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Evaluation of malaria surveillance using retrospective, laboratory-based active case detection in four southwestern states, 1995.

The global resurgence of malaria has raised concerns of the possible reintroduction of indigenous transmission in the United States. The Centers for Disease Control and Prevention's National Malaria Surveillance System, using data supplied by state and local health departments (SLHDs), is maintained to detect local malaria transmission and monitor trends in imported cases. To determine the completeness of reporting of malaria cases to SLHDs, cases identified by local surveillance systems were compared with those identified through active case detection conducted at all laboratories that receive clinical specimens from 11 metropolitan areas in Arizona, California, New Mexico, and Texas. Of the 61 malaria cases identified through either local surveillance or active case detection, 43 (70%) were identified by SLHDs (range by metropolitan area = 50-100%) and 56 (92%) through active case detection. High percentages of cases were identified by SLHDs in New Mexico (80%) and San Diego County (88%), where laboratories are required to send positive blood smears to the SLHD laboratory for confirmation. Completeness of reporting, calculated using the Lincoln-Peterson Capture-Recapture technique, was 69% for SLHD surveillance systems and 89% for laboratory-based active case detection. The high percentage of cases identified by the 11 SLHDs suggests that the National Malaria Surveillance System provides trends that accurately reflect the epidemiology of malaria in the United States. Case identification may be improved by promoting confirmatory testing in SLHD laboratories and incorporating laboratory-based reporting into local surveillance systems.

Blood↗

Tuberculosis along the United States-Mexico border, 1993-2001.

OBJECTIVES: Tuberculosis (TB) is a leading public health problem and a recognized priority for the federal Governments of both Mexico and the United States of America. The objectives of this research, primarily for the four states in the United States that are along the border with Mexico, were to: (1) describe the epidemiological situation of TB, (2) identify TB risk factors, and (3) discuss tuberculosis program strategies. METHODS: We analyzed tuberculosis case reports collected from 1993 through 2001 by the tuberculosis surveillance system of the United States. We used those data to compare TB cases mainly among three groups: (1) Mexican-born persons in the four United States border states (Arizona, California, New Mexico, and Texas), (2) persons in those four border states who had been born in the United States, and (3) Mexican-born persons in the 46 other states of the United States, which do not border Mexico. RESULTS: For the period from 1993 through 2001, of the 16 223 TB cases reported for Mexican-born persons in the United States, 12 450 of them (76.7%) were reported by Arizona, California, New Mexico, and Texas. In those four border states overall in 2001, tuberculosis case rates for Mexican-born persons were 5.0 times as high as the rates for persons born in the United States; those four states have 23 counties that directly border on Mexico, and the ratio in those counties was 5.8. HIV seropositivity, drug and alcohol use, unemployment, and incarceration were significantly less likely to be reported in Mexican-born TB patients from the four border states and the nonborder states than in patients born in the United States from the four border states (P < 0.001). Multivariate analysis revealed that among pulmonary tuberculosis patients who were 18-64 years of age and residing in the four border states, the Mexican-born patients were 3.6 times as likely as the United States-born patients were to have resistance to at least isoniazid and rifampin (i. e., to have multidrug-resistant TB) and twice as likely to have isoniazid resistance. Mexican-born TB patients from the four border states and the nonborder states were significantly more likely to have moved or to be lost to follow-up than were the TB patients born in the United States from the four border states (P < 0.001). CONCLUSIONS: Increased collaborative tuberculosis control efforts by the federal Governments of both Mexico and the United States along the border that they share are needed if tuberculosis is to be eliminated in the United States.

Adolescent↗

Changing perceptions of riskiness in drinking, drugs, and driving: an emergency department-based alcohol and substance abuse prevention program.

For the last three years, the University of New Mexico School of Medicine/Division of Emergency Medicine has sponsored an Alcohol and Substance Abuse Prevention Program (ASAP). The program's objectives were to expose youth to the "real-life" social and medical consequences of alcohol and substance abuse through visits and interviews with patients and their families at the University of New Mexico Emergency Department and Trauma Center. A pretest, post-test, and eight-month follow-up evaluation design was used to assess the program's effects. Questionnaires were administered to randomly selected experimental and control groups of seventh grade students (n = 27). Repeated-measures analysis of variance detected a significant experimental/control condition x time crossover interaction effect for stated perception of riskiness, F (2, 31) = 3.20, P = .049. The data indicated that, over time, the experimental group perceived the riskiness of driving under the influence of drugs or alcohol to be greater, while the control group perceived such behavior to be less risky.

Adolescent↗

Efficacy of auricular acupressure as an adjuvant therapy in substance abuse treatment: a pilot study.

CONTEXT: Substance abuse and its related problems have become a serious public health issue, particularly in underserved border and rural communities. Conventional therapies have not always been effective. Literature regarding the use of auricular acupressure in substance abuse treatment is limited. OBJECTIVE: To examine the efficacy of auricular acupressure in addition to usual care in substance abuse treatment, which has been limited. DESIGN AND SETTING: This placebo-controlled pilot study was carried out in a community mental health center in a US-Mexico border city (Las Cruces) in southwestern New Mexico. PARTICIPANTS: A majority were Hispanic males with an average age of 32.8 years. Participants reported an average lifetime use of drug of choice of 14 years. INTERVENTION: In addition to usual care, participants received specific acupressure treatment and placebo acupressure treatment. The acupressure treatment was offered once a week for 6 consecutive weeks. MAIN OUTCOME MEASURES: The Hopkins Symptom Checklist (SCL-20) Depression Scale was administered before and after 6 weeks of treatment to assess changes in emotional distress. Brief Substance Craving Scale was used at baseline and weekly for 6 weeks to assess changes in craving. RESULTS: Both specific and placebo acupressure groups showed a significant reduction in craving at the end of treatment, with the specific acupressure group having a greater and more steady reduction in craving. Both specific acupressure and usual-care-only groups demonstrated a significant reduction in emotional stress. CONCLUSION: Overall, there was a positive response to the specific auricular acupressure treatment on psychological distress, craving, and drug/alcohol use measures. These encouraging preliminary results need to be duplicated in studies with larger sample sizes and longer treatment phases.

Acupressure↗

Application of bioelectrical impedance analysis to elderly populations.

BACKGROUND: Bioelectrical impedance analysis (BIA) can potentially be used to estimate body composition in large populations studied at multiple sites. However, it is not clear whether age-specific BIA equations are necessary for accurate application of BIA to research on elderly subjects. METHODS: We compared a published equation designed to predict fat-free mass (FFM) that had been derived in a young healthy population (mean age 27 y; mean BMI 23.9 kg/m2), with equations that we developed for the elderly by using data from 455 participants in the Framingham Heart Study (78 Y; 27.3 kg/m2), using dual-energy x-ray absorptiometry (DXA) as a reference technique. The BIA equations were then compared in an independent sample of 283 participants in the New Mexico Aging Process Study (76 y, 25.5 kg/m2), who also underwent BIA and DXA. RESULTS: When the young-population equation was applied to Framingham, it caused an overestimation of FFM in heavier subjects that was eliminated by use of the age-specific equation. However, when the two equations were tested in the New Mexico population, the published equation gave estimates of FFM that were closer to DXA than the Framingham equations did. CONCLUSIONS: The accuracy of a BIA equation depends on the body composition of the population of the population and the validation method rather than on age per se. Application of BIA to elderly populations requires uniform validation procedures in the actual study population, rather than reliance on age-specific equations.

Absorptiometry, Photon↗

Soil and crop management experiments in the Laboratory Biosphere: an analogue system for the Mars on Earth(R) facility.

During the years 2002 and 2003, three closed system experiments were carried out in the "Laboratory Biosphere" facility located in Santa Fe, New Mexico. The program involved experimentation of "Hoyt" Soy Beans, (experiment #1) USU Apogee Wheat (experiment #2) and TU-82-155 sweet potato (experiment #3) using a 5.37 m2 soil planting bed which was 30 cm deep. The soil texture, 40% clay, 31% sand and 28% silt (a clay loam), was collected from an organic farm in New Mexico to avoid chemical residues. Soil management practices involved minimal tillage, mulching, returning crop residues to the soil after each experiment and increasing soil biota by introducing worms, soil bacteria and mycorrhizae fungi. High soil pH of the original soil appeared to be a factor affecting the first two experiments. Hence, between experiments #2 and #3, the top 15 cm of the soil was amended using a mix of peat moss, green sand, humates and pumice to improve soil texture, lower soil pH and increase nutrient availability. This resulted in lowering the initial pH of 8.0-6.7 at the start of experiment #3. At the end of the experiment, the pH was 7.6. Soil nitrogen and phosphorus has been adequate, but some chlorosis was evident in the first two experiments. Aphid infestation was the only crop pest problem during the three experiments and was handled using an introduction of Hyppodamia convergens. Experimentation showed there were environmental differences even in this 1200 cubic foot ecological system facility, such as temperature and humidity gradients because of ventilation and airflow patterns which resulted in consequent variations in plant growth and yield. Additional humidifiers were added to counteract low humidity and helped optimize conditions for the sweet potato experiment. The experience and information gained from these experiments are being applied to the future design of the Mars On Earth(R) facility (Silverstone et al., Development and research program for a soil-based bioregenerative agriculture system to feed a four person crew at a Mars base, Advances in Space Research 31(1) (2003) 69-75; Allen and Alling, The design approach for Mars On Earth(R), a biospheric closed system testing facility for long-term space habitation, American Institute of Aeronautics and Astronautics Inc., IAC-02-IAA.8.2.02, 2002).

Agriculture↗

Carbon allocation, gas exchange, and needle morphology of Pinus ponderosa genotypes known to differ in growth and survival under imposed drought.

Seedlings from 27 open-pollinated families of ponderosa pine representing nine geographically diverse origins were screened for drought tolerance based on survival and growth under imposed drought. Seedlings that had been preconditioned to drought survived 14 days longer than seedlings that had been well watered before being subjected to drought. Seed sources varied in their ability to survive drought and this variation was accentuated by drought preconditioning. Seedlings from a South Dakota source and a Nebraska source generally survived the longest under drought. Seedlings from a Montana source and a New Mexico source succumbed the fastest after water was withheld. Significant family within source variation in drought survival was observed for some sources. In general, drought survival was poorly correlated to climate indices of the seed sources. Allocation of biomass to roots, stems, and needles varied significantly among the seed sources with the most drought-sensitive sources (Montana and New Mexico) showing the most divergent allocation patterns. The relation between drought survival and shoot/root ratio suggested that there is an optimum pattern of allocation for drought survival. A comparison of the most and least drought-tolerant sources indicated that needle gas exchange (net photosynthesis and needle conductance to water vapor) and predawn needle water potential were similar among the sources regardless of their relative ability to survive drought. Needle morphology traits often associated with variation in drought tolerance, such as stomatal density and specific leaf area, did not differ among the seed sources. However, seedlings from the drought-tolerant sources had shorter needles, less surface area per needle, and fewer stomata per needle than seedlings from the drought-sensitive sources. The results suggest that drought tolerance of ponderosa pine may be improved through seed source selection and, within certain sources, family selection. Allocation patterns and needle morphology appear to play a larger role than needle gas exchange patterns in determining drought tolerance in this species.

Journal Article↗

Preceptorships in high-risk perinatal nursing for rural nurses: a pilot project.

A need existed in New Mexico to enhance the skills of nurses in rural areas in the management of high-risk perinatal patients. However, barriers prohibited initiating such a program, including: a) program development and approval; b) legal and insurance issues; c) determining financial responsibility; and d) application and selection process. Resolving these problems came in the form of a collaborative effort among three departments at the University of New Mexico. A preceptor program of clinical and classroom experiences was developed for nurses outside of the Albuquerque metropolitan area. Evaluations of the program at six months revealed that program participants had implemented changes in their nursing practice. Revisions of the program and plans for the future are discussed.

Clinical Competence↗

Economic comparison of home-care-based versus hospital-based treatment of chemotherapy-induced febrile neutropenia in children.

OBJECTIVE: The purpose of this study was to compare health-care resource utilization and outcomes among children treated for low-risk febrile neutropenia (FN) in a hospital-based setting with those treated in a home-care-based setting. METHODS: The perspective of this retrospective, cohort study was the health payer. We collected health-care utilization and treatment outcome data from medical records of 63 children (26 boys and 37 girls) with low-risk, chemotherapy-induced FN who were treated at the University of Arizona (27 children, the hospital-based group) and University of New Mexico (36 children, the home-care-based group). We identified 144 FN episodes (72 episodes in each group). Health-care utilization included physician visits, home-care visits, laboratory visits, outpatient visits, hospital days, intensive care unit days, medical tests and studies, and medications used to manage FN (e.g., filgrastim, antimicrobials, and ancilliary drugs and supplies). We applied uniform charges, based on those used at the University of New Mexico in 1998. We collected outcomes of the FN treatment (success vs. failure and time to resolution, defined as number of days of antibiotic therapy). Rates of positive blood cultures during treatment were also compared. Data were analyzed using nonparametric Mann-Whitney U tests for continuous data and chi-square analysis for categorical data. Sensitivity analyses were conducted by varying the amount of total resource utilization, as well as utilization of specific health-care resources. RESULTS: There was no difference in outcome; all episodes of treatment in both groups resulted in successful recovery from FN. Time to resolution of FN was 8.3 +/- 2.7 days for home-care FN episodes versus 7.3 +/- 3.6 days for hospital FN episodes (P =.064). Median charge per FN episode was significantly (P<.001) greater when managed in the hospital compared to home care (9392 US dollars vs. 5893 US dollars). There was greater use of laboratory and radiographic studies in the hospital-based patients (P <.01). However, children in the home-care-based group were more often treated with granulocyte colony-stimulating factor (filgrastim, median charge 1085 US dollars vs. 451 US dollars, P <.001), and median antibiotic charges were higher (2523 US dollars vs. 1526 US dollars, P <.001). Positive blood cultures were more common among the hospital-based FN treatments (30.6 vs. 11.1%, P=.012). CONCLUSIONS: We found that management of low-risk FN in a home-care-based setting was associated with significantly lower median total charges with no differences in outcome.

Adolescent↗

Why do not patients receive influenza vaccine in December and January?

BACKGROUND: Influenza vaccination levels in older patients have changed little since the mid-1990s. Despite frequent health care visits by a majority of older persons, many missed opportunities continue to occur. METHODS: Patients were eligible for the study if they were age 50 and older, had not received influenza vaccine during the current season and were making a scheduled visit to one of the 13 study sites in California, New York, or New Mexico for purposes other than vaccination. Through direct observation, we determined if office staff inquired about vaccination status, discussed vaccination, or both. We defined missed opportunities as failure to administer influenza vaccine to patients for whom it was indicated. RESULTS: Missed opportunities increased steadily from October to January (P < 0.0001), and were more common when there was no inquiry or discussion (P < 0.00001), among patients aged 50-64 (P < 0.0001) and in California and New Mexico (P = 0.001). A classification tree analysis revealed that lack of inquiry and week of visit contributed most to missed opportunities. DISCUSSION: Early in the vaccination season, missed opportunities were uncommon and specific inquiries into or discussion of vaccination did not appear necessary. In December and January, patients tended to be vaccinated only when vaccination was addressed during the visit. Efforts to remind patients about vaccination later in the vaccination season may be essential to achieving higher coverage in the U.S.

Aged↗

Glucose-6-phosphate dehydrogenase (G-6-PD) mutations in Mexico: four new G-6-PD variants.

Screening for mutations at the G-6-PD gene by PCR-SSCP combined with restriction enzyme analysis and DNA sequencing was performed in nine G-6-PD deficient individuals with negative results for the presence of the most frequent G-6-PD mutations previously observed in Mexican population. The variants G-6-PD Valladolid(406T), G-6-PD Durham(713G), and G-6-PD Viangchan(871A) and four new G-6-PD mutant alleles were identified. The new mutations are located at cDNA nt 376 A --> T (126 Asn --> Tyr), nt 770 G --> T (257 Arg --> Leu), nt 1094 G --> A (365 Arg --> His), and nt 1285 A --> G (429 Lys --> Glu) and they were named G-6-PD San Luis Potosi, G-6-PD Zacatecas, G-6-PD Veracruz, and G-6-PD Yucatán, respectively. To date, a total of 18 different G-6-PD variants have been observed in Mexico and several of them are common in Africa, South Europe, and Southeast Asia.

Base Sequence↗

Joint air pollution sampling program in twin cities on the U.S.-Mexico border.

Ciudad Juárez (Chihuahua) and El Paso (Texas), two cities on the U.S.-Mexico border, form a single environmental system in which the same natural resources, especially air and water, are shared. It also constitutes a single metropolitan area which is characterized by high rates of pipulation growth, economic development, and urban expansion, all these factors mitigating against air quality. Early in 1972 the health authorities in El Paso and Ciudad Juárez initiated a joint air pollution sampling program with assistance from the Pan American Health Organization. The nearby city of Las Cruces (New Mexico) was later included in the program as well. Activities are carried out in accordance with a document entitled "Bases of Cooperation." The guiding criteria of the program are: functional simplicity, operational economy, and complementarity with other sampling programs conducted by the participating services. An Air Pollution Control Subcommittee is responsible for execution coordination of the program. Three studies are currently underway to determine levels of dust pollution in the air. A fourth study is aimed at measuring sulfur dioxide levels through the use of sulfation plates. The results collected reveal concentrations of particulates in the ambient air levels higher than the U.S. Federal primary standards. The program should be expanded to include the study of other pollutants and a joint inventory of emissions. In this way criteria on air quality may be established and joint plans of action and strategies drawn up for the control of air pollution in this important area.

Air Pollutants↗

A.J. Ladman: managing editor of The Anatomical Record, 1968-1998.

In the period 1906-1998, The Anatomical Record has had only six managing editors. One of these individuals, A.J. Ladman, served in this capacity for 30 years, almost a full third of the history of this journal up to 1998. Ladman received his Ph.D. degree from Indiana University in 1952, was at Harvard for 9 years (1952-1961) and at the University of Tennessee from 1961-1964. He became professor and chairman of the Department of Anatomy at the University of New Mexico School of Medicine in 1964. In April 1968, Ladman was appointed managing editor of The Anatomical Record by the American Association of Anatomists (AAA). He brought energy and innovative ideas to the journal and would apply those in the changes he instituted over the years of his tenure. In April 1998, after 30 years of exemplary service to this journal and to the AAA, Ladman passed the responsibility on to Roger Markwald. During his career, and in addition to his editor's work, he conducted research on an impressively wide range of topics, served as an elected officer in several professional organizations, and was founding chair of anatomy at New Mexico. He went to Hahnemann in 1981, served as Dean of the School of Allied Health Professions (1981-1986), and is currently adjunct professor of neurobiology and anatomy. The AAA expresses its sincere appreciation to A.J. Ladman for his excellent stewardship of The Anatominal Reord.

Anatomy↗

Reserve networks based on richness hotspots and representation vary with scale.

While the importance of spatial scale in ecology is well established, few studies have investigated the impact of data grain on conservation planning outcomes. In this study, we compared species richness hotspot and representation networks developed at five grain sizes. We used species distribution maps for mammals and birds developed by the Arizona and New Mexico Gap Analysis Programs (GAP) to produce 1-km2, 100-kmn2, 625-km2, 2500-km2, and 10,000-km2 grid cell resolution distribution maps. We used these distribution maps to generate species richness and hotspot (95th quantile) maps for each taxon in each state. Species composition information at each grain size was used to develop two types of representation networks using the reserve selection software MARXAN. Reserve selection analyses were restricted to Arizona birds due to considerable computation requirements. We used MARXAN to create best reserve networks based on the minimum area required to represent each species at least once and equal area networks based on irreplaceability values. We also measured the median area of each species' distribution included in hotspot (mammals and birds of Arizona and New Mexico) and irreplaceability (Arizona birds) networks across all species. Mean area overlap between richness hotspot reserves identified at the five grain sizes was 29% (grand mean for four within-taxon/state comparisons), mean overlap for irreplaceability reserve networks was 32%, and mean overlap for best reserve networks was 53%. Hotspots for mammals and birds showed low overlap with a mean of 30%. Comparison of hotspots and irreplaceability networks showed very low overlap with a mean of 13%. For hotspots, median species distribution area protected within reserves declined monotonically from a high of 11% for 1-km2 networks down to 6% for 10,000-km2 networks. Irreplaceability networks showed a similar, but more variable, pattern of decline. This work clearly shows that map resolution has a profound effect on conservation planning outcomes and that hotspot and representation outcomes may be strikingly dissimilar. Thus, conservation planning is scale dependent, such that reserves developed using coarse-grained data do not subsume fine-grained reserves. Moreover, preserving both full species representation and species rich areas may require combined reserve design strategies.

Animals↗

[First study of teledermatology in Mexico. A new public health tool].

BACKGROUND: Telemedicine has been used for more than 50 years. Dermatology has been one of the specialties where it has reached great development (Teledermatology). When the observation is made simultaneously by the outreach specialist and by the non-specialist at the workplace, it is called synchronous teledermatology, and asynchronous when information is filmed, stored, and presented to the specialist at a later time. OBJECTIVE: To evaluate efficacy and reliability of asynchronous teledermatology for adequate diagnosis of skin diseases. METHODS: Fifty patients with dermatologic disorders were seen in a poor tropical rural zone, first by non-dermatologists in conventional consultation and then by dermatologists to obtain a diagnosis (gold standard); the latter step consisted of evaluation of filmed lesions by another group of dermatologist later on. RESULTS: There was a high concordance of diagnosis between the two groups of dermatologists when kappa analysis was performed. CONCLUSION: It appears important to use these technological advances in developing-countries to improve delivery of health care.

Adolescent↗

Perchlorate and nitrate in leafy vegetables of North America.

In previous studies trace levels of perchlorate were found in lettuce (Lactuca sativa L.) irrigated with Colorado River water, which is contaminated with low levels of perchlorate from aerospace and defense related industries. In this paper, we report the results of a survey conducted across North America to evaluate the occurrence of perchlorate in leafy vegetables produced outside the lower Colorado River region, and evaluate the relative iodide uptake inhibition potential to perchlorate and nitrate in these leafy vegetables. Conventionally and organically produced lettuce and other leafy vegetable samples were collected from production fields and farmers' markets in the central and coastal valleys of California, New Mexico, Colorado, Michigan, Ohio, New York, Quebec, and New Jersey. Results show that 16% of the conventionally produced samples and 32% of the organically produced samples had quantifiable levels of perchlorate using ion chromatography. Estimated perchlorate exposure from organically produced leafy vegetables was approximately 2 times that of conventional produce, but generally less than 10% of the reference dose recommended by the National Academy of Sciences. Furthermore, the iodide uptake inhibition potential of perchlorate was less than 1% of that of the nitrate present. These data are consistent with those of other reported perchlorate survey work with lettuce, bottled water, breast milk, dairy milk, and human urine, and suggest a wide national presence of perchlorate.

Environmental Monitoring↗

Aryl hydrocarbon receptor-mediated activity of particulate organic matter from the Paso del Norte airshed along the U.S.-Mexico border.

In this study, we determined the biologic activity of dichloromethane-extracted particulate matter < 10 micro m in aerodynamic diameter (PM10) obtained from filters at three sites in the Paso del Norte airshed, which includes El Paso, Texas, USA; Juarez, Chihuahua, Mexico, and Sunland Park, New Mexico, USA. The extracts were rich in polycyclic aromatic hydrocarbons (PAHs) and had significant biologic activity, measured using two in vitro assay systems: ethoxyresorufin-(O-deethylase (EROD) induction and the aryl hydrocarbon-receptor luciferase reporter system. In most cases, both EROD (5.25 pmol/min/mg protein) and luciferase activities (994 relative light units/mg) were highest in extracts from the Advance site located in an industrial neighborhood in Juarez. These values represented 58% and 55%, respectively, of induction associated with 1 micro M ss-naphthoflavone exposures. In contrast, little activity was observed at the Northeast Clinic site in El Paso, the reference site. In most cases, luciferase and EROD activity from extracts collected from the Tillman Health Center site, situated in downtown El Paso, fell between those observed at the other two sites. Overall, a statistically significant correlation existed between PM10 and EROD and luciferase activities. Chemical analysis of extracts collected from the Advance site demonstrated that concentrations of most PAHs were higher than those reported in most other metropolitan areas in the United States. Calculations made with these data suggest a cancer risk of 5-12 cases per 100,000 people. This risk estimate, as well as comparisons with the work of other investigators, raises concern regarding the potential for adverse health effects to the residents of this airshed. Further work is needed to understand the sources, exposure, and effects of PM10 and particulate organic material in the Paso del Norte airshed.

Air Pollutants↗