Delayed cutaneous hypersensitivity: epidemiologic factors affecting and usefulness in predicting diarrheal incidence in young Peruvian children.

Cell-mediated immunity, as assessed by delayed cutaneous hypersensitivity, can be diminished by malnutrition and viral infections. In turn, decreased immune functioning might lead to more frequent or more severe infectious diseases. Delayed cutaneous hypersensitivity was assessed in young Peruvian children by simultaneous application of seven standardized antigens and a negative control (Multitest CMI). Response to tuberculin was frequent and was higher in children vaccinated with Bacillus Calmette-Guérin, response to tetanus or diphtheria toxoids was also good, especially in children who had received at least two doses of diphtheria-tetanus toxoids-pertussis vaccine. Two summary assessments, the number of positive responses and the sum of indurations of all positive responses provided useful measures of delayed cutaneous hypersensitivity. Responsiveness, as assessed by these summary measures, was inversely related to the incidence of diarrhea, identified by household surveillance for the 6 months after the skin test. Undernutrition, as assessed by weight for age or length for age, was also a significant determinant of the incidence of diarrhea, but not the duration of episodes, in this group of study children. Depressed cell-mediated immunity and malnutrition may be important risk factors for diarrhea in developing country children.

Discontinuity indices: a tool for epidemiological studies on breastfeeding.

BACKGROUND: The Discontinuity Index (DI), which measures the percentage of infants who were exclusively breastfed (EBF) at the beginning of a given age interval and had abandoned this mode of feeding at its end, and the relative weight of this discontinuation, was introduced and employed in the National Survey on Breast Feeding and Infant Feeding Practices carried out in Cuba in 1990. The aim of this article is to illustrate, through a specific example, the quality of DI as a simple procedure for assessing breastfeeding trends. METHODS: The prevalence of EBF in the 14 provinces of Cuba at discharge from the maternity services and at 30, 60, 120, and 180 days of age, was obtained using data from a national sample of 6661 infants (4820 urban and 1791 rural) which were processed by means of a logistic regression model. Cumulative DI were calculated for the intervals 0-30, 0-60, 0-120 and 0-180 days, and partial DI for the terms 30-60, 60-120 and 120-180 days, for each province and for the whole country. RESULTS: Cumulative DI show the progress of cessation of breastfeeding and are strongly influenced by previous intervals. The Eastern provinces showed the lowest figures at most of the terms. Discontinuation during the first month of life was particularly high in two Western provinces. Partial DI are more specific and allow discrimination of the intervals at which EBF discontinuation is more frequent. The highest values were observed between 4 and 6 months. CONCLUSIONS: Discontinuity indices are useful complements to prevalence rates in epidemiological studies of breastfeeding. The separate analysis of discontinuation in different periods can be highly useful when comparing trends and in the study of the impact of breastfeeding promotion programmes focused on different age intervals.

PIP: The Discontinuity Index (DI), which measures the percentage of infants who were exclusively breastfed (EBF) at the beginning of a given age interval and had abandoned this mode of feeding at its end, and the relative weigh of this discontinuation, was introduced and employed in the National Survey on Breast Feeding and Infant Feeding Practices carried out in Cuba in 1990. The aim of this article is to illustrate, through a specific example, the quality of DI as a simple procedure for assessing breastfeeding trends. The prevalence of EBF in the 14 provinces of Cuba at discharge from the maternity services and at 30, 60, 120, and 180 days of age, was obtained using data from a national sample of 6661 infants (4820 urban and 1791 rural) which were processed by means of a logistic regression model. Cumulative DIs were calculated for the intervals 0-30, 0-60, 0-120, and 0-180 days, and partial DIs for the terms 30-60, 60-120, and 120--180 days for each province and for the whole country. Cumulative DIs showed the progress of cessation of breastfeeding and were strongly influenced by previous intervals. The eastern provinces showed the lowest figures at most of the terms, and the opposite occurred in the central and western ones. Discontinuation during the first month of life was particularly high in the city of Havana and Matanzas, two western provinces. At 4 months, 74.9% of all the infants who started EBF had abandoned it. DIs were above 99% in two western provinces, Pinar del Rio and Matanzas, whereas the national mean for this age was 90.6%. Partial DI (between 2 given ages) were more specific and allowed discrimination of the intervals at which EBF discontinuation was more frequent. The highest values were observed between 4 and 6 months. Only the city of Havana showed the highest DI between 2 and 4 months. Discontinuity Indices are useful complements to prevalence rates in epidemiological studies of breastfeeding.

The incidence of injuries in young people: I. Methodology and results of a collaborative study in Brazil, Chile, Cuba and Venezuela.

Injuries and accidents are acknowledged as leading causes of mortality among children and adolescents in the developing countries of the world. However, little is known of the extent of non-fatal injuries and of their potential risk factors. The Pan American Health Organization sponsored the first collaborative study to examine morbidity incidence in specified areas of four selected countries in Latin America, and to test the feasibility and practicality of the developed methodology for application in other regions of the world. The study subjects were injured children and adolescents (0-19 years of age) presenting at the study hospitals in the chosen urban centres, as well as injured that were surveyed in households in the catchment area of the hospitals. Falls constituted the most common (40-52%) cause of injury in all areas, and tended to occur in the younger age groups. Motor vehicle injuries were not as frequent (5-24%) as expected from mortality studies. Males outnumbered females 2:1. The home was the most frequent (37-57%) site of injuries, especially for younger ages. Few received medical care at the site of the injury or en route to a hospital, if they went at all. The results found are consistent with those found in other studies in the developed world. The study methodology provides initial valid information for investigating the injury situation in countries with limited resources.

Isolation and characterization of a fibrinogen-clotting enzyme from venom of the snake, Lachesis muta muta (Peruvian bushmaster).

A fibrinogen-clotting enzyme from the venom of the Peruvian bushmaster snake was purified to homogeneity by gel filtration on Sephadex G-100 followed by DEAE-cellulose ion-exchange chromatography using a linear ionic strength gradient with NaCl. The specific activity of the enzyme was 866 NIH U/mg, representing a 55-fold purification, with a recovery of 45%. The amino acid composition was Asx30, Thr14, Ser15, Glx33, Pro23, Gly22, Ala15, Val22, Cys18, Met3, Ile18, Leu23, Tyr2, Phe13, His8, Lys11, Arg11. The total carbohydrate content was 13.4%, comprised of 3.4% hexose, 8.7% hexosamine and 1.3% sialic acid. The enzyme was active against the synthetic amide substrate alpha-N-benzoyl-DL-arginine-p-nitroanilide (BAPNA) and against the ester substrates alpha-N-benzoyl-L-arginine ethyl ester (BAEE) and tosyl-L-arginine methyl ester (TAME). Kinetic parameters for TAME esterolysis were: Vmax, 135 mumoles/min/mg and Km, 2.5 x 10(-4) M. The pH optimum was 8.0. Vmax for BAPNA amidolysis was 0.363 mumoles/min/mg and Km, 7.5 x 10(-5) M. Enzyme activity was reduced by diethylpyrocarbonate and by photo-oxidation, suggesting that the enzyme is a serine protease with a histidine residue involved in the active site. The enzyme released fibrinopeptide A rapidly from purified human fibrinogen and fibrinopeptide B more slowly. Factor XIII was not activated and the clotting activity was not inhibited by heparin. A dose of 50 micrograms/kg brought about defibrinogenation in anaesthetized rats but rabbits were unaffected. A dose of 80 micrograms/kg defibrinogenated conscious rats after 5 hr. There were no hypotensive or haemorrhagic effects.

Feeding during acute diarrhea as a risk factor for persistent diarrhea.

Dietary intake during diarrhea in children less than three years of age was estimated from information recorded on illustrated dietary forms used by children's caretakers during the first week of illness in a prospective community-based study of diarrheal diseases in Lima, Peru. The frequency of consumption and the amount consumed of food groups and selected commonly consumed foods were analyzed by the final duration of the diarrheal episode. Cereals were less frequently consumed during the acute phase of diarrheal episodes that ultimately became persistent (> 14 days' duration), apparently shortening the duration of the episode by one day (median duration of four days in children not consuming vs three days in children consuming cereals during diarrhea, p < 0.02 Kaplan-Meier log-rank test). Only roots and tubers (mainly potatoes) were consumed in greater quantity during episodes that became persistent. There was no evidence that consumption of breast milk or non-maternal milk was associated with an alteration in diarrheal duration. This study provides further evidence of the beneficial effects of continuing feeding during diarrhea using foods available at the home level, especially cereals, which are commonly used in the diet of young children.

[Infant mortality in cuba; analysis of a program for its reduction (1970-1976)]. / Mortalidad infantil en Cuba; análisis del programa para su reducción (1970-1976).

Analysis is made of the results of the reduction program of infantile mortality which began in 1970. Said reduction dropped from 38.7 in 1970 to 22.8 per thousand live births in 1976, for a diminution of 41.5%. The early neonatal decreased from 18.2 to 12.3 per thousand live births for a drop of 32.7%. The late noenatal decreased from 5.3 to 2.30/100 live births with 57.2% reduction and the postneonatal dropped from 15.2 to 8.2 per thousand live births for a diminution of 46.5%. Infantile mortality is reported for the different departments and the order in which the main causes of death are grouped is stressed as follows; 1st, perinatal affections (B43-B44); 2nd, congenital anomalies (B42); 3rd, influenza and pneumonia (B31-B32); 4th, enteritis and other acute diarrheal diseases (B4) AND 5th, sepsis (A21). The average number of puericulture office visits per infant under 1 year of age increased from 2.7 to 6.7. Institutional births increased from 93.3 to 97.8%. The steps taken to achieve these results are described.

[Acute diarrheal diseases in Cuba]. / Las enfermedades diarreicas agudas en Cuba.

A brief description is made of how acute diarrheal diseases, known as gastroenterites, were the cause of diseases and death since the beginning of the Republic. Different results of works carried out by different authors on the mortality due to such diseases is reported. Statistical data show the situation in Latina America according to the criteria of several authors and synthesis is made of the general picture of diarrheal diseases in Cuba, beginning on the decade of 1960. The different causes of these acute diarrheal diseases in our country are analyzed and all the plans and control programs that have been developed up to the presented with the idea of eradicating these diseases are pointed out.

[Maternal and child health in Cuba, 1978: history, present situation and perspectives]. / Salud maternoinfantil en Cuba, 1978: antecedentes, situación actual y perspectivas.

The programs and activities that were developed from the first years of the 1960's devoted to improve, in a general sense, the people's health are stated. The present state of mother-and child-health is exposed and analysis is made on population, natalily, demographic growth, human resources, availability of beds, mother-and child-care units, nursing personnel, organization of mother-and child-care and programs for the integral care to woman and the child. The working prospectivenesses for the coming years, lead to maintain the successes reached as well as to solve other problems derived from the development obtained, are presently considered and reviewed.

Epidemiologic, clinical, and laboratory characteristics of acute vs. persistent diarrhea in periurban Lima, Peru.

Longitudinal studies of acute and persistent diarrhea in 677 children less than 3 years old were conducted for 27 months in an underprivileged, periurban community near Lima, Peru. Incidence rates and accurate durations of diarrhea were obtained by twice-weekly community-based surveillance and clinical and laboratory features of diarrheal episodes were documented. Study children had an overall incidence of diarrhea of 8.1 episodes per child-year and an incidence of persistent (greater than 14 days) diarrhea of 0.25 episodes per child-year. Episodes of longer duration were associated with young age (0-5 months) and more severe illness (greater than or equal to 6 diarrheal stools per day) in the first week. None of the laboratory tests performed in the first week of illness (fecal leukocytes, blood, reducing substances, pH, or fat) proved of value to identify episodes that would become persistent. Although steatorrhea was commonly present in the acute phase of the illness, it became less frequent by the third or subsequent week of illness in the persistent diarrheas. These results suggest that there are no clinical or laboratory features of acute diarrhea that are strongly predictive of the subset of diarrheas that persist. Thus, it is important that all diarrheal episodes should have appropriate fluid and dietary management and follow-up to detect the persistent diarrheas that may need special intervention.

[Infant mortality in Cuba, 1970-1979]. / Mortalidad infantil en Cuba, 1970-1979

PIP: The authors examine the various factors associated with the decline in infant mortality in Cuba between 1970 and 1979. Variations in infant mortality by province, causes of death, and the role of infant health services are discussed. (summary in ENG, FRE, GER, )^ieng

[Infant mortality in Cuba in the 1970-1979 decade]. / Mortalidad infantil en Cuba, en el decenio 1970-79.

PIP: This paper discusses the 50% reduction in infant mortality achieved in Cuba during the decade 1970-1979. After an analysis of the various factors that contributed to such a reduction, it is pointed out that early neonatal mortality during that period declined by 36.2%; late neonatal mortality by 67.2%, and postnatal mortality by 59.3%. By province, the lowest mortality rates were in Matanzas (14.9%), Villa Clara (15.6%), and the city of Havana (16.2%). The highest rates were in Las Tunas (26.1%), Guantanamo (24.1%), and Granma (23.9%) in infants of 1 year of age/1000 live births. With respect to cause of death, diarrheal diseases dropped from 2nd to 6th place, with a reduction of 71.4% in mortality. As a result of decreases in other causes, congenital malformations moved up to 2nd place. Also, acute respiratory diseases were lowered by 43.4%. Furthermore, it is pointed out that 11 consultations/delivery and 6.7 checkups/healthy infant under 1 year of age were attained as an annual average. In the same decade, the birth rate declined from 27.7 to 14.7/1000 inhabitants. (author's)^ieng

Transmission factors and socioeconomic status as determinants of diarrhoeal incidence in Lima, Peru.

As part of a longitudinal, community-based study of diarrhoeal morbidity in a peri-urban community in Lima, Peru, a household survey was administered to ascertain possible risk factors, based on transmission routes, for diarrhoeal incidence. Socioeconomic information was also obtained in the survey and a composite socioeconomic status (SES) indicator was created based on four variables: income (wealth), ownership of 4 functioning electrical household appliances, community participation, and house construction. Both transmission factors and the SES indicator were analysed for their effects on diarrhoeal incidence using both bivariate and multivariate methods. The SES indicator, method of water storage, if the child was seen eating faeces or soil were all significantly associated with diarrhoeal incidence. In a final logistic model, water storage, location of defecation for children, child eating soil or faeces, and age, demonstrated significant results. Children in households with water stored in containers without a faucet were twice as likely to have a high incidence of diarrhoea (greater than 7 episodes/child/year). The SES indicator was not significant in the logistic model, but high SES was associated with whether or not the child was reported as having been seen eating faeces or soil and with non-use of latrines by adults. Also low SES households were more likely to have better water storage methods. Therefore, it would seem that (SES) does not independently determine diarrhoeal incidence, but rather may be functioning through these transmission factors to affect diarrhoeal incidence.

[Breast-feeding trends in Cuba and the Americas]. / Tendencias de la lactancia materna en Cuba y las Américas.

To determine breast-feeding trends in the Region of the Americas and compare them with those observed in Cuba in the last decade, information was complied from a select group of national surveys conducted in the 1970s on the prevalence and duration of breast-feeding and then compared with information from a survey carried out in Cuba in 1973. In addition, data were taken from document HPN/92.7 of the Pan American Health Organization, which contains reports corresponding to the period 1986-1991, and these were compared to the results of the national study carried out in Cuba in 1990. The discontinuation rate (DR) was also calculated. The study found a sustained pattern of initial breast-feeding of a relatively high proportion of babies, with rapid declines in subsequent days and low prevalence of exclusive breast-feeding. In most countries, prevalence and duration showed a tendency to increase. In Cuba intermediate values were observed with a discrete decline in initial prevalence, increases up to 180 days, and lower DR values up to 90 days in 1990 as compared to 1973. This suggests that there have been favorable changes in the factors that help to prolong the duration of breast-feeding. Calculation and analysis of the DR at various intervals proved useful for comparing the trends observed in the different countries.

Breast-feeding trends in Cuba and the Americas.

In order to analyze breast-feeding trends in the Region of the Americas vis-à-vis trends observed in Cuba, information was culled from a selection of national surveys on the prevalence and duration of breast-feeding conducted in the 1970s and compared with the results of a national survey carried out in Cuba in 1973. Similarly, information from PAHO Document HPN/92.7, which contains reports from countries of the Americas for the period 1986-1991, was compared with the results of the National Survey carried out in Cuba in 1990. A cessation index (CI) was calculated with a view to comparing the relative extent to which the cessation of breast-feeding occurred at different ages in the two time periods. The study revealed a consistent pattern: typically, a relatively high percentage of newborns were initially breast-fed, but the prevalence of exclusive breast-feeding was low and the percentage of breast-fed infants declined quickly. However, the more recent data showed improvements in most of the countries involved with respect to both the prevalence and duration of breast-feeding. Cuba was found to have intermediate values relative to the other countries. Although a slight decline in the initial prevalence of breast-feeding was observed in 1990 (as compared to 1973), notably higher percentages of infants were being breast-fed at 30, 60, 90, and 120 days, and the CI values for the corresponding intervals up to 90 days were lower. These results suggest that positive changes have taken place in factors promoting a longer duration of breast-feeding.

Immunogenicity, safety and protective efficacy of one dose of the rhesus rotavirus vaccine and serotype 1 and 2 human-rhesus rotavirus reassortants in children from Lima, Peru.

In a four cell trial, a single 10(4) plaque-forming unit dose of rhesus rotavirus (RRV) vaccine (serotype G3), a human rotavirus-rhesus rotavirus reassortant vaccine with serotype G1 specificity, a similar vaccine with serotype G2 specificity, or a placebo was administered with buffer orally at 2 months of age to 800 Peruvian infants. Only the RRV vaccine was associated with a febrile response (< 38 degrees C) that occurred in 9% of the infants on day 4 after vaccination. Diarrhea or other side-effects were not associated with administration of vaccine. Vaccine strains were shed by only 12-18% of the infants as determined by examination of a single stool specimen obtained on days 4 or 5 after vaccination. Fifty per cent of vaccines developed an IgA ELISA seroresponse; however, a serotype-specific seroresponse by plaque reduction neutralization was demonstrated in < 20% of the participants against each of the three candidate vaccine strains. Vaccine efficacy was evaluated by twice-weekly home surveillance for diarrheal diseases during 24 months post-immunization. Rotavirus diarrheal episodes were identified by ELISA. Only the RRV vaccine had a significant protective efficacy (29%, p = 0.03, chi-square test) against rotavirus diarrhea. Analysis of vaccine efficacy against rotavirus episodes of any severity in which no other enteropathogen was isolated showed a trend towards higher vaccine efficacy. In addition, a similar trend was observed in rotavirus-only episodes in which there was some degree of dehydration or when health services were utilized. Serotype G1 or G2 rotavirus strains were most prevalent during surveillance. Neither serotype G1 or serotype G2 vaccines were protective against serotype 1 or 2 rotavirus diarrhea, respectively. The serotype G2 vaccine was 84% protective against serotype 1 and 2 dehydrating rotavirus diarrhea in the small numbers of individuals evaluated. We conclude that one dose of 10(4) p.f.u. of the RRV, serotype G1, or serotype G2 rotavirus vaccine failed to induce either an adequate serotype-specific seroresponse or serotype-specific protection in children immunized at 2 months of age. Only the RRV vaccine induced a low level of protection against rotavirus diarrhea mainly of serotype G1 specificity. Future studies need to explore whether higher vaccine dose and/or more than one dose would increase the immunogenicity and efficacy of the rotavirus vaccine, especially in developing countries with a high level of baseline rotavirus antibodies.

Salud maternoinfantil en Cuba: situación actual y perspectivas / Mother-and child-health in Cuba: present state and prospectivenesses

Se plantean los programas y actividades que se desarrollaron desde los primeros años de la década de 1960 destinados a mejorar en sentido general la salud del pueblo. Se expone la situación actual de la salud maternoinfantil, y se analizan la población, natalidad, crecimiento demográfico, recursos humanos, recursos-camas, unidades para la atención maternoinfantil, personal de enfermería, organización de la atención maternoinfantil, programas de atención integral a la mujer y al niño. Se exponen las perspectivas de trabajo en los próximos años, encaminando a mentener los éxitos alcanzados, así como a solucionar otros problemas-producto del desarrollo obtenido-y que actualmente son considerados(AU)

Enfermedades diarreicas agudas en Cuba. / Acute diarrheal diseases in Cuba

Se revisa la evolucion y el estado actual de las enfermedades diarreicas en la Republica de Cuba

Mortalidad infantil en Cuba, en el de cenio 1970-1979. / Infant mortality in Cuba, in the decade 1970-1979

Con anterioridad a 1959 y durante los primeros anos del decenio de 1960, las cifras existentes sobre mortalidad infantil en Cu ba eran poco fidedignas. Sin embargo,debido a sucesivas mejoras en la consecucion de los datos, desde 1968 se han comenzado a conocer en detalle los distintos componentes de la mortalidad infantil y se han precisado las causas de muerte

Sexualidad y menopausia en mujeres mayores de 39 años / sexuality and menopause in older than 39 year-old women

Objetivo: Determinar las características de la sexualidad en mujeres mayores de 39 años en una región de la selva peruana. Material y métodos: Encuesta de 25 preguntas sobre sexualidad, con alternativas puntuales múltiples, anónima y voluntaria, a 145 mujeres mayor 40 años. Resultados: Ciento veinte mujeres resolvieron adecuadamente la encuesta. El 78,3 por ciento era menopáusica; 45,8 por ciento hace dos años que no disfrutaba el sexo con su pareja, lo que se correlacionó con la edad mayor 60. Quienes todavía gustaban del sexo eran casadas o convivientes y generalmente menor 50 años. Los factores asociados a no disfrutar del sexo, fueron falta de deseo y dispareunia. El 38,3 por ciento deseaba que su vida sexual fuera como antes. Hubo una estrecha relación entre la falta de deseo y la respuesta negativa a esta pregunta (p menor 0,001). Conclusiones: Las mujeres de Lamas dejaron de encontrar placer sexual entre los 50 y 60 años. Para la vida sexual, el hecho de menstruar no se asoció con el placer sexual. Quienes tuvieron una vida sexual adecuada, deseaban seguir teniendo buena sexualidad, factor incluso más importante que la edad.