ABSTRACT
To determine the risk for diarrheal disease (DD) in day-care centers (DCC) for children residing in a poor urban slum area of Quito, Ecuador, compared with that for children from the same environment but cared for in their own residential home (RH), a prospective age-, sex- and locale-controlled study of DD was conducted, including 115 children in DCC and 115 in RH, ages 12 to 42 months. The overall incidence of DD was 46/1000 child weeks. Diarrhea was more common in DCC than in RH (relative risk (RR), 1.75; 95% confidence interval (CI), 1.38 to 2.22; P < 0.001). Poor hygienic practices were more prevalent in DCC than in RH. The use of reused water for child handwashing before eating and for washing raw vegetables was associated with a higher risk of DD in DCC than in RH (RR = 4.08, CI 2.93 to 5.67, P < 0.001; RR = 3.90, CI 2.79 to 5.44, P < 0.001, respectively). These two practices were risk factors in the DCC (RR = 2.74, CI 2.08 to 3.68, P < 0.001; RR = 2.05, CI 1.55 to 2.71, P < 0.001, respectively) when compared with their absence in the same DCC. Shigella (RR = 3.58, CI 1.19 to 10.78, P < 0.02), Aeromonas (RR = 10.47, CI 1.35 to 81.05, P < 0.01), rotavirus (RR = 2.86, CI 1.87 to 4.39, P < 0.001) and Giardia (RR = 1.59, CI 1.00 to 2.59, P < 0.05) were more common in DCC than in RH. More than two-fifths of the Shigella and Aeromonas isolates were resistant to trimethoprim-sulfamethoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Child Day Care Centers , Developing Countries , Diarrhea/epidemiology , Disease Outbreaks , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Diarrhea/microbiology , Diarrhea/therapy , Drug Resistance, Microbial , Ecuador/epidemiology , Female , Humans , Hygiene , Incidence , Infant , Male , Prospective Studies , Risk Factors , Socioeconomic FactorsABSTRACT
OBJECTIVE: To compare the use of two gonadotropin-releasing hormone agonists, nafarelin acetate (NA) and leuprolide acetate (LA), in conjunction with human menopausal gonadotropins (hMG)/human chorionic gonadotropin (hCG) and intrauterine insemination (IUI). DESIGN: Retrospective analysis of selected patient records. Patients were assigned to treatment groups systematically, but not randomly. Fixed rules were used for selection of medical records, but the study was not blinded. SETTING: University medical center ovulation induction program. PATIENTS AND INTERVENTIONS: Fifteen NA/hMG/IUI cycles were analyzed in comparison with 15 contemporary LA/hMG/IUI cycles. RESULTS: There were no differences in: the number of days to ovarian suppression, the number of ampules of hMG required, the number of 17-mm preovulatory follicles, or the mean peak estradiol levels. However, the minimum estradiol levels at the height of ovarian suppression by GnRH agonist were lower in the LA group than in the NA group. Furthermore, 4/15 NA cycles resulted in pregnancy compared with 0/15 LA cycles. CONCLUSIONS: NA is, at the least, comparable to LA in effecting pregnancy after superovulation/IUI.
