Relación entre médicos y pacientes con VIH: influencia en apego terapéutico y calidad de vida

OBJETIVO: Analizar factores de la relación con los médicos que afectan la adherencia terapéutica y la calidad de vida de las personas con VIH/Sida. MÉTODOS: Estudio cualitativo realizado en México en 2003 con informantes reclutados en grupos de autoayuda y organizaciones no gubernamentales de VIH/Sida y servicios de infectología de hospitales públicos. Fueron entrevistadas 40 personas viviendo con VIH/Sida y cinco líderes de grupos de autoapoyo. Para la recolección de datos los informantes respondieron un cuestionario sociodemográfico y entrevistas en profundidad sobre la experiencia de vivir con VIH/sida, incluyendo los tratamientos, la percepción de la enfermedad, la calidad de vida, la salud física y emocional y la relación con los médicos. Las respuestas fueron grabadas, transcritas y organizadas por temas en base a códigos, usando un análisis inductivo. RESULTADOS: La edad de la mayoría de los entrevistados varió entre 26 y 45 años. Los principales problemas durante la búsqueda de atención se relacionaron con la falta de conciencia de riesgo y de información entre las personas viviendo con VIH/Sida y los médicos. Los médicos mostraron falta de capacitación en VIH/Sida. En la etapa de continuidad de la atención, los problemas se relacionaron con una adherencia terapéutica deficiente, producto principalmente de la falta de comunicación con los médicos y de la discriminación en los servicios públicos. CONCLUSIONES: De manera general se observaron problemas de información; falta de capacitación y paternalismo por parte de los médicos, y estigma social de las personas viviendo con VIH/Sida asociado a la epidemia.

Experiences with the control of schistosomiasis mansoni in two foci in Central Africa

Experiences with population-based chemotherapy and other methods for the control of schistosomiasis mansoni in two subsaharan foci are described. In the forest area of Maniema (Zaire), intense transmission of Schistosoma mansoni, high prevalences and intensities of infection, and important morbidity have been documental. Taking into account the limited financial means and the poor logistic conditions, the control strategy has been based mainly on targeted chemotherapy of heavily infected people (>600 epg). After ten years of intervention, prevalences and intensities have hardly been affected, but the initial severe hepatosplenic morbidity has almost disappeared. In Burundi, a national research and control programme has been initiated in 1982. Prevalences, intensities and morbidity were moderate, transmission was focal and erratic in time and space. A more structural control strategy was developed, based on screening and selective therapy, health education, sanitation and domestic water supply. Prevalences and intensities have been considerably reduced, though the results show focal and unpredicatable variations. Transmission and reinfection were not signifcantly affected by chemotherapy alone, and eventual outcome of repeated selective treatment appears to be limited by the sensitivity of the screening method. Intestinal morbidity was strongly reduced by community-based selective treatment, but hepatosplenic enlargement was hardly affected; this is possibly due to the confounding impact of increasing malaria morbidity. The experiences show the importance of local structures and conditions for the development of an adapted control strategy. It is further concluded that population-based chemotherapy is a highly valid tool for the rapid control of morbidity, but should in most operational conditions not be considered as a tool for transmission control. Integration of planning, execution and surveillance in regular health services...

Low pH and calcium effects on net Na+ and K+ fluxes in two catfish species from the Amazon River (Corydoras: Callichthyidae)

The present study analyzes Na+ and K+ disturbances caused by low pH in two catfish species from the Amazon River. Corydoras adolfoi inhabits ion-poor, black-stained, low pH (3.5-4.0) waters, while C. schwartzi is native to ion-rich waters at circumneutral pH. Fish were exposed to pH 3.5 Ca2+-free, and Ca2+-enriched (~500 µmol/l) water to determine the protective effects of calcium. Net Na+ and K+ fluxes were measured in the water collected from the fish experimental chambers. C. adolfoi was unable to control the Na+ efflux at low pH, exhibiting Na+ loss up to -594 ± 84 nmol g-1 h-1 during the first hour. After 3 and 6 h, net Na+ flux increased by 7- and 23-fold, respectively. In C. schwartzi, at pH 3.5, the initial high Na+ loss (-1,063 ± 73 nmol g-1 h-1) was gradually attenuated. A K+ loss occurred in both species, but remained relatively constant throughout exposure. High [Ca2+] affected ion losses in both species. C. adolfoi had 70% loss attenuation, indicating incapacity to control Na+ efflux. In C. schwartzi, elevated [Ca2+] completely prevented the Na+ losses caused by exposure to low pH. Rather different patterns were seen for K+ fluxes, with C. adolfoi showing no K+ disruption when exposed to low pH/high [Ca2+]. Thus, C. adolfoi loses Na+ during acid exposure, but has the ability to control K+ loss, while C. schwartzi controls diffusive Na+ loss but exhibits a slightly higher K+ loss. Ion balance was influenced by [Ca2+] at low pH in C. schwartzi but not in C. adolfoi.