Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 679
Filtrar
1.
Public Health Genomics ; 22(1-2): 58-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31437847

RESUMO

BACKGROUND: Translational research in genomics has limited reach and requires efforts to broaden access and utility in diverse populations. Skin cancer is common and rates are rising, including among Hispanics. Germline variants in the melanocortin-1 receptor (MC1R) gene are common in the population and confer moderate risk for melanoma and basal cell cancers across skin types. Feedback about MC1R risk status may promote skin cancer risk awareness and risk reduction. AIMS: We examined the level of interest in pursuing MC1R testing, and patterns of interest across skin cancer perceived threat and control attitudes, cultural beliefs (family influence on health, health system distrust, cancer fatalism, skin cancer misconceptions), and health literacy. METHODS: We used a study website to inform primary care patients in Albuquerque, NM about the benefits and drawbacks of MC1R testing. Website logon, request of a saliva test kit, and return of the test kit (yes vs. no) were primary assessments of study interest and uptake. RESULTS: Of 499 participants provided with a test offer, 33% requested and returned the test. Lower family influence on participants' health was an important factor both overall and within ethnicity subgroups, and may indicate that primary care patients interested in skin cancer genetic testing see themselves as proactive health seekers, independent from family encouragement. Lower self-efficacy for skin cancer prevention was also an important characteristic of those who tested. CONCLUSION: As evidence for common genetic markers for skin cancer accumulates, these findings suggest characteristics of those most likely to pursue genetic testing for skin cancer risk.


Assuntos
Atitude Frente a Saúde , Diversidade Cultural , Alfabetização em Saúde , Hispano-Americanos/psicologia , Melanoma , Psicologia , Receptor Tipo 1 de Melanocortina , Neoplasias Cutâneas , Adulto , Feminino , Testes Genéticos/métodos , Humanos , Masculino , Melanoma/etnologia , Melanoma/genética , Melanoma/psicologia , Pessoa de Meia-Idade , New Mexico/epidemiologia , Atenção Primária à Saúde/métodos , Receptor Tipo 1 de Melanocortina/análise , Receptor Tipo 1 de Melanocortina/genética , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/psicologia
2.
Accid Anal Prev ; 129: 230-240, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31176143

RESUMO

The single-vehicle crash has been recognized as a critical crash type due to its high fatality rate. In this study, a two-year crash dataset including all single-vehicle crashes in New Mexico is adopted to analyze the impact of contributing factors on driver injury severity. In order to capture the across-class heterogeneous effects, a latent class approach is designed to classify the whole dataset by maximizing the homogeneous effects within each cluster. The mixed logit model is subsequently developed on each cluster to account for the within-class unobserved heterogeneity and to further analyze the dataset. According to the estimation results, several variables including overturn, fixed object, and snowing, are found to be normally distributed in the observations in the overall sample, indicating there exist some heterogeneous effects in the dataset. Some fixed parameters, including rural, wet, overtaking, seatbelt used, 65 years old or older, etc., are also found to significantly influence driver injury severity. This study provides an insightful understanding of the impacts of these variables on driver injury severity in single-vehicle crashes, and a beneficial reference for developing effective countermeasures and strategies for mitigating driver injury severity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Escala de Gravidade do Ferimento , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Ambiente Construído/estatística & dados numéricos , Feminino , Humanos , Análise de Classes Latentes , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Fatores de Risco , Cintos de Segurança/estatística & dados numéricos , Adulto Jovem
3.
J Wildl Dis ; 55(4): 745-754, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31112469

RESUMO

Informed management of American black bears (Ursus americanus) requires knowledge of the distribution and pathology of diseases affecting the species. Little information is available on pathogen prevalence from black bear populations in the Southwest, US, and it is unknown how these infections may influence black bear populations or disease transmission. We captured New Mexico black bears (Ursus americanus amblyceps) during 2016-17 as part of a long-term monitoring project and opportunistically collected 36 blood samples from 12 female and 17 male black bears. We wanted to determine prior exposure to canine distemper virus, canine parvovirus, Yersinia pestis, Francisella tularensis, West Nile virus, Toxoplasma gondii, and the tick-borne pathogens, Anaplasma spp., Ehrlichia spp., Borrelia burgdorferi, Rickettsia spp., and Babesia spp. Approximately half (55%, 16/29) of the individuals sampled had antibodies to Y. pestis, and 37% (10/27) had antibodies to T. gondii. Prevalence of antibodies to West Nile virus, F. tularensis, and canine parvovirus were lower (i.e., 11, 10, and 3%, respectively). We detected no antibodies to canine distemper, B. burgdorferi, Rickettsia spp., or Babesia spp. We documented changes in antibody titer levels for both sexes of several recaptured black bears. Our data will inform managers of pathogen prevalence and distribution in black bears in north-central New Mexico and provide a vital baseline dataset for future pathogen monitoring. Additionally, these data support actions to minimize exposure through handling wild individuals or through hunter harvest activities.


Assuntos
Anticorpos Antibacterianos/sangue , Anticorpos Antiprotozoários/sangue , Anticorpos Antivirais/sangue , Ursidae/microbiologia , Envelhecimento , Animais , Vírus da Cinomose Canina/imunologia , Feminino , Francisella tularensis/imunologia , Masculino , New Mexico/epidemiologia , Parvovirus Canino/imunologia , Estudos Soroepidemiológicos , Toxoplasma/imunologia , Vírus do Nilo Ocidental/imunologia , Yersinia pestis/imunologia
5.
MMWR Morb Mortal Wkly Rep ; 68(7): 177-180, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30789880

RESUMO

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that can occur following prenatal exposure to opioids (1). NAS surveillance in the United States is based largely on diagnosis codes in hospital discharge data, without validation of these codes or case confirmation. During 2004-2014, reported NAS incidence increased from 1.5 to 8.0 per 1,000 U.S. hospital births (2), based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes identified in hospital discharge data, without case confirmation. However, little is known about how well these codes identify NAS or how the October 1, 2015, transition from ICD-9-CM to the tenth revision of ICD-CM (ICD-10-CM) codes affected estimated NAS incidence. This report describes a pilot project in Illinois, New Mexico, and Vermont to use birth defects surveillance infrastructure to obtain state-level, population-based estimates of NAS incidence among births in 2015 (all three states) and 2016 (Illinois) using hospital discharge records and other sources (varied by state) with case confirmation, and to evaluate the validity of NAS diagnosis codes used by each state. Wide variation in NAS incidence was observed across the three states. In 2015, NAS incidence for Illinois, New Mexico, and Vermont was 3.0, 7.5, and 30.8 per 1,000 births, respectively. Among evaluated diagnosis codes, those with the highest positive predictive values (PPVs) for identifying confirmed cases of NAS, based on a uniform case definition, were drug withdrawal syndrome in a newborn (ICD-9-CM code 779.5; state range = 58.6%-80.2%) and drug withdrawal, infant of dependent mother (ICD-10-CM code P96.1; state range = 58.5%-80.2%). The methods used to assess NAS incidence in this pilot project might help inform other states' NAS surveillance efforts.


Assuntos
Anormalidades Congênitas/epidemiologia , Síndrome de Abstinência Neonatal/epidemiologia , Vigilância da População/métodos , Humanos , Illinois/epidemiologia , Recém-Nascido , New Mexico/epidemiologia , Vermont/epidemiologia
6.
Lupus ; 28(4): 555-559, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30755141

RESUMO

OBJECTIVE: The objective of this report is to analyse retinal changes over a five-year period, assessed by spectral domain-optical coherence tomography (SD-OCT), in patients from the Lupus-Cruces cohort treated with hydroxychloroquine (HCQ). METHODS: SD-OCT screening was performed annually between 2012 and 2017. Average macular thickness (AMT), ganglion cell layer thickness (GCLT) and qualitative data of retinal pigment epithelium (RPE) and external retina (ExtR) were collected prospectively. We compared data from 2012 (first) and 2017 (second) SD-OCT. RESULTS: We studied 110 patients and 195 eyes. No cases of HCQ toxicity were detected. At the time of the second SD-OCT, 99% patients had taken a daily dose of HCQ ≤5 mg/kg/day. The median time on HCQ was 133 months. The mean AMT and GCLT were significantly lower in both eyes at the second SD-OCT; however, all the differences were clinically insignificant at less than 1%. Qualitative analysis of RPE and ExtR showed no significant changes. Similar results were found among patients with risk factors for retinopathy. The comparison of patients with and without risk factors showed no differences. CONCLUSIONS: This study shows clinically irrelevant retinal changes in an SLE cohort on HCQ treatment over a five-year follow-up. Our findings support the safety of long-term HCQ at doses ≤5 mg/kg/day.


Assuntos
Antirreumáticos/efeitos adversos , Hidroxicloroquina/efeitos adversos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/patologia , Retina/patologia , Adulto , Idoso , Antirreumáticos/administração & dosagem , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu , Feminino , Seguimentos , Hospitais Universitários , Humanos , Hidroxicloroquina/administração & dosagem , Incidência , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Estudos Prospectivos , Retina/efeitos dos fármacos , Doenças Retinianas/induzido quimicamente , Doenças Retinianas/patologia , Estatísticas não Paramétricas , Tomografia de Coerência Óptica
7.
Emerg Infect Dis ; 25(2): 383-384, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30666949

RESUMO

Human metapneumovirus is an emerging pathogen that causes upper and lower respiratory illness. Nursing home outbreaks of infection with this virus can cause severe illness and lead to poor patient outcomes. We report an outbreak investigation in a nursing home during 2018 and infection control guidelines to assist in disease control.


Assuntos
Surtos de Doenças , Metapneumovirus , Casas de Saúde , Infecções por Paramyxoviridae/epidemiologia , Infecções por Paramyxoviridae/virologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Humanos , Metapneumovirus/classificação , Metapneumovirus/genética , New Mexico/epidemiologia , Infecções por Paramyxoviridae/diagnóstico , Infecções Respiratórias/diagnóstico , Estados Unidos/epidemiologia
8.
Appl Neuropsychol Child ; 8(1): 1-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28937800

RESUMO

Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.


Assuntos
Disfunção Cognitiva/epidemiologia , Entrevista Psicológica , Delinquência Juvenil/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Modelos Estatísticos , Transtornos do Neurodesenvolvimento/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Escalas de Wechsler/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mães/estatística & dados numéricos , New Mexico/epidemiologia , Gravidez , Gravidez não Planejada , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Cancer Educ ; 34(1): 173-179, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-28956318

RESUMO

We conducted a pilot test of a patient navigation intervention (Una Mano Amiga) to address cancer health disparities in three rural counties in southwest New Mexico. We trained two bilingual lay health workers (promotoras) as patient navigators (PNs) to help adult cancer patients and their participating families in Grant, Luna, and Hidalgo counties "navigate" the health care system, including appropriate access to social and financial services. Our hypothesized outcome was a reduction in time from diagnosis to treatment initiation compared to the average time without PNs in each of the three counties (2000-2009). We enrolled 85 eligible patients and 43 eligible family members who had completed psychosocial and demographic forms in this PN intervention. Mean time from cancer diagnosis to treatment initiation among 41 study patients was 59.6 days across the three counties. Mean time from non-intervention comparison data was 47.1 days. In the intervention group, on a 0-10 satisfaction scale (higher = more), patient mean scores for three items ranged from 9.3 to 9.6, family members, 8.9-9.3. Caregiver stress as measured by a Caregiver Self-Assessment score ≥ 10 (highest stress = 16) decreased from 23.8% of caregivers at study entry to 14.3% at follow-up (not statistically significantly different). Although the PN intervention did not decrease time from diagnosis to treatment initiation compared to three comparison counties, positive reactions of patients and family members support further research with larger samples.


Assuntos
Cuidadores/psicologia , Família/psicologia , Disparidades em Assistência à Saúde/normas , Neoplasias/diagnóstico , Navegação de Pacientes/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , New Mexico/epidemiologia , Projetos Piloto , População Rural
10.
Popul Health Manag ; 22(2): 113-119, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29969375

RESUMO

Understanding how unmet basic needs impact health care in patients with complex conditions is vital to improve health outcomes and reduce health care costs. The purpose of this observational study was to explore the association between health care and socioeconomic needs and health care utilization and disease management among patients with chronic conditions at an intensive, patient-centered, office-based program. The study used a cross-sectional design and a convenience sampling approach. Data were collected through a patient questionnaire and medical records. Analysis included descriptive and inferential statistics. Data from 48 established patients were analyzed. Financial and lack of transportation were the 2 most frequently reported unmet needs. More than 65% of participants had their chronic condition(s) under control. Sex and ethnicity were the only 2 demographic variables that yielded significant differences (P ≤ 0.01) on visits to the emergency room and having chronic condition(s) under control. Those who reported having unmet transportation needs were more likely to have a condition uncontrolled and to have lost medical appointments compared to those who had this social need met (P ≤ 0.05). Statistically significant differences in terms of missing medical appointments also were found between those whose overall financial and housing needs were unmet and those who had those needs met (P ≤ 0.05). Results indicate that participating patients generally had good control of their conditions. The study adds evidence in support of the call for health care to address patients' socioeconomic needs, and the health care benefits of intensive case management programs. The model may be considered for adoption throughout New Mexico, and nationally.


Assuntos
Assistência à Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Análise Custo-Benefício , Assistência à Saúde/economia , Assistência à Saúde/métodos , Assistência à Saúde/estatística & dados numéricos , Gerenciamento Clínico , Humanos , New Mexico/epidemiologia , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/estatística & dados numéricos , Saúde da População , Fatores Socioeconômicos
11.
Prev Chronic Dis ; 15: E161, 2018 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-30576273

RESUMO

PURPOSE AND OBJECTIVES: Prevalence of excessive alcohol use and alcohol-attributable mortality is much higher in New Mexico than in other US states. In 2010, excessive alcohol use cost the state roughly $2.2 billion. Moreover, age-adjusted deaths from alcohol-related chronic liver disease increased 52.5% from 14.1 cases in 2010 to 21.5 cases in 2016. In 2017, the New Mexico Department of Health piloted the Recommended Council of State and Territorial Epidemiologists (CSTE) Surveillance Indicators for Substance Abuse and Mental Health, using 5 indicators to monitor alcohol use and health consequences. The purpose of this study is to evaluate the alcohol surveillance system implemented in New Mexico to ensure that the system yields useful, timely data that can help create effective public health interventions and that resources required for surveillance are adequate. INTERVENTION APPROACH: CSTE alcohol surveillance system data come from existing national and state-based surveys and vital statistics. EVALUATION METHODS: This evaluation assessed attributes defined in Evaluating Behavioral Health Surveillance Systems and Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems. Assessment was informed through data collection, systematic literature review searches, and an interview with the alcohol epidemiologist at New Mexico Department of Health. RESULTS: The CSTE alcohol surveillance system in New Mexico is a useful, stable, and accepted system with good representativeness and population coverage. Data sharing and collaboration between centers within New Mexico Department of Health are well-established, making data access easy and timely. Lastly, the resources required for data collection are accountable and adequate. IMPLICATIONS FOR PUBLIC HEALTH: The CSTE alcohol surveillance system brings together information (alcohol consumption behaviors and associated morbidity, mortality, and policy-related measures) necessary to show a clear picture of the alcohol effects in New Mexico. This information yields useable, timely data from which the state can monitor trends and develop interventions to reduce the prevalence of alcohol-attributable morbidity and mortality.


Assuntos
Consumo de Bebidas Alcoólicas/mortalidade , Vigilância da População/métodos , Avaliação de Programas e Projetos de Saúde , Acidentes de Trânsito/mortalidade , Consumo de Bebidas Alcoólicas/economia , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Humanos , Cirrose Hepática Alcoólica/economia , Cirrose Hepática Alcoólica/mortalidade , New Mexico/epidemiologia , Impostos/estatística & dados numéricos
12.
Prev Chronic Dis ; 15: E151, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522582

RESUMO

Limited information exists about the effectiveness of interventions to enforce laws prohibiting alcohol sales to intoxicated patrons in licensed establishments. New Mexico Behavioral Risk Factor Surveillance System data were used to evaluate an intervention on binge drinking intensity in licensed (eg, bars) versus unlicensed (eg, homes) locations. The proportion of binge drinkers in licensed locations who consumed 8 or more drinks on a binge drinking occasion decreased from 42.1% in 2004-2005 to 22.6% in 2007-2008 (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.9), while the proportion in unlicensed locations was essentially unchanged. Enhanced enforcement of overservice laws may reduce excessive drinking in licensed establishments.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Bebedeira/epidemiologia , Comércio , Adolescente , Adulto , Distribuição por Idade , Bebidas Alcoólicas/economia , Sistema de Vigilância de Fator de Risco Comportamental , Bebedeira/prevenção & controle , Estudos Transversais , Feminino , Humanos , Licenciamento , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
13.
J Stud Alcohol Drugs ; 79(5): 672-679, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30422777

RESUMO

OBJECTIVE: Research in Responsible Beverage Service (RBS) training indicates that such training can prevent over-service of alcohol and reduce drunk driving. However, reviews of the RBS literature suggest that the quality of training methods and the stability of implementation are important factors in determining RBS training effectiveness. Most RBS classes have been taught live, where the quality of instruction varies across instructors and classes, and the stability of the implementation of an RBS curriculum is variable. Web-based RBS training may carry important advantages by stabilizing instruction and implementation factors. Randomized trial results of a web-based onsite RBS training program (WayToServe® [WTS]) are reported here. It was hypothesized that servers trained by WTS would refuse alcohol service at significantly higher rates compared with Usual and Customary (UC) live training. METHOD: On-site alcohol-serving establishments in New Mexico communities were randomized to receive WTS training (n = 154) or the Usual and Customary live RBS training (n = 155). Premises were assessed at baseline, immediate post-training, 6-months post-training, and 1-year post-training intervals. Pseudo-intoxicated patron protocols were used to assess premise alcohol service during the early to mid-evening hours of 6:30 P.M. to 8:30 P.M., with the percentage of alcohol service refusals to apparently intoxicated pseudo-patrons as the primary outcome variable. RESULTS: Results indicate significantly higher refusal rates for WTS than for UC premises at the immediate (WTS = 68% vs. UC = 49%) and the 1-year post-training assessment points (WTS = 68% vs. UC = 58%) but not at the 6-month post-training assessment (WTS = 69% vs. UC = 64%). Differences in refusal rates based on pseudo-patron age were observed where younger pseudo-patrons were consistently refused more often than older pseudo-patrons. CONCLUSIONS: Effective RBS training can be delivered online, making it a potentially cost-effective way of reaching large alcohol server populations.


Assuntos
Bebidas Alcoólicas , Intoxicação Alcoólica/prevenção & controle , Dirigir sob a Influência/prevenção & controle , Internet , Restaurantes , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Intoxicação Alcoólica/epidemiologia , Intoxicação Alcoólica/psicologia , Dirigir sob a Influência/psicologia , Feminino , Humanos , Masculino , Marketing/métodos , Marketing/normas , New Mexico/epidemiologia , Restaurantes/normas
14.
Clin Respir J ; 12(11): 2598-2605, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30257066

RESUMO

BACKGROUND: Current risk factors for Chronic Obstructive Pulmonary Disease mortality focus only on overall and respiratory death. We investigated whether risk factors for each specific cause of mortality are different depending on the outcome under consideration. METHODS: This retrospective cohort study included patients with a clinical diagnosis of COPD, older than 40, greater than 20 pack-years smoking history, and obstructive pattern on spirometry. Collected data included baseline spirometry, comorbidities, medication use, tobacco exposure, severe exacerbations, and cause-specific mortality. RESULTS: This 512 patient cohort of heavy smokers included 277 (54.1%) males, was on average 66.4 ± 9.4 years of age and primarily non-Hispanic white, 395 (83.2%). The average FEV1% was 52.1% (SD = 16.9%) and the median COTE score was 2 (IQR: 0-6). A total of 67 deaths were of respiratory causes in 26 patients (38.8%), malignancies in 21 (31.1%), cardiovascular causes in 6 (9%), and from other etiologies in 14 patients (20.1%). COTE index,low predicted FEV1%, and lower body mass index were significant predictors of overall mortality. Predictors of respiratory deaths were significantly impacted by lower FEV1%, history of COPD exacerbations, lower BMI, and higher number of pack-years smoked. Risk factors for all other cause-specific mortality combined included history of malignancy or cardiovascular disease and smoking status. CONCLUSION: Cause-specific mortality risk factors differ in patients with COPD.


Assuntos
Mortalidade/tendências , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Comorbidade , Progressão da Doença , Feminino , Volume Expiratório Forçado/fisiologia , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Análise de Sobrevida
15.
Prev Chronic Dis ; 15: E113, 2018 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-30218553

RESUMO

INTRODUCTION: The prevalence of obesity is 26% among Hispanic children and teenagers and 47% among Hispanic adults. One contributor to obesity is sedentary behavior, such as using electronic screen devices (ie, screens). Low-income and Hispanic youths spend more time using such devices than other youths. METHODS: We interviewed 202 parents of Mexican-origin children aged 6 to 10 years in 2 rural communities near the US-Mexico border to determine screen use among children. We tested for associations between covariates and heavy screen use (≥4 hours/day) and calculated adjusted odds ratios (AORs) to identify independent, modifiable risk factors for such use. RESULTS: More than two-thirds (68.3%) of households had an annual income of less than $24,000, 89.1% spoke primarily Spanish, and 92.1% had internet access. The percentage of children with heavy screen use was 14.9% on weekdays and 25.2% on weekends. Smartphones were used by 62.4% of children, desktops or laptops by 60.9%; homework was the most common reason for use of these devices. One in 3 children used them for social media. Increased odds of heavy screen use were associated with having a television on while the child ate (weekday AOR = 3.02; 95% confidence interval [CI], 1.08-8.45 and weekend AOR = 2.38; 95% CI, 1.04-5.40) and using electronics to entertain (weekend AOR = 2.94; 95% CI, 1.15-7.51). More than 3 family meals per week (AOR = 0.40; 95% CI, 0.17-0.94 compared with ≤3 meals) and 2 or 3 family activities per week (AOR = 0.33; 95% CI, 0.12-0.87 compared with ≤1 activity) were associated with decreased odds of heavy weekend use. CONCLUSION: Even in low-income, Spanish-speaking communities, children have access to electronic devices, social media, and the internet, and a substantial fraction of them are heavy users. Efforts to reduce screen time might focus on understanding and changing the social norms that promote it.


Assuntos
Americanos Mexicanos/estatística & dados numéricos , Tempo de Tela , Smartphone/estatística & dados numéricos , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Internet/estatística & dados numéricos , Masculino , Mães/estatística & dados numéricos , New Mexico/epidemiologia , Obesidade/etnologia , Obesidade/etiologia , Pobreza , População Rural/estatística & dados numéricos , Comportamento Sedentário/etnologia , Inquéritos e Questionários , Adulto Jovem
16.
Accid Anal Prev ; 120: 139-151, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30121004

RESUMO

Traffic crashes are more likely to occur at intersections where the traffic environment is complicated. In this study, a hybrid approach combining cluster analysis and hierarchical Bayesian models is developed to examine driver injury severity patterns in intersection-related crashes based on two-year crash data in New Mexico. Three clusters are defined by K-means cluster analysis based on weather and roadway environmental conditions in order to reveal drivers' risk compensation instability under diverse external environment. Hierarchical Bayesian random intercept models are developed for each of the three clusters as well as the whole dataset to identify the contributing factors on multilevel driver injury outcomes: property damage only (Level I), complaint of injury and visible injury (Level II), and incapacitating injury and fatality (Level III). Model comparison with an ordinary multinomial logistic model omitting crash data hierarchical features and cross-level interactions verifies the suitability and effectiveness of the proposed hybrid approach. Results show that a number of crash-level variables (time period, weather, light condition, area, and road grade), vehicle/driver-level variables (traffic controls, vehicle action, vehicle type, seatbelt used, driver age, drug/alcohol impaired, and driver age) along with some cross-level interactions (i.e., left turn and night, drug and dark) impose significantly influence driver injury severity. This study provides insightful understandings of the effects of these variables on driver injury severity in intersection-related crashes and beneficial references for developing effective countermeasures for severe crash prevention.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Tempo (Meteorologia) , Ferimentos e Lesões/classificação , Fatores Etários , Teorema de Bayes , Análise por Conglomerados , Dirigir sob a Influência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , New Mexico/epidemiologia , Cintos de Segurança/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia
17.
Int J Health Geogr ; 17(1): 33, 2018 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-30139378

RESUMO

Two-step floating catchment area (2SFCA) methods that account for multiple transportation modes provide more realistic accessibility representation than single-mode methods. However, the use of the impedance coefficient in an impedance function (e.g., Gaussian function) introduces uncertainty to 2SFCA results. This paper proposes an enhancement to the multi-modal 2SFCA methods through incorporating the concept of a spatial access ratio (SPAR) for spatial access measurement. SPAR is the ratio of a given place's access score to the mean of all access scores in the study area. An empirical study on spatial access to primary care physicians (PCPs) in the city of Albuquerque, NM, USA was conducted to evaluate the effectiveness of SPAR in addressing uncertainty introduced by the choice of the impedance coefficient in the classic Gaussian impedance function. We used ESRI StreetMap Premium and General Transit Specification Feed (GTFS) data to calculate the travel time to PCPs by car and bus. We first generated two spatial access scores-using different catchment sizes for car and bus, respectively-for each demanding population location: an accessibility score for car drivers and an accessibility score for bus riders. We then computed three corresponding spatial access ratios of the above scores for each population location. Sensitivity analysis results suggest that the spatial access scores vary significantly when using different impedance coefficients (p < 0.05); while SPAR remains stable (p = 1). Results from this paper suggest that a spatial access ratio can significantly reduce impedance coefficient-related uncertainties in multi-modal 2SFCA methods.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Análise Espacial , Transportes/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Humanos , New Mexico/epidemiologia , Médicos de Atenção Primária/economia , Atenção Primária à Saúde/economia , Transportes/economia
18.
Behav Ther ; 49(4): 551-566, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29937257

RESUMO

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.


Assuntos
Análise Custo-Benefício/métodos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Delinquência Juvenil/economia , Psicoterapia/economia , Psicoterapia/métodos , Adolescente , Terapia Combinada/economia , Terapia Combinada/métodos , Crime/economia , Crime/psicologia , Vítimas de Crime/economia , Vítimas de Crime/psicologia , Feminino , Humanos , Masculino , New Mexico/epidemiologia
19.
BMC Cancer ; 18(1): 665, 2018 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-29914418

RESUMO

Gallbladder cancer is a rare malignancy of the biliary tract with a poor prognosis, frequently presenting at an advanced stage. While rare in the United States overall, gallbladder cancer has an elevated incidence in geographically distinct locations of the globe including Chile, North India, Korea, Japan and the state of New Mexico in the United States. People with Native American ancestry have a much elevated incidence of gallbladder cancer compared to Hispanic and non-Hispanic white populations of New Mexico. Gallbladder cancer is also one of the few bi-gendered cancers with an elevated female incidence compared to men. Similar to other gastrointestinal cancers, gallbladder cancer etiology is likely multi-factorial involving a combination of genomic, immunological, and environmental factors. Understanding the interplay of these unique epidemiological factors is crucial in improving the prevention, early detection, and treatment of this lethal disease. Previous studies have failed to identify a distinct genomic mutational profile in gallbladder cancers, however, work to identify promising clinically actionable targets is this form of cancer is ongoing. Examples include, interest in the HER2/Neu signaling pathway and the recognition that chronic inflammation plays a crucial role in gallbladder cancer pathogenesis. In this review, we provide a comprehensive overview of gallbladder cancer epidemiology, risk factors, pathogenesis, and treatment with a specific focus on the rural and Native American populations of New Mexico. We conclude this review by discussing future research directions with the goal of improving clinical outcomes for patients of this lethal malignancy.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Feminino , Humanos , Masculino , New Mexico/epidemiologia , População Rural
20.
JAMA Dermatol ; 154(6): 684-693, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29801061

RESUMO

Importance: Germline variants in the MC1R gene are common and confer moderate melanoma risk in those with varied skin types. Approaches to precision skin cancer prevention that include genetic information may promote risk awareness and risk reduction in the general population, including Hispanics. Objective: To examine prevalence of interest in and uptake of MC1R testing in the general population and examine patterns across demographic and skin cancer risk factors. Design, Setting, and Participants: A randomized clinical trial examined interest in and uptake of MC1R testing among patients at University of New Mexico General Internal Medicine clinics. Study participants were randomized to either a usual-care condition (National Cancer Institute skin cancer pamphlet for diverse skin types) or an MC1R test offer. Participants were registered clinic patients (≥6 months) and English or Spanish fluent. Of the 600 participants recruited to the overall trial, the present study included those 499 participants randomized to the MC1R test offer. Interventions: Participants were presented with the option to log onto the study website to read 3 educational modules presenting the rationale, benefits, and drawbacks of MC1R testing. Main Outcomes and Measures: Main outcomes include website log on (yes vs no), saliva test kit request (yes vs no), and saliva test kit return for MC1R testing (yes vs no). Demographic and skin cancer risk factors were examined as potential predictors of test interest and uptake. Results: Of the 499 participants (220 [44%] non-Hispanic white, 242 [48%] Hispanic, 396 [79%] female; mean [SD] age, 54 [14.3] years), 232 (46%) elected to learn about MC1R testing by logging onto the website; 204 (88%) of those who logged on decided to request testing; and 167 (82%) of those who requested testing returned the kit. The strongest predictors of website log on were race/ethnicity and education (non-Hispanic whites were more likely to log on [odds ratio for Hispanics vs non-Hispanic whites, 0.5; 95% CI, 0.3-0.7], as were more highly educated individuals [odds ratio for more than high school vs high school or less, 2.7; 95% CI, 1.7-4.3]). The strongest predictor of ordering the test was sunburn history (odds ratio, 5.4; 95% CI, 2.3-12.9 vs no sunburn history). Conclusions and Relevance: There were moderately high levels of MC1R test interest and uptake in this diverse sample. Addressing potential barriers to testing may be warranted as genomic information becomes integrated into general population approaches to the precision prevention of skin cancer. Trial Registration: ClinicalTrials.gov identifier: NCT03130569.


Assuntos
Testes Genéticos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Melanoma/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Receptor Tipo 1 de Melanocortina/genética , Neoplasias Cutâneas/prevenção & controle , Adulto , Idoso , Escolaridade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Internet , Masculino , Melanoma/genética , Pessoa de Meia-Idade , New Mexico/epidemiologia , Educação de Pacientes como Assunto , Medição de Risco/métodos , Neoplasias Cutâneas/genética , Queimadura Solar/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA