[Work conditions, labor fatigue and low birth weight among street vendors]. / Condiciones de trabajo, fatiga laboral y bajo peso al nacer en vendedoras ambulantes.

OBJECTIVE: This study presents the demographic, socioeconomic profile, working conditions and labor fatigue among fertile age street vendors in Mexico City. MATERIAL AND METHODS: 426 female street vendors were interviewed in Mexico City. This population was described and the association between the components labor fatigue and low birth weight (LBW) was analyzed by logistic regression in a subgroup of women who worked as street vendors during their last pregnancy. RESULTS: Of the interviewed group, 56% works more than 48 h per week, 87% had no social security, and 68% only had primary school level. The risk of LBW increased when workers had to cover selling quotes (OR 6.5, CI95% 1.3-31) when the merchandise were seasonal tools such as accessories or spare parts (OR 6.3, CI95% 1.5-26), when women had to exhibit their merchandise on the floor or carry it (OR 7.7 CI95% 1.8-32) and when financial support to initiate vending activities came from someone other than a close relative or friend (OR 7.4 CI95%, 1.2-44). CONCLUSIONS: These results contribute to identify the female vendors with higher risk of having child with LBW and suggest preventive actions.

Acute dopaminergic blockade augments the naloxone-induced LH rise in estrogen-treated postmenopausal women.

OBJECTIVES: To assess the effect of estrogen replacement on the simultaneous blockade of the dopaminergic (DA) and opioidergic neural control of hypothalamic-gonadotropic function in postmenopausal women. METHODS: Twenty healthy postmenopausal women, 48-55 years old were randomly assigned to receive either a 4-h naloxone infusion at 2 mg/h (group 1, n = 7) or a 10 mg i.v. bolus of metoclopramide (group 2, n = 7) or both drugs, simultaneously (group 3, n = 6) before and after 3 weeks of transdermal estradiol (100 microg/day). Blood samples were obtained at 30-min intervals during 4 h and duplicate determinations of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) were performed in all samples. RESULTS: In group 1 only a mild but significant LH rise after but not before estrogen replacement was seen. In group 2 PRL had a greater rise after than before estrogen therapy, without other hormonal changes. In group 3 a greater rise in PRL occurred after than before estrogen administration and serum LH had a sustained rise throughout the test only after estrogen replacement (greater than in group 1). No FSH changes were observed. The after-estradiol PRL response was nearly similar in groups 2 and 3. CONCLUSIONS: Our results indicate that in the untreated postmenopausal women, the dopaminergic system has little and the opioidergic system has no significant input in the control of gonadotropin or prolactin release. However, following estrogen replacement, opioids are involved in the inhibition of LH release and stimulating PRL release, while the dopaminergic system acts to inhibit PRL release and modulates LH release or inhibition, depending on the levels of circulating estrogens.

Effect of quality of care on preventable perinatal mortality.

This study assessed and quantified the effect of quality of care on death preventability, independent of social and biological variables. One hundred and eighty-one avoidable perinatal deaths (cases) were compared to 341 non-avoidable ones (controls). Judgement criteria on death preventability were based predominantly on compliance with explicit hospital medical care standards, determined by peer review. The overall perinatal mortality rate was 24.8 per 1000 births and could be reduced by 35% if all avoidable perinatal deaths were prevented. Sixteen per cent of the deaths presented structural and 31.2% process deficiencies; both predominated among avoidable perinatal deaths (35.4% vs 5.3%, p < 0.000; and 79.3% vs 5.9%, p < 0.000, respectively). Structural deficiencies increased the risk of an avoidable perinatal death eleven-fold (95% confidence interval (CI) 4.1, 26.9; p < 0.001) and process deficiencies eighty-eightfold (95% CI 37.2, 204.5, p < 0.001), after controlling for confounders. The strength of the association between quality of care and preventable perinatal mortality was estimated.

Differences in the metoclopramide-induced prolactin release related to age at first full-term pregnancy or nulliparity.

To investigate if an association exists in parous women between metoclopramide-induced prolactin (PRL) release and chronological age at first full-term pregnancy and to compare their response to a group of non-parous women, we studied 139 healthy, non-lactating women, aged 15.8-48.2 years, on days 18-22 of their menstrual cycle (except two post-menopausal women). There were 61 parous women divided according to chronological age at first full-term pregnancy: 22 were aged < or = 20.0 years, 25 were aged 20.1-29.9 years and 14 were aged > 30 years. There were also 50 nulliparous women and 28 women who had experienced only first trimester abortions. Three basal blood samples were obtained before oral metoclopramide (10 mg) was administered; subsequently samples were taken at 60, 90 and 120 min. Duplicate serum PRL determinations were performed by radioimmunoanalysis and the area under the curve (AUC) calculated. In parous women, the PRL AUC was positively correlated with chronological age at first full-term pregnancy (P < 0.0001), and it was lower than in nulliparous women or in women with abortions. These data suggest that in parous women a greater dopaminergic tone may exist compared with non-parous women, which seems to decrease gradually as chronological age at first full-term pregnancy increases.

Clinical and hormonal response to short-term intermittent versus continuous oral bromocriptine in hyperprolactinemic women.

UNLABELLED: OBJECTIVE -- To determine if intermittent oral bromocriptine administration could be a useful therapeutic alternative in infertile hyperprolactinemic women. DESIGN -- Open, randomized and prospective study. SETTING -- Outpatient infertility clinic of a third-level medical institution. PATIENTS -- Fourteen low-income women, 23 to 36 years of age with anovulatory infertility (1-13 years in duration) secondary to hyperprolactinemia (>35 ng/mL). Endocrine profile ruled out anovulation of other origin. INTERVENTIONS -- After a control period of 30 days, seven women (group 1) received daily oral bromocriptine (2.5-10.0 mg/day) continuously during two consecutive 30-day periods (T-1 and T-2), and seven women (group 2) received oral bromocriptine only from day 1 to 15 of each 30-day period of treatment. Morning blood samples were drawn similarly during the three periods on days 6 to 8, 13 to 15, and 21 to 23. MAIN OUTCOME MEASURES -- FSH, LH, and prolactin were determined in all samples, estradiol only in samples of days 6 to 8 and 13 to 15, and progesterone exclusively between days 21 and 23. RESULTS: Mean serum prolactin levels during the control period were similarly elevated in groups 1 and 2. A marked decrease occurred during period T-1 (P < .004) and further during period T-2 (P < .05) in both groups, but at no time were significant intergroup differences documented. During the control period all women had a serum progesterone < 3.0 ng/mL (<9.54 nmol/L); during period T-2 it was > or = 3.0 ng/mL in three and five women of groups 1 and 2, respectively. Over the following 10 months of treatment, two and three normal pregnancies and deliveries ensued in groups 1 and 2, respectively. CONCLUSION -- The intermittent use of oral bromocriptine may indeed be a useful therapeutic approach in treating infertile hyperprolactinemic women.

Opposite effects of breakfast vs. oral glucose on circulating androgen levels in healthy women.

Since certain hormone abnormalities can be food-dependent as in some cases of nodular adrenal hyperplasia, as a first step to study other more frequent endocrine disorders, using a standard meal as means of a more physiologic stimulus, we investigated in healthy women whether or not the changes in serum glucose, insulin, cortisol, and androgens are different following a breakfast than after oral glucose alone. Ten women (group 1) ingested a 725 kilocalories (173 kiloJoules) breakfast and ten women (group 2) ingested a 100-g glucose load at 8:00 A.M. Serum glucose, insulin, cortisol, dehydroepiandrosterone sulfate (DHEAS), free testosterone (free-T), and androstenedione (A) were determined every 30 min for the next 2 h. Serum glucose rose higher in group 2 than in group 1 (p < or = 0.05), yet insulin increased similarly in both groups. In group 1 free-T and DHEAS increased at 30 min (p < or = 0.05) while cortisol decreased (p < or = 0.04); A did not change. On the contrary, in group 2 only a decrease in free-T (p < or = 0.01) was detected. In these healthy women, serum androgen changed inversely depending on the type and composition of the oral stimulus used. The simultaneous increase of serum insulin, free-T and DHEAS coinciding with a cortisol decrease may enhance insulin anabolic effects following breakfast, but not after oral glucose alone.

[Serum prolactin during oral metoclopramide in normal nulliparous women]. / Prolactina sérica durante metoclopramida oral en mujeres nuligestas normales.

As a first step in an extensive project planned to determine serum PRL levels in response to oral metoclopramide in women with a diverse gyneco-obstetric history, it was decided to study 51 clinically healthy nulliparous women, aged 15.8 to 48.2 years, with history of regular menses at least one year before the study (except the three postmenopausal women), with no regular drug ingestion during the last six months. Women were studied on days 18 to 22 of menstrual period, after a 30 minute rest on basal conditions (3 samples) at 60, 90, and 120 minutes after a single 10 mg. oral dose of metoclopramide. Duplicate PRL determinations were performed in all samples and progesterone(P) only in a pool of the three basal samples by radioimmunoanalysis. All women had serum P levels > or = 4.0 ng/ml. A significant linear positive correlation (r > or = 0.6795, p < 0.001) was observed between chronologic age (CA) and serum PRL levels, regardless the way they were expressed. Considering the individual responses it was decided to divide the group according to CA and it was observed that serum PRL levels--expressed in any form were always significantly greater in women aged > 25 years (Group 2) in contrast with women aged < or = 25 years (Group 1). Since differences were evident, percentiles 3, 50 and 97 for serum PRL levels were calculated during each test time for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Birthweight distributions in Mexico City and among US Southwest Mexican Americans: the effect of altitude.

In this study birthweight distributions for Mexican Americans and Mexico City were compared. Sharp differences in the two distributions were nearly eliminated by controlling for altitude. The small remaining excess in low birthweight in Mexico City appears to be due to a slight overrepresentation of tertiary hospital deliveries, and possibly to a greater prevalence of pathological conditions. The results are consistent with the favorable low birthweight rate reported for Mexican Americans and illustrate the need to adjust for altitude in studies of low birthweight.

Basal and metoclopramide-stimulated prolactin (PRL) serum levels in users and non-users of a copper intrauterine device (TCu-380 IUD).

The study was undertaken to analyze the basal and metoclopramide-stimulated serum PRL levels in healthy parous women users (group 1, n = 12) and non-users (group 2, n = 12) of a TCu-380 IUD. All women had regular menses and were studied between days 18 to 22 of their cycle; none had lactated nor regularly ingested any type of medication during the last six months. After a 10-12 hour overnight fast, peripheral venous blood samples were obtained through an indwelling catheter at -30, -15 and 0 minutes and at 60, 90 and 120 minutes after oral metoclopramide (10 mg). There were no significant differences in serum PRL between both groups, in basal levels nor throughout the test, whether analyzing the mean values at each sampling time, the sum of PRL levels from 60-120 minutes, or the peak levels. No correlation was observed between PRL levels and any of the clinical or obstetric characteristics of the women in both groups. Serum progesterone was greater than or equal to 4.0 ng/ml in all women. Thus, the use of alpha TCu-380 IUD did not induce any significant changes in basal nor in stimulated serum PRL levels.

[Coverage and quality of the registration of perinatal deaths occurring in health institutions in the Federal District]. / Cobertura y calidad del registro de defunciones perinatales ocurridas en instituciones de salud del Distrito Federal.

"This paper presents the results of the first direct attempt at evaluating the coverage of the perinatal death registration in the Distrito Federal [of Mexico]; this study is based on the information gathered from 574 deaths which took place in 23 hospitals in the Distrito Federal during a three month period in 1984. Both the causes of the failure to register many of these deaths and the quality of the information presented in perinatal death certificates are pointed out and discussed here. According to the evidence analyzed, it is clear that underregistration in the Distrito Federal is extremely marked.... The paper suggests the possibility of establishing a hospital registration system which would keep a record of both deaths and births. It also stresses the need for establishing rules to detect fetal deaths plus the need for unifying criteria regarding the definition of 'live birth'." (SUMMARY IN ENG)