Concerning the early and current spread of human immunodeficiency virus type 1 and the scientific burden of proof versus the burden of current human immunodeficiency virus incidence.

The following points were made during the Discussion that followed the paper by Brian Martin.

Carotid body tumors.

Between 1973 and 1984, five patients underwent excision of a carotid body tumor without operative mortality, cranial nerve palsy, cerebrovascular accident, or recurrence when followed to the present or to death from unassociated causes. The importance of preoperative four-vessel extracranial cerebrovascular arteriography for both diagnosis and planning of the operative approach cannot be overemphasized. These operations were performed without preoperative tumor embolization or transfusion, by selectively utilizing arterial resection, replacement, or repair, based on intraoperative evaluation of the individual tumor. Given the propensity of carotid body tumors to progressively enlarge, locally invade, and occasionally metastasize, all patients who are not prohibitive operative risks should undergo resection of carotid body tumors.

Infant outcome, fetal growth, and pregnancy care: relationships in Indonesian university obstetrics.

The risk of perinatal death is displayed for '56 growth combinations', then contracted into 16 gestational age/birthweight categories (GA/BW) with additional control for antenatal visits (AV;CARE) for 36 000 singleton birth deliveries monitored in Indonesia from 1978-1980. For virtually all GA/BW combinations, the risk of perinatal death (PD) drops impressively with pregnancy care (Care effect on PD). Fetal growth curves are then displayed by infant outcome, the BW difference being the deficit birthweight (DBW) that may serve as a specific life-death growth standard (LDGS)--a reference system in relation to which fetal growth curves, to be controlled for factors other than infant outcome, may be studied. By controlling for maternal education and pregnancy care, the fetal growth curve associated with high pregnancy care and low education (HIAV/LOED) is more favorable than that for low pregnancy care and high education (LOAV/HIED). In Indonesia then, pregnancy care is more important than formal education in the reduction of not only perinatal mortality but also low birthweight (Care effect on fetal growth).

3D Display of stillbirth in Indonesian obstetrics part 3: antenatal visits as preventive determinant.

Expansion of previous analytical work with MCM data in Indonesia focuses on antenatal visits (AV). AV is introduced as a systematic co-control of the risk of SB with either registration status, maternal morbidity, complication of labor/delivery or birth weight. 20 out of 22 control categories reveal risk profiles dependent on antenatal visits, the two exceptions being placenta abruptio and very low birth weight (less than 1500g). A systematic confrontation of relative risks obtained across antenatal visits with relative risks obtained within the four co-control variables highlights AV as being an important preventive determinant of late fetal death. In a second step, a clinical baseline of "NOCARE" shows a very strong association with education and a weak association with family planning within controlled education categories. A v-shaped pattern across maternal age is also noted. Two hypotheses are derived. Since FP precedes AV, the next analytical focus is on FP (CONUSE). If co-controlled with the five control factors used so far, the QUINTET will lead to a "closed six-variable control system" (SEXTET) of the risk of stillbirth.

3D Display of stillbirth in Indonesian obstetrics Part 4: Contraception as preventive determinant?

The addition of contraception to five controls (1) of the risk of SB did not alter the previous finding: antenatal visits to emerge apparently as the main determinant of late fetal survival in Indonesian university obstetrics. Parts 1-4 are the basis for inquiring into the effects of parity and education, completing thus an OCTET control model of SB. The inquiry may also be expanded by computerized multivariate analysis; but the strongest determinants should then be used in a control system for 3D display of the SB risk for medical/paramedical education. The professional providers of both "Service and Data" (PSD) need early access to their data in order to apply implications to their service job (5).

Risk of maternal death in Indonesia and Sweden. Patterns and trend in 3D display in teaching.

Epidemiological study of maternal death in Indonesia and Sweden suggests a link between two unrelated data sets. Fifty years ago ('1930'), the Swedish maternal death risk exhibited a pronounced J-shaped pattern by maternal age; and a similar pronounced J-shaped pattern is observed 50 years later in Indonesia for women with prolonged/obstructed labor attended at the top referral and teaching institutions. Epidemiological documentation of 'North data sets' may possibly be used for teaching on factors affecting 'South mortality transition'. The documentation of a 'North-South transition' could accelerate the current dynamics of needed mortality decline by pointed programmatic intervention. The two figures are self-contained reference baselines.

Effects of hypertensive disorders on the outcome of pregnancy: early findings of maternity care monitoring (MCM) in Debrecen, Hungary.

Debrecen is one of the original testing sites of MCM. This report focuses on all single births having occurred from January, 1978 to June, 1980 (N = 8818). Pregnancy outcome associated with maternal Hypertensive Disorders in Pregnancy (HDP) shall be set against pregnancy outcome among women with No Primary Antenatal Conditions (Control), the respective sample sizes being N = 540 (HDP) and N = 5, 472 women. The findings are given in four sections: (1) Occurrence of HDP; (2) Characteristics other than presence/absence of HDP; (3) Reproductive experience prior to current delivery; and (4) Maternal and infant outcome for the current delivery. A specific look is also given at smoking during current pregnancy. Special attention is called for the primordial importance of prenatal visits, preventive care and proper obstetrical management. The role of the MCM early warning system is emphasized and broader use of the system and rationale is suggested for objective international and intranational comparisons to improve pregnancy outcome for both the mother and infant.

Effects of smoking and of induced abortion on pregnancy outcome.

PIP: Regression analyses of preliminary data from 8818 consecutive singleton pregnancies in a study (Medical University of Debrecen, Hungary) concerning the effects of smoking during pregnancy and of a history of induced abortion on birth weight and gestational age are presented. Both individual variables and interaction effects were assessed. It was found that smoking during pregnancy decreased birth weight in a dose-response manner. Smoking works against a favorable pregnancy outcome in 2 ways: 1) lowering birth weight for gestational age, and 2) lowering gestational age in general. Previous induced abortion is associated with a downward shift in the gestational age distribution. Little effect of abortion on birth weight appeared in the sample of total births, but when stillbirths were eliminated, a significant negative effect of abortion on birth weight was seen--an effect apparent only at early gestational ages. In both aspects of this study, the following variables were controlled: maternal age, parity, education, infant sex, gestational age, and birth weight.^ieng

Seasonality of birth in India.

PIP: The article compares seasonal variation in conception in Baroda and Manipal, both at sea level on the west coast of India. The maximum seasonal difference in mean monthly temperature is 3.5 degrees C in Manipal, and 11.3 degrees C in Baroda. Both are industrialized towns, Manipal serving the surrounding taluk of Udupi. Clinical records were obtained from local hospitals; it must be remembered that birth registration in India is compulsory. The number of births in each month were aggregated for the period under review and adjusted to standard month of 30 days, from which an annual mean was calculated. A similar procedure was used to find mean annual temperature. A few relationships are apparent: 1) conception correlates inversely with temperature at both places, 2) abortions and stillbirths are higher in the hottest weather at both places, 3) in Baroda, but not in Udupi, the maximum prematurity rate occurs 5 months after the hottest weather. The links between weather and variations in human reproduction are not clear. Although patterns are not consistent, the conception rate appears to be low at times of maximum temperature. A number of biological and social factors, such as a rise in testicular temperature, can lead to oligospermia. Maternal body temperature can affect the life of spermatozoa, and climate influences the frequency of coitus. Implications from these variations must be taken into consideration in designing new family planning services.^ieng

International maternity care monitoring: results of a pretest.

This report gives the preliminary results of a pretest cosponsored by the International Fertility Research Program and the International Federation of Gynaecology and Obstetrics. It includes data on 33 116 deliveries in 20 maternity centers in Latin America, Europe, Africa and Asia. The findings are organized around four themes: (a) family formation and reproductive history, (b) family health, (c) management of this delivery and (d) desired family size and family planning practices.

Hospital counseling in Khartoum: a study of factors affecting contraceptive acceptance after abortion.

This study examines the impact of contraceptive counseling on 3 263 women hospitalized in Khartoum for treatment of incomplete abortion. The analysis which focused on education and parity/child desire, revealed that the counseling program produced contraceptive acceptance among 47.0% of those followed up. In spite of the counseling efforts, half of the women in this study did not accept contraception following the abortion-regardless of education or parity/child desire. It is difficult to determine why 50% of those who had recently undergone an incomplete abortion were willing to put themselves at risk again. Apparently, future efforts to increase the impact of counseling programs must also examine patients' motivation to accept (or not to accept) contraception.

A study of abortion in countries where abortions are legally restricted.

In countries where induced abortion is permitted, national family planning programs are able to combine pre- and postconceptive fertility control methods to maximize success in achieving personally desired fertility levels and nationally desired growth levels. The proscription against induced abortion tends to produce criminal abortions and consequent morbidity and mortality which, in some countries, are often recognized as a national health problem. The International Fertility Research Program has undertaken this study of incomplete, inevitable, threatened and septic abortion cases, using a standard data collection instrument, to facilitate comparisons across institutions and countries. The data gather since 1971 in nine Asian, African and Middle Eastern hospitals includes 7,331 cases. Policies of the participating institutions with respect to what constitutes a therapeutic abortion affected the proportions of spontaneous abortions and of abortions induced outside the hospital and inside the hospital. Women treated for induced abortion tended to be of higher parity and more likely to have attained their desired family size than patients treated for spontaneous abortions. Morbidity rates were quite low for patients treated in centers where vacuum aspiration was mainly used, particularly in contrast to the morbidity rates for patients treated in centers where dilatation and curettage was used exclusively. High mortality rates in patients admitted with sepsis confirm the need not only for improvement of clinical procedures but also for reconsideration of the legal issues since many patients admitted with sepsis can be assumed to have had abortions induced.

Contraceptive practice after women have undergone "spontaneous" abortion in Indonesia and Sudan.

Studies of hospitalized "spontaneous" abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population.

Clinical measurement of trend in fertility of women attending family planning clinics in Ghana.

1. The need for a simple method of measuring trend in fertility in family planning programme has been stated. 2. The theory of the numerator analysis of age and parity or age and number of living children and its variants the "three area" and the "four quadrant methods" have also been stated. 3. The data from the Korle Bu Teaching Hospital have been analysed. 4. The finding was that the proportion of women of the high fertility group is reducing while that of women in lower fertility is increasing with time. 5. The relevance of this type of analysis to national family planning programme has been emphasised.