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PubMed1994

A population-based autopsy study of sudden, unexpected deaths from natural causes among persons 5 to 39 years old during a 12-year period.

All unexpected deaths in New Mexico from 1977 to 1988 were reviewed. By statute each such death must be reported to the Office of the Medical Examiner (OMI) and according to institutional policy autopsied even when death is presumed to be from natural causes. From this group the 650 index cases that form the basis of this report were obtained. The crude rate of sudden, unexpected death among New Mexico residents 5 to 39 years old during the study period was 6.6/100,000 persons at risk. As documented by autopsy, the underlying cause of death in a majority of these cases (53.4%) was related to cardiovascular disease and alcoholism. Male persons in general are at increased risk for sudden, unexpected death, and American Indian and black male persons are at greater risk than their Anglo and Hispanic counterparts. American Indians account for a disproportionate share of the unexpected deaths resulting from alcoholism, and black male persons are at particular risk for unexpected death resulting from cardiovascular diseases. This report emphasizes the importance of life style and diet in the well-being of persons 5 to 39 years old.

Adolescent↗
PubMed1995

The role of Hispanic race/ethnicity and poverty in breast cancer survival.

The association of Hispanic race/ethnicity and poverty with general survival time and breast cancer survival time was examined for a total of 14,896 breast cancer patients (14,035 White and 861 Hispanic) included in the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER) program in New Mexico and San Francisco between 1975 and 1984. Variables examined included: age, marital status, stage at diagnosis, tumor histology, delay, treatment, period of diagnosis (1975-79 vs. 1980-84), and poverty. Univariate analysis of 14,896 patients indicated that a greater proportion of Hispanics (vs. Whites) with breast cancer were: younger than age 50, married, diagnosed at a later stage, diagnosed in New Mexico, lived in greater poverty, were diagnosed between 1980-84, and died from breast cancer. Univariate Cox Proportion Hazards analysis indicated that poverty was a significant predictor for reduced general survival time. Being diagnosed in the 1980-84 period was a predictor for improved general survival time. Poverty and Hispanic race/ethnicity were significant predictors of reduced breast cancer survival time. Multivariate Cox Proportional Hazards models indicated that Hispanic race/ethnicity was a significant risk factor for breast cancer survival time for women aged 50 and older. For White women: state, marital status, poverty, surgery, radiation/hormonal treatments, and histology were significant risk factors for breast cancer survival time. For Hispanic women: stage, surgery, hormonal treatment and period of diagnosis were significant risk factors for breast cancer survival time. For White breast cancer patients, period of diagnosis was not a significant risk factor for reduced breast cancer survival time; but for Hispanics, it was a significant risk factor. In the age and race/ethnicity-stratified models of breast cancer survival time, similar risk factors emerged for both Whites and Hispanics. For both younger and older Hispanics, being diagnosed in the early 1980's (vs. the late 1970's) was associated with reduced breast cancer survival time--vs. Whites, who experienced no significant change in breast cancer survival time in the same time period. Poverty was not a predictor for Hispanic survival time in any of the models; however, it was a predictor for younger Whites for breast cancer survival time. These results fueled discussion in three areas targeting breast cancer in underserved women: the development of racial/ethnic-specific cancer control guidelines, the development of a breast cancer integrated delivery system, and population management.

Adult↗
PubMedDate not supplied

Mobilizing communities to reduce substance abuse in Indian country.

The impact of substance abuse is notable on Indian reservations in the United States and in the border communities surrounding them. One Indian country community, McKinley County, New Mexico, developed and implemented a series of alcohol policy and programmatic reforms beginning in 1989 which have reduced the impact of substance abuse on this community. Learning from the McKinley County experience, Fremont County in Wyoming, home of the Wind River Indian Reservation, has implemented similar reforms. This article introduces the substance abuse reduction efforts and delineates specific innovations implemented in these communities. The influence that these two communities have had on changes in substance abuse policy and programming statewide in New Mexico and Wyoming is also reviewed.

Accidents, Traffic↗
PubMed1995

IgA nephropathy in renal allografts: increased frequency in Native American patients.

We investigated the frequency of IgA nephropathy in transplanted kidneys in 2 ethnic groups in New Mexico (USA). A total of 80 renal graft biopsies were obtained from 66 patients when clinically indicated for the differential diagnosis of graft dysfunction. Glomerulonephritis was present in 16 patients, in biopsies obtained after the first posttransplantation month. The frequency of IgAN in allografts was not the same in Native Americans and in Caucasians: Nondonor IgAN was observed in 4/18 biopsies from Native American patients (22.2%) but only in 4/48 biopsies from Caucasians (8.3%) (p < 0.01). This study demonstrates that in New Mexico the frequency of IgAN in transplanted kidneys in Native American patients is 2.7 times higher than in Caucasian graft recipients.

Biopsy↗
PubMed1991

Incidence of hairy cell leukemia, mycosis fungoides, and chronic lymphocytic leukemia in first known HTLV-II-endemic population.

Unlike human T cell leukemia-lymphoma virus type I (HTLV-I), HTLV-II has not been convincingly linked to a malignancy. In the first 10 months of serologic screening for HTLV-I/II among blood donors in New Mexico in 1988-1989, HTLV-I/II infection was found in 27 donors. HTLV-I/II infection was present in 1.0%-1.6% of American Indian and 0.16%-0.27% of Hispanic donors compared with 0.009%-0.06% of non-Hispanic white donors. HTLV-II was identified by DNA amplification in 12 of 13 samples from Indian and Hispanic seropositive donors. Despite apparent endemic HTLV-II infection in these populations, New Mexico Tumor Registry data showed that the incidences of hairy cell leukemia, mycosis fungoides, and chronic lymphocytic leukemia were comparable among the three ethnic groups. A population with endemic HTLV-II infection has been identified, and there is no evidence of increased risk for these three malignancies in the endemic groups.

Blood Donors↗
PubMedDate not supplied

Alcohol and aldehyde dehydrogenase isoenzymes in North American Indians.

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) isoenzyme phenotypes were determined in autopsy liver samples from 50 North American Indians from New Mexico. Forty-six of the 50 livers had sufficient ADH activity to allow phenotyping at the ADH2 and ADH3 loci. All 46 livers possessed the "typical" ADH2 1-1 phenotype. The frequency of the ADH3(2) allele was 0.59 and is the highest thus far reported in any racial population. All 50 livers possessed the ALDH I isoenzyme which exhibits the greatest anodic mobility on starch gel electrophoresis at pH 7.6. The results show that ADH and ALDH phenotypes among American Indians living in New Mexico are very similar to those of Caucasian populations and quite different from those of Orientals.

Adolescent↗
PubMed1999

Continuously recorded suckling behaviour and its effect on lactational amenorrhoea.

The hypothesis that the month-specific rate of return to ovarian cyclicity after childbirth is causally related to suckling pattern was tested for a population of New Mexican women recruited within the service area of New Mexico Highlands University and for a nationwide USA subpopulation of women recruited through membership of the Couple to Couple League (CCL). Survival analysis for time-dependent covariates was used, and significant predictors of the first postpartum menses were found. Important differences were detected in the suckling pattern for the two groups and a 5:2 differential was found in their respective rates of menstrual cycle recovery. Although the two groups were comparable perinatally, daily and time-windowed breast-feeding performance fell off at twice the rate for the New Mexico population when contrasted with the CCL sample. For both populations, the introduction of solid feeds was a strong and significant predictor of returning menstrual cyclicity, independent of suckling pattern.

Adult↗
PubMed1997

Three medical schools' responses to the HIV/AIDS epidemic and the effect on students' knowledge and attitudes.

PURPOSE: To assess the relative importance of factors influentail by the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), such as didactic and clinical training, and the number of HIV-infected individuals known personally, on students' HIV-related knowledge and attitudes. METHOD: A survey was undertaken of the classes of 1991 and 1994 at the University of Colorado School of Medicine, the University of New Mexico School of Medicine, and the University of South Dakota School of Medicine. The questionnaire contained 40 knowledge questions, 20 attitude questions, and demographic questions. The students reported estimates of HIV-related didactic hours and clinical encounters experienced during their training, as well as the number of HIV-infected individuals known personally. Data analysis employed two-way analysis of variance (ANOVA) and Pearson correlation coefficients. RESULTS: In 1991 the response rates were 73% from Colorado, 54% from New Mexico, and 50% from South Dakota; in 1994 the rates were 80%, 63%, and 60%, respectively. Training programs were similar between schools and over time, varying only in the amounts of didactic information offered. The 1994 students scored significantly better than did 1991 students on knowledge, overall attitude, fear of infection, and willingness to treat HIV-infected patients; these variables were significantly correlated with the numbers of HIV-infected individuals known personally by the students. Didactic training hours were not significantly correlated with any study variable, and clinical experiences were correlated only with increased knowledge. CONCLUSION: Differences in HIV/AIDS prevalences did not affect the schools' training programs, but indirectly affected the students' knowledge and attitudes, which were related to the numbers of HIV-infected individuals known personally by the students. The authors recommend that medical schools increase students' opportunities for meaningful personal contact with HIV-infected individuals.

Academic Medical Centers↗
PubMed1985

Drownings of children and youth in a desert state.

Despite the fact that New Mexico is a desert state, the drowning rate (4.3) is 40% higher than that nationally (3.0). More than half of those who drown are younger than 25 years, toddlers and adolescents being at greater risk than other age groups. In an epidemiologic study of a six-year period, male drowning victims outnumbered female and American Indian and Hispanic victims outnumbered whites. Other major risk factors were epilepsy, mental retardation and alcohol abuse. In most drownings in the under-25 age group, the victim was involved in recreation near the water or swimming, although many were partially or fully clothed. Most drownings occurred in lakes, ditches or rivers. Because New Mexico is not a water-oriented state, public awareness of drowning hazards needs to be increased and more intensive preventive efforts instituted.

Adolescent↗
PubMed1984

The rural family nurse practitioner: the quest for role-identity.

This study was conceived as an inquiry into the marginal nature of the rural family nurse practitioner's role. Data collection began with administration of a questionnaire to all family nurse practitioners in New Mexico for the purpose of selecting a subgroup for in-depth study. Eight rural family nurse practitioners were identified who were practicing as primary health care providers with a physician on-site 20% of the time or less. This group was studied over a period of 3 months. The major outcome of the study was the delineation of three highly interactive clusters of variables which appear to influence the development of a role-identity: personal attributes; organizational factors and inter-personal relations. Demographic data collected resulted in a profile indicating that the 'average' rural family nurse practitioner in New Mexico is a single 'Anglo' female between 35 and 44 years of age with a BSc in nursing and a strong religious background. Hypothetically, as agreement on role-expectations and behaviour is increased between the rural family nurse practitioner and the role-set, increased institutionalization of the role can be expected to occur.

Adult↗
PubMed2005

Information on chemotherapy and hormone therapy from tumor registry had moderate agreement with chart reviews.

BACKGROUND: Surveillance, Epidemiology, and End Results (SEER) cancer registries provide accurate information on cancer surgery and radiation, but the validity of registry data on chemotherapy and hormone therapy for breast cancer has not been well studied. We validated the registry data for chemotherapy and hormone therapy against an independent medical chart review. METHODS: We identified 1,228 women diagnosed with breast cancer at age > or = 65 in 1993-1999 in the New Mexico SEER Tumor Registry and completed medical chart reviews. RESULTS: Overall, there was moderate agreement between these two databases on chemotherapy that was received within 6 months of diagnosis. The observed agreement was 96.0%, with a kappa of 0.72 (95% confidence interval: 0.64-0.79). The sensitivity of the registry data for chemotherapy was 70.7% and the specificity was 98.2%. The positive predictive value of the registry data for chemotherapy was 77.8%. The sensitivity of the registry data for hormone therapy was 59.7%, and the specificity was 89.5%. The observed agreement for hormone therapy was 80.0%, with a kappa of 0.52 (0.46-0.57). CONCLUSION: Agreement on chemotherapy and hormone therapy between the New Mexico SEER Tumor Registry and chart reviews was moderate. The preferred approach would be to combine data from different sources to obtain more complete information.

Aged↗
PubMed2005

Evaluation of a portable evidential breath alcohol analyzer.

The Scientific Laboratory Division (SLD) of the Department of Health acts by mandate as the regulatory agency for the Implied Consent Program for the State of New Mexico. The Laboratory is responsible for all blood and breath alcohol testing activities for law enforcement statewide. The geographical size and the nature of the state, characterized by a highly rural population, demands portable breath alcohol testing equipment. Moreover, future expansion and success of the breath-testing program has focused on instrument portability and data management as critical issues amongst law enforcement agencies and the courts. Thus, the Implied Consent Section of the SLD evaluated the performance of the Intoxilyzer 8000, a portable instrument, against the Intoxilyzer 5000, a stationary instrument, which is currently approved for use. Instrument performance was evaluated at various ethanol concentrations, ranging from 0.04 to 0.55 g/100mL in blood or g/210 L breath. Special attention was placed on instrument performance at the per se and aggravated DWI levels of 0.08 g/100mL and 0.16 g/dL, respectively, due to their legal significance. Precision and accuracy were evaluated using in-house ethanol controls in a wet bath simulator. Coefficients of variation using the Intoxilyzer 8000 ranged from 0.30 to 1.3% (n=102), while CVs for the Intoxilyzer 5000 were 0.7-2.1% (n=102). Calibration stability was assessed in addition to the distribution of data at concentrations between 0.04 and 0.55 g/210 L. Accuracy was 100-102% for the Intoxilyzer 5000 and 99-101% using the Intoxilyzer 8000. Linear regression analysis of more than 700 comparative measurements revealed an R(2) of 1.000 (y=1.005x-0.001), where the Intoxilyzer 5000 and the Intoxilyzer 8000 were plotted on the x- and y-axis respectively. Instrument response to mouth alcohol and volatile interferences was also investigated. Potential interferences were evaluated alone or in combination with ethanol using a wet bath simulator at 34.0 degrees C. The effects of extreme temperature and altitude were also examined using wet bath simulators and dry gas calibrant. Accuracy and precision were evaluated at high and low temperatures. High altitude performance was evaluated at 3534 m above sea level at a local ski resort. In addition to the scientific study, field evaluations were also conducted by law enforcement personnel. Based upon the results of the study, the Intoxilyzer 8000 was approved as an evidential breath alcohol analyzer in the State of New Mexico.

Altitude↗
PubMed2002

A population-based, cross-sectional survey of the Zuni Pueblo: a collaborative approach to an epidemic of kidney disease.

Approximately 80% of the Zuni Indians live in Zuni Pueblo in rural New Mexico. The Zuni are relatively endogamous and differ culturally and ethnically from neighboring tribes. The Zuni Pueblo is experiencing an epidemic of renal disease. The prevalence of end-stage renal disease (ESRD) among the Zuni Indians, adjusted for age and gender, is 6-fold and 21-fold higher than the prevalence rates for Native Americans and European Americans. Almost all Zuni tribal members have a relative with ESRD. This has led to strong public support for renal research. In response, the Zuni community has partnered with the Indian Health Service (IHS), University of New Mexico Health Sciences Center (UNMHSC), Southwest Foundation for Biomedical Research (SFBR), Dialysis Clinic Inc (DCI), and the National Institutes of Health (NIH) to establish a research consortium, the Zuni Kidney Project (ZKP). The goal of the ZKP is to reduce the burden of renal disease in the Zuni community. The ZKP combines traditional, population-based, epidemiologic methods with modern techniques of population genetics. The foundation of the ZKP is a population-based, cross-sectional survey (PBCSS). The PBCSS has 3 specific aims: (1) estimate the prevalence of renal disease in Zuni; (2) assess risk factors for renal disease susceptibility; and (3) identify participants for planned case-control, longitudinal cohort, and family studies designed to identify environmental, familial, and genetic risk factors for the susceptibility and/or progression of renal disease. Preliminary results of the PBCSS confirm that the epidemic of renal disease in Zuni Indians is due to high rates of both diabetic and nondiabetic renal disease.

Adolescent↗
PubMed1987

Acquired immunodeficiency syndrome in low-incidence areas. How safe is unsafe sex?

Serum specimens from the cohort of persons who attended sexually transmitted disease clinics in New Mexico during a two-month period were tested for human immunodeficiency virus (HIV) antibody. Twenty-seven (2.0%) of 1374 serum specimens had repeatedly low-positive reactions by enzyme-linked immunosorbent assay testing, and 22 (1.6%) had repeatedly high-positive reactions. All sera (sufficient for testing by Western blot) with low-positive reactions gave negative results, and all sera (sufficient for testing by Western blot) with high-positive reactions gave positive results. All persons whose serum had high-positive reactions were male. Most (86%) had been seen at the only urban sexually transmitted disease clinic in New Mexico, and most (72%) were openly gay or bisexual. Of all gay and bisexual men evaluated, 14% (16/112) had high-positive reactions. Rapid plasma reagin positivity was significantly associated with HIV enzyme-linked immunosorbent assay low (false) positivity. The relatively high rate of HIV seropositivity among gay men with other sexually transmitted diseases indicates that transmission of acquired immunodeficiency syndrome is continuing in this low-incidence area and documents the need for testing and counseling programs in sexually transmitted disease clinics.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Availability of narcotics and pharmacists' attitudes toward narcotic prescriptions for cancer patients.

OBJECTIVE: To determine narcotic availability and pharmacist apprehension toward dispensing narcotics for cancer patients. DESIGN: Mailing of a one-page survey. SETTING: All pharmacies in the state of New Mexico. PARTICIPANTS: Of the 309 pharmacies, 76.1 percent (235) completed the survey. MEASUREMENTS AND MAIN RESULTS: Apprehension was significantly elevated for methadone, hydromorphone, and for morphine doses greater than 500 mg/d (p less than 0.001). The most common reasons listed for apprehension were forgery (46.4 percent), theft (40.4 percent), high dosages (23.8 percent), narcotic investigations (18.7 percent), and patient addiction (9.4 percent). Hydromorphone was available (in stock) in 80.5 percent of the pharmacies, followed by morphine 30-mg sustained-release tablets (64.5 percent) and methadone (53.4 percent). The vast majority of pharmacists were willing to order strong narcotics for specific patients. Pharmacists working in chain stores expressed a higher level of apprehension toward dispensing methadone and more frequently cited forgery as a reason for apprehension. Distance from a metropolitan area and practice setting best predicted apprehension to forgery (p = 0.01). CONCLUSIONS: Pharmacists do not appear to be a major obstruction to adequate analgesia for cancer patients in New Mexico but may require further education regarding lack of narcotic addiction and dosing in patients with cancer.

Attitude of Health Personnel↗
PubMed2005

State-by-state incidences of hantavirus pulmonary syndrome in the United States, 1993-2004.

We investigated geographic disparity in numbers of hantavirus pulmonary syndrome (HPS) cases in the United States. The 12-year incidences of HPS (cases/100,000 for total and rural residents) by state did not parallel the number of cases per state. The state with the greatest overall incidence was New Mexico, with Montana ranking second. When rural incidence based on rural human population sizes were compared, New Mexico also had the highest incidence, but Utah, Nevada, Montana, Arizona, and Colorado, in that order, also had high incidences. From these evaluations, it is clear that, in order to allow a precise risk assessment of acquiring HPS, we must first understand the host-virus cycle and we must have data regarding more exact conditions of human behaviors and exposure to the etiologic agent.

Animals↗
PubMed2006

TIPS (trigger an IIF paradigm shift).

CHALLENGE: New Mexico Corporate Services (NMCS) recordable injuries have been averaging 2-4 per year for the last 5 years with no statistical improvement. However, we believe all NM employees must go home incident and injury free every day and just as healthy as they came to work. In addition, we have received feedback from several sources, that indicates some employees are reluctant to report injuries. These indicators showed us that continuing our current strategies, making incremental improvement and changes, would not give us the improvement desired. We needed a paradigm shift to get everyone completely engaged in the IIF (Incident & Injury Free) culture, in order to achieve true IIF results. METHODS/STRATEGIES: We formed a small (3-person) taskforce consisting of safety representatives from EHS, Site Services and CS Operations. We reviewed 5 years worth of data to determine what was injuring our people. We also decided to review all injuries, not simply those classified as recordable by OSHA standards. First we identified the types of injury information needed to get a true picture of our safety issues. We analyzed IRB (Incident Review Board) data showing us the following factors and whether any of them contributed to the injury: - Date - Incident Description - Severity - Root Cause - Type of Injury - Season - Work Group/Shift - Area - Improper evaluation of hazard - Inadequate work procedures - Incorrect Mental Model - Inadequate PPE Requirement - Failure to Follow or Unaware of PPE Requirement - Shortcut or Schedule Pressure - Last or First Day of Shift or Adjacent to Holiday - OT - Aggravate Existing Condition - Inadequate Training or Passdown - Experience in Task - Corrective Action Taken - Overall Quality of Response. Once this information was collected for all injuries in an Excel file, we graphed it several ways to help reveal trends: Shift 7 had double the injuries of shift 5. Night shift injuries were relatively high but lower than Shift 7. Shift 5 had no severe (recordable) injuries. Biggest total injury type was ergonomic. Biggest recordable injury type (58%) was cuts/lacerations. Chemical exposure and inhalations resulted in no recordables. Biggest root cause category was behavioral. Biggest behavioral root cause was "Failure to Evaluate Hazards". Biggest administrative controls root cause was "Inadequate Procedures". Biggest engineering controls root cause was "Unrecognized Workplace Hazard". Majority of injuries occurred in Spring/Summer which accounted for 86% of recordables. Response was inadequate or poor for 25% of injuries. Number of injuries by workgroup were about equal. Work area injuries were mostly in the CUB and Subfab but CUB injuries favored cuts/lacerations while Subfab favored ergonomic injuries. These learnings and gaps were used to develop our New Mexico Site Safety Action Plan for 2005. It has also been used by individual managers and supervisors in their day-to-day business meetings, activities, and communications, for a more focused IIF message and effort. RESULTS: [graph: see text]. CONCLUSIONS/RECOMMENDATIONS: Challenges are different amongst shifts. Shift culture may be stronger than workgroup culture. Work areas pose different challenges that all should be aware of and prepared for. We should prepare ourselves for challenges posed by the Spring and Summer seasons as well. We should be aware of and prepare for the different challenges and cultures characteristic of each shift. Supervisors need to spend more time in the field with their people to help them address safety issues and help make IIF a more consistent component of daily workgroup culture. Each site should analyze their data and look for their unique safety challenges. This will allow customized, focused action plans that meet the unique needs of each site.

Accidents, Occupational↗
PubMed2006

Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach--United States, September 2006.

On September 13, 2006, CDC officials were alerted by epidemiologists in Wisconsin and Oregon that fresh spinach was the suspected source of small clusters of Escherichia coli serotype O157:H7 infections in those states. On the same day, New Mexico epidemiologists contacted Wisconsin and Oregon epidemiologists about a cluster of E. coli O157:H7 infections in New Mexico associated with fresh spinach consumption. Wisconsin public health officials had first reported a cluster of E. coli O157:H7 infections to CDC on September 8. On September 12, CDC PulseNet had confirmed that the E. coli O157:H7 strains from infected patients in Wisconsin had matching pulsed-field gel electrophoresis (PFGE) patterns and identified the same pattern in patient isolates from other states. This report describes the joint investigation and outbreak-control measures undertaken by state public health officials, CDC, and the Food and Drug Administration (FDA). This investigation and additional case finding are ongoing.

Disease Outbreaks↗