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OBJETIVO: Aplicar un plan de capacitación para médicos y pacientes y evaluar su eficacia en términos del cumplimiento por parte de los pacientes del tratamiento contra la tuberculosis pulmonar en la región fronteriza de Chiapas, México. MÉTODOS: Se realizó un estudio de intervención controlado en pacientes mayores de 15 años con tuberculosis pulmonar diagnosticada por baciloscopia entre el 1 de febrero de 2001 y el 31 de enero de 2002 en unidades de salud seleccionadas al azar en la región fronteriza de Chiapas, México. La muestra estuvo formada por pacientes que acudieron por demanda de consulta en ese período a 23 y 25 unidades de salud para cada uno de los grupos en estudio: intervención y control, respectivamente. En el grupo de intervención se aplicó un plan de capacitación para el personal de salud en el que se abordaron los aspectos sociales, culturales y económicos de la tuberculosis; las bases teóricas y prácticas del diagnóstico y el tratamiento de la enfermedad y la formación de grupos de autoayuda. También se formaron grupos de autoayuda para todos los pacientes que acudieron a las 23 unidades del grupo de intervención. A todos los pacientes se les administró un régimen terapéutico abreviado con isoniacida, rifampicina, pirazinamida y etambutol durante 25 semanas, hasta completar 105 dosis. El seguimiento de los pacientes se extendió hasta el mes de diciembre de 2003. Los grupos de intervención y control se compararon mediante la prueba de la ji al cuadrado y se empleó la prueba de la t de Student para comparar las medias. Se calculó el riesgo relativo (RR) de no cumplir y sus intervalos de confianza de 95 por ciento (IC95 por ciento). RESULTADOS: En la investigación participaron 87 pacientes: 44 en el grupo sometido a intervención y 43 en el grupo de control. El cumplimiento del tratamiento fue significativamente mayor en el grupo que recibió la intervención que en el grupo que sirvió de control (97,7 por ciento frente a 81,4 por ciento, respectivamente; RR = 1,20; IC95 por ciento: 1,03 a 1,39; P = 0,015). Se observó que los médicos de la región fronteriza de Chiapas enfocan su actividad hacia la medicina curativa, más que a la preventiva y a la comprensión de las causas sociales de las enfermedades. CONCLUSIONES: Mediante las actividades educativas de la intervención se logró aumentar la proporción de pacientes que cumplieron el tratamiento. Los servicios de salud pueden mejorar el control de la tuberculosis en Chiapas con los recursos...

Objective. To assess the value of a game known as Jugando en salud: dengue [Playing for health: dengue] as a teaching/learning tool leading to the incorporation of schoolchildren enrolled in secondary school in the control of Aedes aegypti and dengue prevention activities in the municipality of Girardot, Aragua state, Venezuela. Methods. We performed a descriptive, quasi-experimental study based on field research carried out in 9 schools that were chosen by systematic random sampling among the 29 public schools in the municipality of Girardot, Aragua state, Venezuela, having three or more sixth-grade classrooms. In each school three workrooms were set up: in group no. 1 (210 students) the game was practiced three times a week for a total of 60 days, and the teacher was furnished with theoretical materials about dengue; in group no. 2 (196 students) only the theoretical materials that were given to the teacher were used, and in group no. 3 (215 students), which was the control group, the regular learning program established by the Ministry of Education was followed. Participating students were evaluated before and after each of the proposed programs by means of a questionnaire that was evaluated using a Likert scale. We calculated concentration and dispersion measures for the data obtained during the evaluations. Simple analysis of variance was used to compare the mean results obtained in the different classrooms and to detect significant differences among the various groups in terms of knowledge and skills before and after the proposed program. Scheffé's test was used to detect differences within groups. Results. Six hundred twenty-one schoolchildren between the ages of 8 and 16 years (mean age: 11.8 years) participated in the study. Of the 210 students that took part in the game, 41% rated its acceptability as "high" and 45% as "very high." The knowledge about dengue and the skills that were measured prior to following the prescribed program were lower (6.5 and 18.4 points, respectively) than those displayed in the final test (8.25 and 22.9 points, respectively; P < 0,05). There appeared to be better learning in the groups that used the game plus the theoretical materials (group no. 1), or that used just the theoretical materials (group no. 2), than in the control group (group no. 3). Students in workrooms 1 and 2 also appeared to acquire more skills than those in the control group (P < 0,05). Conclusions. The game was highly accepted among students enrolled in secondary school. It helped them acquire greater knowledge about dengue and to develop skills and abilities leading to their incorporation in dengue prevention activities in their respective communities. We recommend that the game be extended to all schools as a tool for strengthening the educational process and incorporating children in dengue control activities.

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OBJECTIVE: To implement a training program for physicians and patients and assess its effectiveness in terms of patient compliance with the pulmonary tuberculosis treatment regimen in the border region of Chiapas, Mexico. METHODS: A controlled intervention study was performed with patients over 15 years of age who had pulmonary tuberculosis diagnosed by direct microscopy (bacilloscopy) between 1 February 2001 and 31 January 2002 in health units randomly selected in the border region of Chiapas, Mexico. The sample was made up of patients who sought consultation at 23 and 25 health units over that period (intervention and control group, respectively). The intervention group took part in a training program for health personnel in which the following were discussed: the social, cultural, and economic aspects of tuberculosis; the theoretical and practical underpinnings of the diagnosis and treatment of the illness, and the establishment of self-help groups. Selfhelp groups were also created for all patients at the 23 units where the intervention group sought consultation. All patients were given a short-term treatment regimen with isoniazid, rifampin, pyrazinamide, and ethambutol for a total of 25 weeks, until completing a total of 105 doses. Patient follow-up was extended through December 2003. The intervention and control groups were compared by means of the chi square test, and Student's t test was used to compare means. The relative risk of non-compliance (RR) was calculated along with 95% confidence intervals (95% CI). RESULTS: Eighty-seven patients participated in the study; 44 were exposed to the intervention, and 43 made up the control group. Compliance with treatment was considerably greater in the intervention group than in the control group (97.7% vs. 81.4%, respectively; RR = 1.20; 95% CI: 1.03 to 1.39; P = 0.0015). It was noted that physicians in the border region of Chiapas gear their activities toward curative medicine, rather than preventive medicine or understanding the social determinants of disease. CONCLUSIONS: As a result of the educational activities that were part of the intervention, there was an increase in the proportion of patients who complied with treatment. Health services can improve tuberculosis control in Chiapas with the resources that are available to them at present. Physicians should be taught to view health problems in Chiapas as part of an integral set of conditions, and efforts should be made to improve the doctor-patient relationship. Steps should also be taken to incorporate educational activities and community participation in health services in order to address public health problems in a comprehensive way.

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Objetivo. Conocer las percepciones y prácticas que los enfermos de tuberculosis tienen sobre la enfermedad y la adherencia al tratamiento. Material y métodos. Estudio cualitativo de 11 entrevistas grupales a 62 pacientes con tuberculosis diagnosticados durante 1997 y 1998 en las regiones Centro, Los Altos y Fronteriza de Chiapas, México. Resultados. Las causas de la enfermedad referidas por los pacientes fueron el contagio por trastes, el trabajo excesivo, la alimentación, el frío y otras sin relación con la transmisión de persona a persona. La incapacidad para el trabajo se reflejó en crisis económica del paciente y su familia. El estigma social impactó emocionalmente en la vida personal, familiar, laboral y de comunidad. Conclusiones. El desconocimiento sobre la enfermedad propició la elección de diferentes alternativas para su atención. Los servicios de salud y la inadecuada relación médico-paciente influyó en el retardo en el diagnóstico y falta de adherencia al tratamiento. Se sugiere un programa de difusión sobre aspectos básicos de la enfermedad y su tratamiento.

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