RESUMEN

This study analysed the impact of changing family structure on income distribution. Specifically, it analysed how changes in the proportions of different categories of family in the population contributed to increases in the income of the richest and poorest social strata in Brazil, and the consequent impacts on income inequality. Rural and urban families were compared in order to understand how these dynamics had different impacts on more developed (urban) and less developed (rural) areas. The results emphasize how changes observed in family structure are more pronounced among the richest families, contributing to an increase in (i) the income of the richest families and (ii) income inequality between the richest and poorest families, as well as between urban and rural areas.

Asunto(s)

Composición Familiar , Renta/estadística & datos numéricos , Dinámica Poblacional/estadística & datos numéricos , Adulto , Distribución por Edad , Tasa de Natalidad , Brasil , Humanos , Persona de Mediana Edad , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos

RESUMEN

PIP: This document presents the results of the Bolivia Demographic and Health Survey (DHS), or Encuesta Nacional de Demografia y Salud 1998, conducted by the Instituto Nacional de Estadistica, La Paz, Bolivia, within the framework of the DHS Program of Macro International. Data were collected from 12,109 households and complete interviews were conducted with 11,187 women aged 15-49. A male survey was also conducted, which collected data from 3780 men aged 15-64. The information collected include the following: 1) general characteristics of the population, 2) fertility, 3) fertility preferences, 4) current contraceptive use, 5) contraception, 6) marital and contraceptive status, 7) postpartum variables, 8) infant mortality, 9) health: disease prevention and treatment, and 10) nutritional status: anthropometric measures.^ieng

Asunto(s)

Lactancia Materna/estadística & datos numéricos , Trastornos de la Nutrición del Niño/epidemiología , Anticoncepción/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Diarrea Infantil/epidemiología , Fertilidad , Mortalidad Infantil , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Intervalo entre Nacimientos , Bolivia/epidemiología , Preescolar , Anticoncepción/métodos , Demografía , Diarrea Infantil/terapia , Educación , Composición Familiar , Femenino , Fluidoterapia , Encuestas Epidemiológicas , Humanos , Lactante , Mortalidad Infantil/tendencias , Trastornos de la Nutrición del Lactante/epidemiología , Recién Nacido , Estado Civil , Persona de Mediana Edad , Madres , Estado Nutricional , Población Rural , Población Urbana

RESUMEN

OBJECTIVE: To analyze the influence of parental stature and environmental factors on the stature of adolescents from a national survey sample. METHODS: A nationwide survey was carried out in 1989 among a stratified, two-stage, probability cluster sample of 14,455 Brazilian households to provide estimates of anthropometric deficits for urban and rural populations from the five regions of the country. Stature was measured for 5681 boys and girls age 14-18 years, 78.9% of their fathers, and 93.8% of their mothers. Associations between explanatory variables and adolescent height in centimeters were assessed by fitting multiple linear models to the data. RESULTS: The predicted effects of parental stature and environmental conditions together sum to a total of 17 cm when comparing a boy born to parents with stature below the median and living in the underdeveloped rural Northeast region (1.56 m) with one born to parents with stature above the median and living in the partially industrialized urban South region (1.73 m). For girls, this estimated difference was 12 cm. For boys, the overall influence of parents' stature was 10 cm (R(2)= 0.40) and the sociodemographic factors had an overall influence of 7 cm (R(2) = 0.29). For girls, these values were 7 cm (R(2)= 0.35) for the parental influence and 5 cm (R(2) = 0.11) for the sociodemographic factors. CONCLUSIONS: Mother's stature had the same influence on adolescent's stature as father's stature. Independent of parental stature, environmental factors have a strong influence on adolescent stature, particularly among boys.

Asunto(s)

Adolescente/fisiología , Estatura/fisiología , Padres , Factores Socioeconómicos , Antropometría , Sesgo , Brasil , Análisis por Conglomerados , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Lineales , Masculino , Valor Predictivo de las Pruebas , Características de la Residencia , Salud Rural , Caracteres Sexuales , Distribución por Sexo , Salud Urbana

RESUMEN

PIP: This article asks how family relationships affect the living conditions of low-income elderly people in urban Mexico. The existence of so many elderly women living alone in the country is at odds with cultural beliefs portraying mothers as the archetypal recipients of family charity. It is evident that there is little state provision of accommodation for the elderly, forcing older people to rely on their families for care. Living with family is usually thought to be a better option for older people. Yet many poorer families cannot afford to provide care, and some are not willing to do so. In addition, families treat elderly men and women differently, with significant consequences for housing conditions and well-being of men and women in later life.^ieng

Asunto(s)

Anciano , Relaciones Familiares , Vivienda , Investigación , Factores Sexuales , Adulto , Factores de Edad , Américas , Demografía , Países en Desarrollo , Composición Familiar , Geografía , América Latina , México , América del Norte , Población , Características de la Población , Características de la Residencia

RESUMEN

This study examines the relationships among health-related quality of life (HRQL), social support, sociodemographic factors and disease-related factors in persons infected with the human immunodeficiency virus (HIV) living in Venezuela. A sample of 118 HIV-infected persons living in Caracas, Venezuela, was surveyed using a written questionnaire that included a Spanish translation of the Interpersonal Support Evaluation List (ISEL) developed for this study, the Medical Outcomes Study Short Form-36 (SF-36) and a symptom inventory. All three instruments showed good internal consistency reliability. Multiple regression analyses were used to model SF-36 sub-scale scores as a function of symptoms, social support, HIV-status and use of antiretroviral drugs. The models explained between 16 and 39% of the variance in the different HRQL domains. Controlling for other variables in the model, level of symptomatology was significantly associated with all HRQL domains except social functioning and role-emotional scores. Social support was significantly associated with all HRQL domains except physical functioning and bodily pain. The use of antiretroviral drugs was significantly associated with social functioning. The study indicates the importance of social support to the quality of life of HIV-infected individuals in this culture.

Asunto(s)

Infecciones por VIH/psicología , Calidad de Vida , Apoyo Social , Adulto , Factores de Edad , Anciano , Análisis de Varianza , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Reproducibilidad de los Resultados , Factores Socioeconómicos , Encuestas y Cuestionarios , Venezuela/epidemiología

RESUMEN

PURPOSE: To identify characteristics within the family that were associated with adolescent pregnancy in a group of adolescent girls in Quito, Ecuador. METHODS: Of 135 female adolescents (12-19 years of age), 47 were pregnant and seen at the adolescent prenatal care clinic at an inner city hospital in Quito, and 88 were students from schools located within the same geographic area. Family variables were compared for pregnant and nonpregnant adolescents using chi-square, Student's t-test, and analysis of variance. RESULTS: More nonpregnant adolescents lived with their biological parents when compared with their pregnant peers (p < .002). Pregnant adolescents reported lower mother-daughter and father-daughter communication (p < .02), lesser life satisfaction and happiness in general, and more school and economic difficulties (p < .001). They were less likely to find support for their problems in or outside the family (p < .0001) and showed higher levels of depression and sexual abuse than their nonpregnant peers (68.8% vs. 34.5%, and 14.9% vs. 4.5%, respectively). Nonpregnant adolescents showed higher school performance and expectations regarding school achievement and future perspectives (p < .001). Values such as respect for others and religiosity were higher among nonpregnant adolescents (p < .0001). Parental education was lower in the families of pregnant adolescents (p < .05). Among nonpregnant adolescents, both parents worked outside the home (p < .006), whereas mothers of pregnant adolescents usually stayed at home. CONCLUSION: The current study showed that parental separation or divorce, and poor parent-daughter communication were associated with adolescent pregnancy. Families of nonpregnant adolescents had a higher educational level, and both parents worked to provide financial support to the family in an environment where family authority is shared by both parents. There were also better problem-solving strategies and parent-daughter communication, higher levels of cohesion, connectedness, and life satisfaction in general, and higher future expectations.

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PIP: This paper presents the study on the family risk factors associated with adolescent pregnancy among adolescent girls and their families in Quito, Ecuador. The study aimed to identify characteristics within the family associated with adolescent pregnancy. A total of 135 female adolescents (aged 12-19 years) and their families were separately interviewed. 47 were pregnant and attending prenatal care at an inner city hospital in Quito, and 88 were nonpregnant students from schools located within the same geographical area. Results showed that when compared to their pregnant peers, more nonpregnant adolescents lived with their biological parents (p 0.002); they showed higher school performance (p 0.001); and more values and religiosity (p 0.0001). Pregnant adolescents reported lower mother-daughter and father-daughter communication (p 0.02), lesser life satisfaction in general, and more school and economic difficulties (p 0.001). Moreover, they were less likely to find support for their problems in or outside the family (p 0.0001) and showed higher levels of depression (68.8%) and sexual abuse (14.9%). Parental education was higher in the families of nonpregnant adolescents and both parents worked to provide financial support for the family.

Asunto(s)

Relaciones Familiares , Embarazo en Adolescencia/estadística & datos numéricos , Adolescente , Adulto , Análisis de Varianza , Niño , Ecuador/epidemiología , Composición Familiar , Femenino , Humanos , Embarazo , Embarazo en Adolescencia/psicología , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

OBJECTIVE: To determine the effects of oral contraceptive (OC) treatment on maternal iron and copper metabolism during lactation. DESIGN: Observational study. SETTING: Private and public clinics in Brazil. PATIENT(S): Lactating mothers attending the family planning clinic of the University of Brasilia. INTERVENTION(S): The OCs used were a combination pill (0.15 mg of levonorgestrel and 0.03 mg of ethinyl estradiol) and a minipill (0.35 mg of norethidrone). Blood and breast milk samples were collected before and after a measured period of OC treatment. MAIN OUTCOME MEASURE(S): Iron and copper concentrations were studied in the serum and breast milk of 54 breast-feeding mothers who had been advised by their physicians to use an OC, and in a control group. RESULT(S): Regression analysis was performed using a model that took into consideration socioeconomic status, number of children, duration of previous lactation, type of OC, length of treatment, and age. Repeated measurements (before and after OC treatment) showed that only copper concentrations in breast milk were significantly affected by stage of lactation. During the study period, which varied from 2-15 weeks, the decline in iron concentrations in breast milk was negligible, whereas copper concentrations decreased by 50%. CONCLUSION(S): The use of OCs does not appear to affect significantly the secretion of iron and copper in breast milk during the first 6 months of lactation.

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PIP: This study examines the effects of oral contraceptive (OC) treatment on maternal iron and copper metabolism during lactation. The sample included lactating mothers attending the family planning clinic at the University of Brasilia. Participants were divided into 3 groups: 1) mothers who were taking combination pills (0.15 mg levonorgestrel and 0.03 mg ethinyl estradiol); 2) those who were taking minipills (0.35 mg norethindrone); and 3) a control group. Blood and breast milk samples were collected before and after a measured period of OC treatment. Results showed no significant effects of OC use on either iron or copper concentrations in serum during lactation. However, copper concentrations were significantly affected with the stage of lactation (iron, P = 0.9619; copper, P = 0.0002) as reflected in the multivariate model analysis. Therefore, the use of OCs does not appear to affect significantly the secretion of iron and copper in breast milk during the first 6 months of lactation.

Asunto(s)

Anticonceptivos Orales , Cobre/análisis , Hierro/análisis , Leche Humana/química , Adolescente , Adulto , Anticonceptivos Orales Combinados , Cobre/sangre , Femenino , Humanos , Hierro/sangre , Lactancia

RESUMEN

The study examines an intervention designed to influence mothers' sensitive responsiveness toward their infant by presenting information about the newborn's competence to interact and promoting affectionate handling and interaction with the infant. Thirty-six primiparous mothers and their newborn infants participated in the study. On day 2/3 after delivery, mother-infant dyads were assigned to either: (1) an experimental group that received an intervention program designed to enhance mother-infant interaction; or (2) a control group that was presented with an intervention that emphasized basic caregiving skills. One month later an observation was undertaken in the home to assess mother-infant synchronous and asynchronous co-occurrences during free-play and infant bathing. The enhancement group showed a reliably greater frequency of co-occurrences involving vocal exchanges, looking to the partner, and physical contact. There also were differences in mothers' responsiveness to infant crying and involuntary responses. The findings show that even a modest videotaped early intervention can enhance mothers' sensitive responsiveness to the infant.

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PIP: This study examines the role of an early intervention designed to enhance the quality of interaction between mothers and their infants. Subjects included 36 primiparous mothers and their newborn infants. On day 2 or 3 after delivery and prior to discharge from the hospital, dyads were randomly assigned to one of two groups: an experimental group that received an intervention program designed to enhance mother-infant interaction or a control group that was presented with an intervention program that emphasized basic care-giving skills. Results showed that for the enhancement group, there were more incidences involving infant vocalization with mother's reciprocal vocalization, smiling, soothing, and stimulation compared to the control group. Findings demonstrate the enhancement of mother-infant interaction and highlight the role of the vocal channel in mother-infant exchanges. Moreover, there was also an association between infant crying and involuntary behaviors, and maternal unresponsiveness for the control group, particularly in the bathing situation. Results indicate that a simple videotape/discussion intervention can enhance the sensitive responsiveness of mothers toward their infants.

Asunto(s)

Conducta del Lactante , Conducta Materna , Relaciones Madre-Hijo , Apego a Objetos , Adulto , Análisis de Varianza , Brasil , Distribución de Chi-Cuadrado , Desarrollo Infantil , Femenino , Promoción de la Salud/métodos , Humanos , Lactante , Cuidado del Lactante/normas , Masculino , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , Estudios Prospectivos , Resultado del Tratamiento

RESUMEN

Before carrying out a breastfeeding promotion programme in a periurban area of Mexico City, we conducted a rapid ethnographic study to determine the factors associated with absence of exclusive breastfeeding. The responses to pilot interviews were used to develop a standardized questionnaire regarding reasons for infant feeding choice, sources of advice, and barriers to breastfeeding. We interviewed a random sample of 150 mothers with a child < 5 years of age; 136 (91%) of them had initiated breastfeeding; but only 2% exclusively breastfed up to 4 months. The mothers consistently stated that the child's nutrition, health, growth, and hygiene were the main reasons for the type of feeding selected; cost, comfort, and the husband's opinion were less important. Physicians were ranked as the most important source of advice. Reduction or cessation of breastfeeding occurred on the doctor's advice (68%); or when the mothers encountered local folk illnesses such as "coraje" (52%) or "susto" (54%), which are associated with anger or fright; or had "not enough milk" (62%) or "bad milk" (56%); or because of illness of the mother (56%) or child (43%). During childhood illnesses and conditions, breastfeeding was reduced and the use of supplementary foods was increased. This study emphasizes the importance of cultural values in infant feeding choices, defines specific barriers to breastfeeding, and provides a basis for interventions to promote exclusive breastfeeding in the study population.

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PIP: Prior to initiating a community-based intervention program to promote exclusive breast feeding in San Pedro Martir, Mexico, a 2-month (1994) rapid ethnographic assessment was conducted. 150 mothers whose youngest child was under 5 years of age were interviewed. 136 mothers (91%) had breast-fed their infant, for a median duration of 6 months, but only 2% exclusively breast-fed for up to 4 months. Mothers consistently described breast feeding as the best nutrition for their infant. However, the dominant feeding pattern was mixed breast and bottle-feeding. Formula, tea, and water were introduced during the first postpartum day. By the end of the third month, 63% of mothers had introduced solid food to promote growth. It was common practice to reduce breast feeding and increase feeding of supplementary foods when a child was ill. Physicians were the most respected source of knowledge on breast feeding. 42% of mothers reported that, at some point when they were breast feeding, a doctor had advised them to stop and half these mothers complied. The data collected in this rapid survey were used to guide a peer counseling program to promote exclusive breast feeding in the community.

Asunto(s)

Lactancia Materna/etnología , Lactancia Materna/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Madres/estadística & datos numéricos , Adolescente , Adulto , Antropología Cultural , Lactancia Materna/psicología , Femenino , Promoción de la Salud , Humanos , México , Madres/educación , Madres/psicología , Evaluación de Necesidades , Población Suburbana , Encuestas y Cuestionarios , Destete

RESUMEN

The relationship between economic conditions and marriage patterns in the Dominican Republic is analyzed using data collected in 1994 on women working in a free-trade zone. The author concludes that changes associated with structural adjustment appear to have contributed to a deterioration of the job market and a greater prevalence of female-headed households. It is shown that "structural adjustment increases the need for women to work, because of cuts in government programs, declining real wages, growing inflation, and a deterioration in male employment, which weakens the man's role as principal breadwinner and increases the importance and visibility of women's contribution to the household economy. This change in the gender composition of the labor force has encouraged some women to resist marriage and/or remarriage because the ¿marriage market' of eligible men willing and able to support a family has been reduced, contributing to greater marital instability."

Asunto(s)

Economía , Empleo , Composición Familiar , Matrimonio , Familia Monoparental , Desempleo , Américas , Conducta , Región del Caribe , Países en Desarrollo , República Dominicana , Fuerza Laboral en Salud , América Latina , América del Norte , Conducta Social

RESUMEN

PIP: The authors explore the gender identities among women factory workers in Ciudad Juarez, Mexico. Using data from 3 generations of women, they show that women's participation in the maquila work force is exposing them to new ideologies which challenge traditional images embodied in the marianismo ideal of Mexican womanhood. By focusing upon women's changing experiences of courtship and motherhood, the authors suggest that conventional discourses stressing parentally supervised mate selection and full-time motherhood are being challenged by alternative ones which allow young women to socialize freely with prospective mates in unsupervised contexts, and expand the meaning of responsible motherhood to encompass full-time employment. Women workers' identities are fluid processes in permanent negotiation. ¿^ieng

Asunto(s)

Actitud , Empleo , Industrias , Relaciones Interpersonales , Matrimonio , Madres , Mujeres , Américas , Conducta , Países en Desarrollo , Economía , Composición Familiar , Relaciones Familiares , Fuerza Laboral en Salud , América Latina , México , América del Norte , Padres , Psicología

RESUMEN

PIP: This study analyzes the use of donkeys in San Pablo Tlachichilpan, Mexico from a gender perspective. Information was gathered through survey, participatory rural appraisal methods, and direct observation. The results showed that the donkeys were used exclusively for carrying loads. They usually carry water, laundry, firewood, sand, soil, manure, a plough and maize stover, and the harvest. There were no preferences cited for using either the male or female donkey, as both have their own advantages. The males are stronger while the females are more docile. The main problems associated with donkey use were lack of access to veterinary help and advice; inadequate caring of young; low productivity of females; no adequate hoof care; and shortage of fodder. However, these problems were not considered restrictive to their use. With regard to socioeconomic issues, it was revealed that a majority of the rich (72%) did not have donkeys, while most of the poor (80%) have one donkey. Lastly, the donkey was found to be appropriate to the needs of both men and women. However, it is used almost exclusively for the maintenance activities of the household and is less accepted for productive activities such as cultivation or breeding.^ieng

Asunto(s)

Agricultura , Grupos de Población Animal , Recolección de Datos , Composición Familiar , Población Rural , Américas , Conservación de los Recursos Naturales , Demografía , Países en Desarrollo , Economía , Ambiente , América Latina , México , América del Norte , Población , Características de la Población , Investigación , Muestreo

RESUMEN

OBJECTIVE: Oral contraceptives (OC) are the most efficient method of contraception and it is the most prescribed by doctors in developing countries. Therefore we studied the effects of combination pill and mini-pill on calcium and phosphorus in milk of breast-feeding mothers at different stages of lactation. METHODS: Fifty-four breast-feeding mothers made up three study groups: 33 mothers who had been advised by their doctors to use either combination pill (12), or mini-pill (21), as well as a control group of 21 mothers that used no hormonal contraceptives. All mothers completed a questionnaire and provided samples of milk before and after a measured period of observation. Mean duration of study was 76, 120, and 101 days, respectively for users of mini-pill, combination pill, and controls. Determination of calcium and phosphorus was done by inductively coupled plasma-atomic absorption spectrometry. RESULTS: Overall the decrease in milk concentrations of phosphorus (6%) and calcium (26.3%) during the study period was not influenced by OC treatment. Regression analyses which took into consideration length of treatment, socioeconomic status, number of children, duration of previous lactation, type of contraceptive, and age of mothers and repeated measurements (before and after OC) showed that milk calcium was significantly affected by stage of lactation (p=0.0013). CONCLUSION: The use of hormonal contraceptive such as the combination pill (levonorgestrel 0.15 mg+ethynilestradiol 0.03 mg) and mini-pill (norethindone 0.35 mg) does not seem to affect the secretion of calcium and phosphorus in milk of mothers.

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PIP: This article is based on a study of the effects of oral contraceptives (OCs) on the concentration of calcium and phosphorus in breast milk among 54 lactating Brazilian women. Confounding constitutional variables were considered which include maternal age, previous lactation, length of breast-feeding, and variables associated with contraception, such as type and length of use. The subjects were divided into 3 groups: 12 using combination pills, 21 using mini-pills, and a control group of 21 mothers that used no hormonal contraceptives. Milk was sampled before and after a measured period of observation. The mean durations of study were 76, 120, and 101 days, respectively, for users of mini-pills, combination pills, and controls. The determination of calcium and phosphorous was done by inductively coupled plasma-atomic absorption spectrometry. The results indicate that a mean stage of lactation at start of treatment for the 3 groups ranged from 2.5 to 4 months. Both calcium and phosphorous declined in concentration with time, confounded with OC treatment. There was no significant difference for calcium concentration due to OC treatment, only stage of lactation, per se, was a significant source of variation for calcium concentration. As lactation progressed, the calcium and phosphorous concentration decreased for all mothers. Therefore, short-term use of OCs containing estrogen do not affect calcium and phosphorous concentrations in breast milk.

Asunto(s)

Calcio/análisis , Anticonceptivos Orales/efectos adversos , Lactancia , Leche Humana/química , Fósforo/análisis , Adolescente , Adulto , Anticonceptivos Orales Combinados/efectos adversos , Etinilestradiol/administración & dosificación , Etinilestradiol/efectos adversos , Femenino , Humanos , Levonorgestrel/administración & dosificación , Levonorgestrel/efectos adversos , Noretindrona/administración & dosificación , Noretindrona/efectos adversos , Análisis de Regresión

RESUMEN

BACKGROUND: A number of studies have reported associations between indoor biofuel air pollution in developing countries and chronic obstructive lung disease (COLD) in adults and acute lower respiratory infection (ALRI) in children. Most of these studies have used indirect measures of exposure and generally dealt inadequately with confounding. More reliable, quantified information about this presumed effect is an important pre-requisite for prevention, not least because of the technical, economic and cultural barriers to achieving substantial exposure reductions in the world's poorest households, where ambient pollution levels are typically between ten and a hundred times higher than recommended standards. This study was carried out as part of a programme of research designed to inform the development of intervention studies capable of providing quantified estimates of health benefits. METHODS: The association between respiratory symptoms and the use of open fires and chimney woodstoves ('planchas'), and the distribution of confounding factors, were examined in a cross-sectional study of 340 women aged 15-45 years, living in a poor rural area in the western highlands of Guatemala. RESULTS: The prevalence of reported cough and phlegm was significantly higher for three of six symptom measures among women using open fires. Although this finding is consistent with a number of other studies, none has systematically examined the extent to which strong associations with confounding variables in these settings limit the ability of observational studies to define the effect of indoor air pollution adequately. Very strong associations (P < 0.0001) were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated (P < 0.05). Thus, while 82% of open fire users had dirt floors and only 18% cement or tile floors, the situation was reversed for plancha users, only 16% of whom had dirt floors. CONCLUSIONS: Confounding presents a substantial problem for observational studies of indoor air pollution and health, although there is a reasonable case for believing that the observed association is causal. Intervention studies are required for stronger evidence of this association, and more importantly, to determine the size of health benefit achievable through feasible exposure reductions.

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PIP: The authors investigated the association between respiratory symptoms and the use of open fires and chimney woodstoves, as well as the distribution of confounding factors, in a cross-sectional study of 340 women aged 15-45 years living in a poor rural area in the western highlands of Guatemala, and found a significantly higher prevalence of reported cough and phlegm for 3 of 6 symptom measures among women using open fires. When considering confounding factors, very strong associations were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated. 82% of open fire users had dirt floors, with the remaining 18% having cement or tile floors, while only 16% of chimney woodstove users had dirt floors.

Asunto(s)

Contaminación del Aire Interior/efectos adversos , Países en Desarrollo , Calefacción , Enfermedades Pulmonares Obstructivas/epidemiología , Población Rural/estadística & datos numéricos , Madera , Adolescente , Adulto , Contaminación del Aire Interior/estadística & datos numéricos , Causalidad , Femenino , Guatemala , Humanos , Enfermedades Pulmonares Obstructivas/etiología , Persona de Mediana Edad , Pobreza/estadística & datos numéricos , Factores de Riesgo

RESUMEN

BACKGROUND: The strong relationship between social inequalities and health have been extensively reported. AIM: To measure the effects of social inequalities, assessed through maternal educational level, on infant mortality in Chile. MATERIAL AND METHODS: Using death and birth electronic databases of the Instituto Nacional de Estadisticas, the annual rates of infant mortality per years of approved studies of both parents and per cause were calculated. RESULTS: In the 1990-1995 period, there is a clear gradient of infant mortality according to the level of education of the mother (38.2 per 1000 born alive among those without education versus 7.8 per 1000 born alive among those with university education). The same tendency is maintained for neonatal and post-neonatal mortality. All groups of causes had a similar effect, standing out diseases of the respiratory system with a relative risk (RR) of 14.3 and a population attributable risk (PAR) of 73%, trauma with a RR of 11.3 and a PAR of 69% and infectious diseases with a RR of 10.8 and a PAR of 62%. Between 1985 and 1995, absolute inequalities decreased but relative inequalities remained constant. CONCLUSIONS: The great social inequality in infant mortality has persisted in Chile during the last years. To adequately assess the national progresses in population health using infant mortality as an indicator, the gaps between social groups must be born in mind.

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PIP: Birth and death statistics from Chile¿s National Institute of Statistics were used to determine the influence of socioeconomic status as measured through maternal educational level on infant mortality from 1990-95 and to assess trends since 1985. The rates of infant, neonatal, and postneonatal mortality were calculated for 6 educational groups for the mother and father: 0, 1-3, 4-6,7-9, 10-12, and 13 or more years. The deaths were classified by cause according to the International Classification of Diseases and to Taucher¿s classification into avoidable, difficult to avoid, poorly defined, and other causes. A clear association was observed in levels of infant mortality according to maternal education. Infant mortality rates ranged from 38.2/1000 live births for children of illiterate mothers to 7.8/1000 for children of mothers with higher education. A child of an illiterate mother had a risk of death in the first year 4.9 times higher than the child of a mother with higher education. The same trend was observed for neonatal mortality and for paternal education. The mortality gradient by maternal education was maintained for all causes of death and both classifications studied. Diseases of the respiratory system had a relative risk (RR) of 14.3 and a population attributable risk (PAR) of 73%, trauma had an RR of 11.3 and PAR of 69%, and infectious diseases had an RR of 10.8 and PAR of 62%. Infant mortality rates declined between 1985-95 in all maternal educational groups, but the inequalities remained.

Asunto(s)

Causas de Muerte , Escolaridad , Indicadores de Salud , Mortalidad Infantil/tendencias , Clase Social , Chile , Humanos , Lactante , Recién Nacido , Medición de Riesgo , Factores Socioeconómicos

RESUMEN

Risk factors for HIV infection in partners of HIV-seropositive index cases were investigated in a cross-sectional survey. Between September 1992 and April 1994 a total of 251 HIV-infected persons and 76 of their sexual partners were interviewed at the main sexually transmitted diseases (STDs) clinic in Trinidad. All participants gave signed consent and responded to a questionnaire. Sixty-four couples had risks for HIV infection through heterosexual intercourse only. However, many recruited sex partners (57/64) reported heterosexual intercourse with persons in addition to the index cases. Overall HIV concordance (both index case and partner HIV infected) was 45% in the couples. HIV concordance was not found to be related to the sexual practices within the studied unions nor to the clinical status of the index case. After allowing for confounding factors there was an increased risk for HIV concordance in couples in unions for > or = 1 year (adjusted OR 3.48; 95% CI 0.89-13.69, P = 0.055), and in those in which sex partners had a past history of genital sores (adjusted for prostitution: OR 4.50; 95% CI 1.01-20.4). Interventions targeted at reducing high-risk sexual behaviour, prostitution and cocaine use could be beneficial in reducing the spread of STDs and HIV in Trinidad.

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PIP: A cross-sectional survey conducted at the main sexually transmitted disease clinic in Trinidad in 1992-94 investigated risk factors for concordant HIV infection in 251 HIV-infected persons and 76 of their sexual partners. Sexual contact with the index case was the only reported HIV risk factor for 7 partners; another 57 partners with heterosexual intercourse as the sole HIV risk factor reported intercourse with persons in addition to the index case in the preceding 5 years. Overall, HIV concordance was 45% (38% in couples with a female index case and 50% when the index case was male). HIV concordance was unrelated to either sexual practices within the studied unions (e.g., frequency of intercourse, condom use, male circumcision, sex during menstruation) or the current clinical status of the index case. After adjustment for confounding factors, there was an increased risk for HIV concordance among couples in unions for 1 or more years (adjusted odds ratio (OR), 3.48; 95% confidence interval (CI), 0.89-13.69) and those in which sex partners had a past history of genital sores (OR adjusted for prostitution, 4.50; 95% CI, 1.01-20.4). These findings suggest a need for policies to ensure that the sex partners of HIV-infected persons in Trinidad are notified, counseled, and offered HIV testing because of their elevated risk of infection.

Asunto(s)

Infecciones por VIH/transmisión , Heterosexualidad , Parejas Sexuales , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Población , Factores de Riesgo , Trinidad y Tobago

RESUMEN

BACKGROUND: Childhood diarrhoea is a leading cause of morbidity and mortality in Nicaragua. Amongst the risk factors for its transmission are 'poor' hygiene practices. We investigated the effect of a large number of hygiene practices on diarrhoeal disease in children aged <2 years and validated the technique of direct observation of hygiene behaviour. METHODS: A prospective follow-up study was carried out in a rural zone of Nicaragua. From the database of a previously conducted case-control study on water and sanitation 172 families were recruited, half of which had experienced a higher than expected rate of diarrhoea in their children and the other half a lower rate. Hygiene behaviour was observed over two mornings and diarrhoea incidence was recorded with a calendar, filled out by the mother, and collected every week for 5 months. RESULTS: Of 46 'good' practices studied, 39 were associated with a lower risk of diarrhoea, five were unrelated and only for two a higher risk was observed. Washing of hands, domestic cleanliness (kitchen, living room, yard) and the use of a diaper/underclothes by the child had the strongest protective effect. Schooling (>3 years of primary school) and better economic position (possession of a radio) had a positive influence on general hygiene behaviour, education having a slightly stronger effect when a radio was present. Individual hygiene behaviour appeared to be highly variable in contrast with the consistent behaviour of the community as a whole. Feasible and appropriate indicators of hygiene behaviour were found to be domestic cleanliness and the use of a diaper or underclothes by the child. CONCLUSION: A consistent relationship between almost all hygiene practices and diarrhoea was detected, more schooling producing better hygiene behaviour. The high variability of hygiene behaviour at the individual level requires repeated observations (at least two) before and after the hygiene education in the event one wants to measure the impact of the campaign on the individual.

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PIP: Poor hygiene practices are among the risk factors for the transmission of childhood diarrhea, a leading cause of morbidity and mortality in Nicaragua. Findings are reported from a prospective follow-up study in rural Nicaragua of the effect of a number of hygiene practices upon diarrheal disease in children under age 2 years old. 172 families, of whom half had experienced a higher than expected rate of diarrhea in their children and the other half a lower rate, participated. Hygiene behavior was observed over 2 mornings and diarrhea incidence was recorded with a calendar over the course of 5 months. Of 46 good practices studied, 39 were associated with a lower risk of diarrhea, 5 were unrelated, and a higher risk was observed for 2. The washing of hands, domestic cleanliness, and the use of a diaper/underclothes by the child had the strongest protective effect against diarrhea. Mothers with more than 3 years of primary school education and in a comparatively better economic position, including having a radio, exhibited comparatively better general hygiene behavior. Education had a slightly stronger effect when a radio was present. However, individual hygiene behavior seems to be highly variable compared to the consistent behavior of the overall community. Appropriate indicators of hygiene behavior were domestic cleanliness and the use of a diaper or underclothes by the child.

Asunto(s)

Diarrea Infantil/epidemiología , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Conductas Relacionadas con la Salud , Higiene , Adulto , Estudios de Casos y Controles , Diarrea Infantil/etiología , Diarrea Infantil/prevención & control , Escolaridad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Masculino , Nicaragua/epidemiología , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Población Rural , Tasa de Supervivencia

RESUMEN

PIP: This paper relates the success of a study that helped enhance breast-feeding by means of a support group in Southern Brazil. The International Multicenter Growth Reference Study was designed to help WHO develop new growth charts to measure nutritional status of populations and to evaluate individual growth. Southern Brazil was one of the sites selected for the study, and an ongoing data collection for the longitudinal component of the study (based on children aged 0-24 months) began in July 1997. The new growth reference will be based on the growth of children with the following characteristics: gestational age at birth between 37 and 42 full weeks, single birth, lack of significant perinatal morbidity, absence of maternal smoking, no economic constraints on growth, and being breast-fed for at least 1 full year and given no other foods during the first 4-6 months. Since few mothers in Brazil follow this recommendation, a lactation support group was trained to help mothers breast-feed their babies. It was found that the breast-feeding support group really made a difference, at least with regard to the duration of breast-feeding. Mothers who had support breast-fed longer and waited longer to introduce other foods into their children's diet compared to those who had no support. The factors that contributed to increased breast-feeding duration are enumerated. In conclusion, supporting mothers in breast-feeding is beneficial to both mothers and children and can lead to a better quality of life.^ieng

Asunto(s)

Lactancia Materna , Madres/educación , Madres/psicología , Grupos de Autoayuda/organización & administración , Apoyo Social , Adulto , Brasil , Consultores , Femenino , Humanos , Lactante , Enfermeras Clínicas , Evaluación de Programas y Proyectos de Salud , Organización Mundial de la Salud

RESUMEN

The authors use survey data collected in 1990 from 418 household heads of recent settlements in the Ecuadorian Amazon to study the extent of and reasons for out-migration of the settlers' children. "Our research identifies the types and incidence of out-migration of young adults from settler households in the Ecuadorian Amazon, as well as the effects of individual and household-level factors of out-migration. Important gender differences in both the levels and patterns of migration and in the factors affecting migration decisions are documented."

Asunto(s)

Adolescente , Toma de Decisiones , Emigración e Inmigración , Análisis Factorial , Composición Familiar , Población Rural , Factores Sexuales , Árboles , Factores de Edad , Américas , Conducta , Conservación de los Recursos Naturales , Demografía , Países en Desarrollo , Ecuador , Ambiente , América Latina , Población , Características de la Población , Dinámica Poblacional , Investigación , América del Sur , Estadística como Asunto

RESUMEN

PIP: "The authors analyze the Mexican household in the United States, emphasizing its complexity...as well as...its changes over time. The authors seek to understand the composition of relatives within exiled families, their life-cycle evolution, and the interaction of civil and migratory calendars. They also consider household changes related to the migratory process, changes in marriage and birth civil calendars, changes produced by work or marital events, and the type of migratory decisions developed within families." (EXCERPT)^ieng

Asunto(s)

Aculturación , Emigración e Inmigración , Composición Familiar , Relaciones Familiares , Familia , Américas , Demografía , Países Desarrollados , Países en Desarrollo , América Latina , México , América del Norte , Población , Dinámica Poblacional , Prejuicio , Estados Unidos