Interprofessional training for the delivery of community health services in Mexico: the experience of Partners in Health.

Interprofessional training in health is scarce in Mexico. Partners in Health (CES in Spanish), is the branch of an international civil society organization that provides health services to poor and rural populations. CES runs a set of ten health centers in Chiapas, Mexico, in partnership with the local Ministry of Health. A key component of the provision strategy is to train healthcare providers, mainly medical and nursing students in their final year of training, to create healthcare teams that work together while fostering their individual capacities. CES offers a diploma on Global Health and Social Medicine, where medical and nursing students -also called pasantes- interact to discuss jointly the effects of global and social determinants of health in local communities, as well as specific clinical topics. A qualitative study including interviews and nonparticipant observations was undertaken to identify initial achievements and challenges of the experience. CES has achieved important benefits related to teamwork as well as clinical capacities of individuals as healthcare providers. However, challenges have emerged: differences in social origin, personal development expectations, professional identity and institutional roles hinder team cohesion. Consequently, CES has introduced adjustments to reduce the negative impact of these differences. Although the training model needs further development, the possibility of transferring some of its good practices to non-CES scenarios should be seriously considered by health authorities.

Relationship between chronic transfusion therapy and body composition in subjects with thalassemia.

OBJECTIVE: To measure body composition in patients with thalassemia and explore its relationship to abnormal growth and bone mass. STUDY DESIGN: We conducted a cross-sectional, multicenter study. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy x-ray absorptiometry. Medical history, food frequency, and physical activity questionnaires were conducted in 257 transfused patients with thalassemia (age, 23.7+/-11 years [mean+/-SD]; 51% male) compared with 113 non-transfused patients (21.3+/-13 years; 44% male). RESULTS: Subjects with thalassemia were leaner compared with healthy American subjects from National Health and Nutrition Examination Survey III data. Transfused subjects had a higher percentage of body fat compared with non-transfused subjects after controlling for age, sex, and ethnicity; 11.8% of non-transfused pediatric subjects were considered underweight, significantly lower than National Health and Nutrition Examination Survey data (P=.03). Hemoglobin level was positively related to lean mass (P=.008). Body fat and lean mass were positive predictors for both height and BMD z-scores after adjustment for transfusion status, age, sex, ethnicity, calcium intake, and physical activity (all P<.001). CONCLUSION: Although most adult patients with thalassemia had healthy body composition with rare obesity, young non-transfused patients appear at risk for being underweight. Optimizing physical activity and appropriate use of transfusion therapy may improve growth and bone health in these patients who are at-risk for being underweight.

Effect of hydroxyurea on growth in children with sickle cell anemia: results of the HUG-KIDS Study.

OBJECTIVES: Although hydroxyurea is effective in treating adults with sickle-cell anemia (SCA), there is concern that it may adversely affect growth in children. We report the growth characteristics of patients in the Phase I-II pediatric hydroxyurea trial (HUG-KIDS) before and during treatment at the maximum tolerated dose for one year. STUDY DESIGN: Children and adolescents with SCA (n = 68), aged 5 to 16 years at baseline, reached the maximum tolerated dose and had serial height, weight, and Tanner stage measurements. Data from the Cooperative Study of Sickle Cell Disease (CSSCD) were used for comparison. Mixed-effects models were used to compare serial measurements as a function of age and group. RESULTS: In girls, there were no significant differences in height or weight among the pretreatment, on-treatment, and CSSCD groups. Compared with the CSSCD group, HUG-KIDS boys were heavier starting at age 9 years, and pretreatment HUG-KIDS boys were taller starting at age 7 years. The Tanner stage transitions took place at appropriate ages. CONCLUSIONS: Hydroxyurea treatment had no adverse effect on height or weight gain or pubertal development in school-aged children with SCA.

Blood pressure in four remote populations in the INTERSALT Study.

Four remote population samples (Yanomamo and Xingu Indians of Brazil and rural populations in Kenya and Papua New Guinea) had the lowest average blood pressures among all 52 populations studied in INTERSALT, an international cooperative investigation of electrolytes and blood pressure. Average systolic blood pressure was 103 versus 120 mm Hg in the remaining INTERSALT centers; diastolic blood pressure in these four population samples averaged 63 versus 74 mm Hg in the 48 other centers. There was little or no upward slope of blood pressure with age; hypertension was present in only 5% of the rural Kenyan sample and virtually absent in the other three centers. Also in marked contrast with the rest of the centers was level of daily salt intake, as estimated by 24-hour urinary sodium excretion. Median salt intake ranged from under 1 g to 3 g daily versus more than 9 g in the rest of INTERSALT populations. Average body weight was also low in these four centers, with no or low average alcohol intake, again unlike the other centers. The association within these four centers between the above variables and blood pressure was low, possibly reflecting their limited variability. While several other INTERSALT centers also had low average body weight or low prevalence of alcohol drinking, when this was accompanied by much higher salt intake (7-12 g salt or 120-210 mmol sodium daily), hypertension prevalence ranged from 8% to 19%. These findings confirm previous reports that in populations with a low salt intake, there is little or no hypertension or rise of blood pressure with age.(ABSTRACT TRUNCATED AT 250 WORDS)

International studies of salt and blood pressure.

Comparing the distributions of blood pressure in different populations it has been found that the log-normal distribution gave the best summary of the data. The geometric mean and the coefficient of variation of the underlying blood pressure distribution were the most informative statistics. Using this blood pressure distribution, a model is discussed for the change in blood pressure with age and between populations. These changes are consistent with an environmental factor, such as salt intake, affecting the position of the mean of the blood pressure distribution and with a gradient of susceptibility within a population.