Socio-ecological influences on health-care access and navigation among persons of Mexican descent living on the U.S./Mexico border.

The study reported here examines factors influencing decision-making concerning health care access and navigation among persons of Mexican origin living along the U.S./Mexico border. Specifically, the study examined how persons with limited financial resources accessed these two systems. Seven focus groups were held with 52 low income Mexican American people aged 18-65 years. Transcripts were analyzed to identify themes in Atlasti 5.0 software and the theory used included a socio-ecological framework and complemented by constructed from the Social Cognitive Theory. We found that in addition to a lack of insurance and financial resources to pay for health care; fear, embarrassment and denial associated with a diagnosis of illness; poor medical personnel interactions, and desire for quality but streamlined health care also influenced decision making. This theory-based study raises important issues if health care is to improve the health and welfare of disadvantaged populations and points to the need for greater focus on medical homes and prevention and early intervention approaches.

Acyclovir therapy of chickenpox in immunosuppressed children--a collaborative study.

A randomized double-blind, placebo-controlled, multicenter investigation assessed the usefulness of acyclovir in the treatment of immunosuppressed children with chickenpox. Twelve patients received placebo and eight received acyclovir. If the event of clinical deterioration, patients could be removed from the study to receive acyclovir. Eighteen patients had skin lesions within 96 hours of admission to the study. Nineteen patients had malignancies. The two groups of patients were similar in age, in concomitant or preceding immunosuppressive therapy, in status of malignancy, and in presenting granulocyte and lymphocyte counts. Zoster immune globulin or plasma had been given to 50% of the placebo group but to only 25% of the acyclovir group. One patient in each group had pneumonitis at entry. Of the patients without pneumonitis at entry, five of the 11 placebo patients compared with none of the seven acyclovir patients developed pneumonitis during treatment (P = 0.054). No evidence of toxicity related to acyclovir was observed.

Geographic variation among St. Louis encephalitis virus strains in the viremic responses of avian hosts.

We studied the capacity of 44 strains of St. Louis encephalitis (SLE) virus to induce viremia in an epidemiologically important wild avian host, the House Sparrow (Passer domesticus). Selected virus strains were also inoculated at varying doses into 3-week-old chicks. Viremic responses were analyzed in terms of the proportion of inoculated nestling and adult birds which became viremic, the mean duration and the mean peak titer of viremia. Infectivity of avian sera was determined by plaque assay in primary duck embryo cell cultures. The susceptibility of the House Sparrow to viremic infection with different SLE virus strains varied markedly. Nestling sparrows 6-10 days of age were generally more susceptible than adult birds. All virus strains isolated during Culex pipiens-borne epidemics in the eastern United States were highly viremogenic [viremia in 80% of birds with a mean duration of greater than or equal to 1.6 days in adults or greater than or equal to 2.7 days in nestlings and a mean peak titer of greater than or equal to 10(3.0) plaque-forming units (PFU)/ml in adults and 10(4.0) PFU/ml in nestlings]. All virus strains isolated from Culex tarsalis in the western United States, strains isolated from rodents in South America. and six of 16 strains isolated from various sources elsewhere in tropical America were partially or fully attenuated. A high degree of concordance was demonstrated between experimental viremia in sparrows, viremia in 3-week-old chicks, and neurovirulence for weanling mice. The epidemilogic significance of these findings is discussed.