Social inequalities in HIV-TB and non-HIV-TB patients in two urban areas in southern Spain: multilevel analysis.

SETTING: Two towns in Campo de Gibraltar, southern Spain, with a small foreign population and higher tuberculosis (TB) incidence and human immunodeficiency virus (HIV) prevalence than the national average. OBJECTIVE: To determine the relationship between HIV-TB and non-HIV-TB incidence and social deprivation and other potential individual and contextual determinants. METHODS: In a cross-sectional longitudinal study, individual TB case variables were identified from three sources--routine surveillance, laboratory and hospital discharge records--from 1997 to 2007. Community variables were obtained at the census tract level. A deprivation index was calculated based on percentages of unemployment, low educational level and unskilled labour. Multilevel Poisson models were estimated for TB incidence rates for patients with and without HIV. RESULTS: A total of 490 TB cases were included. Sex and age at individual level and deprivation and residence in the port area at census tract level were associated both with HIV-related TB and with non-HIV-TB. Household crowding contextual variables were also associated with HIV-related TB incidence. Full models account for 78.9% and 51.7% reductions in second-level variance. CONCLUSION: Socio-economic deprivation is associated with higher rates of HIV-TB and non-HIV-TB. Diverse individual and contextual potential risk factors suggest different pathways of transmission. It is necessary to extend the framework for intervention beyond individual-based strategies to the socio-economic contexts in which people live.

Strengthening emergency obstetric care in Ayacucho, Peru.

OBJECTIVE: With support from the Averting Maternal Death and Disability (AMDD) Program, CARE began the FEMME Project in 2000 to increase access and utilization of emergency obstetric care (EmOC) services for the approximately 48,000 pregnant women in the northern provinces of Ayacucho. METHODS: The project targeted 5 facilities with a comprehensive package of interventions designed to improve capacity to provide quality EmOC services and to promote a human rights approach in health care. Key program activities included improvements in infrastructure, human resources capacity development, development of service standards and protocols, quality improvement activities, and promoting a rights-based approach to health. RESULTS: By the end of the project, northern Ayacucho had 6 functioning EmOC facilities: 3 comprehensive (including a non-FEMME project facility) and 3 basic. This exceeds the UN minimum recommendation of 5 EmOC facilities per 500,000 population. Other changes in the UN process indicators indicate an increase in quality and utilization of EmOC services. Met need for EmOC increased significantly from 30% in 2000 to a high of 84% in 2004. Case fatality rates declined and the number of maternal deaths in the entire region declined. CONCLUSION: CARE's work in Ayacucho made an impact on policies and programs related to EmOC throughout the region. Within CARE, project experiences have supported maternal health programs particularly in the Latin American/Caribbean region.

[Actinic prurigo. An assessment of current status]. / Aktinische Prurigo. Eine Standortbestimmung.

BACKGROUND AND OBJECTIVE: Actinic prurigo (AP) is a hereditary photodermatoses with typical symptoms and is quite common in North- and South-America. The key genetic factor appears to be a Native American background. In Europeans this type of AP is extremely rare; some dispute if this disease exists in Caucasians. Some newer publications postulate that these patients share HLA markers with the Native Americans. The most important differential diagnosis for AP is polymorphic light eruption which can be excluded relatively accurately by the clinical picture, typical histology and HLA pattern. PATIENTS/METHODS: The case of a female patient of Mayan ancestry living in Germany is presented. CONCLUSIONS: Since in literature sometimes cases from Europe are diagnosed as AP this is a problem of naming the disease. It would be helpful to integrate the terms hereditary or hereditaria into the name of the disease in indians.