The multiple location time weighted index: Using patient activity spaces to calculate primary care service areas

Geographic health planning analyses, such as service area calculations, are hampered by a lack of patient-specific geographic data. Using the limited patient address information in patient management systems, planners analyze patient origin based on home address. But activity space research done sparingly in public health and extensively in non-health related arenas uses multiple addresses per person when analyzing accessibility. Also, health care access research has shown that there are many non-geographic factors that influence choice of provider. Most planning methods, however, overlook non-geographic factors influencing choice of provider, and the limited data mean the analyses can only be related to home address. This research attempted to determine to what extent geography plays a part in patient choice of provider and to determine if activity space data can be used to calculate service areas for primary care providers. ^ During Spring 2008, a convenience sample of 384 patients of a locally-funded Community Health Center in Houston, Texas, completed a survey that asked about what factors are important when he or she selects a health care provider. A subset of this group (336) also completed an activity space log that captured location and time data on the places where the patient regularly goes. ^ Survey results indicate that for this patient population, geography plays a role in their choice of health care provider, but it is not the most important reason for choosing a provider. Other factors for choosing a health care provider such as the provider offering "free or low cost visits", meeting "all of the patient's health care needs", and seeing "the patient quickly" were all ranked higher than geographic reasons. ^ Analysis of the patient activity locations shows that activity spaces can be used to create service areas for a single primary care provider. Weighted activity-space-based service areas have the potential to include more patients in the service area since more than one location per patient is used. Further analysis of the logs shows that a reduced set of locations by time and type could be used for this methodology, facilitating ongoing data collection for activity-space-based planning efforts. ^

Knowledge of exercise recommendations and energy intake from foods and beverages in relation to exercise behaviors within two Hispanic border communities

This research is a secondary analysis of the Qué Sabrosa Vida population-based cross-sectional study of two predominately Mexican American communities located along the Texas-Mexico border in 2000. There were two aims for this research. The first was to determine the relationship between knowledge of exercise and water recommendations, and exercise behavior and water consumption. The second was to determine the relationship between exercise behavior and percentage of energy consumption from beverages. Chi-square analysis revealed the majority of both populations had adequate knowledge about water and exercise recommendations, although significant percentages of the populations (>40%) did not consume water or exercise in adequate amounts. Knowledge was found to be a component of both behaviors, as it was more prevalent in the adults who exercised and consumed water in adequate amounts. Analysis of variance revealed no significant difference between overall beverage calorie percentage and exercise level (all p-values > 0.05); both regions and genders reported ∼18% of total caloric intake from beverages. There was no disproportionate influence of beverage calories on total caloric intake, after controlling for water consumption and independent of exercise behavior. These findings suggest that overall caloric intake, from both foods and beverages, may be the most influential factor to the energy imbalance contributing to the obesity crisis in these Hispanic border populations. ^

Assessment of markers of medication literacy in a US-Mexico border community

Each year an estimated 180,000 people in the United States (U.S.) die as a result of medication errors, now considered a major public health problem. If a patient cannot correctly act on information related to medication use or "Medication Literacy" there is an increased potential for error. Medication use issues are unique on the US-Mexico border because they include high rates of herbal products and medication products from Mexico as well as issues related to the preferred language (English or Spanish) of the patient. To evaluate the medication literacy in a US-Mexico border community, this retrospective study evaluates 180 subjects representing four diverse economic segments of a metropolitan US-Mexico Border community who have taken a Medication Literacy Assessment. The assessment tool has been created to understand how patients interpret medication information for prescription, over-the-counter, herbal, and Mexican medication product use, and how they problem-solve medication questions. The Medication Literacy Assessment tool specifically assesses document literacy (e.g., prescription labels), prose literacy (e.g., patient leaflets), numeracy (e.g., calculations and measurements) as well as qualitative data related to medication use practices. The main hypothesis of this study is that the ability to interpret and use medications will vary based on education, language (Spanish or English), and recruitment sites (economically diverse communities). The results will provide information to better characterize medication use in a primarily Hispanic population on the US-Mexico border and may be used to influence policy decisions regarding prescription and over-the-counter product information.^

Predictors of diagnostic delay among tuberculosis patients in a U.S.-Mexico border community

Delays in diagnosis of pulmonary tuberculosis have detrimental effects on the health of the ailing patient as well as the people around him or her. These effects are magnified in highly-travelled parts of the world. Identifying factors predictive of diagnostic delay is challenging, as these vary widely by culture and geography. Predictors of delay for tuberculosis patients living in the Northeastern Mexican city of Matamoros, a binationally-transited area, have yet to be described. Using secondary analysis of a retrospective survey, this study sought to identify predictors of diagnostic delay in a sample of culture-positive tuberculosis patients in Matamoros. Sociodemographic, behavioral, and health-related factors were measured and compared. Using bivariate and step-wise regression analyses at an alpha level of 0.05, the author found the following to be statically significant predictors for this sample (R 2=0.171): prior treatment of diabetes, recurrence of tuberculosis, and having ever used cocaine. A question assessing knowledge of immunocompromised subgroups was also identified as a predictor, although its implications are unclear. Notably, the instrument did not distinguish between patient and health system delay. In summary, more research should be conducted in the Matamoros area in order to fully understand the dynamics of delayed diagnosis and its application to public health practice.^

A community-based assessment of the spatiotemporal distribution of influenza in a U.S.-Mexico border county during the spring 2009 novel H1N1 swine-origin influenza A pandemic

This study retrospectively evaluated the spatial and temporal disease patterns associated with influenza-like illness (ILI), positive rapid influenza antigen detection tests (RIDT), and confirmed H1N1 S-OIV cases reported to the Cameron County Department of Health and Human Services between April 26 and May 13, 2009 using the space-time permutation scan statistic software SaTScan in conjunction with geographical information system (GIS) software ArcGIS 9.3. The rate and age-adjusted relative risk of each influenza measure was calculated and a cluster analysis was conducted to determine the geographic regions with statistically higher incidence of disease. A Poisson distribution model was developed to identify the effect that socioeconomic status, population density, and certain population attributes of a census block-group had on that area's frequency of S-OIV confirmed cases over the entire outbreak. Predominant among the spatiotemporal analyses of ILI, RIDT and S-OIV cases in Cameron County is the consistent pattern of a high concentration of cases along the southern border with Mexico. These findings in conjunction with the slight northward space-time shifts of ILI and RIDT cluster centers highlight the southern border as the primary site for public health interventions. Finally, the community-based multiple regression model revealed that three factors—percentage of the population under age 15, average household size, and the number of high school graduates over age 25—were significantly associated with laboratory-confirmed S-OIV in the Lower Rio Grande Valley. Together, these findings underscore the need for community-based surveillance, improve our understanding of the distribution of the burden of influenza within the community, and have implications for vaccination and community outreach initiatives.^

Association of maternal sphinganine:sphingosine ratio and folate levels with neural tube defects along the South Texas border

Neural tube defects (NTDs) remain elevated in Hispanic women along the South Texas Border, despite folate supplementation and folate fortification of cereal products. Missmer et al. examined the relationships between fumonisins, a class of corn mycotoxin, and NTDs in Hispanic women who ate corn tortillas and found increased odds ratios with increasing exposure, as measured by serum sphinganine:sphingosine (sa:so) ratios. This study examined the interactions between categorized maternal serum folate levels and stratified sa:so ratios and the resultant odds ratios of NTDs, stratified by type (anencephaly and spina bifida). The hypothesis was that the above normal folate category would have lower odds ratios of NTDs at given sa:so ratio categories and that there would be a difference in odds ratio patterns for anencephaly and spina bifida. Methods. Data for 406 Hispanic women were obtained from the Missmer case-control study. Sa:so ratios were calculated and subjects were stratified into “below normal,” “normal,” and above normal range for folate. A logistic regression model was applied, controlling for BMI, serum B12, lab batch, and conception date. Results. While OR’s of NTDs increased for increasing sa:so ratios, OR’s for “above normal” folate were not decreased at any sa:so ratio and there was no statistically significant difference between OR’s of anencephaly and spina bifida. Conclusion. Folate does not appear to be protective against the potential teratogenic effect of fumonisins and did not differ in effect on OR’s of NTD by type. More research is necessary to determine the extent of fumonisin exposure in Hispanic women along the South Texas Border.^

A comparison of healthcare access, healthcare utilization and asthma self-management for Hispanic children in border and non-border regions of Texas

The purpose of this culminating experience was to investigate the relationships between healthcare utilization, insurance coverage, and socioeconomic characteristics of children with asthma along the Texas-Mexico Border. A secondary data analysis was conducted on cross-sectional data from the Texas Child Asthma Call-back Survey, a follow-up survey to the random digit dialed Behavior Risk Factor Surveillance Study (BRFSS) conducted between 2006-2009 ( n = 556 adults living in households with a child with asthma).^ The proportion of Hispanic children with asthma in Border areas of Texas was more than twice that of non-Border areas (84.8% vs. 28.8%). Parents in Border areas were less likely to have their own health insurance (OR = 0.251, 95% C.I. = 0.117-0.540) and less likely to complete the survey in English than Spanish (OR = 0.251 95% C.I. = 0.117-0.540) than parents in non-Border areas. No significant socio-economic or health care utilization differences were noted between Hispanic children living in Border areas compared to Hispanic children living in non-Border areas. Children with asthma along the Texas-Mexico Border, regardless of ethnicity and language, have insurance coverage rates, reported cost barriers to care, symptom management, and medication usage patterns similar to those in non-Border areas. When compared to English-speakers, Spanish-speaking parents in Texas as a whole are far less likely to be taught what to do during an asthma attack (50.2% vs. 78.6%).^ Language preference, rather than ethnicity or geographical residence, played a larger role on childhood asthma-related health disparities for children in Texas. Spanish-speaking parents in are less likely to receive adequate asthma self-management education. Investigating the effects of Hispanic acculturation rates and incongruent parent-child health insurance coverage may provide better insight into the health disparities of children along the Texas-Mexico Border.^

Pre-pregnancy obesity on the border and pregnancy complications: A secondary analysis comparing post-natal adult women in Matamoros, Mexico and Cameron County, Texas

Obesity during pregnancy is a serious health concern which has been associated with many adverse health outcomes for both the mother and the infant. In addition, data on the prevalence of obesity and its effects on pregnant women living in the border region are limited. This goal of this study was to examine the prevalence of preconception obesity among women living on each side of the Brownsville-Matamoros border who have just given birth, the relationship between obesity and pregnancy complications for the total population, and these associations by location. Study participants were drawn from a sample (n=947) from the Brownsville-Matamoros Sister City Project which included women from 10 border region hospitals (6 in Matamoros, 4 in Cameron County) who were recruited based on hospital log records indicating they had given birth to a live infant. De-identified data from verbal questionnaires administered within twenty-four hours after birth were analyzed to determine prevalence of preconception obesity on both sides of the border, and associated pregnancy outcomes for women residing in the United States and those in Mexico. Participants with missing height or weight data were excluded from analyses in this study, resulting in a final sample of 727 women. Significant associations were found between pre-pregnancy obesity and adverse pregnancy outcomes (OR=1.85, CI=1.30–2.64), hypertensive conditions (OR=2.76, CI=1.72–4.43), and macrosomia (OR=6.77, CI=1.13–40.57) using the total sample. Comparisons between the United States and Mexico sides of the border showed differences; associations between preconception obesity and adverse pregnancy outcomes were marginally significant among women in the United States (p=0.05), but failed to reach significance within this group for each individual complication. However, significant associations were found between obesity and preeclampsia (OR=3.61, CI=2.14–6.10), as well as obesity and the presence of one or more adverse pregnancy outcome (OR=2.29, CI=1.30–4.02), among women in Mexico. The results from this analysis provide new information specific to women on the Texas and Mexico border, a region that had not previously been studied. These significant associations between preconception obesity and adverse birth outcomes indicate that efforts to prevent obesity should focus on women of childbearing age, especially in Mexico.^

Performance of HbA1c for classifying diabetes and diagnostic threshold for diabetes among the Mexican American border community

Objective. In 2009, the International Expert Committee recommended the use of HbA1c test for diagnosis of diabetes. Although it has been recommended for the diagnosis of diabetes, its precise test performance among Mexican Americans is uncertain. A strong “gold standard” would rely on repeated blood glucose measurement on different days, which is the recommended method for diagnosing diabetes in clinical practice. Our objective was to assess test performance of HbA1c in detecting diabetes and pre-diabetes against repeated fasting blood glucose measurement for the Mexican American population living in United States-Mexico border. Moreover, we wanted to find out a specific and precise threshold value of HbA1c for Diabetes Mellitus (DM) and pre-diabetes for this high-risk population which might assist in better diagnosis and better management of patient diabetes. ^ Research design and methods. We used CCHC dataset for our study. In 2004, the Cameron County Hispanic Cohort (CCHC), now numbering 2,574, was established drawn from randomly selected households on the basis of 2000 Census tract data. The CCHC study randomly selected a subset of people (aged 18-64 years) in CCHC cohort households to determine the influence of SES on diabetes and obesity. Among the participants in Cohort-2000, 67.15% are female; all are Hispanic. ^ Individuals were defined as having diabetes mellitus (Fasting plasma glucose [FPG] ≥ 126 mg/dL or pre-diabetes (100 ≤ FPG < 126 mg/dL). HbA1c test performance was evaluated using receiver operator characteristic (ROC) curves. Moreover, change-point models were used to determine HbA1c thresholds compatible with FPG thresholds for diabetes and pre-diabetes. ^ Results. When assessing Fasting Plasma Glucose (FPG) is used to detect diabetes, the sensitivity and specificity of HbA1c≥ 6.5% was 75% and 87% respectively (area under the curve 0.895). Additionally, when assessing FPG to detect pre-diabetes, the sensitivity and specificity of HbA1c≥ 6.0% (ADA recommended threshold) was 18% and 90% respectively. The sensitivity and specificity of HbA1c≥ 5.7% (International Expert Committee recommended threshold) for detecting pre-diabetes was 31% and 78% respectively. ROC analyses suggest HbA1c as a sound predictor of diabetes mellitus (area under the curve 0.895) but a poorer predictor for pre-diabetes (area under the curve 0.632). ^ Conclusions. Our data support the current recommendations for use of HbA1c in the diagnosis of diabetes for the Mexican American population as it has shown reasonable sensitivity, specificity and accuracy against repeated FPG measures. However, use of HbA1c may be premature for detecting pre-diabetes in this specific population because of the poor sensitivity with FPG. It might be the case that HbA1c is differentiating the cases more effectively who are at risk of developing diabetes. Following these pre-diabetic individuals for a longer-term for the detection of incident diabetes may lead to more confirmatory result.^

Improving care of women at risk of unsafe abortion: implementing a risk-reduction model at the Uruguayan-Brazilian border

OBJECTIVE: To describe the initial stages of the implementation of a risk-reduction model designed by Iniciativas Sanitarias to shield women from unsafe abortion in a traditional community on the Uruguay-Brazil border. METHODS: This mixed-design study was conducted first between 22 and 26 March 2010, and then between 2 and 7 May 2011, in Rivera, Uruguay, to gather information from women seen at health centers, healthcare providers, and local policy makers before the project started and midway through the project. RESULTS: At baseline most women and providers considered abortion justifiable only on narrow grounds, yet favored the implementation of a risk-reduction model that would include preabortion as well as postabortion counseling, the former providing information on different abortion methods and their risks. By the midterm assessment, the counseling service had assisted 87 women with unwanted pregnancies. Of the 52 who came for a postabortion visit, 50 had self-administered misoprostol, with no complications. Women were highly satisfied with the counseling. At baseline, misoprostol seemed to be available from both pharmacists and informal sellers. At midterm, it was still available from informal vendors but pharmacists said they did not provide misoprostol. The risk-reduction initiative heightened public attention to the abortion issue but the controversy it generated did not seriously impede its implementation. CONCLUSION: It is feasible to implement the proposed risk-reduction model in a traditional community such as Rivera, not only in Uruguay but in any country irrespective of its abortion laws.

Un elixir de la palabra : Heterogeneidad interlingüe en la narrativa de Sandra Cisneros

Esta tesis doctoral explora la construcción de algunos aspectos enunciativos relacionados con la heterogeneidad lingüístico-cultural presentes en la narrativa de la escritora chicana Sandra Cisneros [n. 1954]. Más específicamente, esta investigación tiene como objetivo principal explicar el fenómeno de la desterritorialización de la lengua a partir del examen de la conformación de espacios lingüístico-culturales intersticiales a lo largo del desarrollo de la obra de Cisneros [1984, 1991, 2002], que conforma el corpus de nuestro trabajo. Nuestra hipótesis rectora indica que en la escritura de Cisneros. La constitución de la heterogeneidad y la gesta del sentido son ineludiblemente interlingües. Así, proponemos que la heterogeneidad interlingüe es la categoría que permite explicar la complejidad discursivo-enunciativa característica de nuestro corpus. A partir del concepto de heterogeneidad[es] enunciativa[s] elaborado por Authier-Revuz [1984]. Definimos la heterogeneidad interlingüe como un fenómeno enunciativo que se inscribe en el ámbito del dialogismo interdiscursivo [Bajtin [1952-3] 1982] y que se manifiesta a través de las marcas y formas que surgen en el discurso a través de los procesos de negociación y traducción Iingüistico-culturales actualizados en el encuentro constante y constitutivo de distintas lenguas. Según entendemos, la heterogeneidad interlingüe se articula a partir de tres dimensiones que se encuentran en permanente interacción: la conformación de una imagen discursiva o ethos [Ducrot, [1984] 1986; Amossy, 1999] asociado al responsable de la enunciación de la totalidad de los textos narrativos [Iocutor-Autor], la institución de sitios -formas y marcas- que se presentan como heterogéneos desde un punto de vista lingüístico-cultural y la configuración de una practica de lectura particular que exige una competencia discursivo-cultural de parte del lector que debe completar el sentido del texto y también del discurso. En atención alas dimensiones aludidas, esta tesis otorga atención específica a los siguientes aspectos: la constitución interlingüe de la paratextualidad, la alternancia de lenguas, los distintos modos de presencia de la traducción, los enunciados paremiológicos y la dimensión reflexiva de la enunciación. Entre los objetivos centrales de nuestra investigación, se cuentan: 1. la elaboración de un andamiaje teórico-metodológico pluridisciplinario que permita dar cuenta de las particularidades discursivas de nuestro corpus y ser referencia para el análisis de otras escrituras de minorías y narrativas de frontera; 2. la contribución al desarrollo de los estudios del discurso [Authier-Revuz, 1984, 1995; Ducrot. [1984] 1986, 2004] a través de la incorporación de la noción de interlingüismo a la discusión de la constitución de la heterogeneidad y de la gesta del sentido discursivo; 3. la articulación del concepto de desterritorializacion [Deleuze y Guattari, [1975] 1998] con algunas nociones originadas en los modelos provenientes de la teoría de la Frontera [Hicks, 1991; Arteaga, 1997] y de la teoría discursiva de Authier-Revuz [1984, 1995]. En cuanto a los objetivos particulares, este trabajo de tesis se propone examinar las distintas formas y marcas de la heterogeneidad interlingüe presentes en la narrativa de Cisneros y ofrecer un panorama analítico que pondere la evolución de la obra de la escritora chicana en relación con la construcción del responsable de la enunciación, los sitios de la heterogeneidad y la practica de lectura singular que impone esta escritura

Un elixir de la palabra : Heterogeneidad interlingüe en la narrativa de Sandra Cisneros

Esta tesis doctoral explora la construcción de algunos aspectos enunciativos relacionados con la heterogeneidad lingüístico-cultural presentes en la narrativa de la escritora chicana Sandra Cisneros [n. 1954]. Más específicamente, esta investigación tiene como objetivo principal explicar el fenómeno de la desterritorialización de la lengua a partir del examen de la conformación de espacios lingüístico-culturales intersticiales a lo largo del desarrollo de la obra de Cisneros [1984, 1991, 2002], que conforma el corpus de nuestro trabajo. Nuestra hipótesis rectora indica que en la escritura de Cisneros. La constitución de la heterogeneidad y la gesta del sentido son ineludiblemente interlingües. Así, proponemos que la heterogeneidad interlingüe es la categoría que permite explicar la complejidad discursivo-enunciativa característica de nuestro corpus. A partir del concepto de heterogeneidad[es] enunciativa[s] elaborado por Authier-Revuz [1984]. Definimos la heterogeneidad interlingüe como un fenómeno enunciativo que se inscribe en el ámbito del dialogismo interdiscursivo [Bajtin [1952-3] 1982] y que se manifiesta a través de las marcas y formas que surgen en el discurso a través de los procesos de negociación y traducción Iingüistico-culturales actualizados en el encuentro constante y constitutivo de distintas lenguas. Según entendemos, la heterogeneidad interlingüe se articula a partir de tres dimensiones que se encuentran en permanente interacción: la conformación de una imagen discursiva o ethos [Ducrot, [1984] 1986; Amossy, 1999] asociado al responsable de la enunciación de la totalidad de los textos narrativos [Iocutor-Autor], la institución de sitios -formas y marcas- que se presentan como heterogéneos desde un punto de vista lingüístico-cultural y la configuración de una practica de lectura particular que exige una competencia discursivo-cultural de parte del lector que debe completar el sentido del texto y también del discurso. En atención alas dimensiones aludidas, esta tesis otorga atención específica a los siguientes aspectos: la constitución interlingüe de la paratextualidad, la alternancia de lenguas, los distintos modos de presencia de la traducción, los enunciados paremiológicos y la dimensión reflexiva de la enunciación. Entre los objetivos centrales de nuestra investigación, se cuentan: 1. la elaboración de un andamiaje teórico-metodológico pluridisciplinario que permita dar cuenta de las particularidades discursivas de nuestro corpus y ser referencia para el análisis de otras escrituras de minorías y narrativas de frontera; 2. la contribución al desarrollo de los estudios del discurso [Authier-Revuz, 1984, 1995; Ducrot. [1984] 1986, 2004] a través de la incorporación de la noción de interlingüismo a la discusión de la constitución de la heterogeneidad y de la gesta del sentido discursivo; 3. la articulación del concepto de desterritorializacion [Deleuze y Guattari, [1975] 1998] con algunas nociones originadas en los modelos provenientes de la teoría de la Frontera [Hicks, 1991; Arteaga, 1997] y de la teoría discursiva de Authier-Revuz [1984, 1995]. En cuanto a los objetivos particulares, este trabajo de tesis se propone examinar las distintas formas y marcas de la heterogeneidad interlingüe presentes en la narrativa de Cisneros y ofrecer un panorama analítico que pondere la evolución de la obra de la escritora chicana en relación con la construcción del responsable de la enunciación, los sitios de la heterogeneidad y la practica de lectura singular que impone esta escritura

Imágenes de la edición border y sudaca : El entre-catálogos de Eloísa Cartonera

Este artículo analiza un corpus literario en el cual se construyen ciertas imágenes de la edición "border" y "sudaca" de Eloísa Cartonera. Las autobiografías de editores de proyectos editoriales independientes, alternativos y autogestivos discuten modos de organización y asociación en el marco de la transnacionalización editorial. La temporalidad inscrita en estas imágenes permite observar las tensiones, movimientos, desplazamientos, estabilizaciones y cristalizaciones que se producen en sus instancias de organización, afiliación y desafiliación.

Territorialidades, espacios vividos y sentidos de lugar en tiempos de avance de la frontera productiva

En pleno proceso de corrimiento de la frontera productiva y emergente disputa por el uso y apropiación de los recursos, la intervención de distintos sujetos sociales en el oeste de La Pampa está redefiniendo las prácticas productivas-reproductivas de los crianceros campesinos y, en consecuencia, la construcción social del espacio. Desde la finalización de las campañas militares contra las sociedades indígenas diferentes agentes, mediante el ejercicio de poder, construyeron determinadas representaciones territoriales y pusieron en acción prácticas tendientes a articular el oeste pampeano con la economía nacional. Sin embargo la escasa valorización de este espacio posibilitó el desarrollo de cierta autonomía en las formas de organización socio-productivas y simbólicas. Ante la expansión de la frontera ganadera, el impuso hidrocarburífero en la región y creciente presencia de nuevas lógicas territoriales crecen las confrontaciones por el desigual acceso a los recursos naturales, por la apropiación del espacio y la construcción de territorialidades. En este marco, el artículo focaliza la mirada en la organización interna de los asentamientos rurales y en los usos sociales de los espacios a través del tiempo, en dos áreas del "extremo" oeste: La Humada y Chos Malal. De este modo se pretende establecer cómo se organizaron diacrónicamente los espacios doméstico, peridoméstico y monte y qué sentidos expresan los sujetos en torno a los espacios de vida y lugares en tiempos de expansión de la frontera productiva. El nuevo campo social generado producto del avance del capitalismo sobre las unidades campesinas se expresa, no sólo en las modificaciones en las formas de manejo del ganado, organización de la producción y construcción social del espacio, sino también en las formas de sociabilidad y estrategias de resistencia colectivas. Este proceso, que se está gestando en la región, tiene un desarrollo similar en otros espacios donde el avance productivo se ha generado con anterioridad o a un ritmo más acelerado. Para la realización de la investigación se articulan diferentes estrategias de metodología cualitativa que combinan el estudio de caso con historias de vida, entrevistas en profundidad y análisis de fuentes documentales.