The Poor Survival among Pulmonary Tuberculosis Patients in Chiapas, Mexico: The Case of Los Altos Region.

Objective. To analyse survival in patients with pulmonary tuberculosis (PTB) and factors associated with such survival. Design. Study of a cohort of patients aged over 14 years diagnosed with PTB from January 1, 1998 to July 31, 2005. During 2004-2006 a home visit was made to each patient and, during 2008-2009, they were visited again. During these visits a follow-up interview was administered; when the patient had died, a verbal autopsy was conducted with family members. Statistical analysis consisted of survival tests, Kaplan-Meier log-rank test and Cox regression. Results. Of 305 studied patients, 68 had died due to PTB by the time of the first evaluation, 237 were followed-up for a second evaluation, and 10 of them had died of PTB. According to the Cox regression, age (over 45 years) and treatment duration (under six months) were associated with a poorer survival. When treatment duration was excluded, the association between poorer survival with age persisted, whereas with having been treated via DOTS strategy, was barely significant. Conclusions. In the studied area it is necessary that patients receive a complete treatment scheme, and to give priority to patients aged over 45 years.

Social inequalities and health in rural Chiapas, Mexico: agricultural economy, nutrition, and child health in La Fraylesca region.

The objective of this study was to investigate the association between farmers' socioeconomic conditions and their children's health in La Fraylesca, Chiapas. Data were collected using a cross-sectional survey of 1046 households (5546 individuals) sampled from locations in two counties situated in the study area. The survey included anthropometric measurements, a 24-hour dietary recall, stool tests, and childhood mortality data. Children of private farmers and "wealthy peasants" displayed better nutritional status, higher quality diet, lower prevalence of intestinal parasites, and a lower risk of dying than those whose parents were communal farmers, from ejidos, or "poor peasants". The results suggest that using volume of maize production as a classification method proved more valuable than land tenure to identify agricultural groups with different health status. It appears that the main determinants of health differentials are structural inequities in resource distribution. Thus, the impact of medical interventions on inequalities will be limited unless they are accompanied by redistribution of resources.

[Delivery care in Chiapas, Mexico: who and where does provide it?]. / La atención del parto en Chiapas, México: dónde y quién los atiende?

OBJECTIVE: To identify the place and provider of delivery care; to analyse the relationship between the type of delivery care provider and prenatal care and sociodemographic factors; to identify groups with greater and lesser probability of receiving attention at health centers and to identify the reasons for not attending the health center nearest to the household. MATERIAL AND METHODS: Data on the delivery care of 297 women of La Fraylesca Region, Chiapas, were gathered using multivariate logit models to identify groups. RESULTS: From the total, 32% of childbirths occurred at health centers and 60% at home (mostly with poor sanitary conditions). Only 10% of women with less than 5 prenatal visits, school level under 3 years and whose household head was a peasant were attended by health care personnel. CONCLUSIONS: The accessibility and quality of health centers must be improved, and a programme aimed at increasing the number of deliveries that are attended by trained health care personnel should be implemented.

[Social welfare and health services in the Fraylesca Region in Chiapas: the use of prenatal care services]. / Bienestar social y servicios de salud en la Región Fraylesca de Chiapas: el uso de servicios de atención prenatal.

OBJECTIVE: To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. MATERIAL AND METHODS: In 1994, a health survey was performed on a random sample of 1,100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n = 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. RESULTS: Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (Cl 95% 1.12-5.44). CONCLUSIONS: Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.

[Use of an index of social welfare for health planning at a municipal level]. / Uso de un índice de bienestar social para la planificación de la salud a nivel municipal.

OBJECTIVE: This paper analyzes the relationship between a living standards index for small areas based on census data and information on morbidity and health care utilization. MATERIAL AND METHODS: The information was gathered through a health interview survey of a random sample of 1 238 households from rural areas of Tlaxcala, Mexico. RESULTS: The population from localities with lower living standards showed significantly higher prevalences of morbidity and worse self-reported health status measures, as compared to localities with higher living standards. On the contrary, higher living standards were related with a greater utilization of health services. CONCLUSIONS: The approach proved to be useful in discriminating localities and areas of high and low prevalence of morbidity and utilization of health care services, which in turn could be used to identify those areas where needs are greatest. The implications of the results for health planning and resource allocation (based on population health needs and underlying social conditions) at the local level are discussed.

Medical curricula and students' attitudes towards general and family practice in Mexico.

In an exploratory study of the influence of different undergraduate curricula on students' attitudes towards general and family medicine, a questionnaire including a Likert attitude scale was administered to a sample of 1217 first- and fourth-year students at five medical schools with different curricula in Mexico City. The preliminary results suggest that the innovative educational programmes have not apparently had a significant impact on students' attitudes. It is hypothesized that students' perceptions of the job market are stronger in determining their attitudes than the orientation of the curriculum itself. It is also suggested that the differences found among the students of the five schools might have been due to differences in the populations entering them. The instrument developed during the study proved to be sufficiently reliable to warrant further use.

[A new technic for LE cell formation. Preliminary report]. / Formación de células L.E. por un nuevo procedimiento. Communicación preliminar

In special designed vials using coverslides glued to segments of polyethilene test tubes of 0.15 ml of fibrin free blood were incubated during 45 min to 37 degrees C in a humid chamber. Blood samples were obtained from patients with disseminated Lupus erythematosus (DLE) and normal subjects (N). Adhered polymorpho-nuclear cells (PNC) to glass were washed with Hank's solution; immediately 0.15 ml of DLE or N serum containing 5X10(6) lymphocytes (L) were added to culture cells and incubated at 37 degrees C during 30 min. Lymphocytes were previously incubated at 37 degrees C during 30 min with either N serum or DLE serum. Thereafter the segment of polyethilene test tube was detached from coverslides and cells attached to glass was washed with Hank's solution and stained with Wright solution. PMN of DLE and N in presence of L of DLE and N incubated with fresh serum of DLE formed 5 to 15% of LE cells. Determining factor for LE cells formation is the serum of DLE. Slides contained only PMN and LE cells which make easy the observation of results. All possible combinations with PMN and DLE serum and N serum allowed inclusion of several negative or positive control groups.