Yielding components in bean accessions / Componentes do rendimento em acessos de feijão

The importance of genetic resources is widely recognized. The aim of this study was to evaluate the interrelation between grain yield and its components in accessions of common bean, as well as to determine which yelding component has the highest contribution in the grain yield among the different acessions evaluated. The experiment was carried out in Lages, Southern of Brazil, in the growing season of 2005/06, being constituted by 20 accessions of common bean. The path analysis was performed, including grain yield (basic variable) versus their primary components (secondary variables). Of the ten explanatory variables involved in the study, the number of racemes with legume per plant (NRL) was the only one presenting good combination between the direct effect and the correlation coefficient, both of significant values. Thus, the NRL is the most important component to predict grain yield in accessions of common bean, mainly for being of great value in the genetic progress of this character, through indirect selection.

A importância dos recursos genéticos é amplamente reconhecida. O objetivo deste trabalho foi avaliar a inter-relação entre a produtividade de grãos e seus componentes em acessos de feijão comum, bem como determinar qual o componente do rendimento possui maior contribuição na produtividade de grãos dentre os diferentes acessos avaliados. O experimento foi conduzido em Lages, SC, na safra 2005/06, constituído por 20 acessos de feijão comum. Foi realizada uma análise de trilha do rendimento de grãos (variável básica) vs. seus componentes primários (variáveis secundárias). Das dez variáveis explicativas envolvidas no estudo, o número de racemos com legume por planta (NRL) foi a única que apresentou boa combinação entre o efeito direto e o coeficiente de correlação, ambos de valores significativos. Sendo assim, o componente NRL é o componente mais importante na predição da produtividade de grãos em acessos de feijão comum, principalmente por ser de grande valor nos progressos genéticos deste caráter, por meio da seleção indireta.

Yielding components in bean accessions / Componentes do rendimento em acessos de feijão

The importance of genetic resources is widely recognized. The aim of this study was to evaluate the interrelation between grain yield and its components in accessions of common bean, as well as to determine which yelding component has the highest contribution in the grain yield among the different acessions evaluated. The experiment was carried out in Lages, Southern of Brazil, in the growing season of 2005/06, being constituted by 20 accessions of common bean. The path analysis was performed, including grain yield (basic variable) versus their primary components (secondary variables). Of the ten explanatory variables involved in the study, the number of racemes with legume per plant (NRL) was the only one presenting good combination between the direct effect and the correlation coefficient, both of significant values. Thus, the NRL is the most important component to predict grain yield in accessions of common bean, mainly for being of great value in the genetic progress of this character, through indirect selection.

A importância dos recursos genéticos é amplamente reconhecida. O objetivo deste trabalho foi avaliar a inter-relação entre a produtividade de grãos e seus componentes em acessos de feijão comum, bem como determinar qual o componente do rendimento possui maior contribuição na produtividade de grãos dentre os diferentes acessos avaliados. O experimento foi conduzido em Lages, SC, na safra 2005/06, constituído por 20 acessos de feijão comum. Foi realizada uma análise de trilha do rendimento de grãos (variável básica) vs. seus componentes primários (variáveis secundárias). Das dez variáveis explicativas envolvidas no estudo, o número de racemos com legume por planta (NRL) foi a única que apresentou boa combinação entre o efeito direto e o coeficiente de correlação, ambos de valores significativos. Sendo assim, o componente NRL é o componente mais importante na predição da produtividade de grãos em acessos de feijão comum, principalmente por ser de grande valor nos progressos genéticos deste caráter, por meio da seleção indireta.

Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children.

OBJECTIVE: To determine whether nutritional status, anaemia and geohelminth infections were related to school achievement and attendance in Jamaican children. DESIGN: A cross-sectional study using a randomly selected sample. SUBJECTS: Eight hundred children aged 9-13 y randomly selected from those enrolled in grade 5 in 16 primary schools in rural Jamaica. RESULTS: The mean height-for-age of the children was -0.37 z-score +/- 1.0 s.d. with 4.9% having heights-for-age < -2 s.d. of the NCHS references. Anaemia (Hb < 11 g/dl) was present in 14.7% of the children, 38.3% were infected with Trichuris trichiura and 19.4% with Ascaris lumbricoides. Achievement levels on the Wide Range Achievement Test were low, with children performing at grade 3 level. In multilevel analyses, controlling for socioeconomic status, children with Trichuris infections had lower achievement levels than uninfected children in spelling, reading and arithmetic (P < 0.05). Children with Ascaris infections had lower scores in spelling and reading (P < 0.05) Height-for-age (P < 0.01) was positively associated with performance in arithmetic. Ascaris infection (P < 0.001) and anaemia (P < 0.01) predicted poorer school attendance. CONCLUSION: Despite mild levels, undernutrition and geohelminth infections were associated with achievement, suggesting that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children.

PIP: The association of nutritional status, anemia, and geohelminth infection with school attendance and performance was investigated in a cross-sectional study of 800 primary school students 9-13 years of age (mean age, 10.8 years) from 4 rural parishes in Jamaica. 4.9% of the children had heights-for-age less than 2 standard deviations of the US National Center for Health Statistics references and 14.7% were anemic; 38.3% were infected with Trichuris trichiura and 19.4% with Ascaris lumbricoides. Multivariate analyses, controlled for socioeconomic status, indicated children with Trichuris infection had significantly lower achievement levels than uninfected children in spelling, reading, and arithmetic, while those with Ascaris infection had significantly lower scores in spelling and reading. Height-for-age was positively associated with performance in arithmetic. Ascaris infection and anemia predicted poorer school attendance. The associations demonstrated in this study are not necessarily causal. However, these findings indicate that efforts to increase school achievement levels in developing countries should include strategies to address the health and nutritional status of rural children.

Breast milk or animal-product foods improve linear growth of Peruvian toddlers consuming marginal diets.

Although breast-feeding is widely accepted as important for infant health, its benefits during the second year of life have been questioned. We analyzed data from 107 breast-fed and weaned Peruvian children living in a periurban community to determine whether breast milk contributed to improved linear growth between 12 and 15 mo of age. Breast-feeding frequency was self-reported; intakes of complementary foods and animal products were estimated from a food-frequency survey. Multivariate-linear-regression analysis was used to predict the length of the children at 15 mo of age. Determinants of length included length and weight-for-length at 12 mo of age (US National Center for Health Statistics standards), interval between 12- and 15-mo measurements, breast-feeding frequency, incidence of diarrhea, and intakes of complementary and animal-product foods. Complementary foods, animal-product foods, and breast milk all promoted toddlers' linear growth. In subjects with low intakes of animal-product foods, breast-feeding was positively associated (P < 0.05) with linear growth. There was a 0.5-cm/3 mo difference in linear growth between weaned toddlers and children who consumed the average number of feedings of breast milk. Linear growth was also positively associated with intake of animal-product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in subjects with high complementary-food intakes. When the family's diet is low in quality, breast milk is an especially important source of energy, protein, and accompanying micronutrients in young children. Thus, continued breast-feeding after 1 y of age, in conjunction with feeding of complementary foods, should be encouraged in toddlers living in poor circumstances.

PIP: The contribution of prolonged breast feeding to linear growth at 12-15 months of age was investigated in 107 breast-fed and weaned toddlers from a low-income neighborhood in Lima, Peru. The median duration of breast feeding in this sample was 17.1 months; by 15 months, 46 children had been weaned. The prevalence of stunting (length-for-age score -2 SD below the reference standard) was 17.8% at 12 months and 24.3% at 15 months; no child was wasted. Complementary foods, animal product foods, and breast milk all promoted toddlers' linear growth. In children with low intakes of animal product foods, breast feeding was positively associated with linear growth at 15 months (p 0.05). There was a 0.5 cm/3 months difference in linear growth between weaned toddlers and those who consumed the average number (6.3/day) of breast feeds. Linear growth was further positively associated with intake of animal product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in children with high intakes of complementary foods. When the household diet is of poor quality, breast feeding is an especially important source of energy, protein, and micronutrients in toddlers and should be continued beyond 12 months of age in conjunction with the provision of complementary foods. Breast milk not only added to the total diet of these young children, but also potentiated the beneficial effects of complementary foods consumed by increasing their growth promotion capacity.

Human development index as a predictor of infant and maternal mortality rates.

OBJECTIVE: The United Nations Human Development Index (HDI) is a composite index of life expectancy, literacy, and per capita gross domestic product that measures the socioeconomic development of a country. We estimated infant and maternal mortality rates in the world and assessed how well the HDI and its individual components predicted infant and maternal mortality rates for individual countries. MATERIALS: Data on mortality rates and values for HDI components were obtained from the United Nations and the World Bank. RESULTS: For the 1987 to 1990 period, approximately 9 million infant deaths and 349,000 maternal deaths occurred in the world annually, yielding global infant and maternal mortality rates of 67 per 1000 and 250 per 100,000 live births, respectively. HDI is a powerful predictor of both infant and maternal mortality rates. It accounts for 85% to 92% of the variation in infant mortality rates, and 82% to 85% of the variation in maternal mortality rates among countries. Each component of HDI is also strongly correlated with both infant and maternal mortality rates (significance of all values for r, p < 0.001), and eliminating life expectancy from HDI does not decrease significantly the predictive power of HDI for infant or maternal mortality rates. CONCLUSION: HDI is not only a useful measure for socioeconomic development, but also a powerful predictor of infant and maternal mortality rates for individual countries.

PIP: The UN Human Development Index (HDI), a composite index of life expectancy, literacy, and per capita gross domestic product, provides a measure of a country's level of socioeconomic development. An analysis of mortality data obtained from the United Nations and the World Bank indicated that the HDI is, in addition, a powerful predictor of infant and maternal mortality rates. The 1990 infant mortality rate in the 78 countries for which data were available ranged from 5/1000 live births in Japan to 143/1000 live births in Bhutan and Gambia; the maternal mortality rate ranged from 3/100,000 live births in Finland to 1500/100,000 live births in Nepal. The HDI accounted for 85-92% of the variance in infant mortality rates and 82-85% of that in maternal mortality. Although life expectancy tended to be the HDI component with the strongest predictive power, especially for infant mortality, the explanatory power of the index did not decrease significantly even when this component was excluded. If infant and mortality rates in developed countries in 1987-90 had prevailed worldwide, 8 million infant and 340,000 maternal deaths would have been averted each year.

Association of infections with human immunodeficiency virus and human papillomavirus in Honduras.

The etiologic role of the oncogenic types of human papillomavirus (HPV) in the development of cervical cancer has been widely proven. Since this cancer occurs more frequently in immunosuppressed individuals, we sought to evaluate the prevalence of HPV infection among human immunodeficiency virus (HIV)-infected and HIV-noninfected prostitutes in Tegucigalpa, Honduras. Cervical scrapes were collected from 23 HIV-seropositive and 28 HIV-seronegative prostitutes for HPV DNA detection by the polymerase chain reaction. Fifty-six percent of the HIV-seropositive women and only 18% of the seronegative women were HPV DNA positive (odds ratio = 6.0). In addition, there was a significant association between seropositivity for HIV with a history of sexually transmitted diseases (P < 0.01). Our data confirm the association between infections with HIV and HPV.

PIP: Numerous studies have revealed a higher prevalence of human papillomavirus (HPV)--etiologically linked to the development of cervical cancer--in women infected with HIV. This study investigated the association of HPV and HIV among 51 prostitutes in Tegucigalpa, Honduras. 23 were HIV-positive. All participants were in their early thirties, had had at least one pregnancy, and experienced their first pregnancy at a mean age of 16 years. Polymerase chain reaction identified HPV DNA in cervical scrapes from 13 (56.5%) HIV-positive women compared with only 5 (18%) HIV-negative prostitutes (odds ratio, 6.0; 95% confidence interval, 1.5-26.7). In addition, there was a significant association between HIV and a history of other sexually transmitted diseases (p 0.01). Since the progression to invasive cervical disease is more aggressive in HIV-infected women, prostitutes and other women at risk of both these infections should receive frequent cytologic screening and counseling.

Association of breastfeeding and stunting in Peruvian toddlers: an example of reverse causality.

BACKGROUND: Child feeding recommendations include breastfeeding beyond 12 months, however, some researchers have reported increased rates of malnutrition in breastfed toddlers. A negative association between growth and breast-feeding may reflect reverse causality; that is, the outcome (growth) is a determinant of the predictor (breastfeeding), and not vice versa. We examined this question with data from 134 Peruvian toddlers. METHODS: A linear regression analysis predicted length at the age of 15 months by length at 12 months, study interval, and 12-14.9-month breastfeeding, complementary food intake, and diarrhoeal incidence. This analysis defined the association between breastfeeding and linear growth. To elucidate the direction of the effect between breastfeeding and linear growth, logistic regression was used to predict the probability of weaning by the end of 14 months. Determinants included weight-for-age (W/A) at 12 months, complementary food intake at 9-11.9 months, and change in diarrhoeal incidence between 9 and 14.9 months. RESULTS: There was a significant (P < 0.01) interaction of breastfeeding, diarrhoeal incidence, and complementary food intake on length at 15 months. Increased breastfeeding was associated with a 1.0 cm decrease in length gain when dietary intake was low and diarrhoeal morbidity was high, implying that breastfeeding is harmful. The logistic analysis, however, demonstrated that the risk of weaning decreased only when W/A and dietary intake were low and diarrhoeal morbidity was high. CONCLUSIONS: The negative association between breastfeeding and linear growth reflected reverse causality. Increased breastfeeding did not lead to poor growth; children's poor growth and health led to increased breastfeeding. Children's health must be considered when evaluating the association of breastfeeding with anthropometric outcomes.

PIP: There has been a perplexing finding, in many developing countries, of increased rates of stunting and growth faltering in breast-fed toddlers receiving complementary foods relative to their non-breast-fed counterparts. Longitudinal data on 134 children 12-15 months of age from Lima, Peru, were used to investigate the hypothesis that the negative association between growth and breast feeding reflects reverse causality. The toddlers were participants in a broader persistent diarrhea surveillance survey conducted during 1985-87. 72.9% of children were breast-fed beyond 12 months (median duration, 16.8 months). Anthropometric measurements revealed stunting in 19.4% of toddlers at 12 months and in 29.1% at 15 months. Linear growth between 12 and 15 months had a complex relationship with breast feeding, diarrhea, and dietary factors. Increased breast feeding was associated with a 1.0 cm decrease in length gain between 12 and 15 months when dietary intake was low and diarrheal morbidity was high. However, logistic analysis demonstrated that mothers whose children had low dietary intakes, low weight-for-age, and increased incidence of diarrhea were less likely to wean their infants at 12 and 14 months. This finding that mothers modified their children's feeding practices according to the child's health and growth status supports a reverse causality process in which poor growth is a determinant rather than a result of breast feeding.

Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking.

The association between the intensity and duration of cigarette smoking during pregnancy and the frequency of low birthweight, preterm births and intrauterine growth retardation was investigated in a historical cohort. All 5166 livebirths occurring in the city of Pelotas, Brazil, during 1993 were identified and mothers interviewed soon after delivery. Children whose mothers smoked during pregnancy had a birthweight 142 g lower than those of non-smoking mothers. The odds ratio for low birthweight among children of smokers was 1.59 [95% CI 1.30-1.95]. There was no association between smoking and preterm delivery assessed by the Dubowitz score. In relation to intrauterine growth retardation, smoking was associated with an odds ratio of 2.07 [95% CI 1.69-2.53]. There was a direct dose-response association between the number of cigarettes smoked and the risk of growth retardation. Women whose partner smoked were also at higher risk of having a child with growth retardation. All the above results were adjusted for confounding factors. The effect of maternal smoking on low birthweight seems to be attributable to intrauterine growth retardation rather than preterm delivery.

PIP: Although the deleterious effect of maternal smoking on birth weight has been well documented, no study has investigated the impact of smoking on the different combinations of low birth weight (LBW), preterm delivery, and intrauterine growth retardation (IUGR). The present study addressed these associations through a cohort analysis of virtually all 5166 live births occurring in Pelotas, Brazil, in 1993. Mean birth weight was 3169 g; the prevalences of LBW, preterm birth, and IUGR were 9.1%, 8.0%, and 8.9%, respectively. The prevalence of smoking at conception was 33.2%; 26.2% of mothers smoked during the entire pregnancy; and 43% of mothers' partners smoked. The infants of mothers who smoked during pregnancy weighed an average of 142 g less at birth than those of nonsmokers. Logistic regression analyses of LBW were adjusted for social class, maternal education, parity, pregnancy interval, prior LBW, maternal height, and number of antenatal care visits. Mothers who smoked for part or all of the pregnancy were 1.59 times more likely to deliver a LBW infant than nonsmokers. There was no association between maternal smoking and preterm delivery. The risk of IUGR was 2.07 times higher in mothers who smoked; women who stopped smoking during the first trimester, however, had a risk similar to that of nonsmokers. Smoking by the mother's partner also increased the risk of IUGR (odds ratio, 1.33). Smoking was associated with at least a doubling of risk of IUGR, whether or not LBW or preterm birth was also present, suggesting that IUGR is the key factor mediating the effect of smoking on birth weight.

Health and wages: evidence on men and women in urban Brazil.

PIP: This study examines the impact of 4 health measures on wages of urban workers in Brazil. Data are obtained from the 1974-75 Estudo Nacional da Despesa Familiar among a sample population over 14 years old for wages earned by respondents 15-50 years old. The 4 health measures include height, body mass index (weight divided by height squared), per capita calorie intake, and per capita protein intake. Findings indicate that health measures significantly affected wages, even after accounting for endogeneity. Taller men and women earned more, even after controlling for education and other health measures. Body mass index affected only men's wages. The effect of height was larger for men. Body mass index had a larger impact on wages among persons with low levels of education. Nutrient intake affected wages of men and women in the market sector. More protein had the greatest return at high levels of intake, depending upon calorie intake, mass, and height. Height was a strong predictor of wages for self-employed men only. Body mass index affected the wages of only self-employed men with little or no education. Neither protein or caloric intake significantly affected wages of the self-employed. Models controlled for selection into the labor market and the choice between market and self-employment sectors in the estimated hazard rates based on multinomial logits, according to Heckman (1974) and Lee (1983). It is assumed that relative food prices and nonlabor income had no direct effect on wages. Findings suggest that health produces a substantial return in the formal sector of Brazilian labor markets.^ieng

Lens opacities, demographic factors and nutritional supplements in the Barbados Eye Study.

BACKGROUND: This study evaluated the association of age-related lens opacities with the use of nutritional supplements and demographic factors among 4314 black participants (> or = 40 years) in the population-based Barbados Eye Study. METHODS: Lenses were classified at the slit lamp by the Lens Opacities Classification System II (LOCS II); a score > or = 2 was used to define the presence of gradable lens opacities, by type. Lens changes also included prior cataract surgery or cataract too advanced to grade. Associations with risk factors were evaluated by logistic regression analyses. RESULTS: The study identified 1800 individuals with lens changes in at least one eye; 229 had nuclear opacities only; 851 had cortical opacities only. Older age and indicators of lower socioeconomic status (low education and/or non-professional occupation), were positively associated with both nuclear (odds ratio [OR] = 1.90) and cortical (OR = 1.47) opacities. Women had an increased risk of cortical opacities (OR = 1.41). Regular users of nutritional supplements were less likely to have lens changes (OR = 0.78) and, specifically, cortical opacities (OR = 0.77). The association with nutritional supplements was present in those < 70 years, but not at older ages. CONCLUSIONS: The study supports the association of lower socioeconomic status with lens changes, including nuclear and cortical lens opacities. The findings also suggest that regular users of nutritional supplements have a one-fourth lower risk of lens changes and particularly, of cortical opacities; a result seen at ages under 70 years. The associations with potentially modifiable factors indicate the need for further evaluations, given the high prevalence of lens opacities.

PIP: The associations between age-related lens opacities and nutritional supplementation and selected demographic factors were investigated in 4314 men and women 41-84 years of age enrolled in the Barbados Eye Study. The Lens Opacities Classification System II was used for grading. 1800 of these adults had lens changes (defined as any type of gradable lens opacities, a history of cataract surgery, or cataract too advanced to grade) in at least one eye; 229 had nuclear opacities only and 851 had cortical opacities only. In logistic regression analyses, older age and low socioeconomic status (assessed on the basis of educational and occupational status) were positively associated with both nuclear (odds ratio (OR), 1.90) and cortical (OR, 1.47) opacities. The average age of participants with lens changes was 68.2 years compared with 51.8 years among those without such opacities. Compared with men, women had an increased risk of cortical opacities (OR, 1.41). Regular use of nutritional supplements (primarily cod liver oil and multivitamins) was associated with a decreased risk of lens changes (OR, 0.78), especially cortical opacities (OR, 0.77). The association with nutritional supplements did not persist beyond 70 years of age, however. The potential of nutritional supplements to reduce cataract in adults under 70 years of age could have significant public health implications, but requires confirmation in controlled clinical trials.

Use of the Pap test by a population group in Buenos Aires.

The study reported here sought to assess Pap test coverage of a group of asymptomatic Argentine women from the poor urban district of La Matanza in the Buenos Aires metropolitan area Initially, all 2495 women who voluntarily enrolled in a program for early detection of breast cancer between January 1991 and June 1993 were included. After removing those who did not meet various study criteria, there remained 779 study subjects with no gynecologic or mammary symptomatology. Two subgroups of these 779 were established-women who had received a Pap test at any time and those who had received such a test within the previous three years. Using these subgroups, the influence of certain sociodemographic and other variables upon the likelihood of Pap testing was assessed. The results indicated significant associations between past Pap testing and age, formal education, parity, and a family history of cancer Likewise, significant associations were found between Pap testing within the preceding three years and age, formal education, and parity. The study findings affirm the idea that it would be advisable to seek Pap testing for all study population women once every three years instead of every year. Since the study population was not necessarily representative of Buenos Aires population, however, and the findings could have been affected by self-selection and other biases, additional studies are needed to determine actual Pap test coverage among women of the metropolitan area.

PIP: The incidence of Pap test coverage was assessed in 779 asymptomatic women from a low-income district (La Matanza) of Buenos Aires, Argentina, who had enrolled voluntarily in a breast cancer screening program. Overall, 66% of respondents were 30-49 years old, 71% had no secondary education, and 67% lacked social security coverage. A total of 262 women (33.6%) had undergone Pap testing during the year preceding the survey, 279 (35.8%) had received such testing during the preceding 2 years, and 135 (17.4%) had had the test 3 or more years earlier, the remaining 103 (13.2%) had never been tested. Univariate analysis indicated that age, education, parity, and a family history of cancer other than breast cancer were significantly associated with having had a Pap test. Pap testing in the preceding 3 years was significantly associated with age, education, and parity. In the multivariate analysis, age, education, parity, and family history of cancer retained significance for testing at any time. Although the likelihood of testing increased with age, women in the oldest age group (50-69 years) were less likely to have been tested within the past 3 years than women 30-49 years. Parous women were 3-4 times more likely to have been tested than nulliparous women. These findings provide support for the recommendation that Pap testing should be scheduled every 3 years rather than every year to maximize coverage and make effective use of the health system's limited resources. The relatively high coverage rate identified in this study may not be representative of the Buenos Aires population, however, given the possibility of a self-selection bias of women concerned enough with their health to enroll in a cancer prevention program.

Limited education as a risk factor in cervical cancer.

The study reported here analyzes the influence of formal education on the behavior and age at onset of carcinoma of the cervix in 2204 women in Quito, Ecuador, between 1985 and 1994. The results indicate that education had a considerable degree of influence on the behavior of this neoplasia. That is, women with primary education or less were found to have almost twice the cervical cancer incidence of those with secondary or higher education, while those who were illiterate had almost six times the incidence found among university-educated women. Overall, it seems reasonable to consider women's education a key factor in defining risk groups for cervical cancer-so much so that grouping by instructional level would make it possible to improve the effectiveness of cervical cytology-based preventive measures.

PIP: To investigate the association between formal education and cervical cancer incidence, the 2204 cervical cancer cases from Quito, Ecuador, reported to the National Tumor Registry for the 1985-94 period were reviewed. The incidence of cervical cancer (in situ and invasive) per 100,000 women was 88.3 among women with no education, 52.6 among those with a primary education, 28.8 among women with a secondary education, and 14.9 among those with a university education. Invasive cervical cancer incidence among women with no more than a primary education rose sharply from the 20-24 year group to the 55-59 year group, declined slightly in the 60-64 year group, then peaked at 123 cases/100,000 women 65 years and over. Among those with a secondary education, incidence peaked at 72.5 cases/100,000 in the 55-59-year group. Among women with higher education, the incidence was only 8.6/100,000 in the 40-44 year group, remained under 30 in the 45-49 and 50-54-year groups, and peaked at 44/100,000 in women 65 years and over. A similar pattern was observed for in situ carcinoma. Among illiterate women, only 13.1% of cancers were detected at stage I compared with 48.5% among women with a secondary or higher education; conversely, 51.7% of cancers among illiterate women were detected in the advanced stages III and IV compared with 21.8% among those with a secondary or higher education. These findings suggest the feasibility of considering women's education a significant factor in defining risk groups for cervical cancer.

Human immunodeficiency virus infection in Mexico City. Rectal bleeding and anal warts as risk factors among men reporting sex with men.

The objectives of this study were to evaluate the frequency and determinants of rectal bleeding and the association between rectal bleeding and risk of human immunodeficiency virus (HIV) infection among homosexual/ bisexual men in Mexico City. Men who requested anonymous HIV testing at a public clinic in Mexico City and who reported engaging in any homosexual behavior were eligible to participate in this study. Trained staff collected information on demographic factors, sexual behavior, psychological states, and HIV serostatus from all consenting, eligible clients. Logistic regression modeling was used to investigate the independent effect of risk factors among 2,758 men who were tested between June 1991 and December 1992. Bleeding during anal intercourse was a common occurrence: More than one third of the men in the study reported some bleeding, and 8% reported bleeding in half or more of their intercourse episodes. The prevalence of HIV infection among bleeders was 42% as compared with 28% in nonbleeders (p < 0.0001), and the adjusted odds ratio was 1.8 (95% confidence interval (CI) 1.1-2.8) for men who bled in more than half of their anal intercourse episodes relative to nonbleeders. There was a trend of increasing HIV seroprevalence with increasing frequency of rectal bleeding (p = 0.001). Nine percent of all HIV infections and 42% of infections among frequent bleeders were attributable to rectal bleeding. Men who reported both rectal bleeding and anal warts were 3.5 (95% CI 2.1-5.8) times more likely to be HIV-infected in multivariate analysis than men reporting neither rectal bleeding nor anal warts. Determinants of rectal bleeding included older age, more education, more receptive anal intercourse than insertive intercourse, receptive digital-anal contact, anal warts, and genital ulcers. Among men reporting sex with men in Mexico City, rectal bleeding is common. It is an independent risk factor for HIV infection, and warrants attention in acquired immunodeficiency syndrome prevention efforts. Rectal bleeding that results from rupture of anal warts may be an especially effective portal of HIV transmission.

PIP: During June 1991 to December 1992, 68.8% of all men who gave informed consent for HIV testing at a public health clinic in Mexico City and for participation in this study had ever had sexual intercourse with men. The final sample size was 2758 men. The study examined the reported frequency of rectal bleeding, the determinants of rectal bleeding, and the interactions between rectal bleeding and other risk factors with HIV infection among homosexual/bisexual men. It also aimed to determine whether rectal bleeding is an independent risk factor for HIV transmission. 32.8% had HIV infection. 39% reported some rectal bleeding during anal intercourse. 8% experienced rectal bleeding during at least 50% of intercourse episodes. Overall, bleeders were more likely to be HIV infected than nonbleeders (42% vs. 28%; p 0.0001; adjusted odds ratio [AOR] = 1.8 for men who bled in more than 50% of anal intercourse episodes; AOR = 1.3 for men who sometimes bled). The odds ratios increased as the frequency of reported rectal bleeding increased (p = 0.001). Condom use during receptive anal intercourse did not affect the association between rectal bleeding and HIV infection. 9% of all HIV infections were attributable to rectal bleeding. 42% of HIV infections among bleeders were attributable to rectal bleeding. In the multivariate analysis, men with both rectal bleeding and anal warts were more likely to have HIV infection than men who had neither (67.9% vs. 27.2%; AOR = 3.5). Significant predictors of rectal bleeding were older age (i.e., =or 30) (AOR = 1.5), more education (AOR = 1.4-1.5), more receptive anal intercourse than insertive intercourse (AOR = 5.3-16.1), receptive digital-anal contact (AOR = 1.6), anal warts (AOR = 1.9), and genital ulcers (AOR = 2). These findings show that rectal bleeding is an independent risk factor for HIV infection. Rupture of anal warts is an especially effective portal of HIV transmission.

[Precocious neonatal mortality in premature newborns with low weight at birth and death]. / Mortalidad neonatal precoz en recien nacidos prematuros de bajo peso al nacer y de termino.

PIP: A retrospective study was conducted of all live births occurring in 1992 at a Dominican Institute of Social Security hospital in Santo Domingo to analyze the association between prematurity, low birth weight, and early neonatal mortality. Stillbirths, infants weighing less than 1000 g or born before 28 weeks of gestation, and those with lethal malformations were excluded. 5142 newborns met the inclusion criteria. 1701 deliveries (33%) were cesarean. 550 of the newborns (10.7%) were low birth weight, and 338 (6.6%) were premature. The early neonatal mortality rate was 17/1000. Low birth weight infants accounted for 66.2% of early neonatal mortality. 10.7% of low birth weight infants died within the first week of life, and their relative risk of early neonatal death was 16.42. 64% of all infants dying in their first week of life were also premature. The specific mortality rate for premature infants was 168.6/1000 live births. The relative risk was 25.32 for premature infants. Low birth weight infants born at term had an early neonatal mortality rate of 24.6/1000 live births, compared to 5.5/1000 for term births of adequate weight.^ieng

Differential response to early nutrition supplementation: long-term effects on height at adolescence.

BACKGROUND: The classical risk approach to predicting who benefits from an intervention is unsound because it relies on the theoretical assumption that those at risk will necessarily benefit. A better approach to systematically test who benefits from nutrition supplementation is proposed using interactive models. METHODS: Differential effects of nutrition supplementation during early childhood on stature at adolescence were studied in 245 males and 215 females to identify determinants of long-term benefit from food supplementation. Factors studied included family socioeconomic status (SES) and children's home diet and diarrhoea during the first 3 years of life. To determine whether a factor conferred benefit, the statistical significance of the interaction between this factor and the intervention was tested. Data from the INCAP supplementation trial in Guatemala and from the follow-up of the same subjects at adolescence were used. RESULTS: Ordinary least squares (OLS) showed that high rates of diarrhoea in males and poor SES in females were significant determinants of benefit from supplementation at adolescence, and that the effects were mediated by length at 3 years old. Results of two-stage least squares (2SLS) analysis showed that length at 36 months, maturation and maternal height were significant determinants of height at adolescence but SES was not. CONCLUSIONS: Nutrition supplementation in early childhood has long-lasting effects on body size and the larger benefits acquired by some groups of children remain throughout early adulthood. The relevance of these findings for screening and targeting of nutritional interventions is discussed.

PIP: Differential effects of nutrition supplementation during early childhood on stature at adolescence were studied in 245 males and 215 females, 14-20 years old, who had been exposed to either a high-calorie, high-protein drink (Atole) in 2 villages or a low-calorie, non-protein drink (Fresco) in 2 other villages from birth to 3 years of age in order to identify determinants of long-term benefit from food supplementation. Factors studied included family socioeconomic status (SES), children's home diet, and diarrhea during the first 3 years of life. To determine whether a factor conferred benefit, the statistical significance of the interaction between this factor and the intervention was tested. Data from the Institute of Nutrition of Central America and Panama (INCAP) supplementation trial in Guatemala and from the follow-up of the same subjects at adolescence were used. In women differences between the groups were significant only for length at 36 months and height at adolescence. In males length at 36 months was statistically greater among the Atole group, but height in adolescence was not. Ordinary least squares (OLS) showed that high rates of diarrhea in males and poor SES in females were significant determinants of benefit from supplementation at adolescence, and that the effects were mediated by length at 3 years old. Male children who benefited from the supplementation were those with more diarrhea in early infancy. The difference in length at 36 months was 3.03 cm in favor of the Atole group compared to 0.98 cm for the groups with less diarrhea. 2-stage least squares analysis showed that length at 36 months, maturation, and maternal height were significant determinants of height at adolescence but SES was not. Nutrition supplementation in early childhood has long-lasting effects on body size, and the larger benefits acquired by some groups of children remain throughout early adulthood.

Factors associated with Hispanic women's HIV-related communication and condom use with male partners.

To determine factors influencing Hispanic women's HIV-related communication and condom use with their primary male partner, 189 Dominican, Puerto Rican, and Mexican women were interviewed regarding sexual behaviour and condom use, relationship characteristics, perceived risk for HIV, and HIV-related communication with the primary male partner. Level of HIV-related communication with the primary male partner was associated with the woman's perceived risk for HIV and her rating of the openness with which she could communicate with her primary partner. Mexican women were less likely than Puerto Rican or Dominican women and women with multiple partners were less likely than those with one partner to communicate about HIV-related issues with their primary partner. Women reporting more condom use with their primary partner were younger, had discussed HIV-related issues more with the primary partner, and were less likely to expect negative reactions to requests for condom use than those reporting less condom use. These results suggest that prevention programmes that increase both general and HIV-specific communication between members of a couple may facilitate safer sex practices by the couple. Prevention programmes that encourage women to insist on condom use should consider the woman's expectations about her partner's reaction as a potential barrier to the initiation of safer sex practices.

PIP: To determine factors influencing Hispanic women's HIV-related communication and condom use with their primary male partner, 189 Dominican (n = 44), Puerto Rican (n = 54), and Mexican women (n = 91) 18-40 years old were interviewed regarding sexual behavior and condom use, relationship characteristics, perceived risk of HIV, and HIV-related communication with the primary male partner. They were recruited from the waiting rooms of primary health care clinics in the Washington Heights (Dominican), and East Harlem (Puerto Rican) sections of New York City and in El Paso, Texas (Mexican). Level of HIV-related communication with the primary male partner was associated with the woman's perceived risk of HIV. Mexican women were less likely than Puerto Rican or Dominican women and women with multiple partners were less likely than those with one partner to communicate about HIV-related issues with their primary partner. Puerto Rican and Dominican women reported more HIV-related communication with their primary partner than did Mexican women (p 0.02). 71% of the participants had told their partner they were worried about getting the AIDS virus from him. 59% of the women had asked their partner to change his behavior to this effect, but Mexican women were less likely to request such change and they were also the least likely to report any condom use (p 0.05). Overall, 74% of the women reported never using condoms with their primary partner in the past 6 months, 13% reported sometimes using condoms, and 13% reported always using them. Women reporting more condom use with their primary partner were younger, had discussed HIV-related issues more with the primary partner, and were less likely to expect negative reactions to requests for condom use than those reporting less condom use. These results suggest that prevention programs that increase both general and HIV-specific communication between members of a couple may facilitate safer sex practices by the couple.

Associations between social and environmental factors and perinatal mortality in Jamaica.

Social and environmental factors in Jamaica were compared between 9919 mothers delivering in a 2-month period a singleton who survived the early neonatal period and 1847 mothers who were delivered of a singleton perinatal death in a contiguous 12-month period. Logistic regression showed independent positive statistically significant increased odds of having a perinatal death among mothers who lived in rural parishes, older mothers (aged 30 +), single parents, no other children in the household, large number of adults in the household, mother unemployed, the major wage earner of the household not being in a managerial, professional or skilled non-manual occupation, the household not having sole use of toilet facilities, smaller mothers and those classified as obese or undernourished. Variations were found for different categories of death. Intrapartum asphyxia deaths were not related to union (marital) status, occupation of major wage earner, number of adults nor to the use of the toilet. Antepartum fetal deaths did not vary significantly with occupation of major wage earner or maternal height, but did show a relationship with maternal education, mothers with lowest levels having reduced risk. Deaths from immaturity were significantly related only to occupation of major wage earner, number of children in the household, number of social amenities available (negative relationships) and maternal age (< 17 at highest risk). In conclusion there was little to indicate that social deprivation per se was related to perinatal death, although specific features of the environment showed strong relationships.

PIP: The Jamaican Perinatal Mortality Survey provided the data for this logistic regression analysis of factors related to perinatal mortality. The sample included 94% of all mothers delivering in September and October 1986 and clinical records of still births and infant mortality with 7 days of birth during September 1986 and August 1987. Causes were identified according to the Wigglesworth classification as antepartum fetal deaths (APFD), congenital malformations and immaturity (IMMAT), intrapartum asphyxia (IPA), and miscellaneous. The results showed the lowest risk among married mothers and the highest among women with a visiting partner, but the relationship was not strong. Expenditures on food per person was unrelated. Unemployed women had a higher risk for all causes except immaturity. There were reduced risks for all deaths and IPA among households with heads engaged in professional and nonmanual skilled occupations. There was a strong relationship with the number of children under 11 years old in the household. The risk was very high in households with no children and risk declined with number of children under 11 years old. Housing size or type of ownership were unrelated. The more crowded the sleeping conditions, the lower the risk of perinatal death for IPA and all perinatal deaths. Risk was increased with lack of access to a private water supply in the household and use of shared toilet facilities. Increased risk was also related to lack of access to urban facilities. Risk was lowest in the eastern area of the island and highest in the far western areas. Lowest risks for all deaths were in the urban areas of Kingston, St. Andrew, and St. James. A U-shaped pattern appeared for age, with high risk among those under 17 years and over 35 years old for all deaths and IPAs. APFDs and IMMAT were more likely among mothers under 17 years old. Women taller than 5 feet 6 inches had the lowest mortality. APFDs and total perinatal mortality were significantly related to increased weight. Risk was increased among mothers either malnourished or obese. The final logistic model showed increased risk among mothers who were unmarried or cohabiting, with no young children regardless of parity, with shared toilet facilities, with lower nutrition, and increased age.

Cultural change, polygyny, and fertility among the Shipibo of the Peruvian Amazon.

PIP: Household interview in 8 Shipibo communities on the Ucayali and Pisqui Rivers in Peru in 1983 and 1984 were conducted in order to obtain reproductive histories of 386 women aged 13 years and older. Polygyny was defined in three ways: as ever experienced, as operant during a specific birth interval, and as the mean length of closed birth intervals and the proportion polygynous. The aim was to determine the effect of the decline in polygyny on increased fertility. The results showed that of 1445 individuals in 8 villages, 585 (over 33%) lived in Paoyhan village. The sex ratio was 104 men to 100 women and varied among the villages. 49.3% were younger than 15 years and 60.3% younger than 20 years. Crude birth rates varied from 42.6 to 89.6/1000. Crude death rates ranged from 14 to 63.8/1000. Infant mortality was 138/1000. The village of 9 de Octubre had the lowest compared fertility and also had the highest rate of polygyny. Irazola village had the highest man completed fertility, and the lowest polygyny. The median reported age at marriage was 14 years; median reported age at menarche was 13 years. Age at menarche was the same regardless of marriage type, but polygynous women tended to marry about a year earlier. First delivery averaged about 15.6 years and was lower for polygynous women. 75 (19.4%) had ever engaged in a polygynous unions. The highest polygynous unions were in 9 de Octubre, Vencedor, Tupac Amaru, and charashmanan villages, and ranged from 56.5% to 5.3%. The proportion of men in polygynous unions ranged from 3.4% in Paoyhan to 21.9% in Vencedor. 84.5% of women aged 15 years and older had had at least one pregnancy. The mean reproductive span was 13 years. The mean age at delivery was 28.8 years. The mean birth interval was 31.5 months; mean interval for women aged 45 years and older was 36.2 years. There was found no correlation between birth interval number and birth interval length, or mother's age at birth interval and length of birth interval. Polygynous unions had a mean birth interval length 4 months longer, and lower fertility: 4.7 births versus 6.0 births. Regression analysis showed a straight line positive correlation between mean birth intervals and polygyny, even excluding Paoyhan, and a negative relationship between the prevalence of polygyny and fertility.^ieng

Early onset psychopathology and the risk for teenage pregnancy among clinically referred girls.

OBJECTIVE: To investigate whether early onset DSM-III depressive and conduct disorders and historical/familial variables increased the risk of teenage pregnancy among clinically referred girls, whose referral was unrelated to their reproductive status. METHOD: The sample of 83 girls, 8 to 13 years old at study entry, were participating in a longitudinal investigation of childhood-onset psychiatric disorders. They were repeatedly evaluated during an interval of up to 12 years. RESULTS: Twenty-nine girls had at least one pregnancy, and 25 had their first pregnancies as teenagers (< or = 18 years old). Several variables that predicted earlier age at first pregnancy in longitudinal univariate analyses became nonsignificant in the multivariate model. In the final model, childhood or adolescent onset conduct disorders (but not depressive disorders), and race were significantly associated with teenage pregnancy. Among the girls with conduct disorders, 54.8% became pregnant teenagers versus 12% of the rest, and 56% of the black adolescents versus 12% of the rest, had teenage pregnancies. CONCLUSIONS: After adjusting for race, early onset conduct disorder represents a risk factor for teenage pregnancy among psychiatrically referred girls. The mechanisms may entail behavioral dysregulation, delay in social-cognitive development, and misinformation about reproductive issues. Such girls may benefit from therapeutic and educational interventions to delay childbearing.

PIP: An existing longitudinal data set was used to investigate the hypothesis that a depressive disorder in childhood increases the risk of an adolescent pregnancy. Depression is characterized by low self-esteem, lowered concern about one's personal welfare, passivity, and impaired motivation--all of which may prevent teenage girls from taking steps to protect themselves from pregnancy. The 83 subjects had been referred to a child psychiatric clinic (86%) or a general medical facility (12%) in Pittsburgh, Pennsylvania, between the ages of 8-13 years (average age at intake, 11.5 years). They underwent 4 clinical assessments in the first year of study participation and 2 assessments in each subsequent year. 65 girls experienced 1 or more DSM-III-R defined depressive episodes during the study period; the rest, who served as psychopathologic controls, had conduct disorders. 25 of the 83 subjects (30%, compared to the national average of 24%) had documented pregnancies by the age of 18 years. 28% of the pregnant teens had a history of early onset depression compared with 66% of their nonpregnant counterparts. On the other hand, 76% of the pregnant teens had been diagnosed with a conduct disorder by the age of 18 compared with 24% of the nonpregnant girls. Preliminary analysis further indicated that teenage pregnancy was associated with having been born out of wedlock or to a mother aged 18 years or younger; living in an intact family at time of study enrollment and socioeconomic status were not significant correlates. In the multivariate analysis, however, only two factors retained significance: a conduct disorder diagnosis in childhood (mean time to first pregnancy was 17.3 years compared to 18.7 years among remaining subjects) and race (Blacks tended to become pregnant by 17.4 years compared to an average of 18.7 years for Whites). No significant interaction was detected between a conduct disorder and race. These findings suggest that educational interventions aimed at decreasing impulsivity and undesirable consequences should be targeted at girls with conduct disorders.

Abortion and adolescence: relation between the menarche and sexual activity.

PIP: The finding that adolescents comprised 16.4% of 2588 cases of women with post-abortion complications treated at a Sao Paulo, Brazil, hospital during 1978-92 led to an analysis of the biological and demographic factors associated with induced abortion among women under 20 years of age. Compared to abortion patients 20 years of age and above, adolescents in this study were more likely to be single, work in domestic service, to opt for abortion rather than pregnancy continuation, and to delay abortion to 14-20 weeks of gestation. The average age at menarche in the study population as a whole was 13.4 years, with a range of 9-19 years. 81.4% initiated sexual intercourse before the age of 14 years (range, 10-39 years). The average difference between age at menarche and age at first intercourse was 2.8 years for adolescent abortion seekers compared to 5.9 years for older women, while the difference between age at first intercourse and age at onset of first pregnancy was 1.3 years among adolescents compared to 4.8 years for older women. The finding that young women are at risk of an unwanted pregnancy soon after menarche should be considered in the design of adolescent health care services.^ieng