Letter to the Editor (Human immunodeficiency virus in Costa Rica)

Recent reports of 12 confirmed cases of acquired immunodeficiency syndrome (AIDS) in Costa Rica have generated interest in the extent of spread of human T-lymphotropic virus type III/LAV (HTLV-III) in Latin America (1). To date, all cases of AIDS in Costa Rica have occurred in members of previously identified, high-risk groups, chiefly hemophiliacs. To examine the possibility of heterosexual transmission in Costa Rica, we utilized sera collected in a population-based case-control study of cervical cancer, conducted by the Costa Rican Demographic Association and other institution

Screening practices for cervical and breast cáncer in Costa Rica

Cervical cancer and breast cancer are leading causes of cancer-related morbidity and mortality in Costa Rica. This article reports results of an evaluation of cervical and breast cancer screening practices among Costa Rican women 25 to 58 years old that was based on a nationwide 1984-1985 survey. The evaluation showed that while Pap smears were widely used to screen for cervical cancer, many women did not have their first cervical smear or gynecologic examination until age 30, and that cervical cancer screening was less common among certain high-risk groups, including women with multiple sexual partners and those with high parity. Less than half the women surveyed reported having had a breast examination by a health care provider. Utilization of both cervical cancer and breast cancer screening examinations could be increased by targeting inadequately screened high-risk women through the existing health care systemInstituto de investigaciones en Salud Universidad de Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Prevalencia de enfermedades de transmisión sexual en las mujeres de Costa Rica

Capítulo científico -- Universidad de Costa Rica. Instituto de Investigaciones en Salud, 1990Pocos estudios han descrito Ia epidemiología de las infecciones por enfermedades de transmisión sexual (ETS) basándose en muestras serológicas representativas de Ia población en general y no solo en grupos selectos de pacientes. Ello se debe a la dificultad para obtener serologías en muestras representativas de Ia población y a Ia falta de información sobré el historial medico y sexual de los pacientes para quienes existen estudios serológicos. Por otra parte, es solo en años recientes que se ha desarrollado una prueba serológica lo suficientemente especifica para diferenciar los anticuerpos a los tipos 1 y 2 del virus del Herpes simplex (VHS) (1) lo que ha hecho posible estimar con precisión la pre valencia de Ia infección con el VHS de tipo 2 (VHS-2): una de las mas importantes ETS. El presento articulo se base en las pruebas serológicas y Ia información de una muestra nacionalmente representativo de las mujeres de Costa Rica. Describe la prevalencia de anticuerpos al virus del Herpes simplex tipos 1 y 2, sífilis, chlamydia, virus de inmunodeficiencia humane (1-I1V-1) y virus linfotrópico de células humanas-T (HTLV-1) según características demográficas, medicas y sexuales. El articulo también muestra la distribución regional de la prevalencia de anticuerpos a estos agentes.Center for Infectious Diseases, Centers for Disease Control, AtlantaUniversidad de Costa Rica. Instituto de Investigaciones en SaludUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Herpes Simplex Virus Type 2 Antibodies: High Prevalence in Monogamous Women in Costa Rica

We studied the prevalence of antibody to Herpes simplex virus types I and 2 (HSV-I and HSV-2) in 766 randomly selected Costa Rican women 25-59 years of age in a national household survey in 1984-1985. Overall, 97.1% were seropositive for HSV-l and 39.4% for HSV -2. Only 1.1% of HSV -2 seropositive women gave a history of symptomatic genital herpes. HSV-2 virus antibody increased with age and with the number of lifetime sexual partners. HSV -2 seroprevalence among women who reported only 1 lifetime sexual partner was almost twice as high as the prevalence among women who denied sexual experience (30.5% vs. 17.7%) and reached 79.2% among women with \u3c 4 partners. HSV-2 seroprevalence was lower among women whose partners used condoms: 28.9% for those who had used condoms for at least 2 years vs. 44.3% for those who never used condoms

Integrating open-source technologies to build low-cost information systems for improved access to public health data

Effective public health practice relies on the availability of public health data sources and assessment tools to convey information to investigators, practitioners, policy makers, and the general public. Emerging communication technologies on the Internet can deliver all components of the "who, what, when, and where" quartet more quickly than ever with a potentially higher level of quality and assurance, using new analysis and visualization tools. Open-source software provides the opportunity to build low-cost information systems allowing health departments with modest resources access to modern data analysis and visualization tools. In this paper, we integrate open-source technologies and public health data to create a web information system which is accessible to a wide audience through the Internet. Our web application, "EpiVue," was tested using two public health datasets from the Washington State Cancer Registry and Washington State Center for Health Statistics. A third dataset shows the extensibility and scalability of EpiVue in displaying gender-based longevity statistics over a twenty-year interval for 3,143 United States counties. In addition to providing an integrated visualization framework, EpiVue's highly interactive web environment empowers users by allowing them to upload their own geospatial public health data in either comma-separated text files or MS Excel™ spreadsheet files and visualize the geospatial datasets with Google Maps™

A case-control study of breast cancer and hormonal contraception in Costa Rica

By 1981, 11% of married women in Costa Rica ages 20-49 years had used depot-medroxyprogesterone acetate (DMPA) and 58% had used oral contraceptives (OCs). Since 1977, the Costa Rican Ministry of Health has maintained a nationwide cancer registry. These circumstances provided an opportunity for a population-based, case-control study of DMPA, OCs, and breast cancer in Costa Rica. Cases were 171 women ages 25-58 years with breast cancer diagnosed between 1982 and 1984; controls were 826 women randomly chosen during a nationwide household survey. Cases and controls were interviewed with the use of a standard questionnaire covering their reproductive and contraceptive histories. Logistic regression methods were used to adjust for confounding factors. While few cases or controls had ever used DMPA, DMPA users had an elevated relative risk (RR) estimate of breast cancer of 2.6 (95% confidence limits=1.4-4.7) compared with never users. However, no dose-response relationship was found; even the group of women who had used DMPA for less than 1 year had an elevated RR estimate (RR =2.3; 95% confidence limits=1.0-5.1). In contrast, OC users had no elevation in RR compared with never users (RR=1.2; 95% confidence limits= 0.8-1.8). The results of the DMPA analysis are inconclusive. Before decisions are made on whether to continue providing this effective contraceptive method, other ongoing studies will need to confirm of refute these findings.Universidad de Costa Rica, Instituto de investigaciones en SaludUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Seroprevalence of human T-Lymphotropic virus type I (HTLV-I) in Costa Rica

artículo -- Universidad de Costa Rica. Instituto de Investigaciones en Salud,1990Infection within the human T linphotropic virus type I (HTLV-I), a virus associated with two diseases, adult T-cell leukemia lyriphornal and tropical spastic paraparesis/HTLV-I associated myelopathy,2 is prevalent in Panama' and Colombia. To determine if HTLV-I is present in neighboring Costa Rica, we tested 436 sera from women who participated, between 1984 and 198.5, in a case-control study of cervical cancer in Costa Rica. These sera were all that were still available to us from the 765 collected from control participants in the study. Study participants had all been interviewed and tested for several serologic markers of sexually transmitted diseases (STDs).Universidad de Costa Rica. Instituto de Investigaciones en SaludUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

The effect of using different reference dates for control exposure measurement on relative risk estimates in a case-control study

Artículo científico -- Universidad de Costa Rica, Instituto de Investigaciones en Saud. 1993. Debido a las políticas de la revista en la que el artículo fue publicado, no es posible distribuir la edición del editor/PDF.In case-control studies in which case and control enrollment periods are not identical, exposure status for time-dependent variables is often measured relative to a reference date. Using data from a case-control study of the relation between cervical cancer and oral contraceptive (OC) use in which control enrollment began 6 months after the end of case enrollment, we evaluated the effect on odds ratios from using five different reference dates to determine the controls' exposure status. The choice of reference date had little effect on the odds ratios in this study. Reference dates for time-dependent exposure variables should be considered carefully in studies when case and control enrollment periods are not identical.Universidad de Costa Rica, Instituto de Investigaciones en SaludUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Tabaquismo en la mujer costarricense, 1984-85

En este artículo se analizan los resultados de una encuesta con representatividad nacional de 870 mujeres costarricenses de 25 a 59 años de edad, entrevistadas entre 1984 y 1985. El 14 por ciento de las entrevistadas declararon ser fumadoras al momento de la encuesta y el 21 por ciento que alguna vez lo habían sido. La prevalencia del fumado resultó mayor entre las mujeres con más educación, pertenecientes a los estratos socioeconómicos más altos y entre las residentes en áreas urbanas. La mayoría de fumadoras comenzaron a fumar antes de los 25 años de edad. En las cohortes más jóvenes, el 22 por ciento comenzaron a fumar entre los 15 y 24 años de edad, lo que representa más del doble que en las cohortes más viejas. El autor concluye que las estrategias para prevenir el fumado en las mujeres costarricenses, deben centrar su atención en las jóvenes y adolescentes, especialmente en los grupos socioeconómicamente más privilegiados.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP

Confirmación histología del diagnóstico de cáncer cérvico uterino en Costa Rica, 1982-84

Un panel de patologías costarricenses efectuó un análisis histológico de las biopsias de 677 casos de cáncer de cuello de útero in situ e invasor diagnosticados en Costa Rica en 1982 - 1984. El panel confirmó el diagnóstico inicial del 81% de los casos de cáncer in situ y del 72% de los casos de cáncer invasor. El panel redujo la severidad del diagnóstico a displasia u otra lesión no cancerosa en el 12% de los casos de cáncer in situ y en el 3% de los casos de cáncer invasor. El 8% de los casos de cáncer invasor fueron reclasificados como in situ. Un 9% adicional podría ser reclasificados en el mismo sentido, pero hay dudas sobre el diagnóstico definitivo. El error más grave ocurrió en 3% de los casos inicialmente diagnosticados como de cáncer in situ los cuales fueron reclasificados por el panel como cáncer invasor, pero este error probablemente no afectó el tratamiento de las pacientes. Las modificaciones en el diagnóstico obtenidos en el presente estudio pueden derivarse de un examen mas cuidadoso efectuado por el panel o de la dificultad propia del diagnóstico histología del cáncer de cuello de útero.A group of costarrican pathologist carried out a hystological analysis of 677 biopsies corresponding to in situ and invading cervical cancer diagnosed in our country from 1982 to 1984. They confirmed the initial diagnosis in 81% of in situ carcinomas and in 72% of those showing invading features. The medical team changed the severity of the diagnosis to displasia or other non carcinomatous stages in 12% of the in situ cases and 3% of the invading lessions. 8% of the invading cancers were reclassified as in situ cases. An additional 9% could be reclassified in the same direction but some doubts still remain about the final diagnosis. The mayor misinter pretation occurred in 3% of those cases initially labeled as in situ carcinomas with after further analysis were reclassified as invading. Nevertheless this erroneous assessment did not affect the treatment indicated to these patients. The modifications made in the diagnosis during this study might have arisen from a more detailed analysis or the obvious difficulties in the differential diagnosis in uterine cervical cancer.Universidad de Costa Rica//UCR/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA