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Risk factors for intracerebral and subarachnoid hemorrhage among Hispanics and non-Hispanic whites in a New Mexico community.

BACKGROUND AND OBJECTIVE: A higher incidence of spontaneous intracerebral and subarachnoid hemorrhage among Hispanics than non-Hispanic whites has been measured in Bernalillo County, New Mexico. In an attempt to explain these differences, we compared historical vascular risk factors between Hispanics and non-Hispanic whites living in this community. METHODS: An ongoing telephone survey, the Behavioral Risk Factor Surveillance System, collected annual data about vascular risk factors among non-institutionalized, randomly selected adults. Data covering 6 years, 1988-1993, were analyzed. RESULTS: There were 843 Hispanic and 1,635 non-Hispanic white residents of Bernalillo County, New Mexico, who participated in this survey. Because Hispanics were significantly younger than non-Hispanic whites (37.7 vs. 43.4 years, p < 0.001), all other comparisons were adjusted for age. Prevalence of hypertension was similar between these ethnic groups (15-17%). Prevalence of alcohol drinking considered risky for abuse was similar between these ethnic groups (5-6%), but was significantly higher among Hispanic men than women (8.5 vs. 1.6%, p < 0.001). The quantity of alcohol consumption among those at risk for abuse was similar between these ethnic groups. Prevalence of current cigarette smoking was similar between these ethnic groups (22-23%), but Hispanics smoked significantly less than non-Hispanic whites (11.4 vs. 15.2 cigarettes per day, p < 0.001) and among non-Hispanic whites, men smoked significantly more than women (17.0 vs. 13.4 cigarettes per day, p = 0.001). CONCLUSION: The vascular risk factors which we compared between Hispanics and non-Hispanic whites do not help to explain the higher incidence of hemorrhagic strokes among the Hispanics in Bernalillo County, New Mexico. Additional risk factors for hemorrhagic strokes in these two ethnic groups should be studied.

Adult↗

Prevalence of self-reported illnesses in elderly Hispanic and non-Hispanic Whites in New Mexico.

OBJECTIVE: To report on the prevalences of self-reported illnesses from the New Mexico Elder Health Survey. DESIGN: Randomized community-based cross-sectional survey of elderly (> or = 65 years of age) Hispanics and non-Hispanic Whites. METHOD: Analysis of data from the 883 participants in the New Mexico Elder Health Survey. RESULTS: Complete data on 848 subjects were available for this analysis: Hispanic males, 212; Hispanic females, 189; non-Hispanic White males, 236; non-Hispanic White females, 211. The mean age was 74 years (age range 65-98). Hispanics had fewer years of school and lower income. Hispanics reported a significantly (P<.05) higher prevalence of type 2 diabetes; leg ulcers/pressure sores; and Parkinson's Disease. Non-Hispanic Whites reported a significantly (P<.05) higher prevalence of asthma; circulatory problems; stomach (not ulcers), intestinal or gallbladder disease; urinary tract disorders (other than kidney disease); and cancer. Prevalence odds ratios and confidence intervals were calculated. Hispanic males reported a higher prevalence of type 2 diabetes (OR 1.88, CI 1.10-3.26, P = .02), and lower prevalences of asthma (OR 0.43, CI 0.18-0.93, P = .04); urinary tract disorders, other than kidney disease (OR 0.59, CI 0.38-0.91, P = .01); and cancer (OR 0.31, CI 0.13-0.68, P = .005). Hispanic females reported a higher prevalence of diabetes (OR 3.01, CI 1.48-6.50, P = .003), and a lower prevalence of glaucoma (OR 0.48, CI 0.22-1.00, P = .05). These differences remained significant after adjustment for age, education, income, and language. CONCLUSION: There are significant differences in the prevalences of self-reported illnesses between Hispanic and non-Hispanic White elderly.

Aged↗

A state-based immunization campaign: the New Mexico experience.

Hepatitis B prophylaxis in the form of immunization has become an increasingly effective protective measure across the United States. Various cohorts have been targeted and methodologies used by public health officials to attain optimal coverage of the population. New Mexico is in its third year of school-based hepatitis B immunization programs. New Mexico's approach to this issue is characterized by significant rates of participation (66% in middle schools and 56% in high schools), high vaccination series completion (88% in middle schools and 89% in high schools), and minimal financial investment (cost of vaccine). The "Roll Up Your Sleeves" campaign was piloted, modified, and adapted to New Mexico's multi-lingual and multi-cultural environment, resulting in these successes.

Adolescent↗

Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients.

OBJECTIVE: To determine health care costs associated with pressure ulcers, ulcers of the lower limbs, other chronic ulcers, and venous leg ulcers from the New Mexico Medicaid fee-for-service program perspective. DESIGN: Retrospective analysis of claims database MAIN OUTCOME MEASURES: Physician visit, hospital, and prescription costs were determined for New Mexico Medicaid patients with a primary and/or secondary diagnosis of 1 of 4 identified categories of skin ulcers from January 1, 1994, through December 31, 1998. Costs were determined in terms of mean and median annual cost per patient and total costs per year. Zero dollar claims were included within the cost calculations. All costs are expressed in 2000-dollar values. MAIN RESULTS: Mean annual physician visit costs per patient ranged from $71 (standard deviation [SD] = $60) for venous leg ulcers in 1998 to $520 (SD = $1228) for pressure ulcers in 1996. Mean annual hospital costs per patient ranged from $266 (SD = $348) for other chronic ulcers in 1998 to $15,760 (SD = $30,706) for pressure ulcers in 1998. Mean annual prescription costs per patient ranged from $145 (SD = $282) for other chronic ulcers in 1998 to $654 (SD = $1488) for pressure ulcers in 1994. CONCLUSION: The New Mexico Medicaid fee-for-service system incurred a total cost of approximately $11.6 million (in 2000 dollars) from 1994 through 1998 for the treatment of the 4 categories of skin ulcers studied. The data showed that the majority of wounds were coded as pressure ulcers, which had the highest associated costs.

Chronic Disease↗

Fatal poisoning among American Indian, Hispanic, and non-Hispanic white children in New Mexico, 1958 to 1982.

Childhood fatalities from unintentional poisoning are a substantial health problem in New Mexico, which ranks second in the nation in injury-related mortality rates. To determine the extent of poison-related mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexico's American Indian, Hispanic, and non-Hispanic white children aged 0 to 14 years, we analyzed vital records collected from 1958 to 1982. New Mexican children experienced higher mortality rates than US white children of similar age--approximately eight times higher for children under 5 years old. Of the three ethnic groups, American Indian children had the highest mortality rates from unintentional poisoning during the 25-year period. Children less than 5 years old were at the highest risk for poison-related fatalities among all three ethnic groups.

Adolescent↗

Comparison of mosquito trapping method efficacy for West Nile virus surveillance in New Mexico.

As part of the West Nile virus surveillance program for the state of New Mexico, 13 sites along the Rio Grande River were sampled for mosquitoes during spring and summer 2003. We evaluated 3 different trapping procedures for their effectiveness at capturing selected species of mosquitoes. The 3 methods used were a dry ice-baited Centers for Disease Control and Prevention (CDC) light trap set 1.5 m above the ground (standard method), a CDC light trap suspended within the forest canopy, and a gravid trap set on the ground. Thirteen sites were sampled for 10 1-night periods biweekly from May through September. The relative numbers of captured Culex tarsalis, Cx. salinarius, Cx. quinquefasciatus, and Aedes vexans as well as the numbers of total recorded captures of all species were compared for each trapping method. Significant differences were observed for each species by location and by trapping method. Culex tarsalis was most commonly caught in canopy or standard CDC traps, especially in cottonwood bosque. Culex salinarius was found most frequently in association with marshy water, and was most often caught in gravid or standard light traps. Culex quinquefasciatus was captured almost exclusively in gravid traps within urban areas. Aedes vexans was primarily sampled in standard CDC light traps and found most frequently in wooded areas near floodplains. With the exception of Cx. Quinquefasciatus, no species was collected significantly more frequently in gravid or canopy traps than in the standard CDC light trap. Our findings do not support altering the methods currently used in New Mexico, namely, the use of 1.5-m CDC light traps and gravid traps. An increased use of gravid traps seems to be warranted in monitoring urban vector populations (specifically Cx. quinquefasciatus and Cx. salinarius) that may be involved in human transmission.

Aedes↗

Contrasting trends of prostate cancer incidence and mortality in New Mexico's Hispanics, non-Hispanic whites, American Indians, and blacks.

BACKGROUND: Prostate cancer has increased in epidemic proportions during the 1980s. Although marked differences in ethnic and racial temporal trends for prostate cancer have been observed both in the United States and internationally, the trends in Hispanics and American Indians have not been described extensively. METHODS: To characterize the occurrence of prostate cancer among non-Hispanic whites, Hispanics, American Indians, and blacks in New Mexico, the authors examined cancer incidence data collected by the New Mexico Tumor Registry for the period 1969-1991 and mortality data collected by the New Mexico Bureau of Vital Statistics for the period 1958-1991. RESULTS: From 1969 to 1991, age-adjusted incidence rates increased from 74.4 to 139.1 per 100,000 (87%) among non-Hispanic whites and from 54.0 to 94.7 (75%) among Hispanics. American Indians had the lowest incidence rates of all groups. Over the same period, incidence rates for local-stage cancers increased by 93% and 81% among non-Hispanic whites and Hispanics, respectively, but were stable for American Indians and blacks, whereas rates for regional-stage cancers increased sharply. Incidence rates of distant-stage disease decreased among non-Hispanic whites from 1969 through 1991. In contrast, incidence rates of distant-stage disease among Hispanics increased through 1982. From 1983 to date, age-adjusted mortality rates of prostate cancer decreased among all groups except Hispanics. CONCLUSION: The patterns of incidence and mortality are consistent with a stage migration. The recent decrease in age-adjusted prostate cancer mortality rates for non-Hispanic whites is consistent with that expected following the decrease in distant-stage disease incidence. Differential access to medical care and prostate cancer screening may account for these trends.

Black or African American↗

Chlamydia trachomatis and Neisseria gonorrhoeae in asymptomatic family planning patients in rural New Mexico.

We tested 98 asymptomatic women seen in state-funded contraception clinics in rural New Mexico. A fluorescein-conjugated monoclonal antibody stain revealed Chlamydia trachomatis infection in 25% of asymptomatic unmarried women and 3% of married women (P = .03). Neisseria gonorrhoeae was detected in only one woman. As in urban clinics providing contraception, the prevalence of gonorrhea is rare in rural New Mexico, but chlamydial infections are common in young unmarried women.

Adolescent↗

Pedestrian fatalities--New Mexico, 1958-1987.

Pedestrian fatalities constitute approximately one seventh of all traffic-related deaths in the United States (1). In addition to the disproportionate numbers of pedestrian fatalities that occur among children and the elderly, minority populations are at increased risk for pedestrian deaths (2-4). In New Mexico, approximately half the population are minority persons--primarily Hispanics and American Indians. Injury fatality rates for these groups are substantially higher than national rates, especially for the state's American Indians (4,5). This report summarizes an analysis by the University of New Mexico School of Medicine of pedestrian fatalities among New Mexico's American Indians, Hispanics, and non-Hispanic whites.

Accidents, Traffic↗

Guns, alcohol, and intimate partner violence: the epidemiology of female suicide in New Mexico.

Suicide is among the leading causes of death in the United States, and in women the second leading cause of injury death overall. Previous studies have suggested links between intimate partner violence and suicide in women. We examined female suicide deaths to identify and describe associated risk factors. We reviewed all reports from the New Mexico Office of the Medical Investigator for female suicide deaths occurring in New Mexico from 1990 to 1994. Information abstracted included demographics, mechanism of death, presence of alcohol/drugs, clinical depression, intimate partner violence, health problems, and other variables. Annual rates were calculated based on the 1990 census. The New Mexico female suicide death rate was 8.2/100,000 persons per year (n = 313), nearly twice the U.S. rate of 4.5/100,000. Non-Hispanic whites were overrepresented compared to Hispanics and American Indians. Decedents ranged in age from 14 to 93 years (median = 43 years). Firearms accounted for 45.7% of the suicide deaths, followed by ingested poisons (29.1%), hanging (10.5%), other (7.7%), and inhaled poisons (7.0%). Intimate partner violence was documented in 5.1% of female suicide deaths; in an additional 22.1% of cases, a male intimate partner fought with or separated from the decedent immediately preceding the suicide. Nearly two-thirds (65.5%) of the decedents had alcohol or drugs present in their blood at autopsy. Among decedents who had alcohol present (34.5%), blood alcohol levels were far higher among American Indians compared to Hispanics and non-Hispanic Whites (p = .01). Interpersonal conflict was documented in over 25% of cases, indicating that studies of the mortality of intimate partner violence should include victims of both suicide and homicide deaths to fully characterize the mortality patterns of intimate partner violence.

Adolescent↗

Curanderismo in Taos County, New Mexico--a possible case of anthropological romanticism?

Interviews with 25 Spanish-Americans of Taos County, New Mexico, indicate that time and acculturation have greatly eroded the belief in and practice of curanderismo, the traditional folk medical system of the Southwest. Curanderismo in northern New Mexico today has moved from being a primary and important source of medical care to one used alternatively and very occasionally in cases of pediatric disorders, chronic illnesses and pain, and for those maladies still classified according to the traditional folk beliefs.

Acculturation↗

The rise and fall of psoroptic scabies in bighorn sheep in the San Andres Mountains, New Mexico.

Between 1978 and 1997, a combination of psoroptic scabies (Psoroptes spp.), mountain lion (Puma concolor) predation, and periodic drought reduced a population of native desert bighorn sheep (Ovis canadensis) in the San Andres Mountains (SAM), New Mexico, from >200 individuals to a single ewe. In 1999, this ewe was captured, ensured to be Psoroptes-free, and released back into the SAM. Eleven radio-collared rams were translocated from the Red Rock Wildlife Area (RRWA) in New Mexico into the SAM range and monitored through 2002 to determine whether Psoroptes spp. mites were still in the environment. None of these sentinel rams acquired scabies during this period, and no additional native sheep were found to be present in the range. In 2002, 51 desert bighorn sheep were translocated into the SAM from the Kofa National Wildlife Refuge in Arizona (n = 20) and the RRWA in New Mexico (n = 31). Twenty-one bighorn sheep have died in the SAM since that time, but Psoroptes spp. mites have not been detected on any of these animals, nor have they been found on mule deer (Odocoileus hemionus) sampled since 2000. We conclude that psoroptic scabies is no longer present in the San Andres bighorn sheep population and that psoroptic scabies poses a minimal to nonexistent threat to the persistence of this population at this time.

Animals↗

Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico.

BACKGROUND: A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures. METHODS: Chi-square tests determined if there was a statistically significant difference between the number of self-pay and insured patient cancellations for financial reasons. A multivariate binomial regression model was used to calculate risk ratios and confidence limits for effects of race/ethnicity, and insurance status, controlling for gender, on these cancellations. RESULTS: Of the 667 cancellations, there were 99 self-pay and 568 insured patients. Cancellations for financial reasons occurred in 55.6% of self-pay and 9.3% of insured patients (p < 0.0001). Inability to pay 50% up front accounted for 76.4% of self-pay patient cancellations for financial reasons. Self-pay, non-Hispanic whites and minority race/ethnicities were 8.76 and 8.61 times more likely to cancel for financial reasons, respectively, than insured non-Hispanic whites. CONCLUSION: Self-pay patients, regardless of race/ethnicity, have elective surgical procedures cancelled for financial reasons significantly more often than insured patients. The hospital's 50% up-front payment policy represents a significant financial barrier to accessing elective surgical procedures for self-pay patients.

Journal Article↗

Gallbladder disease and gallbladder cancer among American Indians in tricultural New Mexico.

Previous studies have reported high rates of gallbladder disease and gallbladder cancer among all American Indians. Data from the New Mexico Tumor Registry confirm these findings, specifically showing high rates for New Mexico's American Indians, as well as for the state's Spanish population. This review explores several risk factors, including parity, obesity, age, cholesterol level, and genetic factors. From the available evidence, genetic factors appear to be the most important, with parity a contributing factor.

Epidemiologic Methods↗

Dying patients' thoughts of ending their lives: a pilot study of rural New Mexico.

Forty-nine hospice patients in rural New Mexico were directly interviewed concerning their thoughts about ending their lives. Thirty-one patients (63%) did not have thoughts of ending their lives, whereas 18 patients (37%) reported having suicidal thoughts. There were no differences between patients with and without thoughts of suicide related to gender; ethnicity; age; education; disease; religion; importance of religion; location of hospice agency; remaining financial, family, or spiritual issues; satisfaction with hospice care; sum of hospice personnel seen; or sum of medical equipment used. There were significant differences between patients with and without thoughts of suicide related to the number of household members (p = .02); the symptoms of trouble sleeping (p = .04) and nervousness (p =.03); and Medicare insurance coverage for hospice care (p =.01). No other symptom, including pain and hopelessness, was significant. Seven (39%) of the 18 patients who thought of ending their lives told someone about these thoughts. There were no variable differences between patients who did and did not tell someone about these thoughts.

Adaptation, Psychological↗

Geographic variability in alcohol-related crashes in response to legalized Sunday packaged alcohol sales in New Mexico.

On July 1, 1995 the state of New Mexico lifted its ban on Sunday packaged alcohol sales. Legislation lifting the ban included a local option allowing individual communities within the state to hold an election to reinstitute the ban on Sunday packaged alcohol sales. Previous research has shown a clear statewide increase in alcohol-related crash and crash fatality rates after the ban was lifted. The goal of this study is to measure county-level variability in changes in alcohol-related crash rates while adjusting for county socio-demographic characteristics, spatial patterns in crash rates and temporal trends in alcohol-related crash rates. Bayesian hierarchical binomial regression models were fit to the observed quarterly crash counts for all counties between July 1, 1990 and June 30, 2000. Results show marked variability in the impact of legalized Sunday packaged alcohol sales on alcohol-related crash rates. Relative risks of an alcohol-related crash for the post-repeal versus pre-repeal period vary across counties from 1.04 to 1.90. Counties with older population suffered a greater negative impact of legalized Sunday packaged alcohol sales. Counties with communities that quickly passed the local option to re-ban packaged sales on Sundays were able to mitigate most of the deleterious impact of increased alcohol availability that was observed across the state.

Accidents, Traffic↗

Emergence of West Nile virus in mosquito (Diptera: Culicidae) communities of the New Mexico Rio Grande Valley.

The first appearances of West Nile virus (family Flaviviridae, genus Flavivirus, WNV) in New Mexico were reported in late summer to early fall 2002. Several dead birds tested positive for WNV, and 78 equine cases were confirmed. All mosquito pools tested (n = 268) were negative. A statewide surveillance program was launched in May 2003 to study the emergence and spread of this new arbovirus in mosquitoes from the Rio Grande valley. Mosquitoes were trapped at 32 sites along a 750-km stretch of the Rio Grande valley. Sites were trapped for one night either weekly or biweekly, by using CO2-baited CDC light traps and gravid traps. Pools of captured mosquitoes were tested for WNV by reverse transcription-polymerase chain reaction. By mid-July 2003, WNV levels in the mosquito population had reached levels that were detectable by the surveillance program. Positive pools of mosquitoes were found in the Rio Grande valley from mid-July through late September. In total, 75 positive pools were found, from sites throughout the study area. The predominant species infected with WNV in this region were Culex tarsalis (Coquillett) in rural areas, and Culex salinarius (Coquillett) and Culex pipiens quinquefasciatus (Say) in urban areas. There were 202 human cases and 438 equine cases of WNV in New Mexico in 2003, which corresponded well in time with the positive mosquitoes. Our results seemed to be consistent with introduction of WNV in late summer 2002, followed by a period of transmission and amplification cycles between local avian hosts and mosquito vectors.

Animals↗

Fleas on gray foxes in New Mexico.

From April 1992 to April 1993, fleas were collected from 15 gray foxes, Urocyon cinereoargenteus Schreber, in New Mexico. Flea species collected were Cediopsylla inaequalis inaequalis Baker (14/15), Echidnophaga gallinacea (Westwood) (1/15), Euhoplopsyllus glacialis affinis Baker (10/15), Foxella ignota Baker (1/15), Pulex irritans (L.) (6/15), and Pulex simulans Baker (15/15). C. i. inaequalis and F. ignota are new host records for gray foxes. The collection of C. i. inaequalis, E. g. affinis, F. ignota, and P. simulans are new host records for New Mexico. Fleas on gray foxes in the Southwest are reviewed.

Animals↗