Life course influences on food provisioning among low-income, Mexican-born mothers with young children at risk of food insecurity.

BACKGROUND: World migration shifts emphasize the necessity of framing health behavior in the context of life course. Mexican-born households in the U.S. disproportionally experience food insecurity, a condition associated with poor health. Food assistance programs may not be accessible to immigrants, suggesting food provisioning strategies may play a critical protective role. OBJECTIVE: To explore life course and ecological system influences on food provisioning among low-income, Mexican-born mothers in the U.S. to identify target influences and behaviors for interventions. METHODS: Life Course Perspective and Ecological Systems Theory guided this qualitative study. INCLUSION CRITERIA: 1) woman born in Mexico, 2) ≤10 years in U.S., 3) residing in one of two New York State counties, 4) at least one child ≤5 years old, and 5) <200% of the federal poverty line. Participants completed two semi-structured interviews, including a participant-driven photo elicitation interview, in English or Spanish, and a food insecurity assessment. Thematic content analysis identified emergent themes. RESULTS: Five themes emerged that were related to three key life course concepts: social context in Mexico (food insecurity experiences, agrarian experiences, and traditional foods and flavors), transitions (motherhood), and turning points (health events). All themes related to mothers' overall priority of providing home-cooked meals, and demonstrated life course influences shaping food provisioning values and strategies. CONCLUSION: Considering life course experiences is important to creating effective, multi-level approaches to reduce food insecurity among Mexican-born families in the northeastern U.S. Programs should have a particular emphasis on new or soon-to-be mothers and should include improved access to affordable in-season produce or gardening opportunities, peer-led food provisioning programs, and food and nutrition assistance programs.

Idiopathic granulomatous mastitis: experience at a New York hospital.

INTRODUCTION: Idiopathic granulomatous mastitis (IGM) often mimics breast cancer. Presentation includes pain, palpable mass, suppuration or suspicious imaging. Widely reported in Asia and the Middle East, IGM is diagnosed after excluding specific granulomatous mastitis (SGM). Aetiology remains unknown. Lactation, prolactinaemia, ethnicity, autoimmune disease and Corynebacteria are associated. Treatment is controversial and the prevalence rising. Surgery and non-operative treatments including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate and observation have advocates. METHODS: A retrospective chart review of 63 patients with IGM from 2008 to 2018 was undertaken focusing on birthplace, age, clinical presentation, wound cultures, imaging, treatments and outcomes. RESULTS: Sixty-one of 63 patients were Hispanic; 53 were Mexican-born women aged 23-46. Clinical presentation included pain, painful mass, painless mass, suppuration and abnormal imaging. Some 31/61 ultrasound examinations and 17/33 mammograms were deemed Breast Imaging Reporting and Data System (BI-RADS) score 4 or 5. Management included antibiotics (43), incision and drainage (24), NSAIDs (29), steroids (8), lumpectomy (18) and observation (12). Some 12/20 patients with painless masses resolved with observation, 3 received NSAIDs, 2 received steroids and 3 underwent lumpectomies. Antibiotics resolved 8/43 cases, 5 needed incision and drainage, 26 received NSAIDs, 6 received steroids and 5 underwent lumpectomies. Nineteen patients had indolent disease or recurrence. CONCLUSIONS: Excluding malignancy is critical, treatment challenging and recurrence common in IGM. A preponderance of patients were Mexican-born, similar to other reports from the USA. Over 50% of IGM cases had suspicious BI-RADS scores. Best management remains a challenge and ranges from observation to lumpectomy.

Sex, Nativity, and Disability in Older Mexican Americans.

OBJECTIVES: To examine the effect of nativity and sex on activities of daily living (ADLs) and mobility limitations in older Mexican Americans. DESIGN: Cross-sectional. SETTING: Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE) (2004-05). PARTICIPANTS: Noninstitutionalized Mexican Americans aged 75 and older (N = 2,069; 56.3% U.S. born, 43.7% Mexican born). MEASUREMENTS: Sociodemographic characteristics, self-reported medical conditions (arthritis, cancer, diabetes mellitus, stroke, heart attack, hip fracture), ADLs, and gross mobility function. RESULTS: The prevalence of ADL limitation was 32.9% in U.S.-born participants and 33.9% in Mexican-born participants of mobility limitation was 56.6% in U.S.-born participants and 55.6% in Mexican-born participants. Mexican-born participants tended to report less ADL limitation (odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.59-1.05)) after controlling for sociodemographic variables and medical conditions. They were also less likely to report mobility limitation (OR = 0.64, 95% CI = 0.48-0.86) after controlling for all covariates. There was a significant effect of the interaction between nativity and sex (OR = 0.42, 95% CI = 0.24-0.74) on ADL limitation, suggesting that Mexican-born men were less disabled than U.S.-born men, whereas the opposite was true for women. No significant interaction between nativity and sex was found for mobility limitation. CONCLUSION: Mexican-born men were less disabled than their U.S.-born counterparts, and Mexican-born women were more likely to report disability than Mexican-born men.