A burn formula in clinical practice.

In a retrospective review of the 10-year period 1969-78 the intravenous plasma loads given to patients admitted to one burn centre were studied and compared with the volumes predicted by the formula used at that centre. Of 1728 patients admitted 342 (19.8%) received intravenous resuscitation with plasma. The formula appeared to be a good empirical guide to transfusion needs in the 36 h after burning. Patients with burns in excess of 45% body surface area (BSA), and particularly children, were likely to require more fluid than that indicated by the formula estimate. However, as burns in excess of 50% BSA are uncommon (50/1728 admissions) it seems reasonable to use a formula which is a guide to the probable needs of most patients while accepting the clinical response as the best means of assessing the actual fluid need of each patient, especially those with extensive injury.

Periodic abstinence in the Philippines: new findings from a national survey.

This paper presents the main survey findings from a nationally representative sample of 607 users of periodic abstinence methods in the Philippines in 1984. The survey was conducted because of the widespread popularity of periodic abstinence in the Philippines and a lack of detailed knowledge about how the method is understood and practiced in the Philippines. Findings are presented on the prevalence of the different types of periodic abstinence methods, the nature of their use, knowledge about the various periodic abstinence methods, instruction received, perceived advantages and disadvantages, the husband's role, and the use-effectiveness of periodic abstinence both with and without backup methods. The implications of these findings for program management and for future research are also discussed.

Natural family planning in the Philippines.

The calendar rhythm method of natural family planning (NFP) is one of the most popular contraceptive methods in the Philippines. As a result, the Philippines has one of the highest NFP prevalence rates in the developing world. In recent years, family planning program officials have become increasingly interested in improving the practice of NFP, both by improving the quality of rhythm practice and by introducing newer, more accurate NFP methods. Over the years a substantial body of research data related to NFP practice in the Philippines has accumulated. This paper presents major findings from past research on NFP in the Philippines, discusses their implications for program management, describes current research, and suggests needs for future research.

PIP: The calendar rhythm method of natural family planning (NFP) is one of the most popular contraceptive methods in the Philippines. As a result, the Philippines has one of the highest NFP prevalence rates in the developing world. In recent years, family planning program officials have become increasingly interested in improving the practice of NFP, both by improving the quality of rhythm practice and by introducing newer, more acurate NFP methods. Over the years, a substantial body of research data related to NFP practice in the Philippines has accumulated. During the 1968-78 period, the proportion of married women aged 15-44 who said that they had ever tried the rhythm method rose from 9 to 23%. Rhythm users have relied more on nonprogram sources than on program personnel for instruction in the rhythm method. The rate of continuation was very similar for pill and rhythm users. Rhythm plus withdrawal was as likely to be continued as the IUD and as use-effective in preventing accidental pregnancy as the pill. Even though rhythm alone has been less effective in reducing fertility than pills, it has been more effective than either withdrawal or condoms. The main reasons for preferring the rhythm method over any other method were medical, (absence of side effects, pain or halth dangers) and convenience, (no need to get supplies, have an insertion, or interrupt the sex act). Problems associated with the rhythm method are the difficulty of abstaining during the unsafe days, and its in applicability during post-partum amenorrhea. In recent years, the attention of family planning program managers has been increasingly directed toward the need to improve NFP instruction and practice. Future research is directed towards the study of parish-based volunteer workers to instruct couples in calendar rhythm, demographic surveys and tests of program strategies.

Program-relevant findings from UPPI research.

PIP: Presents implications derived from the findings contained in a major report by the author, in which findings and implications of University of the Philippines Population Institute studies conducted between 1970 and 1979 were synthesized. Included in that report were discussions of studies on the population program's target audience, program acceptors, the effectiveness of contraceptive use, and issues of management and the program implications of those studies with regard to contraceptive practice, information/education communication efforts, and for efficient use of program resources. The present article is divided into 5 parts, providing major findings and recommendations under various headings. 1) Contraceptive practice: includes the need for increased emphasis on highly effective methods, for improved instruction on the rhythm method, and for promoting use of methods in combination. 2) communication and motivation: includes the need for wider distribution of IEC materials, for more effort to reduce the family size norm, for more accurate knowledge about contraception, for special attention to husbands, lower status couples, newlyweds, postpartum women, and breastfeeding, and the need for better training of outreach workers in IEC work. 3) Mobilization of resources: includes the need for coordination of population activities, for increased involvement of village service point operators, and for more use of social support as a motivational aid. 4) Coverage of married couples of reproductive age: includes need for clarification of present coverage by outreach workers, for increased coverage within village supply point areas and for more supply points. 5) Village supply point record-keeping: including need for more complete data and for use of records for local management.^ieng

Estimating the effects of contraceptive use on fertility: techniques and findings from the 1974 Philippine National Acceptor Survey.

Survey data on contraceptive use-effectiveness and on the fertility of family planning acceptors can provide a useful basis for estimating the fertility effects of a family planning program. The 1974 Philippine National Acceptor Survey (NAS), a sample survey of nearly 3,000 family planning acceptors reported by clinics in 1970--72 and interviewed in 1974, provided data for such an evaluation of the Philippine family planning program. The program's effects on the fertility of acceptors were estimated utilizing a series of analytical techniques, which are described in this article. Data from the NAS on continuation, pregnancy, and fertility following acceptance, as well as estimates of fertility decline associated with acceptance and continuing use of contraception, are analyzed. Findings are presented for acceptors of the four major program methods--pills, and the IUD, rhythm, and condoms. An appendix presents special procedures employed in estimating fertility effects.

1976 National Acceptor Survey (NAS): summary preliminary report based on marginals.

PIP: 5892 respondents from clinics representing 17 agencies in the Philippines were interviewed and their clinic records were examined in an effort to present highlights from the marginals on the main file and subfiles for acceptors of oral contraceptives (OCs), IUD, rhythm, and condoms; for non-acceptors, and cases lost to follow-up. The following were among the survey findings: 1) 18% of those interviewed reported that they had not accepted family planning from the clinic where their names were obtained; 2) nearly 36% of the non-acceptors had used family planning before the interviews, and 19% said that they were using a method at the time of the interview; 3) there was a poor clinic and survey record of condom use because of the fact that wives were the focus of motivation; 4) the family planning program clearly improved levels of contraceptive use; 5) clinic follow-up work clearly fell short of ideal; 6) there was a much higher proportion of contraceptive prevalence for the 1976 National Acceptor Survey (30%) than for the 1977 National Acceptor Survey (25%); 7) comparison of 1974 and 1976 National Acceptor Survey data showed slight declines in almost all continuation rates and increases in almost all pregnancy rates, with the exception of IUD rates which remain unchanged; 8) additional weaknesses in the provision of clinic services included the failure to recruit many new cases outside the clinic, remoteness of the clinic, lengthy waiting time in the clinic, overworked clinic staff, and inadequate clinic space; and 9) the primary sources of communication at the clinic were paramedical workers and lay motivators.^ieng

1976 National Acceptor Survey (NAS): estimation of national contraceptive prevalence from survey data on acceptors.

PIP: A representative sample of 5892 acceptors reported by Philippine program clinics from December 1969 through June 1976 were interviewed in order to provide a reasonably accurate estimate of 1977 contraceptive prevalence. It was learned that about 32% of eligible couples (1,720,000 couples) were practicing some method of contraception. Nearly 1/2 of the couples were using 1 of the more effective methods -- OC (oral contraception), IUD, or sterilization. Findings from adjusted survey data indicated an upward trend in the prevalence of all program methods between 1968 and 1976, but a net decline between early 1976 and early 1977 because of sharp declines in the number of OC and condom users which were not totally offset by increases in sterilization and IUD prevalence. The trends in estimated prevalence suggested a decline of about 4 points in the crude birthrate during the 1972-1977 period and an 0.3% point decline in the population growth rate for the same period.^ieng

Effects of the Philippine family planning outreach project on contraceptive prevalence: a multivariate analysis.

PIP: The 1980 Community Outreach Survey was used to assess the impact of the Outreach Project involving 2600 community workers on contraceptive prevalence. The primary measure was clinical prevalence (numerator limited to use of clinical methods--pills, IUD, and sterilization; the denominator was married women aged 15-44). The 46 socioeconomic (SES) and program input variables that appeared to be most closely correlated with contraceptive prevalence were subject to multivariate analysis on a stepwise basis. Of these 5 out of 7 SES variables accounted for 26.9% of the variance in clinical prevalence (household SES 22%, education of head of household 3%). 10 program variables (apart from specific Outreach Project variables) accounted for less than 4%. 12 Outreach Project variables accounted for a further 11.9% of the total variance or 17.2% of the residual variance. The most influential Outreach Project variables were whether the supply point officer was currently using a clinical method and the amount of personal contact with couples. The Outreach Project variables with no appreciable independent effect included mass media inputs, background characteristics of workers, and job satisfaction of the workers. Overall, the multivariate analysis demonstrated that the Outreach Project has affected contraceptive prevalence in the rural areas of the Philippines not reached by clinic-based operations.^ieng

Continuation and effectiveness of contraceptive practice: a cross-sectional approach.

This paper proposes a cross-sectional approach to the study of contraceptive continuation and use-effectiveness, based on data from surveys of married women of reproductive age rather than the more conventional follow-up surveys of family planning acceptors. Such an approach has the advantages of indicating the fertility effects of contraceptive practice during a particular period of time and providing information on the experience of users who obtain contraceptive information or supplies from nonprogram sources. An application of the approach in the context of a nationwide survey of wives living in areas covered by the Outreach Project of the Philippine Commission on Population is presented and the findings are discussed in relation both to program management and to the validity of the methodology.

PIP: Conventional methods for the study of fertility effects of contraceptive practice include direct or retrospective analyses of records from family planning centers. The authors suggest an alternative method, a cross-sectional approach based on data from surveys of married reproductive age women. The advantage is the ability to follow methods and efficacy of fertility regulation control for those contraceptive users not affiliated with a family planning program. In short, this offers an approach to study contraceptive continuation and effectiveness. The result is information on average continuation rates and effectiveness levels which can be more helpful in planning future programs. Data was collected from 1320 interviews conducted during the 1980 Community Outreach Survey. Those interviewed were married and lived in areas serviced by volunteer workers of the National Family Planning Outreach Project of the Philippine Commission on Population (POPCOM), thus presenting a rural representation of the Philippines. Analyzing reversible contraceptive methods showed the IUD in 1st place for continuation rates and effectiveness while the condom was in last place. Failure rates were unusually high for pills and condoms, suggesting a decline in effectiveness for nonprogram users. Nonprogram users preferred the natural methods of abstinence, withdrawal, and the rhythym method. All of these were used more extensively and successfully than were condoms, suggesting a benefit in promoting these methods for women resistant to contraception. Further analysis revealed positive correlations between continuation and desire to avoid childbearing, socioeconomic status, urbanization of place of residence, exposure to clinics and contraceptive information, family planning knowledge and experience, and spousal support. Contraceptive effectiveness was most strongly linked to exposure to family planning information. The authors conclude that contraceptive effectiveness is more reliable as an indicator of relative effectiveness than the conventional Pearl Pregnancy rates.

Kairomone-mediated host finding by spruce budworm egg parasite,Trichogramma minutum.

The host-finding responses of the egg parasite,Trichogramma minutum Riley, reared from its natural host,Choristoneura fumiferana (Clemens) and a laboratory host,Sitotroga cerealella (Oliver), to hexane extracts of scales of these hosts were compared in laboratory experiments. When presented withC. fumiferana eggs on filter papers treated with hexane and hexane extract of grain moth scales, egg finding byT. minutum was random. When presented with budworm eggs on filter papers treated with hexane and hexane extract of budworm scales,T. minutum found significantly more eggs on extract-treated filter papers, indicating the presence of kairomones on the scales of spruce budworms.T. minutum responded to kairomone-treated patches with a localized search behavior characterized by intense antennal tapping, decreased locomotion and increased turning within the patch, and repeated returns to the patch. In the absence of successful host finding, this response slowly waned. No significant difference in behavior ofT. minutum reared on eitherC. fumiferana orS. cerealella was observed.

A low volume burn resuscitation regimen: assessment of performance by probit analysis.

The findings are presented of a 10-year retrospective review of burn admissions to the Wessex Regional Burn Centre, where a low volume colloid resuscitation regimen is employed. An analysis of mortality probability has been conducted using probit analysis, and the areas of burn injury associated with a 50 per cent mortality probability (LA50) were determined for four different age groups. LA50 values obtained were 0-14 years 59 per cent body surface area (BSA) burn, 15-44 years 70 per cent BSA burn, 45-64 years 38 per cent burn, 65 years and over 17 per cent BSA burn. The figures obtained parallel closely those reported from another large burn centre in the United Kingdom where a widely different fluid regimen is used. The results of this analysis suggest that wide variations in fluid resuscitation regimens, particularly with regard to volume, do little to affect the mortality associated with burn injury as assessed by probit analysis.

Family planning in Bali.

Despite low per capita income and little evidence of economic development, the response to the government-sponsored family planning program in Bali has been remarkably favorable. After five years of government involvement, a total of 29 percent of eligible women are estimated to be using program methods, including 25 percent who have accepted IUDs, and 4 percent more are estimated to be using nonprogram methods. This level of performance is higher than in most other developing areas of the world. A number of the factors that might help to explain the success of the program in Bali are identified, and the future prospects for continued success are assessed.