Quality of life in persons with Human Immunodeficiency Virus infection in Mexico / Calidad de vida en personas infectadas con virus de la inmunodeficiencia humana en México

Background: The evaluation of quality of life related to health (HRQOL) has become an important prognostic indicator in HIV/AIDS. The aim of this study was to determine the impact of socio-demographic, clinical and psychological factors in HRQOL in a group of subjects with HIV/AIDS in northwestern Mexico and determine which variables best predict HRQOL. Methods: In a cross-sectional study with a sample of 87% of patients receiving care at a clinic for HIV/AIDS in northwestern Mexico between November 2010 to June 2011, we measure the HRQOL using the Tool Medical Outcomes Study HIV Health Survey (MOS-HIV). A model of multiple linear regression was performed to identify variables that allow us to predict HRQOL in this population. Results: In a sample of 54 subjects with HIV/AIDS. Patients had an average age of 43 ± 9 years, 83% were men with a mean time of 6.5 ± 4.5 years from diagnosis. HRQOL scores of physical and mental health of the participants were 57 ± 6 and 57 ± 13 respectively. In multivariate analysis, the variables that influenced the physical health punctuation were gender, marital status, sexual orientation, time since diagnosis and viral load (log). Conclusions: Prospective studies are needed to better explain the influence of the factors that predict changes or trends in HRQOL in patients with HIV/AIDS.

Introducción: la evaluación de la calidad de vida relacionada con la salud (CVRS) se ha convertido en un importante indicador pronóstico en el enfermo con VIH/SIDA. El objetivo de este estudio fue determinar el impacto de los factores sociodemográficos, clínicos y psicológicos en la CVRS de un grupo de pacientes portadores de VIH/SIDA del noroeste de México, así como determinar qué variables predicen mejor la CVRS. Métodos: estudio transversal con una muestra del 87% de los pacientes que recibían atención en una clínica de VIH/SIDA en el noroeste de México, entre noviembre del 2010 y junio del 2011, se midió la CVRS utilizando el instrumento Medical Outcomes Study HIV Health Survey (MOS-HIV). Se realizó un modelo de regresión lineal múltiple para identificar aquellas variables que permiten predecir la CVRS en esta población. Resultados: en una muestra de 54 sujetos con VIH/SIDA que tenían una edad de 43 ± 9 años, 83% eran hombres con un tiempo de 6.5 ± 4.5 años desde el diagnóstico. Las puntuaciones de CVRS de salud mental y física de los participantes fueron de 57 ± 6 y 57 ± 13 respectivamente. En el análisis multivariado, las variables que influyeron en la puntuación de salud física fueron el género, el estado civil, la orientación sexual, el tiempo transcurrido desde el diagnóstico y la carga viral (log). Conclusiones: es necesario realizar estudios prospectivos para explicar mejor la influencia de los factores que predicen cambios o tendencias en la CVRS en pacientes con VIH/SIDA.

Acculturation, parent-child acculturation differential, and chronic disease risk factors in a Mexican-American population.

Acculturation is typically defined in terms of individual responses to a dominant culture. In the present study, we examined the effects of different levels of acculturation among family members. Specifically, we looked at the health and risk behavior in Mexican-American children as related to a variety of psychosocial predictors, especially the differences in orientation toward Mexican- and Anglo-American cultures between them and their parents. Mother and child pairs (n = 106) noted their orientation toward both Anglo and Mexican cultures. Children's dietary and sedentary behaviors, tobacco and alcohol use (and susceptibility to use), and depressive symptoms were also measured. Males were more likely to be sedentary and consume higher levels of total fat and saturated fat, whereas girls reported higher levels of depression. Anglo-oriented youth consumed lower levels of calories from fat but also more alcohol than did their Mexican-oriented counterparts. The latter was particularly the case among those children who were relatively more Anglo oriented than were their parents. Parent-child acculturation differential in terms of the differences in Mexican orientation, in comparison, predicted susceptibility to tobacco use. However, the sum of the absolute values of these two differences predicted only lifetime alcohol use, and in a counter-intuitive direction. This familial measure of acculturation shows some promise, but additional formative research is needed to operationalize this construct.

A prenatal intervention study to improve timeliness of immunization initiation in Latino infants.

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups. Participants received either a culturally and linguistically appropriate session on infant immunization (intervention) or a session on prevention of Sudden Infant Death Syndrome (control). The main outcome measures were pre-post immunization knowledge change and infant immunization status at 92 days. Immunization knowledge increased significantly in the intervention group [p < .0001, 95%CI (1.76, 2.47)]. No difference was found between groups in immunization series initiation: 95 percent of the children in the intervention group were up-to-date by 92 days from birth, and 93 percent of the control group was up-to-date at 92 days. The lack of significant association between receiving immunization education and infant immunization series initiation suggests that parent education may be necessary but not sufficient for timely immunization, particularly in clinics with effective well-child programs. Given the significant increase in immunization knowledge, the broader and perhaps more important implication is that language- and culturally specific infant health education messages in the prenatal period may have a positive long-term impact on the child's health and promote well-child care overall. Future studies should assess the role of prenatal well-child education in the context of clinics with low immunization levels.

Assessing an intensive school-based assistance program to enroll uninsured children.

Children eligible but not enrolled in subsidized health insurance programs, such as Medicaid and S-CHIP, received considerable outreach activity in recent years. Schools in low-income and middle-income communities often are cited as excellent places to find and reach parents. This study assessed the cost and effectiveness of contacting parents through schools, educating them about health insurance programs and preventive care, and assisting them with insurance applications. The accumulative cost per enrolled child was $75, and schools were able to locate and assist large numbers of uninsured children who had failed other outreach methods. School-based application assistance and parent education succeeded in improving child access to care and utilization of services.