Endothelial cells require functional FLVCR1a during developmental and adult angiogenesis.

The Feline Leukemia Virus Subgroup C Receptor 1a (FLVCR1a) is a transmembrane heme exporter essential for embryonic vascular development. However, the exact role of FLVCR1a during blood vessel development remains largely undefined. Here, we show that FLVCR1a is highly expressed in angiogenic endothelial cells (ECs) compared to quiescent ECs. Consistently, ECs lacking FLVCR1a give rise to structurally and functionally abnormal vascular networks in multiple models of developmental and pathologic angiogenesis. Firstly, zebrafish embryos without FLVCR1a displayed defective intersegmental vessels formation. Furthermore, endothelial-specific Flvcr1a targeting in mice led to a reduced radial expansion of the retinal vasculature associated to decreased EC proliferation. Moreover, Flvcr1a null retinas showed defective vascular organization and loose attachment of pericytes. Finally, adult neo-angiogenesis is severely affected in murine models of tumor angiogenesis. Tumor blood vessels lacking Flvcr1a were disorganized and dysfunctional. Collectively, our results demonstrate the critical role of FLVCR1a as a regulator of developmental and pathological angiogenesis identifying FLVCR1a as a potential therapeutic target in human diseases characterized by aberrant neovascularization.

At-home transcutaneous electrical nerve stimulation: a therapeutic alternative in the management of pediatric overactive bladder syndrome. / Influencia del sobrepeso y obesidad infantil en la apendicitis aguda en niños. Estudio de cohortes.

INTRODUCTION: In recent years, bladder electroneurostimulation or TENS (Transcutaneous Electrical Nerve Stimulation) has emerged as a new alternative in the management of lower urinary tract dysfunctions. Our objective was to evaluate the efficacy and safety of this therapy in children with overactive bladder. MATERIAL AND METHODS: Prospective study of patients diagnosed with overactive bladder and treated with electroneurostimulation. The system was maintained for 6 months. The severity of urinary symptoms was assessed using the PLUTSS (Pediatric Lower Urinary Tract Scoring System) questionnaire. RESULTS: A total of 21 patients were included in the study, with an average age of 10 years (range: 6-16). The most frequent symptoms were incontinence (89%) and urgency (100%). Statistically significant differences (p<0.05) in mean PLUTSS scores between treatment initiation and treatment completion were found: PLUTSS was 17.8 (range: 10-29) at baseline, 7.21 (range: 2-16) at month 3, and 5.6 (range: 3-12) at month 6. The maximum voiding volume of all patients increased after 6 months of treatment. All patients had their quality of life improved at the end of the study. CONCLUSIONS: Home TENS therapy is a safe and effective option in the management of overactive bladder in the pediatric population. However, further randomized studies should be carried out to protocolize and clarify the effectiveness of this therapeutic approach.

INTRODUCCION: La electroneuroestimulación vesical o TENS (transcutaneous electrical nerve stimulation) ha surgido como nueva alternativa en el manejo de las disfunciones del tracto urinario inferior. Nuestro objetivo fue evaluar la eficacia y seguridad de esta terapia en niños con diagnóstico de vejiga hiperactiva. MATERIAL Y METODOS: Estudio prospectivo de pacientes con diagnóstico de vejiga hiperactiva tratados con electroneuroestimulación. La terapia con TENS domiciliario se mantuvo durante 6 meses. Evaluamos la severidad de la sintomatología urinaria utilizando el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score). RESULTADOS: Un total de 21 pacientes (13 niñas) fueron incluidos en el estudio, con una edad media de 10 años (Rango: 6-16). Los síntomas más frecuentes fueron: incontinencia (89%) y urgencia (100%). Encontramos diferencias estadísticamente significativas (p<0,05) en los valores medios del PLUTSS antes de iniciar tratamiento y al finalizar el mismo: PLUTSS inicial 17,8 (Rango: 10-29), a los 3 meses: 7,21 (Rango: 2-16), a los 6 meses: 5,6 (Rango: 3-12). El volumen miccional máximo de todos los pacientes aumentó a los 6 meses de tratamiento. Todos los pacientes sintieron una mejora en su calidad de vida al finalizar el estudio. CONCLUSIONES: La terapia con TENS domiciliario parece una opción segura y eficaz en el manejo de la vejiga hiperactiva, sin embargo, deben ser realizados más estudios randomizados para demostrar su efectividad y protocolizar su aplicación en los pacientes en edad pediátrica.

Histological and radiological evaluation of subcutaneous implants in mouse of a 3D-printable material (Fulcure 720) and experimental application in mandibular reconstruction.

INTRODUCTION: The aim of this study was to evaluate the bioactivity of Fullcure compared to porous polyethylene implants (Medpor) in rats prior to custom-made scaffold support manufacturing for mandible segmental defects (MSD) reconstruction in sheep. METHODS: Twelve Fullcure and Medpor laminaes were implanted in the left and right dorsum respectively of six wistar rats. Toxicity was assessed by skin, kidney and liver histopathology three months post-implantation. Computed Tomography (CT) was carried out in order to assess radiological differences between implants. Fullcure containers were subsequently manufactured by CAD/CAM to hold scaffold cylinders for MSD reconstruction in sheep. RESULTS: No statistical differences were observed in tissue response between implants. Fullcure radiodensity was higher than Medpor (P<0.05). Fullcure manufactured support was successfully used for mandible repair in sheep. Nevertheless, the manufactured container did not accomplish the goal of guiding new bone formation according to the mandible shape. CONCLUSIONS: Fullcure showed similar biocompatibility and stronger radiodensity than Medpor. Despite its cheaper price and endless 3D-printing possibilities as scaffold holder for mandible reconstruction, further animal studies are needed to ensure Fullcure biocompatibility as implantable biomaterial.

[Management of recurrent urethrocutaneous fistula after hypospadias surgery in pediatric patients: initial experience with dermal regeneration sheet Integra]. / Manejo de la fístula uretrocutánea recurrente tras cirugía de hipospadias: experiencia inicial con lámina de regeneración dérmica.

OBJECTIVE: To present our initial experience using a dermal regeneration sheet as an urethral cover in the repair of recurrent urethrocutaneous fistulae in pediatric patients. METHODS: Since May 2016 to March a total of 8 fistulaes were repaired using this new technique. We performed the ddissection of the fistulous tract and posterior closure of the urethral defect. A dermal regeneration sheet was used to cover the urethral suture. Finally a rotational flap was performed to avoid overlap sutures. RESULTS: During the follow-up (average 6 months), one patient presented in the immediate postoperative period infection of the surgical wound. This patient presented recurrence of the fistula. 88% of the patients included presented a good evolution with no other complications. CONCLUSIONS: In our initial experience the new technique seems easy, safe and effective in the management of the recurrent urethrocutaneous fistulae in pediatric patients. More studies are needed to prove these results.

OBJETIVO: Describir nuestra experiencia inicial en la reparación de la fístula uretrocutánea recurrente en la población pediátrica, mediante el uso de una lámina de regeneración dérmica como cobertura uretral. MATERIAL Y METODOS: Desde mayo del 2016 hasta marzo del 2017 se repararon 8 fístulas uretrocutáneas mediante esta técnica. Se realizó la disección del trayecto fistuloso, la sección del mismo y el posterior cierre del defecto uretral. Una lámina de regeneración dérmica monocapa se utilizó como cobertura sobre la sutura uretral. Finalmente se realizó un colgajo cutáneo de rotación evitando la superposición de las suturas. Los pacientes fueron seguidos mensualmente en consulta mediante exploración física. RESULTADOS: Durante un seguimiento medio de 6 meses (R: 2-10), únicamente 1 paciente (12%), que sufrió una infección de la herida quirúrgica durante el postoperatorio inmediato, sufrió una recidiva de la fístula uretrocutánea. El resto de los pacientes (88%) no desarrollaron ninguna complicación durante su evolución. CONCLUSION: En nuestra experiencia inicial, la técnica descrita parece sencilla, segura y eficaz en el manejo de los pacientes con fístulas uretrocutáneas recurrentes. No obstante, estudios a largo plazo son necesarios para corroborar estos resultados.

Drug utilisation study in patients receiving antiepileptic drugs in Colombia.

INTRODUCTION: This study examines the indications according to which antiepileptic drugs are prescribed and used in a population of patients enrolled in the Colombian national health system (SGSSS). METHODS: Retrospective cross-sectional study. From the pool of individuals in 34 Colombian cities who used antiepileptic drugs between 18 July, 2013 and 31 August, 2014 during a period of no less than 12 months, we obtained a random sample stratified by city. Socio-demographic, pharmacological and comorbidity variables were analysed. Continuous and categorical variables were compared, and logistic regression models were used. RESULTS: Our patient total was 373 patients, with 197 women (52.1%) and a mean age of 41.9 ± 21.7 years; 65.4% of the patients were treated with monotherapy. The most frequently used drugs were valproic acid (53.1%) and carbamazepine (33.2%). Epilepsy was the most frequent indication (n=178; 47.7%); however, 52.3% of the patients were prescribed antiepileptics for different indications, especially neuropathic pain (26.8%), affective disorders (14.2%) and migraine prophylaxis (12.3%). A total of 81 patients with epilepsy (46.6%) displayed good seizure control while another 25 (14.4%) had drug-resistant epilepsy. In the multivariate analysis, medication adherence was associated with a lower risk of treatment failure in patients with epilepsy (OR: 0.27; 95%CI, 0.11-0.67). CONCLUSIONS: In Colombia, antiepileptic drugs are being used for indications other than those originally intended. Monotherapy is the most commonly used treatment approach, together with the use of classic antiepileptic drugs.

[Results of an intervention to reduce potentially inappropriate prescriptions of beta blockers and calcium channel blockers]. / Resultados de una intervención para disminuir prescripciones potencialmente inapropiadas de bloqueadores beta y calcioantagonistas.

OBJECTIVE: To determine the frequency of simultaneous prescription of ß-blockers and calcium channel blockers, notify the cardiovascular risk of these patients to the health care professionals in charge of them, and achieve a reduction in the number of those who use them. METHODS: Quasi-experimental, prospective study by developing an intervention on medical prescriptions of patients older than 65 years treated between January 1 and July 30, 2014, affiliated to the Health System in 101 cities in Colombia. A total of 43,180 patients received a ß-blocker each month, and 14,560 receiving a calcium channel blocker were identified. Educational interventions were performed and an evaluation was made, using sociodemographic and pharmacological variables, on the number of patients that stopped taking any of the two drugs in the following three months. RESULTS: A total of 535 patients, with a mean age 75.8±6.7 years received concomitant ß-blockers plus calcium channel blockers. Modification of therapy was achieved in 235 patients (43.9% of users) after 66 educational interventions. In 209 cases (88.9%) one of the two drugs was suspended, and 11.1% changed to other antihypertensive drugs. The variable of being more than 85 years old (OR: 1.93; 95% CI: 1.07-3.50), and receiving concomitant medication with inhibitors of the renin-angiotensin system (OR: 2.16; 95% CI: 1.28-3.65) were associated with increased risk of their doctor changing or stopping the prescription. CONCLUSIONS: An improved adherence to recommendations for appropriate use of ß-blockers and calcium channel blockers by health service providers was achieved. Intervention programs that reduce potentially inappropriate prescriptions for patients treated for cardiovascular disease should be used more frequently.

Comparison of micronuclei frequency in bone marrow cells of three rat lines.

The aim of this paper is to compare the spontaneous and induced with cyclophosphamide micronucleus indexes in bone marrow cells of the Sprague Dawley, Lewis and Wistar rat lines. Five experimental groups were formed (10 animals of each sex and of each line, in every group). The first group was used as the negative control (intact animals), the second one was exposed to oral administration of drugs; other conditions were the same as for the other groups. The third group was treated with 2% Tween 65 and the fourth group was treated with 0.9% NaCl. Both substances were administered by oral way to 2 ml/kg during 14 days. The fifth group was treated intraperitoneally with strong mutagen cyclophosphamide in the dose of 50 mg/kg (10 ml/kg in solution), on 48th and 24th hours before euthanasia. The Sprague Dawley line (both sexes) was significantly different from the other lines. Rats of this line had lower index of spontaneous formation of micronuclei, higher index of cyclophosphamide-induced micronucle formation, percent of micronucleated erythrocytes in bone marrow and the index of cytotoxicity. The results obtained make it possible to identify the most appropriate line of rats as model animals for studies of genotoxicity. It will allow also to obtain more accurate estimates of genotoxicity of various substances.

Cervical assessment at 22 and 27 weeks for the prediction of spontaneous birth before 34 weeks in twin pregnancies: is transvaginal sonography more accurate than digital examination?

OBJECTIVES: This study compared the accuracy of ultrasound cervical assessment (cervical length and cervical index) and digital examination (Bishop score and cervical score) in the prediction of spontaneous birth before 34 weeks in twin pregnancies. METHODS: In a prospective multicenter study, digital examination and transvaginal sonography were performed consecutively in twin pregnancies attending for routine sonography at either 22 weeks (175 women) or 27 weeks (153 women). The digital examination took place first, and the Bishop score and cervical score (cervical length minus cervical dilatation) were calculated. Ultrasound measurements were then made of cervical length and funnel length to yield the cervical index (1 + funnel length/cervical length). The association between each variable and delivery before 34 weeks was tested by the Mann-Whitney U-test. The receiver-operating characteristics (ROC) curves of the ultrasound and digital indicators were determined for both gestational age periods, and the areas under the ROC curves compared. The best cut-off values for each indicator were used to determine predictive values for delivery before 34 weeks. RESULTS: The median gestational age at delivery among the women included in the 22-week examination period was 36.0 (range, 21-40) weeks; 10.9% (19) gave birth spontaneously before 34 weeks. The median cervical length was 40 (range, 6-65) mm. All four parameters were predictors of delivery before 34 weeks. The areas under the ROC curves for cervical index, cervical length, Bishop score and cervical score did not differ significantly. The median gestational age at delivery among the women in the 27-week examination period was 36.0 (range, 27-40) weeks; 9.2% (14) gave birth spontaneously before 34 weeks. The median cervical length was 35 (range, 1-57) mm. All parameters except the Bishop score were predictors of delivery before 34 weeks. The likelihood ratio of the positive and negative tests for cervical length < or = 25 mm was 5.4 (range, 3.2-9.0) and 0.3 (range, 0.1-0.7), respectively, compared with 2.3 (range, 1.3-4.2) and 0.6 (range, 0.3-1.1), respectively, for cervical score < or = 1. The area under the curve for the cervical index was significantly larger than that for the Bishop score (P = 0.008) or cervical score (P = 0.02). CONCLUSION: Transvaginal sonography predicted spontaneous delivery before 34 weeks better than digital examination at the 27-week but not the 22-week examination.

Optical fiber immunosensor based on a poly(pyrrole-benzophenone) film for the detection of antibodies to viral antigen.

We describe herein a newly developed optical microbiosensor for the diagnosis of hepatitis C virus (HCV) by using a novel photoimmobilization methodology based on a photoactivable electrogenerated polymer film deposited upon surface-conductive fiber optics, which are then used to link a biological receptor to the fiber tip through light mediation. This fiber-optic electroconductive surface modification is done by the deposition of a thin layer of indium tin oxide on the silica surface of the fiber optics. Monomers are then electropolymerized onto the conductive metal oxide surface; thereafter, the fibers are immersed in a solution containing HCV-E2 envelope protein antigen and illuminated with UV light (wavelength approximately 345 nm). As a result of the photochemical reaction, a thin layer of the antigen becomes covalently bound to the benzophenone-modified surface. The photochemically modified fiber optics were tested as immunosensors for the detection of anti-E2 protein antibody analyte that was measured through chemiluminescence reaction. The biosensor was tested for sensitivity, specificity, and overall practicality. Our results suggest that the detection of anti-E2 antibodies with this microbiosensor may enhance significantly HCV serological standard testing especially among patients during dialysis, which were diagnosed as HCV negative, by standard immunological tests, but were known to carry the virus. If transformed into an easy to use procedure, this assay might be used in the future as an important clinical tool for HCV screening in blood banks.

Monitoring genotoxicity during the photocatalytic degradation of p-nitrophenol.

p-Nitrophenol is a common structural unit of many pesticides and was chosen as a model compound to monitor genotoxicity during photocatalytic degradation. The genotoxicity of p-nitrophenol (PNP) and its breakdown products was measured using a bioluminescent bacterial bioassay, Vitotox. The genotoxic potential decreased with the concomitant photocatalytic degradation of the parent PNP concentration. The rate of genotoxicity reduction was slower than the rate of removal of the parent PNP, due to the formation of genotoxic by-products. After 6 h of photocatalytic treatment the total genotoxicity was removed. These results indicate that bioassays can be used as a simple and highly sensitive method for monitoring the general toxicity of chemical pollutants before, during and after photocatalytic treatment or other destructive processes.

The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees.

BACKGROUND: We estimated the effect of remote BCG vaccination on tuberculin reactivity and the booster effect among hospital employees. METHODS: Cross-sectional survey at a university hospital. All personnel employed during a 24-month period were included in the study. Employees were administered 2-step tuberculin testing, and BCG vaccination scars were verified. RESULTS: Of 665 hospital employees studied, 239 (36%) had been vaccinated with BCG in childhood. Significant tuberculin reactions (> or =5 mm) were more frequent among BCG-vaccinated (60%) than among nonvaccinated (29%) employees (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.6-5.2). The predictive value of tuberculosis infection increased with increasing reaction size and greater age (from 37% in subjects 30 years or younger with indurations > or =5 mm to 100% in subjects 50 years or older with indurations > or =15 mm). Among 374 employees with a negative tuberculin test reaction who underwent a second test, 39 (43%) of 91 vaccinated subjects had a positive booster reaction in contrast to 51 (22%) of 232 nonvaccinated subjects (OR, 3.4; 95% CI, 2-5.7). Neither different size criteria nor different definitions of the booster effect had an impact on the predictive value of tuberculosis infection. CONCLUSIONS: Remote BCG vaccination largely influences the tuberculin reaction and the boosting phenomenon among hospital employees. The interpretation of the results of 2-step tuberculin testing in a BCG-vaccinated subject must take into account age, size of the reaction, and local prevalence of tuberculosis infection. No single criterion, however, can accurately separate reactions caused by true infection from those caused by BCG vaccination.

The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994.

OBJECTIVE: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals. METHODS: Data were taken from the Maputo City death register and autopsy records for 1994. FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178). CONCLUSIONS: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

[Occupational exposures to blood-borne pathogens in health care workers]. / Exposición a patógenos hemáticos en el personal sanitario.

OBJECTIVE: To determine the rate of occupational exposures to blood-borne pathogens in different occupations of health care workers. To analyze the characteristics and outcome of the occupational exposure. MATERIAL AND METHODS: We have evaluate occupational exposures to blood-borne pathogens reported by health care workers during 1996-1999. The following data were collected: characteristics of the workers, type of occupational exposure, immunity status of the exposed worker, infectivity of the source patient and follow up serologic testing of the worker. RESULTS: A total of 407 occupational exposures were reported. The highest rate of occupational exposure was found among nurses (61.6%). Needlestick accident was the most often occupational exposure reported (84.5%). Mucosal exposures with accidental splashes were reported in 15.2% of cases. In 14.5% of these accidents workers were at risk for occupational transmission of blood-borne pathogens. Among the different occupations of health care workers, the rate of exposures with a source infected patient was higher in medical staffs (28.3%) than nurses (13.9%) The rate of exposures with a source infected patient was higher in accidental splashes than in percutaneous exposures (33.8% vs 13.3%), besides in none of the accidental splashes, employees had used appropriate barrier precautions. There were no cases of transmission of occupational blood-borne infections. CONCLUSIONS: Although nurses are the health care workers with highest rates of occupational exposures, medical staffs are the most often occupationally exposed to a source infected patient. Universal barrier precautions are no appropriately used in most of the occupational accidents, specially in those involving mucosal exposures.

A comparative physical study of two different hydrophilic synthetic latex matrices for the construction of a glucose biosensor.

Two different biodegradable latex polymers functionalised by hydroxy (1) or gluconamide (2) groups proved to be good immobilisation matrixes for glucose oxidase. The responses of these biosensors to glucose additions were measured by potentiostating the modified electrodes at 0.6 V/SCE in order to oxidise the hydrogen peroxide generated by the enzymatic oxidation of glucose in the presence of oxygen. The response of such electrodes was evaluated as a function of film thickness, pH and temperature. Rotating disk electrode experiments showed the influence of the enzyme on the structure of both latex films, namely a marked improvement in matrix permeability. The high permeability of the latex 1 based enzyme sensor (bilayer, P(m)=8.10x10(-4) cm s(-1)) resulted in a high dynamic range. Furthermore, the activation energy for a latex 1 sensor was determined to be 44.55 and 18.03 kJ mol(-1), respectively depending on the conformation of the enzyme.

The human autoantigen MCP1 is required during early stages of DNA replication.

Metaphase chromosome protein 1 (MCP1) is a nuclear autoantigen that is associated with condensed chromosomes throughout mitosis. During interphase, this antigen shows a speckle distribution in the nucleus, excluding the nucleolus. Additionally, MCP1 binds tightly to the scaffold/matrix component of nuclei and isolated chromosomes. In order to determine the in-vivo localization of the antigen, we have expressed MCP1 fused to EGFP in tissue culture cells. The results demonstrate that MCP1 is located in the nucleus during interphase and during mitosis associates tightly to condensed chromosomes. Furthermore, microinjection of specific antibody confirms these results. We have used a specific monoclonal antibody (mAb 402) against MCP1 to assess the function of this antigen during cell cycle progression. HeLa and Ptk-2 cells that were microinjected into the nucleus and/or cytoplasm at G1/S and very early S phase were not able to progress and complete DNA replication. However, injection of mAb 402 at mid or late S phase does not prevent completion of DNA replication and subsequent progression into mitosis. Microinjection of mAb 402 in Ptk-2 cells synchronized in mitosis did not interfere with progression of mitosis and cells divided. Our results suggest that MCP1 is required at the G1/S transition and during early S phase.

[Effectiveness of brief medical counseling to reduce drinkers' alcohol consumption]. / Efectividad del consejo médico breve para reducir el consumo de alcohol en bebedores.

OBJECTIVE: To evaluate the effectiveness of medical counselling in reducing alcohol consumption in male heavy drinkers. DESIGN: A controlled, randomised, simple-blind intervention study. SETTING: Four Primary Care teams in Area 10, Madrid. PATIENTS: 152 men who attended for on-demand treatment from the four teams and whose alcohol consumption was over 21 International Units (IU) a week. INTERVENTION: Brief medical counselling backed up by didactic material. Two questionnaires on alcohol consumption in IU, consumption habits and problems related to alcohol were administered, separated by an interval of between 6 and 18 months. Non-parametric tests for paired samples (McNemar) were applied. RESULTS: 60% answered the second questionnaire. Neither sociodemographic nor health habit differences were found between those who responded and those who did not, except for social class. There were no appreciable differences between the intervention and control groups. The percentage of drinkers above 35 IU decreased significantly in the intervention group. CONCLUSIONS: The intervention was clearly effective in reducing the percentage of drinkers whose weekly consumption was over 35 IU.

Child and maternal mortality during a period of conflict in Beira City, Mozambique.

BACKGROUND: Child mortality rates have been declining in most developing countries. We studied child and maternal mortality risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. METHODS: A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality ('children ever born' method and Preceding Birth Techniques (PBT) and maternal mortality (sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. RESULTS: Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, (5)q(0) per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate of 1990/91 was 154 (95 percent confidence interval [CI]: 124-184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio [OR] = 2.0, 95 percent CI: 1.1-3.8), absence of the father (OR = 2.4, 95 percent CI : 1.2-4.8), low paternal educational level (OR = 2.1, 95 percent CI: 0.8-5.4), young maternal age (OR = 2.0, 95 percent CI: 1.0-3.7), self-reported maternal illness (OR = 2.4, 95 percent CI : 1.2-4.9), and home delivery of the child (OR = 2.3, 95 percent CI : 1.2-4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. CONCLUSIONS: Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.

PIP: In July 1993, public health specialists conducted a cluster sample survey of 4609 women aged 15-49 living in 3190 houses in Beira city to determine child and maternal mortality after 10 years of internal conflict in Mozambique and a nested case control study of risk factors for child mortality. The indirect estimate techniques were child ever born and preceding birth techniques for child mortality and the sisterhood method for maternal mortality. The case control study compared 106 deaths among the most recent born child born since July 1990 with two age- and cluster-matched controls. The proportion of dead sisters who died of pregnancy-related causes was only 10.3% compared to 25-33% in developing countries. In 1982, the estimated maternal mortality ratio was 410/100,000 live births. The lifetime risk of maternal mortality was 263/1000. The preceding birth technique obtained a much lower child mortality estimate than the child ever born technique (154 vs. 212/1000). The child ever born technique analyzed data from 1977-1978 to 1988-1989 and found that the probability of dying from birth to age 5 fell 14% (246-212). During this period, coverage of health services improved. Even though the preceding birth technique is usually more reliable for recent estimates, underreporting of recent child deaths likely contributed to the lower child mortality estimate. Risk factors for child mortality included no beds in the household (odds ratio [OR] = 2.02), absence of the father (OR = 2.43), low paternal educational level (OR = 2.08), young maternal age (OR = 1.96), self-reported maternal illness since birth of child (OR = 2.43), and home delivery (OR = 2.31). Yet the sensitivity of these risk factors was rather low (15-57%). These findings show that child mortality fell slowly during the 1980s despite the poor living conditions brought about by the indirect effects of the civil war. They point to the need to further evaluate the appropriateness of a risk approach to maternal and child health care needs.