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Objective This study investigated ethnic differentials in the use of pregnancy-related care and aimed to identify whether the differences persist when geographical access to services is equal. This study was based in the north-eastern Ch'orti area of Guatemala, an area characterised by a mixed ladino (of Spanish descent) and Maya (Ch'orti) culture. Methods Data from a household survey carried out in 2001 in the town of Jocotán, and a previous survey carried out in 1994 in two nearby indigenous villages (aldeas), were used in this study. Logistic regression was used to explore the data. Unlike the Demographic and Health Survey (DHS) (1998–1999) that classifies ethnic groups according to dress and language, this study introduced an alternative approach based on self-identification. Results The results showed significant differences and a gradient in the use of modern pregnancy care services among self-identified ethnic groups within the same town, after controlling for socioeconomic and cultural indicators. Women of ‘mixed’ ethnicity had an intermediate behaviour between ladino and indigenous women. Women in the nearby aldeas almost solely relied on the traditional birth attendant for pregnancy-related care. The DHS data did not permit the detection of ethnic diversity in the use of pregnancy care for this region. Conclusions Differences in the use of modern pregnancy care exist even among self-identified ethnic groups with no outward markers of ethnicity and persist when access to services is equal. For the majority of the population, living in indigenous villages, pregnancy care remains traditional. This ethnic diversity highlights the importance of further extending affordable, high-quality and culturally adapted maternal health care services in Guatemala.

Objectives: Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease. Methods: Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year. Results: Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from £2,415 savings to £49,476 additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable. Conclusions: Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences.

The mid-year estimates (MYEs) resulting from the 2001 Census have a sex ratio pattern differing from patterns in previous estimates. Research has been undertaken to explain the observed sex ratio pattern in England and Wales (EW), covering recent censuses and population estimates during the current intercensal period. The aims of this paper are to present some of the research explaining this sex ratio pattern and, secondly, suggest ways to prepare for the 2011 Census and beyond. A number of approaches have been taken to understand the drivers of the sex ratio pattern and provide evidence on plausibility. The Patient Register Data (PRD) was examined as a potential comparator. Sex ratios in other countries were compared with the EW sex ratio patterns. An accounting exercise for different explanatory scenarios around the remaining unexplained difference between estimates and 2001 Census was undertaken. Finally, demographic analyses examine trends in sex ratios among the migrant stock of the EW and foreign born populations to put into context the sex ratios in MYEs following the 2001 Census.

This study investigates the ethnic differentials in contraceptive use in the north-eastern Ch’orti area of Guatemala, a region dominated by the Ladino culture. Data come from a household survey and in-depth interviews with service providers carried out in 2001 in the town of Jocotán, and a survey carried out in 1994 in two nearby indigenous villages (aldeas). Descriptive analysis and logistic regression are used to explore the data. Previous DHS surveys have used dress and language to classify ethnic groups. In this paper, an alternative approach based on self-identification is adopted. The results reveal significant differences in contraceptive behaviour among different ethnic groups within the same town and region. The results show that self-identified Ladino women who represented the minority of the population had contraceptive behaviour similar to their counterparts elsewhere in Latin America. The extremely low levels of contraceptive use among indigenous women from the aldeas suggest that the corresponding DHS figures in this region are probably overestimated.