Free clinic utilisation by immigrants after the introduction of a restrictive health policy in the Basque Country (Spain).

OBJECTIVES: Policies restricting healthcare access for immigrants were applied in times of reduced public funding for welfare in Spain. This study aimed to assess the impact of the implementation of a more restrictive health policy in the Basque Country region, Decree 114/2012, on the number of consultations attended at a free clinic, where the majority of patients are undocumented immigrants. STUDY DESIGN: Interrupted time series. METHODS: A negative binomial regression model was applied in two phases to the number of healthcare consultations during the period 2007-2017 (n = 9272) to estimate the level and trend changes associated with the implementation of the policy. Data were analysed separately by sex and adjusted for consultations' seasonality and unemployment rate and the sex-specific percentage of migrant population in Biscay province as confounding factors. RESULTS: Different trends of attendance between men and women were observed during the whole period, constituting 76.94% and 23.06% of all consultations, respectively. After the implementation of the decree, the number of consultations for women per trimester decreased and increased for men by 1%, although it was not statistically significant in either of the trends. CONCLUSIONS: No clear relationship between the implementation of the Basque Decree 114/2012 and an increase in the attendance of immigrants in a free clinic during the studied period was found.

Social Distance and Community Attitudes Towards People with Psycho-Social Disabilities in Uttarakhand, India.

Stigma is an important contributor to the large treatment gap for people with mental and psycho-social disabilities (PPSD) in India. Social distance as assessed by willingness to engage in relationships with PPSD is a proxy measure of stigma and potential discrimination. In North India, investigations of community attitudes towards PPSD have been limited. To describe attitudes towards people with depression and psychosis, a community sample of 960 adults in Dehradun district, India from 30 randomised clusters, was surveyed using a validated tool to assess social distance, beliefs and attitudes related to mental illness. Participants preferred greater social distance from a person with psychosis than a person with depression. Beliefs and attitudes around mental illness were diverse reflecting a wide spread of belief frameworks. After controlling for confounding, there was increased social distance among people who believed PPSD were dangerous. Factors that reduced social distance included familiarity with PPSD, and belief that PPSD can recover. Attitudes to PPSD, stigma and social distance are complex and likely to require complex responses that include promoting awareness of mental health and illness, direct contact with PPSD and increasing access to care for PPSD.

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain.

BACKGROUND: Spain's financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period. METHODS: An ecological longitudinal study was carried out in Spain's 17 regions. Two study periods were defined: pre-crisis period (2005-2007) and crisis period (2008-2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design. RESULTS: Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008. DISCUSSION: The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates. CONCLUSIONS: The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

Transformaciones de los procesos imaginativos en la producción gráfica de niños en tratamiento psicopedagógico / Imaginative processes transformations in the graphic production of children in psychopedagogical treatment

En este artículo se presentarán algunos resultados del proyecto "Procesos imaginativos en los dibujos de niños con problemas de aprendizaje antes y después del tratamiento". (Subsidio IPA 2010-12), enmarcado en el Programa de Investigación de la Cátedra de Psicopedagogía Clínica, Facultad de Psicología, Universidad de Buenos Aires. El objetivo de este estudio es caracterizar las transformaciones en la producción simból ica gráfica en el transcurso del tratamiento y sus vinculaciones con la dinamización del pensamiento creativo y la autonomía psíquica. Este estudio consta de 16 casos de niños con problemas de aprendizaje, de 6 a 12 años de edad, los cuales son derivados al Programa de Asistencia Psicopedagógica de la Cátedra. Esta investigación implica evaluaciones de los dibujos y sus relatos (Dibujo Libre y Familia Kinética), realizados en el diagnóstico inicial, y el retest (luego de un año de tratamiento). Resultados: la actividad gráfica se dinamiza, pudiendo realizar producciones con mayor plasticidad, y menor estereotipia y rigidez.(AU)

This article presents some results of the project "Imaginative Processes in Drawings of Children with Learning Disorders before and after Treatment" (IPA grant 2010-12), framed in the Reasearch Program that the Chair of Clinical Psychopedagogy, Faculty of Psychology, University of Buenos Aires. The aim of this study is to characterize transformations in children´s graphic symbolic production along treatment in relation to the dynamization of creative thinking and psychic autonomy. This study is composed of 16 cases of children with learning disorders, from 6 to 12 years old, who are referred to the Psychopedagogical Assistance Program of the Chair. This research consists in the assessment of drawings (free drawing and kinetic family) with their verbal associations made during the initial psychodiagnosis and then in the retest (after one year of group treatment). Results show that graphic activity is dinamized, becoming more plastic and less rigid and stereotyped.(AU)

Transformaciones de los procesos imaginativos en la producción gráfica de niños en tratamiento psicopedagógico / Imaginative processes transformations in the graphic production of children in psychopedagogical treatment

En este artículo se presentarán algunos resultados del proyecto "Procesos imaginativos en los dibujos de niños con problemas de aprendizaje antes y después del tratamiento". (Subsidio IPA 2010-12), enmarcado en el Programa de Investigación de la Cátedra de Psicopedagogía Clínica, Facultad de Psicología, Universidad de Buenos Aires. El objetivo de este estudio es caracterizar las transformaciones en la producción simból ica gráfica en el transcurso del tratamiento y sus vinculaciones con la dinamización del pensamiento creativo y la autonomía psíquica. Este estudio consta de 16 casos de niños con problemas de aprendizaje, de 6 a 12 años de edad, los cuales son derivados al Programa de Asistencia Psicopedagógica de la Cátedra. Esta investigación implica evaluaciones de los dibujos y sus relatos (Dibujo Libre y Familia Kinética), realizados en el diagnóstico inicial, y el retest (luego de un año de tratamiento). Resultados: la actividad gráfica se dinamiza, pudiendo realizar producciones con mayor plasticidad, y menor estereotipia y rigidez.

This article presents some results of the project "Imaginative Processes in Drawings of Children with Learning Disorders before and after Treatment" (IPA grant 2010-12), framed in the Reasearch Program that the Chair of Clinical Psychopedagogy, Faculty of Psychology, University of Buenos Aires. The aim of this study is to characterize transformations in children´s graphic symbolic production along treatment in relation to the dynamization of creative thinking and psychic autonomy. This study is composed of 16 cases of children with learning disorders, from 6 to 12 years old, who are referred to the Psychopedagogical Assistance Program of the Chair. This research consists in the assessment of drawings (free drawing and kinetic family) with their verbal associations made during the initial psychodiagnosis and then in the retest (after one year of group treatment). Results show that graphic activity is dinamized, becoming more plastic and less rigid and stereotyped.

[Health of women living near oil wells and oil production stations in the Amazon region of Ecuador]. / La salud de mujeres que viven cerca de pozos y estaciones de petróleo en la Amazonía ecuatoriana.

OBJECTIVE: Investigate the environmental conditions in and the state of health of women who live in rural communities surrounded by oil wells and oil production stations in the Amazon region of Ecuador. METHOD: We used a comparative cross-sectional design, classifying exposure according to the location of the communities with respect to the oil wells and production stations. Water samples from the local rivers were analyzed to determine total petroleum hydrocarbons, and a structured questionnaire was used with the head of each family in the study. The study was performed in rural communities in northeastern Ecuador from November 1998 through April 1999. The study included 9 communities in the exposed area (368 participants) and 14 communities in the unexposed area (291 participants). RESULTS: The rivers of the exposed communities showed contamination levels much above the limits acceptable for human use. Statistically significant differences between the exposed communities and the unexposed communities were found for the prevalence of skin fungi for the two weeks prior to the study (odds ratio (OR) = 1.37; 95% confidence interval (CI) = 1.01-1.86) as well as for nasal irritation (OR = 2.18, 95% CI = 1.64-2.91) and for throat irritation (OR = 1.68, 95% CI = 1.02-2.75) in the preceding 12 months. Also associated with exposure in the two preceding weeks were fatigue and the category of "other symptoms"; similarly associated with exposure in the preceding 12 months were headaches, eye irritation, earaches, diarrhea, and gastritis. CONCLUSIONS: The symptoms found among the participants in the exposed communities match the toxicity symptoms caused by oil. There is an urgent need to establish an adequate environmental control and remediation program in order to prevent unnecessary and unacceptable health hazards for these populations.

Exposures and cancer incidence near oil fields in the Amazon basin of Ecuador.

OBJECTIVES: To examine environmental exposure and incidence and mortality of cancer in the village of San Carlos surrounded by oil fields in the Amazon basin of Ecuador. METHODS: Water samples of the local streams were analyzed for total petroleum hydrocarbons (TPHs). A preliminary list of potential cancer cases from 1989 to 1998 was prepared. Cases were compared with expected numbers of cancer morbidity and mortality registrations from a Quito reference population. RESULTS: Water analysis showed severe exposure to TPHs by the residents. Ten patients with cancer were diagnosed while resident in the village of San Carlos. An overall excess for all types of cancer was found in the male population (8 observed v 3.5 expected) with a risk 2.26 times higher than expected (95% confidence interval (95% CI) 0.97 to 4.46). There was an overall excess of deaths for all types of cancer (6 v 1.6 expected) among the male population 3.6 times higher than the reference population (95% CI 1.31 to 7.81). CONCLUSIONS: The observed excess of cancer might be associated with the pollution of the environment by toxic contaminants coming from the oil production.

Improving immunization coverage in rural areas of Ecuador: a cost-effectiveness analysis.

This study describes the costs and outcomes of two different immunization strategies used by the district level of the Ministry of Health carried out between 1993 and 1995 in Low-Napo area, Napo, Ecuador. One was centrally planned and managed by the District Hospital (DH) and the other planned and implemented together with community health workers (CHW). Immunization costs were estimated directly from survey records and communication of the Ministry of Health. Outcomes information was abstracted from the vaccination statistics of the Napo Province Health Department for 1993/1995. Community health workers strategy immunized 113 children with an average cost of US $32 per child. District Hospital strategy had an average cost of US $777.6 per immunized child.Thus, CHWs strategy is more effective and less costly than the DH strategy. This study shows that in order to maximize the cost-effectiveness of immunization, it is important to involve community participation in both planning and implementation. Continuous follow-up and evaluation of the immunization programme and further research on vaccine efficacy are necessary in order to maintain these results.

Control of intestinal helminths in schoolchildren in Low-Napo, Ecuador: impact of a two-year chemotherapy program.

A school-based control program of intestinal helminths was undertaken among schoolchildren in the Low-Napo region, north-eastern Ecuador. Forty-eight percent of children were infected with one or more helminths at the first examination. The prevalence at the baseline was Ascaris 33.2% followed by hookworm 24.1% and Trichuris 6.5%. Sex was found to be a significant factor influencing the prevalence of hookworm and Trichuris. Prevalence was compared 9 months and 18 months after treatment. After 9 months, Ascaris and Trichuris prevalence had decreased but not hookworm. All of them increased after 18 months. The findings suggest that only a course of mebendazol had a minor effect on the control of helminth infections.

Epidemiology of malaria in the Amazon basin of Ecuador.

Malaria is reemerging in most endemic countries of South America. In Ecuador, malaria is endemic on the Pacific coast, in the inter-Andean valleys, and in the Amazon River basin. In the Lower-Napo region of northeastern Ecuador, malaria was considered eliminated in the 1970s, but the disease has reemerged in recent years. Three organizations are involved in malaria-related work in the area, but they are not coordinating their efforts. This study was designed to describe the epidemiology of malaria incidence in the Lower-Napo region for the period of January 1992 through December 1995, and to determine the extent of seasonality in transmission in the area. To determine malaria incidence, data were collected for that 4-year period from the records of the three malaria-related organizations: the office of the National Center for Malaria Eradication (NCME) in the town of Coca, the district hospital in Nuevo Rocafuerte (DHNR), and an association of community health workers called Sandi Yura. Data on climatic conditions for the same period were collected from the Ecuadorian Air Force and civil aviation authorities. During the 1992-1995 period, NCME diagnosed a total of 773 malaria cases, DHNR diagnosed 485, and Sandi Yura clinically diagnosed 859. For the 4-year period, an annual parasite index of 40.4 was found with the DHNR data, 35.8 with the Sandi Yura data, and 6.2 with the NCME data. The predominant parasite in the area was Plasmodium vivax (92% of all the cases). Twenty-eight percent of the infected persons were under 10 years old. No discernible differences between the genders were found. There was also no seasonal variation among the cases. Further research is needed in order to confirm these findings and better understand malaria transmission in the region. The study highlights the need for a closer coordination among the area's malaria-control organizations so as to have an improved understanding of malaria epidemiology and to design and implement effective control strategies.

The health status of rural school children in the Amazon basin of Ecuador.

An assessment of the health status among school children of the Naporuna ethnicity was conducted in north-eastern Ecuador. Prevalence of protein-energy malnutrition (PEM), parasitic infections, and pathology was investigated among 511 school children. The overall nutritional status of the school children was found to be good despite a high prevalence of helminthic infections. The prevalence of stunting was 1.4 per cent and of wasting 1.8 per cent. Sixty-four per cent of the children surveyed were found infected with one or more of the soil-transmitted helminths. In the clinical examination high prevalence of pterigium (89.2 per cent) was found. Upper respiratory infections (5.2 per cent), septic skin lesions (4.4 per cent), mycotic otitis (3.8 per cent), tinea (3.4 per cent) and bronchitis (2 per cent) were the main infectious pathology found. Likely explanations of these findings are discussed.

Beriberi in a well-nourished Amazonian population.

Beriberi is an endemic disease among the Naporuna indigenous people of Ecuadorean Amazonia (annual morbidity rate of 1.5%). A total of 47 patients with dry beriberi were seen at the Franklin Tello Hospital, Napo, during 1995-1996; a similar incidence was observed in previous years. No wet beriberi was found. Although the diagnosis of the disease was made clinically, an effective and quick response to thiamine treatment excluded other differential diagnoses, such as tropical ataxic neuropathy. Although indigenous people have several possible dietetic risk factors, none of them adequately explain the disease's high incidence. Some suggestions are made for the high incidence of beriberi among this Amazonian people but its cause remains unknown.

Atypical scabies in HIV-positive patients.

Five cases of Norwegian or keratotic scabies in HIV-positive patients are described. One of these patients was the source of an outbreak in a hospital, ultimately involving 72 persons. Three of our patients had a markedly pruritic eruption. This is unusual in crusted scabies in which pruritus is usually slight or absent. Two of the five patients had unusual CD4 counts of more than 200 cells per cubic millimeter. All our patients responded to lindane and keratolytic agents. When generalized papular, crusted, or eczematoid lesions are observed in HIV-positive patients, particularly if the CD4 count is less than 200/mm3, scabies should be included in the differential diagnosis.

[An ischiorectal abscess due to Actinomyces]. / Absceso isquio-rectal por Actinomyces.

Actinomycosis is a chronic granulomatous inflammatory disease, with fistulization tendency, caused by Actinomyces. The clinical observation in presented of a patient with intermittent fever of three weeks duration, associated to pain and functional impotence of the right hip, observing with CT Scan an ischium-rectal abscess. After spontaneous fistulization, Actinomyces israelii was isolated in the biopsy sample by culture in anaerobic medium, confirming the diagnosis by anatomo-pathology. The patient was treated with intravenous penicillin for six weeks, followed by six months of oral treatment with which the symptoms disappeared and the radiological images normalized. Bone infection ranges between 1 and 15% of total actinomycosis.