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OBJECTIVE: The study was designed to evaluate the association between socioeconomic level (as measured by maternal education, maternal occupation, and monthly family income) and anencephaly. METHODS: The authors conducted a case-control study using data from the Epidemiological Surveillance System Register for Neural Tube Defects for three states of the Mexican Republic: Puebla, Guerrero and the State of Mexico. Mothers of 151 cases of infants born with anencephaly and mothers of 151 control infants born during the period March 2000 to February 2001 were interviewed about their socioeconomic characteristics and other factors including reproductive history, use of prenatal care, use of tobacco and alcohol, fever during pregnancy, and folic acid supplementation. RESULTS: After adjustment for potential confounders, a risk gradient was seen with decreasing maternal education. Women with less than a primary school education (adjusted odds ratio [OR]=3.0; 95% confidence interval [CI] 1.2, 7.6) and women who had completed primary school but had not completed junior high school (adjusted OR=2.2; 95% CI 0.9, 5.7) had higher risks of giving birth to an infant with anencephaly, compared to women with a higher educational level. A monthly income < or = 1,000 pesos (approximately dollars 100 U.S.) was also associated with a higher risk of anencephaly (OR=2.5; 95% CI 1.2, 5.1). Women employed in industry or agriculture during the acute risk period (three months prior to conception to one month after conception) had a risk 6.5 times (95% CI 1.4, 29.6) that of professional and business women. CONCLUSIONS: This study helps to identify groups that may be especially vulnerable to this type of congenital malformation so that primary and secondary preventive strategies can be targeted to these groups.

Background

Community participation was a core tenet of Primary Health Care as articulated in the 1970s. How this could be generated and maintained was less clear. This historical article describes development of protocols for evidence-based community mobilisation in five local administrative units (municipios) in the Mexican state of Guerrero between 1992 and 1995.

Methods

A sample of five to eight sentinel sites represented each of the most impoverished municipalities of the poorest five of the state's seven regions. A 1992 baseline survey of diarrhoea and its actionable determinants provided the substrate for discussion with local planners and communities. Municipal planners used different strategies to promote participation. In one municipality, new health committees took control of water quality. In another, municipal authorities hired health promoters; a song promoted oral rehydration, and house-to-house interpersonal discussions promoted chlorination. In the poorest and most mountainous municipality, radio casera (home-made radio) soap operas used local "stars". In the largest and most disparate municipality, a child-to-family scheme relied on primary and secondary school teachers. The research team assessed outcomes at intervals and used the results to reinforce local planning and action.

Results

Diarrhoea rates declined in all five municipalities, and there were several positive intermediate outcomes from the communication strategies – changing knowledge, household practices and uptake of services. There was a strong link between specific contents of the communication package and the changing knowledge or practices.

Conclusions

Apart from these evidence-based interventions, other factors probably contributed to the decline of childhood diarrhoea. But, by monitoring implementation of planning decisions and the impact this has at community level, micro-regional planning can stimulate and reinforce actions likely to improve the health of communities. The process empowered municipalities to get access to more resources from the state government and international agencies.

Objective

To evaluate the prevalence of hypertension in older Mexicans in the United States and Mexico.

Design

Stratified by sex, logistic regression models to predict physician diagnosed hypertension were conducted using the Hispanic EPESE (wave 3) and the Mexican Health and Aging Study (MHAS- 70 years and older) datasets.

Setting

Five Southwestern States of Texas, Arizona, California, Colorado, and New Mexico in the United States.

Participants

Older Mexican and Mexican Americans ages 70 and over living in the United States and Mexico.

Main Outcome Measures

Physician diagnosed hypertension.

Results

Older Mexican and Mexican American women have a greater prevalence of hypertension than their male counterparts. Mexican women, who have migrated to the United States and returned to Mexico, have similarly high rates of hypertension as their female counterparts in the United States. After adjusting for demographic characteristics, obesity, and smoking, older Mexican and Mexican American women who have migrated or immigrated to the United States are at increased risk for hypertension.

Conclusions

Gender differences exist in hypertension risk for older Mexicans and Mexican Americans living in the United States and Mexico. Older women who migrate to the United States are at a particular risk for hypertension in both the United States and Mexico.

We review the potential impact of DDT on public health in Mexico. DDT production and consumption patterns in Mexico during the last 20 years are described and compared with those in the United States. In spite of the restrictions on DDT use in antimalaria campaigns in Mexico, use of DDT is still higher than in other Latin American countries. We analyzed information from published studies to determine accumulated levels of this insecticide in blood, adipose tissue, and breast milk samples from Mexican women. Current lipid-adjusted DDE levels from women living in Mexico City are 6.66 ppb in mammary adipose tissue and 0.594 ppm in total breast milk. Finally, the methodological limitations of existing epidemiological studies on DDT exposure and breast cancer are discussed. We conclude that DDT use in Mexico is a public health problem, and suggest two solutions: identification of alternatives for the control of malaria and educational intervention to reduce DDT exposure. We also recommend strengthening epidemiological studies to evaluate the association between accumulated DDT levels in adipose tissue and breast cancer incidence among Mexican women.

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OBJECTIVE

The purpose of our study was to accurately describe facility characteristics among community-based screening and diagnostic mammography practices in the United States.

MATERIALS AND METHODS

A survey was developed and applied to community-based facilities providing screening mammography in three geographically distinct locations in the states of Washington, Colorado, and New Hampshire. The facility survey was conducted between December 2001 and September 2002. Characteristics surveyed included facility type, services offered, charges for screening and diagnostic mammography, information systems, and interpretation methods, including the frequency of double interpretation.

RESULTS

Among 45 responding facilities, services offered included screening mammography at all facilities, diagnostic mammography at 34 facilities (76%), breast sonography at 30 (67%), breast MRI at seven (16%), and nuclear medicine breast scanning at seven (16%). Most facilities surveyed were radiology practices in nonhospital settings. Eight facilities (18%) reported performing clinical breast examinations routinely along with screening mammography. Only five screening sites (11%) used computer-aided detection (CAD) and only two (5%) used digital mammography. Nearly two thirds of facilities interpreted screening mammography examinations on-site, whereas 91% of facilities interpreted diagnostic examinations on-site. Only three facilities (7%) interpreted screening examinations on line as they were performed. Approximately half of facilities reported using some type of double interpretation, although the methods of double interpretation and the fraction of cases double-interpreted varied widely across facilities. On average, approximately 15% of screening examinations and 10% of diagnostic examinations were reported as being double-interpreted.

CONCLUSION

Comparison of this survey’s results with those collected a decade earlier indicates dramatic changes in the practice of mammography, including a clear distinction between screening and diagnostic mammography, batch interpretation of screening mammograms, and improved quality assurance and medical audit tools. Diffusion of new technologies such as CAD and digital mammography was not widespread. The methods of double-interpretation and the fraction of cases double-interpreted varied widely across study sites.

Purpose: At present, there are two basic picture archiving and communication system (PACS) architectures: centralized with a central cache and controller, and distributed with a distributed cache and central controller. A third architecture proposed here is an autonomous one with a distributed cache and no controller. This report will investigate the performance (as measured be central processing unit [CPU] and networkload, scalability, and examination retrieval and display latency) of these three types.Methods: The distributed PACS architecture will be simulated using an IM PAX R3.5 (AGFA, Ridgefield Park, NJ) PACS, while the centralized design will be simulated using an IMPAX R4 (AGFA) PACS. The autonomous system will be designed and implementedin-house. The autonomous system consists of two types of entities: basic components such as acquisition gateways, display stations, and long-term archives, and registry servers, which store global state information about the individual PACS components. The key feature of the autonomous system will be the replacement of the central PACS controller by the registry servers. In this scenario the registry servers monitor the interactions between the components, but do not directly govern them. Instead each component will contain the application logic it requires and will use the state information from the registry servers to take the appropriate action, such as routing images, prefetching studies, and expiring images from near line cache. In addition the routing of examinations will be optimized to reduce the duplication of image data. Display stations will be categorized by specialty (neuroradiology, pediatrics, chest, etc) and will retrieve studies for display on demand from intermediate servers dedicated to the corresponding specialty. Studies will be routed only to the intermediate servers and not to display stations.Results: By distributing the application logic, an autonomous PACS architecture can provide increased fault tolerance and therefore increased uptime. In addition, the lack of a central controller and the use of intermediate servers improve the scalability of the system, as well as reduce CPU and network loads.

Although the financial remittances sent by male Mexican migrant workers residing in the United States can result in higher standards of living for their families and home communities, out-migration may lead to increased migrant problem drinking and sexual risk behaviors, which may in turn impact these same communities of origin. Based on semi-structured interviewing (n=60) and participant observation in a migrant sending community in central Mexico and a receiving community in the Northeastern United States, this paper explores the effects of out-migration on HIV risk and problem drinking among United States-based migrants from a small agricultural community in the Mexican state of Puebla. We argue that problem drinking and risky sexual behaviors among these migrant workers have had significant consequences for their home community in terms of diminished remittances, the introduction of HIV and other sexually transmitted infections, and loss of husbands or kinsmen to automobile accidents. Moreover, although rumor and gossip between the two communities serve as a form of social control, they may also contribute to increased problem drinking and sexual risk.

Using data from Mexico’s Matrícula Consular program, we analyze the geographic organization of undocumented Mexican migration to the United States. We show that emigration has moved beyond its historical origins in west-central Mexico into the central region and, to a lesser extent, the southeast and border regions. In the United States, traditional gateways continue to dominate, but a variety of new destinations have emerged. California, in particular, has lost its overwhelming dominance. Although the geographic structure of Mexico-U.S. migration is relatively stable, it has nonetheless continued to evolve and change over time.

Background

The purpose of this study is to determine the relationship between nativity and nutritional behaviors and beliefs in the Mexican American population living in the South Texas border region.

Methods

Mexican Americans living the border region of South Texas were sampled to assess their nutrition behaviors and beliefs. Nativity was measured as whether subjects were born in the United States or Mexico. Nutritional behaviors were measured using the SPAN and indexes were used to measure barriers to good nutrition, dietary self-efficacy, and dietary importance. OLS regression analysis was used and adjustments were made for sociodemographic factors.

Results

Differences between U.S. born Mexican Americans and Mexico born Mexican Americans existed in nutritional beliefs, but not in behaviors. Mexico born Mexican Americans reported their dietary choices as more important and reported greater food self-efficacy than their U.S. born Mexican American counterparts. Socioeconomic status influenced U.S. born Mexican Americans nutritional beliefs only and the same effect was not observed for Mexico born Mexican Americans.

Discussion

Despite low levels of overall acculturation in the border region dietary beliefs still exist between immigrants and US born Mexican Americans in dietary beliefs, but, not behaviors in U.S. born Mexican Americans.

Prescription medication can often be purchased in Mexico without a physician's prescription. United States residents living along the border may have access to dangerous medications by crossing the border and purchasing them in Mexican pharmacies. We sought to determine the extent and frequency of this behavior in a sample of our ambulatory clinic population. Patients from the Texas Tech University Internal Medicine Clinic were surveyed to collect information about their use of medications, use of alternative sources of health care in Mexico, and purchasing of prescription medication in Juarez, Mexico. More than 80% of patients stated they had purchased prescription-type medication at a pharmacy without a physician's prescription. The most common reasons for buying prescription medication in Mexico were because it was less expensive or because a prescription was not necessary. These data indicate a potential for US residents along the border to take medications in an unregulated manner, a practice that could pose problems for health care providers on both sides of the border.

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Objectives

This study examines the joint impact of psychological and structural factors on Mexican and Mexican American elders' sense of personal control over important aspects of their lives and health in Mexico and the United States.

Methods

We employ the Mexican Health and Aging Study (MHAS) and the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) to explore patterns of association among structural factors, personal characteristics, indicators of material and physical vulnerability, and expressed locus of control.

Results

The results suggest that an older individual's sense of personal control over important aspects of his or her life, including health, reflects real material and social resources in addition to individual predispositions. In Mexico, only the most privileged segment of the population has health insurance, and coverage increases one's sense of personal control. In the United States, on the other hand, Medicare guarantees basic coverage to the vast majority of Mexican Americans over 65, reducing its impact on one's sense of control.

Discussion

Psychological characteristics affect older individuals' sense of personal control over aspects of their health, but the effects are mediated by the economic and health services context in which they are expressed.

SYNOPSIS

Project Extension for Community Healthcare Outcomes (Project ECHO) is a telemedicine and distance-learning program designed to improve access to quality health care for New Mexicans with hepatitis C. Project ECHO links health-care providers from rural clinics, the Indian Health Service, and prisons with specialists at the University of New Mexico. At weekly clinics, partners present and discuss patients with hepatitis C with specialists. Partners can receive continuing education credits for participating. Since June 2003, 173 hepatitis C clinics have been conducted with 1,843 case presentations. Partners have received 390 hours of training and 2,997 hours of continuing education credits. And in 2006, the State Legislature approved $1.5 million in annual funding for the project. Project ECHO has increased access to state-of-the art hepatitis C virus care for patients living in rural areas or prisons. Because of its success with hepatitis C, this project is being expanded to other chronic medical conditions.

Objectives

We examined migration to the United States as a risk factor for suicidal behavior among people of Mexican origin.

Methods

We pooled data from 2 nationally representative surveys in the United States (2001–2003; n=1284) and Mexico (2001–2002; n=5782). We used discrete time survival models to account for time-varying and time-invariant characteristics, including psychiatric disorders.

Results

Risk for suicidal ideation was higher among Mexicans with a family member in the United States (odds ratio [OR]=1.50; 95% confidence interval [CI]=1.06, 2.11), Mexican-born immigrants who arrived in the United States at 12 years or younger (OR=1.84; 95% CI=1.09, 3.09), and US-born Mexican Americans (OR=1.56; 95% CI=1.03, 2.38) than among Mexicans with neither a history of migration to the United States nor a family member currently living there. Risk for suicide attempts was also higher among Mexicans with a family member in the United States (OR=1.68; 95% CI=1.13, 2.52) and US-born Mexican Americans (OR=1.97; 95% CI=1.06, 3.65). Selection bias caused by differential migration or differential return migration of persons at higher risk of suicidal ideation or attempt did not account for these findings.

Conclusions

Public health efforts should focus on the impact of Mexico–US migration on family members of migrants and on US-born Mexican Americans.

Increasing levels of obesity could compromise future gains in life expectancy in low- and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BMI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U.S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.

Background: Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. Methods: The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. Results: More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for ≥6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). Conclusion: The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.

Mishandling of hazardous wastes, like their unauthorized disposal in abandoned dump yards or sites, in river beds, estuaries or in the sea, causes substantial damage to the environment and its resources and, given the persistence and toxicity of these pollutants, they can seriously damage human health and quality of life. The importance of controlling management, transport, and disposal of toxic and hazardous substances in the years to come will be a crucial issue in the design and implementation of public policies. This is especially true for residents of such areas as the border between the United States and Mexico, where historically hazardous wastes have been a public health and environmental problem. The aim of this Conference on the Fate, Transport, and Interactions of Metals, A Joint United States-Mexico Conference, co-sponsored by the National Institute of Environmental Health Sciences, Superfund Basic Research Program, the National University of Mexico, Program for the Environment and the Pan American Health Organization, and hosted by the University of Arizona Center for Toxicology, College of Pharmacy, is to begin a joint effort by the United States and Mexico to better understand the complex problems related to heavy metals as hazardous wastes.

Introduction

Although regionalization of neonatal intensive care is associated with improved outcomes, implementation has been difficult because of increased deliveries of sicker neonates in smaller nurseries. Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.

Methods

The Community Based Research and Education Core Facility of the Center for Translational Neuroscience established a network of 15 telemedicine units with real-time teleconferencing and diagnostic quality imaging, called Telenursery, placed in Neonatal Intensive Care Units, using T1 lines to link these units with a large academic neonatal practice. Weekly educational conferences were conducted to establish guidelines for obstetrical, neonatal and pediatric care in a program called PedsPLACE (Physician Learning and Collaborative Education). Patterns of delivery were assessed through a linked Medicaid database before and after the Telenursery initiative to determine if the most at risk neonates were transferred to the academic perinatal center for delivery. Clinician satisfaction with the PedsPLACE educational conference was high as assessed through written survey instruments.

Results

Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

Conclusion

Telemedicine is an effective way to translate evidence based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.

Objective

To investigate differences in associations between physical activity and overweight for students in two adjacent areas on the border between Mexico and the United States of America: students in the city of Matamoros, Mexico, and Mexican-American students in the Lower Rio Grande Valley (LRGV) area of southern Texas. Since the extremely high prevalence of overweight among Mexican-American adolescents is well-recognized, we wanted to determine whether overweight has become a problem among Mexican adolescents.

Methods

Students from 6 schools (n = 669), representing 12% of the ninth-grade students in Matamoros during 2002-2003, and students from 13 high schools (n = 4 736), representing 22% of the ninth-grade students in the LRGV during 2000-2001, completed questionnaires. Polytomous logistic regression was performed to estimate the risk of being at risk of overweight (≥85th percentile to <95th percentile of body mass index (BMI) for age and sex) and the risk of being overweight (≥95th percentile of BMI-for-age and sex) versus normal weight associated with measures of physical activity. For simplicity normal weight includes underweight.

Results

A higher percentage of adolescents in the LRGV were at risk of overweight (17.2%) in comparison with adolescents from Matamoros (14.8%). The percentages of LRGV and Matamoros adolescents who were overweight were identical (16.9%). LRGV adolescent boys (OR = 0.87, 95% CI = 0.77-0.98) who participated in team sports were less likely to be at or above the 85th percentile of BMI-for-age and sex. Although of borderline significance, Matamoros and LRGV adolescent boys who participated in physical education classes were less likely to be at risk of overweight. Neither in Matamoros nor LRGV students were any of the various physical activity categories or levels associated with being at risk of overweight or being overweight.

Conclusions

Nearly one-third of the students in both Matamoros and the LRGV are at risk of overweight and are overweight. Implementation of interventions on healthful dietary choices and participation in physical education classes and sports teams are essential for reducing the extremely high prevalence of overweight among students on both sides of the Texas/Mexico border.

ABSTRACT. Spanish.

Objetivo: Investigar si hay diferencias en las asociaciones entre la actividad física y el sobrepeso observadas en estudiantes de dos zonas colindantes en la frontera mexicanoestadounidense: estudiantes de la ciudad de Matamoros, México, y estudiantes mexicanoestadounidenses del valle a lo largo de la desembocadura del Río Bravo (VRB) en la parte sur del estado de Texas. Dada la consabida prevalencia extremadamente alta de sobrepeso en adolescentes mexicanoestadounidenses, los autores queríamos determinar si el sobrepeso también se ha convertido en un problema entre adolescentes mexicanos.

Métodos: Estudiantes de 6 escuelas (n = 653), que comprenden 11% de los estudiantes de noveno grado en Matamoros durante 2002–2003, y estudiantes de 13 bachilleratos (n = 4 736), que comprenden 22% de los estudiantes de noveno grado del VRB durante 2000–2001, contestaron cuestionarios. Se llevó a cabo una regresión logística politómica a fin de calcular el riesgo de estar en riesgo de tener sobrepeso (≥85.° percentil a <95.° percentil de índice de masa corporal (IMC) para la edad y el sexo) y el riesgo de tener sobrepeso (≥95.° percentil de índice de masa corporal (IMC) para la edad y el sexo), frente a un peso normal, que se asociaban con distintos grados de actividad física. En aras de la sencillez, en la clasificación del peso normal también se abarcó la insuficiencia de peso.

Resultados: Un mayor porcentaje de adolescentes estaban en riesgo de sufrir sobrepeso en el VRB (17%) que en Matamoros (15%). Los porcentajes de adolescentes de VRB y de Matamoros que tenían sobrepeso fueron idénticos (17%). Los varones adolescentes en el VRB (razón de posibilidades [RP] = 0,87; IC95% = 0,77 a 0,98) que participaron en deportes en equipo tuvieron una menor probabilidad de estar en riesgo de tener sobrepeso. No se encontraron asociaciones entre ningunas de las demás categorías de actividad física por un lado, y estar en riesgo de sufrir sobrepeso o tener sobrepeso por el otro, ni en estudiantes de Matamoros ni en los del VRB.

Conclusiones: Casi una tercera parte de los estudiantes tanto en Matamoros como en el VRB está en riesgo de tener sobrepeso o tiene sobrepeso. La puesta en práctica de intervenciones para fomentar hábitos alimentarios sanos y la participación en clases de educación física y en deportes en equipo es una medida esencial para reducir la prevalencia extremadamente alta de sobrepeso observada en estudiantes a ambos lados de la frontera entre México y Estados Unidos.

Background

Epidemiologic research has consistently found lower prevalence of alcohol and drug use disorders among Hispanic immigrants to the US than among US-born Hispanics. Recent research has begun to examine how this change occurs in the process of assimilation in the US. We aimed to study immigration, US nativity, and return migration as risk factors for alcohol and drug use among people of Mexican origin in both the US and Mexico.

Methods

Data come from nationally representative surveys in the United States (2001–2003; n= 1208) and Mexico (2001–2002; n=5782). We used discrete time event history models to account for time-varying and time-invariant characteristics.

Results

We found no evidence that current Mexican immigrants in the US have higher risk for alcohol or alcohol use disorders than Mexicans living in Mexico, but current immigrants were at higher risk for drug use and drug use disorders. Current Mexican immigrants were at lower risk for drug use and drug disorders than US-born Mexican-Americans. US nativity, regardless of parent nativity, is the main factor associated with increasing use of alcohol and drugs. Among families of migrants and among return migrants we found increased risk for alcohol use, drug use and alcohol and drug use disorders. Evidence of selective migration and return of immigrants with disorders was found regarding alcohol use disorders only.

Conclusions

Research efforts that combine populations from sending and receiving countries are needed. This effort will require much more complex research designs that will call for true international collaboration.

In the United States, despite substantial investment in public health initiatives to promote early detection of breast cancer through screening mammography, the proportion of female breast cancers that have advanced beyond the localized stage by the time of diagnosis remains high. Our objective in this exploratory study was to investigate whether stage of breast cancer at diagnosis among Chicago residents is associated with characteristics of the neighborhoods in which proximate mammography facilities are located. Those characteristics may influence likelihood of utilizing the service routinely and partly explain differences in stage at diagnosis. We used a retrospective cohort design and combined 3 years of data from the Illinois State Cancer Registry (ISCR) with information on locations of mammography facilities, public transportation service, crime, and area demographic and economic characteristics. Using a Geographic Information System (GIS), we identified the five facilities located nearest to each case’s residence. Estimates of the association between characteristics of mammography facility locations and breast cancer stage at diagnosis were obtained using the partial proportional odds regression model. We found that the number of homicides in areas in which the nearest mammography facilities were located was associated with increased odds of later stage diagnosis. This effect was independent of age, race, and residential area education and income. We found no effect on stage of distance, public transportation service, or measures of neighborhood social similarity. The “spatial dynamics” of health may involve geographies beyond the immediate neighborhood. The results of our study suggest that areas in which the nearest mammography facilities are located may be one such geography. We hope that this study will spark research interest in the impact of health service locations on utilization.

Introduction

Breast cancer control efforts could benefit from estimating mammography prevalence at the substate level because studies have primarily analyzed health survey data at the national and state levels. The purpose of this study was to evaluate the extent to which geographic disparities exist in mammography use across counties in the contiguous United States.

Methods

We estimated county-level prevalence of recent mammography (past 2 years) for women aged 40 to 79 years by using synthetic regression, a small-area estimation method. The 2000 Behavioral Risk Factor Surveillance System (BRFSS), 2000 Census, Area Resource File, and Food and Drug Administration mammography facility data were merged by BRFSS respondents' county of residence. We conducted separate analyses to produce county-level prevalence estimates for each race and age group.

Results

Mammography use varied geographically, and the magnitude of geographic disparities differed by race and age. Nonwhite women showed the lowest prevalence of mammography and widest range in county-level estimates. Women aged 40 to 49 had generally lower prevalence than other age groups, while women aged 65 to 79 showed the greatest variation in county-level mammography estimates.

Conclusions

Small-area estimation using BRFSS data is advantageous for surveillance of mammography use at the county level. This method allows documentation of geographic disparities and improves our understanding of the spatial distribution of mammography prevalence. Future interventions should consider this county-level geographic variation, targeting women in the neediest counties.

A typical telemedicine system involves a small set of hospitals providing remote healthcare services to a small section of the society using dedicated nodal centers. However, in developing nations like India where majority live in rural areas that lack specialist care, we envision the need for much larger Internet-based telemedicine systems that would enable a large pool of doctors and hospitals to collectively provide healthcare services to entire populations. We propose a scalable, Internet-based P2P architecture for telemedicine integrating multiple hospitals, mobile medical specialists, and rural mobile units. This system, based on the store and forward model, features a distributed context-aware scheduler for providing timely and location-aware telemedicine services. Other features like zone-based overlay structure and persistent object space abstraction make the system efficient and easy to use. Lastly, the system uses the existing internet infrastructure and supports mobility at doctor and patient ends.

SYNOPSIS

The New Mexico Department of Health and the New Mexico Medical Society invited organizations to participate in an initiative to promote clinical preventive services. The Clinical Preventive Initiative (CPI) focuses on the following interventions based on burden of illness, preventability of the condition, cost, current level of services, availability of leadership, and programmatic support: adult pneumococcal vaccination, tobacco use prevention and cessation, mammography screening, colorectal cancer screening, healthier weight, screening and treatment for chlamydia and gonorrhea, screening and intervention for problem drinking, childhood immunization, and prevention of unintended pregnancy. Specific workgroups plan and implement interventions directed at New Mexico medical practices, practitioners, and health-care systems. Several state measures suggest effectiveness of CPI efforts.

CPI is a successful public-private collaboration providing an active forum for statewide clinical prevention policy development, an effective mechanism to achieve greater awareness of prevention and improved delivery of preventive services.

Recent research suggests that the favorable mortality outcomes for the Mexican immigrant population in the United States may largely be attributable to selective out-migration among Mexican immigrants, resulting in artificially low recorded death rates for the Mexican-origin population. In this paper we calculate detailed age-specific infant mortality rates by maternal race/ethnicity and nativity for two important reasons: (1) it is extremely unlikely that women of Mexican origin would migrate to Mexico with newborn babies, especially if the infants were only a few hours or a few days old; and (2) more than 50% of all infant deaths in the United States occur during the first week of life, when the chances of out-migration are very small. We use concatenated data from the U. S. linked birth and infant death cohort files from 1995 to 2000, which provides us with over 20 million births and more than 150,000 infant deaths to analyze. Our results clearly show that first-hour, first-day, and first-week mortality rates among infants born in the United States to Mexican immigrant women are about 10% lower than those experienced by infants of non-Hispanic, white U.S.-born women. It is extremely unlikely that such favorable rates are artificially caused by the out-migration of Mexican-origin women and infants, as we demonstrate with a simulation exercise. Further, infants born to U.S.-born Mexican American women exhibit rates of mortality that are statistically equal to those of non-Hispanic white women during the first weeks of life and fare considerably better than infants born to non-Hispanic black women, with whom they share similar socioeconomic profiles. These patterns are all consistent with the definition of the epidemiologic paradox as originally proposed by Markides and Coreil (1986).

Abstract

Introduction

Evidence suggests Latinas residing along the United States-Mexico border face higher breast cancer mortality rates compared to Latinas in the interior of either country. The purpose of this study was to investigate breast cancer knowledge, attitudes, and use of breast cancer preventive screening among U.S. Latina and Mexican women residing along the U.S.-Mexico border.

Methods

For this binational cross-sectional study, 265 participants completed an interviewer-administered questionnaire that obtained information on sociodemographic characteristics, knowledge, attitudes, family history, and screening practices. Differences between Mexican (n=128) and U.S. Latina (n=137) participants were assessed by Pearson's chi-square, Fischer's exact test, t tests, and multivariate regression analyses.

Results

U.S. Latinas had significantly increased odds of having ever received a mammogram/breast ultrasound (adjusted odds ratio [OR]=2.95) and clinical breast examination (OR=2.67) compared to Mexican participants. A significantly greater proportion of Mexican women had high knowledge levels (54.8%) compared to U.S. Latinas (45.2%, p<0.05). Age, education, and insurance status were significantly associated with breast cancer screening use.

Conclusions

Despite having higher levels of breast cancer knowledge than U.S. Latinas, Mexican women along the U.S.-Mexico border are not receiving the recommended breast cancer screening procedures. Although U.S. border Latinas had higher breast cancer screening levels than their Mexican counterparts, these levels are lower than those seen among the general U.S. Latina population. Our findings underscore the lack of access to breast cancer prevention screening services and emphasize the need to ensure that existing breast cancer screening programs are effective in reaching women along the U.S.-Mexico border.