1.  Title: Seasonal distribution of otitis media pathogens among Costa Rican children. Author: Guevara S; Soley C; Arguedas A; Porat N; Dagan R Source: Pediatric Infectious Disease Journal. 2008 Jan;27(1):12-16. Abstract: Otitis media is an important cause of pediatric consultation, and knowledge of yearly pathogen distribution might improve antimicrobial selection. The objectives were to determine the seasonal pathogen and antimicrobial resistance distribution among Costa Rican children with otitis media. Between 1999 and 2004, 952 children with otitis media, aged 3-144 months who participated in various clinical trials, were analyzed. Data obtained from this period were compared against historical data collected between 1992 and 1997. Five hundred sixteen (52%) children had a baseline middle ear fluid pathogen isolated. The most common pathogens were Streptococcus pneumoniae 252 (49%), Haemophilus influenzae 190 (37%), S. pyogenes 38 (7%), and Moraxella catarrhalis 36 (7%). The overall proportion of H. influenzae (24-37%; P = 0.01) and the production of Beta-lactamase producing H. influenzae (2.6-7%; P = 0.02) increased from 1992-1997 to 1999-2004. There was a nonstatistically significant trend for a higher frequency of S. pneumoniae and H. influenzae isolates detected during the rainy season than during the dry season: S. pneumoniae 58% versus 42% but not significant (P = 0.1) and H. influenzae 68% versus 32% (P = 0.06), respectively. During the rainy season, penicillin-nonsusceptible S. pneumoniae was identified more frequently (38.5%) than during the dry season (18%) (P = 0.003; odds ratio: 2.94; 95% confidence interval: 1.4-6.45). Penicillin-nonsusceptible S. pneumoniae decreased from 46.5% (1999 -2001) to 16% (2002-2003) and this was associated with a significant decline of a circulating 19F penicillin-resistant S. pneumoniae serotype (from 89% to 26%), respectively. S. pneumoniae and H. influenzae are the 2 most common pathogens producing otitis media in Costa Rican children. An increase in the number of H. influenzae and M. catarrhalis was observed in recent years. Penicillin-nonsusceptible S. pneumoniae isolates were more commonly observed during the rainy season, in which increased morbidity with respiratorypathogens is observed. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | LONGITUDINAL STUDIES | CHILDREN | SEASONAL VARIATION | BACTERIAL AND FUNGAL DISEASES | PNEUMONIA | INFLUENZA | ANTIBIOTICS | DRUG RESISTANCE | Central America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Population Dynamics | Infections | Diseases | Pulmonary Effects | Physiology | Biology | Viral Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 323207 |
2.  Title: Knowledge of prenatal health care among Costa Rican and Panamanian women. Author: Guilford WH; Downs KE; Royce TJ Source: Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2008 Jun 30;23(6):369-376. Abstract: There is evidence that health care during pregnancy is a crucial component in ensuring a safe delivery. Because the infant mortality rate in Costa Rica is almost half the rate of Panama, the researchers tested the hypothesis that women in Costa Rica are more knowledgeable about prenatal health care than women in neighboring Panama. A multiple-choice survey was used to evaluate women's knowledge of prenatal care using WHO recommendations as the nominal standard. Oral surveys were administered to 320 women in Costa Rican and Panamanian health care clinics. The surveys consisted of multiple-choice questions designed to assess four specific domains of knowledge in prenatal care: nutrition, danger signs, threats from illness, and acceptable activities during pregnancy. Survey answers were scored, and significant factors in assessing women's knowledge of prenatal care were determined using analysis of variance and general linear models. Costa Rican women scored higher than Panamanian women in most domains of knowledge in prenatal health care. Only country of origin and educational level were significant factors in determining knowledge of prenatal care. However, country of origin was a stronger predictor of knowledge of prenatal care than was having completed high school. These data suggest that Costa Rican women are more knowledgeable about necessary prenatal care than Panamanian women, and that this difference is probably related to direct education about and promotion of prenatal care in Costa Rica. This suggests an influence of cultural health care awareness that extends beyond the previously established negative correlation between maternal educational level and infant mortality. (author's) Language: English Keywords: COSTA RICA | PANAMA | RESEARCH REPORT | SURVEYS | WOMEN | MATERNAL HEALTH SERVICES | ANTENATAL CARE | KNOWLEDGE | AWARENESS | HEALTH EDUCATION | Central America | Latin America | Americas | Developing Countries | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Sociocultural Factors | Education Document Number: 327534 |
| 3. Peer Reviewed Title: Rationale and design of a community-based double-blind randomized clinical trial of an HPV 16 and 18 vaccine in Guanacaste, Costa Rica. Author: Herrero R; Hildesheim A; Rodriguez AC; Wacholder S; Bratti C Source: Vaccine. 2008 Sep 2;26(37):4795-4808. Abstract: We report the rationale, design, methods and details of participation of a community-based, double-blind, randomized clinical trial of an HPV 16 and 18 vaccine conducted in two provinces of Costa Rica to investigate the efficacy and population impact of the vaccine in the prevention of cervical cancer precursors. More than 24,000women between 18 and 25 years of age were invited to participate and pre-screened for eligibility, with recruitment of 7466 women (30% of those pre-screened, 59% of those eligible) who were randomized to receive 3 doses of the HPV vaccine or hepatitis A vaccine as control. A complex protocol of data and specimen collection was applied, including an interview, pelvic exam for sexually active women, blood for serology and cell-mediated immunity, cervical secretions for local immunity and cells for HPV, Chlamydia trachomatis and gonorrhea testing. Eighty percent of the women received three doses, 12.4% two doses and 7.4% one dose. At visits, compliance with data and specimen collection was close to 100%. Baseline characteristics and age-specific prevalence of HPV and cervical neoplasia are reported. Overall prevalence of HPV was high (50%), with 8.3% of women having HPV 16 and 3.2% HPV 18. LSIL was detected in 12.7% of women at baseline and HSIL in 1.9%. Prevalence of Chlamydia was 14.2%. There was very good agreement in HPV detection between clinician-collected and self- collected specimens (89.4% agreement for all types, kappa 0.59). Follow up will continue with yearly or more frequent examinations for at least 4 years for each participant. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | HPV | VACCINES | CERVICAL CANCER | DISEASE PREVENTION | Central America | Latin America | Americas | Developing Countries | Clinical Research | Research Methodology | Studies | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Prevention and Control Document Number: 328141 |
| 4. Peer Reviewed Title: Epidemiology of genital chlamydia trachomatis infection among young women in Costa Rica. Author: Porras C; Safaeian M; Gonzalez P; Hildesheim A; Silva S Source: Sexually Transmitted Diseases. 2008 May;35(5):461-468. Abstract: The objective was to investigate Chlamydia trachomatis (Ct) epidemiology among 5829 women 18 to 25 years old, in Costa Rica. Data are from a community-based human papillomavirus 16/18 vaccine trial. Before randomization, eligible women who reported previous sexual activity were interviewed and tested for Ct DNA by Hybrid Capture 2 and polymerase chain reaction-based genotyping. Multivariate models were developed. Overall prevalence was 14.2% (95% confidence interval, 13.3-15.1). Among Ct genotypes, serovar E was the most common (4.3%), followed by serovar F (3.0%), serovar D/Da (2.9%), and serovar I/Ia (2.1%). Ct increased with lifetime sexual partners of the women, and among women with 1 lifetime partner, with sexual partners of the partner. Current intrauterine device users had an increase in Ct detection [odds ratio (OR) 1.6, 1.1-2.5] but hormonal contraceptives or condom users did not. Miscarriages were associated with a reduction in Ct detection (OR 0.7, 0.5-1.0) while current regular smokingincreased it (OR 1.7, 1.2-2.5). Vaginal discharge, reactive changes, ASCUS or LSIL and moderate to severe inflammation in the cytology were significantly more common among Ct positive women (P less than 0.001). Gonorrhea prevalence was 0.8%, and it was, as other STIs, highly correlated with Ct detection. This is a high-prevalence population where we confirmed the strong link between Ct and sexual behavior of women and their partners. The establishment of a screening program in the age group included in this study should be considered. More studies are needed in developing countries to further investigate the role of intrauterine devices and the lack of protection by condoms, in addition to the interplay between Ct and other STIs, ectopy, inflammation, and epithelial abnormalities. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | INTERVIEWS | CLINICAL RESEARCH | WOMEN | CHLAMYDIA | PREVALENCE | EPIDEMIOLOGY | SEX BEHAVIOR | CONDOM USE | Central America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Demographic Factors | Population | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Measurement | Public Health | Health | Behavior | Risk Reduction Behavior Document Number: 326411 |
| 5. Title: Female tourists, casual sex, and HIV risk in Costa Rica. Author: Romero-Daza N; Freidus A Source: Qualitative Sociology. 2008 Jun;31(2):169-187. Abstract: This paper describes the involvement of young female tourists who visit rural Costa Rica with gringueros (i.e., local men who actively seek relationships with foreign women), and explores the implications of these relations, which gringueros see as outlets for sexual adventure, for sexual behaviors that could contribute to the spread of HIV/AIDS. The findings highlight the need to use tourism-related locales to implement HIV/AIDS awareness strategies targeted at women tourists, gringueros, and other local youth. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | RURAL AREAS | WOMEN | TRAVELERS | TRAVEL AND TOURISM | SEX BEHAVIOR | RISK BEHAVIOR | HIV INFECTIONS | RISK FACTORS | Central America | Latin America | Americas | Developing Countries | Geographic Factors | Population | Demographic Factors | Behavior | Viral Diseases | Diseases | Biology Document Number: 326941 |
| 6. Peer Reviewed Title: The exceptionally high life expectancy of Costa Rican nonagenarians. Author: Rosero-Bixby L Source: Demography. 2008 Aug;45(3):673-691. Abstract: Robust data from a voter registry show that Costa Rican nonagenarians have an exceptionally high life expectancy. Mortality at age 90 in Costa Rica is at least 14% lower than an average of 13 high-income countries. This advantage increases with age by 1% per year. Males have an additional 12% advantage. Age-90 life expectancy for males is 4.4 years, one-half year more than any other country in the world. These estimates do not use problematic data on reported ages, but ages are computed from birth dates in the Costa Rican birth-registration ledgers. Census data confirm the exceptionally high survival of elderly Costa Ricans, especially males. Comparisons with the United States and Sweden show that the Costa Rican advantage comes mostly from reduced incidence of cardiovascular diseases, coupled with a low prevalence of obesity, as the only available explanatory risk factor. Costa Rican nonagenarians are survivors of cohorts that underwent extremely harsh health conditions when young, and their advantage might be just a heterogeneity in frailty effect that might disappear in more recent cohorts. The availability of reliable estimates for the oldest-old in low- income populations is extremely rare. These results may enlighten the debate over how harsh early-life health conditions affect older-age mortality. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | OLDER ADULTS, 80 AND OVER | LIFE EXPECTANCY | HEALTH | HETEROGENEITY | MORTALITY DETERMINANTS | DATA QUALITY | ESTIMATION TECHNIQUES | VALIDITY | MORTALITY | SEX FACTORS | Central America | Latin America | Americas | Developing Countries | Older Adults | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Length of Life | Population Dynamics | Data Analysis | Research Methodology | Measurement Document Number: 327989 |
| 7. Peer Reviewed Title: Costa Rica: Achievements of a heterodox health policy. Author: Unger JP; De Paepe P; Buitron R; Woors W Source: American Journal of Public Health. 2008 Apr;98(4):636-643. Abstract: Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance. Costa Rica's population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system. However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system. (author's) Language: English Keywords: COSTA RICA | SUMMARY REPORT | LITERATURE REVIEW | PRIVATE SECTOR | HEALTH POLICY | HEALTH SERVICES | QUALITY OF HEALTH CARE | HEALTH INSURANCE | SOCIOECONOMIC FACTORS | POLITICAL FACTORS | ECONOMIC FACTORS | EXPENDITURES | FEES | Central America | Latin America | Americas | Developing Countries | Macroeconomic Factors | Policy | Sociocultural Factors | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Financial Activities Document Number: 325535 |
| 8. Title: Consideration of reports submitted by states parties under Article 12(1) of the Optional Protocol to the Convention on the Rights of the Child on the Sale of Children, Child Prostitution and Child Pornography. Concluding observations: Costa Rica. Unedited version. Author: United Nations. Office of the High Commissioner for Human Rights [OHCHR]. Committee on the Rights of the Child Source: [Geneva, Switzerland], United Nations, OHCHR, 2007. 8 p. (CRC/C/OPSC/CRI/CO/1) Abstract: The Committee considered the initial report of Costa Rica (CRC/C/OPSC/CRI/1) at its 1201st meeting (see CRC/C/SR.1201st), held on 15 January 2007, and adopted at its 1228th meeting, held on 2 February 2007, the following concluding observations. The Committee welcomes the submission of the State party's initial report, as well as the replies to its list of issues submitted in a timely fashion. The Committee also appreciates the constructive and informative dialogue held with the State party's high-level delegation. The Committee reminds the State party that these concluding observations should be read in conjunction with its previous concluding observations adopted on the State party's third periodic report on 3 June 2005 contained in CRC/C/15/Add.266. The Committee notes with appreciation: a) the establishment, in 1999, of a unit to combat sexual exploitation of children within the Ministry of Public Security and of a specialized unit within the Judicial Investigation Department; b) the establishment of the National Commission to Combat the Commercial Sexual Exploitation of Children and Adolescents (CONACOES) as a special thematic commission of the National Council on Children and Adolescents; and the participation of nongovernmental organizations to this Commission; c) the adoption in September 2006 of the "Program for the Integral Care of children and adolescents at risk and in vulnerable situation", a project implemented by the National Child Welfare Agency (PANI) offices at local level. (excerpt) Language: English Keywords: COSTA RICA | PROGRESS REPORT | RECOMMENDATIONS | DATA COLLECTION | CHILDREN | ADOLESCENTS | SEXUAL ABUSE | CHILD ABUSE | FILM AND VIDEO | INTERNET | PROGRAM EVALUATION | PREVENTION AND CONTROL | SEXUAL TRAFFICKING | GOVERNMENT PROGRAMS | LEGISLATION | Developing Countries | Central America | Latin America | Americas | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Mass Media | Communication | Information Networks | Programs | Organization and Administration | Diseases | Political Factors Document Number: 312553 |
| 9. Title: Fetal risk associated with rubella vaccination during pregnancy. Author: Badilla X; Morice A; Avila-Aguero ML; Saenz E; Cerda I Source: Pediatric Infectious Disease Journal. 2007 Sep;26(9):830-835. Abstract: Costa Rica implemented a nationwide measles-rubella vaccination campaign among men and women (15-39 years old) in May 2001. A protocol was developed to follow-up the vaccinated women who were unknowingly pregnant, to determine the risk of congenital rubella syndrome (CRS) or congenital rubella infection only associated with the administration of the rubella vaccine RA27/3 during pregnancy. To classify the prevaccination maternal immune status, a serum sample was taken at the initial evaluation to detect IgM and IgG rubella antibodies (enzyme-linked immunosorbent assay). All pregnancies were followed up and all newborns were evaluated. A cord serum sample of their children was taken at birth. We calculated odds ratio, OR (95% confidence interval, 95% CI) associated with miscarriage, stillbirth, prematurity, low birth weight, and the presence of defects compatible with CRS. The prevaccination immune status was established in 797 women and 1191 mother and child pairs were analyzed. Adjusted OR for miscarriage (OR = 0.60, 95% CI = 0.26-1.39), stillbirth (OR = 1.32, 95% CI = 0.10-16.81), prematurity (OR = 0.25, 95% CI = 0.03-2.39), low birth weight (OR = 0.25, 95% CI = 0.03-2.23) and defects compatible with CRS (OR = 1.09, 95% CI = 0.34-3.54) showed no association between immune and susceptible maternal status. There were no cases of CRS and no children were IgM positive. No adverse pregnancy outcome such as miscarriages or CRS was documented in women who were vaccinated and unknowingly pregnant. These results support RA27/3 rubella vaccine safety. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CLINICAL RESEARCH | FOLLOW-UP STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | FETUS | RUBELLA | IMMUNIZATION | MOTHER-TO-CHILD TRANSMISSION | ABORTION, SPONTANEOUS | FETAL DEATH | LOW BIRTH WEIGHT | BIRTH DEFECTS | Central America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Pregnancy | Reproduction | Viral Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Transmission | Infections | Pregnancy Complications | Mortality | Population Dynamics | Birth Weight | Body Weight | Physiology | Biology | Neonatal Diseases and Abnormalities Document Number: 319667 |
| 10. Title: Triggers of nonfatal myocardial infarction in Costa Rica: heavy physical exertion, sexual activity, and infection. Author: Baylin A; Hernandez-Diaz S; Siles X; Kabagambe EK; Campos H Source: Annals of Epidemiology. 2007 Feb;17(2):112-118. Abstract: There are no data for factors that could trigger myocardial infarction (MI) in the context of lifestyles in developing countries. Using a case-crossover design, we assessed the effect of heavy physical exertion, sexual activity, acute respiratory tract infections, and gastroenteritis as triggers for MI in 530 survivors of a first MI from Costa Rica. Relative risks (RRs) for MI in the hour after heavy physical exertion and 2 hours after sexual activity were 4.94 (95% confidence interval [CI], 3.73-6.54) and 5.47 (95% CI, 2.71-11.02). Risk for MI after heavy physical exertion was greater for patients with poor physical fitness or elevated underlying cardiovascular risk (p < 0.0001 and p = 0.06, tests of homogeneity). RRs for acute respiratory tract infection and gastroenteritis were 1.48 (95% CI, 0.92-2.38) and 1.27 (95% CI, 0.95-1.69), respectively. Patients with three or more risk factors had an RR for MI for gastroenteritis of 2.08 (95% CI, 1.31-3.28). Our results confirm previous studies in developed countries showing that heavy physical exertion and sexual activity are potential triggers for MI, and their effect is modified by physical fitness and underlying cardiovascular risk. Additional studies that explore the biologic effects of gastroenteritis as triggers of MI are warranted. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | STATISTICAL STUDIES | CLIENTS | MYOCARDIAL INFARCTION | FITNESS | GASTROINTESTINAL EFFECTS | RESPIRATORY INFECTIONS | SEXUAL INTERCOURSE | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Heart Diseases | Diseases | Health | Physiology | Biology | Infections | Reproduction Document Number: 311551 |
| 11. Title: The therapeutic exception: Abortion, sterilization and medical necessity in Costa Rica. Author: Carranza M Source: Developing World Bioethics. 2007 Aug;7(2):55-63. Abstract: Based on the case of Rosa, a nine-year-old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CHILD | PREGNANCY | ABORTION LAW | LEGISLATION | ABORTION | PARENTAL INVOLVEMENT | PSYCHOSOCIAL FACTORS | Central America | Latin America | Americas | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproduction | Fertility Control, Postconception | Family Planning | Political Factors | Sociocultural Factors | Child Rearing | Behavior Document Number: 318828 Notification |
| 12. Title: Children in female-headed households: interrogating the concept of an 'inter-generational transmission of disadvantage' with particular reference to The Gambia, Philippines and Costa Rica. Author: Chant S Source: London, England, London School of Economics, Gender Institute, 2007 Feb. 107 p. (London School of Economics, Gender Institute New Working Paper Series No. 19) Abstract: Grounded in a popular stereotype that female-headed households are the 'poorest of the poor', it is often assumed that women and children suffer greater poverty than in households which conform with a more common (and idealised) male-headed arrangement. In addition, a conjectured 'inter-generational transmission of disadvantage' in female-headed households is imagined not only to compromise the material well-being of children, but to compound other privations - emotional, psychological, social and otherwise. Beyond affecting young people in the short-term, these are also deemed to sow the seeds of future hardship. However, a mounting body of evidence suggests that household headship is not necessarily a good predictor of the start that children have in life, nor of their trajectories into adolescence and adulthood. On the basis of such evidence, the present paper seeks to interrogate -- and challenge -- some (mis)conceptions about female household headship and poverty among children. It finds thatwhile risks to children's well-being may arise through discriminatory or hostile attitudes towards female-headed households in society at large, gender dynamics within male-headed units can be just as prejudicial in this regard. With this in mind, suggestions are offered for gender-sensitive policies which might help to ensure that children in all poor households are guaranteed equality in basic needs and rights. (author's) Language: English Keywords: GAMBIA | PHILIPPINES | COSTA RICA | TECHNICAL REPORT | WOMEN | HEAD OF HOUSEHOLD | CHILD | MISINFORMATION | STIGMA | SOCIAL DISCRIMINATION | PERCEPTION | POVERTY | GENDER ISSUES | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Asia, Southeastern | Asia | Central America | Latin America | Americas | Demographic Factors | Population | Households | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Communication | Social Problems | Psychological Factors | Behavior | Socioeconomic Factors | Economic Factors Document Number: 320941 |
| 13. Peer Reviewed Title: Effect of human papillomavirus 16 / 18 L1 viruslike particle vaccine among young women with preexisting infection: A randomized trail. Author: Hildesheim A; Herrero R; Wacholder S; Rodriguez AC; Solomon D Source: JAMA. Journal of the American Medical Association. 2007 Aug 15;298(7):743-753. Abstract: Virus like particle human papillomavirus (HPV) vaccines were designed to prevent HPV infection and development of cervical precancers and cancer. Women with oncogenic HPV infections might consider vaccination as therapy. The objective was to determine whether vaccination against HPV types 16 and 18 increases the rate of viral clearance in women already infected with HPV. Phase 3, masked, community-based randomized trial conducted in 2 provinces of Costa Rica. A total of 2189 women aged 18 to 25 years who were recruited between June 2004 and December 2005. Participants were positive for HPV DNA at enrollment, had at least 6 months of follow-up, and had follow-up HPV DNA results. Participants were randomly assigned to receive 3 doses of a bivalent HPV-16/18 L1 protein virus like particle AS04 candidate vaccine (n=1088) or a control hepatitis A vaccine (n=1101) over 6 months. Presence of HPV DNA was determined in cervical specimins by a molecular hybridization assay using chemiluminescence with HPV RNA probes and by polymerase chain reaction using SPF10 primers and a line probe assay detection system before vaccination and by polymerase chain reaction after vaccination. We compared rates of type-specific viral clearance using generalized estimating equations methods at the 6-month visit (after 2 doses) and 12-month visit (after 3 doses) in the 2 study groups. There was no evidence of increased viral clearance at 6 or 12 months in the group Who received HPV vaccine compared with the control group. Clearance rates for HPV-16/18 infections at 6 months were 33.4% (82/248) in the HPV vaccine group and 31.6% (95/ 298) in the control group (vaccine efficacy for viral clearance, 2.5%; 95% confidence interval,- 9.8%to 13.5%).Humanpapilloma virus 16/18 clearance rates at 12 months were 48.8%(86/177) in the HPV vaccine group and 49.8%(110/220) in the control group (vaccine efficacy for viral clearance,-2.0%;95%confidence interval,-24.3%to 16.3%). There was no evidence of a therapeutic effect for other oncogenic or nononcogenic HPV categories, among women receiving all vaccine doses, among women with single infections, or among women stratified by the following entry variables: HPV-16/18 serology, cytologic results, HPV DNA viral load, time since sexual debut, Chlamydia trachomatis or Neisseria gonorrhoeae infection, hormonal contraceptive use, or smoking. In women positive for HPV DNA, HPV-16/18 vaccination does not accelerate clearance of the virus and should not be used to treat prevalent infections. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CLINICAL TRIALS | CONTROL GROUPS | WOMEN | YOUTH | HPV | VIRAL DISEASES | VACCINES | Central America | Latin America | Americas | Developing Countries | Clinical Research | Research Methodology | Demographic Factors | Population | Age Factors | Population Characteristics | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 320274 |
| 14. Title: [Reasons to promote emergency contraception in Costa Rica] Razones para promover anticoncepcion de emergencia en Costa Rica. Author: Orlich Castelan C; Carvajal Alvarez J Source: Revista Medica de Costa Rica y Centroamerica. 2007 Jan-Mar;64(578):11-13. Abstract: In spite of the fact that Costa Rica is one of the countries with major prevalence in the use of contraceptive methods and that the ideal number of sons and daughters decrease from 4.6 in 1980 to 2.7 hi 1999, the percentage of unwanted pregnancies has been stable among 42.3 % and 41.4 % in 1992 and 1999 respectively. This situation happens for many reasons; being one of them the incorrect and not systematical use of the contraceptives methods, which diminishes their efficiency. The 60 % of the women use some methods that need a correct and systematical use: the condom, the pills and the natural methods. Besides, we must take into account the cases in which women are forced to have sexual relations. Considering this panorama, the emergency contraception (EC) is a procedure that helps to prevent unwanted pregnancies and abortions. It is the only procedure that prevents the pregnancies after the sexual relation. The EC acts before the fertilization, because of it the EC is not an abortive procedure. (author's) Language: Spanish Keywords: COSTA RICA | CRITIQUE | EVALUATION | WOMEN IN DEVELOPMENT | EMERGENCY CONTRACEPTION | CONTRACEPTIVE PREVALENCE | FAMILY SIZE, IDEAL | PREGNANCY, UNWANTED | CONTRACEPTIVE USAGE | CONTRACEPTIVE EFFECTIVENESS | SEX BEHAVIOR | Central America | Latin America | Americas | Developing Countries | Economic Development | Economic Factors | Contraception | Family Planning | Family Size | Family Characteristics | Family and Household | Sociocultural Factors | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Behavior Document Number: 308806 |
| 15. Peer Reviewed Title: The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the Guanacaste cohort shortly after initiation of sexual life. Author: Rodriguez AC; Burk R; Herrero R; Hildesheim A; Bratti C Source: Sexually Transmitted Diseases. 2007 Jul;34(7):494-502. Abstract: Cross-sectional analyses of our 10,000-woman, population-based Guanacaste cohort suggest a lag of >10 years between the peak of human papillomavirus (HPV) infection and the later peak of cervical intraepithelial neoplasia grade 3 (CIN 3). We wanted to explore early HPV natural history and CIN 3 prospectively. As part of the Guanacaste cohort, we followed 206 initially virginal women aged 18 to 26 semiannually for a median of 3.6 years after initiation of sexual life. A total of 53.4% of women tested positive during the study for >/= 1 HPV type. Very few infections persisted for >1 to 2 years. Three women had histologically confirmed CIN 3, of which 2 showed persistent HPV 16. The other had serologic evidence of HPV 31. HPV infection occurs frequently and clears rapidly in most young women initiating sexual intercourse. Persistent HPV 16 can cause early CIN 3. The peak age for CIN 3 will decline with the increased screening intensity and sensitivity typical of longitudinal studies. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | HEALTH SURVEYS | COHORT ANALYSIS | LONGITUDINAL STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | YOUTH | HPV | CERVICAL CANCER | FIRST INTERCOURSE | PREVALENCE | Central America | Latin America | Americas | Developing Countries | Research Methodology | Health | Studies | Economic Development | Economic Factors | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Cancer | Neoplasms | Sex Behavior | Behavior | Measurement Document Number: 319011 |
| 16. Title: The puzzling SES gradients in adult health and mortality of a Latin American population. Author: Rosero-Bixby L; Dow W Source: [Unpublished] 2007. Presented at the Population Association of America 2007 Annual Meeting, New York, New York, March 29-31, 2007. 7 p. Abstract: Vast evidence has shown that poorer health and higher mortality in children are clearly associated with lower socioeconomic status of parents everywhere. In contrast, the evidence of a SES gradient in developing country adult health is scarce and conflicting. Particularly puzzling is the fact that subjective general health status measures have been found in some studies to have much larger SES gradients than more objectively measured health indicators. This paper further investigates this paradox using data from an ongoing longitudinal study of health and survival among elderly Costa Ricans (the CRELES study). We document varying SES gradients across a rich array of health indicators including subjective health, functional status, disease conditions, objective risk factors from blood and urine samples, and mortality data. In addition, we estimate SES gradients in key mediating environmental and behavior variables in order to elucidate what hypotheses may be most promising for further research. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | LONGITUDINAL STUDIES | CLINICAL RESEARCH | OLDER ADULTS | SOCIOECONOMIC STATUS | HEALTH STATUS INDEXES | SELF-PERCEPTION | RISK FACTORS | MORTALITY DETERMINANTS | DISEASES | ENVIRONMENT | RISK BEHAVIOR | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors | Health | Perception | Psychological Factors | Behavior | Biology | Mortality | Population Dynamics Document Number: 317872 |
| 17. Title: [Detection of cervical pathology] Deteccion de patologia cervical. Author: Acosta Valerin RF Source: Revista Medica de Costa Rica y Centroamerica. 2006 Jul-Sep;63(576):115-117. Abstract: Cervical citology or PAP test is an ambulatory procedure for screening uterine cervical patologies, with minimal morbidity, low cost and high confiability. The main reason of this study is to describe the results obtained from the screening of uterine cervical pathology with the papanicolau's test during last year in the population of Palmar Sur located at the Osa's Peninsule. At the same time, it details the corresponding follow up of the patients detected with intraepitelial lesions and correlations with the already known risk factors for uterine's cervical premaligne patologies. (author's) Language: Spanish Keywords: COSTA RICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | CERVICAL EFFECTS | PAP SMEAR | SCREENING | UTERUS | UTERINE CANCER | FEES | Central America | Latin America | Americas | Developing Countries | Research Methodology | Economic Development | Economic Factors | Cervix | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Financial Activities Document Number: 308810 |
| 18. Peer Reviewed Title: Seroprevalence of dengue virus antibodies in asymptomatic Costa Rican children, 2002--2003: a pilot study. Author: Iturrino-Monge R; Avila-Aguero ML; Avila-Aguero CR; Moya-Moya T; Canas-Coto A Source: Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2006;20(1):39-43. Abstract: Since 1993 dengue has become more frequent in Costa Rica. Adults have been the most affected population, while children have remained virtually unharmed. So far no studies have investigated how many asymptomatic children have been affected by this virus. This pilot study documents the seroprevalence, measured as the presence of IgG antibodies, of dengue virus in asymptomatic children from two different geographical areas. This descriptive, prospective epidemiologic study compared the presence of antibodies in children who live in a coastal region of a tropical country where dengue is endemic, and an inland area where dengue is not endemic. An enzyme-linked immunosorbent assay was used to test the serum for dengue virus IgG antibodies. None of the children had a prior history of dengue, fever, immunosuppressive therapy or underlying disease. During the period from July 2002 to July 2003, 103 children were recruited from each area. In the costal region we found a seroprevalence of 36.9%. In the inland area seroprevalence was 2.9%. We found a substantial number of asymptomatic infections in Costa Rican children. This greatly increases the risk of dengue hemorrhagic fever or dengue shock syndrome in these children, in whom previous dengue infection had gone undetected. Preventive efforts should be targeted at the costal region due to the higher prevalence in this area. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | PILOT PROJECTS | CHILD | DENGUE | FEVER | LABORATORY EXAMINATIONS AND DIAGNOSES | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Body Temperature | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 307219 |
| 19. Peer Reviewed Title: Double burden of iron deficiency in infancy and low socioeconomic status: a longitudinal analysis of cognitive test scores to age 19 years. Author: Lozoff B; Jimenez E; Smith JB Source: Archives of Pediatrics and Adolescent Medicine. 2006 Nov;160(11):1108-1113. Abstract: The objective was to assess change in cognitive functioning after iron deficiency in infancy, depending on socioeconomic status (SES; middle vs low). Design: Longitudinal study. Setting: Urban community in Costa Rica (infancy phase [July 26, 1983, through February 28, 1985] through 19-year follow-up [March 19, 2000, through November 4, 2002]). A total of 185 individuals enrolled at 12 to 23 months of age (no preterm or low-birth-weight infants or infants with acute or chronic health problems). The participants were assessed in infancy and at 5, 11 to 14, 15 to 18, and 19 years of age. A total of 97% were evaluated at 5 or 11 to 14 years and 78% at 15 to 18 or 19 years. Individuals who had chronic iron deficiency in infancy (iron deficiency with hemoglobin concentrations = 10.0 g/dL or, with higher hemoglobin concentrations, not fully corrected within 3 months of iron therapy) were compared with those who had good iron status as infants (hemoglobin concentrations_12.0 g/dL and normal iron measures before and/or after therapy). Main Outcome Measures: Cognitive change over time (composite of standardized scores at each age). For middle-SES participants, scores averaged 101.2 in the group with chronic iron deficiency vs 109.3 in the group with good iron status in infancy and remained 8 to 9 points lower through 19 years (95% confidence interval [CI], -10.1 to -6.2). For low-SES participants, the gap widened from 10 points (93.1 vs 102.8; 95% CI for difference, -12.8 to -6.6) to 25 points (70.4 vs 95.3; 95% CI for difference, 20.6 to 29.4). The group with chronic iron deficiency in infancy did not catch up to the group with good iron status in cognitive scores over time. There was a widening gap for those in low-SES families. The results suggest the value of preventing iron deficiency in infancy. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CLINICAL RESEARCH | INFANT | LOW INCOME POPULATION | ANEMIA | SERUM IRON LEVEL | POVERTY | SOCIOECONOMIC STATUS | HEMOGLOBIN LEVEL | AGE FACTORS | Central America | Latin America | Americas | Developing Countries | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Social Class | Socioeconomic Factors | Economic Factors | Diseases | Hemic System | Physiology | Biology Document Number: 309101 |
| 20. Peer Reviewed Title: Where the boys are: Sexual expectations and behaviour among young women on holiday. Author: Ragsdale K; Di Franceisco W; Pinkerton SD Source: Culture, Health and Sexuality. 2006 Mar-Apr;8(2):85-98. Abstract: The main objectives of this study were to examine relationships between vacation sex expectations and travelling companionship type (solo, paired, or group), and behavioural outcomes such as engaging in a relationship while on vacation, procuring condoms, and initiating condom use with vacation sex partners among tourist women in Costa Rica. A brief interview was used to assess sociodemographic characteristics, vacation sex expectations and relationships, casual sex variables, and alcohol use among a convenience sample of 128 single female tourists 18 years of age or older. Univariate and multivariate analysis were used to examine relationships among variables of interest. Women who travelled solo or with a single female companion and women who anticipated having sex on holiday were more likely than other tourist women to report one or more vacation relationships, to have procured condoms, and to have initiated condom use with a vacation sex partner. Women who engage in unanticipated vacation relationships may be at increased risk of participating in unsafe sex with a partner met on holiday due to lack of condom procurement and/or initiation of condom use. The findings point to the importance of public health efforts to educate women regarding safer sex precautions when travelling on holiday. (author's) Language: English Keywords: COSTA RICA | UNITED STATES OF AMERICA | RESEARCH REPORT | INTERVIEWS | WOMEN | TRAVELERS | SEXUAL PARTNERS | TRAVEL AND TOURISM | SEX BEHAVIOR | CONDOM USE | RISK REDUCTION BEHAVIOR | ALCOHOL USE AND ABUSE | Developing Countries | Central America | Latin America | Americas | North America | Developed Countries | Data Collection | Research Methodology | Demographic Factors | Population | Behavior Document Number: 303960 |
| 21. Title: Sex and SES paradox in health status and mortality among elderly populations. Author: Rosero-Bixby L; Fernandez X; Mendez E; Pinto G Source: [Unpublished] 2006. Presented at the 2006 Annual Meeting of the Population Association of America, Los Angeles, California, March 30 - April 1, 2006. 14 p. Abstract: Adult males have higher mortality than females, while, paradoxically, health status indicators often show the contrary: males are better off than females. Mortality indicators are hard, indisputable data. Health indicators, however, are often based on "soft" data, dependent on definitions, interpretations, and subjective self-reports. Based on panel data for elderly Mexicans (MHAS study) and biomarkers for elderly Costa Ricans (CRELES), we conclude that self-reported health indicators may be misleading. The sex gap showing elderly women with poorer health than men is to some extent a spurious result of differential age structure, survival selection, and sex-bias in self-reports. The paper also explores whether the large socioeconomic gap in self-reported health suffers similar problems as the sex gap. Elderly Costa Ricans do not show the inverse gradient in health by socioeconomic status (SES) for important biomarkers. This finding contradicts the results obtained when using self reported indicators. (author's) Language: English Keywords: MEXICO | COSTA RICA | RESEARCH REPORT | SAMPLING STUDIES | ADULTS | OLDER ADULTS | HEALTH STATUS INDEXES | SEX FACTORS | SOCIOECONOMIC FACTORS | BIAS | AGE DISTRIBUTION | MORTALITY | North America | Americas | Developing Countries | Central America | Latin America | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Economic Factors | Error Sources | Measurement | Population Dynamics Document Number: 318881 |
| 22. Title: The impact of pesticide exposure on breast cancer incidence: evidence from Costa Rica, 1996-2000. Author: Santamaria C Source: [Unpublished] 2006. Presented at the Population Association of America, 2006 Annual Meeting, Los Angeles, California, March 30 - April 1, 2006. 33 p. Abstract: The low percentage of breast cancer cases related to reproductive history risk factors and to genetics suggests that the environment may play a role in breast cancer etiology. Pesticide exposure has been hypothesized to have an important effect. This ecological study tests whether breast cancer incidence in Costa Rica is related to pesticide exposure, after controlling for parity, socioeconomic status, age at first full-term pregnancy, and access to health care. Spatial analysis techniques were used to test for spatial autocorrelation and to rule out the heterogeneity of a possible relationship between breast cancer and pesticides. Because of the time-lag between exposure and incidence, migration bias was also mitigated. Results suggest that there is a heterogeneous association between pesticides and breast cancer, which is significant only in some rural agricultural areas of the country. Conclusions about causality can not be drawn from an ecologic approach, like the one taken in this study. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | RURAL POPULATION | BREAST CANCER | PESTICIDES | TOXICITY | ECOLOGY | RISK FACTORS | HUMAN GEOGRAPHY | Central America | Latin America | Americas | Developing Countries | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Ingredients and Chemicals | Physiology | Biology | Environment | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 317436 |
| 23. Peer Reviewed Title: A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica. [Estudio prospectivo de tendencias por edad en el contagio y la persistencia de la infección por papilomavirus humano cervical en Guanacaste, Costa Rica] Author: Castle PE; Schiffman M; Herrero R; Hildesheim A; Rodriguez AC Source: Journal of Infectious Diseases. 2005;191:1808-1816. Abstract: Background. Cross-sectional human papillomavirus (HPV) DNA prevalence peaks at young ages, reflecting sexual acquisition and typically rapid clearance. In some populations, HPV prevalence demonstrates a second peak in older women. Longitudinal data may help to explain this second peak. Methods. We followed a population-based cohort of 7237 women in Guanacaste, Costa Rica, in which we had previously observed a second peak in the baseline HPV prevalence in older women. We tested for >40 HPV types by polymerase chain reaction. We analyzed age-specific patterns of acquisition and persistence 5-7 years after enrollment for individual HPV types. Results. At enrollment and follow-up, cross-sectional data revealed U-shaped age-specific HPV prevalence curves for virtually every type, with higher prevalences in the younger and older women than in the middle-aged women. Prospectively, acquisition of types decreased significantly as women aged (P(-Trend)<.05, for both), with the highest peak in young women and a secondary minor peak in older women. Type-specific persistence of HPV increased with age (P(-Trend)<.0001). Overall, HPV acquisition predominated at younger ages, whereas persistent infections gradually became more prominent with age (P(-Trend)<.0001). Conclusions. Newly apparent infections decreased, whereas persistence increased, with age; this latter tendency supports the utility of HPV screening in older women. (author's) Spanish Abstract: Antecedentes. Estudio transversal de picos de prevalencia de ADN de papilomavirus humano (PVH) en edad temprana, que refleja el contagio por vía sexual y la típica depuración rápida. En algunas poblaciones, la prevalencia de PVH demuestra un segundo pico en mujeres de mayor edad. Los datos longitudinales pueden ayudar a explicar este segundo pico. Métodos. Se realizó un seguimiento de una cohorte basada en la población de 7237 mujeres en Guanacaste, Costa Rica, en la que antes se había observado un segundo pico en la prevalencia inicial de PVH en mujeres de mayor edad. Se utilizó la prueba de la reacción en cadena de la polimerasa para analizar > 40 tipos de PVH. Se determinó la presencia de tipos individuales de PVH mediante análisis de patrones de contagio y persistencia específicos a cada edad de los 5 a los 7 años después de la inclusión en el estudio. Resultados. Al momento de la inclusión y del seguimiento, los datos transversales revelaron curvas de prevalencia de PVH con forma de U específicas para la edad para prácticamente todos los tipos, con una mayor prevalencia en las mujeres más jóvenes y de mayor edad en comparación con las mujeres de mediana edad. Probablemente, el contagio de los tipos disminuyó significativamente a medida que las mujeres envejecían (P (Tendencia negativa) <0,05, para ambos grupos) y el pico más alto en las mujeres más jóvenes y un pico secundario menor en las de mayor edad. La persistencia de PVH específica por tipo aumentó con la edad (P (Tendencia negativa) < 0,0001). En general, el contagio de PVH predominó a edades tempranas, mientras que las infecciones persistentes se volvieron gradualmente más prominentes con la edad (P (Tendencia negativa) < 0,0001). Conclusiones. Las infecciones aparentes recientes disminuyeron y, por el contrario, la persistencia aumentó, con la edad; esta segunda tendencia apoya la utilidad de realizar detecciones de PVH en mujeres de mayor edad. (del autor) Language: English Keywords: COSTA RICA | RESEARCH REPORT | PROSPECTIVE STUDIES | CROSS SECTIONAL ANALYSIS | GENETIC TECHNIQUES | COHORT ANALYSIS | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | VIRAL DISEASES | PREVALENCE | AGE FACTORS | Developing Countries | Central America | Latin America | Americas | Studies | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Economic Development | Economic Factors | Diseases | Measurement | Population Characteristics | Demographic Factors | Population Document Number: 286156 |
| 24. Peer Reviewed Title: Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. [Perfil epidemiológico de infección por papilomavirus humano específica por tipo y neoplasia cervical en Guanacaste, Costa Rica] Author: Herrero R; Castle PE; Schiffman M; Bratti MC; Hildesheim A Source: Journal of Infectious Diseases. 2005;191:1796-1807. Abstract: Detailed epidemiologic studies of cervical type-specific human papillomavirus (HPV) infection in large populations are scarce. We recruited a population-based cohort in Guanacaste, Costa Rica. Participants were interviewed, screened for cervical neoplasia, and tested for >40 HPV types by use of MY09/11 L1 consensus primer polymerase chain reaction. We estimated the risk factors for infection and the associations between type-specific HPV infections and cervical intraepithelial neoplasia (CIN) and cancer in 8514 sexually active women who had not undergone a hysterectomy. The overall HPV prevalence was 26.5%. The most common type was HPV-16 (3.6% of the population). HPV prevalence showed a U-shaped age-specific curve. Sexual behaviors were the main determinants of oncogenic and nononcogenic infections; age at first sexual intercourse was not independently associated with infection. Barrier contraceptive use was somewhat protective against infection. Oncogenic infections were strongly associated with risk of all grades of CIN and of cancer. Types 16, 18, and 58 were the most common in women diagnosed with CIN3 and cancer. Except for those that included HPV-16, multiple-type infections were associated with an increased risk (compared with that for single-type infections) of all grades of CIN and of cancer. We confirmed the bimodal age pattern of HPV infection in Guanacaste and the sexually transmitted nature of both oncogenic and nononcogenic HPV types. (author's) Spanish Abstract: Se han realizado escasos estudios epidemiológicos detallados de infección por papilomavirus humano (PVH) cervical específica por tipo en poblaciones numerosas. Se reclutó una cohorte basada en la población en Guanacaste, Costa Rica. Los pacientes fueron entrevistados, se les realizaron estudios de detección de neoplasia cervical y pruebas de > 40 tipos de PVH utilizando la reacción en cadena de la polimerasa mediada por cebador consenso MY09/11. Se calcularon los factores de riesgo para la infección y las asociaciones entre infecciones por PVH específicas por tipo y la neoplasia intraepitelial cervical (NIC) y el cáncer en 8514 mujeres sexualmente activas a quienes no se les había realizado histerectomía. La prevalencia general del PVH fue del 26,5%. El tipo más común fue el PVH-16 (3,6% de la población). La prevalencia del PVH presentó una curva con forma de U específica por edad. Las conductas sexuales fueron los principales factores determinantes de infecciones oncogénicas y no oncogénicas; la edad en la primera relación sexual no se asoció independientemente con la infección. El uso de anticonceptivos de barrera aportó un cierto grado de protección contra la infección. Se observó una fuerte asociación entre las infecciones oncogénicas y el riesgo de todos los estadíos de NIC y cáncer. Los tipos 16, 18 y 58 fueron los más frecuentes en las mujeres con diagnóstico de NIC3 y cáncer. Con excepción de los casos que incluyeron PVH-16, las infecciones de tipo múltiple se asociaron con un mayor riesgo (en comparación con las infecciones para un único tipo) de todos los estadíos de NIC y cáncer. Se confirmó el patrón bimodal de edad de la infección por PVH en Guanacaste y la naturaleza de transmisión sexual de los tipos oncogénicos y no oncogénicos de PVH. (del autor) Language: English Keywords: COSTA RICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | WOMEN IN DEVELOPMENT | CERVICAL CANCER | VIRAL DISEASES | PREVALENCE | AGE FACTORS | SEX BEHAVIOR | FIRST INTERCOURSE | BARRIER METHODS | RISK FACTORS | Developing Countries | Central America | Latin America | Americas | Research Methodology | Economic Development | Economic Factors | Cancer | Neoplasms | Diseases | Measurement | Population Characteristics | Demographic Factors | Population | Behavior | Contraceptive Methods | Contraception | Family Planning | Biology Document Number: 286155 |
| 25. Title: Biochemical indicators of nutritional status and dietary intake in Costa Rican Cabécar Indian adolescents. Author: Monge-Rojas R; Barrantes M; Holst I; Nunez-Rivas H; Alfaro T Source: Food and Nutrition Bulletin. 2005;26(1):3-16. Abstract: The purpose of this study was to determine the blood levels of selected nutritional status indicators and the dietary intake of Costa Rican Cabécar Indians aged 10 to 16 years. The results showed that 65% of the adolescents had an adequate body mass index (BMI) for their age, and 32% had a BMI < 5th percentile. Likewise, the study revealed a high prevalence of anemia (57%), deficient serum folate levels (54%), deficient vitamin B12 levels (31%), and subclinical vitamin A deficiency (10%). Additionally, the youngsters had elevated prevalences of high triglyceride levels (77%), borderline high-density lipoprotein (HDL) cholesterol levels (46%), homocysteine levels > 10 µmol/L (29%), and homozygous mutation of methylenetetrahydrofolate reductase (MTHFR) (49%). The diet was poor, being high in saturated fat and low in polyunsaturated fat, fiber, and several micronutrients. The dietary intakes of more than 55% of the adolescents did not meet 50% of the estimated average requirements (EAR) for zinc, vitamin A, vitamin C, vitamin B12, vitamin B2, and folate. Furthermore, a high prevalence of parasitosis was found (68%). Our results show an adolescent Cabécar population with a mosaic of nutritional deficiencies and cardiovascular risk factors. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | CRITIQUE | EVALUATION INDEXES | NUTRITION SURVEYS | INDIGENOUS POPULATION | ADOLESCENTS | HEALTH STATUS INDEXES | CHILD NUTRITION | ADOLESCENT HEALTH | DIET | LABORATORY EXAMINATIONS AND DIAGNOSES | Central America | Latin America | Americas | Developing Countries | Quantitative Evaluation | Evaluation | Nutrition | Health | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 311860 |
| 26. Title: Generations and motivations: Russian and other former Soviet immigrants in Costa Rica. Author: Rodriguez L; Cohen JH Source: International Migration. 2005;43(4):147-165. Abstract: In this paper, we examine the role that social networks have played in the migration and settlement of Russian and other former Soviet immigrants to Costa Rica. This group of immigrants is of particular interest in that it is an example of migration from a former communist nation to a Third World country, not to the first world (Europe or the United States). Furthermore, a group of Soviet women who married Costa Rican men beginning in the late 1970s set this migration in motion. The objective of our research was to examine the structure and meaning of these immigrants' social networks, and the role that they play in the migration process and during settlement. The findings suggest there is a significant difference in the form and function of the social networks of those immigrants who arrived prior to 1991 (during the Soviet era), and those who came post-1991 and following the collapse of the Soviet Union. (author's) Language: English Keywords: COSTA RICA | RUSSIA | RESEARCH REPORT | SURVEYS | IMMIGRANTS | SOCIAL ADJUSTMENT | SOCIAL NETWORKS | INTERNATIONAL MIGRATION | SETTLEMENT AND RESETTLEMENT | COMMUNISM | ETHNIC GROUPS | Developing Countries | Central America | Latin America | Americas | Asia, Northern | Asia | Sampling Studies | Studies | Research Methodology | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Social Behavior | Behavior | Friends and Relatives | Family and Household | Sociocultural Factors | Socialism | Political Systems | Political Factors | Cultural Background | Population Characteristics Document Number: 302420 |
| 27. Peer Reviewed Title: Insurance and other socioeconomic determinants of elderly longevity in a Costa Rican panel. [Seguros y otros determinantes socioeconómicos de longevidad en la tercera edad en un panel costarricense] Author: Rosero-Bixby L; Dow WH; Laclé A Source: Journal of Biosocial Science. 2005;37:705-720. Abstract: Official figures show that life expectancy in Costa Rica is longer than in the United States (US), in spite of the fact that per capita health expenditure is only one-tenth that of the US. To check whether this is for real and to explore some of its determinants, 900 Costa Ricans aged 60+ were followed from 1984 to 2001. Follow-up household visits were made, deaths were tracked in the national death registry, and survival status in the voting registry was double-checked. In addition, the survivors were contacted in 2002. Two-thirds of the panel had died by December 2001. Kaplan–Meier curves, life tables and Cox regression were used to analyse the panel’s survival. Mortality in the panel was slightly higher than the Costa Rican average and similar to that in the US, confirming the exceptional longevity of Costa Ricans. Survival was substantially lower among unmarried men and individuals with limited autonomy at the beginning of the study. The effect of socioeconomic status is weak. Insurance effects seem to be confounded by selection biases. (author's) Spanish Abstract: Las cifras oficiales muestran que la expectativa de vida en Costa Rica es superior que en Estados Unidos, a pesar de que el gasto per capita en salud equivale solamente a la décima parte del de Estados Unidos. Para comprobar la veracidad de este dato y estudiar algunos de sus factores determinantes, se realizó un seguimiento de 900 costarricenses de 60 años o más desde 1984 hasta 2001. Se realizaron visitas domiciliarias de seguimiento, controles de las muertes en el registro nacional de defunciones y reconfirmación de condición de sobrevida en el registro de votantes. Asimismo, los supervivientes fueron contactados en el año 2002. Para diciembre de 2001 dos tercios del panel había fallecido. Se emplearon curvas Kaplan-Meier, tablas de vida y regresión de Cox para analizar la sobrevida del panel. La mortalidad en el panel fue ligeramente más alta que el promedio costarricense y similar a la de Estados Unidos, por lo tanto, se confirmó la excepcional longevidad de los costarricenses. La sobrevida fue marcadamente menor entre los hombres solteros y las personas con autonomía limitada al comienzo del estudio. El efecto de la condición socioeconómica es débil. Los efectos de contar con un seguro aparentemente padecen de sesgos de selección. (del autor) Language: English Keywords: COSTA RICA | RESEARCH REPORT | PROSPECTIVE STUDIES | OLDER ADULTS | MORTALITY DETERMINANTS | LENGTH OF LIFE | HEALTH INSURANCE | SOCIOECONOMIC FACTORS | MARRIAGE | SEX FACTORS | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Financial Activities | Economic Factors | Nuptiality Document Number: 291158 |
| 28. Title: Family history as a co-factor for adenocarcinoma and squamous cell carcinoma of the uterine cervix: results from two studies conducted in Costa Rica and the United States. [Antecedentes familiares como cofactores de adenocarcinoma y carcinoma epidermoide de cuello uterino: resultados de dos estudios realizados en Costa Rica y los Estados Unidos] Author: Zelmanowicz Ade M; Schiffman M; Herrero R; Goldstein AM; Sherman ME Source: International Journal of Cancer. 2005 Sep 10;116(4):599-605. Abstract: Previous work suggests that cervical cancer may aggregate in families. We evaluated the association between a family history of gynecological tumors and risk of squamous cell and adenocarcinomas of the cervix in 2 studies conducted in Costa Rica and the United States. The Costa Rican study consisted of 2,073 women (85 diagnosed with CIN3 or cancer, 55 diagnosed with CIN2 and 1,933 controls) selected from a population-based study of 10,049 women. The U.S. study consisted of 570 women (124 with in situ or invasive adenocarcinomas, 139 with in situ or invasive squamous cell carcinomas of the cervix and 307 community-based controls) recruited as part of a multicentric case-control study in the eastern part of the United States. Information on family history of cervical and other cancers among first-degree relatives was ascertained via questionnaire. Information on other risk factors for cervical cancer was obtained via questionnaire. Human papilloma-virus (HPV) exposure was assessed in both studies using broad spectrum HPV L1-based PCR testing of exfoliated cervicovaginal cells and in Costa Rica by additional testing of plasma collected from participants for antibodies against the L1 protein of HPV types 16, 18, 31 and 45 by ELISA. A family history of cervical cancer in a first-degree relative was associated with increased risk of squamous tumors in both studies (odds ration [OR] = 3.2 for CIN3/cancer vs. controls; 95% confidence interval [CI] = 1.1-9.4 in Costa Rica; OR = 2.6 for in situ/invasive squamous cell carcinoma cases vs. controls, 95% CI = 1.1-6.4 in the Eastern United States study). These associations were evident regardless of whether the affected relative was a mother, sister or daughter of the study participant. Furthermore, observed effects were not strongly modified by age. In Costa Rica, the effect persisted in analysis restricted to HPV-exposed individuals (OR = 3.0; 95% CI = 1.0-9.0), whereas in the Eastern United States study there was evidence of attenuation of risk in analysis of squamous carcinoma cases restricted to HPV positive women (OR = 1.4; 95% CI = 0.29-6.6). No significant association was observed between a family history of cervical cancer in a first-degree relative and adenocarcinomas (OR = 1.3; 95% CI = 0.43-3.9). History of gynecological tumors other than cervical cancer in a first-degree relative was not significantly associated with risk of disease in either study. These results are consistent with a role of host factors in the pathogenesis of squamous cell cervical cancer, although familial aggregation due to shared environmental exposures cannot be ruled out. (author's) Spanish Abstract: Trabajos anteriores sugieren una posible agregación familiar en el cáncer cervical. Se evaluó la asociación entre los antecedentes familiares de tumores ginecológicos y el riesgo de desarrollar carcinomas epidermoides y adenocarcinomas de cuello uterino en dos estudios realizados en Costa Rica y los Estados Unidos. El estudio en Costa Rica incluyó 2073 mujeres (85 con diagnóstico de NIC3 o cáncer, 55 con diagnóstico de NIC2 y 1933 controles) seleccionadas a partir de un estudio basado en una población sobre 10.049 mujeres. El estudio de Estados Unidos incluyó 570 mujeres (124 con adenocarcinomas in situ o invasivos, 139 con carcinomas epidermoides in situ o invasivos de cuello uterino y 307 controles de la comunidad) reclutadas como parte de un estudio multicéntrico de control de casos en la región este de los Estados Unidos. Se emplearon cuestionarios tanto para recabar información sobre antecedentes familiares de cáncer cervical y otros tipos de cáncer en familiares de primer grado como para verificar otros factores de riesgo de cáncer cervical. En ambos estudios se evaluó la exposición al papilomavirus humano (HPV, human papilloma-virus) mediante reacción en cadena de la polimerasa (PCR, polymerase chain reaction) de amplio espectro basada en la proteína L1 del HPV en células cervicovaginales exfoliadas y en Costa Rica se realizaron, además, enzimoinmunoensayos (ELISA) para detectar anticuerpos a la proteína L1 del HPV 16, 18, 31 y 45 en el plasma obtenido de las participantes. En ambos estudios, los antecedentes familiares de cáncer cervical en familiares de primer grado se asociaron a un mayor riesgo de desarrollar tumores epidermoides (odds ratio [OR] = 3,2 para NIC3/cáncer versus controles; intervalo de confianza [IC] 95% = 1,1 - 9,4 en Costa Rica; OR = 2,6 para casos de carcinoma in situ/células escamosas invasivas versus controles, IC 95% = 1,1 - 6,4 en el estudio del Este de Estados Unidos). Estas asociaciones se observaron independientemente de que el familiar afectado fuera la madre, una hermana o una hija de la participante del estudio. No se registró una modificación importante de los efectos por la edad. En Costa Rica, el efecto persistió en el análisis limitado a las participantes expuestas a HPV (OR = 3,0; IC 95% = 1,0 - 9,0), mientras que en el estudio del este de Estados Unidos se observó una atenuación del riesgo en el análisis de las pacientes con carcinoma epidermoide limitado a mujeres HPV positivas (OR = 1,4; IC 95% = 0,29 - 6,6). No se observó una asociación significativa entre los antecedentes familiares de cáncer cervical en familiares de primer grado y los adenocarcinomas (OR = 1,3; IC 95% = 0,43 - 3,9). Los antecedentes de tumores ginecológicos, excluido el cáncer cervical, en un familiar de primer grado no se asociaron significativamente con riesgo de desarrollar la enfermedad en ninguno de los dos estudios. Los resultados demuestran una participación de estos factores en la patogenia del carcinoma epidermoide cervical, aunque no puede excluirse la agregación familiar derivada de compartir exposiciones ambientales. (del autor) Language: English Keywords: UNITED STATES OF AMERICA | COSTA RICA | RESEARCH REPORT | WOMEN | CERVICAL CANCER | HPV | POPULATION GENETICS | FAMILY RESEARCH | North America | Americas | Developed Countries | Central America | Latin America | Developing Countries | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Viral Diseases | Genetics | Biology | Family and Household Document Number: 291806 |
| 29. Title: Farmers' perspectives on the role of shade trees in coffee production systems: an assessment from the Nicoya Peninsula, Costa Rica. [Perspectivas de los agricultores sobre el papel de los árboles de sombra en los sistemas de producción de café: evaluación de la península Nicoya, Costa Rica] Author: Albertin A; Nair PK Source: Human Ecology. 2004 Aug;32(4):443-463. Abstract: Interest in shade-grown coffee is now increasing because of declining coffee prices in the world market and an increasing trend toward “green consumerism.” It is therefore important to understand farmers’ perception of the role of shade trees in coffee fields, an area that has not received deserving attention in research agendas. On the basis of detailed interviews involving both “open-ended” and “closed” questions with 83 small-scale coffee farmers in the Peninsula of Nicoya, Costa Rica, we found that characteristics that farmers considered important were mostly comparable to those stated in the literature. But some differences were also noted; examples included tree height (considered important by farmers, but not in literature) and leaf size (mentioned in literature, but not by farmers). Some tree species that were not considered beneficial as coffee shade trees were still retained in the fields because of the additional benefits they provided. Eighty-eight percent of farmers were interested in incorporating more trees, especially fruit trees, into their coffee plantations. The results of the study underscore the need for research on the little-studied area of interaction between coffee plants and fruit trees. (author's) Spanish Abstract: Se ha registrado un aumento en el interés del café producido bajo sombra debido a la disminución de los precios del grano en el mercado mundial y a la creciente tendencia en pro del "consumismo verde". Por lo tanto, es importante comprender la percepción de los agricultores respecto de los árboles de sombra en los campos de café, un área que no ha recibido la merecida atención en las prioridades de investigación. En función de los resultados obtenidos en entrevistas detalladas que incluían preguntas abiertas y cerradas realizadas a 83 pequeños productores de café en la península de Nicoya, Costa Rica, se descubrió que las características que los agricultores consideraban importantes, en su mayoría, eran similares a las definidas en las publicaciones. No obstante, se registraron diferencias, por ejemplo, los agricultores consideran importante la altura de los árboles, mientras que en los trabajos publicados se menciona el tamaño de las hojas. Algunas especies de árboles que no se consideraban beneficiosas como árboles de sombra para el café se conservaron en los campos debido a los beneficios adicionales que proveen. El 83% de los agricultores mostró interés en incorporar más árboles, en especial frutales, a sus plantaciones de café. Los resultados del estudio subrayan la necesidad de investigar la escasamente estudiada área de interacción entre las plantas de café y los árboles frutales. (del autor) Language: English Keywords: COSTA RICA | RESEARCH REPORT | RECOMMENDATIONS | KAP SURVEYS | AGRICULTURAL WORKERS | PERCEPTION | ENVIRONMENTAL PROTECTION | ECOLOGY | Developing Countries | Central America | Latin America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Labor Force | Human Resources | Economic Factors | Psychological Factors | Behavior | Natural Resources | Environment Document Number: 278734 |
| 30. Title: Description of a seven-year prospective study of human papillomavirus infection and cervical neoplasia among 10 000 women in Guanacaste, Costa Rica. Author: Bratti MC; Rodriguez AC; Schiffman M; Hildesheim A; Morales J Source: Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2004;15(2):75-89. Abstract: The Guanacaste study ("Guanacaste Project," or GP), was designed to investigate the role of human papillomavirus (HPV) infection and its cofactors in the development of cervical neoplasia and to evaluate new cervical cancer screening technologies. The follow-up phase of the GP was designed to study why a small proportion of women infected with HPV develop cervical intraepithelial neoplasia grade 2 (CIN 2), CIN 3, or cancer (these three together are globally referred to as = CIN 2, that is, CIN 2 or worse). The purpose of this article is to describe this prospective study in detail and to present the preliminary findings regarding the incidence of cervical neoplasia. A cohort of 10 049 randomly selected women from 18 to 97 years old from Guanacaste, a province in northwestern Costa Rica, was intensively screened in 1993-1994 and then followed up for seven years after being enrolled. A questionnaire for demographic and risk factors was administered, and a pelvic examination was performed on sexually active women at each follow-up visit in order to obtain samples for screening tests and for research purposes. The final diagnosis given at the end of the enrollment phase categorized women into several groups according to the perceived risk of their developing either high-grade precursors of cancer or cancer. These groups were followed up at different intervals according to the risk of developing = CIN 2. The most active follow-up (every 6-12 months) was concentrated on the women most likely to develop = CIN 2, based on cytology (n = 492). The remainder of the cohort was followed either annually (n = 2 574) or after five to seven years of passive follow-up (n = 3 926). All women with possibly severe lesions detected by any technique were referred to colposcopy for further evaluation and treatment, and they were also censored from the study. Lesions = CIN 2 served as both the censoring outcome and our surrogate for cancer risk. ResParticipation during follow-up was high (near 90%). Suspected = CIN 2 by any screening technique censored 4.6% of women. Most of the women censored because of suspected = CIN 2 came from the large group perceived at entry as being at low risk of developing = CIN 2, but the greatest rates of progression to = CIN 2 were observed among women perceived at entry to be at highest risk of = CIN 2, based on their cytology, virology, or sexual behavior. The GP is the largest population-based longitudinal cohort for the study of HPV and cervical neoplasia in the world, and its results will hopefully let us soon plan future worldwide prevention strategies. Research projects such as this one require the long-term commitment of a large multidisciplinary team and ample financial resources. The intensive effort and expertise applied in all aspects of this study were key factors in its success as a model of cooperative, interdisciplinary cancer research in Latin America. Quality control played an important role at all times during the study and made it possible to adapt new diagnostic and screening technology to Guanacaste. The systematic follow-up of a population-based group of close to 10 000 women in Guanacaste should permit careful, time-dependent evaluation of factors postulated to be linked to the development of cervical cancer as well as the evaluation of clinical markers of disease progression. The study results that have already been published have validated sensitive screening techniques and have also promoted the use of more affordable screening techniques in resource-poor, developing countries. The GP has also contributed to building knowledge for the search for vaccines against HPV as part of the effort to develop an effective tool to reduce the incidence and mortality of cervical cancer worldwide. (author's) Language: English Keywords: COSTA RICA | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | HPV | CERVICAL EFFECTS | NEOPLASMS | RISK FACTORS | CERVICAL CANCER | SCREENING | INCIDENCE | COLPOSCOPY | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cancer | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Endoscopy | Physical Examinations and Diagnoses Document Number: 309942 |
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