Lifelong physical activity in maintaining bone strength in older men and women of the Age, Gene/Environment Susceptibility-Reykjavik Study.

UNLABELLED: We examined if lifelong physical activity is important for maintaining bone strength in the elderly. Associations of quantitative computerized tomography-acquired bone measures (vertebral and femoral) and self-reported physical activity in mid-life (mean age, 50 years), in old age (≥65 years), and throughout life (recalled during old age) were investigated in 2,110 men and 2,682 women in the AGES-Reykjavik Study. Results conclude lifelong physical activity with continuation into old age (≥65 years) best maintains better bone health later in life. INTRODUCTION: Skeletal loading is thought to modulate the loss of bone in later life, and physical activity is a chief means of affecting bone strength by skeletal loading. Despite much discussion regarding lifelong versus early adulthood physical activity for preventing bone loss later in life, inconsistency still exists regarding how to maintain bone mass later in life (≥65 years). METHODS: We examined if lifelong physical activity is important for maintaining bone strength in the elderly. RESULTS: The associations of quantitative computerized tomography-acquired vertebral and femoral bone measures and self-reported physical activity in mid-life (mean age, 50 years), in old age (≥65 years), and throughout life (recalled during old age) were investigated in 2,110 men and 2,682 women in the AGES-Reykjavik Study. CONCLUSION: Our findings conclude that lifelong physical activity with continuation into old age (≥65 years) best maintains better bone health in the elderly.

The prevalence of neonatal herpes simplex virus infection compared with serious bacterial illness in hospitalized neonates.

OBJECTIVE: To determine the prevalence of herpes simplex virus (HSV) relative to other viral infections and serious bacterial illnesses (SBIs) in hospitalized neonates admitted from a pediatric emergency department over a 5-year period. STUDY DESIGN: Retrospective prevalence study of laboratory-confirmed viral infections and culture-proven SBIs, with electronic databases and medical record review. RESULTS: A total 5817 neonates were included: 8.4% with viral infection, 4.6% with SBIs. Of 960 neonates with documented fever, 17.2% had viral infections (0.3% HSV infection) and 14.2% had SBIs (1.3% bacterial meningitis). Of 204 neonates with fever and cerebrospinal fluid (CSF) pleocytosis, 1.0% had HSV infection and 5.4% had bacterial meningitis. Of 124 neonates with fever and mononuclear CSF pleocytosis, 1.6% had HSV and 0.8% had bacterial meningitis. Of 187 neonates with hypothermia, 1.1% had HSV infection presenting as a sepsis-like syndrome. CONCLUSIONS: In febrile neonates admitted to the hospital from the emergency department, the prevalence of HSV infection was similar to that of bacterial meningitis, suggesting that HSV infection be considered in the differential diagnosis of neonatal fever, especially in the presence of mononuclear CSF pleocytosis. HSV infection should also be considered in neonates with hypothermia and a sepsis-like syndrome.

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador.

BACKGROUND: Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains-aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors-among public secondary school students in central El Salvador. METHODS: We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12-20 years participated in the study. RESULTS: Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%). CONCLUSION: A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.

The Blood Pressure Study in Mexican Children (BPSMC): I. Distribution and correlates of blood pressure in adolescent Mexican girls.

Blood pressure rises in adolescence and its increase appears to be more closely related to body size than to age. This cross-sectional study assessed the relationship between selected anthropometric and demographic factors and blood pressure during early adolescence in a sample of 233 females aged 10-12 years enrolled in public and private primary schools in Tlalpan, Mexico. Standardized measurements of blood pressure, arm circumference and length, height, weight, body mass index, and triceps skinfold were obtained. All anthropometric attributes were strong univariate correlates of blood pressure. Multiple regression analyses suggest positive associations between both body mass index and arm length and systolic blood pressure early in adolescence. When cross-cultural comparisons were made of blood pressure levels in the Blood Pressure Study in Mexican Children (BPSMC) with results in other countries, the BPSMC mean blood pressure levels were found to be the lowest. Possible explanations are discussed.

Coverage and patterns of ambulatory medical care use in Tlalpan, Mexico City.

Health officials planned a stepped care system (regionalized) for Tlalpan, in the Federal District of Mexico (D.F.), to address problems of duplicated services, inappropriate use of available resources, increasing costs of medical care, and unmet health needs in the population. Cross-sectional surveys were carried out in the community, in health centers and in hospital based ambulatory services (outpatient department and emergency department) to obtain current, specific and valid information about need and utilization patterns. Users of the various services differed from each other and from the community by age, educational level, occupation, rights to prepaid care and utilization patterns. Emergency department users came back for care repeatedly and sought preventive services from the emergency department. Major reasons for attending the emergency department included respiratory and gastrointestinal problems, plus poisonings, accidents, and complications of pregnancy. Outpatient department users arrived without referral from medical sources and continued to return frequently for care. Users were mostly adults, particularly older adults, with problems of a more chronic nature, e.g. nervous system problems, genitourinary problems, etc. The health centers attended clients from the designated area of influence who had referred themselves to the center for care. Children were the most frequent clients with acute, common problems, e.g. diarrhea and respiratory problems. Health maintenance activities were assessed for which children received the most complete coverage, but some women lacked the necessary care for perinatal health and family planning. In general, health centers seemed to be functioning appropriately, although the magnitude of unattended need in their areas of influence must be investigated further.(ABSTRACT TRUNCATED AT 250 WORDS)

Initiation of prenatal care by low-income Hispanic women in Houston.

OBJECTIVE: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy. METHODS: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care. RESULTS: A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby was associated with earlier initiation of care, as was having an eligibility card for hospital district services. Several barriers to care were mentioned by women on open-ended questioning, including long waiting times, embarrassment the physical examination, and lack of transportation. CONCLUSIONS: Recommendations for practice included decreasing the number of visits for women at low risk for poor pregnancy outcomes while increasing the time spent with the provider at each visit, decreasing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emphasizing specific messages about benefits to the baby, and increasing general health motivation to seek preventive care through community interventions.

Effects of smoking on pulmonary function and symptomatology in occupationally exposed groups.

Records of 3006 employees of nine companies in southeast Texas screened by a local lung association during the years 1974-1975 were examined to assess the effect of smoking, age, and occupational and residential ambient air pollution exposure. The effects of smoking and occupational exposure were strong when tested against a respiratory morbidity response questionnaire considered to be diagnostic for early-stage bronchitis. Occupational exposure lost statistical significance after place of residence was controlled in the analysis. Smoking and age variables exhibited significant effects when the response variable was pulmonary function test results. The differences between questionnaire and pulmonary function test results may indicate early-stage vs. later-stage respiratory morbidity ascertainment. Agreement in classifying "abnormal" subjects with these two methods decreased with increasing levels of smoking.

Adolescent human immunodeficiency virus and sexually transmitted disease prevention programmes: are gender-blind approaches justified?

OBJECTIVE: To present findings that gender might be more predictive of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) knowledge, and sexual behaviour, compared with participation in knowledge-based HIV prevention programmes. STUDY DESIGN: A cross-sectional study comparing students attending public high schools running an HIV and STD prevention programme. It is based on a study that evaluated the City of Houston HIV and STD prevention programme in public high schools. Comparison was initially between groups (intervention vs comparison) and subsequently between gender. The main variables for comparison were level of interest and knowledge of the subject of HIV and STD, and a range of sexual behaviour variables. METHODS: Self-administered questionnaires were used for eliciting both knowledge and behavioural data. A specific question required participants to rate their level of interest in the subject of HIV and STD on a scale of 1-4 (lowest to highest). The knowledge component was marked and scores awarded in percentage form. Descriptive statistical analysis was followed by stratified analysis. Finally, a select number of variables were used in a logistic regression model. STATA version 8 was the main statistical software. RESULTS: A significantly large proportion of girls reported the highest level of interest in the subject of HIV and STD (a score of 4); had higher HIV and STD knowledge scores; and reported less risk-taking sexual behaviour compared with boys. The only variable in which boys faired better was condom use, reporting higher rates of condom use than girls. CONCLUSIONS: Gender-blind HIV and STD prevention programmes seem to have a minimal effect on boys. Although a myriad of other factors influence male response to such programmes, the relatively low level of interest in the subject of HIV and STD among boys might be contributory. HIV and STD prevention programmes need to be re-designed using approaches that are more appealing to boys. Boys will otherwise remain the weak link and therefore the rate-limiting step in the quest for sexual behaviour change among adolescents.

Factors associated with the awareness and practice of evidence-based obstetric care in an African setting.

OBJECTIVE: To identify the factors associated with important (> or =50%) variation in awareness and practice of evidence-based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence-based reproductive interventions. DESIGN: Cross-sectional analysis of data from our Reproductive Health Interventions Study. SETTING: North-west province, Cameroon, Africa. POPULATION: Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care. MAIN OUTCOME MEASURES: Prevalence ratios (PR) of uniform awareness and practice of four key evidence-based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis. METHODS: Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence-based interventions. RESULTS: A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence-based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3-55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3-53.8) as was median work experience of 5-15 years (aPOR = 2.0; 95% CI: 1.0-3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0-11.8). Other potentially important variations were observed, although they did not attain statistical significance. CONCLUSIONS: Several factors including obstetric training and continuous education positively influence evidence-based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.

An epidemiological approach to the study of users and nonusers of child health services.

A case-comparison study was carried out in 1972 to determine the characteristics of users and nonusers of child health services. A sample of 529 mothers with children under five years of age (eligible children) residing in one poor barrio in Cali, Colombia was selected. The characteristics of mothers and their eligible children were described in relation to their use or nonuse of health services and a set of indicators was develop which differentiated the nonuser group from the user group. A two-stage sampling technique was used. First, blocks in the barrio were sampled, and second, an equal number of mothers with eligible children who used and who did not use services in the year prior to the study were selected for interview. Nonusers were matched with users on distance from home to local health center. The set of indicators which best discriminated the groups was: the number of eligible children, age of mother, access to free medical care, the action proneness score (attitudes), and knowledge of health, illness, and services. The study method permitted identification of the target population for services, determination of current patterns of use, and quantification of morbidity and immunization levels.

The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries. Coordinated Data Group of BOSTID Researchers.

Investigators from 10 countries studied the epidemiology of acute respiratory tract infection (ARI) among children 0-59 months old. Data on incidence rates, by age, gender, and season; on pathogenic agents; on case-fatality rates; and on selected risk factor findings are presented. Incidence rates from six of the community-based studies ranged from 12.7 to 16.8 new episodes of ARI per 100 child-weeks at risk, and rates of lower respiratory tract infection (LRI) ranged from 0.2 to 3.4 new episodes per 100 child-weeks at risk. Children spend from 21.7% to 40.1% of observed weeks with ARI and from 1% to 14.4% of observed weeks with LRI. The incidence rates for ARI are highest in younger children. Viruses, especially respiratory syncytial virus, are isolated more frequently than bacteria from children with episodes of LRI. Risk factors exhibited different patterns of association with ARI in different studies. Interventions could have great impact on high-risk levels common in the study populations. These studies provide interesting and useful data on the epidemiologic dynamics of ARI.

Vitamin A supplementation and health outcomes for children in Nepal.

PURPOSE: To compare vitamin A supplementation status of children age 6-60 months to the prevalence of vitamin A deficiency disease, malnutrition, diarrhea, and acute respiratory infection. METHODS: The nutritional status of children was estimated using mid-upper-arm circumference measurements. A trained ophthalmology assistant assessed for clinical signs of vitamin A deficiency disease. A trained female community health worker interviewed mothers about child health status using a standardized questionnaire. RESULTS: Compared to children who did not receive supplements, children who received vitamin A supplements regularly had less malnutrition, diarrhea, and acute respiratory infection, regardless of the number of children per household, age, sex, or father's occupation. CONCLUSIONS: Supplementation with vitamin A is necessary twice a year. Children who received a vitamin A capsule only one time were not as protected as were those children who received vitamin A as a regular twice yearly scheduled dose.

Birth practice patterns in urban slums of Dhaka, Bangladesh.

This study describes the patterns of birth related practices amongst women from an urban slum population in Dhaka city during December 1988 to May 1989. A household census identified all resident women of childbearing age in Rajabazar ward of Dhaka city. Of the 1017 women so identified, 289 women who had given birth to their last child over the previous five years were randomly selected for interview using a structured interview schedule. To observe actual birth practices, sixteen women pregnant for six months or more at the time of the census were followed-up to the immediate post-natal period. Eight local traditional birth attendants (TBAs) were interviewed informally to obtain insights about birthing techniques. A case study for a typical 'normal' delivery is presented and discussed.

PIP: This study is based on interviews among 753 women who lived in the urban slums of Razabazar ward of Dhaka City, Bangladesh, during 1988-89, and who gave birth within 5 years preceding the survey. In-depth interviews were conducted among 50 women. The household census of 1017 women 15-45 years old included 58 pregnant women, of whom 16 who were due within 3 months of the survey date and delivered in the study area were followed up. The 8 local traditional birth attendants (TBAs) were also interviewed. There were 178 live births and 34 infant deaths in the last year before the survey. Infant mortality was an estimated 191/1000 live births. Among the sample of 289 women with a birth within the 5 years preceding the survey, there were 30% who were pregnant 5-8 times, 6% who were pregnant 9-12 times, and few stillbirths. Most women did not know the cause of neonatal death. 46% of the 289 mothers experienced a perinatal or postneonatal death during their entire reproductive life. The strongest predictor of previous infant loss was maternal education. Findings from an analysis of data from the 174 mothers who gave birth within the last 2 years indicate that most women were under 25 years old, had no schooling, lived over 4 years in the slum, and had limited household income. 69% had no prenatal care. 96% delivered outside the hospital, and 57.9% delivered at home. Over 75% had deliveries performed by an untrained attendant. 8% delivered the infant by themselves. 3% had a doctor-assisted delivery. 95% reported that the umbilical cord was cut with a razor blade, and 5% used a strip of bamboo. 13% reported boiling the razor blade for sterilization. 71% applied nothing to the umbilical cord. Breast feeding delays over 24 hours occurred more frequently among traditional birth attendant deliveries. This article includes a case study of a typical normal delivery.

Ecuadorian adolescents and cigarette smoking: a cross-sectional survey.

This study investigates adolescents' attitudes and behaviors toward cigarette smoking in Ecuador. Using social cognitive theory as a basis, the cross-sectional survey focuses attention on such social influences as the smoking habits of family members and peers, as well as on the role of cigarette advertisements. Data on prevalence of actual use, access to cigarettes, and knowledge and attitudes about smoking are also obtained. The survey was conducted during the summer of 1994 in both urban and rural areas. Fifty schools in 40 different communities participated, resulting in a sample of 2,625 adolescents aged 9 to 15 years who completed the self-administered questionnaire. This study was conducted in collaboration with Amigos de las Américas (AMIGOS), an international health organization. Staff and volunteers who participated in projects conducted by AMIGOS in Ecuador worked with local health and education officials to implement the survey. Nearly 9% of students identified themselves as current smokers, 24.5% had experimented with smoking, and 61.1% had never smoked. The results varied significantly by age and gender, with older students and boys smoking at the highest rate. The smoking status of family members and peers also significantly predicted student smoking status. The results from this sample replicate findings from North American samples. Although Ecuadorian students smoke somewhat less than their American counterparts, cigarette smoking in Ecuador is a significant public health problem and clearly warrants a coordinated response. The present study points to several strategies for preventing smoking among youth.

Evaluation of the home-based maternal record: a WHO collaborative study.

Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks.

PIP: An evaluation was made of the home-based maternal record (HBMR) as an impetus to improved continuity of care and to improved education of women about their health status. The study involved Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen, and Zambia. THe HBMR is a system for recording risk factors and early signs of complications, referrals, and treatment of the mother and infant. Data entry comes from a variety of sources, including the mother and other health personnel. Previous experience with home-based recording systems was reviewed. The WHO record was developed in 1982 and a set of guidelines was developed to evaluate the objectives and explore the functions. The evaluation was conducted between 1984 and 1988 in the 13 countries previously indicated with pre- and post-intervention designs and with controls, where possible. HBMRs were given to mothers during the second through the eight month of pregnancy, and those identified at risk were referred for appropriate care. Study populations ranged from 14,000 to 250,000 and female literacy ranged from 15% to 91%. Sample populations ranged from 75 to 819. Evaluation and results were provided for each of 6 objectives: 1) to encourage continuity of care from pregnancy through interpregnancy periods; 2) to encourage early identification of at-risk women and newborns; 3) to promote referral suitable to women and encouraging self-care; 4) to promote initiation of appropriate care suitable to needs; 5) to provide a useful and practical record of care; and 6) to provide a focus for health education about risk and health care during pregnancy and the interpregnancy period, and for the neonatal period. The findings revealed that HBMR was an important asset in increasing the quality and quantity of prenatal, postnatal, and interpregnancy care of mothers. There was also improved neonatal health care. Mother's knowledge about helpful practices was improved. Other improvements were evident in early identification of risk factors both before and after pregnancy, referrals of at-risk persons, initiation of care, registration of mothers and infants at health centers, vaccination with tetanus toxoid, and provision of useful health information. Continuity of care was improved when compared with baseline and control data. The HBMR was found to be suitable for use with all women regardless of childbearing age.

Dietary vitamin C and beta-carotene and risk of death in middle-aged men. The Western Electric Study.

In the Western Electric Company Study, carried out in Chicago, Illinois, data on diet and other factors were obtained in 1958 and 1959 for a cohort of 1,556 employed, middle-aged men. Nutrients included vitamin C and beta-carotene. An index that summarized combined intake of both nutrients was constructed. Mean intakes of vitamin C in the lowest and highest tertiles of the index were 66 and 138 mg/day; corresponding values for beta-carotene were 2.3 and 5.3 mg/day. A total of 522 of 1,556 men died during 32,935 person-years of follow-up, 231 from coronary heart disease and 155 from cancer. After adjustment for potentially confounding factors, relative risks (95% confidence intervals) associated with an increment of 19 points in the index (difference between means of the lowest and highest tertiles) were 0.60 (0.39-0.93) for cancer mortality, 0.70 (0.49-0.98) for coronary disease mortality, and 0.69 (0.55-0.87) for all-cause mortality. These results support the hypothesis that consumption of foods rich in vitamin C and beta-carotene reduces risk of death in middle-aged men.

Lung cancer mortality among women employed in high-risk industries and occupations in Harris County, Texas, 1977-1980.

Lung cancer is rapidly becoming the leading cause of cancer mortality among women. Interviews conducted with 259 women with lung cancer and 278 women without lung cancer or with their next-of-kin in Harris County, Texas from July 1, 1977 to June 30, 1980 revealed that 12 (4.6%) of the women with lung cancer had never smoked cigarettes. The odds ratio (OR) for current smoking was 15.7. Odds ratios for smoking for living women (OR = 17.5) were higher than for those who were deceased (OR = 12.6). Lifetime occupational histories were classified a priori into high- and low-risk categories. Data were stratified according to employment in a high-risk industry or occupation, a high-risk industry, a high-risk occupation, or both a high-risk industry and occupation. Although not statistically significant, odds ratios for employment in high-risk categories support earlier estimates that attributed 5% of lung cancer mortality in women to employment in hazardous occupations. Employment of a husband or household member in selected industries and occupations yielded significantly increased odds ratios. More cases (15.9%) than controls (6.9%) reported a family history of lung cancer (OR = 2.4). No significant increase in smoking-adjusted odds ratios was found for the use of hair spray, hand-held dryers, or alcohol, or for having lived with a household member who smoked cigarettes.

A simplified methodology for the community-based assessment of breast-feeding and amenorrhoea in Mexico.

Reported is the use of a simplified methodology for carrying out a community-based epidemiological assessment that is compatible with the goals of primary health care research. For this purpose, a current-status life table analysis of data from 1131 women who were served by community health workers in the State of México was used to determine the distributions of the duration of postpartum breast-feeding, amenorrhoea, and contraceptive use. The field methods used incorporated quality assurance procedures. At 1 month postpartum, 78% of the infants were still being breast-fed, at 5 months 50%, and at 12 months 25%. The level of amenorrhoea at 1 month postpartum was 85%, at 3 months 50%, and at 5 months 25%. Use of contraceptives was initiated at an early stage, with 42% of all users beginning during the first month postpartum. The simplified method described permitted the area's primary health care administrators to carry out research projects for programme development rapidly and was compatible with the locally available resources.

PIP: Reported here is the use of a simplified methodology for carrying out a community-based epidemiological assessment that is compatible with the goals of primary health care research. For this purpose, a current status life table analysis of data from 1131 women who were served by community healthworkers in the state of Mexico was used to determine the distributions of the duration of postpartum breastfeeding, amenorrhea, and contraceptive use. The field methods used incorporated quality assurance procedures. At 1 month postpartum, 78% of the infants were still being breastfed, at 5 months 50%, and at 12 months 25%. The level of amenorrhea at 1 month postpartum was 85%, at 3 months 50%, and at 5 months 25%. Use of contraceptives was initiated at an early stage, with 42% of all users beginning during the 1st month postpartum. The simplified method described permitted the area's primary health care administrators to carry out research projects for program development rapidly and was compatible with the locally available resources. (author's)

Test of a noninvasive instrument for measuring hemoglobin concentration.

A colorimetric instrument for the noninvasive quantification of hemoglobin, designed using color shades resembling those observed in the conjunctiva, was tested. The instrument's colors are contrasted against the color of the conjunctiva to measure hemoglobin content. Sensitivity, specificity, negative predictive value, and false-negative value were estimated to test the instrument's accuracy; kappa coefficients were used to estimate inter- and intraobserver variability. Physician field evaluations of conjunctiva color for the screening of anemia, reported in the literature, have had sensitivities and specificities as high as 70%. Readings with the instrument demonstrated a 63% sensitivity, 72% specificity, and 38% false negatives for screening hemoglobin values of less than or equal to 13 g/dl. The interobserver kappa coefficients for three pairs of readers were good to excellent for the same hemoglobin screening value. Statistically significant differences were noted, however, between observers during the reliability test. The instrument can be used by unskilled personnel to improve their decision-making about whom to send for further care or for supplementation with iron.

Incidence of pelvic endometriosis in Rochester, Minnesota, 1970-1979.

To the authors' knowledge, the incidence pelvic endometriosis in the general female population has not been previously reported. The purpose of the present study was to determine the incidence rate of diagnosed pelvic endometriosis among white females of reproductive age (15-49 years) in Rochester, Minnesota, during 1970-1979. Incidence rates were prepared first with histologically confirmed cases alone and then with the successive inclusion of progressively less certain cases: surgically visualized, clinically probable, and clinically possible. The overall incidence of pelvic endometriosis more than doubled (from 108.8 to 246.9 cases per 100,000 person-years) as the definition of a case was extended from histologically confirmed cases alone to all cases. Age-specific incidence rates increased in successive age groups through age 44 and then declined for women 45-49 years of age. Methodological problems in the definition and ascertainment of incident cases of pelvic endometriosis are described in detail.