The risk of birth defects among children of Persian Gulf War veterans.

Background: There has been suspicion that service in the Persian Gulf War affected the health of veterans adversely, and there have been claims of an increased rate of birth defects among the children of those veterans.

Methods: We evaluated the routinely collected data on all live births at 135 military hospitals in 1991, 1992, and 1993. The data base included up to eight diagnoses from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) for each birth hospitalization, plus information on the demographic characteristics and service history of the parents.

[A community referral system for the permanent program of universal vaccination].

This article describes a community referral system for the permanent immunization program, tested in Tijuana, Baja California, Mexico, by the Regional Nucleus for Health Systems Development (NUREDESS-Norte). The model was designed to facilitate the participation of the intermediate organizations that make up the community in urban settings. Through appropriate technology, health counselors identify with precision, ease and rapidity the specific immunization needs of pre-school age children.

Field supervision for quality control of local family planning workers in developing countries.

On-the-job supervision is the most crucial and most often neglected mechanism for promoting program effectiveness. This article focuses on promoting the quality of worker performance, based on experience with the community-based distribution of contraceptives in Zaire and Zimbabwe. A three-tiered approach to evaluating worker performance, based on testing distributor acknowledge, observing distributors in the field, and interviewing their clients, proved overambitious for routine evaluation purposes, but elements from it are included in a proposed supervisory system.