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PubMed2001

Preventing and controlling tuberculosis along the U.S.-Mexico border.

Converging factors contribute to elevated tuberculosis (TB) incidence and complicate case management in the U.S. states bordering Mexico. These factors include a) Mexico's higher TB rate; b) low socioeconomic status and limited access to health care in the border area; c) frequent border crossings and travel in the United States for employment, commerce, health services, and leisure; d) language and sociocultural differences; and e) lack of coordinated care across health jurisdictions on both sides of the U.S.-Mexico border. Prevention and control efforts that address the challenges created by border-crossing populations require collaboration among local, state, and national TB control programs in both countries. In June 1999, to facilitate future discussions with Mexican counterparts, CDC convened a meeting of TB control officials from the four U.S. states bordering Mexico (i.e., California, Arizona, New Mexico, and Texas) to address TB prevention and control in the border area. Focus areas included a) surveillance needs, b) case management and therapy completion, c) performance indicators and program evaluation, and d) research needs. Meeting participants' deliberations and resulting proposals for action by CDC and state and local TB control programs are detailed in this report.

Antitubercular Agents↗
PubMed2006

Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: a cross-sectional study of U.S.- and Mexico-born Hispanic women with young children.

BACKGROUND: Detrimental effects of environmental tobacco smoke (ETS) exposure on child health are well documented. Because young children's primary exposure to ETS occurs in homes and automobiles, voluntary smoking restrictions can substantially reduce exposure. We assessed the prevalence of home and automobile smoking bans among U.S.- and Mexico-born Hispanics in the southwestern United States, and examined the influence of mother's country of birth and smoking practices on voluntary smoking bans and on child ETS exposure. METHODS: U.S.- and Mexico-born Hispanic mothers of children aged 2 through 12 years were systematically sampled from health clinics in Albuquerque, New Mexico. In-person interviews were conducted with 269 mothers (75.4% response rate) to obtain information on main study outcomes (complete versus no/partial home and automobile smoking bans; child room and automobile ETS exposure) and risk factors (mother's country of birth, maternal and household smoking behaviors). Data were analyzed with chi square tests and logistic regression models. RESULTS: Three-fourths (74-77%) of U.S.-born and 90-95% of Mexico-born mothers reported complete automobile and home smoking bans. In multivariate analyses, mother's U.S nativity, mother's current smoking, and presence of other adult smokers in the home were associated with significantly increased odds of not having a complete home or automobile smoking ban. Mother's smoking was associated with child ETS exposure both indoors (odds ratio [OR] = 3.31) and in automobiles (OR = 2.97). Children of U.S.-born mothers had increased odds of exposure to ETS indoors (OR = 3.24; 95% confidence interval [CI]: 1.37-7.69), but not in automobiles. Having complete smoking bans was associated with substantially reduced odds of child ETS exposure both indoors (OR = 0.10; 95% CI: 0.04-0.27) and in automobiles (OR = 0.14; 95% CI: 0.05-0.36). CONCLUSION: This study of Hispanic mothers in the southwestern U.S. indicates that there are substantial differences between U.S.- and Mexico-born mothers in the prevalence of home and automobile smoking bans, and resulting child ETS exposure. Tobacco interventions to increase smoke-free environments for U.S. Hispanic children should focus on both home and automobile smoking practices, especially among U.S.-born mothers, and utilize strategies that impact smoking practices of all household members.

Adult↗
PubMed1986

Seasonal variation of indoor Rn at a location in the southwestern United States.

Radon-222 concentrations have been measured in 12 homes typical of a small town in the southwestern United States. Nine of the houses, in which both summer and winter data are available, have an annual mean of 63 +/- 18 Bq m-3 (1.7 +/- 0.5 pCi L-1) and a range of 41 to 96 Bq m-3 (1.1 to 2.6 pCi L-1). These results were obtained with passive Rn dosimeters using polycarbonate nuclear track detector foils. The overall results fall slightly above the middle of the range of values obtained in other studies in the United States. Winter levels clearly exceed summer by a factor of from two to three. This result is attributed primarily to wide use of evaporative air conditioners for daytime cooling in the summer together with the fact that doors and windows are left open frequently during evening and nighttime hours. Both practices enhance the exchange of outdoor air with indoor air contributing to a decrease in the indoor Rn levels during the summer season. Room-to-room differences were evident during the winter season only. Bedrooms and bathrooms were generally higher in Rn than kitchens and living rooms but by only about 25%. The two adobe houses in the group showed higher Rn concentrations during the winter season than did those of frame-stucco, concrete, or cinder block construction. Dose equivalent calculations yielded a mean figure of 0.29 WLM y-1 for typical occupancy patterns in these New Mexico houses.

New Mexico↗
PubMed1998

Multistate evaluation of anonymous HIV testing and access to medical care. Multistate Evaluation of Surveillance of HIV (MESH) Study Group.

CONTEXT: Infection with the human immunodeficiency virus (HIV) is the only infectious disease for which anonymous testing is publicly funded, an exception that has been controversial. OBJECTIVE: To assess whether anonymous HIV testing was associated with earlier HIV testing and HIV-related medical care than confidential HIV testing. DESIGN: Retrospective cohort. SETTING: Arizona, Colorado, Missouri, New Mexico, North Carolina, Oregon, and Texas. PARTICIPANTS: Probability sample of 835 new acquired immunodeficiency syndrome (AIDS) cases reported to the state health department's HIV/AIDS Reporting System from May 1995 through December 1996. All had responded to the AIDS Patient Survey; 643 had been tested confidentially for HIV, and 192 had been tested anonymously. MAIN OUTCOME MEASURES: First CD4+ cell count; number of days from HIV-positive test result to first HIV-related medical care, from first HIV-related medical care to AIDS, and from first HIV-positive test result to AIDS. RESULTS: Persons tested anonymously sought testing and medical care earlier in the course of HIV disease than did persons tested confidentially. Mean first CD4+ cell count was 0.427x 10(9)/L in persons tested anonymously vs 0.267x 10(9)/L in persons tested confidentially. Persons tested anonymously experienced an average of 918 days in HIV-related medical care before an AIDS diagnosis vs 531 days for persons tested confidentially. The mean time from learning they were HIV positive to the diagnosis of AIDS was 1246 days for persons tested anonymously vs 718 days for persons tested confidentially. After adjustment for the subject's age, sex, race/ethnicity, education, income, insurance status, HIV exposure group, whether the respondent had a regular source of care or symptoms at the time of the HIV test, and state residence, anonymous testing remained significantly associated with earlier entry into medical care (P<.001). CONCLUSION: Anonymous testing contributes to early HIV testing and medical care.

AIDS Serodiagnosis↗
PubMed2006

Implementing an over-the-counter medication administration policy in an elementary school.

A major focus of school nursing interventions is to improve school attendance. In many schools, parents are required to leave work and/or to arrange transportation to bring their children over-the-counter medicines. Many times these children went home, missing class and making it difficult to keep up with class work. The purpose of this study was to examine the impact of a new policy and procedure allowing school nurses to administer certain over-the-counter medications in elementary schools in a southern New Mexico public school district. "Sent home" rates before implementation of the new policy were compared with sent home rates for 2 years following implementation. Although not statistically significant, findings indicated that over-the-counter medication administration by school nurses does show a trend toward sending fewer students home and, therefore, keeping them in the learning environment.

Absenteeism↗
PubMed1989

Prevalence of gallstone disease in Hispanic populations in the United States.

The 1982-1984 Hispanic Health and Nutrition Examination Survey used ultrasonography to investigate the epidemiology of gallstone disease. Mexican American, Cuban American, and Puerto Rican men and women, aged 20-74 yr, were selected from household samples in Texas, New Mexico, Arizona, Colorado, California, Connecticut, New Jersey, New York, and Florida. Ultrasonography was performed on 2299 persons. The age-adjusted prevalence of gallstone disease (gallstones + cholecystectomy) among Mexican American men (7.2%) was 1.7 times that of Cuban American men and 1.8 times that of Puerto Rican men. The prevalence for Mexican American women (23.2%) was 1.5 times that of Cuban American women and 1.7 times that of Puerto Rican women. Rates were about three times higher among women than men and increased with age in both sexes and all ethnic groups except older Puerto Rican women. Among Mexican American women aged 60-74 yr, the prevalence of gallstone disease reached 44.1%. These results support the hypothesis that Mexican Americans are at increased risk of gallstone disease.

Aged↗
PubMed2000

Managed care for uninsured patients at an academic health center: a case study.

In 1997, the University of New Mexico Health Sciences Center ("the Center") created a managed care plan ("the Plan") for its uninsured patients who were county residents. The Plan's features include pooling the resources of existing county safety-net providers, enrolling patients with primary care providers at easily accessible neighborhood-based clinics, and investing in social support services, case management, and 24-hour telephone triage. After two years of the Plan's operation, the utilization of ambulatory care services by Plan enrollees, the number of discharges per 1,000 enrollees from the Center-affiliated University Hospital, and the number of hospital days per 1,000 enrollees had all dropped significantly (p < .001 for all). For the 13,114 enrollees in the Plan, University Hospital saved an estimated $1,904,872 per year in costs. The replacement of unpaid hospital days with paying patients is estimated to have yielded over $695,000 in additional revenues per year. The authors conclude that managing the care of uninsured patients in an academic health center can reduce ambulatory care and inpatient utilization and reduce the cost of care. To achieve these favorable outcomes requires the organization of services to meet the unique needs of the uninsured and underserved population.

Academic Medical Centers↗
PubMed2006

Binational study of pediatric blood lead levels along the United States/Mexico border.

To evaluate lead exposure among children living in border communities, the states of Arizona and New Mexico in the United States (US), and the states of Sonora and Chihuahua in Mexico collaboratively requested that the Centers for Disease Control and Prevention (CDC) provide technical assistance to document pediatric blood lead levels (BLLs) in children living along this part of the US/Mexico border. Two studies were conducted to evaluate BLLs of children aged 1-6 years. In 1998, 1210 children were tested in the Arizona/Sonora study; in 1999, 874 children were tested in New Mexico/Chihuahua. Overall geometric mean BLL was 32.5 microg/l (95% Confidence Interval 31.5-33.5) with BLLs ranging from below limit of detection to 320.0 microg/l. Mean BLLs were higher among children living on the Mexican side of the border (43.2 microg/l) compared to those on the US side (22.3 microg/l). Mean BLLs ranged from 14.9 to 31.2 microg/l at the US sites and from 26.9 to 55.2 microg/l at the Mexican sites. This study used a convenience sample and cannot be considered representative of the general population. Nonetheless, the range of mean BLLs among the sites and especially the higher mean BLLs among children living in the border communities in Mexico suggests different exposures to lead and warrants further attention.

Arizona↗
PubMed2003

Early use of corrective lenses in Spanish colonies of the Americas including parts of the future United States: reference to Viceroy Luis de Velasco (the Son).

We discuss many aspects of a reproduction of a formal painting from the XVIth century. It is a portrait of Viceroy of New Spain Luis de Velasco, El Joven or Hijo (son-see text), found at the Museum of the Pecos National Monument (near Pecos and Santa Fe, New Mexico). A formal portrait of each Viceroy of New Spain was created, and this one was painted during de Velasco's first term as Viceroy (1590 to 1595 AD). In this depiction, he is seen wearing spectacles. To our knowledge, this is the first known reference suggesting the introduction of this form of visual correction in the Spanish Colonies in the Americas and in the future United States. There are three known portraits of Luis de Velasco (son): One painting, which included his father and significant others, hangs in the Colegiata (a small cathedral) de San Luis near Valladolid, Spain. In this portrayal, he was shown as a young man without a spectacle correction. And there are two viceregal portraits (Term 1, 1590 to 1595; Term 2, 1607 to 1611) in which he wears the same spectacle correction (these are located in Mexico City).

Eyeglasses↗
PubMed1994

Cheating by students: findings, reflections, and remedies.

Cheating among students is surprisingly frequent and may be increasing. The 1991 study reported herein was prompted by an episode of cheating involving three second-year medical students at the University of New Mexico School of Medicine (UNM SOM) and was undertaken (1) to elicit the opinions of faculty members and students at that institution about whether selected descriptions of students' behaviors were unethical; (2) to document possible discrepancies between the opinions of the two groups concerning these behaviors; (3) to define the prevalence of unethical behavior among current students as estimated by faculty and students; and (4) to determine how best to approach future instances of unethical behavior. Questionnaires were distributed to all faculty and students. The first two parts, sent to both groups, concerned reactions to a series of described physician and student behaviors. For each described behavior, respondents were asked whether or not it was unethical and, for the described student behaviors, whether they had personal knowledge of such behavior by local medical students. The third portion of the questionnaire concerned faculty perceptions regarding students' behaviors over time. With the exception of the class involved in the cheating incident, faculty and students were surprisingly similar in their opinions regarding the ethical nature of the described behaviors. According to both faculty and students, there was a significant incidence ( > or = to 10% of the respondents) of unethical behavior at the school of medicine, most commonly in relation to cheating on examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗
PubMed1982

Personality type and curriculum preference in primary care.

The study was conducted to examine the impact which personality types may have on the selection process of two preclinical medical school curricula. The two curricula run concurrently at the University of New Mexico School of Medicine. One curriculum has a conventional-lecture format, and the other a new student-centered curriculum, which is designed to graduate students planning careers in rural primary-care. Results indicated that those students preferring the innovative curriculum were personality types unlikely to enter rural primary-care, whereas students preferring the conventional curriculum had personality profiles more consistent with those making rural primary-care career choices. Discussion deals with the implications of personality type and curriculum choice in terms of the curriculum goals and educational method.

Career Choice↗
PubMed1994

Los Alamos rolls out technology transfer project for radiology.

Los Alamos National Laboratory in New Mexico has targeted the healthcare sector for defense technology conversion for peace-time use. As part of that transfer, a new teleradiology repository and network may soon give pulmonary specialists a powerful new information weapon to fight tuberculosis and other lung diseases.

Colorado↗
PubMedDate not supplied

Political and cultural factors in achieving continuity with a primary health care provider at an Indian Health Service hospital.

A primary care system was established at Zuni-Ramah Indian Health Service Hospital and clinic in New Mexico. Continuity and coordination of care were added to a health care system that was already accountable, accessible, and comprehensive. The new system offered each patient a personal health care provider who worked as a member of a multidisciplinary team. In changing the health care system, special attention was given to its cultural and political setting, the village of Zuni. After thorough discussion with community and staff, community members' concerns about patients' privacy and free choice were better understood, and special efforts were made to safeguard them. Ongoing evaluation is essential to maintain continuity. Eight months after the primary care system was begun, 64 percent of patients who came for care had established a personal relationship with a health care provider. For 59 percent of the visits during the 1-month evaluation period, patients saw their regular provider and, for 82 percent, patients saw their provider or one of his or her team colleagues. These percentages include night and walk-in visits. The system required no extra funding or staff. The political process of planning and consultation helped anticipate and alleviate the community's concerns, but resistance from physician's assistants and some physicians was unexpected. A flexible approach has led to a gradual acceptance of this voluntary system. This experience with the people of Zuni village shows that a primary care system can be started in a rural Indian Health Service facility with minimal outside help. Apparent improvements in quality of care make the continuity of primary care worthy of further consideration in the IHS and similar health services systems.

Continuity of Patient Care↗
PubMed1987

Epidemics in nonrandomly mixing populations: a simulation.

Two stochastic, discrete-time simulation models for the spread of an epidemic through a population are presented. The models explore the effects of nonrandom mixing within the population and are based on an SIR epidemic model without vital statistics. They consider a population of preschool children, some of whom attend child care facilities. Disease transmission occurs both within the home neighborhood and at the child care facility used, if any. The two models differ in population size used, population density, the proportions of children using different kinds of care, and the functions used for calculating the probability of disease transmission. Results are presented for seven different variables--length of the epidemic in weeks, number of cases, number of cases in each kind of care (two day care centers, private homes, and children staying at home), and the number of private home providers affected by the epidemic. In addition, the distribution of total epidemic size and the progress of an epidemic are estimated from 25 epidemic trials. The effects of the location of homes of initial cases, the type of care used by initial cases, and the density of the population are discussed. Results from the simulation confirmed the importance of type of care on the risk for disease transmission. Results from all runs of the simulation showed that children who attended a day care center were most likely to become infected, children who went to a private home were intermediate, and children who did not use any day care facility were at the lowest risk. The size and length of the epidemics were related to the presence of the disease in day care centers, regardless of the location of the initial case, and the time at which the disease entered the center(s). The simulations also showed that the geographical distribution of the homes of children attending a particular center was a critical feature involved in the production of epidemics. The center with more widely distributed homes of students was less likely to experience a major epidemic than the center with clustering of student's homes within a neighborhood. This indicates that it is not simply attendance at a day care center that is critical for disease spread, but that the nature of the population of children attending a center is also of critical importance in the actual risk for disease spread within the center. These results are discussed with reference to the spread of hepatitis A among day care centers in Albuquerque, New Mexico.

Child Day Care Centers↗
PubMed1998

Implications of the analogy between recombinant cytokine toxicities and manifestations of hantavirus infections.

The etiologic hantavirus of the 1993 emergence of an acute pulmonary failure syndrome in the area around northwestern New Mexico was quickly recognized as related to the Hantaan virus responsible for the outbreak of Korean epidemic hemorrhagic fever (EHF) among UN troops in 1951. Discovery of the new disease which was named the hantavirus pulmonary syndrome (HPS) and its causative agent the Sine Nombre virus (SNV) inspired detailed comparisons between the two disorders. Major damage to the epithelial cells of the capillaries and arterioles throughout the body leading to extensive capillary leak and subsequent hypotension and shock was the common denominator. The lung capillaries and arterioles were the focus of attack that could lead to rapid pulmonary failure in HPS and the corresponding renal and retroperitoneal vessels that caused a more protracted illness in EHF, but both displayed remarkably similar peripheral blood abnormalities including abnormal mononuclear cells, immature neutrophilia, thrombocytopenia, and hemoconcentration characteristic enough to make blood smear examination a useful tool in early diagnosis. There are evidences that a heavy virus presence in the involved endothelial cells is accompanied by various mononuclear cells capable of generating potent immune response in these areas. Relevant toxic effects of systemically-administered high-dose interleukin-2 for resistant cancers include fever, chills, diarrhea, renal dysfunction, capillary leak syndrome accompanied by hypotension requiring aggressive pressor support, and occasional pleural effusions with diffuse pulmonary infiltrates and hypoxia severe enough to require ventilatory assistance. Peripheral blood mononuclear cells cultured in vitro with IL-2 secrete secondary cytokines such as IL-1, TNF-alpha, and interferon-gamma (IFN-gamma). TNF-alpha, implicated in the pathophysiology of septic shock, is capable of inducing adult respiratory distress syndrome (ARDS) in experimental animals and humans. The strong similarity of these effects to the manifestations noted in the hantavirus diseases justifies the conviction that these and other cytokines involved in potent immune responses would constitute the pathogenic toxic substances predicted by perceptive early investigators of EHF. This concept is favored by clear indications that in both diseases active virus infection disappears the first few days and the ages of involvement correlate with periods of immunocompetence. The paradox of systemic injections of IL-2 that risk hantavirus-type toxicities for treating renal cell carcinoma and melanoma might be avoided by giving potentially more efficacious plant mitogens like PHA as previously reported. The expanded disclosure of a collaborator's method suggesting superior potential for cancer cure involves a unique application of pokeweed mitogen that delivers various cellular and cytokine responses directly to the tumor.

Adult↗
PubMed2000

Expanded emergency medical services for the provision of primary care in remote rural areas.

It is now widely recognised that a potential recruitment crisis is looming in the provision of primary care physicians for remote rural areas of the United Kingdom. Anecdotal evidence suggests that rural registrar, associate and principal vacancies are becoming increasingly difficult to fill and for many rural GPs locums are an impossible dream. Many practitioners are no longer prepared to work in areas where out-of-hours cooperatives are not available. We are now faced with the very real possibility that in some remote areas of the Scottish Highlands and Islands the recruitment of suitable GPs may no longer be possible. So what are the alternatives? In October 1999 I visited a community in the mountains of northern New Mexico which has had to deal with this very problem.

Emergency Medical Services↗
PubMed2006

Brief communication: unusual finding at Pueblo Bonito: multiple cases of hyperostosis frontalis interna.

Hyperostosis frontalis interna (HFI) is a disease characterized by excess bone growth on the internal lamina of the frontal bone and, occasionally, other cranial bones. Although the disease is fairly common in modern populations, its etiology is poorly understood. Hyperostosis frontalis interna has been identified in antiquity, primarily in the Old World, but with a much lower frequency than in modern groups. The purpose of the present study is to report multiple cases of HFI at Pueblo Bonito (Chaco Canyon, New Mexico). Twelve out of 37 adults with observable frontal bones exhibited HFI, ranging from mild to severe, including 11 females and one male. This is the first published case report of HFI in archaeological remains from the New World having a frequency comparable with modern groups. Most archaeological cases of HFI are isolated, so comparative data for multiple cases at one site are rare. The results of this study emphasize the importance of looking for HFI in archaeological remains, although it is rarely observed. Possible genetic and environmental factors for the high frequency of HFI at Chaco Canyon are considered, but additional research is needed to discover the etiology and to better understand why HFI sometimes occurs at modern frequencies in ancient populations.

Fossils↗