An analysis of social policy, health and socioeconomic mobility in Mexico : could a conditional cash transfer programme promote mobility?

The overall scope of this thesis is to document the relevance of health capital investments for development, as well as highlighting barriers for the accumulation of health capital in the context of policies and programmes aimed to this. In order to promote development, Mexico decided to focus its social policy on generating incentives for human capital investments. For this approach to work, returns to human capital, part of which is health, have to be positive and sufficiently high. Using data from a national representative survey, I found that returns to health in Mexico are positive and in order of magnitude similar to those reported for other countries, and that social mobility is present, although still there is an important intergenerational transmission of educational attainments. One key assumption for interventions and policies aiming promote development through increasing the accumulation of human capital, and in particular health capital is that increasing access and utilization of health services will translate into health capital. The capacity of health services to generate health is related to its quality. Structural quality is a necessary but not sufficient factor for quality. I present results for primary health services in Mexico, showing that magnitude of heterogeneity on structural quality is large, and that is negatively correlated with locality marginalization. One key element for development is the accumulation of appropriate levels of human capital. Insufficient attention has been paid to factors that may counterbalance investments in human capital. Risk behaviours such as smoking and unprotected sex may reduce both creation of human capital and accumulated stock. Analyzing data from the Mexican CeT programme Oportunidades, I found that this programme may decrease participation in risk behaviours, although among its target population (poor households) they are still highly prevalent. The analysis reported in this thesis makes the case for increasing investments in health capital among the means through which to increase the accumulation of human capital, but at the same time devoting resources to increase the chances of these investments in translating effectively to human capital. That is, increasing quality of health services and promoting healthy behaviours

A quasi-experimental evaluation of parents as sexual health educators resulting in delayed sexual initiation and increased access to condoms.

OBJECTIVE: To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents' sexual behavior, knowledge and access to contraception. MATERIAL AND METHODS: Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent-child dyads in the control and intervention schools were matched according to parents' propensity score; the average treatment effect (ATE) was estimated for adolescent's outcome variables. RESULTS: At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools. CONCLUSIONS: Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health

Educación y modernidad. Entre la utopía y la burocracia

Sin resume

HIV prevention in Mexican schools: prospective randomised evaluation of intervention.

OBJECTIVE: To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. DESIGN: Cluster randomised controlled trial. SETTING: 40 public high schools in the state of Morelos, Mexico. PARTICIPANTS: 10 954 first year high school students. INTERVENTION: Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contraception as back-up, or the existing sex education course. Self administered anonymous questionnaires were completed at baseline, four months, and 16 months. Students at intervention schools received a 30 hour course (over 15 weeks) on HIV prevention and life skills, designed in accordance with guidelines of the joint United Nations programme on HIV/AIDS. Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm. MAIN OUTCOME MEASURES: Primary outcome measure was reported condom use. Other outcomes were reported sexual activity; knowledge and attitudes about HIV and emergency contraception; and attitudes and confidence about condom use. RESULTS: Intervention did not affect reported condom use. Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm. Reported sexual behaviour was similar in the intervention arms and the control group. CONCLUSION: A rigorously designed, implemented, and evaluated HIV education course based in public high schools did not reduce risk behaviour, so such courses need to be redesigned and evaluated. Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception

Optimal design of a carbon dioxide separation process with market uncertainty and waste reduction

The aim of this work is to optimize the conceptual design of an amine-based carbon dioxide (CO2) separation process for Enhanced Oil Recovery (EOR). A systematic approach is applied to predict the economic profitability of the system while reducing the environmental impacts. Firstly, we model the process with UniSim and determine the governing degrees of freedom (DoF) through a sensitivity analysis. Then, we proceed with the formulation of the economic problem, where the employment of econometric models allows us to predict the highest dynamic economic potential (DEP). In the second part, we apply the Waste Reduction (WAR) algorithm to quantify the environmental risks of the studied process. This method is based on the minimization of the potential environmental indicator (PEI) by using the generalization of the Waste Reduction algorithm. Results show that the CO2 separation plant is promising in terms of economic revenues. However, the PEI value indicates that the higher the profitability, the larger the environmental risk. The optimal value of the DEP corresponds to 0.0274 kmol/h and 60 ◦C, with a plant capacity according to the mole flow rate of the produced acid gas. In addition, the highest environmental risk is observed at the upper bounds of the DoF.Fil: Gutierrez, Juan Pablo. Universidad Nacional de Salta. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Erdmann, Eleonora. Universidad Nacional de Salta. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Manca, Davide. Politecnico di Milano; Itali

Access to condoms for female sex workers in Andhra Pradesh.

BACKGROUND: Condoms are an essential part of comprehensive HIV prevention and care programmes. We report the accessibility of male condoms for female sex workers (FSWs) and the associated characteristics that may play a major role in determining access to condoms for FSWs. METHODS: Confidential interviews of 6509 street- and home-based FSWs in 13 districts of the Indian state of Andhra Pradesh provided data on the number of paying clients and various aspects of access to free condoms and purchase of condoms. Access to condoms was defined as having ever obtained condoms either through free distribution or through purchase. Multivariate analyses were done separately for street- and home-based FSWs to describe correlates of their access to condoms. The requirement of condoms was assessed based on the number of paying clients during the past 15 days. RESULTS: Data on condom access were available for 6465 (99.3%) FSWs. A total of 2850 (44.1%; 95% CI: 36.2%-52.0%) reported accessing free condoms ever and 2336 (36.1%; 95% CI: 30.6%-41.6%) had purchased condoms ever (not mutually exclusive). The primary sources for condoms were non-governmental organization facilities (73.8%) and pharmacies (79.7%) for free and purchased condoms, respectively. A total of 3510 (54.3%; 95% CI: 48.5%-60.1%) FSWs reported no access to free or purchased condoms during the past 15 days, and this no access was significantly higher for those > 30 years of age, with no schooling, street-based FSWs, and with no participation in a FSW support group (p < 0.001 for each in univariate analysis). Participation in a FSW support group was the main predictor of access to free condoms for both types of FSWs during the past 15 days with multivariate analysis. Condom requirements during the past 15 days were met for 67.5% of FSWs who had accessed only free condoms and for 33.8% of those who had accessed only purchased condoms. CONCLUSIONS: One-fourth of FSWs had never accessed condoms, and a little over half of those who had ever accessed reported no access during the past 15 days. Condom requirements were not met for three-fifths of the FSWs. HIV prevention programmes need to Increase access to free condoms for FSWs in Andhra Pradesh as access to condoms is a necessary prerequisite for condom use

Crisis y paradojas del discurso escolar en la modernidad

Sin resume

Resource requirements to fight HIV/AIDS in Latin America and the Caribbean.

OBJECTIVES: Economists and epidemiologists from 10 countries in Latin America and the Caribbean (LAC) reviewed the methods used to develop estimates for resource requirements to address HIV/AIDS prevention and care in low- and middle-income countries. METHODS: They applied their country-specific knowledge to re-estimate the costs, coverage, and capacity of their health and education systems to expand HIV/AIDS interventions by 2005. A discrepancy of 173 million US dollars exists between the model estimates and those of country specialists. RESULTS: The most important difference between the model estimates and those of country specialists was in the estimated future price of highly active antiretroviral therapy. To a large extent, the estimates of the model reflect the efficiency gains that could result from purchasing arrangements that lead LAC countries to lower prices for antiretroviral drugs. CONCLUSION: This preliminary exercise with 10 LAC countries confirmed the validity of the use of these estimates as tools at the international level, given current data limitations, both to guide the allocation of resources across diseases and countries, and for advocacy and resource mobilization. In addition, with the country revisions, these estimates have also been shown to be key tools for country-level strategic planning

HIV testing among female sex workers in Andhra Pradesh, India.

Of 6648 female sex workers (FSW) in 13 districts of Andhra Pradesh state in India, only 7.9% reported having undergone HIV testing, and three-quarters of the rest were unwilling to undergo HIV testing in the future. The risk of HIV infection as a result of the non-use of condoms was higher among FSW who reported not having been tested and were also unwilling to get tested, and they also held significantly more negative beliefs about HIV/AIDS