Haitian women in New York City use global food plants for women's health.

BACKGROUND: Despite the availability of mainstream biomedical healthcare in New York City (NYC), community-based ethnomedicine practices remain a low-cost, culturally relevant treatment for many immigrants. Previous urban ethnobotany research in NYC has established that several Caribbean communities continue using medicinal plants for women's health after immigration. This study sought to address to what extent: (1) NYC Haitian women continue using medicinal plants for women's health after migration; (2) their plants and the conditions treated were similar to those identified in an earlier survey with NYC immigrants from the Dominican Republic. METHODS: Through an ethnobotanical survey, 100 Haitian women living in NYC and born in Haiti were interviewed about their knowledge of medicinal plants for women's health conditions. Reported species were purchased based on local names in NYC Haitian stores and markets, vouchered, and identified. RESULTS: Nearly all Haitian women (97%) reported using medicinal plants while living in Haiti. Most Haitian women continued using medicinal plants after coming to the USA (83%). The 14% decrease, although significant (z = 3.3; p = 0.001), was mainly due to logistical difficulties with sourcing plants after recent immigration. Popular medicinal plant species reported were primarily global food plants, re-emphasizing the intertwined food-medicine relationship in Caribbean diasporas. Comparison with data from NYC Dominicans identified childbirth and puerperium, gynecological infections, and vaginal cleansing as priority Haitian women's health concerns treated with plants. CONCLUSION: Our findings support the global nature of Caribbean migrant plant pharmacopeia, predominantly centered around food plants and adapted to transnational urban settings. They underscore cultural diversity, dispelling the notion of one uniform traditional knowledge system labeled "Caribbean." The importance of preventative medicine for women's health, particularly the regular consumption of "healthy" foods or teas highlights the role food plants play in maintaining health without seeking treatment for a particular condition. Cross-cultural comparisons with other NYC Caribbean immigrants emphasize the importance of conducting ethnobotanical surveys to ground-truth plant use in the community. Such surveys can also identify culture-specific health priorities treated with these plants. Healthcare providers can leverage these insights to formulate culturally relevant and community-tailored healthcare strategies aligned with Haitian women's health beliefs and needs.

Properties of the EQ-5D-3L index distribution when longitudinal data from 27,328 spine surgery procedures are applied to nine national EQ-5D-3L value sets.

PURPOSE: The purpose of the current study was to apply a single large longitudinal EQ-5D-3L data set to several national EQ-5D-3L value sets and explore differences in EQ-5D-3L index density functions and effect sizes before and after treatment. METHODS: Patients, surgically treated for lumbar spinal stenosis or lumbar disk herniation between 2007 and 2017, were recruited from the national Swedish spine register. A total of 27,328 procedures were eligible for analysis. The EQ-5D health states were coded to EQ-5D-3L summary indices using value sets for 9 countries: Argentina, Australia, Canada, China, Germany, Italy, Sweden, the UK, and the US. The EQ-5D-3L summary index distributions were then estimated with kernel density estimation. The change in EQ-5D-3L index before and after treatment was evaluated with the standardized response mean (SRM). RESULTS: There was a high variability in the resulting EQ-5D-3L index density functions. There were also considerable differences in EQ-5D-3L index density functions before and after treatment using the same value set. Effect sizes of 2-year change (SRM), however, were similar when the 9 value sets were applied on pre- and post-treatment data. CONCLUSIONS: We found a marked variability in EQ-5D-3L index density functions when a single large data set was applied to 9 national EQ-5D-3L value sets. Consequently, studies that aggregate international data, e.g. meta-analyses, may produce misleading results if the underlying differences in EQ-5D-3L index density functions are inadequately handled. On the basis of the results of our study, we recommend against pooling of different national EQ-5D-3L index data.

Maternal perinatal representations and their associations with mother-infant interaction and attachment: A longitudinal comparison of Portuguese and Brazilian dyads.

Prior research in Western countries (mostly the US, Canada and northern Europe) indicates that mothers' representations are associated with mother-infant interaction quality and their child's attachment security later in the first year. Fewer studies, however, have evaluated whether these associations hold for mother-infant dyads in other countries, such as Brazil and Portugal. Although these countries share a similar language and culture, they differ on societal dimensions that may affect parenting attitudes and mother-infant relationships, such as economic stress, social organisation, social policy, and the availability of services for young families. In this longitudinal study, we followed two independent samples of Brazilian and Portuguese mother-infant dyads from the perinatal period to 12 months post-partum. We assessed mothers' perinatal representations using semi-structured interviews in the first 48 hours after the infant's birth, and evaluated the associations of these representations with mother interaction quality at 9 months and infant attachment at 12 months. Results were similar in each country, corroborating prior research in single Western countries: Mothers with more positive perinatal representations were more sensitive to their infants during free play at 9 months and were more likely to have infants classified as securely attached at 12 months.

How Universal Is the General Factor of Personality? An Analysis of the Big Five in Forager Farmers of the Bolivian Amazon.

In various personality models, such as the Big Five, a consistent higher order general factor of personality (GFP) can be identified. One view in the literature is that the GFP reflects general social effectiveness. Most GFP studies, however, have been conducted in Western, educated, industrialized, and rich democracies (WEIRD). Therefore, to address the question of the universality of the GFP, we test whether the GFP can also be identified in a preliterate indigenous sample of Tsimane by using self-reports, spouse reports, and interviewer ratings. In the Tsimane, a viable GFP could be identified and the intercorrelations between personality traits were significantly stronger than in samples from industrial countries. The GFP correlated with the ratings of social engagement. In addition, self and spouse ratings of the GFP overlapped. Overall, the findings are in line with the notion that the GFP is a human universal and a substantive personality factor reflecting social effectiveness.

Factor structure and psychometric properties of the Dispositional Resilience Scale among Brazilian adult patients / Estrutura fatorial e propriedades psicométricas da Escala de Resiliência Disposicional para pacientes brasileiros adultos

ABSTRACT Objective Verifying the psychometrics of a Brazilian version of the Dispositional Resilience Scale (DRS-15). Methods Cross-cultural adaptation was done interviewing 65 adult patients. Validation was evaluated by application of the Lipp Brazilian Stress Symptoms Inventory (ISSL), Self-Report Questionnaire (SRQ), and other measures to 575 participants from the psychiatric ambulatories (for borderline personality, anxiety or post-traumatic stress disorders) and non-psychiatric ambulatories (chronic pain, pre-anesthetic consultation and companions for the latter). Temporal stability was verified with 123 participants. Results Exploratory factor analysis yielded a three-factor solution. Psychometrics were acceptable (alpha coefficient, 0.71; intraclass correlation coefficient, 0.81). Correlations with the ISSL, SRQ and other measures were noted except for factor 3. In the psychiatric sample, hardiness scores of borderline patients were lower than those of patients with anxiety disorders. Conclusion This version of the DRS-15 exhibited good reliability in a sample of Brazilian patients; validity was confirmed in two of the scale factors.

RESUMO Objetivo Verificar as propriedades psicométricas da versão brasileira da Escala de Resiliência Disposicional (DRS-15). Métodos A adaptação transcultural foi feita com 65 pacientes. A validação foi estudada pela aplicação do Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Self-Report Questionnaire (SRQ) e outros instrumentos a 575 participantes de ambulatórios psiquiátricos (transtorno borderline de personalidade, ansiedade ou transtorno de estresse pós-traumático) e não-psiquiátricos (dor crônica, avaliação pré-anestésica ou acompanhantes). A estabilidade foi verificada com 123 participantes. Resultados A análise exploratória revelou três fatores, com propriedades aceitáveis (alfa de 0,71; coeficiente de correlação intraclasse de 0,81). Notaram-se correlações com o ISSL, SRQ e demais instrumentos, exceto para o fator 3. Na amostra psiquiátrica, a resiliência disposicional dos pacientes borderlines foi menor que a dos pacientes com transtornos de ansiedade. Conclusão Esta versão da DRS-15 apresentou boa confiabilidade numa amostra de adultos; a validade foi confirmada para dois fatores da escala.

Conhecimento e adesão às precauções padrão: estudantes diante dos riscos biológicos no Brasil e na Colômbia / Knowledge of and compliance with universal precautions: students dealing with biological risk in Brazil and Colombia / Conocimiento y adhesión a las precauciones universales: estudiantes frente a los virus, en Brasil y en Colombia

Objetivo Avaliar as escalas de adesão às precauções padrão (PPs) e conhecimento sobre meios de transmissão entre estudantes da saúde no Brasil e na Colômbia. Métodos Trata-se de um estudo piloto para validar o questionário que iniciou estudo de coorte. Selecionamos intencionalmente 26 estudantes na Colômbia e 25 no Brasil, comparáveis em número e características sociodemográficas, que cursavam profissões da saúde (medicina, enfermagem e odontologia). Utilizamos o programa SPSS versão 18.0 para criar o banco de dados e a análise estatística. Resultados : Avaliamos 51 estudantes, com média ± Desvio Padrão de idade de 21,78 ± 2,33, dos quais 84,3 % eram mulheres, 66,7 % de cor de pele branca, , 47,1 % de medicina, e 70,6 % do 70 semestre. Responderam sobre hábitos sexuais afirmando que 45,1 % tiveram no último ano só um parceiro, 23,5 % não usaram proteção, e dos que se protegeram, 45,1 % utilizaram o preservativo. A média de con0hecimento foi 10,88 (±0,952) pontos, para valor esperado de 9 pontos; com Alpha de Cronbach's (α) de 0,823. A média de adesão às precauções padrão (PPs) foi 33,69 (±3,36) pontos, para 30,75 esperados. O α foi de 0,741. Encontramos diferença significativa no conhecimento (p<0,007) entre os dois países, e na adesão as PPs segundo o curso (p<0,001). Conclusões O conhecimento sobre meios de transmissão foi bom. A adesão às precauções padrão em geral foi aceitável, mas foi baixa para algumas precauções avaliadas como o uso de óculos, máscara e o descarte de perfurocortantes. Estudantes de odontologia tiveram melhor adesão.(AU)

Objective To assess scales of adherence to universal precautions and means of knowledge transmission among healthcare students in Brazil and Colombia. Methods We conducted a pilot study to validate the questionnaire that started a cohort study. Twenty-six students in Colombia and 25 in Brazil were intentionally selected. The participants were comparable in number and sociodemographic characteristics in both countries and studied the health professions (medicine, nursing and dentistry). The program SPSS version 18.0 was used to create the database and to carry out statistical analysis. Results We evaluated a total of 51 students. They had a a mean (SD) age of 21.78 (2.33), 84.3 % were women, 66.7 % had white skin, 47.1 % were medical students, and 70,6 % were in their 4th year. They answered about sexual habits reporting that 45.1 had only one partner% in the last year, 23.5 % did not use protection, and, of those who were protected, 45.1 % used a condom. The mean knowledge was 10.88 (±0.952) points to an expected 9 points; Cronbach's Alpha (α) was 0.823. The mean adherence to universal precautions (UPs) was 33.69 (±3.36) points to an expected 30.75; α was 0.741. We found a significant difference in knowledge levels (p<0.007) between the two countries and in the adherence to PUs by year of study (p<0.001). Conclusions Knowledge about means of transmission was good. Adherence to universal precautions was acceptable, but low in terms of the use of glasses, face masks, and discarding sharp objects. Dentistry students showed the best adherence.(AU)

Objetivo Evaluar escalas de adhesión a las precauciones universales y de conocimiento sobre medios de transmisión entre estudiantes de la salud, en Brasil y Colombia. Métodos Realizamos estudio piloto para validar cuestionario utilizado en el inicio del estudio de cohorte. Seleccionamos intencionalmente 26 estudiantes en Colombia y 25 en Brasil, comparables en número y características socio-demográficas, de profesiones de la salud (medicina, enfermería y odontología). Se utilizó el programa SPSS versión 18.0 para crear el banco de datos y realizar el análisis estadístico. Resultados Evaluamos 51 estudiantes, con media (SD) de edad de 21,78 años (2,33), 84,3 % eran mujeres, 66,7 % de tez blanca, 47,1 % de medicina, y 70,6 % del 70 período. Ellos contestaran sobre sus hábitos sexuales reportando que 45,1 % tuvieron en el último año sólo un compañero, 23,5 % no usaron protección, y de los que se protegieron, 45,1 % utilizaron el preservativo. La media de conocimiento fue 10,88 (±0,952) puntos, para una esperada de 9 puntos; con Alpha de Cronbach's (α) de 0,823. La media de adhesión a las Precauciones Universales (PUs) fue 33,69 (±3,36) puntos, con una expectativa de 30,75; α fue de 0,741. Se encontró diferencia significativa en el conocimiento (p<0,007) entre los dos países, y en la adhesión de las PUs según el curso (p<0,001). Conclusiones El conocimiento sobre medios de transmisión era bueno. La adhesión a las precauciones universales era aceptable, pero baja para el uso de gafas, tapabocas y el descarte de elementos cortantes y perforantes. Estudiantes de odontología tuvieron mejor adhesión.(AU)

Adaptación transcultural de los criterios diagnósticos para la investigación de los trastornos temporomandibulares (CDI/TTM) / Cross-cultural adaptation of research diagnostic criteria for temporomandibular disorders (RDC/TMD)

Introducción: el objetivo de este trabajo fue establecer la adaptación transcultural de los criterios diagnósticos para la investigación de los trastornos temporomandibulares (CDI/TTM). Métodos: bajo un diseño de estudio prueba reprueba, fueron evaluadas las propiedades psicométricas de los CDI/TTM versión en español. Sujetos bilingües fueron evaluados para probar la congruencia entre las versiones en español e inglés del instrumento; incluidos ambos ejes I (grupo diagnóstico) y II (perfil psicosocial del paciente). Resultados: la confiabilidad del eje I prueba reprueba para la clasificación del diagnóstico fue excelente (Kappa: 1.0). El análisis de confiabilidad de la prueba reprueba del eje I para la clasificación de los diferentes diagnósticos fue excelente (Kappa: 1.0). Para el eje II, el coeficiente de correlación intraclase (CCI) fue calculado para la escala del grado de dolor crónico GDC (0,96), y para la lista de cotejo de la discapacidad mandibular LCDM (0,77), depresión(0,87) y síntomas físicos no específicos (0,98). Adicionalmente se calculó el Alpha de Cronbach para la LCDM (0,89). Correlaciones de Spearman entre los reactivos del eje II mostraron una mediana de la correlación de 0,50 (0,293-0,856) con valores altos entre la LCDM y la GDC. Dichas correlaciones proveen soporte para la consistencia interna de los CDI/TTM en español. Conclusión: la validez y confiabilidad de los CDI/TTM demostrada se soporta en sus propiedades psicométricas. Su adaptación transcultural permite el uso de dicho instrumento en las poblacioneshispanoparlantes con el objetivo de evaluar el papel de los TTM en esta población.

Introduction: the goal of this study was to establish the cross-cultural adaptation of Research Diagnostic Criteria forTemporomandibular Disorders (RDC/TMD). Methods: with a test-retest design, this study evaluated the psychometric properties of RDC/TMD intheir Spanish version. Bilingual subjects were evaluated in order to test consistency between the Spanish and English versions of the instrument,including axis I (clinical conditions of TMD) and axis II (psychosocial aspects related to TMD). Results: the reliability of axis I test re-test for diagnosis classification was excellent (Kappa = 1,0). The reliability analysis of axis I test-retest for classifying different diagnoses was also excellent(Kappa = 1,0). Concerning axis II, the intraclass correlation coefficient (ICC) was calculated for Graded Chronic Pain Scale (GCPS) (0,96) as well as for Jaw Disability Checklist (JDC) (0,77), depression (0,87), and nonspecific physical symptoms (0,98). Also, Cronbach’s Alpha for JDC wascalculated (0,89). Spearman correlations among axis II reagents showed a median of correlation of 0.50 (0.293 to 0.856) with high values between JDC and GCPS. These correlations provide support for internal consistency of RDC/TMD in Spanish. Conclusion: the demonstrated validity and reliability of the RDC/TMD lie in thier psychometric properties. The cross-cultural adaptation of this instrument allows its use in Spanish-speakingpopulations for the assessment of the role of TMD in this population.

China's "tidal wave" of migrant labor: what can we learn from Mexican undocumented migration to the United States?

"The purpose of this article is to place Chinese labor migration from agriculture within the context of the literature on labor mobility in developing countries by comparing it to undocumented Mexican migration to the United States. The similarities fall within three general areas: the migration process, the economic and social position of migrants at their destination, and the agrarian structure and process of agricultural development that has perpetuated circular migration. The last section of the article draws upon these similarities, as well as differences between the two countries, to generate predictions concerning the development of labor migration in China."

Refugee remittances: conceptual issues and the Cuban and Nicaraguan experiences.

"This article assesses the notion that the determinants of remittances generated by refugee flows, particularly from Communist-inspired systems, are different from those associated with labor migrations....These differences have a major bearing on how labor migrants and refugees perceive their relationship with countries of origin. The propensity of labor migrants to dissociate themselves from the home country is considerably less than among refugees whose perceptions are mediated by opposition to the ruling regime and other factors, such as political relations between refugee-sending and refugee-receiving countries and whether or not there has been a regime change or one is expected to occur. The conceptual issues elaborated here are based on the Cuban-American experience, but also reflect an assessment of Nicaraguan emigration during the 1980s."

Stressful events among pregnant Salvadoran women: a cross-cultural comparison.

OBJECTIVE: To compare stressful events, including violent episodes, experienced by pregnant Salvadoran women with those experienced by two other groups of low-income, pregnant women living in the United States (non-Salvadoran Hispanics and non-Hispanics) and to examine the association between episodes of violence and drug or alcohol use among the three groups. DESIGN: Comparative, descriptive study. SETTING: Public health prenatal clinics. PARTICIPANTS: One hundred four Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women. MAIN OUTCOME MEASURES: Difficult Life Circumstances (DLC) scale and psychosocial history assessment. RESULTS: Statistically significant differences were found among the three groups in total DLC scores, F(2, 357) = 14.98, p < .001; reported episodes of violence, F(2, 357 = 17.82, p < .001; and drug or alcohol use, F(2, 357) = 6.33, p < .001. A significant difference was found to the extent that alcohol or drug use accounted for the variance in violence among the three groups, F(3, 360) = 6.28, p < .001. CONCLUSIONS: Cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

PIP: A comparative, descriptive study was conducted among 104 Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women concerning the stressful events including episodes of violence experienced. Furthermore, it also compared the relationship between episodes of violence and drug or alcohol use among the three groups. The measures used are the Difficult Life Circumstances scale and psychosocial history assessment. Results showed that stressful events were found to occur more frequently among the non-Hispanic mothers than among either Hispanic subgroups. However, cultural distinctions between Salvadoran and non-Salvadoran Hispanic mothers did not emerge. Alcohol and drug use differed significantly among the groups in this study. In conclusion, cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

Maternal mortality in England and Wales 1970-1985: an analysis by country of birth.

OBJECTIVE: To determine the risk of maternal mortality in immigrants to England and Wales. DESIGN: Analysis of death registrations, 1970-1985, by country of birth. SETTING: England and Wales. POPULATION: Women dying in England and Wales during pregnancy, childbirth or the puerperium, or dying from malignant tumour of the placenta. MAIN OUTCOME MEASURES: The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause-specific death, adjusted for age, in immigrants compared with women born in England and Wales. RESULTS: Women born in West Africa (relative risk 10.3; 95% CI 8.0-13.2) and the Caribbean (4.6; 3.8-5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3-2.0) and "Europe and the USSR' (1.7; 1.2-2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the "Rest of the World' and Scotland were at significantly elevated risk. CONCLUSIONS: An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non-immigrants is required, and into whether this affects the risk of maternal mortality.

[Immigration and labor: Australia and Canada compared]. / Inmigracion y trabajo: Australia y Canada comparados.

"Australia and Canada share...a common colonial history and many similarities in geography, economy, demography, etc., as well as a substantial anti-non anglo-celtic immigrant tradition, in spite of their being immigration countries. Those similarities and differences are analyzed here, as far as labor migration and relationships between immigrant and local labor are concerned. The arrival of European labor first, Asian later, was perceived similarly by both Australia and Canada, combining racial prejudice and unions' hostility towards contract labor migration as well as towards assisted migration. The evolution of those difficult relations through the 19th and 20th centuries is analyzed here." (SUMMARY IN ENG)

[Causes of adult mortality in developing and developed countries with low mortality rates]. / Causas de defuncion de adultos en paises en desarrollo y desarrollados con bajas tasas de mortalidad.

"In a certain number of developing countries, life expectancy levels now approach those of the developed world. But, though life expectancies at birth may be similar, the infant mortality rate in developing countries remains higher, but is compensated by a lower rate of mortality for adults. Is it to be expected that as infant mortality rates continue to decline, the developing countries will maintain their advantageous adult mortality rates and that life expectancy will forge ahead of the level achieved in developed countries?... To answer this question, recent trends in adult cause-specific mortality rates in four developing countries (Chile, Hong Kong, Mexico, and Costa Rica) were compared with those in three industrialized countries (France, Germany and Japan). The results were inconclusive. Whilst life expectancies in some of these countries may be expected to forge ahead (Chile, Hong Kong), in others the margin between their life expectancies and those of developed countries have already narrowed." (SUMMARY IN ENG)

[Adult mortality in developing countries: a global overview]. / La mortalidad adulta en paises en desarrollo: una vision general.

"The article analyzes [selected] developing countries with reliable information on adult mortality between ages 15 and 65 years....A brief analysis of each country indicates the following aspects. Females maintained a more sustained and systematic decline of adult mortality than males. There are some countries that in spite of reasonable development, as Mexico, still have a great excess of male mortality in relation to other countries. Finally, some countries experienced a stagnation of the male mortality decline, while females continued benefiting from a decline of mortality." (SUMMARY IN ENG)

Comparison of effects of breast-feeding practices on birth-spacing in three societies: nomadic Turkana, Gainj, and Quechua.

Variation in the duration and pattern of breast-feeding contributes significantly to inter-population differences in fertility. In this paper, measures of suckling frequency and intensity are used to compare the effects of breast-feeding practices on the duration of lactational amenorrhoea, and on the length of the birth interval in three prospective studies undertaken during the 1980s, among Quechua Indians of Peru, Turkana nomads of Kenya, and Gainj of Papua New Guinea. In all three societies, lactation is prolonged well into the second year postpartum, and frequent, on-demand breast-feeding is the norm. However, the duration of lactational amenorrhoea and the length of birth intervals vary considerably. Breast-feeding patterns among Gainj and Turkana are similar, but Turkana women resume menses some 3 months earlier than do the Gainj. The average birth interval among the Gainj exceeds that of nomadic Turkana by over 15 months. Suckling activity decreases significantly with increasing age of nurslings among both Gainj and Quechua, but not among Turkana. Earlier resumption of menses among Turkana women may be linked to the unpredictable demands of the pastoral system, which increase day-to-day variation in the number of periods of on-demand breast-feeding, although not in suckling patterns. This effect is independent of the age of infants. The short birth intervals of Turkana women, relative to those of the Gainj, may be related to early supplementation of Turkana nurslings with butterfat and animals' milk, which reduces energetic demands on lactating women at risk of negative energy balance.

PIP: Between July 1989 and late February 1990. an anthropologist observed breast feeding patterns of 24 mother-infant pairs of the nomadic Ngisonyoka Turkana in Kenya to determine suckling frequency and intensity and their effect on the duration of lactational amenorrhea and the length of the birth interval. She compared her results with those of studies of the Gainj of Papua New Guinea and of the Quechua Indians of Peru, studies which used the same unite of analysis as the Turkana study. Prolonged lactation and frequent, on-demand ruled in each group. Turkana infants suckled all day and night, with each nursing period being 1-2 minutes long and with 10-15 minutes between each period. The Gainj also had prolonged lactation and similar nursing sessions. On the other hand, the Quechua clumped their breast feeding sessions, which were longer than those of both the Turkana and the Gainj. Turkana birth intervals were shorter than those of Gainj (29 vs. 44.3 months). Turkana women also had a higher fertility rate than did the Gainj (6.5 vs. 4 live births). Suckling activity fell considerably as age increased for Gainj and Quechua infants, but not for Turkana infants. Early introduction of butterfat from goats' and camels' milk during the first few weeks after birth and the daily difference in amount of suckling during the lactational period due to variable maternal work schedules (based on the labor demand of the pastoral system of the Turkana) reduced the effect of age. In conclusion, differences in the length and pattern of breast feeding practices account for much of the interpopulation variation in fertility.

Patterns of contraceptive use and pregnancy among young Hispanic women on the Texas-Mexico border.

Our objective was to identify significant family planning and health access problems of young Hispanic women on the Texas-Mexico border. Samples of 300 young Hispanic women living in each of the twin cities of El Paso and Juarez were interviewed regarding their knowledge, attitudes, and experiences with respect to birth control, pregnancy, maternal and child health, and health-care services. Knowledge and attitudes of the women about birth control technology were assessed along with their beliefs regarding the use of such technology. Results showed that contraceptive knowledge and usage patterns for young Hispanic women in Juarez and El Paso were significantly different. They relied on different types of birth control methods and also differed with respect to confidence in these methods and related medical services. Both groups reflected positive attitudes toward both child bearing and use of birth control although Juarez women were significantly more favorable toward child bearing. Both groups overwhelmingly favored female doctors. The young women studied have accepted the need for birth control, prefer fewer children, and have some degree of confidence in medical services. Their knowledge and use of reliable versus unreliable birth control devices appear to be major areas requiring culturally sensitive intervention.

PIP: Social work students administered a questionnaire to 600 randomly selected adolescent females from El Paso, Texas, and Juarez, Mexico, to examine their knowledge and use of contraceptive methods and their attitudes about pregnancy, contraception, and child care. 11.7% of the El Paso respondents and 16.7% of the Juarez respondents had been pregnant at some time. Oral contraceptives (OCs) were the most known contraceptive method. Women in El Paso were more likely to be familiar with OCs (98% vs. 91.3%), condoms (93.7% vs. 74.7%), vaginal methods (79.7% vs. 67.8%), and withdrawal (65.3% vs. 44.5%) than were those in Juarez (p = .001). On the other hand, more Juarez women than El Paso women knew about injectables (79.8% vs. 34.1%), sterility or tubal ligation (89.9% vs. 63.3%), vasectomy (73.2% vs. 69%), Billing's method (19.2% vs. 5.3%), and the rhythm method (73.6% vs. 36.4%) (= = .001). Many women from both cities used ineffective methods. Women in Juarez were much more likely to use the rhythm method than those in El Paso (26.4% vs. 3.4%; p = .001). Women from both cities, particularly those in Juarez (p = .001), believed more information on contraception was needed. They felt strongly that men should also be responsible for family planning and approve of women using contraceptives. They believed that couples should have fewer children. Juarez women has a more positive view of pregnancy and childbearing than did El Paso women. El Paso women were more likely to visit a physician in the last year for reasons other than check-ups (mean number of visits, 1.88 vs. 1.25; p = .005). Most women preferred to receive maternal and child health/family planning services from a female physician (56% in Juarez and 64.3% in El Paso). These findings indicated that cultural differences in contraceptive knowledge and usage as well as confidence in various methods and related medical services existed. They emphasized the need for culturally relevant education, research, and service programs concerning adolescents in the Texas-Mexico border region.

Child maltreatment: international perspectives.

The purpose of this literature review was to explore definitions, incidence, and management of child maltreatment across cultures. Articles written in the English language published from 1962 to 1991 were reviewed to answer the following questions: (1) What role does cross-cultural variability play in defining child maltreatment? (2) What is the incidence of maltreatment in developed and developing countries across continents? (3) What measures have been instituted by countries to prevent and manage child maltreatment? Cross-cultural information was found to be limited. Child rearing attitudes had an impact on the identification, prevention, and management of maltreatment across nations.

PIP: This literature review relied on data from a MEDLINE search of articles on child abuse published in English from 1962 to August 1991. The literature was examined to determine 1) the role of cross-cultural variability in defining child maltreatment, 2) the incidence of maltreatment in developed and developing countries across continents, and 3) the measures instituted to prevent and manage child abuse. In Africa, information was available for Nigeria and Tunisia. In Asia, data were available Hong Kong, Japan, Jordan, Korea, and the Philippines. Reports from the Australian region covered New South Wales, South Australia and New Zealand, and Victoria. Data from Europe related to France, Great Britain, and The Netherlands. Scandinavia was represented by studies from Denmark, Finland, and Sweden. Canada and the US each yielded studies, and South America was represented in this review by Brazil. The authors concluded that awareness of child maltreatment varies from society to society but more and more countries are becoming concerned about this phenomenon. Data on incidence of child abuse are lacking in many countries, but many researchers in diverse cultures are attempting to fill in the gap. Prevention and management strategies are as diverse as the countries which generate them. Thus, cultural attitudes and behaviors impact on the identification, prevention, and management of maltreatment. Comparable cross-cultural definitions of child maltreatment are needed, with the parameters of acceptable behavior drawn. Criteria for determining the occurrence of child abuse must also be determined.

Triangulation in cross-cultural research of child development in Jamaica.

PIP: Triangulation is the use of multiple concepts and methods to study a single phenomenon. Ethnographic field studies and standardized measures of development were used in a study of long-term effects of perinatal cannabis (marijuana) use in Jamaica. The study was launched in 1983 in order to evaluate the effects of cannabis (or ganja, as it is called in Jamaica) consumption during pregnancy and lactation on infants from birth to school age in rural communities. Some researchers reported symptoms such as increased startles, high-pitched cry in the newborn, shortened gestation, and low birth weight. The project was based in St. Thomas, where ganja use is widespread. The ethnographic part involved home observations and interviews of each child in selected communities. The clinical component included monitoring 60 pregnant women (30 users and 30 nonusers) and their offspring from birth through age 5. The instruments for evaluation included the Brazelton Neonatal Assessment Scale (BNAS), the Bayley Scales of Infant Development (BSID), the McCarthy Scales of Children's Abilities (MSCA, for children aged 2 years 6 months to 8 years 6 months), and the Behavioral Style Questionnaire (BSQ, for temperament in 3 to 7 year olds). The MSCA and BSQ had to be adapted to local culture, partly because of different uses of words in the rural dialect and cultural experience. The MSCA modifications included the elimination of time limits, changes in language, and culturally correct alternative responses. Five of 72 items on the BSQ were modified. Most scores fell in the middle range of about 4, similar to the North American scores, except for the lower mean in the category of Threshold of Responsiveness, because of an unanticipated cultural difference. The adjustments made did not compromise the comparability of the findings.^ieng

Portage guide to early intervention: cross-cultural aspects and intra-cultural variability.

The issues arising from implementing an early intervention service, developed in the rural United States in the late 1960s in a range of different cultural contexts over a period of a quarter of a century, are explained. Services from India, Bangladesh, Jamaica and the United Kingdom are compared. As well as considering cross-cultural aspects of Portage, variability within one country, the United Kingdom, is considered by comparing one service in an inner-city area and one in a rural area.

PIP: In the late 1960s in rural Wisconsin, the Portage Guide to Early Intervention was developed to manage development delay in preschool children. A parent, usually the mother, teaches the child each day and keeps a record. A home visitor monitors progress weekly and teaches the parent by modelling the program with the child. It operates under basic assumptions, some of which many countries cannot meet. For example, services available in developed countries (e.g., health services) are not available in Bangladesh and India, because resources are limited and the population is so large. Further, there are considerable differences in culture between these countries and the West (e.g., extended family vs. nuclear family). Moreover, the major causes of developmental delay in these South Asian countries are different than in developed countries (birth asphyxia, malnutrition, and deficiency diseases vs. genetic causes). Professionals in India and Bangladesh have incorporated Portage into a variety of early intervention services, thereby modifying the model considerably. In Jamaica, however, professionals use the Portage model with only a few modifications. Fore example, they use it with all disabled children rather than just those with learning disabilities. A problem with using the model is the lack of manufactured toys and play materials listed in the curriculum. Jamaica has a training program for child development aides. Portage services exist throughout the UK. Urban programs serve many more immigrants from developing countries than do the rural programs. This requires modifying the Portage model. In all countries, costs pose a constraint. This overview of Portage services in various countries indicates that these services alone are relatively unimportant as direct agents of social change and may be an important element of broader social changes.

Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean.

OBJECTIVE: To present estimates of maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean, and to discuss strategies to prevent these deaths. DESIGN: Retrospective review of all available data. SETTING: Database of the World Health Organization's Maternal Health and Safe Motherhood Programme. MAIN OUTCOME MEASURES: Estimates of the total maternal mortality and the proportions of deaths associated with hypertensive disorders of pregnancy. RESULTS: Estimates of mortality associated with hypertensive disorders of pregnancy were similar in Africa, Latin America and the Caribbean, despite considerably higher total mortality in Africa. Variations in both overall mortality and that associated with hypertensive disorders of pregnancy were greatest in Asia. Despite their limitations, these data suggest that between 10-15% of maternal deaths are associated with hypertensive disorders of pregnancy, and that 10% are associated with eclampsia. CONCLUSIONS: Where maternal mortality is relatively high, the excess is likely to be due to a high mortality associated with haemorrhage and infection and reductions are most likely to come from reductions in these deaths. Evidence from both developed and developing countries suggests that deaths associated with hypertensive disorders of pregnancy are the most difficult to prevent. More rigorous assessment of interventions designed to prevent these deaths is urgently required.

PIP: An epidemiologist analyzed community and hospital-based data obtained from the WHO data base on maternal mortality and morbidity to examine maternal mortality associated with hypertensive disorders of pregnancy (HDP) in Africa, Asia, the Caribbean, and Latin America. Overall estimates of mortality associated with HDP among countries in Africa, Latin America, and the Caribbean did not differ, even though overall maternal mortality was much higher in Africa than in Latin America and the Caribbean. In Asia, however, estimates of both maternal mortality and mortality associated with HDP were quite varied (maternal mortality range = 15-905 and percentage of deaths due to HDP range = 4 = 55%). Qatar had the lowest maternal mortality (15) and the highest percentage of deaths due to HDP (55%). Even though maternal mortality was lowest in southern Africa (90-115 vs. 80-1140), percentage of deaths due to HDP was basically high (10-27%). In West Africa, the same HDP levels ranged from 7% to 18%. Maternal mortality was relatively low in the Caribbean (30-80), but it had a very high percentage of deaths due to HDP (30-73%). In Argentina and Chile, maternal mortality was higher than that of the Caribbean (180 and 110. respectively), yet had a low percentage of deaths due to HDP (10%). These data indicated that overall 10-15% of all maternal deaths were associated with HDP. In those countries with detailed data, 60-100% of these deaths were due to eclampsia. Thus eclampsia caused 10% of all maternal deaths. These results suggested that infection and hemorrhage were responsible for the excess maternal mortality. They also implied that deaths associated with HDP may be the most difficult to prevent in developed and developing countries. Health practitioners do not agree on the optimal management of preeclampsia and eclampsia. Several clinical trials worldwide are now evaluating the various management options.