[Social capital, poverty and self-perception of family support in cases of acute respiratory illness]. / Capital social, pobreza familiar y autopercepción de apoyo en casos de enfermedad respiratoria aguda.

The aim of this study was to correlate the socio structural variables of the Simplified Index of Family Poverty with the self-perception of resources that conform social capital among patients with acute respiratory disease (ARD). We used a qualitative and quantitative methodology. The sample included 848 cases distributed in seven Rural Medicine Units of Mexico. We considered three pathways described by Kawachi where social capital might have an impact on individual health. The bivariate correlation and discriminant analysis showed that when there is evidence of poverty in the family, the statistically significant differences are mainly observed in self-perception. Moral support of sons and daughters is thereby increased when there is an ARD. We concluded that when there is a higher index of family poverty there is a decreased access to social resources when a family member is diagnosed with an ARD.

[Factors of risk of bacterial vaginosis]. / Factores de riesgo asociados a vaginosis bacteriana.

OBJECTIVES: To recognise factors in the host that might condition the appearance of the bacterial vaginosis (BV) syndrome, whether gynae-obstetrical factors, habits of sexual conduct, hygiene, or other factors. DESIGN: Cross-sectional, observational study. SETTING: The study was conducted from January 2002 to June 2003 in the Primary Care Dr. Jose Castro Villagrana Community Health Centre at Tlalpan, Mexico City. PARTICIPANTS: 968 patients with an active sexual life who had not taken antibiotics for at least 15 days before the study and who were not menstruating at the moment of taking a swab, 859 of whom had a diagnosis of cervico-vaginitis and 109 had no symptoms. MAIN MEASUREMENTS: Confidential questionnaire and a cervical-vaginal culture. The Amsel criteria were used to make the diagnosis of bacterial vaginosis. RESULTS: There was 32.9% prevalence of BV. There was a statistically significant association with factors such as age, start of active sexual life, the number of sexual relations per week, the number of sexual partners, and pregnancy. CONCLUSIONS: Bacterial vaginosis is the main cause of infectious processes in the vagina. Its appearance appears to be linked to factors involving sexual transmission. Interventions to reduce its prevalence and complications are recommended.

[Is the Papanicolaou smear useful as aid for diagnosing some sexually transmitted infections?]. / ¿Es útil la tinción de Papanicolaou como auxiliar del diagnóstico de algunas infecciones de transmisión sexual?

OBJECTIVE: We undertook this study to assess the validity of cytologic diagnosis of sexually transmitted infections like: bacterial vaginosis (BV), tricomoniasis and candidiasis using the Papanicolaou (Pap) smear. DESIGN: Prospective, descriptive transverse study. SETTING: The present study was carried out in the Health Center Dr. José Castro Villagrana in Tlalpan, México, D.F. from January 1997, to February 2000. PARTICIPANTS: Routine Pap smears and vaginal secretion smears were collected from two hundred and seventy one patients ranged from age 16-66 years, with cervicovaginitis diagnosis. MEASUREMENTS AND MAIN RESULTS: Of the 271 patients, 92 (33.9%) had bacterial vaginosis diagnosed by Amsel criteria, 47 (17.3%) had candidiasis by culture and 5 (1.8%) had tricomoniasis by wet smear. The Bethesda system for diagnosing BV on Pap smear had 66% sensitivity and a specificity of 86%. The respective positive predictive and negative predictive value were 79% and 84%. Therefore, compared to the Candida culture, cervical cytologic test results had a sensitivity of 21% and specificity of 99%. The predictive positive predictive and negative predictive values were 90% and 85%. CONCLUSIONS: Specificity tended to be higher than sensitivity, in other words cytology tended to be more efficient in identifying women without sexually transmitted infection than in identifying those with infection. In summary, the Pap smear should not be used in lieu of more effective diagnostic test for sexually transmitted disease, and treatment should not be based on cytologic findings alone.

¿Es útil la tinción de Papanicolaou como auxiliar del diagnóstico de algunas infecciones de transmisión sexual? / Is the Papanicolaou smear useful for diagnosing some sexually transmitted infections?

Objetivo. Validar si la tinción de Papanicolaou es útil para el diagnóstico de tres de las patologías mayormente asociadas a infecciones de transmisión sexual (ITS): vaginosis bacteriana (VB), candidiasis y tricomoniasis. Diseño. Estudio prospectivo, descriptivo y transversal. Emplazamiento. El estudio se realizó en la Unidad de Atención Primaria Dr. José Castro Villagrana, Tlalpan, México, DF, entre enero de 1997 y febrero de 2000.Participantes. A 271 pacientes de 16-66 años (media, 32,2) con diagnóstico de cervicovaginitis se les realizó toma de muestra cervical para tinción de Papanicolaou (Pap) y toma de muestra vaginal para pruebas de laboratorio de rutina. Mediciones y resultados principales. La prevalencia de VB diagnosticada por criterios de Amsel fue de 33,9 por ciento, de candidiasis por cultivo de 17,3 por ciento y de tricomoniasis por fresco del 1,8 por ciento. Para VB utilizando el sistema Bethesda para interpretar el Pap se obtuvo 66 por ciento de sensibilidad y 86 por ciento de especificidad y valores predictivos positivo y negativo (VPP y VPN) del 79 por ciento y 84 por ciento, respectivamente. Para candidiasis se obtuvo 21 por ciento de sensibilidad, 99 por ciento de especificidad, VPP y VPN de 90 por ciento y 85 por ciento, respectivamente. Conclusiones. El Pap tiene baja sensibilidad y elevada especificidad para detectar ITS, por lo tanto parece más adecuado para excluir que para diagnosticar dichas infecciones. Tanto los métodos de laboratorio, como los criterios para diagnosticar ITS no son uniformes, por lo que el Pap no debe usarse en lugar de una prueba diagnóstica más efectiva y el tratamiento no debe basarse en los hallazgos citológicos (AU)

[A comparison of 2 clinical laboratory methods in the diagnosis of bacterial vaginosis]. / Comparación de 2 métodos de laboratorio clínico en el diagnóstico de la vaginosis bacteriana.

OBJECTIVE: To determine the sensitivity, the specificity, and positive and negative predictive values of two laboratory methods used to diagnose bacterial vaginosis; Gram stain and the Gardnerella vaginalis culture, in comparison with the clinical sings of vaginal discharge; homogeneous secretion, pH > 4.7, positive amine test and the presence of clue cells. DESIGN: A prospective, comparative and crossover type. SETTING: This study was carried out in the Health Center "Dr. José Castro Villagrana" SSA, situated in Tlalpan, México City. From January, 1992 to July, 1996. PARTICIPANTS: 3,142 women, from 16 to 55 years old with cervicovaginitis diagnosis, without previous treatment and sexual active life history. RESULTS: By means of clinical criterion (33.1%), it was diagnosed 1,041 women with bacterial vaginosis. Statistical differences were not found between the culture and Gram stain in the presence or no-presence of bacterial vaginosis diagnosed by clinical criterion (p = 0.33) The clue cells were the best predictor of bacterial vaginosis. CONCLUSIONS: The differences between both methods analysed were minimal and they didn't have statistical value so that, it is proposed the Gram stain as diagnostic method of bacterial vaginosis based on factors like speed, reproductiveness and low cost.