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PubMedDate not supplied

Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women.

A telephone survey of a random sample of Rhode Island women ages 40 and older residing in minority low-income census tracts--census tracts in the lowest quartile of a variety of socioeconomic indicators in which at least 5 percent of the population was classified as Hispanic or non-Hispanic black--was conducted in 1991, focusing on breast cancer screening. Hispanic women were found to have about half the breast cancer screening rate (20 percent, according to current screening guidelines) of other respondents (37 percent). Determinants of screening were explored to suggest reasons for this difference. The Health Belief Model was used to identify and compare determinants of breast cancer screening (sociodemographics, health care utilization, perceived susceptibility to breast cancer, perceived seriousness of breast cancer, cues to screening such as a provider's recommendation, and the perceived benefits and costs of screening) among Hispanics, non-Hispanic whites, and non-Hispanic blacks. Hispanics were younger, less educated, and had lower family incomes than other women residing in minority low-income census tracts, were less likely to receive medical care, to perceive themselves as susceptible to breast cancer, and to perceive breast cancer as curable. Logistic regression analyses revealed the importance of use of health care, cues for screening, and perceptions of mammography to explain the screening behavior of Hispanics and non-Hispanics alike. Access to medical care is a significant problem in the Rhode Island Hispanic community, related to recent immigration, undocumented immigration, and low income characteristics of its members. Efforts to increase long-term screening for breast cancer in this community should focus on access while paying attention to its unique perceptions of breast cancer.

Adult↗
PubMed1994

Clinical characteristics of type II diabetic subjects consuming high versus low carbohydrate diets in Mexico City and San Antonio, Texas.

OBJECTIVE: To compare the clinical status of type II diabetic subjects identified in two population-based surveys, one performed in Mexico City, Mexico and the other in San Antonio, Texas. RESEARCH DESIGN AND METHODS: In a low income area of Mexico City, 3,517 age-eligible (35-64 years of age) individuals were randomly selected of whom 3,319 were interviewed at home and 2,198 were examined in a clinic (response rates 62.5%). In San Antonio, 2,357 similarly aged low-income Mexican Americans were randomly selected of whom 2,076 were interviewed at home and 1,511 were examined (response rate 64.1%). Oral glucose tolerance tests were performed at both sites and diabetes was diagnosed according to the World Health Organization (WHO) criteria. In Mexico City, 288 type II diabetic individuals were identified, and 255 were identified in San Antonio. The following variables were measured: height, weight, subscapular and triceps skinfolds, waist-to-hip circumference ratios (WHR), systolic and diastolic blood pressure (random 0 sphygmomanometer), fasting and 2-h postglucose load glucose and insulin concentrations, and fasting total-cholesterol, HDL-cholesterol, and triglyceride (TG) levels. A food frequency questionnaire was used to estimate total calories and the percentage of calories derived from protein, fat, and carbohydrate. Only type II diabetic patients were included in the analyses. Age-adjustment was performed by analysis of covariance for continuous variables and by the Mantel-Haenszel procedure for discrete variables. RESULTS: The mean age, the percentage newly diagnosed cases, and the percentage of males were similar in both sites. The percentage of diabetic patients treated with oral agents was significantly higher in Mexico City (56.9 vs. 72.7% in San Antonio and Mexico City, respectively, P < 0.001), whereas the percentage treated with insulin was significantly higher in San Antonio (18.8 vs. 2.1% for San Antonio and Mexico City, respectively, P < 0.001). A significant difference was observed in the percentage of calories derived from carbohydrate (61.7-63.2 vs. 47.1-47.5% for Mexico City and San Antonio, respectively, P < 0.001) and fat (18.4-20.0 and 30.1-33.0% for Mexico City and San Antonio, respectively, P < 0.001). Body mass index (BMI) was higher in San Antonio (27.6-30.4 vs. 30.2-32.9% for Mexico City and San Antonio, respectively, P < 0.05). Total serum cholesterol was similar at both sites. HDL cholesterol, however, was lower in Mexico City, both in newly and in previously diagnosed patients (30.5-35.8 vs. 39.6-43.3 mg/dl in Mexico City and San Antonio, respectively, P < 0.001). TG levels were higher in Mexico City patients (187-249 vs. 167-179 mg/dl in Mexico City and San Antonio, respectively, P < 0.001). The association between diabetes and the anthropometric and metabolic variables was similar in Mexico City and San Antonio with the following exceptions: Diabetes in Mexico City was associated with less of an elevation in BMI, WHR, and fasting insulin concentration and less of a reduction in the 2-h postoral glucose load insulin concentration compared with diabetes in San Antonio. In addition, although diabetes was associated with a lower HDL in San Antonio subjects, no association appeared between diabetes and HDL in Mexico City subjects. CONCLUSIONS: Diabetic subjects in Mexico City were more likely to be treated with oral agents and less likely to be treated with insulin compared with San Antonio patients. Previously diagnosed diabetic subjects in San Antonio had higher BMIs than diabetic subjects in Mexico City. Diabetic subjects in Mexico City ate less fat but more carbohydrate than those in San Antonio. TG levels were higher and HDL-cholesterol levels were lower in Mexico City diabetic subjects compared with those in San Antonio. San Antonio diabetic subjects had lower HDL levels than nondiabetic subjects but, in Mexico City, HDL levels were similar in diabetic subjects and nondiabetic subjects...

Adult↗
PubMed1993

Caring for neighbors: an examination of nonresident use of New York City hospitals.

In 1989, almost 10 percent of all patients--or nearly 100,000 patients--hospitalized at facilities located in New York City were not city residents. Nonresidents are attracted to the city by the prestige and expertise of the city's hospitals; they are more likely than residents to require the hospitals' most sophisticated and specialized services, ranging from transplantation and coronary bypass surgery to treatment of malignant conditions. The largest numbers of nonresident patients, however, receive care for conditions that are relatively routine, care which would seem to be generally available at suburban hospitals. Although New York City hospitals continued to serve a substantial number of patients residing outside the city, the flow of nonresident patients seems to be slowly diminishing, particularly at the city's academic medical centers. (The specialty hospitals, on the other hand, seem to be attracting an increasing share of nonresident patients.) This decline occurred despite the one-third increase in population since 1960 in the New York State counties surrounding the city. To complicate matters, many New Yorkers are leaving the city for care. Almost 40,000 New York City residents were admitted to hospitals elsewhere in New York State, and perhaps another 20,000 to 40,000 may be receiving hospital care in other states. These trends have obvious implications for the city's hospital in their dual role as leaders in advanced and sophisticated medical care and as providers of vital patient care services to the city's population. The most highly specialized services can maintain clinical expertise and remain financially viable only if a sufficient number of patients can be attracted from throughout the metropolitan area and beyond. Likewise, the city's hospitals can be confident of fulfilling basic patient care needs only as long as New Yorkers do not look elsewhere for care. With the myriad pressures on our hospitals, the challenge of keeping them inviting and responsive will be formidable, but the construction of modern facilities, emphasis on patient-centered care, cultivation of strong relationships with communities and practitioners, and careful monitoring of patient flows and patient satisfaction should help the city's hospitals continue to attract patients, both from within the city and beyond the city limits.

Adolescent↗