RESUMO
The goal of this study was to assess condom use and related behaviour in young women in Vitória, Brazil. From March to December 2006, a cross-sectional sample of women aged 18-29 years was recruited into a population-based study. Risk behaviours for HIV and sexually transmitted infections (STIs) were surveyed. Condom use at last intercourse was assessed as a principal outcome describing protective sexual behaviour. Of 1200 eligible women identified, 1029 (85.8%) enrolled. Among them, 904 (87.9%) reported a history of sexual activity. Only 36.6% reported condom use at last intercourse; those who did were more likely to report commercial sex work (odds ratio [OR] 9.01 [1.46-55.55]), to state that STI prevention was a primary reason for using condoms (OR = 6.84 [4.81-9.71]), to have been previously diagnosed with an STI (OR = 2.39 [1.36-4.21]), to report that 'it is easy to tell a sexual partner they will not have vaginal/anal sex without a condom' (OR = 2.30 [1.56-3.39]), to report that sexual intercourse is only risky when people have anal sex (OR = 1.98 [1.22-3.22]); and less likely to be married (OR = 0.65 [0.54-0.78]), and to find it difficult to use condom consistently in all sexual encounters (OR = 0.36 [0.25-0.52]). Women who reported condom use were more concerned with preventing STIs, and to report less difficulty insisting on condom use with partners.
Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/virologia , Humanos , Entrevistas como Assunto , Prevalência , Assunção de Riscos , Sexo Seguro , Trabalho Sexual , Infecções Sexualmente Transmissíveis/etiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Adulto JovemRESUMO
Secondary hospital wastewater treatment was investigated as an alternative to detoxification and disinfection after anaerobic digestion in a hospital located in southern Brazil. Tertiary and secondary effluents were assessed by general parameters. The use of advanced oxidation processes (UV/O3 and UV/TiO2/O3) showed potential capacity for disinfection and detoxification of wastewater effluents. The UV/TiO2/O3 method yielded the best results, decreasing toxicity of EC50 = 65 to nontoxic levels, also reducing MPN/100ml of 1.1 x 10(6) to values less than 2 and increasing wastewater biodegradability. The low energetic consumption of the proposed UV/TiO2/O3 method can be considered operationally advantageous.
Assuntos
Hospitais , Resíduos Industriais , Brasil , Catálise , Oxirredução , Ozônio/química , Titânio/química , Raios UltravioletaRESUMO
BACKGROUND: The frequency of haplotypes of Nsp I-Eco47 III sites, at the IDUA (alpha-L iduronidase) gene, in Huichol, Tarahumara and Mestizo Mexican population is reported. METHODS: Eco47 III and Nsp I intragenic polymorphisms in IDUA gene are studied in three (Mestizo, Huichol and Tarahumara populations) Mexican groups. Data from normal Australian [Hum. Genet. 90 (1992) 327] individuals were considered for comparative analyses. RESULTS: The genotypes for IDUA Eco47 III and Nsp I sites in Mexicans were in agreement with Hardy-Weinberg equilibrium. Allele frequency distributions for individual sites differed (P < 0.05) except at site B1 in the Huichol group. Haplotype Eco47 III-Nsp I frequency distributions were different in the three Mexican normal groups, and it was also observed when to compared with the normal Australians. CONCLUSIONS: This characteristic makes the two IDUA polymorphic sites useful for identification purposes, and these polymorphisms could be included in a PCR based battery of DNA markers.
Assuntos
Desoxirribonucleases de Sítio Específico do Tipo II/genética , Frequência do Gene , Iduronidase/genética , Polimorfismo de Fragmento de Restrição , Adulto , Haplótipos , Humanos , México/etnologiaRESUMO
Se comparan los resultados operatorios entre las dos técnicas más usadas en lesiones aisladas de la región selar, respecto a exposición quirúrgica, morbilidad asociada y evolución postoperatoria. Se realiza un estudio descriptivo, retrospectivo, identificando aquellas lesiones neuroquirúrgicas de la silla turca diagnosticadas entre enero de 1995 y agosto de 2003, en el Hospital Clínico de la Universidad de Chile e intervenidas mediante técnica microendoscópica, con vías de abordaje transnasal directa o transeptal. Se analizaron ciento cincuenta y cuatro cirugías, 123 realizadas por vía transeptal y 31, por vía transnasal. No se observó diferencias significativas en la distribución de los grupos en cuanto a edad, sexo, motivo de consulta, evaluación otorrinolaringológica, imagenológica y éxito de abordaje. Hubo diferencias en el tiempo operatorio, siendo subjetivamente menor mediante la vía transnasal. La tasa de complicaciones intraoperatorias fue menor al 5 por ciento, sin diferencias significativas entre las dos técnicas analizadas, pero con mayor comodidad postoperatoria para aquellos pacientes intervenidos por vía transnasal. Se concluye que ambas técnicas son comparables en relación al éxito de abordaje y morbilidad asociada, observándose un menor tiempo operatorio mediante vía transnasal y con mayor comodidad para el paciente, con esta técnica, en el postoperatorio.
Assuntos
Humanos , Masculino , Feminino , Procedimentos Neurocirúrgicos/métodos , Sela Túrcica/cirurgia , Distribuição por Idade , Distribuição por Sexo , Estudos Retrospectivos , Osso EsfenoideRESUMO
A spontaneous recessive mutation named nackt (symbol: nkt) affecting hair growth and T-cell development was discovered in a moderately inbred stock of mice. Skin lesions were characterized by sparse rough coat, bare patches around the eyes and neck, and a scratching behavior throughout life. Fluorescence-activated cell sorter analysis indicated a deficiency in the CD4(+) 8(-) T-cell subset in the thymus and a marked decrease in CD4(+) T cells in peripheral lymphoid organs. Linkage analysis using a set of molecular markers and an F2 intersubspecific cross indicated that the mutation maps to the central region of mouse chromosome 13, in a region homologous to human chromosome 5q22-q35.
Assuntos
Alopecia/genética , Antígenos CD4/genética , Dermatite/genética , Camundongos Mutantes , Mutação , Animais , Comportamento Animal , Mapeamento Cromossômico , Genes Recessivos , Ligação Genética , Haplótipos , Camundongos , Subpopulações de Linfócitos T , Timo/citologia , Timo/imunologiaRESUMO
Ignorance about the costs, case loads and case mixes of different hospitals within the public health system constitutes an important obstacle to reforming health care spending in many developing countries. National (tertiary) hospitals generally receive significantly larger budgets, per patient, than lower-level (district) hospitals. One reason for these differential allocations is the widely held belief that national hospitals treat persons with more difficult illnesses and persons who are more severely ill than do other, non-national, hospitals. This belief is but a presumption and one that warrants investigation. This paper analyzes expenditures among public hospitals in El Salvador over a 12-year period to address this question. While controlling for patient morbidity, outputs and other characteristics, district hospitals are found to be substantially underfunded relative to national hospitals. Four policy options to redress this situation are examined.
Assuntos
Alocação de Recursos para a Atenção à Saúde , Hospitais Públicos/economia , Risco Ajustado , Orçamentos , El Salvador , Hospitais de Distrito/economia , Humanos , Análise de RegressãoRESUMO
National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.
Assuntos
Grupos Diagnósticos Relacionados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Ocupação de Leitos/estatística & dados numéricos , Orçamentos , Grupos Diagnósticos Relacionados/classificação , Eficiência Organizacional , El Salvador/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/classificação , Recursos em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Humanos , Morbidade , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To determine plasma erythropoietin levels and their association with hemoglobin and reticulocyte counts in healthy term infants. DESIGN: We compared plasma erythropoietin levels measured in serial blood samples obtained every 4 weeks during the first 6 months of life with one another and with levels in term fetuses and healthy adults. Correlation analysis was applied to examine for associations of erythropoietin with hemoglobin and with reticulocyte count. RESULTS: Plasma erythropoietin levels were lowest in the first and highest in the second postnatal months, a pattern reciprocal to that observed for hemoglobin during the period of physiologic anemia. The erythropoietin level was negatively correlated with hemoglobin (p < 0.0001) and positively correlated with reticulocytes (p < 0.0001). The slope of the inverse relationship of hemoglobin and plasma erythropoietin in infants was similar to those previously reported for anemic fetuses and premature infants, but much less steep than for anemic children and adults. CONCLUSION: This study is the first to report simultaneous patterns of change observed in plasma erythropoietin, hemoglobin, and reticulocytes during normal infancy. These patterns are consistent with postnatal perturbations in tissue oxygenation and suggest a major role for erythropoietin in the regulation of erythropoiesis during normal infancy, but at a lower hemoglobin concentration than for older children and adults with pathologic anemia.
Assuntos
Eritropoese/fisiologia , Eritropoetina/sangue , Adulto , Fatores Etários , Feminino , Hemoglobinometria , Humanos , Lactente , Recém-Nascido , Masculino , Valores de Referência , Contagem de ReticulócitosRESUMO
1. In the anesthetized and artificially ventilated cat, stimulation of the posterior articular nerve (PAN) with low strengths (1.2-1.4 x T) produced a small negative response (N1) in the cord dorsum of the lumbosacral spinal cord with a mean onset latency of 5.2 ms. Stronger stimuli (> 1.4 x T) produced two additional components (N2 and N3) with longer latencies (mean latencies 7.5 and 15.7 ms, respectively), usually followed by a slow positivity lasting 100-150 ms. With stimulus strengths above 10 x T there was in some experiments a delayed response (N4; mean latency 32 ms). 2. Activation of posterior knee joint nerve with single pulses and intensities producing N1 responses only, usually produced no dorsal root potentials (DRPs), or these were rather small. Stimulation with strengths producing N2 and N3 responses produced distinct DRPs. Trains of pulses were clearly more effective than single pulses in producing DRPs, even in the low-intensity range. 3. Cooling the thoracic spinal cord to block impulse conduction, increased the DRPs and the N3 responses produced by PAN stimulation without significantly affecting the N2 responses. Reversible spinalization also increased the DRPs produced by stimulation of cutaneous nerves. In contrast, the DRPs produced by stimulation of group I afferents from flexors were reduced. 4. Conditioning electrical stimulation of intermediate and high-threshold myelinated fibers in the PAN depressed the DRPs produced by stimulation of group I muscle and of cutaneous nerves. 5. Analysis of the intraspinal threshold changes of single Ia and Ib fibers has provided evidence that stimulation of intermediate and high threshold myelinated fibers in the posterior knee joint nerve inhibits the primary afferent depolarization (PAD) of Ia fibers, and may either produce PAD or inhibit the PAD in Ib fibers, in the same manner as stimulation of cutaneous nerves. In 7/16 group I fibers the inhibition of the PAD was increased during reversible spinalization. 6. The results obtained suggest that intermediate and high-threshold myelinated fibers in the PAN have the same actions on Ia and Ib fibers as intermediate and high-threshold cutaneous afferents and may therefore be considered as belonging to the same functional system. They further indicate that in anesthetized preparations the pathways mediating the PAD of group I fibers, as well as the pathways mediating the inhibition of the PAD, may be subjected to a descending control that is removed by spinalization.
Assuntos
Articulações/inervação , Músculos/inervação , Medula Espinal/fisiologia , Transmissão Sináptica/fisiologia , Vias Aferentes/fisiologia , Animais , Gatos , Estimulação Elétrica , Feminino , Gânglios Espinais/fisiologia , Membro Posterior/inervação , Interneurônios/fisiologia , Locomoção/fisiologia , Masculino , Neurônios Motores/fisiologia , Contração Muscular/fisiologia , Fibras Nervosas Mielinizadas/fisiologia , Nervos Periféricos/fisiologia , Limiar Sensorial/fisiologiaRESUMO
MRI and Doppler Sonography allow to study the effects of risk factors on brain parenchyma and vessels walls already in clinically silent stages of cerebrovascular disease and almost one third of normal volunteers reveal minimal to moderate carotid arterioclerosis at the presence of cerevasacular risk factors. However, it is yet unclear whether the detection of such abnormalities will also improve our predictive reliability in respect to the individual risk for stroke or vascular dementia. Basedon the similarity of white matter lesions with the MRI appearance of arteriosclerotic encephalopathy and neuropsychologic test results a tumely evolution of these changes towards dementia seems to be conceivable. Follow-up studies on the fate of white matter lesions will clarify, whether or not the appearence of such changes implies additional risk for vascular dementia than could be expected by the presence of risk factors alone. Serum fibrinogen has been indentified as the major predictor of extracranial arteriosclerosis in normals besides age. Increasing levels correlate with increasing probability of vessels wall damage. These data are of special interest since a previous study demostrate a higher risk for stroke and myocardial infarction in individuals with elevated serum fibrinogen levels than in those without. However. at the moment it can not be decided, if rheologic changes are the cause or sequence of vessels disease. Moreover future research has to determine, if serum fibrinogen increases the risk for stroke per se or may at least help to identify individuals at a high risk
Assuntos
Embolia e Trombose Intracraniana/epidemiologia , Hemorragia Cerebral/epidemiologia , Isquemia Encefálica/epidemiologia , Demência Vascular/epidemiologia , Fatores de Risco , Fibrinogênio/diagnóstico , Embolia e Trombose Intracraniana/diagnóstico , Hemorragia Cerebral/diagnóstico , Isquemia Encefálica/diagnóstico , Demência Vascular/diagnóstico , Espectroscopia de Ressonância Magnética , Hipertensão/complicações , Ultrassonografia , Estudo de Avaliação , Estudos Epidemiológicos , PrognósticoRESUMO
It could be shown that MRI has capability of demostrating parenchymal damage due to cerebrovascular disease even in asymptomatic individuals. In ischemic stroke MRI is superior to CT because of the earlier detection of the lesion, a More precise delineation of lacunes, of brainstem infarcts, and of hemorrhagic components. Evidence of confluent white matter damage is helpful in differentiating vascualr dementia from degenerative forms. Is hemorrhagic stroke CT remains the preferred imaging technique during the acute phase but MRI will detect remnants of a cerebral hemorrhage for lifetime
Assuntos
Hemorragia Cerebral/diagnóstico , Embolia e Trombose Intracraniana/diagnóstico , Espectroscopia de Ressonância Magnética/diagnóstico , Tomografia Computadorizada por Raios X , Hemorragia Cerebral/diagnóstico por imagem , Embolia e Trombose Intracraniana/diagnóstico por imagem , Infarto Cerebral/diagnóstico , Infarto Cerebral/diagnóstico por imagem , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/diagnóstico por imagem , Demência Vascular/diagnóstico , Demência Vascular/diagnóstico por imagem , Estudo de AvaliaçãoRESUMO
MRI and Doppler Sonography allow to study the effects of risk factors on brain parenchyma and vessels walls already in clinically silent stages of cerebrovascular disease and almost one third of normal volunteers reveal minimal to moderate carotid arterioclerosis at the presence of cerevasacular risk factors. However, it is yet unclear whether the detection of such abnormalities will also improve our predictive reliability in respect to the individual risk for stroke or vascular dementia. Basedon the similarity of white matter lesions with the MRI appearance of arteriosclerotic encephalopathy and neuropsychologic test results a tumely evolution of these changes towards dementia seems to be conceivable. Follow-up studies on the fate of white matter lesions will clarify, whether or not the appearence of such changes implies additional risk for vascular dementia than could be expected by the presence of risk factors alone. Serum fibrinogen has been indentified as the major predictor of extracranial arteriosclerosis in normals besides age. Increasing levels correlate with increasing probability of vessels wall damage. These data are of special interest since a previous study demostrate a higher risk for stroke and myocardial infarction in individuals with elevated serum fibrinogen levels than in those without. However. at the moment it can not be decided, if rheologic changes are the cause or sequence of vessels disease. Moreover future research has to determine, if serum fibrinogen increases the risk for stroke per se or may at least help to identify individuals at a high risk
Assuntos
Demência Vascular/epidemiologia , Embolia e Trombose Intracraniana/epidemiologia , Hemorragia Cerebral/epidemiologia , Isquemia Encefálica/epidemiologia , Fatores de Risco , Fibrinogênio , Demência Vascular/diagnóstico , Estudos Epidemiológicos , Embolia e Trombose Intracraniana/diagnóstico , Hemorragia Cerebral/diagnóstico , Isquemia Encefálica/diagnóstico , Ultrassonografia , Estudo de Avaliação , Hipertensão/complicações , Prognóstico , Espectroscopia de Ressonância MagnéticaRESUMO
It could be shown that MRI has capability of demostrating parenchymal damage due to cerebrovascular disease even in asymptomatic individuals. In ischemic stroke MRI is superior to CT because of the earlier detection of the lesion, a More precise delineation of lacunes, of brainstem infarcts, and of hemorrhagic components. Evidence of confluent white matter damage is helpful in differentiating vascualr dementia from degenerative forms. Is hemorrhagic stroke CT remains the preferred imaging technique during the acute phase but MRI will detect remnants of a cerebral hemorrhage for lifetime
Assuntos
Embolia e Trombose Intracraniana/diagnóstico , Hemorragia Cerebral/diagnóstico , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X , Demência Vascular/diagnóstico , Demência Vascular , Embolia e Trombose Intracraniana , Hemorragia Cerebral , Infarto Cerebral/diagnóstico , Infarto Cerebral , Isquemia Encefálica/diagnóstico , Isquemia Encefálica , Estudo de AvaliaçãoRESUMO
Because chronic hypoxemia causes a redistribution of iron from serum and storage pools into an expanding erythrocyte mass, and because infants of diabetic mothers are often hypoxemic in utero and have a high prevalence of polycythemia at birth, we studied iron distribution in 43 term infants of diabetic mothers. Twenty-four infants were at an appropriate size for gestational age; 19 were large for gestational age. At birth, 28 infants (65%) had abnormal serum iron profiles; eight had decreased ferritin concentrations only (stage 1), nine had decreased ferritin and increased total iron-binding capacity values (stage 2), and 11 had these serum findings plus elevated free erythrocyte protoporphyrin concentrations (stage 3). The hypoglycemic infants who were large for gestational age (n = 14) had a higher prevalence of abnormal iron profiles than euglycemic infants who were appropriate in size for gestational age (n = 20; 93% vs 50%; p = 0.009). Progressively abnormal iron profiles were associated with higher glycosylated fetal hemoglobin values, greater degrees of macrosomia, increased hemoglobin and erythropoietin concentrations, and increased erythrocyte/storage iron ratios. Erythropoietin concentrations were inversely linearly correlated with serum iron values (n = 32, r = -0.54; p = 0.003). The combined erythrocyte and storage iron pools were significantly lower in infants with abnormal iron values whose mothers were diabetic, particularly in infants of women with confirmed diabetic vasculopathy. We speculate that these findings are likely due to (1) increased fetal iron utilization during compensatory hemoglobin synthesis in response to chronic hypoxemia and (2) reduced iron transfer during late gestation complicated by diabetes.
Assuntos
Complicações do Diabetes , Hipóxia Fetal/etiologia , Ferro/metabolismo , Gravidez em Diabéticas , Peso ao Nascer , Feminino , Ferritinas/análise , Hipóxia Fetal/sangue , Hipóxia Fetal/metabolismo , Humanos , Recém-Nascido , Ferro/sangue , GravidezRESUMO
We describe a case of paraganglioma arising in the spermatic cord, which is an extremely rare location. Immunohistochemical studies characterized two types of cells: (1) polygonal cells expressing neuron-specific enolase, chromogranin A, and synaptophysin and (2) S100 protein-positive sustentacular cells. Electron microscopy revealed that within the cytoplasm of the polygonal cells, there were electron-dense granules whose morphological appearance was consistent with that of neurosecretory granules. Paraganglioma of the spermatic cord may originate from embryonic chromaffin cells that have followed the testis into the scrotum.
Assuntos
Neoplasias dos Genitais Masculinos/patologia , Paraganglioma/patologia , Cordão Espermático/patologia , Adolescente , Neoplasias dos Genitais Masculinos/diagnóstico , Neoplasias dos Genitais Masculinos/ultraestrutura , Humanos , Técnicas Imunoenzimáticas , Masculino , Microscopia Eletrônica , Paraganglioma/diagnóstico , Paraganglioma/ultraestrutura , Cordão Espermático/ultraestruturaRESUMO
Fifty-eight actively psychotic inpatients who initially met criteria for long-standing schizophrenia and subsequently met Research Diagnostic Criteria for a current episode of schizoaffective disorder (mainly schizophrenic) with a depressive syndrome, and who scored at least 30 (mean = 55, SEM = 1.6) on the Brief Psychiatric Rating Scale and 17 (mean = 23, SEM = 0.7) on the Hamilton Rating Scale for Depression, were treated for 5 weeks with haloperidol hydrochloride and benztropine. Haloperidol and benztropine treatment was continued, while those patients who consistently scored greater than 17 on the Hamilton Rating Scale for Depression were randomly assigned to the following double-blind treatment groups for 4 weeks: adjunctive amitriptyline hydrochloride, desipramine hydrochloride, or placebo. Adjunctive desipramine or amitriptyline showed no significant therapeutic advantage, when compared with haloperidol and placebo, on the Brief Psychiatric Rating Scale or the Hamilton Rating Scale for Depression. After 4 weeks of combine therapy, patients receiving adjunctive amitriptyline or desipramine, as compared with those receiving adjunctive placebo, tended to score higher on the Brief Psychiatric Rating Scale hallucinatory behavior item and on the thinking disturbance factor than patients receiving placebo. These results suggest that adjunctive antidepressants are not indicated for the treatment of depressive symptoms in actively psychotic schizophrenic inpatients. Adjunctive antidepressants may retard the rate of resolution of psychosis in this population.
Assuntos
Amitriptilina/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Desipramina/uso terapêutico , Haloperidol/uso terapêutico , Hospitalização , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Benzotropina/uso terapêutico , Ensaios Clínicos como Assunto , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Escalas de Graduação Psiquiátrica , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Psicologia do EsquizofrênicoRESUMO
PIP: Household-level fertility research was examined with the broader contexts of the demographic transition and public policy. The Easterlin-Crimmins (1982, 1985) model was the framework chosen for the examination. It was modified and applied to a sample of rural Egyptian households. An interesting dimension of the Easterlin-Crimmins framework is the presence of a phase of development where fertility is constrained by supplying factors -- a phenomenon most likely to occur in rural settings in the 3rd world. Thus the data set from rural Egypt offers a good opportunity to explore this aspect of their model. The framework also is useful for delineating the relative importance of behavioral versus family planning factors in explaining changes in the fertility of a population. On average, estimated Cn (surviving natural fertility) approximately equaled Cd (desired surviving family size) for the noncontracepting subpopulation of rural Egypt. These families had little or no motivation for contraception and remain in the premodernization Phase I, i.e., the desired number of surviving children exceeds the number of surviving children under a natural fertility regime. In contrast, the noncontracepting subset of families drawn from both the rural and urban areas of Sri Lanka and Colombia, already had embarked on Phase II, i.e., the supply constraint is released, but contraception is too costly. By applying child survivorship rates (s) to actual fertility for the contracepting subsets of women, on average, actual surviving fertility exceeded Cd by 1.0 children in rural Egypt, 2.0 in Sri Lanka, and 2.9 in Colombia. All 3 of these populations are in Phase III, i.e., contraception becomes increasingly pervasive as the gap between Cn and Cd widens and contraceptive costs decline. The methodology offers promise for identifying the separate influences of family planning and socioeconomic change. The results provided insights into the basic determinants underlying the demographic transition. Duration of marriage was the most single powerful determinant of completed family size in rural Egypt. Prolonged breastfeeding (20 months on average) was only slightly less powerful in reducing fertility in rural Egypt than contraception. The rise in child survivorship inherent in socioeconomic development raised the natural supply of children. Families did respond when family size expectations exceed desired, with the most educated being the most responsive. Contraceptors were more fecund than noncontraceptors in rural Egypt, and their child survivorship rates were higher.^ieng