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PubMed1999

Trends in incidence and treatment for ductal carcinoma in situ in Hispanic, American Indian, and non-Hispanic white women in New Mexico, 1973-1994.

BACKGROUND: Incidence rates of ductal carcinoma in situ (DCIS) breast carcinoma and the use of breast-conserving surgery (BCS) for its treatment show substantial geographic and ethnic variations nationwide. To the authors' knowledge, few studies have investigated incidence rates and treatment patterns in Hispanics and American Indians. METHODS: The authors used data from the population-based New Mexico Tumor Registry to describe trends in DCIS incidence rates between 1973-1994 and investigate patient and physician characteristics related to BCS in a multiethnic population between 1985-1994. Multiple logistic regression was used to evaluate patient and physician factors related to receiving BCS. RESULTS: Incidence rates for DCIS in Hispanics were approximately 50% lower compared with non-Hispanic whites. American Indians had the lowest incidence rate. Beginning in 1985, incidence rates for Hispanics and non-Hispanic whites showed a 21% annual increase. Between 1990-1994, incidence rates in American Indians increased more than twofold. BCS increased 5.8% per year between 1985-1994, with 50% of Hispanic and non-Hispanic white patients treated with BCS in 1994. The strongest factor associated with receiving BCS was geographic location of treatment (P < 0.001). The odds of receiving BCS were 5.8 times higher in the northern third of the state compared with the southern third. No significant variation in BCS was found by ethnicity, rural/urban residency, socioeconomic status, or physician characteristics. CONCLUSIONS: Incidence rates for DCIS increased substantially in all three ethnic groups. The use of BCS was associated most strongly with the location of treatment, most likely reflecting differences in physician practices and treatment recommendations. Further research is needed to investigate the increasing incidence rates of DCIS and the determinants of BCS for the treatment of DCIS.

Adolescent↗
PubMed1993

Does planning pay off? A look at the experience of New Mexico's rural hospitals.

When Medicare's prospective payment system (PPS) was implemented, hospitals faced the prospect of diminishing reimbursement. Added to other fundamental changes involving medical practice, consumerism, competition, and medical technology, hospitals had significant incentives to focus more attention on strategic planning. This article examines how rural hospitals altered their strategic planning in response to PPS and the extent to which planning is related to better performance. It presents results from a case study of rural New Mexico hospitals. The implications of these results for other hospitals are discussed by the authors.

Chief Executive Officers, Hospital↗
PubMed1996

Access of Native Americans to renal transplantation in Arizona and New Mexico.

Lower rates of transplantation among minority groups are a nationally recognized phenomenon. Native Americans (NA) nationally have nearly four times the risk of end-stage renal disease (ESRD) as compared with white (W) Americans and are significantly overrepresented in the Network 15 ESRD population. To understand more about NA and W transplant rates, we looked at all reported Arizona (AZ) and New Mexico (NM) resident cases from the Network No. 15 data base. Age of onset, sex, primary diagnosis, payment source, transplant donor source, and other factors were examined. NA experienced a slightly earlier onset of ESRD than W, and diabetes mellitus was the primary ESRD diagnosis for 63-73% of NA and for 34-39% of W. Because age distribution and frequency of diabetes mellitus of the NA ESRD population differ from those of W in the Network, age-specific and diagnosis-specific transplant rates were examined. Age-adjusted transplant rates per 100 ESRD patients for AZ were 16.4 (NA) and 21.0 (W) and for NM 14.2 (NA) and 22.4 (W). Diagnosis-specific age-adjusted transplant rates for patients with the primary diagnoses of diabetes mellitus and glomerulonephritis, the two most common causes of ESRD among NA, showed a large difference between W and NA rates. Age-adjusted rates for diabetes were: AZ 8.4% (NA) and 14.5% (W); NM 9.8% (NA) and 15.9% (W). Age-adjusted rates for patients with glomerulonephritis were: AZ 23.7% (NA) and 28.0% (W); NM 22.3% (NA) and 33.0% (W). In all comparisons and in both the W and NA ESRD populations, women were transplanted at lower rates than men. NA experienced a greater delay from onset of treated ESRD to transplant than W. Payment source and transplant donor source did not appear to be significantly different between NA and W. The lower transplant rates in NA versus W in Network No. 15 cannot be explained by age- or diagnosis-specific factors.

Adolescent↗
PubMed2001

Family history and risk of breast cancer in hispanic and non-hispanic women: the New Mexico Women's Health Study.

OBJECTIVES: Many epidemiologic studies have demonstrated that an increased risk of breast cancer is associated with positive family history of this disease. Little information had been available on the relationship of breast cancer risk with family history in Hispanic women. To investigate the association of family history of breast cancer on the risk of breast cancer, we examined the data from the New Mexico Women's Health Study (NMWHS), a statewide case-control study. METHODS: In this study 712 women (332 Hispanics and 380 non-Hispanic whites) with breast cancer and 844 controls (388 Hispanics and 456 non-Hispanic whites) were included. Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI). adjusted for sociodemographic, medical, and reproductive factors. RESULTS: We found an increased risk in women with a history of breast cancer in one or more first-degree or second-degree relatives (OR= 1.5, 95% CI 1.2-1.9), first-degree relatives (OR= 1.3, 95% CI 1.0-1.8) and second-degree relatives (OR = 1.6, 95% CI 1.2-2.2). Hispanic women had higher risk estimates for a positive family history (OR= 1.7, 95% CI 1.1-2.5) than non-Hispanic white women (OR= 1.4, 95% CI 1.0-2.0); however, the differences were not statistically significant. In both ethnic groups a higher risk was observed in premenopausal women compared with postmenopausal women and women diagnosed with breast cancer before age 50 years compared with older women. CONCLUSIONS: The results indicate that Hispanic women with a family history of breast cancer are at increased risk of breast cancer.

Adult↗
PubMed1998

Rat-bite fever--New Mexico, 1996.

Rat-bite fever (RBF) is a systemic bacterial illness caused by Streptobacillus moniliformis that can be acquired through the bite or scratch of a rodent or the ingestion of food or water contaminated with rat feces. Cases are rarely reported in the United States and the true incidence of disease is unknown. On August 7, 1996, a physician in a rural community reported a case of infection with S. moniliformis bacteremia in a 15-year-old boy to the New Mexico Department of Health. This report summarizes the results of the investigation of this case and indicates the need for ongoing surveillance for this illness.

Adolescent↗
PubMed1998

The roles of library liaisons in a problem-based learning (PBL) medical school curriculum: a case study from University of New Mexico.

The relationships between problem-based learning (PBL) curricula and libraries have generated a substantial number of journal articles, but few have addressed the importance of the interaction between health science libraries and PBL curricula. This article attempts to contribute to this dimension through a description of the roles of library liaisons. First we describe the evolution of the liaison roles beginning 2 years prior to the implementation of a PBL curriculum. We then describe the core responsibilities of liaisons at the University of New Mexico (UNM) with mention of other innovative roles developed by some liaisons.

Curriculum↗
PubMed2003

Climatic factors and the occurrence of vesicular stomatitis in New Mexico, United States of America.

Vesicular stomatitis (VS) outbreaks occurred in the southwestern United States of America in 1995, 1997 and 1998. The epidemiology of VS is not understood completely and some of the epidemiologic aspects of this disease are currently under investigation. In this study, daily maximum temperature, daily minimum temperature, daily mean temperature, daily mean relative humidity and daily total precipitation were collected at the Sevilleta Long Term Ecological Research site in central New Mexico. Discriminant analysis was used to identify the climatic variables best able to classify in which months VS would occur. The study found that the amounts of precipitation occurring two, ten, eleven and twelve months prior to the month in which cases were diagnosed, were the climatic variables that best described the occurrence of VS cases. The association of VS cases and precipitation suggests that, like numerous other arthropod-borne diseases, transmission of the disease-causing pathogen is linked to variations in climate.

Animals↗
PubMed1999

Measuring social responsiveness of medical schools: a case study from New Mexico.

Medical schools can assess their social responsiveness by gauging the degrees to which the health needs of the populations and communities they serve frame their missions and endeavors in education, service, and research. Beyond considering these traditional academic missions, medical schools can also assess how well they apply their expertise to needed reform of the health care delivery system and to the formation of health policies aimed at improving community health status. This article summarizes the means by which a medical school's social responsiveness can be judged in each of the above areas, and it presents examples of successes and failures in such responsiveness by the University of New Mexico School of Medicine. It concludes with lessons learned that can guide future innovations in social responsiveness of medical schools.

Curriculum↗
PubMed1997

Risk factor information found in medical records of lung and prostate cancer cases, New Mexico Tumor Registry (United States).

The conduct of public health surveillance and epidemiologic investigations would be enhanced by a cost-effective method for the collection of population-based cancer risk-factor data. We assessed the feasibility of ascertaining such data from hospital medical records during routine abstraction of information from a cancer registry. We examined the medical records of a representative sample of prostate and lung cancer cases diagnosed during 1992 and 1993 from the New Mexico (United States) Tumor Registry (NMTR) database. Registry personnel abstracted ancillary information from the medical records of 575 prostate and 273 lung cancer cases. Of medical records from 848 cases, 90 percent documented a history of tobacco use, 77 percent contained any family medical history, and 48 percent documented occupational information sufficient to allow coding into standard occupational groups. Availability of occupation and industry varied by patient ethnicity, age at diagnosis, marital status, and type of hospital, indicating the potential for bias in studies using occupational information from medical records. Our findings suggest that risk factor information abstracted from medical records may provide valuable information for public health surveillance, but is generally too incomplete to serve as a single source of exposure information for etiologic studies. Family histories in medical records may be sufficient for population-based ascertainment of affected relative pairs for genetic epidemiology studies for some cancer types.

Aged↗
PubMed1999

Interdisciplinary ambulatory education and service in primary care at the University of New Mexico.

To compete and survive in a managed care market, academic health centers must develop integrated delivery systems in general and an integrated primary care system in particular. However, the departmental-based structure at most academic health centers is ill-suited to this purpose. Service and education are usually segregated by department, and the professional activities of primary care faculty in different departments are fragmented, leaving them weakened as a political force within the institution. The University of New Mexico established a model of integrated primary care education and service by creating three interdisciplinary primary care clinics staffed by primary care residents and faculty. The clinics attracted a substantial portion of each department's faculty and residents. The clinics united primary care providers from different departments as a stronger, more unified voice in negotiating with the hospital and in fostering needed changes for primary care in the institution. Interdisciplinary teams require considerable time and labor both in planning (because of joint decision making) and in operation. Better staff structures and staff development must be learned through trial and error because there are not established benchmarks for interdisciplinary teams. Governance presents problems, primarily because loyalties to departments may supersede those to the clinic practice, and sometimes the departments' teaching priorities are challenged by clinic directors' need to ensure filling their interdisciplinary staff needs. These obstacles to collaboration can be addressed creatively, and ultimately the comprehensiveness and quality of care convinces providers and the institution.

Academic Medical Centers↗
PubMed2000

Serum vitamin B12, C and folate concentrations in the New Mexico elder health survey: correlations with cognitive and affective functions.

OBJECTIVES: 1) To compare serum vitamin B12, C and folate concentrations in a randomly selected sample of elderly (age 65 years or older) male and female Hispanics and nonHispanic whites (NHW) and 2) to examine associations between serum B12, C and folate concentrations compared to measures of cognitive and affective (depression) functions. METHODS: Equal numbers of male and female Hispanics and NHW were randomly sampled from the Health Care Financing Administration (Medicare) registrant list for Bernalillo County, New Mexico, and asked to volunteer for a paid home interview followed by a paid comprehensive interview/examination covering health and health-related issues. In addition to serum determinations of B12, C and folate, associations were examined between these vitamins and measures of cognitive and affective functions. RESULTS: Males and Hispanics had lower serum vitamin B12, C and folate concentrations than females and NHW respectively. Participants taking a multivitamin supplement (MVI) had higher serum vitamin concentrations than those not taking MVI. There were significant associations between serum folate concentrations and measures of cognitive function, not seen with B12 or C, nor between any of the vitamins and affective function. CONCLUSIONS: Hispanics, even after adjustments for gender, age, vitamin supplementation, vitamin content of dietary foods, education and household income, had lower serum concentrations of B12, C and folate than NHW. The most significant associations observed were those between serum folate and various measures of cognitive function, even after adjusting for presence of depression.

Affect↗
PubMed2005

Confronting utilization review in New Mexico's Medicaid mental health system: the critical role of "medical necessity".

The insertion of managed care into Medicaid services for the mentally ill has created contention about clinical decision making. At the center of this debate is the matter of what constitutes a medical necessity. Employing ethnographic methodology, this study examines utilization review (UR), the context in which decisions concerning the authorization of mental health care services are made. Interviews carried out in the study contrast ideological underpinnings of providers and advocates of the mentally ill, on the one hand, with employees and administrators of managed care institutions, on the other. The result is an exploration into the ways discourses surrounding the mental health care needs of New Mexico's Medicaid population are being constructed and are determining the actual care they receive.

Adolescent↗
PubMed1999

Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999.

Products containing gamma-butyrolactone (GBL) are marketed for many claimed purposes, including to induce sleep, release growth hormone, enhance sexual activity and athletic performance, relieve depression, and prolong life. GBL is converted by the body into gamma-hydroxybutyrate (GHB), a drug banned outside of clinical trials approved by the Food and Drug Administration (FDA). Recognized manifestations of GHB toxicity include bradycardia, hypothermia, central nervous system depression, and uncontrolled movements. This report describes seven cases of GBL toxicity involving the product "Revivarant," which is labeled as containing 1.82 g of GBL per fluid ounce, reported from two hospital emergency departments (EDs) in Minnesota during October-December 1998 and summarizes an additional 34 cases of GBL toxicity reported to poison centers in New Mexico and Texas during October 1998-January 1999.

4-Butyrolactone↗
PubMed2003

Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey.

The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (age > or =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) values < or =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (>10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.

Aged↗
PubMed2002

Sampling for sand flies (Diptera: Psychodidae) among prairie dog colonies on ranches with histories of vesicular stomatitis in new Mexico and Colorado.

The possible presence of sand flies (Diptera: Psychodidae) among colonies of Gunnison's prairie dogs, Cynomys gunnisoni Baird, was investigated on or near ranches with histories of vesicular stomatitis (VS) in domestic livestock in the mid-Rio Grande River Valley, NM, and west-slope region of Colorado. Sampling was conducted at six locations, three in each region, using three methods: standard down-draft suction/light traps, up-draft suction/light traps (both supplemented with CO2), and burrow-emergence traps. Two male and four female sand flies, Lutzomyia apache, Young and Perkins were recovered from prairie dog colony and sand-sagebrush association habitats on a cattle ranch in Socorro County, NM. Sand flies were captured only in up-draft suction/light traps. This record is of interest for the following reasons: (1) sand flies have not been reported from the Rio Grande River Valley of New Mexico, (2) sand flies are biological vectors of VS viruses in other areas, (3) the mid-Rio Grande River Valley has been a focus of VS virus activity in domestic livestock during recent outbreaks, and (4) the source of vesicular stomatitis viruses that infect livestock in the western United States is unknown, but may involve introductions of virus from Mexico or an endemic cycle maintained by vector insects.

Animals↗
PubMed1997

Phylogenetic evidence of mitochondrial DNA introgression among pocket gophers in New Mexico (family Geomyidae).

Mitochondrial DNA (mtDNA) variation in the cytochrome b gene was determined for two divergent taxa of pocket gophers, Thomomys bottae actuosus and T. b. ruidosae. These two taxa hybridize in a narrow contact zone, but introgression of nuclear markers such as allozymes or chromosomes does not extend much beyond the hybrid zone (Patton et al. 1979). We found that despite their distinctness, the two subspecies shared very similar mtDNA haplotypes. By a comparison of phylogenetic histories derived from nuclear markers (allozymes) and from mtDNA haplotypes sampled in different populations of T. bottae from New Mexico, we show that apparent similarity is due to an introgression of T. b. ruidosae mtDNA into T. b. actuosus nuclear background. Evidence of introgression is not limited to the present-day contact zone between these two taxa, but extends at least 75 km away from it. The actuosus haplotype coexists along with the ruidosae mtDNA in the Gallinas Mts., which are inhabited by otherwise pure T. b. actuosus, while further north only typical actuosus haplotypes were detected. Of several potential mechanisms which could lead to such a geographical pattern of variation, we argue that a combination of range shifts due to climatic fluctuations, and genetic drift are most likely. Horizontal gene transfers due to hybridization are historical events which seem rather common among pocket gophers. Although they can be identified with careful phylogenetic study using independent data sets, the potential for misinterpreting a gene tree as an organismal tree is great in this and other groups of animals.

Animals↗
PubMed1999

Power between evaluator and community: research relationships within New Mexico's healthier communities.

The relationship between evaluators and communities has been changing in the last two decades to a model of research 'with' the community, instead of research 'on' the community. This shift has paralleled increasing community demands for accountability and authority as community participation rhetoric has given way to words such as partnership, collaboration and community empowerment. Despite the rhetoric, there has been little reflection on the problematic and contradictory relationships between communities and researchers, specifically as related to their differing positions of power. This article provides a reflective examination of the contested power dynamics of the research relationship within a participatory evaluation process of the Healthier Communities initiative in New Mexico. An in-depth literature review of the philosophical principles and the complex realities of evaluations based on participatory, community-driven and post-modern inquiry precedes the case study. Without ongoing consideration of power issues, the article argues that evaluation design, implementation and utilization of findings will be compromised.

Community Health Planning↗
PubMed2003

Emergency contraception: pharmacy access in Albuquerque, New Mexico.

OBJECTIVE: Emergency contraception could reduce the approximately 3 million unintended pregnancies that occur annually in the United States. Dedicated emergency contraception products may be particularly useful because instructions are easy to understand and simple to follow. However, they must be available within a few days to women who have had unprotected intercourse. The goal of this study was to investigate whether women presenting to pharmacies in a moderately sized metropolitan area with a prescription for Plan B or Preven could get it filled. METHODS: Two research assistants posed as women needing emergency contraception. They visited 89 pharmacies in Albuquerque, New Mexico, presenting a prescription for either Plan B or Preven. The assistants recorded the availability of the products in the pharmacies. When the product was not in stock, the research assistants asked pharmacy providers why the products were not carried. Fisher exact test was performed to compare categoric data. RESULTS: Plan B and Preven were in stock at only 19 visits (11%). Of the pharmacies that did not stock the products, 53% reported they could obtain Plan B or Preven within 24 hours. The most common reason cited by pharmacy providers for not stocking Plan B or Preven was the lack of prescriptions received for them (65%). CONCLUSION: Plan B and Preven were not in stock at the majority of pharmacies in a moderately sized metropolitan area. Lack of availability at the pharmacy constitutes a major barrier to emergency contraception access.

Contraceptives, Oral, Combined↗