[Exposure to Mycobacterium tuberculosis during a bus travel]. / Exposición a Mycobacterium tuberculosis durante un viaje en autobús.

BACKGROUND: In an outbreak of tuberculosis that occurred in a school, we evaluated the possible transmission during a trip in a school bus as the cause of infection. SUBJECTS, PATIENTS AND METHODS: Contact tracing of the driver, 3 teachers and 49 students from different grades who were travelling from Málaga to Sierra Nevada (Spain) in March 1998. All the students from the ten grades where any case of tuberculosis appeared from April to December 1998 and all the teachers of the school were included. RESULTS: At the school, 232 students were studied. The prevalence of the infection was 35%. A total of 12 new cases among the students were found. No teachers out of the 127 examined became ill. Out of the people who travelled by school bus, 2 teachers and 19 students were infected, prevalence among students 46%; five of those become ill. The odds ratio of infection for those having a class mate with positive smears was 5,5. On the other hand, the trip by bus (compared with those who did not take it) meant a odds ratio of 3,4. Most of the infected travellers were sitting in the bus close to the index case. CONCLUSIONS: In this tuberculosis outbreak some of the students who became ill or infected were not near the index case nor friendly with him at class. Therefore is possible that in some cases tuberculosis was transmitted inside the bus.

[Negotiations between a general practitioner and the patient after his visit to a private physician]. / La negociación médico de cabecera-paciente tras acudir a un médico privado.

OBJECTIVE: To find what patients request from their general practitioner after they have seen a doctor privately and the type of negotiation which follows. DESIGN: A descriptive observation study of a crossover type. SETTING: Palma-Palmilla Health Centre (Málaga); within the primary care ambit. PATIENTS AND OTHER PARTICIPANTS: Everyone at the on-demand clinics of five general medical practices, who requested something concrete from their general practitioner after they had seen a doctor privately, in the period from june to october 1993. MEASUREMENTS AND MAIN RESULTS: There were 83 patients who attended a clinic after seeing a doctor privately, which was 0.63% of the total consultations during this period. 69 of these patients asked their general practitioner to give them the same prescriptions that they had been prescribed privately. In 77% of the cases there was negotiation with the patient, a mutual promise being the most common result. There was no negotiation with 19 patients (23%). In 74% of the cases the medication prescribed privately was considered necessary. The wishes of the patients were fulfilled in practice in 65% of cases. CONCLUSIONS: In most cases there was negotiation with patients. doctors agreed to a high degree with patients' requests, which doctors considered sufficient and necessary for the diagnosis and/or treatment of their condition.