In 1996 and 1997, cyclosporiasis outbreaks in North America were linked to eating Guatemalan raspberries. We conducted a study in health-care facilities and among raspberry farm workers, as well as a case-control study, to assess risk factors for the disease in Guatemala. From April 6, 1997, to March 19, 1998, 126 (2.3%) of 5,552 surveillance specimens tested positive for Cyclospora; prevalence peaked in June (6.7%). Infection was most common among children 1.5 to 9 years old and among persons with gastroenteritis. Among 182 raspberry farm workers and family members monitored from April 6 to May 29, six had Cyclospora infection. In the case-control analysis, 62 (91%) of 68 persons with Cyclospora infection reported drinking untreated water in the 2 weeks before illness, compared with 88 (73%) of 120 controls (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.4, 10.8 by univariate analysis). Other risk factors included water source, type of sewage drainage, ownership of chickens or other fowl, and contact with soil (among children younger than 2 years).
Using questionnaire information provided by 4,385 vasectomized and 13,155 matched, non-vasectomized men, we found no significant differences between them for a large number of symptoms and diseases, including those of the cardiovascular system. After taking into account differences in their marital status, past smoking habits, and physical activity at work, significant statistical associations of vasectomy with joint pain or swelling, back trouble, and a history of kidney or bladder infection persisted. Our data are inconsistent with the occurrence of large increases in the risks of many important diseases in vasectomized humans. (Am J Public Health 1982; 72:476-480.) Reports that vasectomized monkeys have more severe atherosclerosis than non-vasectomized monkeys has caused concern about the possibility that vasectomy may have unanticipated health effects in humans' 2. We investigated this possibility using computer-stored information from health questionnaires completed during the period from 1977 through 1980 by members of a large Northern California prepaid medical care program who had multiphasic health check-ups. Materials and MethodsMedical Care Program taking multiphasic health check-ups in Oakland or in San Francisco has been computer stored. The information provided on these questionnaires about vasectomies, personal habits, symptoms of illness, and the histories of certain diseases constitute the basic data for this study.In the period from 1977 through 1980, 4,392 male examinees indicated on the health questionnaires that they had had vasectomies. We matched each vasectomized man with three men who did not indicate on the questionnaires that they had had vasectomies. The matching variables were age, race, and date of the health check-up. For 98 per cent of the vasectomized men, we found three "exact" matches (birth year was plus or minus one year, date of check-up was plus or minus one month, and race was same). To find matches for the remaining two per cent of vasectomized men, we relaxed the matching criteria by stages. For seven vasectomized men, three matches could not be found. These men were excluded, leaving 4,385 vasectomized and 13,155 matched, non-vasectomized men for the analyses.We used x2 tests for independent samples to assess statistical significance. As a measure of strength of association, we present here the ratio of the prevalence rates of the symptoms and illnesses in men with and without vasectomies. We used the test-based method to calculated 95 per cent confidence intervals for the rate ratios. We used stratification to handle confounding.
To evaluate the effectiveness of the Volunteer Collaborator Network (VCN) of Latin America as a community-based malaria case detection and treatment system, we conducted a study of the VCN of Guatemala. Volunteer Collaborators took 72.6% of all blood smears and identified 81.3% of all malaria cases reported by the Guatemalan National Malaria Service. The average volunteer treated 5.8 patients per month (range 0-32.8). In contrast, passive case detection (PCD) posts in government hospitals and health centers treated an average of 12.5 patients per month (range 0.5-91.4). The slide positivity rate of blood smears taken by Volunteer Collaborators was 16.2% compared with 9.7% for PCD posts in health centers and 10.3% for malaria workers during active case detection. The average delay between the date a blood smear was taken and examined ranged from 18.1 days on the Pacific coastal plain to 26.3 days in the less accessible northern region of the country. An additional 14.5 to 47.6 days elapsed before the radical treatments were initiated in these two regions. Seventy percent of the patients completed their radical treatments. In a survey conducted on the Pacific coastal plain of Guatemala, of 1,021 patients with chills and/or fever who believed they had malaria, 20.0% had visited a Volunteer Collaborator and 4.9% were treated at a government health center. Thus, the PCD network detected only 25% of all patients with symptoms suggestive of malaria. Most of the remaining patients treated themselves with antimalarial medications purchased in stores and pharmacies, but less than 15% of these patients used adequate courses of therapy. Furthermore, the rate of detection of symptomatic patients with malaria varied considerably from one community to another. Thus, data from the VCN are probably most useful when groups of communities or geographic areas are stratified for malaria control activities because at this level, variations between individual Volunteer Collaborator posts will be minimized. In spite of these problems, the VCN remains an excellent source of epidemiologic data for malaria control programs and the most practical means available for providing timely, appropriate antimalarial therapy to febrile patients in rural areas.
SUMMARY The goal of the present study was to document the neonatal behavior and the psychophysiological development in infancy of a group of 157 Guatemalan infants drawn from a long‐term prospective study of the effects of chronic malnutrition during pregnancy. Behavior in the neonatal period which reflected neuro‐motor adequacy as well as social interaction were related significantly to gestational age, birthweight and age of testing. Maternal variables such as unexpectedly prolonged intervals between pregnancies, maternal height and socio–economic group, also related to neonatal performance in the offspring. These findings seem to point to inherited, non‐genetic variables which can affect intrauterine conditions unfavourably and perpetuate the depleting effects of poverty from one generation to another. RÉSUMÉ Comportement de nouveaux‐nŕs guatŕmaltŕgues après agression nutritionelle Le but de la prŕsente ŕtude a ŕtŕ de prŕciser le comportement nŕonatal et le dŕveloppement psycho‐physiologique durant la première enfance d̂un groupe de 150 nourrissons guatŕmaltèques tirŕs d̂une ŕtude prospective à long terme sur les effets de la malnutrition chronique durant les grossesses. Les comportements de la pŕriode nŕonatale indiquant 'intŕgritŕ neuromotrice aussi bien que 'interaction sociale ŕtaient reliŕs significativement à 'âge de gestation, au poids de naissance et à 'âge des examens. Les variables maternelles, telles que des intervalles prolongŕs inattendus entre les grossesses, la taille et le groupe socio‐ŕconomique ŕtaient ŕgalement reliŕsaux performances nŕonatales des descendants. Ces faits semblent souligner 'existence de variables innŕes, non gŕnŕtiques pouvant affecter dŕfavorablement les conditions intra‐utŕrines et perpŕtuer les effets nŕgatifs de la pauvretŕ d̂une gŕnŕration à 'autre. ZUSAMMENFASSUNG Das Verhalten von unterernährten Neugeborenen in Guatemala Das Ziel dieser Arbeit bestand darin, Neugeborenenverhalten und psycho‐physiologische Entwicklung im Kindesalter an einer Gruppe von 157 Kindern aus Guatemala darzustellen, die aus einer Langzeitstudie über die Auswirkungen chronischer Unterernährung während der Schwangerschaft herausgenommen wurden. Verhaltensmuster in der Neonatalperiode, die für die neuro‐motorische Entwicklung sowie für die soziale Interaktion zu werten waren, waren signifikant zum Gestationsalter, zum Geburtsgewicht und zum Testalter korreliert. Mütterliche Faktoren wie unerwartet lange Intervalle zwischen den Schwangerschaften, Größe der Mutter und sozio‐ökonomischer Status zeigten ebenfalls eine Relation zu dem Neonatalverhalten des Kindes. Diese Befunde scheinen auf vererbte nicht genetische Faktoren zu deuten, die intrauterine Bedingungen ungünstig beeinflussen und die die körperliche Erschöpfung durch die Armut von einer Generation zur anderen weitertragen können. RESUMEN El comportamiento de reciŕn nacidos Guatemaltecos con un stress nutritivo La finalidad del presente estudio era documentar el comportamiento neonatal y el desarrollo psico‐fisiológico en la lactancia de un ...
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