Bioactive furonaphtoquinones from Tabebuia barbata (Bignoniaceae).

Tabebuia barbata (E. Mey) Sandw. (Bignoniaceae), locally known as "palo de arco", is indigenous to the upper Orinoco and Amazonas rivers. Brine shrimp lethality-directed fractionation and extensive column chromatography, normal-phase preparative TLC and normal-phase HPLC separation of the ethanol extract of the bark of this previously uninvestigated species has led to the isolation of five active compounds 1-5. The combined spectral evidence (UV, IR, 1H and 13C NMR and mass) identified these compounds as naphthoquinones. These compounds, characterized as lapachol (1), 2-acetylnaphtho-[2,3-b]-furan-4,9-dione (2), 2-acetyl-5-hydroxy-naphtho-[2,3-b]-furan-4,9-dione (3), 2-acetyl-8-hydroxy-naphtho-[2,3-b]-furan-4,9-dione (4), and (+)-8-hydroxy-2(1-hydroxy-ethyl) naphtho-[2,3-b]-furan-4,9-dione (5), were reported previously from other species of the genus Tabebuia but not from T. barbata. Compounds 2-5, reference adriamycin, were significantly cytotoxic against A-549 human lung adeno-carcinoma, MCF-7 human breast carcinoma, and HT-29 human colon carcinoma cells. The compounds isolated (1-5) were also shown to be inhibitors of electron transport in rat liver mitochondria, reference to rotenone, with IC50 values in the range of 15 microM to 82.5 microM. In addition, this study demonstrated that screening and activity-directed fractionation, using brine shrimp lethality as a simple and inexpensive bioassay, can effectively lead to potential antitumor compounds.

A lifetable analysis of sterilization failure: data from the Profamilia Clinic, Bogota, Colombia.

Sterilization failure rates were computed using lifetable methods for sterilizations occurring between 1973 and 1982 in the Profamilia family planning clinic in Bogota, Colombia. Out of a total of nearly 45,000 sterilizations occurring during this period 503 sterilization failures were detected. Comparing methods, laparoscopy with the silastic band method had a significantly higher rate of failure, 1.5% after 5 years compared to 0.9% for laparoscopy with cautery and 0.6% for minilaparotomy.

Contraceptive use and fertility in Guatemala.

In 1983, one-quarter of married Guatemalan women aged 15-44 years were using contraception, and female sterilization was the most prevalent method. Fertility rates for the population were at correspondingly high levels, with an overall total fertility rate of about six births per woman. Contraceptive prevalence varied by residence and ethnic group; less than 5 percent of currently married Indian women and about 50 percent of married women in the capital city area were using contraception. From 1978 to 1983, prevalence increased overall by six percentage points, with surgical contraception accounting for most of the increase. Findings of the study suggest that different strategies need to be employed among Ladino and Indian women in order to increase contraceptive prevalence in these subgroups.

PIP: A 1983 survey shows that Guatemala continues to have a relatively low level of contraceptive use by Latin American standards. However, by comparing the results of the 1983 survey with those of a similar survey conducted in 1978, it is clear that contraceptive use has increased slightly. During the 5-year interval between these surveys, the % of married women aged 15-44 years old who were using contraception increased from 19 to 25%. Most of the increase in prevalence was in the use of sterilization, which was found to be the most prevalent method in both surveys. This report describes the results of the 1983 Family Planning and Maternal/Child Health Survey conducted in Guatemala. Also discussed are trends in fertility, breastfeeding, contraceptive use, source of contraception, and women at risk of unplanned pregnancies since the 1978 survey. The 1983 data indicate that mean parity was higher for Indian women than for Ladino women at every age above 20. The mean parity for all women in the 1983 survey is slightly less than that of women in the 1978 survey, but of generally the same magnitude. Overall, the mean duration of breastfeeding estimated from the 1983 survey is 18 months. Postpartum amenorrhea averages about 12 months for all groups. A comparison of duration of breastfeeding for respondents in the 1978 survey with those in the 1983 survey provides no evidence of a trend away from breastfeeding in Guatemala. Overall, 1/4 of married women aged 15-44 were using contraceptive methods at the time of the 1983 survey. The most prevalent method was female sterilization (10%), which, together with male sterilization, accounted for 45% of all contraceptive use. The 2nd most commonly used method, oral contraceptives, had a relatively low prevalence of 5%, followed by rhythm, the IUD, injectables and vaginal methods, and finally, the condom. Contraceptive use also varied by age, reaching a peak among married women 30-39 years old and was lowest for those 15-24. Use of contraception was strongly related to education, being lowest among women with little or formal education. Results in general suggest that contraceptive use is part of a larger predisposition among women to use modern health care. Among Indians, the major reason given for nonuse of contraceptives unrelated to pregnancy was lack of knowledge of contraception or where to obtain family planning services. Among Ladinos, the most frequently mentioned reason was fear of contraception or fear of side effects. The methods of choice for nonusers desiring to use a method were oral contraceptives (27%), sterilization (18%) and injectables (14%). The survey data indicate that the family planning program in Guatemala should be oriented toward high parity, married, nonworking women living in the interior, both Ladino and Indian, who have less than a primary school education. Family planning efforts need to incorporate different approaches for Ladino and Indian women.

Breastfeeding and use of the health care system in Bahia State, Brazil: three multivariate analyses.

Three multivariate methods--deviation from total proportion breastfeeding, polynomial regression, and proportional hazards--are used on current status breastfeeding data to explain an inverse relationship between use of the health care system and breastfeeding in Bahia State, Brazil. Among the intervening variables analyzed--urban/rural residence, educational attainment, age of woman, and place of last live birth--education and place of last live birth are found to have a net effect on breastfeeding by all three methods of analysis. The advantages and disadvantages of each method are described.

PIP: The health care system in northeastern Brazil (Bahia State) should be encouraging breast feeding, but data suggest that women who use the system breast feed for a shorter time than those who do not use the system. The question posed in the multivariate analysis is whether this relationship is due to the association between the use of health care and socioeconomic status, residence, or demographic characteristics. 3 multivariate methods--deviation from total proportion breast feeding, polynomic regression, and proportional hazards--are compared. Data were obtained as part of the 1980 Northeastern Brazil Survey of Maternal-Child Health and Family Planning. The survey was a statewide sample of households with 1 woman of childbearing age (15-44) selected/household. Interviews were obtained with 2091 women. All had births 1-24 months before the interview. Measures of the entent and duration of breast feeding for selected variables are given, as are zero-order correlation coefficients for the polynomial regression method with current breast feeding status as a dependent variable. The proportion of women who are currently breast feeding is given by 2 regression methods, as is the net effects on the proportion currently breast feeding. Estimated coefficients for the proportional hazards method are also given, as is the relative risk of weaning in the same multivariate analysis model. The results of the comparisons made suggest that, of variables considered--educational status, urban/rural residence, age, and place of last live birth--only education and place of last live birth are found to have a net effect on breast feeding.

Contraceptive use and fertility in the Republic of Panama.

Panama has a high prevalence of contraception, with surgical sterilization being the dominant method. Use of contraception is fairly high even in rural areas. Seventy-one percent of users named a public sector source for their contraception. High use of contraception is part of an overall program of public sector maternal and child health services that also shows substantial penetration of rural areas. The high reliance on public sector sources in panama distinguishes it from other Latin American populations with comparable levels of contraceptive use, such as Sao Paulo state, Brazil, and Costa Rica. These populations also differ in that oral contraceptives are the most prevalent method of contraception. The survey results indicate that the risk of unplanned pregnancy is greatest for unemployed married women who have children. It is particularly important to expand program coverage in rural areas, where two-thirds of those at risk of unplanned pregnancies reside; risk of an unplanned pregnancy for rural women is more than twice that for urban women. While unmarried teenage women do not appear to constitute an important group by this definition, there are other compelling reasons, some supported by other results of the survey, for a special effort oriented toward teenagers. The experience of Panama may be unique in many ways. It shows that an integrated MCH-FP public sector program can meet a high demand for surgical contraception and achieve a fairly high level of contraceptive use. Finally, the results illustrate the value of periodic surveys to gauge the impact of public health programs by monitoring trends in contraceptive use, fertility, breastfeeding, and other aspects of reproductive health.

Determinants of fertility in Guatemala.

The 1978 Contraceptive Prevalence Survey for Guatemala provides an opportunity to examine fertility levels and a number of determinants of fertility for three broad segments of the country: the Department of Guatemala and, in the remainder of the country, the Ladino and Indian populations. While Ladinos had a much higher rate of contraceptive use than did Indians, the two groups had similar birth rates. The lack of difference in fertility appears to be due to the pattern of prolonged breastfeeding among Indians and perhaps to differences in the rate of conception due to nutrition, coital frequency, or other factors.

PIP: The Contraceptive Prevalence Survey for Guatemala examined fertility levels and determinants of fertility for the Department of Guatemala and for the rest of the country which encompasses the Ladino and Indian populations. Survey data were evaluated and found to be consistent with data from other sources; for example, there seems to be little difference between the 2 ethnic groups insofar as fertility rates are concerned. Various factors which affected fertility included contraceptive use, nuptiality, and mortality. The prevalence rate of contraceptive usage for Indians was extremely low, and while the fertility levels of the 2 groups are similar, there is a wide difference in contraceptive use rates. Clearly there are other factors at work which help to diminish the differences in fertility between the 2. The proportion of women in marital unions is another factor which supports observed fertility differences. 50% of those in the Department of Guatemala as compared with 70% of the Ladinos and 80% of the Indians are married. Increasing child mortality is seen as one moves across the 3 groups; this can affect fertility in a population by terminating lactation and curtailing postpartum amenorrhea. Undernutrition and its effects on fertility is a matter of controversy; however, portions of the Guatemalan population are undernourished. While studies from various areas imply that the effects of nutrition on fertility variation is unlikely to be great, it may have some bearing on the lack of difference between Indians and Ladinos. The impact of induced and spontaneous abortions on fertility rates are insignificant but it may be important for some parts of the population. Breastfeeding, on the contrary, exerts a substantial effect on fertility. Despite the fact that Indians have a low rate of contraceptive usage, their fertility is low relative to what might be expected under conditions of natural fertility. While the 2 groups had similar birth rates, the Ladinos had a higher level of contraceptive usage; similarities in fertility seem due to prolonged breastfeeding among the Indians and differences in conception rate due to nutrition, coital frequency, etc.

Contraceptive prevalence in Paraguay.

Contraceptive use, source of contraception, history of abortion, current pregnancy intention, and fertility rates are evaluated for a national sample of women using data from the Paraguay Contraceptive Prevalence Survey, conducted in 1977. The survey found that 15.5 percent of all women aged 15--44 and 23.6 percent of ever-married women were using effective contraceptive methods. The urban/rural difference in contraceptive use paralleled fertility differentials: over 40 percent of ever-married women were using contraception in Greater Asuncion and other urban areas compared with 15 percent in rural areas. Overall, the data indicate that high-parity rural women have the greatest need for family planning services in Paraguay.