an IUD. The silicone skeleton of the Wang SS (soft and safe) Copper 380 and 300 IUDs is bow-shaped with each arm of the bow tapering off from the middle and ending with a small rounded knob. Copper wire (0.31 mm x 380 sq mm or 0.31 mm x 300 sq mm) coils around the holeless vertical stem (3 cm). The monofilament nylon string is fixed in the middle of the stem by an enlarged top. Researchers designed the Wang SS Cu 300 for nulliparous women and the Wang SS Cu 380 for multiparous women. If physicians use a Wang IUD from a sterilized package, they can insert it without wearing sterile gloves. They need to clean the cervix. They must use a single tooth tenaculum to stabilize the uterus and to straighten the uterine axis. After placing the Wang IUD in the inserter, adjusting the flange, and putting the plunger on the inserter, they need to safely introduce the inserter into the uterine cavity to the point where the inserter touches the fundus or the flange touches the cervix. They then must push the plunger to insert the IUD. Insertion should be done immediately after menstruation. Clinicians need to conduct clinical trials to test the safety and effectiveness of the Wang Ss Cu IUDs.
[URBIQUITO: population and environment]
The population of Ecuador has tripled from 3.2 million in 1950 to 9.6 million in 1990 with an average annual rate of growth of 2.7% at which rate it will again double by 2016. The total fertility rate has dropped to 3.8 children/mother in the last 15 years, but this is still above the average of 3.6 in Latin America. Quito's population grew from 335,000 in 1962 to 599,000 in 1974, and to 1,095,000 in 1990. The natural increase was 1.6% in 1985 and migration increased it to 2.4%. At this rate Quito will have 1,676,000 inhabitants in 2000 and 3,535,000 in 2020. Between 1986-89 the urban zones increased by 2959 hectares. In 1986 the area of metropolitan Quito was 19,421 hectares. By 2000 it would increase to 27,295 and by 2020 to 44,693 hectares with serious implications for the soil and the fragile agricultural and forested areas. Forests and wooded areas would decrease from 14,000 in 1989 to 6175 hectares. Between 1970-90 the number of cars increased 5.6-fold. There were 111,000 vehicles in Quito in 1990; the number is expected to increase to 475,070 by 2010. There would be 1,290,131 tons of air pollutants emitted by 2020. Annually about 79,136 tons of garbage is uncollected by municipal services in Quito. The city generates 723 tons of solid waste every day; this would increase to 3182 tons by 2020. In 1989 a total of 111 million cubic meters of water were produced equivalent to 250 liters/person/day, however, accounting records indicated that only 74 million cubic meters were consumed, the rest was lost in the pipelines or via illicit connections. The demand would increase to 246 million cubic meters by 2020 necessitating new sources of water from distant sites unless more economy and lower population growth could be implemented. Some recommendations are offered for action against an impending environmental crisis whose central thrust would be lower population growth.
Bacterial vaginosis associated with G vaginallis / Mobiluncus sp: ultrastructural parameters.
Physicians at the National Institute of Perinatology in Mexico City, Mexico used a Carl-Zeiss EM 10C electron microscope to examine genital secretion samples from 10 pregnant women (15-38 weeks' gestation) who had been diagnosed with Mobiluncus species and Gardnerella vaginalis infections to illustrate the form and structure of bacteria responsible for bacterial vaginosis. They were concerned that these bacteria induce preterm labor and premature rupture of membranes (PL/PROM). These bacteria have been present in the genital tract of 30% of pregnant women with a thick whitish discharge who have attended the Institute's prenatal outpatient clinic. Physicians noted on the microscope slides that bacteria surrounded vaginal squamous epithelial cells (clue cells). Numerous gardnerella-like bacteria surrounded elongated squamous epithelial cells with many plasma projections. An extensive area of lysis existed around the bacteria in the cytoplasm of many squamous epithelial cells with intact membrane and nonexistent microfilaments. This finding indicated that the bacteria invade and destroy the cells. Plasma membrane projections almost completely surrounded the gardnerella-like bacteria in certain areas. Since this study strengthened the theory that G. vaginalis enters the vaginal squamous epithelial cells, researchers should conduct more studies to determine its role in PL/PROM.
Paramedics collected data on 2849 single live infants born between July 1989-June 1990 at the maternal and Child Health Training Institute in Dhaka, Bangladesh to examine effects and the timing of antenatal care on birth weight. Mean birth weight stood at 2667 gm which was considerably lower than the mean for Asia (2900 gm). 26.7% weighed <2500 gm (low birth weight [LBW]). Female infants were more likely to have an LBW than male infants (28.7% vs. 24.6%; p<.05). 83.6% of the LBW infants were full-term infants so they were small for gestational age (SGA). Either fetal or maternal malnutrition was probably responsible for this high proportion of SGA infants. Only 4 of the 128 premature infants weighed =or> 2500 gm. 65.9% of all mothers had antenatal care. 43.4% of the mothers who did not receive antenatal care had an LBW infant compared with 18% for mothers who did receive antenatal care. The mean birth weights for these 2 groups were 2508 gm and 2742 gm, respectively. Birth weight had a positive correlation with the frequency of antenatal care visits (p<.0001). 3 antenatal care visits were quite effective in reducing the proportion of LBW infants. Just 13% of the mothers visited the clinic regularly from the 1st trimester. The timing of the 1st visit did not have a significant effect on birth weight. Antenatal care had a positive effect on birth weight independent of the effect of maternal age. These results showed that motivating pregnant women to seek antenatal care can be productive even if they are in the last trimester of pregnancy. They also indicated a need to improve information, education, and communication efforts. Researchers should conduct a well-designed prospective operational study to determine whether a minimal number of visits are needed to improve birth weight.
Bracing for pollution disaster. Mexico City smog seen eventual death trap.
The serious air pollution problem in Mexico City is described. Attempts to reduce the levels of pollution have been made, but are still insufficient to prevent ecological catastrophe. The worst months of pollution are the dry months of December through February. Combustion at the above sea level altitude which results in incomplete combustion or 66% efficiency contributes considerably to the smog. Schoolchildren must be protected and foreign embassies consider the city a health hazard. The Secretariat for Urban Development and Ecology (SEDUE) is announcing new regulations, which many consider too little, too late. SEDUE promotes frequent auto tune ups and initiates Level 1 alerts when levels are too high. This thermal pollution is in addition to another air quality problem: lead. Mexican gasoline is 700% above the US standard for safety in lead content. Pemex in 1986 switched to a secret mixture of hydrocarbons but without catalytic converters the new fuel caused rising ozone levels. Air analysis revealed the presence of benzene, toluene, and xylene which are known carcinogens. Lead in air levels declined but the levels are still to high by international standards. 4 tons/day are emitted. Infants exposed from birth to lead levels of 10-25 micrograms/deciliter of blood can be expected to show a loss of 5-10 intelligence points. Applied to Mexico City's conditions, this means that the retardation level in the population would rise to 20% compared with the normal distribution of 9%. Other studies suggest that ozone in the atmosphere may be mutagenic. US recommended ozone levels are .12 parts/million (ppm) not to be exceeded more than 1 hour 1 time/day. In Mexico City, the level of .11 or 100 on the Mexico scale is exceeded 300 days/year. 100 times/year a level of 200 is exceeded, but alerts which required industry to cut production 30% have occurred only 4 times. The government measurement is also considered to be inaccurate based on other testing. Respiratory illness has doubled between 1982-86. It is not known how many cardiovascular and respiratory deaths have occurred due to pollution, but the estimate is expected to continue to be high. Even Mexico Olympic long distance runners must train elsewhere because of pulmonary obstruction.
Family planning (FP) and social marketing messages must utilize the rules concerning artfulness developed in the private sector for effective communication in the mass media around the world. They have to compete for the attention of television program viewers accustomed to receiving hundreds of 30-second messages. There are some rules essential to any effective communication program: 1) Command attention. In the US over 1350 different mass media messages vie for attention every single day. FP messages are sensitive, but dullness and passivity is not a requisite. 2) Clarify the message, and keep it simple and direct. Mixed messages equal less effective communication. 3) Communicate a benefit. Consumers do not only buy products, they buy expectations of benefits. 4) Consistency counts. The central message should remain consistent to allow the evaluation of its effectiveness, but execution should vary from time to time and medium to medium. 5) Cater to the heart and the head. Effective communication offers real emotional values. 6) Create trust. Words, graphics, sounds, and casting in the campaign should support 1 central key promise to a single prime prospect. 7) Call for action. Both commercial and social marketing campaigns can calculate results by quantifiable measurement of sales (of condoms) transactions (the number of IUD insertions), floor traffic (clinic visits), attitude shifts, and behavior change. The PRO-PATER Vasectomy Campaign of 1988 in Sao Paulo, Brazil successfully used the above rules for effective communication. During the 1st 2 months of the campaign, phone calls increased by over 300%, new clients by 97%, and actual vasectomies performed by 79%.
Sandiford and colleagues respond [letter]
A reply is offered to Richard Garfield's criticism of the suggestion that improved access to health care was the most likely factor to have reduced child mortality in Nicaragua starting in the mid-1970s. Nicaragua's last period of rapid economic growth ended in 1965, and it is implausible that income growth of the early 1960s was still improving infant mortality 13 or 14 years later. The same is true of transport, communications, electricity, and potable water supplies whose growth and decline was closely related to the ebbs and flows of the gross domestic product. The fall in mortality was as rapid in rural as in urban areas. In contrast to the supply of energy, water, transport, and communications, the supply of government social services including primary health care rose steeply in the 1970s and 1980s. It is difficult to see how the number of medical visits almost tripled between 1978-80 while the number of doctors in the country fell by almost 10%. The assertion that only 1/4 of the population had access to health care by the end of the 1970s did not intimate whether coverage was improving or not. Garfield's own figures revealed that the number of births in health institutions grew by an average of 6.0%/year from 1974 to 1978 but only by 4.2%/year from 1980 to 1986. The explanation for Nicaragua's interesting trend in child mortality is somewhat speculative because of the limitations of available data.
The influence of chemotherapy agents, doxorubicin (adriamycin), cyclophosphamide, procarbazine, and dexamethasone on the activity of sialyltransferase in human semen has been examined. Aliquots of 25 mcL semen were incubated for 2 hours with the above substances at concentrations ranging from 10 to 800 mcg/incubation mixture. The measurement of sialyltransferase activity was based on the incorporation of radioactive sialic acid from CMP (<14) C sialic acid) into asialofetuin. Doxorubicin and cyclophosphamide, at the maximal concentration of 800 mcg/incubation mixture exhibited an inhibiting effect on sialyltransferase activity which accounted for 15.7 +or- 16% and 12.2 +or- 16%, respectively. The rate of inhibition following incubation with maximal doses of dexamethasone (400 mcg) was 25.3 +or- 13%, respectively. The rate of inhibition following incubation with maximal doses of dexamethasone (400 mcg) was 25.3 +or- 12%. Inhibition caused by procarbazine did not exceed 5%. Inhibition of sialyltransferase in human semen by the materials examined in this study can diminish the transfer of sialic acid, thus interfering with normal glycoprotein's and glycolipid's syntheses in semen and possibly also in other fluids and tissues. (author's)
[Alcohol, drugs and sex: a study of adolescent students]
The Netherlands health care service for school age youngsters carried out a study querying a representative sample of 11,431 students aged 12-19 by questionnaire. The frequency of alcohol use, drunkenness, and the use of cannabis was assessed. At ages 11-13 about 80% of girls did not drink alcohol, but by age 18 slightly >20%. For boys the respective figures were a little >60% and <20%. Absence of drunkenness was almost 100% got girls aged 11-13 and close to 90% at age 18 (>90% and <70%, respectively, for boys). At age 18 about 75% of boys and about 90% of girls had not used cannabis. 6% had sexual intercourse at the age of 11-13, 16% at the age of 14-15, 36% at the age of 16-17, and 61% at the age of 18 and over in a sample of 10,732. Alcohol use and sexual experience were strongly correlated. Girls had a lower rate of sexual intercourse than boys, but girls who drank had the same rate and a higher rate than nondrinking boys. Girls and boys who used cannabis also had more sexual experience. Sexual experience and alcohol and cannabis use as well as age, gender, and religious upbringing were examined by the nonlinear variant CANALS method. Age was a significant factor in sexual experience but neither religion nor gender was as important. 48% of girls and 40% of boys had sexual experience when the variables of age and alcohol and cannabis use were combined. Condom use reached 63% in those who drank a little, 44% in those who drank a lot, and 65% among nondrinkers. About 20% of students with sexual experience had used cannabis. Condom use was 40% among never users of cannabis, 33% among ever users of cannabis, and 30% among steady users. 15% of nondrinkers had known their partner for 1 week or less. 1/3 of partners of nondrinkers had sex with another person compared with 1/2 of partners of drinkers. 6.5% of partners of monthly cannabis users injected drugs compared with only .7% of partners of nonusers of cannabis.
Population crisis and desertification in the Sudano-Sahelian region.
People living in the area just south of the Sahara Desert in Africa face their 3rd major drought since 1900. This drought brings about famine. Drought and famine are only manifestations of more profound problems: soil erosion and degradation. They diminish land productivity which aggravates the population's poverty. Yet soil erosion and degradation occur due to an expanding population. Continued pressures on the land and soil degradation results in desertification. The UN Environment Programme's Assessment of the Status and Trend of Desertification shows that between 1978-84 desertification spread. Expanding deserts now endanger 35% of the world's land and 20% of the population. In the thorn bush savanna zone, most people are subsistence farmers or herdsmen and rely on the soils, forests, and rangelands. Even though the mean population density in the Sahel is low, it is overpopulated since people concentrate in areas where water is available. These areas tend to be cities where near or total deforestation has already occurred. Between 1959-84, the population in the Sahel doubled so farmers have extended cultivation into marginal areas which are vulnerable to desertification. The livestock populations have also grown tremendously resulting in overgrazing and deforestation. People must cook their food which involves cutting down trees for fuelwood. Mismanagement of the land is the key cause for desertification, but the growing poor populations have no choice but to eke out an existence on increasingly marginal lands. Long fallow periods would allow the land to regain its fertility, but with the ever-increasing population this is almost impossible. Humans caused desertification. We can improve land use and farming methods to stop it.
Estrogen receptors and the response to sex hormones in angiolymphoid hyperplasia with eosinophilia.
A 28-year old white woman had had angiolymphoid hyperplasia (ALH) with eosinophilia for 1 year. For 6 months, physicians treated her with several injections of 0.5 mg/mL vinblastine sulfate into the tumors which removed most lesions. They also used electrodesiccation curettage and carbon dioxide laser to destroy tumors. Yet new lesions developed and only stopped recurring when she quit taking oral contraceptives. Another 28-year old white woman had had a 2.5 cm ALH with eosinophilia lesion on her forehead which itched and sometimes bled. 5 years later when she was 6 months pregnant she gained 4 new lesions. Physicians decided to withhold treatment until after delivery. 4 months after the delivery the tumors sizes decreased by 1/2. Physicians then excised the 5 shrunken tumors. Histologists examined the 2 women's tumor tissues for estrogen and progesterone receptors. The specimens had 10 and 12 fmol/mg, respectively, of protein while normal skin tissue had no estrogen receptors. The specimens also had considerable progesterone receptors (17 and 9 fmol/mg of protein) while normal skin tissue had 5 and 3 fmol/mg. These results suggested that ALH with eosinophilia tumor nodules probably had hormonal receptors regulated by hyperestrogen states. They could account for the relatively common occurrence or worsening of these tumors in pregnancy. They also suggested the use of antiestrogen drugs to treat ALH with eosinophilia.
In February-March 1990, health workers administered a single dose of the oral cholera CVD 103 HgR vaccine with 5 x 100 million colony forming units (CFU), 5 x 10 million CFU, or 5 x 1 million CFU or of a placebo to 274 5-9 year old children in a village within the catchment area of the Infectious Diseases Hospital in North Jakarta, Indonesia. In September-October 1990, they gave a dose of the same vaccine containing either 5 x 1 billion CFU or 1 x 10 billion CFU from 1 of 2 different batches or a placebo (5 x 100 million inactivated Escherichia coli K 12) to 140 5-9 year old children. 70 children also received an extra dose of buffer. They conducted these trials to examine the safety, immunogenicity, and excretion of this live cholera vaccine. The higher dose genetically engineered oral cholera vaccine (5 x 1 billion CFU) resulted in higher seroconversion rates than the 5 x 100 million CFU vaccine which has >90% seroconversion rates among North American and European children (16% vs. 75-87% for 2 different batches). The centrifuged prepared vaccine resulted in significantly greater geometric mean titers (16-fold rise over baseline) than did the filtered prepared vaccine (10-fold rise over baseline) (p=.001). The extra buffer did not improve immunogenicity of CVD 10 HgR in these children. None of the 124 children who took the 5 x 1 billion or 1 x 10 billion CFU dose excreted the attenuated strain of Vibrio cholerae 01. Thus this recombinant vaccine strain would unlikely enter the environment or b transmitted to others. The frequency of adverse reactions was basically the same for the vaccine and the placebo. These results showed that the Indonesian children tolerated a single 5 x 1 billion dose of CVD 103 HgR well and induced considerable immunogenicity. Future studies using the same dose in 2-4 year old children are planned.
Using the Luker model to explain contraceptive use among adolescents.
The Luker model specifies that failure to contracept might be deliberate. The determinants of contraceptive behavior are the assignment of advantages and disadvantages to contraceptive use and pregnancy. A subjective probability is given to the likelihood of getting pregnant and to reversing any pregnancy that might occur. Successful risk taking leads to a lower probability of pregnancy and thus more risk taking. Stressful life events or interpersonal situations may change the probabilities. The advantage of this model is its proximity to the actual coital event. The goal is to identify factors related to risk taking. Examination of the model involved a sample of 425 sexually active women aged 13-19 years from a multiservice center for youth in New York City in 1981 who visited the agency at least 1 month prior to the interview. The sample was 36% black, 36% white, 24% Hispanic, and 4% Oriental or other. 77% were enrolled in school and 55% were from intact homes. 38% had professionally employed parents and 14% received welfare. Questions were directed to the likelihood of pregnancy and contraception and the advantages and disadvantages, the likelihood of abortion if pregnancy occurred, and background variables (social and psychological characteristics; situational factors at last intercourse; sexual, contraceptive and pregnancy histories; degree of support from partners, peers, parents; ego development; and knowledge of pregnancy risk and contraception). Reliability of each scale was assessed. The results showed that 26% of women at last coitus had taken a pregnancy risk. These risk takers considered birth control as more disadvantageous and pregnancy more advantageous. The probability of pregnancy at last coitus was considered by risk takers to be lower than non-risk takers. Risk and non-risk takers were at the same risk of pregnancy regardless of subjective perception. <50% thought about pregnancy or contraception at last coitus. 48% reported thinking about the good or bad things about getting pregnant, and 38% actually thought about being pregnant. 9 of 43 variables were related to risk taking. The multivariate models revealed that significant variables were knowledge of welfare history, previous risk taking, ego development, and 5 variables from the Luker model. Adding the scale for stressful life events did not affect the results. The Luker model and developmental reasons for pregnancy risk are supported. There was moderate support for Luker's feedback mechanism, but good longitudinal data are necessary for accurate cost accounting. The assumption that motivation to attend a clinic will affect all future coital acts is deceptive.
A closet pro-lifer turns activist.
A nurse on the board of directors of Kansas State Nurses Association experienced a spiritual calling to be an antiabortion advocate during the Operation Rescue demonstrations at abortion clinics in Wichita, Kansas in July 1991. This mother of an adopted daughter who is infertile had attended a christian nursing conference in June. When the demonstrations began, as a closet prolifer, she prayed for God's intervention. An unmarried mother asked her to join the demonstrations against abortion. The nurse said that it was the unwed mother who guided her to Christ instead of her guiding the unwed mother as she had planned. She found justification for her stand in Isaiah 49 where Isaiah extols his calling to God and his development in the womb. She carried a sign proclaiming adoption to be the answer to abortion. She found compassion in her heart for women with unwanted pregnancies seeking abortion and their aborted infants. Since the experience in Wichita, she has continued to pray for women with unwanted pregnancies, physicians and nurses heading up abortion clinics, elected officials, and area churches. She has written letters tot he media and officials expressing her antiabortion views. She has begun volunteering at a crisis pregnancy center counseling women about health care needs, reproduction, and Jesus Christ. She does not see herself as a religious zealot, but as someone who leads others to repentance and obedience to God which, according to her, involves repealing abortion laws. She advocates meeting the medical, physical, emotional, spiritual, and material needs of women with unplanned pregnancies such as nurses befriending such women. She calls for other closet prolifers to become involved by praying and interceding, becoming informed by contracting prolife groups, spreading the word, voting for prolife candidates, and educating local media and elected officials.
In a retrospective case control study of 96 obstetrical patients 48 cases had partial thromboplastin time (TTPA) with kaolin over 4 seconds compared with the test group. The control group of 48 women with normal TTPA were also studied. Age, socioeconomic status, weight, family and personal illness history were included. Habitual abortion,neonatal death, and hypertension were recorded. The average TTPA value was 53.6 +or- 7.87 seconds for the case group vs 38.8 =or- 4.9 for the controls which was not statistically significant. No statistical significance was found regarding age, start of menarche, nutritional and socioeconomic status, and blood group. The body weight of the case group was higher with 58.5 kg =or- 14.4 kg (a range of 43.4-81.4 kg). There were 7 cases of thrombophlebitis (14.5%) in the lower extremities in the case group and none in the controls. There were 7 cases of habitual abortion in the case group defined as 3 or more miscarriages before 20 weeks of gestation vs 2 cases in controls. There were 4 cases of neonatal deaths associated with premature delivery in the case groups and none in controls. Acute hypertensive disease associated with pregnancy totaled to 8 cases in the 1st group (16.6%) and 4 cases in controls (8.3%). In both groups there were 2 cases of fetal death. In the case group there was 1 case of chromosomopathy and in the control group 1 case of premature expulsion of placenta. The TTPAs test is used mostly for the initial phase of studying patients suspected of having lupus anticoagulant (LA). LA belongs to abnormalities characterized by the presence of antiphospholipid antibodies. It is often used for diagnosing initial stages of autoimmunity which can frequently occur in thrombotic process, fetal loss, intrauterine growth retardation, and increased hypertensive illness in pregnancy.
[Excess mortality in an inner-city area: the case of Ciutat Vella in Barcelona]
The historic district of Ciutat Vella, 1 of 10 municipal districts of Barcelona, has an aging population with bad socioeconomic indicators and higher mortality compared with the rest of the city. Crude death rates, and age- sex- and cause-specific mortality data of this district derived from the Barcelona Statistical Bulletin of Deaths were compared with the whole of Barcelona for the period of 1983-87. The causes of death were classified according to the International Classification of Diseases, 9th revision. Perinatal deaths were obtained from the Statistical Bulletin of Births and Abortions. Premature death was measured by the method of potential years of life lost between the ages of 1-70 (YPLL) and the direct method of Comparative Mortality Figure (CMF). There were 8541 deaths in the district (16.9/1000) out of 78,664 in Barcelona (9.2/1000). In Ciutat Vella life expectancy was 73.4 years compared with 77.1 in Barcelona; and infant mortality was 15.6/1000 live births compared with 9 in Barcelona. The principal causes of death in both locations were cerebrovascular diseases and ischemic heart disease in both sexes; malignant tumors of the trachea, bronchi, and lungs in men. In women cirrhosis caused most deaths in the district and malignant breast cancer in Barcelona. Compared with the values of 100 each in Barcelona. In Ciutat Vella The CMF was 129 (95% confidence interval: 126.2-131.8), and the YPLL ratio was 182.1 (95% confidence interval: 173.1-191.8). There were 2 1/2 times more deaths in the district in the age groups 1-4, 25-34 and 35-44. Avoidable deaths amounted to 9.5% in Ciutat Vella compared with 8.2% in Barcelona.
The opinions and a biographical sketch of Wes Jackson, the founder of the Land Institute, are presented. The land Institute near Salina, Kansas is a nonprofit organization devoted to sustainable agriculture. Opinions are provided on the relationship of the Land Institute to sustainable agriculture, the definition of sustainability, the feasibility of replication of his work, his ideas about the destruction wreaked by the plow vs. the sword, technology and population growth, the future farmer, and the speed with which modern science has destroyed the ozone layer. Sustainable agriculture is using the prairie to provide answers to how agriculture can work with nature; the approach will take longer but will sustain both agriculture and people for another 10,000 years. The system runs on sunlight and recycles all materials and is based on the principles of ecosystems, which have been around for hundreds of years. Agricultural technology is based on a fossil fuel intensive infrastructure and is "parachuted into Third World countries." "Corn - the gift of the gods has been the killer of this continent." 50% of the topsoil has been lost, and soil is more important than oil. Advances in biotechnology are seen as the "human cleverness" approach; the preference is for an ecological approach first. Biotechnology tells how to "spin wheels faster," but it also generates more waste. The future farmer is more like the 19th century British naturalist. A projection is that 1st the oil is used up, then the natural gas, and when nuclear power is embraced, Murphy's Law must be repealed. It is important to understand the "we can'ts". Realization of limits will direct energy to the sun's potential and recycling and the flow of energy. Descartes' notion of correctable ignorance must be repudiated. Our knowledge-based world has led to acid rain, global warming, the ozone hole, and Chernobyl. It took just 25 years for chlorofluorocarbons to destroy the ozone layer. A philosophical shift in thinking must occur. It is easier to build roads than to think ecologically. Accounting must be considered i the ecological spreadsheet of species survival. This achievement would be > the Copernican Revolution.
Beyond the Green Revolution: singin' the population blues.
The "green revolution" was desirable because of increased crop yields, but 25 years later after the results of land degradation, groundwater contamination, and environmentally harmful practices were revealed, there is a return to sustainable agriculture. The aim is to minimize agriculture's harmful effects on the environment and to maintain water ad soil resources. Present and future food production depends on suitable land, water, climate, and finances. Unfortunately, the timing is wrong. Population growth is putting pressure on farmers to increase yields. The current conditions are the 11% of the earth's vegetative land surface has diminished productivity due to human activity. There is loss of biodiversity and genetic material. CAttle grazing is inefficient and adds to desertification; animal waste contributes to pollution. Pesticides and fertilizers are the largest US water pollutants. Sustainable agriculture means new tilling methods, reducing pesticide use, and crop rotation. The National Research Council in 1989 reported on alternative agriculture: 1) making the most of natural biological processes; 2) reducing or eliminating pesticides and other chemicals; 3) conserving soil, water, and energy; and 4) matching crops with land to ensure sustainable production levels. Reeducation is needed. Operation SAVE (Sustainable Agriculture that's Voluntary and Economical) produces an annual directory and guide for farmers adopting new methods. Land trusts and conservation easements are being established to preserve farmland. Reclamation of degraded land is being promoted by distribution of tree seedlings to developing countries. Community supported agriculture groups share in the cost of raising crops and receive organic, fresh produce. There are fears about economic feasibility. Conventional farmers argue for pesticide use to increase yields, but a Cornell University study refutes this for organically grown corn. High technology research is not likely to yield a new variety of seed before 2000. Research is needed for poor subsistence farmers. Food distribution is not a problem if everyone is vegetarian. Global warming could also precipitously change climate and affect crops. Population growth will play a significant role in determining the outcome of the world's struggle to feed people and protect the planet.
Breast feeding and weaning practices among urban Muslims of district Lucknow.
Data on 73 Moslem women living in an urban area of District Lucknow, India were analyzed to determine duration and frequency of breast feeding, child spacing, and their beliefs about advantages and disadvantages of breast feeding. Physicians attended 78.9% of the deliveries. Nurse-midwives and trained traditional birth attendants delivered the remaining infants. The woman had a average 5.9 children. All women breast fed their infants from day 1. The mothers were more likely to breast feed sons longer than daughters (24.9 months vs. 21.3 months). Median breast feeding duration was 22.4 months compared with 23.8 months for Moslem women in Bangladesh. It declined with parity except for the 1st child which was 23 months and the 5th child which was 17 months (26.7 months for parity 2, 25.6 for parity 3, 14.8 for parity 4, and 11 for parity 6). Infants <3 months old received more feeds each day than those >3 months old (7.5 vs. 5.3). 50% of mothers who breast fed for 12-17 months had a 2-year birth interval and those who breast fed for >2 years had an interval of about 4 years. While 100% of the noneducated mothers and 72.7% of the educated mothers knew that breast feeding maintains a child's health only 36.3% of educated mothers and none of the noneducated mothers knew that it conferred immunity. Mothers began giving their infants other liquids at a mean of 1.4 months. These liquids were water, diluted milk, toned milk, barley water, and pulse's water. The average age for introduction of solid foods (rice, kheer, porridge, bread, biscuits, boiled eggs, egg yolks, bananas, pudding, curd, and wheat) was 8.2 months.
Epidermal growth factor in human ovarian follicular fluid.
Physicians aspirated 69 samples of preovulatory follicular fluid (FF) from 15 women being treated for infertility with in vitro fertilization/embryo transfer (IVF/ET) and 16 samples of fluid from small follicles of 2 women during elective cesarean section at term at Rigshospitalet in Copenhagen, Denmark to learn the possible physiological role of epidermal growth factor (EGF) in local control of ovarian follicular development and oocyte meiosis. 5 IVF/ET women became pregnant. A strong linear correlation between the mean level of EGF in the FF and in serum existed (p<.001). EGF levels were not associated with levels of progesterone or estradiol in the FF. The mean level of EGF in the preovulatory FF was 1 ng/ml and about 60% of that in serum. Levels of EGF in fluid from follicles that generated oocytes that cleaved in vitro were basically the same as those in fluid from follicles that generated oocytes that did not cleave in vitro, independent of whether or not the woman became pregnant. Results of preovulatory samples signified that EGF probably does not regulate oocyte steroidogenesis or meiosis. EGF levels in FF from small follicles were as high as 20 times greater that those in serum. Indeed these levels differed among follicles. The mean EGF level in follicles <2 mm in diameter was considerably higher than that in follicles 3-4 mm in diameter (p<.05). These findings suggested that high intrafollicular EGF levels may occur in the early stages of follicular development. The constant concentration gradient of EGF in serum and in the preovulatory FF suggested that passive diffusion of the factor from circulation through the theca vessels into follicles with diameters of =or< 4 mm was the source of the growth factor. Local production eventually diminishes as the follicle grows beyond 5-6 mm in diameter. It stops at the preovulatory stage.
20 (18%) of 111 Peruvian men with sexually acquired human immunodeficiency virus (HIV) infection were found to also be infected with human T-lymphotrophic virus type I or II in a retrospective study. At the time of data evaluation, 75 patients had reached Centers for Disease Control stage IV (clinical acquired immunodeficiency syndrome; [AIDS]) and had not received antiviral medication; mortality in this group was 63.3% (38/60) among patients infected with HIV alone and 80% (12/15) in the dually infected group. Of the 50 patients who had died, survival time from onset of stage IV to death was shorter in the dually infected group (5.02 +or- 3.27 months) than in those with HIV infection alone (10.07 +or- 4.42 months). In Peru, sexually acquired HIV infection in men is often accompanied by human T-lymphotrophic virus type I/II infection, and dual retrovirus infection is associated with a shorter survival after onset of clinical AIDS. (author's)
Human spumavirus antibodies in sera from African patients.
Serum samples collected from patients with a wide variety of diseases from African and other countries were tested for antibodies to the human spumaretrovirus (HSRV). A spumaviral env-specific ELISA was used as a screening test. Of the 3020 samples of human sera tested, 106 were found to be positive (3.2%). While the majority of patients' sera from Europe (1581) were negative, 26 were positive (1.6%). Sera from healthy blood donors (609), from patients with multiple sclerosis (48), Graves' disease (45), and chronic fatigue syndrome (41) were negative or showed very low prevalence for spumaviral env antibodies. A higher % of seropositives (6.3%) were found among 1338 African patients from Tanzania, Kenya, and Gabon. Of 1180 patients from Tanzania, 708 suffered from tumors, 75 from AIDS, and 128 had gynecologic problems; 51 of the Tanzanian patients were HSRV seropositive (4.3%). A particularly high % of 16.6% seropositives were identified among nasopharyngeal carcinoma patients (NPC) from Kenya and Tanzania consistent with results reported 10 years ago. However, 20 nasopharyngeal carcinoma patients from Malaysia were HSRV-seronegative. In selected cases, sera from seropositive individuals were reacted with proteins from HSRV-infected cells in vitro. HSRV env- and gag-specific antibodies were specifically detected by these sear in Western blots. The results indicate spumavirus infections in human patients with various diseases at a relatively low prevalence worldwide; in African patients, however, the prevalence of spumavirus infections is markedly higher. (author's)
Idiopathic pulmonary fibrosis (IPF) necessitating therapeutic midtrimester abortion: a case report.
A 35-year old multiparous woman was admitted at 19 weeks' gestation with rapid onset of dyspnoea which progressed to grade 3 in 2 months. She was diagnosed with a case of idiopathic pulmonary fibrosis (IPF). She had a vital capacity of 1.25 1, 46.5% of predicted and PaO2 of 60 mmHg at rest, which dropped to 35 mmHg on mild exercise testing. She did not respond to prednisolone 40 mg daily given orally for 1 month. In view of the lack of improvement, therapeutic abortion was carried out at 24 weeks by abdominal hysterotomy combined with a tubal ligation. subsequent to termination of pregnancy, her clinical status and pulmonary function improved markedly and she had only grade 1 dyspnoea 30 months later without corticosteroids. The effect of pregnancy on interstitial lung disorders, especially IPF, is not yet clear because of the extreme rarity of their association. Therapeutic abortion should be seriously considered in patients who cannot increase their own oxygen consumption 3 times normal without uncorrectable hypoxemia. (author's)
[Spondylo-arthritis in Togolese patients]
A survey was conducted to determine the frequency and semiological characteristics of spondylarthropathies seen during hospital consultation in Lome, Togo. Spondylarthropathy was diagnosed in 13 of 1498 consulting patients. All were male and ranged in age from 18 to 44 at the onset of the disease. 6 patients suffering from ankylosing spondylitis had bilateral sacroiliitis--5 were HIV positive and had no signs of sacroiliitis on pelvic x-rays and the remaining 2 were HIV negative and had no sacroiliitis. HLA typing was not carried out in any patient. The symptoms of ankylosing spondylitis in these patients were comparable to those of European patients. The symptoms of HIV-positive patients were reminiscent of those describing reactive arthritis in such patients. The results of this study contradict the reputed scarcity of ankylosing spondylitis and other spondylarthropathies in black Africa. HIV infection may increase the incidence of reactive arthritis and, as a consequence, that of spondylarthropathies in this region. (author's) (summaries in FRE, ENG)
Perinatal deaths: relevance of Wigglesworth's classification.
Of a total of 4572 births over a 16-month period occurring at St. Philomena's Hospital, Bangalore, India (with level 2 nursery facilities), there were 196 cases of perinatal death. Perinatal mortality was 42.9/1000 total births. The case fatality rate was 12.4% for those born with a birthweight between 1501-2000 g, 35.5% for those between 1001-1500 g, and 100% for those under 1001 g. These deaths were grouped according to Wigglesworth's classification--20% were due to prematurity and 24% to birth asphyxia. These 2 categories contributed to almost 1/2 of the perinatal deaths. Classification of perinatal deaths using this classification appeared to be a practical and problem-oriented system. It also carried clear implications for improving perinatal care. The adoption of this method of classification by all major hospitals is recommended so that easy comparison can be drawn over time and between different centers. (author's modified)
Thailand case studies on sex differences in the utilization of health resources.
Public sector-provided health care in Thailand offers largely provincial health care services. 4 classes of facilities exist, and include midwifery centers, health centers, district hospitals, and provincial hospitals at the village, tambon, district, and province levels, respectively. The present quantity of such facilities, and the quality of services provided therein, are, however, most inadequate. While 100% of provinces, and 75% of tambons are covered by the appropriate facilities, only 54% of districts and 4% of villages are so served. Ministry of Public Health service statistics and population surveys are employed in reviewing patterns of health resource use by sex over the period 1970-79. The determinants and effects of differential resource use are also considered. Examination reveals that 1/2 of the Thai population relies upon lower quality health services, with the urban sector generally using services of comparatively higher quality. Additionally, a higher incidence of morbidity exists among females compares with males in all age groups expect through ages 7-14. Compared with males, females used health facilities to a disproportionately greater extent. Data suggest that males may have a comparatively better self-perception of health needs. In rural populations, long distances to facilities negatively impacts their use, while income, education, and occupation influence differential service use patterns according to sex. Incorporating additional variables, never-married, middle-aged, rural females of low socioeconomic status suffer a higher incidence of illness, and call upon facilities on a comparatively more frequent basis. Access to, and utilization of health facilities are determinants of health status. Health status, in turn, affects survivorship.
Mexican agencies reach teenagers.
The Gente Joven project of the Mexican Foundation for Family Planning (MEXFAM) trains young volunteers in 19 cities to spread messages about sexually transmitted diseases and population growth to their peers. They also distribute condoms and spermicides. It also uses films and materials to spread its messages. The project would like to influence young men's behavior, but the Latin image of machismo poses a big challenge. It would like to become more responsible toward pregnancy prevention. About 50% of adolescents have sexual intercourse, but few use contraceptives resulting in a high adolescent pregnancy rate. Many of these pregnant teenagers choose not to marry. Adolescent pregnancy leads to girls leaving school, few marketable skills, and rearing children alone. Besides women who began childbearing as a teenager have 1.5 times more children than other women. Male involvement in pregnancy prevention should improve these statistics. As late as 1973, the Health Code banned promotion and sales of contraceptives, but by 1992 about 50% of women of reproductive age use contraceptives. The Center for the Orientation of Adolescents has organized 8 Young Men's Clubs in Mexico City to involve male teenagers more in family planning and to develop self-confidence. It uses a holistic approach to their development through discussions with their peers. A MEXFAM study shows that young men are not close with their fathers who tend to exude a machismo attitude, thus the young men do not have a role model for responsible sexual behavior. MEXFAM's work is cut out for them, however, since the same study indicates that 50% of the young men believe it is fine to have >1 girlfriend and 33% think women should earn more than men. A teenager volunteer reports, however, that more boys have been coming to him for contraception and information than girls in 1992 while in other years girls outnumbered the boys.
Management of empyema thoracis at Lusaka, Zambia.
Surgeons managed the care of 39 patients with empyema thoracis at the University Teaching Hospital in Lusaka, Zambia between April 1989-March 1990. 33 patients were males. 26 (23 males and 3 females) tested seropositive for HIV and had AIDS. 19 patients (17 male and 2 females) had tuberculosis (TB) of the lungs. Only 2 did not test positive for HIV. The leading complaints of the 39 patients were cough (30), chest pain (29), and generalized lymphadenopathy (28). HIV positive patients stayed in the hospital longer than HIV negative patients (60 days vs. 5 days). Most patients with empyema thoracis (30) were between 16-40 years old, as were AIDS patients (22) and TB patients (19). 2 of the 4 0-5 year old patients with empyema thoracis suffered from AIDS. The leading surgical procedure for the patients with empyema thoracis was intercostal drainage (12). All 12 patients who underwent rib resection were those who suffered from AIDS. Rib resection was required because these patients presented to the hospital late at which time the aspirate had already become thick. The surgeons were able to aspirate the accumulated pus quite easily in 8 of the 9 patients with AIDS who underwent only intercostal drainage. 8 AIDS patients experienced dried up sinuses at 8 weeks. A home care team managed the rib resection patients at home which resulted in a shorter mean duration at the hospital than for intercostal drainage (8 days vs. 0 days). None of the AIDS patients died from the procedure. Yet 3 AIDS patients died within 2 weeks of entry into the hospital. 5 other AIDS patients died within 6 months of their 1st admission. All HIV negative patients recovered satisfactorily. Home care minimized the burden on hospital resources.
Very hot and really crowded: quasi-experimental investigations of Indian "tempos".
In February, April, and May 1991, researchers compared the effects of 3 temperature levels and 3 levels of density (crowding) on attitude and behavior of 250 passengers in 3-wheeled motorized rickshaws (tempos) in Allahbad in Uttar Pradesh, India, Crowding had the strongest effect of all the variables (number of people in the tempo, p<.001; month of the study, p<.05; and the interaction of number of people and month, p<.05). The passengers tended to rate the weather better and the temperature cooler in February than in April and better in April than in May. The passengers were more likely to perceive crowding when the tempo had 9 passengers compared with 8 passengers and feel better with 4 persons in the tempos. They also felt more crowded in April and May than in February. Month (temperature) had fewer significant main effects than did crowding. When temperatures were higher, 1st passengers were more likely to perceive more yelling when 9 passengers were in the tempos than when there were 8 or 4 persons (p<.001). Yet this variable may not be sensitive since some yelling is considered socially acceptable and extreme yelling rarely occurs. Interactions occurred only with perceived crowding and general affect. In July 1991, researcher assistants rode on the tempos and informed 80 passengers of a study examining how people feel on public transportation. They either said nothing else about the study or described the effects of crowding and of heat. At the end of the route, different men interviewed the passengers. Like the results of the 1st study, passengers felt more crowded with 7 other passengers than with 3 other passengers (p<.001). The effect of heat was not as strong, however. Providing information about heat yielded the passengers much more control than withholding the information (p<.05). Yet information about crowding did not yield more control and indeed added stress.
About 1 year ago, 1 of my patients who was taking norethindrone 2 mg. with mestranol 0.1 mg. (Ortho-Novum, 2 mg.), on a cyclical basis as a contraceptive, complained of vague malaise and indigestion. Nothing unusual was detected on physical examination and there was no bilirubinemia. In view of the well-recorded occurrence of jaundice and liver derangement in association with ingestion of these drugs, I ordered a cephalin-cholesterol flocculation (CCF) test, which was reported as 4 plus in 24 hours. The test was repeated twice, with the same result. The serum bilirubin value was normal: total 0.6 mg.%; 1 minute, 0.2 mg.%. Serum albumin was 6.38 g.%, alpha-1 globulin 0.19, alpha-2 globulin 0.56, beta globulin 0.84, gamma globulin 1.13. Jaundice did not develop and the patient's symptoms cleared up rapidly without treatment. Her antiovulatory medication was discontinued, and I inserted an IUD. She remains symptom-free, but her CCF has not yet reverted to normal. During the past few weeks I have, in addition to my usual regimen of 6-monthly weight and blood pressure determinations, yearly pelvic examination and biennial Papanicolaou tests, requested CCF tests for my women patients who are receiving oral contraceptive agents. As of this date, I have had this test performed on a further 11 patients. 4 showed a negative reaction. 7 showed a positive reaction, varying from 1 to 4 plus in 24 hours. I feel sure that these figures, albeit small, are of significance, although I do not presume to say what it is. In view of the absence of other evidence of liver derangement, I no longer discontinue the drug--but I confess to some qualms in view of the persistence of this abnormal finding. I would be grateful for any practical advice in the management of this problem. (full text) (4 references cited in original document)
Values-based sexuality education: confronting extremists to get the message across.
The teenage pregnancy rate remains high and more and more people are becoming infected with sexually transmitted diseases (STDs) and AIDS. Educators try to effectively communicate values based messages on sexual health, sexuality, and safer sex. Yet reactionaries who tend to attribute widespread moral decadence to sexuality educators are often in positions of power at the state and national levels. They do not realize that at the most only 10% of US children are exposed to anything close to sex education. Most sex education is limited to anatomy and sexual abstinence. Youth need to know about anatomy and that sexual abstinence is preferable but they also need to know how to prevent pregnancy and protect themselves from STDs and AIDS. Sexuality educators are not taking advantage of the fact that most people in the US and Canada (80-86%) approve of sexuality education in the schools including contraception information. Sex education program task forces often try to appease the small number of extremists which results in an effective and potentially harmful program. The 1st step of such a task force should be to outline operational guidelines about closure of debate and the recognition that unanimity is not required or not necessarily always wanted. Sex educators need to communicate that they too favor moral and ethically based sex education. They also need to convey that youth armed with knowledge about sex tend to delay 1st intercourse and to use contraceptives. Sex educators must morally commit to democratic ideals and allow reflection on controversial issues such as abortion. They need to reflect on why they have not been able to move beyond this moralistic position of the extremists and identify strategies to convey safer sex messages. This article has several sidebars with messages to adolescents touching on love, sexuality, self-esteem, and contraception.
Tolley's model: some more time series of actual and predicted urban growth.
This is an expansion of a previous paper by the author on migration to urban areas. "In [that] paper, George S. Tolley's supply-driven two-sector urban growth model for a closed economy...was used to predict migration and urban growth rates for the U.S." In this article, the author presents 12 more cases from around the world, with a focus on time series information, "for each of which Tolley model predictions of the urban growth rate are compared with the actuals, for time periods that are as long as 150 years." (EXCERPT)
Trends in firearm and non-firearm homicide rates in U.S. urban areas are analyzed for the period 1979-1989 using data from the Compressed Mortality File maintained by the National Center for Health Statistics (NCHS). "Large urbanization differentials in firearm homicide and smaller differentials in nonfirearm homicide are identified. Firearm homicide rates are highest and increasing the fastest among black teenage males in the core, fringe, and medium metropolitan strata." (EXCERPT)
Mortality among female manual workers.
"The aim of this study was to see if a cohort of female manual workers, defined by their own occupation, had higher mortality than other women....The study population comprised 18,878 women who contributed to a pension fund for unskilled manual workers in Reykjavik [Iceland] any time during the period 1970-1986." The authors found that "mortality is high among some groups of female manual workers. A deficit was found among those with the longest employment....An excess of suicides shows that women in this group have, for some reason, less will to live than other women." (EXCERPT)
"Bread and a pennyworth of treacle": excess female mortality in England in the 1840s.
The author analyzes excess female mortality in nineteenth-century England. She concludes that such mortality was affected by the economic environment and that "much literary evidence points to unequal access to food and a resulting susceptibility to epidemic and respiratory diseases as the transmission mechanism converting dependence and discrimination into relatively high death rates." Women were also adversely affected by harsh labor conditions, in addition to the heavy duties involved in motherhood and housework. (EXCERPT)
[Migration and socioeconomic changes in the community of Zoogocho, Oaxaca]
"This study of migration and the socioeconomic dynamics of the community of Zoogocho in the state of Oaxaca [Mexico] is an example of what happens in rural areas when Indian-campesinos establish contacts with foreign parts. The penetration of alien socioeconomic and cultural values alters both family and communal structures to such an extent that available resources prove insufficient in competing with the colliding external society. This leads to increasingly more complex movements of the population, the manifestations, causes and consequences of which vary through time not only in the places of origin but also in destinations." (SUMMARY IN ENG) (EXCERPT)
Underurbanisation and the zero urban growth hypothesis: diverted migration in Albania.
The author challenges the hypothesis "that the mode of production accounts for the specific forms of urbanisation under socialism and the slow urban growth observed...[and emphasizes instead] the effects of planning in the traditionally organised command economy." It is suggested that strict migration policy is a pivotal factor in achieving zero urban growth. "A case study focusing on patterns of diverted migration and the growth of non-urban settlements on the outskirts of the Albanian capital, Tirana, illustrates how the proposed explanations may help to re-interpret the particulars of urbanisation under orthodox socialist rule." (EXCERPT)
Factors differentiating elderly residential movers and nonmovers: a longitudinal analysis.
"This paper identifies factors which differentiate elderly residential movers and nonmovers. Longitudinal data were used in the analysis. Logistic regression results showed that length of residency, home ownership, use of community support services, and number of adult children each had an effect on relocation. Respondents who reported longer lengths of residency and those who owned a home were less likely to relocate. Those elders who utilized more community support services were also less likely to move. Conversely, elders with greater numbers of adult children were more likely to relocate. There was not a significant effect of health status on relocation....The data set used in this project is the 1984-86 [U.S.] National Health Interview Survey: Longitudinal Study of Aging (LSOA)." (EXCERPT)
"In this study we examine a portion of the inter-metropolitan periphery with explicit attention to the impact of a large, nonmetropolitan center on a changing spatial structure. In particular, we consider the ways in which three familiar concepts, spread-and-backwash, the population turnaround, and corridor effects have expressed themselves in a portion of the inter-metropolitan periphery....The complex interactions between these aspects of metropolitan structure and growth are viewed primarily from the vantage point of a single large nonmetropolitan city (NMC), Portsmouth, Ohio. The focus is on the period between 1960 and 1980....This study suggests that the emphasis on randomized samples of county-level data dispersed over large areas may have obscured a complex, rural-area pattern that is evolving around corridors and hierarchical sets of nonmetropolitan cities of different sizes." (EXCERPT)
[The impact of migration on ethno-national structure]
Trends in ethnic assimilation and migration in the former Soviet Union are analyzed for the period 1959-1989 using census data. Differences in the rate of growth of different ethnic groups are first outlined. The focus is on the process of assimilation into an ethnic group of individuals of mixed backgrounds. The author notes that there has been a trend toward greater dissemination among certain groups, primarily those from Eastern Europe, while at the same time a trend toward greater concentration among others, such as those from Central Asia. The increasing significance of refugee movements is noted. Probable future developments among ethnic groups in the region are reviewed.
Friends in life and death: the British and Irish Quakers in the demographic transition, 1650-1900.
The technique of family reconstitution is used to analyze social, demographic, and familial changes among some 8,000 Quaker families in Great Britain and Ireland over the period 1650-1900. The authors "show how Quaker religious values delayed marriage, and the evidence suggests that in the seventeenth century English Quakers practiced family limitation, although their Irish counterparts, by contrast, became one of the most fertile of all demographic groupings. Severe urban mortality was the fate of many urban Quakers prior to 1750, but sanitary improvements seem to have reduced this, and from 1825 onwards the Quakers were in the vanguard of the move toward the small, modern family." (EXCERPT)
[Employment and urban growth; an application of Czamanski's model to the Mexican case]
The author applies the 1964 model developed by Stanislaw Czamanski, based on theories of urban growth and industrial localization, to the analysis of urban growth in Mexico. "The advantages of this model in its application as a support instrument in the process of urban planning when the information available is incomplete are...discussed...." Census data for 44 cities in Mexico are used. (SUMMARY IN ENG) (EXCERPT)
A health plan for the Banana Control Board, Belize, South Stann Creek, Belize, September 5-11, 1987.
The South Stann Creek area of Belize is experiencing rapid growth in many private industrial sectors. For banana operations alone, acreage is expected to increase 250% over the next 5 years, and associated population will surge from 6155 in 1987, to a total of more than 15,000 in 1991. Given this industrial and worker growth, and current dearth of accessible health services, assessment has been made of the level and nature of health service demand in the banana-growing area, projected cost, and available financing and provision options open to area banana growers. Most growth in service demand will take place between 1989 and 1990. Clinics will therefore be deluged with demand over a relatively short period. commitment should be made to significantly expand both facilities and staff over the next 2 years. To minimize clinic revenue sensitivity, the report suggests developing an areawide multiemployer, prepaid health system by 1989. While recurrent costs may be met internally, start-up capital infusion will be required from outside sources. Potential public and private financing strategies are discussed, as is the future role of the US Agency for International Development in meeting mother-child health equipment needs and providing technical assistance for financial information systems and planning. Given the necessary start-up capital and recurrent cost tracking and revenue maximization, a self-sustaining health system therefore seems technically and financially feasible for the workers and poor population of the South Stann Creek area.
[Some reflections on the study of demographic situations ("conjunctural demography")]
The term conjuncture has developed quite recently in demography and refers to the evolution of a population's status and dynamics over the course of a short and recent period. The related term "conjunctural measure" has not yet been included in the Multilingual Demographic Dictionary. Conjunctural measures are indices intended to suggest the future results of maintaining current population trends. The development of conjunctural demography, which appears to fill a reasonable need, has occurred so recently in part because the study of mortality dominated the discipline of demography for so long. Conjunctural demography requires information on fertility as well as mortality. The net reproduction rate was greatly used between the 2 world wars as an easily calculated synthetic index; it was used as a conjunctural measure under the assumption that current fertility and mortality rates would remain unchanged. The Royal Commission on Population criticized the net reproduction rate as somewhat unrealistic and gave greater importance to cohort analysis, which had previously been neglected. Conjunctural indices of nuptiality obtained by adding indices for cohorts sometimes give rates of 1st marriage for men or women that exceed unity and are thus impossible. Cross-sectional nuptiality rates that are impossible longitudinally occur during periods of rapid decline in the age at 1st marriage. Minor variations in the age distribution of 1st marriages cause nonnegligible variations in the cross-sectional sum of nuptiality rates of single persons. The variations persist significantly longer than those in the age distributions of 1st marriage. Despite their inherent shortcoming of sensitivity to changes in age distribution, conjunctural measures have the advantage of providing simple and rapid information to governments and the public, and of drawing attention to the longterm implications of population dynamics.
[An aid to analysis. Isoquotients: Nuptiality]
The sum of age-specific rates is a commonly used indicator of fertility, but the use of the corresponding measure for studying 1st marriages is controversial. In longitudinal analysis, indicators based on the sum of age-specific 1st marriage rates and the hazards of marriage yield similar results, but in cross sectional analysis the 2 types of measures may be very different, especially in times of changing age structures at marriage. In cases of declining age at marriage, the sum of age-specific rates may exceed unity, which makes this indicator unacceptable for analysts who regard the rate as an index for a fictitious cohort. Each index has advantages and disadvantages. Period analysis can only refer to the year in question while attempting to show how past changes have influenced events in that year. Attempts to project future cohort behavior would require combining information from both methods. But the sum of age-specific rates requires only information on the age and sex structure, while indices based on the hazards of marriage require information on marital status and on the age, year of birth, and marital status for mortality and migration as well. The greater simplicity of the sum of age-specific rates makes this the more commonly used indicator. This work suggests a method for making use of the relationship between rates and hazards to estimate the probability of marriage without having to calculate both rates and hazards. Rates are calculated on the basis of the entire population regardless of marital status, whereas hazards are calculated on the basis of single persons only. Rates and hazards are linked through the proportion of persons who are unmarried. The 3 elements in a nuptiality table can be represented on a 3-dimensional diagram in which the y-axis shows the total marriage rate, the x-axis shows the proportion of persons already married, and the z-axis shows the probability of marriage. The probability of marriage could be estimated from a knowledge of the marriage rate at age X in a cohort and the cumulated total of marriage rates to age X-1 in the same cohort, as long as mortality and migration have not differentially affected the married and single populations within each cohort. An illustration of the technique using French data from 1968 to 1988 yielded satisfactory results. The error for ages before 30 years when marriage rates are highest was almost always <5% and did not introduce any significant bias.
[HIV infection and tuberculosis]
In recognition of the relationship between HIV infection and tuberculosis (TB), the US Centers for disease control in 1987 added extrapulmonary of disseminated infection with Mycobacterium tuberculosis to its revised diagnostic criteria for AIDS. Different types of evidence support the association of TB and HIV infection. Immunosuppressive disorders in general are known to be associated with heightened risk of TB. The greatest increases in TB cases have occurred in areas with large numbers of AIDS cases. The demographic groups involved tend to be identical for both diseases. The great number of TB cases in patients with advanced HIV in another indicator. In areas with a high incidence of HIV, persons diagnosed with TB have a high prevalence of HIV infection, and the prevalence rates are increasing. The great majority of seropositive TB patients develop AIDS within 6 months before or after diagnosis of TB. The strongest association between HIV infection and TB occurs in iv drug users. The combination of HIV and TB is 7 or 8 times more prevalent in men than in women. Most cases of TB relate to HIV infection represent reactivation of latent infections. Because of the greater virulence of M. tuberculosis than of the causative agents of other common opportunistic infections, TB in seropositive individuals usually precedes other defining infections by between 1 month and 2 years. Extrapulmonary and disseminated forms are more common in seropositive than seronegative TB patients. Seropositive patients in early stages of HIV infection are more likely to develop pulmonary forms of TB. Pulmonary TB in seropositive patients most frequently has a typical characteristics. Extrapulmonary forms occur in 40-75% of HIV patients, often with concomitant pulmonary infection. Lymphatic involvement and hematogenous dissemination are common in these patients. Extrapulmonary localizations in seropositive patients have been described at practically all levels of the organism. TB symptoms in HIV patients are similar to those in other patients, and include fever, nocturnal sweats, weight loss, anorexia, and asthenia. Signs and symptoms specific to the site of extrapulmonary disease may also occur. Symptoms may be difficult to distinguish from those of other opportunistic infections. A thoracic radiography and a tuberculin test should accompany the history and physical examination of suspected HIV patients. Thoracic radiography is often atypical, but may be normal in cases of extrathoracic TB or even pulmonary cases. TB management is different in patients seropositive for HIV. Prompt treatment and identification of contact are important if the upward trend in TB cases is to be stopped. Seropositive patients usually respond well to the standard drugs, but side effects may be more severe.
Underreaction to AIDS in Sub-Saharan Africa.
Sub-Saharan Africa claims 9% of the world's population, yet 55% of all who are infected with HIV. This disproportionate prevalence of HIV infection exists despite AIDS being only in the early stages in the region. Much death will result form the ensuing epidemic, and AIDS will be recorded as the major health crisis of our time. High short-term mortality is unavoidable, although longterm effects my be buffered by vaccines, behavioral change, and the potential waning of the epidemic over time. Commoners and leaders alike, however, deny the risk of AIDS, are defensive and skeptical, and fail to discuss AIDS and HIV outside of elite circles. In turn, this lack of fear, discussion, and acknowledgement that AIDS is a real threat allows governments to move more slowly than necessary to contain the regional epidemic. These populations are not convinced that biomedical determinism is the only operative force with AIDS. Most believe that the biomedical onslaught of AIDS and other diseases is triggered by other forces, and that these forces are especially evil in the case of AIDS. Accordingly, people shun discussion of the topic. Further supporting general silence over AIDS, and the subsequent lack of governmental action are a broad belief in destiny, weak health systems, the need for comprehensive social change, and expectations of a cure. Governments are afraid of inciting crisis, feel that their efforts would be futile against the epidemic, and accuse the West and international organizations of singling out Africa. All of these factors result in government inaction, when instead programs should be expanded, with more technical and financial assistance sought from donor nations.
Experimental research on sexual networking in the Ekiti district of Nigeria.
Exploring the potential for spread of the AIDS epidemic to Nigeria, this paper considers sexual networking in the Ekiti district, the northernmost part of Ondo state, in which no cases of AIDS have been reported. The district is highly urbanized with towns of 30,000-150,000, and many large villages of 5000 and more inhabitants. A total of 400 persons were interviewed in a large town and a rural village. 100 males aged 17-50 and 100 females aged 15-45 were interviewed in each locale. Extensive premarital and extramarital sexual activity is deeply rooted in traditional culture, and is supported largely by women's long period of postpartum abstinence and the high social value placed on conceiving and bearing children. Traditional society allows young, unmarried men to enjoy premarital sex, just as married men are permitted to have sex with others while their wives abstain after childbirth. Before the availability of commercial sex, these men often had discrete relations with other married women in the community. The degree of networking has increased, with the society enjoying greater sexual freedom and commercial sex. Constraints against free sex do, however, include religion, the fear of venereal disease, and the fear of pregnancy. The fear of AIDS also exists, yet to a lesser extent than these other concerns. As the proportion of polygynous marriages decline and the period of postpartum sexual abstinence shortens, the authors caution to not expect a decline in the degree of sexual networking. 2 possible reasons exist for the comparative dearth of AIDS in western Africa: 1) sexual activity is more diffused within the population, with sexual networking less a factor of relations between many men and few women and 2) the predominance of circumcision among Yoruba and other western African males may also play a role in preventing HIV transmission within the region.
Hypnocontraception effectivity tested.
The potential for contraception by hypnosis was investigated in 23 women selected by hypnosis susceptibility testing from a pool of 86 volunteers. The women were 21-38 years old, 11 single, 12 married, ranging in parity from 0-4. Most were interested in hypno-contraception because they feared the side effects of other methods. Subjects were given the Stanford scale and several other tests of hypnotic susceptibility, and referred to 1 of 3 hypnotists. They were treated with 2 sessions, and those selected received 8 more sessions in which they were instructed that they would become temporarily sterile for 6 months. Women were also informed that they could become sterile for a longer period. 14 became pregnant in the 1st 12 months of the study. 9 did not conceive during hypnosis treatment of 1 to 22 months duration. The study was closed sooner than planned because of the poor results. This method of contraception was suggested by Italian researchers who claimed hypnosis was 99% effective. They did not publish any information about how effectiveness was measured, or methods of follow-up.
In 1956, public health specialists implemented a family planning program serving several villages in the Khanna region of the Punjab in India to reduce fertility; to observe birth and death rates in the villages; and to study the determinants of these rates. Program staff made a census of each visit every year (1956-72) and visited each household with a married woman of reproductive age every month. Death and birth rates were high. Death rates were highest among the lower castes. Death rates were especially high in the spring and summer. Infants most likely to die were 1st born infants, those of high parity, and those whose mothers had short birth intervals. Women of all castes had about 7 children. Malnutrition was common. Families preferred male children to female children. The findings identified 5 key means to reduce illness and death among <5-year old children: 1) All pregnant women should be immunized against tetanus and all infants against measles and pertussis. 2) Health workers need to identify malnourished children and clusters of children, and they must educate mothers about the importance of breast feeding for 2 years and supplementing breast milk with solid, home-prepared foods at 3-4 months. 3) Health workers must identify diarrhea and pneumonia cases. They then must encourage caretakers to rehydrate, maintain feeding, and identify and remove or change the fecal source for diarrhea cases. Health workers must use penicillin to treat pneumonia. 4) They should identify mothers who had a deceased child or children and gather information about each case. Specifically they need to determine the age, cause of death, and clustering to develop preventive strategies. 5) They must find clusters and causes of poverty. They should then help the poor to develop income-generation activities and to promote good nutrition and rehydration of children and mothers.
The function of the hormone-binding domain of the human progesterone receptor was examined in a yeast cell system and in mammalian HeLa cells using mutant receptors, progesterone, the progesterone agonist R502, and the antagonists RU-486, Org31806, and Org31376. The hormone-binding domain, located on the carboxy terminal of the peptide, is known to initiate a conformational change in the receptor upon binding an agonist or antagonist, then shedding of associated proteins including the heat shock protein, dimerization of the receptor, and finally, binding to DNA, leading to transcription. Binding of a progesterone antagonist such as RU-486 elicits all these events except transcription. First the progesterone receptor was inserted in yeast with a plasmid, and a set of mutants were generated, using beta galactosidase as an indicator. A mutant progesterone receptor, U-P1, was selected for mechanistic studies, that binds and was activated by antagonists, but was inactive with progesterone. This receptor had a deletion at base 2636, resulting in a shift of reading frame so that a stop codon 36 nucleotides downstream caused truncation of 54 amino acids at the C-terminus and addition of 12 novel amino acids. Western blot analysis confirmed the expected molecular weight. The mutant receptor was active with RU-486, suggesting that the C-terminus may be responsible for poor transcription with RU-486, suggesting in normal receptors. 2 other truncated mutants were inactive with progesterone. These data suggested that the terminal 42 amino acids of the progesterone receptor are needed to bind progesterone, and that the antagonist is contacting different amino acids than the native receptor, possibly inducing a different conformational change. The activity of the UP-1 mutant was also confirmed in HeLa cells, with the chloramphenicol acetyltransferase reporter system. The results were interpreted to mean that progesterone agonists and antagonists contact at least some different amino acids in the hormone binding domain of the receptor, and that the conformational changes resulting from binding these agents are different. It appears that the C-terminus of the receptor contains an inhibitory domain which, when removed, turns antagonists into agonists.
17 species from 6 genera of the Crassulaceae family of Mexican plants were tested for sperm agglutination, killing, and immobilizing activity. These plants, which grow in the valley of Mexico and surrounding areas, have long been used as a vaginal postcoital douche. The genera tested were Aeonium, Crassula, Echeveria, Kalanchoe, Pachyphytum, and Sedum. The plants were harvested in the flowering phase, which varied over the season for species. Aqueous crude extracts were prepared by grinding 260 gm fresh leaves, filtering through gauze, centrifuging at 3000 rpm for 15 minutes, lyophilizing, and dialyzing against 2 changes of deionized water. The final extracts were reconstituted 1 mg/ml in Keyhani and Storey medium. Motility, viability, and agglutination of washed human sperm were estimated. All 17 species exhibited immobilizing, agglutinating, and sperm killing activity. Aqueous extracts and infusions of several other plants from 5 other families were also tested without effect on sperm. Preliminary work suggests that the active agent is a micromolecule rather than a macromolecular protein.
Transmission of HIV through blood transfusion.
HIV transmission in transfused blood is a high risk in Nigeria. Although official government policy directs that all blood be screened for HIV, and that all blood donation should be voluntary, there is no legal enforcement of quality of the blood supply, and at least 85% of blood is estimated to be sold by professional donors. About 75% of blood banks are based in hospitals, mostly in major cities and teaching centers. The rest of the blood banks are unregulated small commercial operations without quality control or standard refrigerators. In small health facilities it is usual to infuse 1 unit at a time, suggesting that indications for transfusion are not emergencies, but rather anemias that could be corrected with nutritional replacement. These blood units are usually donated on request by families, but more often by professional donors managed by agents. People have misconceptions about the hazards of donating blood, such as the fear that donation will bewitch, poison them, or turn them into criminals, or that it is immoral. Blood donors who may be HIV positive are rarely traceable for counseling, since they often change their names and addresses. The Nigerian government is now deliberating in committee about forming a National Blood Transfusion Service, though the efforts of the Nigerian Society of Haematology and Blood Transfusion.
Population growth and water scarcity will likely cause water crises, international disputes, and wars in the Middle East, especially in the Jordan River, the Nile River, and the Tigris-Euphrates basins. Water instead of oil is becoming the dominant resource of the Middle East. The main problem for all 3 basins is that downstream countries rely on the water form better endowed upstream countries, but the upstream countries (Ethiopia from the Blue Nile, Syria from the Yarmuk, and Turkey from the upper Tigris-Euphrates) plan to divert water for irrigation to increase agricultural production. The water situation in the Jordan basin is the most severe. Almost 25% of water resources in Israel exist in the aquifer it shares with the West Bank. Water scarcity in the West Bank may inhibit the creation of an independent Palestinian state. Very rapid population growth in all the countries affects the finite water resources. Syria wants to divert up to 40% of the flow of the Yarmuk River it shares with Jordan which threatens Jordan's future water supply. This may result in increased salinity in the lower Yarmuk and the lower Jordan rivers. Iraq has agreed to transfer water from the Euphrates to Jordan. Ethiopia plans to divert water from the Blue Nile to irrigate 120,000 hectares. Sudan intends to divert water from the Nile river through a pipeline to support Saudi Arabia. The S.E. Anatolia Project in Turkey reduces water inflow into Syria and Iraq. Upstream pollution in Turkey only adds to the water problems, especially in Iraq. Desalination, various techniques based on solar energy, and the feasibility of irrigating with seawater after growing halophytes do allow some optimism, however. Turkey has proposed a peace pipeline which would divert water form 2 rivers feeding the Mediterranean to Jordan, Saudi Arabia, Syria, and the Gulf states.
Household registration type and compliance with the one child policy in China, 1979-1988.
Researchers analyzed 1988 data on 8020 Han women living in Hebei Province, China to examine how government control as reflected in household registration type affected compliance with the government's 1-child policy. Despite many incentives and negative sanctions for unauthorized 2nd births, just 22.1% of all women accepted the 1-child certificate. Ever use of contraception rate after the 1st birth stood at only 47.8% yet the law required all women to control fertility. 65.9% had another pregnancy. The abortion rate for these women was 26.4%. Thus almost 50% gave birth again of which 89.1% were not authorized by the government. 86.8% of the women had a type I household registration indicating that they could either keep or sell agricultural products after they sell some to the government but it did not guarantee them food, cash income, medical services, or old age pension. The remaining women had a type II registration indicating the government guaranteed them what it would not guarantee type I women. It exercised control to type II women via career promotion opportunities, maternity leave, housing, and children's education. Household registration type had the greatest independent effect on compliance with the 1-child policy (p<.05). Type II women were 7.2 times and 10.8 times more likely to accept the certificate and have an abortion, respectively. Household registration effects were less significant for contraceptive use and subsequent pregnancy. Modernization forces promoting fertility were weakest in the rural Xiang areas. Other significant factors influencing compliance with the 1-child policy included the socioeconomic variables of urbanization and education and the cultural variables of son preference and parental coresidence (p<.05). These results indicated that culture had a stronger influence on family size than did the government in rural areas. The government would probably allow couples to have 2 children in the future as it did for rural couples with only a daughter in 1989.
Environmental and project displacement of population in India. Part I: Development and deracination.
Official development projects in India have displaced at least 20 million persons since Indian independence in 1947, and the majority have not been relocated in planned resettlement. India is in a race to implement development projects needed to support the growth of its population, which increased from 361 million in 1951 to 840 million in 1990. Through the 1960s and 1970s about 1/4 of these oustees were minimally resettled and the rest had to find their own way to get reestablished. There is no international consensus on the rights of internally displaced persons, but most countries compensate people. Agricultural labor and construction labor are the most common types of work of the landless oustees. 1,589 large dams built since independence ousted the largest number of people. Dams, reservoirs, and canals displaced 11,000,000 people; 2,750,000 were rehabilitated and 8,250,000 found their own way. Mines displaced 1,700,000; 450,000 were rehabilitated and 1,250,000 found their own way. Industries displaced 1,000,000; 300,000 were rehabilitated and 700,000 found their own way. Parks and sanctuaries displaced 600,000; 150,000 were rehabilitated and 450,000 relocated on their own. Other projects displacing people are forest preserves, wildlife sanctuaries, military installations, weapons testing grounds, nuclear installations, and railroads and roads. The World Bank requires compensation for people displaced by 12 dam projects it is funding in India: the underestimated count is 610,500 persons. The Pong Dam, a 130 m high gravel dam, under the western Himalayas ousted 30,330 families, about 167,000 people, but only 16,001 families were found eligible for compensation. The Subarnarekha Project in southern Bihar is displacing 10,000 families, about 55,000 people. The state government estimates that 35% of these will not settle in suggested relocation sites because land is not available.
Husband-wife communication and the decision for male or female sterilization.
Sociologists analyzed 1984 data on 313 couples who sought surgical sterilization at the Brooke Army Hospital in San Antonio, Texas or the Walter Reed Army, Malcolm Grow Air Force, or Bethesda Naval Hospitals in the Washington, D.C. area to examine the relationship between perceptions of marital communication of both spouses and the kind of sterilization chosen. Among all wives, wife's perception of marital communication was positively related to the couple choosing vasectomy (p<.01-.05). A wife's perception of marital communication influenced this proclivity depending on whether she had or had not participated in the labor force since the birth of her last child (p<.01). The association between perception of good marital communication and labor force participation was cumulative and positive (correlation coefficient=.527; p<.05). On the other hand, the relationship between perception of poor marital communication and labor force participation was negative (CC=-.041; p<.01). Thus these women took control and underwent surgical sterilization themselves. Perception of good marital communication for nonworking wives was positive toward the couple choosing vasectomy only when the husband's perception was also good. This suggested that males needed social support to make a decision about having a vasectomy. It also indicated the mutual dependence of spouses. The sociologists recommended further research to understand the important role wife's labor force participation may have in influencing the balance and texture of marital power.
A new series of luteinizing hormone-releasing hormone (LH-RH) antagonists containing L-azetidine-2,2-carboxylic acid has been synthesized and tested for safety and initial trails in laboratory animals. L-azetidine-2-carboxylic acid is the lower homolog of proline, and derivatives of LH-RH containing it have not previously been reported. These new drugs have been designed to improve potency, solubility in aqueous media, and safety in terms of local histamine release. Antide has the substitutions D-2-Nal(1), NicLys(5), D-NicLys(6), Leu(7). Antide has N-nicotinoyl-D-lysine at position 6 and N-isopropyl-lysine at position 8 instead of the basic arginines, which in combination with a cluster of hydrophobic aromatic amino acids at the N-terminus, are thought to elicit histamine release. Antide had 36% antiovulatory activity at 0.5 mcg, an ED50 for histamine release of >300 mcg/ml, and a wheal area in square mm/10 mcg of 132.7. 3 of 21 other analogs of Antide also showed significant antiovulatory activity at 0.125 mcg, and 13 others had some antiovulatory activity at 0.250 mcg.
HIV seroprevalence surveys in Uruguay [letter]
In August-September 1991, the National AIDS Prevention and Control Program (NAPCP) of Uruguay conducted cross sectional survey of several population groups to determine the magnitude of the HIV/AIDS epidemic. This study served to gather baseline data. Laboratory personnel used the ELISA test to screen 13,121 blood samples from adult workers, patients at 2 sexually transmitted disease (STD) clinics, pregnant women, newborns, and blood donors from 7 centers in either Montevideo, Artigas, or Salto for HIV and confirmed all positive results with the Western blot test. NAPCP did unlinked anonymous testing for only the adult workers. None of the pregnant women, blood donors, or people attending the STD clinic in Artigas tested positive for HIV. On the other hand, the people attending the STD clinic in Montevideo had the highest HIV seroprevalence rate (1.26%). 71% of all females attending as STD clinic were prostitutes, but none was HIV positive. Yet 9.2% of the males attending an STD clinic who claimed to be prostitutes did test positive for HIV. Only 1 of the 10 (10%) people attending an STD clinic who were not prostitutes but took part either in homosexual or bisexual activity tested HIV positive. Only 1 of the 132 (0.7%) people who indeed had an STD tested positive for HIV. NAPCP had designed the 7 clinics as sentinel surveillance sites. It planned to study these same groups each year. The existing health infrastructures absorbed the cost for determining these groups' HIV seropositivity status. PAHO provided US$10,000. Low cost surveys such as this survey allow public health officials to monitor the epidemic and plan relevant prevention strategies.
Turning trash into cash: a Cairo tradition takes a new tack.
Manchiet Nasser is the workplace of more than 10,000 Zabbaleen or garbage collectors, who collect an sort the household garbage of Cairo. Manchiet Nasser and 6 other settlements are part of one of the oldest and most extensive recycling operations in the world. This traditional system relies on donkey carts and thousands of small entrepreneurs who buy used materials. The Zabbaleen include 2 distinct groups. In the 1930s landless farmers, mainly Coptic Christians form Upper Egypt, began assisting the Wahis in garbage collection. The Wahis still administer the system, while the Zarrabs (or pig breeders) do most of the physical labor. The Zabbaleen have remained physically and socially on the fringes of society. In the early 1980s with over 10 million inhabitants, growing by 1000 more each day, Cairo's garbage was rapidly overtaxing the system. The Environmental Protection Company (EPC) includes representatives from both the Wahi and Zarrab communities. the EPC won a bid to mechanize part of Cairo's household garbage collection service. Their 20 trucks now cover 2 residential areas where 40 donkey carts once operated. The city also offered contracts to other private sanitation companies, which were given free access to city landfills for dumping. Up to 500 factories in Cairo alone use recycled polymers, which are about 1/2 as expensive. Full integration of the Zabbaleen into the municipal sanitation system will still take another 3-5 years. Improvements also began in Manchiet Nasser in the early 1980s as part of a large, urban upgrading program financed by a World Bank loan. With assistance from the Ford Foundation, Oxfam, and a number of Christian charities, schools and health clinics have opened, and hundreds of workshops are processing waste in Manchiet Nasser. Other Zabbaleen communities have requested similar assistance.
A G1-specific spermatogonial chalone.
What is known about spermatogonial chalones in rats and mice, and by implication whether they may have a future as male contraceptives, is discussed. Chalones are putative factors that inhibit, or control, cell division. By definition, they are naturally occurring, produced in and active in specific tissue or cell lines, and are not species specific. There are 2 chalones in spermatogonia, acting in cell phases G1 and G2, based on research in rats and mice. The G1 chalone is heat labile, precipitable with ethanol, tissue specific, not species specific, and less than 5000 molecular weight. Rats less than 40 days old have demonstrable receptors for the G1 spermatogonial chalone. Using testicular extracts as a source of the chalone, the authors presented evidence that intracellular cyclic AMP may mediate its effects on inhibition of mitosis. Their work supports the idea that chalones maintain cAMP levels, thus inhibiting nucleoside kinase activity needed for DNA synthesis. Initial studies with antisera raised against testicular extract suggested that chalone activity could be neutralized, but the active site was not affected. Experiments on mice involving longterm injections of testicular extracts have not resulted in any effect on spermatogonial proliferation. Thus there is not yet any indication that these factors will provide a lead for a new type of male contraception.
The distribution and increase of population has relevance for public health, medicine, social sciences, psychology, economy, technology, environmental sciences, agriculture, and food production. The multidisciplinary problems of population processes including mortality,fertility, and mobility are studied at the University of Sao Paulo at the Faculty of Hygiene and Public Health, the Department of Applied Statistics, and the Department of Sociology. Rapid population growth has a negative effect on economic development and leads to urban congestion and migration to major cities causing regional disparities. The establishment of a center of multidisciplinary research and education in population dynamics and health attached to the University of Sao Paulo has been proposed to facilitate regional planning and the disposal of financial resources, and to create employment via dissemination of research results with government and nongovernment administrators. In Brazil population growth is attributable to the decline of mortality while fertility has stayed high. The planned center requires trained personnel, structure, and administration; multidirectional cooperation with the University, with Latin American and inter-American institutes in addition to Brazilian organizations; research funding; and specialists in demography, biometrics, statistics, biomedics, and human reproduction. Research projects, curriculum, intensive programs lasting 1-2 years, courses for candidates from other disciplines to concentrate on population matters, and special short courses would be offered.
"Hu's line" still holds effective for China.
The population distribution data of the 1990 census showed no significant change in the geographic distribution of population in China since 1933. In 1935 a population geographer drew up China's 1st population map based on 1933 population figures of 458 million. A demarcation line called Hu's Line, which is still valid today, indicated regional distribution of population from Aihui (now Heihe City in the northeast Heilongjiang Province) to Tengchong (in the southwest Yunnan Province). The territory to the east of the line accounted for 36% of the total national area while the territory to the west of the line represented 64%. The population in the territory to the east of the line accounted for 96% while those living on the west only for 4% of the people. In 1990 China, had 1.16 billion people (including Taiwan, Hong Kong, Macao), with 94.2% in the east and 5.8% in the west. There was only a 1.8% change in the proportions after 56 years caused by migration to the west from 1949 to 1982 and a higher total fertility rate in the west. From 1933 the formerly densely populated areas become even denser by 1990. In the Yangtze River Delta and Qiantang River Plain population density increased form 500 persons/sq km in 1933 to 750 in 1990; in the Huang (River) Huai (River) Hai (River) Big Plain, it increased from 300 to 700 and in the deltas of the China's southeast coastal areas, from 400 to 700. Eastern China consists of plains and hilly land which account for 25.2% of the country's territory and 79.1% of population. But the immense 1.49 million sq km of desert, gobi, and desertified land (15.6% of the territory) in the west is still uninhabited as in 1933. The rural population still comprises 73.77% of the total. The East possesses 82% of the national railways, 85% of highways, and 99% of navigable rivers. 16 of 17 megacities with more than 2 million population are located in the East.
Using quantitative and qualitative 1982-89 data from 1164 women in rural Mali, this study investigates how community services effect behavioral change in infant and child care. It estimates the effect of individual, family, and community factors on survival duration for children born over the period. Individually, higher risk of early death was found among those born to mothers having experienced prior perinatal infant death, those born during the drought of 1983-85, and those born into prevailing periods of short birth interval. Among mothers, those providing the best protection had gone to primary school or had recently migrated. These positive effects were, however, offset by both relative affluence an polygamy. Of especially significant import is the finding that the physical structures of maternities and clinics have no effect on the risk of death; visiting midwife health care services reduce the risk of death. Village solidarity and political organization also have positive effects to a nonsignificant extent. Children in isolated villages were found to have greater risk of early death, while no effect on survival duration was evidenced by other village structures including food sufficiency, economic development level, and diversity. Seasonal water shortages raise the risk o death at the community level, and point to the need for public sanitation. Further implications of these findings are discussed.
Cox's proportional hazard model is used to analyze retrospective data collected by Harpending and Pennington in Botswana from 1985 to 1987 on duration of birth interval. Independent variables are marital history of women, survival status of children and year of death, marital status of grandparents, and survivorship of the grandmother. The population consisted of the Herero of the Ngamiland district in Botswana, and was measured at 2 intervals: before and after fertility recovery. The age structure of this population and the age pattern of fertility between 1909 and 1987 is discussed. In contrast to prior findings on pathological sterility and maternal mortality, the transition from high to low fertility is attributed to the presence or absence of the young woman's mother; a supportive maternal household favors high fertility. The hypothesis is that the presence of mothers as a source of child rearing contributes to a shorter duration of birth interval for daughters, and an increase in fertility. The social organization of the Herero household is described as a 2-stage structure: the corporate group or male household and the female household. The age and sex structure shows high fertility after 1970, birth surges for birth years 1930s, 1950s, and 1960s, a population decline between 1916 and 1926, and a surplus of female children between 1966 and 1976. Births before 1960, from 1960 to 1974, and from 1975 to 1988 are examined. Births before 1960 show a pattern which is a result of sterility. Sociocultural factors affecting fertility are the separation of roles between the male and female head, and fosterage. Regression results indicate that the 1.3 increase in duration of birth interval is attributed to the hazard for a grandmother dead. The increase is 1.43 at parity 2 and 1.38 at parity 3. At parities >3, the results are insignificant. Also, women have shorter birth intervals when their mother is not married (meaning economically independent and in full control of the household). Grandmother's survival status had a stronger effect when mother's age was controlled for. Grandmother dead had zero variance for women >35 years at parity 1 and 2, and for women <35 years at parity 5 only.
Training needs assessment and performance analysis of the Ugandan Health Inspectorate staff.
The objectives of the 1991 study of training needs in the Ugandan health inspectorate (HI) were as follows: 1) to assess the training and support needs, 2) to determine the pattern and frequency of contact between the community and health staff, 3) to determine community awareness of and contact with staff, 4) to determine the community's understanding of the roles and responsibilities of the HI staff, and 5) to assess the effectiveness in informing the community about latrines, water protection, personal hygiene, solid waste, and diarrheal disease case management. 30 household surveys per parish in Kamuli, Kasese, Masaka, and Masindi districts in the easter, central, western, and southwestern regions were conducted; structured interviews were also conducted among 4 District and 8 County Health Inspectors, 3 Health Inspectors, and 46 Health Assistants. The results of the assessment of the Diarrheal Disease Control (CDD) training program suggest that CDD training was effects. There were high levels of self-assurance and reported activity. Basic knowledge was good among HI staff. The community was aware of HI activity is making presentations on diarrhea treatment or prevention. Knowledge of community members was improved through HI teaching about home diarrheal management, i.e., higher rates of improved mixing (55% vs. 45%) and greater knowledge of the germ theory of transmission (77% vs. 66%). However, improvements were possible in recommending extra fluids and oral rehydration solution (ORS), in the mixing of ORS, hand-washing, and community coverage by HI staff. Health education during illness visits was poor. HI-delivered health education was more effective. Time allocation needs to be considered before expansion of teaching schedules. The greatest obstacles were in logistics: transportation (lack of vehicles or gas), lack of personal support (schools or access to health care), and finances (low salaries or late payments). Supervision was good. The health staff felt comfortable with its knowledge of diarrhea management, water source protection, latrine construction, and health education, but weak in meat inspection, malaria and communicable disease control, vector control, and community mobilization. Recommendations were to train local leaders, provide uniforms and more educational materials, HI in-service training, and increasing supplies and equipment.
Evaluation of the NEWVERN software component of the Family Planning Logistics Management II Project.
Contraceptive logistics management for the US Agency for International Development (USAID) is handled by John Snow, Inc. (JSI). Management involves forecasting and estimating contraceptive need, contracting with manufacturers for production, processing orders from USAID missions and cooperating agencies (CA), tracking funding sources and expenditures, and warehousing and shipping contraceptives to programs throughout the world. JSI took over the operation in 1987, and automated it over the period 1987-88, under multiuser software known as NEWVERN. JSI developed NEWVERN both responsibly and cost-effectively. In 1991, USAID awarded $58 million in contracts, buying condoms for $0.05/unit, and 1-month cycles of oral contraceptives for $0.15. In that year, NEWVERN kept track of 520 mission and CA orders for over 1 billion contraceptive units, and tracked 424 payment vouchers. To improve the present system, USAID's Commodities and Program Support Division approval process should be automated, USAID should manage the operation more closely, NEWVERN should be tested for completeness and accuracy, the version release schedule should be followed, management reporting should be improved, NEWVERN should be made more user-friendly, financial accountability should be increased, and more system technical documentation should be provided to USAID. In-depth discussion of the operation is included.
Environmental negotiations in the Ok Tedi Mine in Papua New Guinea.
This paper discusses the reconciliation of differences between investors and government over the environmental impact of the OK Tedi mine established in 1984 in Papua New Guinea. The successful negotiation allowed conflicting attitudes and interests to be resolved outside of costly legal proceedings, and suggest the potential application to similar projects in other developing nations (less developed countries [LDC]) where environmental regulation is of concern. The paper describes the legal and institutional framework, the OK Tedi project, offers a technical description, discusses the relationship of environment to other negotiating issues, and ponders the contractual understandings and implementation of environmental negotiations. Without suggesting whether the OK Tedi experience may be generalized to apply elsewhere, the paper lists lessons learned and considers some imperatives of environmental relations, the LDC environmental knowledge base, equity credit, and the role of government in such issues and projects.
Religious beliefs and environmental protection: the Malshegu sacred grove in northern Ghana.
The case study of the Malshegu practices in forest protection in northern Ghana serves to support policy recommendations for decentralization and local protection of ecosystems. Forest protection is reflected 1) in a strong religious belief that the grove is the home of the local god, 2) in the reinforcement of the belief (the "Kpalevorgu" god fetish) when there is knowledge of degradation of other adjacent sacred groves, and 3) in regulations from past centuries for using and protecting the groves. These core elements of effective management are described in terms of operational definitions. The terrain and degradation in Ghana is described. In 1985, 20-30% of closed forest remain and several of the 7 forest types are either not included in protected areas or are not well represented. Serious degradation remains outside of protected areas. The Malshegu community has for 300 years protected a 1 hectare sacred grove by restricting human interferences, limiting the use of forest products, and protecting against natural disasters and other events such as annual bush fires. A site visit in 1989 revealed the profile of the Malshegu sacred grove: its location and ecology, land use changes, traditional religion and effective environmental protection and history, traditional religion and effective environmental protection and practice, and limitations and adaptations. The implications are that there are important connections between religious systems and natural resource management. In this case the groves are small in size, but large in number. Other communities may have larger tracts, or have other gods which protect coastal waters and fishing or animal habitats. The Ghana government understands the importance of these religious practices and has established strategies and laws for promoting cultural traditions that protect the environment: the 1948 National Forestry Policy and revision in 1989-90, the Volta Dam relocation of and libations and sacrifices for sacred fetishes and groves and shrines, and the 1988 National Environmental Action Plan. Recommendations are for legal government support for locally managed natural areas and meeting local needs for forest resources, which may involve village based training in forest management, more efficient means of forest use, and environmental training.
Policies for maximizing nature tourism's ecological and economic benefits.
Sustainable development has been enhanced in some cases by nature tourism. Nature tourism can provide the funds and incentives for conservation efforts with appropriate management. This paper after defining nature tourism and its contributions looks at policies that have economic and ecological benefits. Topics are identified as 1) the consequences of open access to natural attractions, 2) revenue increases through a levy, 3) revenue increases from indirect expenditures, 4) reduction of revenue loss through leakage, 5) efficiency increases through decentralization and public-private partnerships, 6) protection of revenue for sustainable development, 7) the importance of education, and 8) the need for planning. The troubles of nature tourism are over use and over exploitation, low return on investment, and diversion of funds away from sustainable development. Many areas of ecological interest are inaccessible or incapable of enduring the byproduct of tourism development. The pitfalls during the tourism cycle are delineated as tourist site selection which relies on existing facilities and attracts more tourists and overloads facilities; facilities are tailored to tourists and are promoted with foreign financing and visitors declines. Popularity is undependable. Maintaining limits to visitation through quotas or prices with cooperative management can help to avoid overuse. Entrance fees need to be increased regardless, and products must not be given away. Nature tourists may be hard core, dedicated, mainstream, or casual. Nature tourism includes both cultural and adventure tourism as well as nature parks and protected areas. The emphasis is on visiting nature parks. Tourism in 1988 totaled $55 billion for developing countries of which nature tourism ranges from $2 to $12 billion. The financial impact on countries varies. Kenya, Rwanda, Costa Rica, Ecuador, and Nepal earn significant amounts through foreign exchange. The Caribbean area earns almost $1 billion from scuba divers alone. In Kenya foreign exchange earnings from tourism are around 30% and are greater than that from coffee or tea.
Abortifacient drugs and devices: medical and moral dilemmas.
The journal of the National Federation of Catholic Physicians' Guilds has printed a philosophical overview from a registered pharmacist concerning the need for her antiabortion colleagues to refuse to dispense oral contraceptives (OCs) and abortifacient drugs. Saline solution causes vasodilation, edema, congestion, bleeding, and shock resulting in fetal death. Some physicians prescribe the E and F prostaglandins to induce premature labor and, depending on gestational age, delivery of dead fetus. A prostaglandin analog approved for treatment for gastric ulcers can cause miscarriage. Antiabortion groups tried to convince the US Food and Drug Administration to not approve it for fear that physicians would prescribe it for women who wanted to induce abortion. These same groups object to IUDs, the low dose combined OC, progestin only OC, Depo-Provera, Norplant, vaginal rings, and RU-486 since they prevent implantation of a fertilized ovum. They also do not support WHO research on the anti-human chorionic gonadotropin vaccine on the same grounds. Therefore antiabortion pharmacists who believe life begins at conception struggle between their moral and ethical standards and their need to work. In fact, a grocery store chain with pharmacies fired some pharmacists who refused to dispense an OC. Some independent pharmacists refused to dispense OCs. Pharmacists for Life have developed a model pharmacist's conscience clause in hopes it would be adopted by professional associations, employers, and state pharmacy boards. The registered pharmacist who brought this issue to the journal believes pharmacists need to be protected from losing their jobs if they choose not to dispense drugs she labels as abortifacients just as nurses and physicians are now protected.
Rickets: a potential cause of child disability at Chakaria.
Rickets is a disease in growing children in which endochondral ossification is inhibited by delayed calcification of maturing cartilage cells in the growth plates at the end of the bones. It results in deformities of the long bones, with severe bowing of the legs or severe "Knoch Knee." Rickets interfere with the usual shape and size of the body and also inhibit the natural growth in relation with age. It obstructs the movement, sports and in every step of daily life of a child. He bounds to negotiate with the usual events that is, the disability. What is happening at Chakaria? This area seems to be unique in the high incidence of rickets. No explanation has yet been found for this high incidence of rickets in this particular locality. I went to Chakaria Upazila of Cox's Bazar district to work for the disabled persons caused by the cyclone and tidal bore of 29th April of 1991 on behalf of a NGO and I worked there for about 2 1/2 months. I attended 799 disabled persons. Out of total attended patients 45.31% were below of 10 years old and 18.52 were the victims of rickets. I was surprised at this alarming condition. A great % of children of Chakaria becoming disable only by a simple disease that is, rickets. One can treat the patient by dietary changes, medication and braces or surgery to correct the deformities. But it is a very hard job. Much counselling the time is needed to deal with such patients. Many areas of Chakaria Upazila are far from medical centers. Like all of our Upazila Health Complexes there is neither surgical not prosthesis facilities in Chakaria Upazila Health Complex, or in Cox's Bazar district hospital. Most of the people are uneducated, and their knowledge of things outside their immediate vicinity is very limited. Most of the people are also very poor and it is very difficult for them the make a trip to Chittagong Medical College Hospital or any other specialized hospital where surgical and prosthesis and orthodosis facilities are available, and to stay there during the course of treatment. In this I like to mention here that prosthesis and orthodosis are neglected in our country. But if is well known that we cannot treat the disabled persons. Without the help of prosthesis or orthodosis. What can we do? The easiest way to solve the problem is through prevention. If we want to prevent rickets, at first we have to find out the cause. As I mentioned earlier the cause of rickets at Chakaria is not yet detected. Rickets is a disease of vitamin D deficiency. Due to vitamin D deficiency bone cannot accumulate calcium and phosphorus. So bone becomes softened and distorted. When the child begins to walk this soft bone bears the weight of the whole body and naturally it is deformed. Causes of vitamin D deficiency: 1. Dietary lack. 2. Inadequate exposure to sunlight with reduced endogenous synthesis of vitamin D processors. 3. Malabsorption of lipid, including vitamin D. 4. Derangements in metabolism of vitamin D (as chronic renal failure). 5. End organ resistance to vitamin D. 6. Other uncommon hereditary and acquired disorder of vitamin D metabolism. There is neither inadequate sunlight not lack of dietary vitamin D at Chakaria. Then we can come to the conclusion that the cause of rickets at Chakaria is limited between no. 3-6. Which is not yet identified by scientific experiments. If we want to prevent rickets, a potential cause of child disability at Chakaria we have to find out the cause at first by laboratory investigation and then to prevent and treat accordingly. (full text)
Why woman partners of drug users will continue to be at high risk for HIV infection.
Women who acquired HIV from their IV drug user sexual partners make up the 2nd largest group of women with AIDS in the US. By May 1991,k more than 3600 women had AIDS due to sexual intercourse with an IV drug user. Yet this is a low estimate because women partners of IV drug users are not visible and either do not know or want to know about their sexual partners drug use, but women partners of IV drug users constitute the fastest growing subgroup of adults with AIDS since 1983. The rise is particularly quick among black and hispanic women. They come from all racial, ethnic, and social group and tend to abuse alcohol and drugs but not usually IV drugs. Those in urban areas tend to be of reproductive age, have children, and are poor. Due to their diversity and their relative invisibility, service providers and programs that can help them avoid acquiring HIV infection either cannot identify them or their needs or they neglect them. The most successful HIV prevention programs are those designed and managed by women peers. HIV prevention programs based in drug treatment programs used by the women's partners and in AIDS-related programs have not been successful. Prevention messages geared towards women have tended to focus on condom usage and prevention of HIV transmission to infants without considering their social and psychological needs. They need prevention methods which they can control. Use of existing methods (e.g., asking a partner to use a condom) may result in various reactions such as sexual rejection and domestic violence. Thus providers must become more familiar with their characteristics and needs to develop sensitive educational, preventive, and therapeutic approaches to reduce the burden of AIDS-related sickness and death among women partners of IV drug users and their families.
Determinants of the Egyptian labour migration.
The objective is to summarize the pattern of Egyptian migration to Arab oil-producing countries (AOPC), to review some factors that are important determinants of labor movement based on theory, and to empirically model the migration rate to AOPC and to Saudi Arabia. Factors are differentiated as to their relative importance. Push factors are the low wages, high inflation rate, and high population density in Egypt; pull factors are higher wages. It is predicted that an increase in income from destination countries has a significant positive impact on the migration rate. An increase in population density stimulates migration. An increase in inflation acts to increase out-migration with a 2-year lag, which accommodates departure preparation. Egypt's experience with labor migration is described for the pre-oil boom, and the post-oil boom. Several estimates of labor migration are given. Government policy toward migration is positive. Theory postulates migration to be determined by differences in the availability of labor, labor rewards between destination and origin, and the cost of migration. In the empirical model, push factors are population density, the current inflation rate, and the ratio of income/capita in AOPC to Egypt. The results indicate that the ratio of income/capita had a strong pull impact and population density had a strong push impact. The inflation rate has a positive impact with a lag estimated at 2 years. Prior to the Camp David Accord, there was a significant decrease in the number of Egyptian migrants due to political tension. The findings support the classical theory of factor mobility. The consequences of migration on the Egyptian economy have been adverse. Future models should disaggregate data because chronic shortages exist in some parts of the labor market. Manpower needs assessment would be helpful for policy makers.
A cultural analysis of the economy of affection and the uncaptured peasantry in Tanzania.
The author reviews and comments upon Goran Hyden's thesis of the economy of affection and the uncaptured peasantry in East Africa. Hyden hold that villagers and city-dwellers are linked in webs of kinship and tribal obligation which mitigate against the accumulation of wealth or capital necessary to form either industrial modes of production or class-based societies. The high value placed on personal relationships virtually demands a peasant mode of production. In contrast to former European and Asian scenarios, uncultivated, arable land remains available. Peasants may therefore participate to varying degrees in both the market economy and the traditional socioeconomic system as they desire, without being trapped in capitalist production. Together, however, the availability of land and the economy of affection may combine as the most significant force thwarting economic development in Tanzania. Applying a methodological framework recently suggested by Wendy Griswold for the sociology of culture, the author reviews and reformulates part of Hyden's analysis. The intentions of creative agents, the reception of cultural objects over time and space, understanding the intrinsic values of cultural objects, and the significance of perpetuating social groups are discussed.
Psychologists from Simon Fraser University in Burnaby, British Columbia in Canada examine the standard cross-cultural sample on attitudes toward female fatness and the socioecological variables to investigate whether associations exist as predicted by various hypotheses. These hypotheses involve 3 biological functions of body fat in human females which are insulation, storage of calories, and fertility regulation. Food security; small but healthy; climate; male preference; battle of sexes; adaptive reproductive suppression; fraternal interest groups; church, kitchen, and children; and whims of fashion comprise the examined hypotheses. Even though the analysis shows that cultural attitudes toward fatness in women differ, some socioecological variables account for 41.3% of the variance in cultural attitudes toward fatness in women. These cross culturally related variables which determine cultural beauty standards include reliability of food supply, climate, relative social dominance of women, the value placed on women's work, and the probability that the expression of adolescent sexuality will have adverse effects on female teenagers. Thus underlying social and ecological variables affect the cultural beauty standard. North American psychologists should consider this finding when counseling patients who diet excessively. These results stress the need for industrialized societies to address the contradictory attitudes toward the sexuality of teenage girls and the incompatibility of women's work with child rearing instead of blaming mass media or the fashion industry for the cultural attitudes toward fatness in women.
HIV infection and AIDS in China.
Through November 1990, phlebotomists took serum samples from 305,280 people (32,093 of whom were foreigners) to determine the prevalence of HIV-1 infection and AIDS in China. The phlebotomists worked in the laboratory at the Academy of Preventive Medicine in Beijing, provincial health and antiepidemic stations, and other health institutions throughout China. The Virology Institute at the Academy used the ELISA, immunoenzymatic tests, gelatin particle agglutination test, or immunofluorescence test to detect HIV-1 and confirmed positive samples with the Western Blot test. HIV-1 was introduced into China from Thailand in 1983. 378 Chinese tested positive with the vast majority (365) being drug abusers from southwest China near Myanmar (Burma). 90.2% of the HIV-1 positive drug abusers were 15-39 years old. 83% were from minority ethnic groups especially the Dai and Jing Po groups. 80% worked on farms. 64% of the 164 intravenous (IV) drug abusers tested HIV-1 positive and they had the highest incidence rate of all groups. No IV drug abuser who did not live in the southwest region bordering Burma tested HIV-1 positive. 19 Chinese with hemophilia tested HIV-1 positive, 4 of whom had received factor VIII produced in the US and imported into China in 1983. Only 1 of 96 homosexual men tested HIV-1 positive. Just .2% (68) of the 32,093 foreigners tested HIV-1 positive. No prostitutes, sexually transmitted disease patients, or blood transfusion patients (traditional high risk groups) were HIV-1 positive. There were only 5 AIDS patients (2 Chinese [a drug abuser and 1 infected abroad] who died in 1990 and 3 from the US). The laboratory was able to isolate HIV-1 virus from 1 of the US AIDS patients. It did not find HIV-2 in any of the 50 sera from African students and Chinese who had been to Africa. These results indicated a need to limit or prevent HIV transmission from the border area with Burma to other parts of China.
Defect of NK regulation in HIV-infected patients.
In Buenos Aires, Argentina, health workers obtained peripheral blood samples from 22 HIV-infected people with either no symptoms or persistent lymphadenopathy to examine natural killer cytotoxicity (NKC) of asymptomatic HIV-infected (HIV+AS) cases and the effect of factors that regulate normal NKC. Researchers compared these results with those of 10 healthy heterosexual controls. Even though NK cells of the HIV+AS cases were present in the same numbers and functioned as well as those in the controls, an inducer of interferon (Concanavalin A or ConA) could not force the cell system in vitro which demonstrated NK defectiveness. NK response to ConA of HIV+AS cases was lower than that of the healthy controls (p<.05). On the other hand, the NK response to a prostaglandin antagonist (Indomethacin or IM) matched that of the healthy controls. Cell supernatants from normal peripheral blood mononuclear cells increased normal NK cell function (p<.001), but those from HIV+AS cases did not do so. Thus it appeared that the HIV+AS cases were unable to produce sufficient NK enhancer factors. Cell supernatants from HIV+AS reduced normal NKC below baseline (p<.05) indicating the presence of NK suppressor factors. The researchers believed products of the arachidonic acid metabolism by the cyclooexgenase pathway, maybe PGE2, may have contributed to NK suppression since IM negated suppressor activity of cell supernatants from HIV+AS subjects on normal NK function. They concluded that reduced production of enhancing factors, additional release of inhibitory factors, and deficiency at the NK effector system are likely to be the underlying causes for NK deficient function in AIDS. They noted that these effects function synergistically.
Syphilis serology in men at an andrology clinic in South Africa.
Much attention has recently been given to the serious health implications of AIDS, hepatitis B infection and the human papillomavirus. In spite of these, syphilis/gonorrhea are still the most common of the "old" sexually transmitted diseases (STDs) and syphilis is, with the exception of AIDS, the STD with potentially the most destructive sequelae. Recent observations indicate that syphilis may be an important cofactor in facilitating transmission of HIV. A history of syphilis or a positive serologic test for syphilis is associated with HIV seropositivity in men. Although the incidence of syphilis in the UK is 1 of the lowest in the world, syphilis is increased in most countries. In several areas of the US there has been a dramatic increase in the prevalence of syphilis and in some first-world areas congenital syphilis is now considered epidemic. Syphilis is considerably more common in Africa than in Europe/US. Syphilis is also prevalent in most developing countries. The worldwide resurgence of syphilis has a serious implication on neonatal morbidity. The aim of this study was to evaluate the seroprevalence of syphilis in men attending and infertility clinic. Blood samples from 782 males were screened using the titrated RPR/TPHA tests. If either of these tests was positive, FTA-Abs IgG was performed. The RPR was positive in 63 (8%) cases. In 24 (3%) patients the titer was >or= 1/8 with positive TPHA and FTA-Abs IgG tests and these were regarded as current infections. 39 (5%) cases had RPR titers <1/8 with positive specific tests (Table 1). These were probably patients either treated inadequately, or in the early stage of primary syphilis. In addition 92 (2%) patients were RPR negative but TPHA and FTA positive. This was evidence of previous exposure to syphilis. The overall seropositivity in this group was 20% (155 cases). 627 (80%) tested negative with RPR and TPHA. Syphilis may still have a major impact on health in Southern Africa. Since syphilis is significantly associated with HIV seropositivity, efforts to prevent and control syphilis may also be important in limiting HIV spread. The 3-8% incidence of active disease among an asymptomatic group of men, referred for evaluation of infertility underlines the statement that "serologic screening should be done at the least indication". A community-based program with continuous adequate screening and treatment would be of great help. While the absolute yield for such screening may be low, the potential for reducing the morbidity and mortality of congenital syphilis is great. (full text) (6 references cited in original document)
Family Development Services and Research (FDSR) stresses AFLE.
Adolescent Family Life Education (AFLE) programs are aimed at adolescents to teach them about the basic facts of life, physical and mental. Ignorance or negligence during adolescence can cause irreparable damage to life afterwards. Family Development Services and Research (RDSR) is among the organizations to adopt such programs. RDSR is a voluntary organization formed in 1985 to fulfill unmet needs of all aspects of family life. Dr. Fatima Alauddin heads the organization and is also the Chairman of the 5-member Executive Board. The general body consists of 26 members and 382 temporary and permanent workers. RDSR has projects in 6 upazilas of 5 districts of Bangladesh: Raipura of Narsingdi, Gopalpur and Modhupur of Tangail, Shingar of Natore, Godabari of Rajshahi, and Dakhin Khan union of Dhaka. FDSR focuses mainly on mother-child health and family planning, nutrition, and women development. It also conducts research on social development and training programs for target groups. A 1987 project developed regarding the status of adolescent girls (under 13 years old) resulted in programs taken in several existing project areas. About 275 groups (called Duhita Sangha) in 4 project areas exist with each group containing 10 members and 1 leader. The leaders receive training on running the group which meets at least once a month and covers 12 family life topics per year that members discuss and share with others. The group is encouraged to save and generate group income, sometimes with FDSR technical assistance, e.g., investing in stock business and goat raising. The maintenance of monthly health records helps teach health awareness. Eventually these adolescents drop out of the program, possibly due to education, employment, illness, or lack of transportation, although members begin with enthusiasm. Those who remain surely get a better direction toward life.
AIDS: the situation in Mogadishu during Spring 1987.
To determine if AIDS was present in Magadishu during spring 1987, the authors screened hospital patients for the presence of diseases compatible with acquired immunodeficiency. 29 such patients were identified and had their serum tested for antibodies to HIV by standard serologic techniques. All these sera were negative for HIV antibodies. During the same time, at the Mogadishu clinic for sexually transmitted diseases, 48 individuals were examined for evidence of HIV infection. No patient displayed clinical signs compatible with AIDS; however 1 serum was anti-HIV antibody positive in both the ELISA an Western blot assay. The authors conclude that there was no clinical AIDS in Mogadishu in early 1987 and that prevalence of HIV infection in high risk individuals was very low. (author's)
Utilization of maternal and child health services in rural areas of Jammu and Kashmir.
Researchers analyzed data on 100 14-45 year old mothers who had a child whose age was 0-3 years old and lived in Gurihaker village in Zachaldara block in Kupwara district of Jammu and Kashmir in India to determine use of maternal and child health care (MCH) services, their perception of needing these services, and the relationship between MCH utilization and social, economic, and demographic factors. 68 had 1-3 children. Only 57 registered with a health facility, mainly primary health centers (26), during their last pregnancy. Most (30) registered during the 4th-6th month of pregnancy. 56.14% of registered mothers visited the facility >4 times. The major reason for visiting the facility was problems (87.72%). 60 mothers were not vaccinated against tetanus. Only 15% of the 40 who did receive the tetanus toxoid received 2 doses. Just 54 took iron/folic acid tablets. Only 13 went to a facility for postpartum follow up; 8 went to a private practitioner. 84% gave birth to their child a home. A traditional birth attendant (dai) were present for all home births. The leading reasons for delivering at home were tradition (79.76%), no obstetric problems (75%), family demanded a home delivery (61.9%), convenience (48.8%), and high hospital costs (48.85%). Reasons for having a dai present included tradition (77.38%), family preferences (65.47%), privacy (60.71%), and less expensive (47.61%). Only 18 children did not receive any vaccinations. 29 used family planning methods especially female sterilization (10) and copper T IUD (7). 61 believed they need prenatal services. 78 perceived the need for intranatal care. 70 and 80 expressed the need for child care/immunization and family planning, respectively. Women of the high socioeconomic group, 15-29 years old, and with <3 children were more likely to adequately use prenatal care. These results highlighted the need to develop a strong health education program using the mass media, recruiting more female health guides than male, and training dais in MCH services.
In 1979, Rotary International, a US-based voluntary service organization, began its immunization efforts in collaboration with WHO and other groups. That year it and a private Canadian donor sent 4 tons of polio vaccines and 683,000 doses of tetanus toxoid to the Philippines. A large-scale measles immunization project in southern India proposed by Canadian and Indian Rotarians in 1980 received grants from Rotary International and the Canadian International Development Agency to immunize >3 million children. In 1982, it expanded its goal to immunization of all children in the world by 2005. By 1985, it formed its Polio Plus Program. Polio Plus provides grants to ministries of health after assuring that the ministries have a WHO-approved plan for immunization and agree to not hold Rotary International accountable for any problems and that local Rotarians support the project. By mid-1990, most grants had gone to southeast Asia (31%), sub-Saharan Africa (23%), and Latin America (22%). In early 1989, Rotary International had purchased 80% of the polio vaccine issued by PAHO and UNICEF. Local Rotarians along with colleagues from other countries organize social mobilization efforts. They also receive training manuals and undergo practical training via international voluntary exchanges. The manuals discuss vaccine promotion, organizing a delivery system, and training teams to help with immunization and monitor outcomes. Various ways Rotarians publicize programs are posters, banners, children's demonstrations, and radio and TV spots. They also provide refrigerated vehicles, participate in censuses, and sponsor workshops for health professionals. In late 1988, it gave PAHO and WHO grants to improve immunization efforts. By mid-1990, Rotary International fund-raising efforts had generated US$ 210 million with an additional US$ 20 million promised. It has invested these funds.
Researchers compared data on 30 25-35 year old women who took the combined oral contraceptive (OC) Ovlar (0.05 mg ethinyl estradiol and 0.5 mg dinorgestrel) for 2-5 years with data on 10 women who did not take OCs to determine the longterm effect of Ovlar on vitamin B6 metabolism and urinary Xanthurenic acid (XA). Cases received either 50 mg or 100 mg of vitamin B6 tablets every day for 4 weeks. Mean XA excretion/24 hours stood much higher among OC users than among the controls (12.51 vs. 2.33; p<.01), e.g., XA excretion among OC users ranged from 3.45 to 34.95 mcg/24 hours. Among the OC users, mean urinary XA excretion/24 hours was significantly higher before 50 mg vitamin B6 administration than it was after its administration (13.5 mcg vs. 2.71 mcg; p<.01). Administration of 100 mg vitamin B6 had the same effect (11.52 mcg vs. 2.26 mcg; p<.01). XA excretion was basically the same for the 2 OC user groups (50 mg and 100 mg administration of vitamin B6). Both doses of vitamin B6 brought about comparable XA excretion levels as the control group. The researchers concluded that 50 mg of vitamin B6 taken daily for 4 weeks is sufficient to correct vitamin B6 deficiency and changed metabolism among OC users. Research has demonstrated that OCs alter vitamin B6 tryptophan metabolism in 2 ways. They increase hepatic tryptophan oxygenase activity resulting in a surplus of tryptophan further in the pathway to niacin. This effect explains the higher production of several metabolites. OCs also reduce the proclivity for kynureninase, the pyridoxal phosphate of vitamin B6 dependent enzyme of tryptophan metabolism perhaps increasing the need for plasma pyridoxal phosphate.
HIV infection in Tirupati, India [letter]
In their serosurveillance study of "high risk group" individuals for the prevalence of HIV infection at Tirupati, 7050 high risk group individuals, namely 4957 STD clinic patients (3594 males and 1363 females), 1195 blood donors (1144 males and 51 females), 54 female prostitutes, 820 antenatal cases and 24 contacts of HIV infected cases were screened. Out of 7050 samples screened, 50 were seropositive (0.71%). Among 3594 male STD patients, 31 (0.86%) were seropositive. However, among 1363 female STD patients who were either contacts or wives of male STD patients, no HIV seropositivity was detected. In contrast to this, a high prevalence of HIV infection was found among 14 (25.92%) of 54 female prostitutes tested. These figures clearly indicate that the prostitutes in Tirupati may act as a reservoir of HIV infection and may transmit the disease to their clients who could be Hindus visiting Madras or the sacred temple in Tirupati in India from most parts of the world including the US. This could lead to further dissemination of the disease. I feel that most pilgrims and holiday makers from UK are unaware of the prevalence of HIV infection in Tirupati and some men may indulge in casual unprotected sex with an infected prostitute and acquire the infection. It is therefore mandatory that Hindus from UK, US, Canada, Australia and other European countries should be made aware of the prevalence of the infection in these areas and thus not indulge in casual unprotected sex. This may perhaps be implemented by publishing information in the lay press to which many Hindus have greater access. I wondered whether it would be feasible for the Government of India to print posters indicating the prevalence of the infection in these areas, thereby increasing the awareness of the general public. These posters may be displayed in public places such as hospital waiting areas, railway stations, central bus stations and crowded city centers, etc., possibly avoiding the sacred areas like Thirumalai. Ideally specialist medical practitioners with an interest in HIV infection would be trained in India, as in the UK and the other parts of the western world. Only then will a cohort of dedicated physicians be able to influence the attitude of the society and government to take effective control measures to limit further morbidity and mortality from HIV disease. (full text) (3 references cited in original document)
The aim of the present study was to compare the clinical and radiographic presentation as well as the therapeutic outcome of pulmonary tuberculosis (PT) in adult patients with and without human immunodeficiency virus type 1 (HIV-1) infection in Kigali, Rwanda. Over a 17-month period, 59 consecutive patients with bacteriologically and/or histopathologically documented PT were enrolled. Of these, 48 (81%) patients were HIV seropositive. Among these, 35 fit the WHO clinical criteria for AIDS (WHOCCA) at the time of admission. Significant differences were found between the HIV-seropositive and HIV-seronegative groups of patients: fever (85 vs. 36%; p<0.001), tuberculin skin test energy (69 vs. 0%; p<0.01), mediastinal and/or hilar adenopathies (31 vs. 0%; p=0.05), and pleural effusion (43 vs. 9%; p<0.05) were more frequently encountered in the HIV-seropositive group, and upper lobe infiltrates (55 vs. 16%; p<0.02) and cavitation (91 vs. 39%; p<0.003) were more often seen in the HIV-seronegative group. However, HIV-seropositive patients who did not meet WHOCCA were less frequently anergic (1 vs. 100%; p<0.001) and feverish (53 vs. 97% p<0.01) and more often had cavitation (69 vs. 28%; p<0.02) and less often mediastinal and/or hilar adenopathies (7 vs. 40%; p<0.04) compared with HIV seropositive patients who met WHOCCA. Under antituberculosis treatment, clearance of fever was slower in HIV-seropositive compared with HIV-seronegative patients, and among the HIV-seropositive group, it was slower in those who fit WHOCCA. Data collected from this study suggest that the clinical severity and the radiographic pattern of Hiv-associated PT are strongly related to the degree of progression of HIV infection. Although slower in advanced HIV infection, a favorable response to antituberculosis treatment was seen in all these groups of patients. (Author's)
Operations research project summaries are given for family planning (FP) and maternal-child health service delivery systems in the following countries: Barbados (contraceptive distribution to factory workers and increasing condom sales), Bolivia (mass media to influence vasectomy choice and health maintenance organizations with FP services), Colombia (IUD distribution to private physicians, AIDS prevention and FP strategy, and strategies to promote vasectomy), Dominican Republic (effectiveness and cost of multiple counseling sessions, and supervision and training for improving couple months of protection), Ecuador (home visits in rural areas to improve FP acceptance), Grenada (community education for high risk women), Guatemala (on site training for community-based distribution promoters, and indigenous population's interest in FP), Honduras (postpartum FP promotion of breast feeding, and health providers motivation and understanding reproductive risk), Jamaica (education and adolescent mothers), Mexico (12 projects on distribution approaches for young people, workplace distribution, contraceptive acceptance, operations research, condoms sales near cash registers, cost effectiveness and youth, increasing male contraception, ineffective vasectomy promotion in the workplace, mass media as AIDS prevention strategy, AIDS prevention compatibility with FP, and the needs of youth), Paraguay (distribution strategies, and improving rural distribution of FP), Peru (10 projects on effective work site retraining, integrating FP and women's development, FP improvement through integration, rezoning to stop duplication of effort, FP acceptance postpartum, male distributor's role in increasing condom use, AIDS prevention, Norplant trials, and an AIDS information center for increasing preventive messages to media). Each program is described with attention to findings and implications of the project, background and purpose, and study description and sponsoring organization.
The challenge of survival. Safe motherhood in the SADCC region.
In late 1990, about 250 individuals participated in the Southern Africa Development Coordination (SADCC) Conference in Harare, Zimbabwe to develop an action plan to confront problems related to women's health. Delegations from each of the 10 SADCC countries gave status reports depicting the needs and priorities of their Safe Motherhood initiatives. Participants drafted practical and realistic national action plans based on the status reports, working group discussions, the conference background paper, and presentations on family planning, adolescent fertility, abortion, AIDS, sexually transmitted diseases, women's status, role of health service providers, and research. Participants worked together on a case study of a theoretical SADCC country. Participants agreed upon an extensive Action Agenda for the whole region during the last round of the conference. It listed specific goals and objectives, e.g., reduce maternal morbidity and mortality rates by at least 50%. The overall principles of the Agenda included mobilization of political will and commitment; empowerment of women; sensitization of men; community participation to build programs; involvement of all media and nongovernmental organizations; sharing of information, ideas, materials, and experiences within and among SADCC countries; and continual evaluation, education, and communication at all decision making levels. The agenda made specific recommendations to improve emergency obstetric care and routine reproductive health care to address the root causes of maternal morbidity and mortality. SADCC strategies for safe motherhood were improving outreach, personnel, transportation, communication, operational research, and data collection and capitalizing on resources.
Lactation performance of rural Mesoamerindians.
Researchers analyzed data on 30 postpartum women from the Otomi Indian community living in rural Capulhuac, Mexico to examine interrelationships among lactation performance, maternal body size/composition, and dietary intake to learn which maternal factors limit lactation and thus infant growth. Infant food supplementation was minimal. Current diet did not affect milk production or levels of energy and fat in milk. Even though the body mass index (BMI) was lower than the normal range (19.8-26 kg/sq meter) for only 2 women, 8 women had <20% body fat indicating considerable undernutrition. Women consumed a mean of 68% and 80% of energy and protein requirements. Mean energy intakes (kcal/kg/day) at 4 and 6 months postpartum were 33.8 and 35.1 respectively, compared with the recommended 51. Mean protein intakes (g/kg/day) were 0.75 and 0.84 respectively compared with the recommended 1.1 3-day intake records based on memory, estimation of portion sizes, food preparation, and food composition data led to the above energy intake results, but they may not have been accurate since a mean of 35 would not allow much physical activity. Fats and carbohydrates mainly from maize made up 17% and 76% respectively of the Otomi diet suggesting a suboptimal diet. Yet human milk production rates (885 g/day at 4 months and 869 g/day at 6 months) tended to equal or be higher than those of women of higher socioeconomic status (711-925 g/day) and other poor women (525-789 g/day). The greater the levels of maternal body fat the smaller the amount of milk women produced (p=.006). Total nitrogen, protein nitrogen, lactose, and nonprotein nitrogen levels fell within the range of that of privileged women. Fat and energy levels in the milk were lower than those of privileged women, however heavy women (p=.002) with high BMI (p=.05) and body fat (p=.004) levels tended to have high levels of energy and fat in the milk. Energy levels in milk were not linked with milk production. Neither milk production nor composition were related to dietary intake.
At the Royal North Shore Hospital in St. Leonards, New South Wales, Australia, physicians examined the effects of estrogen-progestogen oral contraceptives (OCs) and progestogen-only OCs (350 mcg norethisterone) on erythrocyte cation co- and countertransport for 3-6 months in 46 normal 18-36 year old women. They compared the cases' data with those of 11 controls. The combined OCs included ethinyl estradiol and norethisterone or levonorgestrel. The researchers used the ouabain-resistant, frusemide-sensitive component of rubidium influx to measure sodium and potassium co-transport and ouabain-resistant, phloretin-sensitive component of sodium influx to measure sodium countertransport. Sodium and potassium co-transport and sodium countertransport increased significantly on days 1-21 of the menstrual cycles of women using combined OCs with 30-50 mcg ethinyl estradiol and 500-1000 mcg norethisterone for 3-6 months (p<.01). It did not change in the control group or in women taking OCs with ethinyl estradiol and levonorgestrel, however. No changes occurred at 3-6 months in sodium and potassium co-transport in women using 350 mcg/day of norethisterone for 6 months who began using it at 6 weeks postpartum or in the control group. They could not explain the changes in erythrocyte cation transport by linking the parallel changes in plasma triacylglycerol concentrations or renin-aldosterone axis to the changes. Neither could they explain the changes by a link with increased blood pressure. Since no changes in erythrocyte cation transport occurred in women taking norethisterone-only OCs, OCs with ethinyl estradiol and levonorgestrel, or in the controls, but did occur in those women taking combined OCs with 500-1000 mcg norethisterone led to the conclusion that higher dose preparations of norethisterone causes changes in erythrocyte cation transport.
Hepatic cavernous haemangioma: a 10 year review.
Between January 1981 and July 1991, 61 patients with hepatic hemangiomata were examined at Westmead Hospital in New South Wales, Australia, there were 14 males (22%) and 47 females (78%). They ranged in age from 26-85 years with a median of 49 years. 41 displayed abdominal symptoms but these were attributed to a hemangioma in only 7 cases. There was at least 1 subcapsular lesion in 17 (28%); 6 of the 7 symptomatic lesions were subcapsular and 5 of these were giant hemangiomata (i.e. >4 cm in greatest diameter). 1 large symptomatic lesion was intrahepatic. No association was observed between hepatic hemangiomata and other hepatic or extrahepatic diseases. Hemangiomata were resected from 6 patients, 4 of whom were symptomatic. Symptoms improved in all 4 but did not resolve completely in any. Follow-up ranged from nil in 5 patients to 108 months in 1. The median follow-up was 12 months after initial diagnosis. 10 patients demonstrated evidence of change in their lesions or symptoms while under observation. Only 3 had worsening symptoms or suspected change in the size of a hemangioma. This study highlights the benign, static nature of most hepatic hemangiomata. When this lesion is suspected, the diagnosis should be confirmed with ultrasound and labelled red blood cell scanning. Referral for evaluation by a specialist hepatobiliary surgery unit is needed when symptoms are intolerable, increasing size is definitely demonstrated or the diagnosis is uncertain and cannot be established without specialized investigations. Bleeding into or from these lesions is rare. (author's)
The effect of a "safer sex" film as mediated by erotophobia and gender on attitudes toward condoms.
A psychologist asked 80 male and 80 female sexually active undergraduate students at the University of Georgia to complete the Sexual Opinion Survey and the Attitude Toward Condoms Scale 1-3 weeks before and immediately after viewing a safer sex film to determine whether the film would influence their attitudes toward condom use especially the role erotophobia and gender play on this effect. The safer sex film which showed condom placement in an erotic way between a man and woman induced the most positive change in attitudes toward condoms (p<.01) and willingness to use condoms (p<.0005). This increased willingness occurred only among women (p<.004), however. They expressed more positive comments about condoms than men (p<.02). Erotrophobia did not mediate these effects of the safer sex film. The psychologist suspected that the men were distracted by the appearance and activities of the actors in the film thereby explaining no change in their willingness to use condoms. Despite the positive effect the film had on attitudes toward condoms in both men and women, none of the students exchanged their coupons for free condoms. They could have been embarrassed about acquiring condoms on campus and bought condoms somewhere else. Perhaps the 3-minute film was not strong enough to affect instantaneous behavioral change. Another possibility to change behavior may be showing the film and providing substantial information about contraception and sexual health. Even though these results showed the safer sex film did exert a positive attitude change toward condoms, further research is warranted to determine whether it can bring about measurable behavioral changes.
Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya.
Between January 1989 and December 1991, health workers took blood samples from 4883 pregnant women attending the Nairobi City Commission's Langata Clinic in Nairobi, Kenya to determine demographic factors and indicators of sexual behavior to explain the increase in HIV-1 infection and syphilis among these women of low socioeconomic status. HIV-1 seroprevalence stood at 8.8%. Syphilis seroreactivity was 3.6%. HIV-1 seropositive mothers were 2.5 times more likely to also test positive for syphilis than were HIV-1 seronegative mothers (7.7% vs. 3.2%; p<.001). There was no significant association between HIV-1 seropositivity and gonococcal infection rate (7.3% vs. 8.9%), however. Women who tested HIV-1 positive tended to be from western Kenya (60.1% vs. 39.1%; p<.0001). Between 1989 and 1991, annual HIV-1 seroprevalence rates increased from 6.5% to 13% (p<.001) as did annual syphilis seroreactivity rates (2.9-5.3%; p=.02). The HIV-1 seroprevalence rates remained high, but did not rise significantly among syphilis seroreactive women between 1989 and 1991 (17.9-20.7%). They did rise among syphilis seronegative women (6.9-12.5%; p<.0001), however. The HIV-1 infection rate increase was greater among <25-year old women (5.6-13.2%; p<.001) than it was among >25-year old women (6.8-12.7%; p=.09). Indeed the annual incidence rate for <25-year old women was 3-4%. Between 1989-1991, there was a decrease in the percentage of both HIV-1 seropositive and seronegative women who had had >1 sex partner during the last 2 years (39.1% vs. 20%; p=.0001). Demographic factors remained the same throughout the study period. These results verified the link between HIV-1 infection and syphilis and their rapid rise among women in low risk groups. Thus there was a pressing need to improve HIV-1 and sexually transmitted disease prevention programs.
Veto -- or threat thereof -- prevails over majority as 102nd Congress adjourns.
In October 1992, the 102nd US Congress passed bills that would have restored the Title X family planning program and reversed the gag rule. But President Bush vetoed it and Congress could not override his veto. The House Labor-Health and Human Services (HHS) Appropriations Subcommittee supported an increase for Title X. Many congressional members worried about the political outcome if they supported controversial amendments to the Freedom of Choice Act, so Congress did not pass it. Congress increased funding of the Centers for Disease Control (CDC) breast and cervical cancer screening program. It also passed a bill for more screening of chlamydia in CDC's sexually transmitted disease program. Congress also expanded funding for international population assistance, but this did not restore the US contribution to UNFPA and did not override policy set in Mexico City. President Bush's threat to veto any bills undoing the Administration's abortion stand prevented Congress from attaching any such moves to bills that needed to be passed, e.g., Congress did not send 2 defense bills to Bush which would allow privately funded abortions in military hospitals abroad. Yet both the Senate and the House did approve the dropped provision as a freestanding minibill, but they expected Bush to pocket veto it. The House Labor-HHS appropriations subcommittee dropped the Senate bill's section on allowing Medicaid abortion funding for rape or incest cases. Bush vetoed the appropriations bill for the District of Columbia permitting the city to use its funds to pay for abortions for poor women. Under threat of veto, Congress did not resubmit a bill reauthorizing the national institutes of Health to conduct some fetal tissue research and implementing a women's health initiative. The Senate tried to move a bill making health insurance more affordable to the House, but it did not include prenatal care, contraceptives, or reproductive health services. It passed legislation to decrease drug prices paid by family planning clinics.
Change to Tri-Regol from other oral contraceptives.
Researchers analyzed data on 72 16-40 year old women patients attending the Semmelweis University Medical School in Budapest, Hungary to evaluate the effectiveness of the triphasic oral contraceptive (OC) Tri-Regol (.03, .04, and .03 ethinyl estradiol and .05, .076, and .125 levonorgestrel) in women who did not tolerate other combined OCs well. Women were more likely to be intolerant of Ovidon (27 women with 7 main side effects) and Bisecurin (19 with 6 main side effects) than Rigevidon (17 with 5 main side effects) and Anteovin (9 with 4 main side effects). These 2 combined OCs had the higher hormone levels and the physicians were unjustified to use OCs with these high levels. 77.7% of the women successfully made the change to Tri-Regol. Previous side effects stopped and none of these women had any new complaints. 9.8% of the women did not tolerate Tri-Regol well, e.g., 2 developed nausea and headaches thereby the physicians discontinued Tri-Regol. The remaining 12.5% of women experienced the end of only some of the previous complaints or Tri-Regol brought about additional side effects. None of the women became pregnant during the trial. The researchers concluded that Tri-Regol was just as effective and more tolerable than the other combined OCs previously used by the women. They suggested its use for young an premenopausal women. Nevertheless they did note that physicians may be justified to use the higher hormone OCs in cases with breakthrough bleeding.
Use of primary health care in Spili, Crete, and in Dalby, Sweden.
In 1989, researchers from Crete University in Crete and Lund University in Dalby, Sweden examined similarities and differences in the health care use pattern at the Spili Health Center (SHC) in Crete and at the Dalby Health Center (DHC) in Sweden. They also needed to establish a computerized medical record system in Greek primary health care. Essentially the same proportion of the population visited the 2 health centers (56% for SHC and 57% for DHC), but DHC patients made more frequent visits than did SHC patients (3.33 vs. 2.3). Yet there were more physicians per person in Spili than in Dalby (10.1 vs. 5.2/10,000 population). The mountainous terrain in an near Spili may have made it more difficult for people to go to the health center. Another possible explanation for the differences in number of visits for each patient in 1989 was that Swedes are perhaps more willing to go the health center for medical advice than the Cretes. 36% of visits to DHC were appointments compared with only 12.6% at SHC. In Crete, males were just as likely to visit the health center as females (55% vs. 57%), but females were more likely to visit the health center than males in Sweden (64% vs. 50%). People 65 years of age or older were more common in Spili than in Dalby (28% vs. 11%). Acute upper respiratory infections were the most common diagnoses in the 0-14 and 15-44 age groups. Head injuries were more common among 0-14 year old patients at SHC than their DHC counterparts (5% vs. 1.3%). Ear inflammation was the 2nd most common diagnosis at DHC but it was not 1 of the 10 most common diagnoses at SHC. This may have been due to better diagnostic abilities and modern equipment at DHC. Hypertension and diabetes mellitus predominated among >45 year old people.
Women's employment and child welfare: the social context of women's work in rural South India.
While much research has been directed toward gender inequality within the family and, expect for education, relatively little attention has been directed toward gender inequality within other social and political institutions, and the interaction between gender inequality and other forms of inequality within a society. This limitation results in a prescription for change within the family (where government fears to tread) without addressing inequality within the overall social structure where government can reduce women's dependency by altering the economic environment. This paper examines the relationship between mother's employment and child welfare within the context of gender inequality in the labor market, poverty, and lack of access to infrastructure (e.g., running water and fuel) in rural South India, using household surveys. Because of the assumed decrease in time available to care for young children (a negative impact) when women pursue employment (a positive impact because female income means more income spent on the children), economic programs have mistakenly focused on "traditional" skills (e.g., knitting) that are labor intensive, low paying, and ignores a women's other domestic responsibilities--collecting firewood, cooking, and cleaning. The domestic responsibilities may pose a greater impediment to child care responsibilities than participation in economic activities. The results of the survey argue for a greater recognition of the economic importance of rural women's economic activities which are typically dismissed as being solely domestic or as extensions of domestic work. Statistically invisible work on the family farm, for example, contributes income as well as releases men to participate in the cash economy, benefiting the family as a whole, but reducing the women's bargaining power within the family, and perpetuating the discrimination against women, caused in part by inequality in the political process where men receive higher pay.