Diabetes and disability among Mexican Americans: the effect of different measures of diabetes on its association with disability.

The association of non-insulin-dependent diabetes mellitus and disability was evaluated in a population of Mexican Americans from the southwest U.S. using data from the Hispanic Health and Nutrition Examination Survey. Among the total sample of persons who completed a clinical examination, 14.6% reported a limitation of job performance, the inability to complete housework, or the inability to perform activities of daily living. Among the subsample who completed the clinical examination and reported having diabetes, 31.6% claimed similar disability. In those respondents who also completed an oral glucose tolerance test (OGTT) or who were currently receiving insulin, the prevalence of disability was 25% in persons with an abnormal OGTT and 40.2% in those who were receiving insulin compared with 14.9% in those with a normal OGTT. Self-reported diabetes was positively associated with functional impairment in the examined population after adjusting for demographic variables and comorbidity; however, diabetes confirmed by OGTT was not significantly associated with disability after adjustment for other factors. Differences in pre-existing health status between persons who completed the OGTT and those who did not are discussed in relation to these results.

Vesicular stomatitis New Jersey virus glycoprotein gene sequence and neutralizing epitope stability in an enzootic focus.

Vesicular stomatitis New Jersey (VS NJ) virus is capable of undergoing rapid evolution in nature and therefore has the potential for antigenic variation. We selected an area of Costa Rica where VS NJ virus is enzootic to study whether this virus used the mechanism of antigenic variation to persist in nature. Three sentinel herds and three nonsentinel herds were observed from 1986 to 1988. Eleven VS NJ virus isolates were collected from naturally infected cattle. Remarkably, nine animals that were bled prior to reinfection with VS NJ virus had neutralizing antibody titers up to 1: 102,400 yet virus was isolated from, and disease was observed in, these animals. Sequence analysis of the portion of the glycoprotein gene coding for the neutralizing epitopes demonstrated that all virus isolates were 98-100% similar with no indication of specific genetic variation. The 3' end of the glycoprotein gene also remained stable in that all isolates were again 98-100% similar in nucleotide sequence. Each isolate was neutralized to equivalent titers with monoclonal antibodies directed against four neutralizing epitopes on the glycoprotein. Additionally, preisolation sera from each animal were able to neutralize the virus that caused the subsequent disease. These results provide evidence that antigenic variation is not a mechanism used by VS NJ virus to persist in an enzootic focus of Costa Rica.

Serological monitoring of vesicular stomatitis New Jersey virus in enzootic regions of Costa Rica.

The activity of vesicular stomatitis viruses was monitored on 3 dairy farms in Costa Rica. Antibody levels were measured and clinical disease monitored in 165 cattle during a 20 month period (1986-1988). Vesicular stomatitis New Jersey (VS NJ) virus was shown to be enzootic on these farms by a 94.2% prevalence of neutralizing antibody; this did not vary significantly between herds. The mean prevalence of antibody to vesicular stomatitis Indiana (VS IN) virus was 15.2%, but was significantly higher in 1 herd. A total of 25 cases (annual incidence rate of 9%) of clinical vesicular stomatitis (VS) was reported. VS NJ virus was identified as the causal agent by detection of VS NJ virus antigens by the complement fixation test. VS NJ virus was isolated in 11 cases. All episodes of disease occurred between November and January, the beginning of the dry season. Most animals maintained stable neutralizing antibody titers throughout the study, and all diseased animals were previously seropositive to VS NJ virus. A total of 31 animals with neutralizing antibodies to VS NJ virus had a VS NJ virus-specific IgM response, and 6 animals had IgM responses that persisted for as long as 6 months. There was no relation between IgM responses and clinical disease occurrence. VS NJ virus persisted predominantly as a subclinical infection in cattle throughout the year in enzootic areas of Costa Rica. The humoral response did not prevent reinfection with VS NJ virus.

Using the CES-D scale to screen for depression and anxiety: effects of language and ethnic status.

The purpose of this report is to present data on the effects of language (English/Spanish) and ethnic status (white/non-Hispanic or Mexican origin) on the ability of the Center for Epidemiologic Studies Depression (CES-D) scale to detect cases of clinical depression and generalized anxiety identified using the Diagnostic Interview Schedule (DIS) in psychiatric treatment settings. The agreement between the CES-D scale and the DIS diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) was poor, especially among Mexican-origin patients interviewed in Spanish. Multiple regression analysis revealed that the CES-D scale was positively associated with MDD in all groups. In addition, GAD also was associated with the CES-D scale in Anglos and English-speaking Mexican-Americans but not in Spanish-speaking Mexican-Americans.

Aging, sex-role orientation, and adjustment: a three-generations study of Mexican Americans.

The effect of sex-role orientation on psychological well-being was investigated with data from a three-generations study of Mexican Americans. More specifically, we examined the hypothesis that less traditional sex-role orientation is positively related to psychological well-being (other things equal) and that this relationship is stronger among the older than among younger generations. Traditional sex-role orientation was positively related to depression among older women, lending partial support to the hypothesis. Among men, however, traditional sex-role orientation was not related to well-being in the older generation but was related to both depression and life satisfaction in the younger generation. The interactive effects of marital status and retirement status with sex-role orientation were also examined but were not found to be significant.

Ethnic status and participation in longitudinal health surveys.

Ethnic differences in survey participation and their effects on self-reported physical and psychiatric health status measures were examined in a longitudinal health study in Alameda County, California, in 1978 following two time intervals. Blacks and Mexican-Americans were more likely than whites to refuse to participate in follow-up surveys and were more difficult to trace when the time interval between interviews was long. With the exception of age, demographic characteristics were not consistently associated with participation status either across ethnic groups or across time periods. Self-reported psychiatric and physical health status were not statistically associated with participation status in any ethnic group for either time period, despite differential participation by ethnicity.

Response tendencies, ethnicity, and depression scores.

The Center for Epidemiologic Studies Depression scale was given to a sample of whites, blacks, and Mexican-Americans residing in Alameda County, California, in 1978. Scores on the scale were analyzed to see whether or not a potentially important source of bias called response tendencies affected prevalence estimates and associations between symptom scores and demographic variables. Response tendencies were found to be differentially correlated with symptom scores by ethnic status; however, their effects were not of sufficient magnitude to alter most associations observed between symptom scores and demographic variables. The need for further methodological studies to clarify the definitions of concepts such as "depression" is discussed.

Use of the SADS-RDC in a tri-ethnic community survey.

The Schedule for Affective Disorders and Schizophrenia and the Research Diagnostic Criteria were used to ascertain community-based rates of affective and nonaffective psychiatric disorders. Both current-point and lifetime prevalence rates were reported for a sample of whites, blacks and Mexican-Americans. Rates for whites were compared with those reported for another community sample in which the same diagnostic criteria were applied. Comparison of lifetime rates from the two studies showed good concurrence for most of the affective disorders, particularly depression. This study also examined differences in rates by ethnic status.

Prevalence of treated and untreated psychiatric disorders in three ethnic groups.

The pattern and overlap of treated and untreated rates of psychiatric symptoms and disorders were examined in a sample of whites, blacks, and Mexican-Americans. In addition, we compared treatment sources for family or personal problems for the three groups. The results suggest caution in substituting treated for untreated rates and also in interchanging rates based on symptom scales with rates from clinical diagnostic instruments. Underutilization was assessed by linking psychiatric status with reports of help-seeking behavior. Comparisons indicated that all groups underuse services relative to need, but underutilization is greater for blacks and Mexican-Americans. With the exception of nonpsychiatric physicians, use of treatment sources was similar for all groups. Whites were much more likely than blacks or Mexican-Americans to use this source of care. Possible reasons for this difference are discussed in the context of the methodology employed in the study.