Behavioral and subjective health changes in US and Mexico border residing participants in two promotora-led chronic disease preventive interventions

Chronic diseases are the primary health burden among Mexican-origin populations and health promotion efforts have not been able to change negative population trends. This research presents behavioral and subjective health impacts of two related community health worker (CHW) interventions conducted in the US-Mexico border region. Pasos Adelante (United States) and Meta Salud (Mexico) are 12-13 week CHW-led preventive interventions implemented with Mexico-origin adults. Curricula include active learning modules to promote healthy dietary changes and increasing physical activity; they also incorporate strategies to promote social support, empowerment and group exercise components responsive to their communities. Questionnaire data at baseline (N = 347 for Pasos; 171 for Meta Salud), program completion and 3-month follow-up were analyzed. Results showed statistically significant improvements in multiple reported dietary, physical activity and subjective health indicators. Furthermore, at follow-up across both cohorts there were ≥10% improvements in participants' meeting recommended physical activity guidelines, consumption of whole milk, days of poor mental health and self-rated health. While this study identifies some robust health improvements and contributes to the evidence base for these interventions current dissemination, the lack of change observed for some targeted behaviors (e.g. time sitting) suggests they may have stronger overall impacts with curricula refinement.

Conceptual basis for an integrated system for the management of a protected area. Examples from its application in a mediterranean area

Improving the efficiency of management in protected areas is imperative in a generalized context of limited conservation budgets. However, this is overlooked due to flaws in problem definition, general disregard for cost information, and a lack of suitable tools for measuring costs and management quality. This study describes an innovative methodological framework, implemented in the web application SIGEIN, focused on maximizing the quality of management against its costs, establishing an explicit justification for any decision. The tool integrates, with this aim, a procedure for prioritizing management objects according to a conservation value, modified by a functional criterion; a project management module; and a module for management of continuous assessment. This appraisal associates the relevance of the conservation targets, the efficacy of the methods employed, both resource and personnel investments, and the resulting costs. Preliminary results of a prototypical SIGEIN application on the Site of Community Importance Chafarinas Islands are included.

Bodyweight gain to predict treatment outcome in patients with pulmonary tuberculosis in Peru

SETTING

Tuberculosis control programmes of two health care centres in the central rainforest of Peru.

OBJECTIVE

To evaluate if bodyweight gain (BWG) predicts treatment outcome in patients with pulmonary tuberculosis (PTB).

DESIGN

Retrospective cohort study of adults with PTB diagnosed between 1995 and 2004. BWG was assessed after month 1 of treatment, after the initial phase and at the end of treatment. Patients were stratified into two BWG categories, < or = 5% and >5%. Failures and relapses were grouped together as unsuccessful treatment outcome.

RESULTS

A total of 650 patients were included: 7.2% (n = 47) had an unsuccessful outcome. Unsuccessful outcome was associated with BWG < or = 5% at the end of treatment (RR 2.05, 95%CI 1.10-3.80), but not at the completion of month 1 (RR 0.99, 95%CI 0.52-1.88) or at completion of the initial phase (RR 1.46, 95%CI 0.82-2.57). Median BWG at completion of the initial phase was higher in cured patients (P = 0.007). BWG < or = 5% at end of treatment (RR 2.35, 95%CI 1.17-4.72), initial sputum smear 2+ (RR 2.48, 95%CI 1.14-5.31) and positive smear microscopy at month 2 (RR 4.0, 95%CI 1.30-12.31) were independent predictors of unsuccessful treatment outcome.

CONCLUSION

BWG < or = 5% at the end of treatment, high bacterial load and lack of sputum conversion correlate with unsuccessful treatment outcome in this setting. New discriminative cut-offs for BWG are proposed.

[Medical care in 7 Chilean cities]

BACKGROUND

In countries with an intermediate development level such as Chile, health care is the main factor that improves the health status of the community.

AIM

To inform the results of morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco.

MATERIAL AND METHODS

A random sample of 951 dwellings with 4,192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time.

RESULTS

Half of sick people received medical care and the rest was managed with self care techniques. Sixty nine percent of subjects with acute diseases received medical care, compared to 32% of those with chronic diseases. The National Health Fund (FONASA) financed most of these medical attentions, half of these were done in private centers and the rest in public premises. Private centers took care of 71% of acute patients, 48% of chronic patients and 27% of health controls. The proportion of private care in different cities paralleled the income of their populations. An estimation of 3.5 medical attentions per capita per year in these cities can be reached. Health care was considered very good by 33% of patients, as good by 55%, as regular by 9% and as deficient by 3%. Quality of care of private centers was perceived as better than that of public centers. Eighty five percent of sick people that did not seek medical care, did so due to the mildness of their ailments. People had to afford a mean of US$ 30 per episode of acute disease, US$ 32 per episode of chronic disease and US$ 56 per each dental attention.

CONCLUSIONS

Two thirds of patients with acute diseases and one third of patients with chronic diseases received medical care during the study period.

[Characteristics and management of morbidity in seven Chilean cities]

BACKGROUND

Health population inquiries give information about morbidity as perceived by people, the quality of medical care and the costs of diseases.

AIM

To inform the results on morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco.

MATERIAL AND METHODS

A random sample of 951 dwellings with 4.192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time.

RESULTS

Health events were registered in 30.1% people. When extrapolating fortnight findings to a one year period, each person had 2.37 annual episodes of acute diseases, 0.94 health examinations and 0.69 dental attentions. The prevalence of chronic diseases was 13.2%. The frequency of health events was higher among women and in elders. Hospital stays and deaths were less frequent in higher income levels. Most acute diseases were respiratory illnesses, followed by communicable diseases. The most important chronic diseases detected were hypertension, diabetes mellitus, bronchial asthma and heart diseases. Medical care was provided in 66% of acute and 34% of chronic diseases.

CONCLUSIONS

When comparing these results with previous surveys, an increase in the frequency of acute and chronic diseases is found.

[Smoking in Santiago, 1993-94]

The aim of this work was to study smoking habits, alcohol and drug use and living standards in a random sample of 1000 dwellings and 4700 people of Santiago through periodic surveys during 1993 and 1994. Forty nine percent of dwellings had at least one inhabitant that was a daily smoker and 73% had at least one occasional smoker. Thirty seven percent of subjects older than 15 years were smokers (40% of men and 35% of women), 27% were presumably addicted to tobacco and 16% former smokers. Alcohol abuse had a prevalence of 2.3%. The highest prevalence of smoking was noticed in low socioeconomical strata. Smoking was not related to educational level or emotional disturbances. Frequency of alcohol abuse or marihuana use was 8.8 times higher in former smokers and 25 times higher in actual smokers, compared to people that never smoked. Comparing these results with previous population surveys, the prevalence of smoking increased in the period 1971-1986 from 47 to 51% in men and from 26 to 43% in women. On the other hand, during the period 1986-1994 the prevalence decreased from 51 to 40% in men and from 43 to 35% in women.

[Development of products for the elderly population: vitamin enriched pudding]

An instant dessert powder, pudding type was developed to be consumed at lunch or dinner time. The dessert was designed to be prepared in skim milk and meets the nutritional needs of elderly people. The dessert contains modified starch, carragenine, vegetal fat, sacharose. Each serving has been enriched with 30% of the daily vitamin requirement advised for adults over 51 years old. The optimized process was carried out according to the Karlsruhe test. Each serving consists of 22g powder prepared in proportion of 18% in skim milk. The optimized dessert powder was controlled by means of physical, chemical and microbiological analyses. The sensory quality was determined in the ready to eat product and the acceptability level was measured in a group of people selected according to the characteristics of the target population. The dessert powder contains 1.1% protein, 5.2% fats, 89.76% carbohidrates, and provides 409 Kcal/100g. Both the sensory and microbiological quality were good and the level of acceptance reached 98%.

[Medical care in Santiago, 1993]

Results of morbidity and medical care surveys performed in Santiago in 1993-94 are presented in this paper. The study has been done in an aleatory population sample of 4,700 people coming from 1,000 dwellings. Main results are as following: The Health National Fund (FONASA) is the most important financing medical care's agency in Santiago (49% out of total population). A majority of medical services are given in private offices or clinics. Medical care systems show significant differences among the studied city districts. A significant direct correlation between people's income and private practice is noticed. One half of acute diseases had medical care and the other half used self care practices; the proportion of medical care is 29% in the case of chronic disease patients. National Health Service eligible people show a significant higher morbidity rate and medical consultation rate than other groups. Lack of medical care mainly depends on low severity of illness episodes or lack of symptoms in chronic disease conditions. In 12% out of total cases, lack of medical care was due to problems in the medical care systems. The quality of care was judged "good or excellent" by 82% of the people, "fair" by 9%, and "bad or deficient" by the remaining 8%. Personal expenditures due to health care are high, one third depending on medical care and two thirds on dental care. In the case of medical care the reasons for expenditures are linked to chronic diseases (60%), acute diseases (28%), injuries and health examinations (15%). Main activities causing personal disbursements are the purchase of drugs (44%), medical visits (30%), laboratory tests (13%) and hospital charges (7%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Characteristics and management of morbidity in Santiago 1993]

Results of morbidity and medical care surveys of the Santiago's population are presented in this paper. A random sample of 1,000 dwellings with 4,700 people was selected and studied 3 times, in 1993 and 1994. All health events (acute and chronic morbidity, health examinations, dental care) and main features of medical care were registered in the interviews which covered a 2-week period each time. The population sample had similar characteristics than the results of the last Population and Dwellings Chilean Census. Health events were registered with high frequency: 56% of the families had one or more members with chronic disease; 51% with acute diseases; 46% with emotional troubles; 24% had dental care; 17% health examination and 6% different types of injuries. Frequency of medical care during the fortnight period was 5.6% out of total population of acute diseases; 1.0% of injuries; 4.9% for chronic diseases, 3.9% of health examinations and 5.6% of dental care. Frequency of diseases was significantly higher among women (50%) than in men (33%) and in poor people than in higher socioeconomic levels. Most of the acute disease were respiratory illnesses followed by communicable diseases, skin troubles and rheumatologic disorders. The most important detected chronic diseases were blood hypertension, diabetes mellitus, bronchial asthma and alcoholic addiction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Attitudes and behaviour concerning tobacco use among physicians from Santiago]

The aim of this work was to study the prevalence, behavior and opinions towards smoking in a sample of 288 physicians from Santiago, stratified according to sex and specialty. The WHO Europe questionnaire was applied and smoker was defined as the person that consumed one or more cigarettes per day. Thirty six percent of the sample (40.2% of men and 23.8% of women) smoked an average of 9 cigarettes per day, compared to the figure of 28.3% obtained in a similar study in 1983. Fifty percent of smokers felt that they will not quit. No differences in knowledge about problems associated to smoking or forbidding smoking in hospitals, were observed between smokers and non-smokers. A majority of smokers did not smoke in front of their patients and did not allow smoking in their private clinics. It is concluded that, although a high proportion of physicians continue to smoke, their opinions and behavior will support smoking cessation efforts.

[Work absenteeism in a mining company: trends in 1985-1988]

The magnitude of medical and non medical absenteeism among male workers performing rotative shifts in a high altitude mining company was studied. There was a general rate of absenteeism of 8.8 absent days per 100 labor days, which means that 31.8% of the total labor force was absent every month. Absenteeism due to medical causes correspond to a mean of 85% of total lost days during the four years of the study. Common diseases (digestive, respiratory, and osteo-muscular diseases, traumatisms and poisonings) give account 84.3% of these lost days. Among these, respiratory diseases had the higher prevalence and traumatisms and osteo-muscular diseases the higher severity (with values over 10 days off). The production areas and people working in shifts had the higher prevalences of medical absenteeism. The numbers of days off for medical causes almost doubled during the four year period and in 1988 represented 14% of all the salaries paid during the year. This increasing tendency was associated with a massive entrance to private health systems. It is concluded that the problem of medical absenteeism in this company is complex and growing and its attenuation requires preventive measures.

[Epidemiologic and nutritional characteristics of the elderly]

A sample of 1365 elders of both sexes from rural and urban populations was studied. Thirty four percent of the subjects were older that 80 years. 21.6% lived alone, 25% were illiterate and 50% did not finish elementary school. Mental impairment was found in 5.6% and body mass index was normal in 41.4% of subjects. Eighty seven percent did not smoke and 80% were teetotalers. Medical services were requested at least every one year by 15.4% and twice a year by 11.9% of subjects. These numbers will help to design preventive and interventional policies directed to this segment of the population.

[Ill-defined causes of death in the elderly]

Over one-half of death certificates from elderly people contain ill-defined causes of death. Usually, signs and symptoms rather than causes of death are registered. Electrolyte imbalance, decubitus ulcer, atherosclerosis, diabetes, etc are some of the most frequently quoted conditions. Adequate preventive programs are jeopardized by lack of more precise information regarding the cause of death and relevant associated conditions in the elderly.

[Headache of cervical origin]

We studied 40 patients with cervical spine disease who had headache (Group A) with 40 patients with disease and no headache (Group B). In addition to clinical and radiologic evaluation, 24 patients in group A and 27 in Group B had electromyographic study, which was normal en 18 of the former and 4 of the latter group. Abnormal neurologic findings were present only in Group B (37% of patients). Alterations of the cervical spine were more pronounced in Group B. These findings suggest that headache is not related to cervical spine disease and may be caused by other factors such as inadequate posture, brisk movements of the neck and emotional and psychologic disturbances.

Intraarticular progesterone: effects of a local treatment for rheumatoid arthritis

The antiinflammatory effect of a single intraarticular injection of progesterone was investigated in 12 patients with rheumatoid arthritis. A local, but no systemic decline of inflammation was observed in 10 of them for at least one month. The average local scores of inflammation at Days 7, 14, 21 and 30 after injection were significantly lower than pretreatment scores (p less than 0.000003 for each comparison). In some patients the effect continued for up to 2 months. No important side effects were observed during the following 2 months. However, a more prolonged followup of treated patients is necessary to rule out the late onset of side effects.

[Television and alcoholic and non-alcoholic beverages]

Dadas las implicancias educativas de la televisión, se decidió estudiar la frecuencia y características de los eventos con bebidas alcohólicas y analcohólicas en la televisión chilena utilizando el método ideado por Garlington. El registro fue hecho por períodos de media hora, distribuidos aleatoriamente, para cada observador, voluntaria perteneciente a una comuna que se caracteriza por su bajo nivel sociocultural; ellas monitorearon durante una semana, de Lunes a Viernes todos los programas transmitidos desde las 20:00 a las 24:00 horas. Se observó que, en promedio, por cada canal se transmite un evento de bebida alcohólica cada 24 minutos 19 segundos y uno de bebida no alcohólica cada 37 minutos y medio; las imágenes de bebida alcohólicas se incrementan a partir de las 21:30 horas. Del total de eventos, 60,7% corresponden a bebidas alcohólicas y de éstos el 61,1% tiene carácter publicitario. Los eventos relacionados con bebidas alcohólicas ocurren principalmente en la casa, por amistad y en forma de escenas, los con no alcohólicas en lugares desportivos, por amistad y en escena de ingestión.