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Biomedical subjects

A M Navarro

Publications and source records attributed to A M Navarro.

At least 19 recordsLinked to original sources
PubMed2001

Simulated effect of tobacco tax variation on Latino health in California.

BACKGROUND: Over one fourth of the California population was Latino in 1999, and by 2015 Latinos are expected to be the single largest ethnic group in California. Patterns of smoking and nicotine dependence among Latino smokers may be quite different from those of smokers in other ethnic groups. In addition, Latino smokers may be more sensitive to cigarette prices. Therefore, the effect of an increase in cigarette excise taxes on Latino smoking prevalence may be quite large, and consequently the impact on Latino health may be proportionately greater than on population health in general. METHODS: We simulated changes in Latino smoking, morbidity, mortality, and quality-adjusted life years (QALYs) that would result from a range of actual and proposed cigarette excise-tax increases using a range of cigarette price-elasticity estimates specific to Latino smokers. Monte Carlo simulation was used to generate confidence intervals. RESULTS: Assuming a Latino price elasticity of demand for cigarettes of -1.0, reductions in Latino smoking resulting from an additional $0.50/pack tax would produce nearly 3000 Latino QALYs in California in 1999. Greater benefits would accrue each year, until a steady state relative to population size is reached 75 years after the program is initiated. CONCLUSIONS: If Latino smokers are more responsive to changes in cigarette prices than other smokers, Latino smokers also stand to gain a disproportionate share of the health benefit from an excise tax increase.

California↗
PubMed2001

Simulated effect of tobacco tax variation on population health in California.

OBJECTIVES: This study simulated the effects of tobacco excise tax increases on population health. METHODS: Five simulations were used to estimate health outcomes associated with tobacco tax policies: (1) the effects of price on smoking prevalence; (2) the effects of tobacco use on years of potential life lost; (3) the effect of tobacco use on quality of life (morbidity); (4) the integration of prevalence, mortality, and morbidity into a model of quality adjusted life years (QALYs); and (5) the development of confidence intervals around these estimates. Effects were estimated for 1 year after the tax's initiation and 75 years into the future. RESULTS: In California, a $0.50 tax increase and price elasticity of -0.40 would result in about 8389 QALYs (95% confidence interval [CI] = 4629, 12,113) saved the first year. Greater benefits would accrue each year until a steady state was reached after 75 years, when 52,136 QALYs (95% CI = 38,297, 66,262) would accrue each year. Higher taxes would produce even greater health benefits. CONCLUSIONS: A tobacco excise tax may be among a few policy options that will enhance a population's health status while making revenues available to government.

Adolescent↗
PubMed2000

The effects of psychological therapies under clinically representative conditions: a meta-analysis.

Recently, concern has arisen that meta-analyses overestimate the effects of psychological therapies and that those therapies may not work under clinically representative conditions. This meta-analysis of 90 studies found that therapies are effective over a range of clinical representativeness. The projected effects of an ideal study of clinically representative therapy are similar to effect sizes in past meta-analyses. Effects increase with larger dose and when outcome measures are specific to treatment. Some clinically representative studies used self-selected treatment clients who were more distressed than available controls, and these quasi-experiments underestimated therapy effects. This study illustrates the joint use of fixed and random effects models, use of pretest effect sizes to study selection bias in quasi-experiments, and use of regression analysis to project results to an ideal study in the spirit of response surface modeling.

Humans↗
PubMed2000

Prevalence of sensitization to Tetranychus urticae in greenhouse workers.

BACKGROUND: Tetranychus urticae (TU) is a macroscopic mite which infests a large number of plants of economic interest worldwide. It has recently been described as a cause of occupational allergic disease in greenhouse workers. However, there are no epidemiological data concerning the prevalence of TU allergy in an unselected exposed population. OBJECTIVE: The aims were to study the prevalence of TU sensitization among greenhouse workers and its relationship to the working environment and to personal factors. METHODS: We studied 246 consecutive greenhouse workers, recruited directly from the field. A clinical and epidemiological questionnaire, a skin-prick test (SPT) to TU and common allergens and TU-specific IgE (RAST) determinations were performed. Seventy-five healthy volunteers and 152 atopic patients were used as a control group. RESULTS: The prevalence of a positive SPT to TU was of 25%. Forty-five workers (19%) were TU-allergic, occurring more often in atopic greenhouse workers (P < 0.0001). Seven per cent showed asymptomatic sensitization. The time of exposure to TU was significantly greater in the TU-allergic patients (P < 0.05). The probability of sensitization to TU was 3.7 times greater in exposed than in non-exposed subjects (P < 0.0001). CONCLUSIONS: In this study, the prevalence of TU sensitization was 25%. There were significant associations with TU allergy and atopy and the time of exposure to TU.

Adult↗
PubMed2000

Community-based education in nutrition and cancer: the Por La Vida Cuidándome curriculum.

The Por La Vida (PLV) intervention model relies on community lay health advisors trained to conduct education sessions among members of their existing social networks. PLV Cuidándome was funded by the NCI to develop, implement, and evaluate the PLV model with respect to nutrition and cancer prevention, as well as early detection of breast and cervical cancers. The target population is the Latino community, for which substantial barriers to health care access exist. This article presents the curriculum that guides the sessions and describes its development, which was based on semi-structured interviews with Latina lay-health community workers to explore relevant attitudes and behaviors. Also key to the process was the work of the educational materials committee, whose members offered community representation as well as expertise in nutritional sciences, educational technologies, and community-based health promotion interventions and research. The 12-session curriculum's goal was to increase both the variety and the quality of fruits and/or vegetables consumed. It included information about consumption of fiber and fat in the importance of balance between energy intake and physical activity. The program has been well received. An ongoing study examines how it enhances nutrition and cancer prevention.

Community Health Services↗
PubMed1999

Smoking status by proxy and self report: rate of agreement in different ethnic groups.

OBJECTIVE: To examine the rate of agreement between proxy and self report of smoking status in Hispanics compared with other ethnic groups. DESIGN: Data source is the 1990 California Tobacco Survey (CTS) which includes proxy and self reported smoking status. The CTS is a random digit dialed survey conducted in 57,244 households. A sample of 10,011 adults was included in the analyses. MAIN OUTCOME MEASURE: Percentages of agreement and disagreement between self report and report by other member of the household on smoking status. RESULTS: Cohen's kappa coefficients of agreement on smoking status between self report and proxy report was highest in non-Hispanic whites and African Americans (kappa = 0.91), followed by Asian Americans (kappa = 0.82) and Hispanics (kappa = 0.76). Among adults identified as current smokers by proxy, a lower percentage of Hispanics compared with non-Hispanics indicated that they were current smokers (odds ratio (OR) = 3.74, 95% confidence intervals (CI) = 3.28 to 4.20). Furthermore, agreement between proxy and self report was also lower in Hispanics of low acculturation compared with Hispanics with a high level of acculturation (OR = 0.40, 95% CI = 0 to 0.94). CONCLUSIONS: The agreement between self reported and proxy reported smoking status is higher among non-Hispanics compared with Hispanics. Smoking rates in different ethnic groups that are estimated by telephone surveys including proxy and self report might not be comparable.

Adolescent↗
PubMed1998

Por La Vida model intervention enhances use of cancer screening tests among Latinas.

OBJECTIVE: To describe the short-term impact of the intervention known as Por La Vida (PLV) on cancer screening for Latinas in San Diego, California. METHODS: Thirty-six lay community workers (consejeras) were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program. The consejeras were randomly assigned to either a twelve-week cancer screening intervention group or a control group in which they participated in an equally engaging program entitled "Community Living Skills." Pre- and post-intervention self-report information was obtained from project participants on the use of cancer screening examinations. Outcome measures were changes in the percentages of women who had breast and cervical cancer screening test within the past year before and after the intervention occurred. Experimental and control groups were compared using t-tests. Analyses were conducted using both consejeras and participants as the unit of analysis. RESULTS: The increase in the use of the cancer screening test was higher in the PLV cancer intervention group in comparison to women in the community living skills control group. CONCLUSIONS: Key to the PLV intervention model is the identification of natural helpers in the Latino community and their subsequent training in intervention based on social learning theory using culturally appropriate educational materials. The model is an effective and viable approach for increasing the use of cancer screening tests in Latinas of low socioeconomic level and low level of acculturation.

Adult↗
PubMed1997

What meta-analyses have and have not taught us about psychotherapy effects: a review and future directions.

Sixty-three meta-analyses of psychotherapeutic interventions are reviewed to examine what we have learned from them about the causal nature, magnitude, and generalizability of psychotherapy effects. Despite the large number of meta-analyses demonstrating specific and nonspecific causal effects of psychotherapeutic interventions, limitations in outcome studies and in meta-analytic reviews currently prevent us from drawing strong generalized inferences about the magnitude of effects, conditions that moderate their size, and variables that mediate therapy effects. There is mounting evidence suggesting that biases associated with individual studies do not cancel each other out when studies are combined meta-analytically, leading to inflated mean effect estimates for some interventions, diagnoses, and outcomes, and deflated estimates for others. There is currently little agreement in the reviewed meta-analyses concerning the limits of the apparent robustness of intervention effects, and variables considered as potential moderators of psychotherapy effects are frequently confounded with other study characteristics. Moreover, generalizability of psychotherapy effects to major target universes (e.g., clinical practice settings, African-American and Latino populations) is compromised by the predominance of efficacy studies conducted in controlled research settings on Anglo populations. Future directions for meta-analyses of psychotherapy outcome studies are discussed.

Bias↗
PubMed1997

Evidence that therapy works in clinically representative conditions.

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.

Humans↗
PubMed1997

Occupational allergy in greenhouse workers: sensitization to Tetranychus urticae.

BACKGROUND: Tetranychus urticae (TU) is a macroscopic mite which is found infesting a large number of plants of economic interest. It has rarely been described as a cause of occupational allergic disease in agricultural workers. OBJECTIVE: To describe TU sensitization in greenhouse workers attending the outpatient allergy unit and its clinical associations, and to characterize the allergens involved. MATERIALS AND METHODS: Twenty-four consecutive carnation greenhouse workers with allergy-related symptoms, referred to our outpatient clinic during a 6-month period, were included. We made the diagnostic extract from carnation leaves heavily infested with TU. Skin-prick test, specific IgE measurement and bronchial provocation test with TU extract were carried out in all subjects. Allergen characterization was achieved by SDS-PAGE (sodium dodecylsulfate-polyacrylamide gel electrophoresis) and immunoblotting. RESULTS: Sixteen patients (66%) presented positive skin-prick test and specific IgE and were diagnosed allergic to TU. Fifteen patients suffered from bronchial asthma, 14 rhinitis and five urticaria. Twelve exhibited positive bronchial provocation test to the TU extract. On RAST-inhibition studies, there was no evidence of crossreactivity between TU extract and D. pteronyssinus. An allergen at 19 kDa was determined in the TU extract by SDS-PAGE immunoblotting studies. CONCLUSION: TU could be an important occupational allergen in greenhouse workers showing allergic symptomatology. There is no crossreactivity between this mite and the house dust mite D. pteronyssinus.

Adolescent↗
PubMed1996

Mammography screening: prospects and opportunity costs.

Health care costs in the United States now consume nearly 15% of the gross domestic product. Continued expansion of health expenditures may have serious economic consequences, including reduction in the standard of living. Health care reform must include cost control without consequent detrimental effects on health status. As a case example, we consider the controversy surrounding mammography screening for premenopausal women. Several literature reviews of published studies suggest that screening of women less than 50 years of age does not statistically significantly reduce mortality from breast cancer. These results are not explained by screening interval, recentness of study, or patient compliance to screening. We conclude that screening is effective in decreasing mortality from breast cancer for women older than 50 years. For women less than 50, mammography screening programs displace resources that could have a greater benefit in women's health status if used for other purposes.

Adult↗
PubMed1995

Por La Vida intervention model for cancer prevention in Latinas.

Our goal was to describe the development and implementation of an intervention on cancer prevention for Latinas in San Diego, Calif. Thirty-six lay community workers ("consejeras") were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program (total number = 512). Half of the consejeras were randomly assigned to a control group, in which they participated in an equally engaging program entitled "Community Living Skills." Implementation of the intervention was assessed by qualitative and quantitative methods. Preintervention and postintervention self-report information was obtained from project participants on access to health care services, cancer knowledge, preventive measures, and previous cancer-screening examinations. Base-line data suggest that lack of knowledge, costs of cancer-screening tests, and the lack of a regular health care provider are the major obstacles against obtaining cancer-screening tests. Predisposing factors, such as fear and embarrassment, also constitute barriers to getting regular cervical cancer screening. Preliminary analysis indicates that the Por La Vida intervention increases use of cancer-screening tests in comparison to a community living skills control group. Universal access to health care would remove some of the major financial barriers to cancer screening. The Por La Vida program attempts to overcome the substantial barriers by reaching out to low-income Latinas and by providing information regarding the availability, acceptability, and preventive nature of cancer-screening tests.

Adult↗
PubMedDate not supplied

[Cimetidine in the treatment of postoperative peptic ulcer].

The results of treatment with cimetidine in 12 patients with postoperative peptic ulcer are presented. Anterior surgical procedures were: Billroth II gastrectomy (8 cases), proximal selective vagotomy (1 case), truncal vagotomy plus pyloroplasty (1 case), gastroenteroanastomosis (1 case) and intrathoracic esophagogastric anastomosis (1 case). Clinical diagnosis was confirmed by radiology and endoscopy. Gastric secretion, both, basal and stimulated by Histalog was considered high (basal from 0,82 to 4,68 mEq/1 stimulated from 6,06 to 54,1 mEq/1). The patients were treated with 1,0 g of cimetidine daily, divided in four dosis. Healing assessed endoscopically, was seen in 75%. Treatment with cimetidine failed in three patients (25%) who were submitted to selective vagotomy and their ulcers healed. The authors conclude that treatment with cimetidine in postoperative peptic ulcer is effective and should be the first choice before surgical reoperation.

Adult↗
PubMedDate not supplied

Completeness of tuberculosis case reporting, San Juan and Caguas Regions, Puerto Rico, 1992.

Completeness of tuberculosis case reporting in Puerto Rico was assessed. Cases diagnosed among hospitalized, tuberculosis, and human immunodeficiency virus clinic patients during 1992 were retrospectively reviewed. Hospital discharge diagnoses, pharmacy listings of patients receiving anti-tuberculous medications, laboratory and acquired immunodeficiency syndrome registry data were used for case finding in selected hospitals and clinics. Identified cases were matched to the health department TB case registry to determine previous reporting through routine surveillance. Records of unreported cases were reviewed to verify tuberculosis diagnoses. Of 159 patients with tuberculosis, 31 (19.5%) were unreported. A case was defined according to the Centers for Disease Control and Prevention definition. Unreported cases were less likely than previously reported cases to have specimens that were culture positive for M. tuberculosis, 14 of 31 (45.2%) compared with 111 of 128 (86.7%). Excluding the laboratory, tuberculosis diagnoses in acquired immunodeficiency syndrome registry patients had the highest predictive value of finding tuberculosis (94.1%), followed by tuberculosis clinic records (71.7%), and pharmacy listings (45.6%). Tuberculosis discharge diagnoses, however, yielded the largest number of unreported cases (14). Health care providers should be educated regarding the importance of promptly reporting all suspected TB cases regardless of results of laboratory testing.

Acquired Immunodeficiency Syndrome↗