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OBJECTIVES: Published data on the indirect effect of maternal smoking on birth weight as mediated by gestational age in Hispanic populations are lacking. Our goal was to conduct such a mediation analysis using data from El Paso County, Texas. METHODS: El Paso County is located on the US-Mexico border. A simple mediation analysis was conducted using year 2010 El Paso County birth certificate data. The SAS macro PROCESS 3.5.3 was used to estimate the direct and indirect effects of active maternal smoking (by trimester) on birth weight (in grams) in the setting of linear regression. The single mediator was gestational age in weeks. A direct or indirect effect was deemed to be present if the 95% confidence limits (CLs) excluded 0. Analyses were adjusted for multiple variables, including maternal prepregnancy body mass index. The indirect effect was reported along with a 95% bootstrap CL. RESULTS: A total of 16,654 singleton births were included in the cohort. The majority of the mothers were White Hispanic (87.2%). The mean (standard deviation) birth weight was 3198.6 g (517.2). A direct effect of maternal smoking during each trimester on birth weight was detected. An indirect effect of maternal smoking on birth weight was not detected in any of the trimesters. In adjusted analyses for the third trimester, the indirect effect for every 1-U increase in the mean number of cigarettes smoked per day was -4.18 (95% bootstrap CL -10.64 to 1.99). CONCLUSIONS: In our large, predominantly Hispanic cohort, it appears that gestational age is not a mediator of the effect of maternal smoking on birth weight. Future studies in our population should explore other possible mediators of this association.
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Análisis de Mediación , Fumar , Embarazo , Femenino , Humanos , Edad Gestacional , Texas/epidemiología , México , Fumar/efectos adversos , Fumar/epidemiología , Peso al NacerRESUMEN
BACKGROUND: The Texas/Chihuahua (US/Mexico) border is a medically underserved region with many reported barriers for health care access. Although Hispanic ethnicity is associated with health disparities for many different diseases, the population-based estimates of incidence and survival for patients with blood cancer along the border are unknown. The authors hypothesized that Hispanic ethnicity and border proximity is associated with poor blood cancer outcomes. METHODS: Data from the Texas Cancer Registry (1995-2016) were used to investigate the primary exposures of patient ethnicity (Hispanic vs non-Hispanic) and geographic location (border vs non-border). Other confounders and covariates included sex, age, year of diagnosis, rurality, insurance status, poverty indicators, and comorbidities. The Mantel-Haenszel method and Cox regression analyses were used to determine adjusted effects of ethnicity and border proximity on the relative risk (RR) and survival of patients with different blood cancer types. RESULTS: Hispanic patients were diagnosed at a younger age than non-Hispanic patients and presented with increased comorbidities. Whereas non-Hispanics had a higher incidence of developing blood cancer compared with Hispanics overall, Hispanics demonstrated a higher incidence of acute lymphoblastic leukemia (RR, 1.92; 95% CI, 1.79-2.08; P < .001) with worse outcomes. Hispanics from the Texas/Chihuahua border demonstrated a higher incidence of chronic myeloid leukemia (RR, 1.28; 95% CI, 1.07-1.51; P = .02) and acute myeloid leukemia (RR, 1.17; 95% CI, 1.04-1.33; P = .0009) compared with Hispanics living elsewhere in Texas. CONCLUSIONS: Hispanic ethnicity and border proximity were associated with a poor presentation and an adverse prognosis despite the younger age of diagnosis. Future studies should explore differences in disease biology and treatment strategies that could drive these regional disparities.
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Enfermedades Hematológicas/etnología , Hispánicos o Latinos , Área sin Atención Médica , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Accesibilidad a los Servicios de Salud , Enfermedades Hematológicas/epidemiología , Enfermedades Hematológicas/mortalidad , Humanos , Incidencia , Cobertura del Seguro , Leucemia Mielógena Crónica BCR-ABL Positiva/epidemiología , Leucemia Mielógena Crónica BCR-ABL Positiva/etnología , Leucemia Mielógena Crónica BCR-ABL Positiva/mortalidad , Leucemia Mieloide Aguda/epidemiología , Leucemia Mieloide Aguda/etnología , Leucemia Mieloide Aguda/mortalidad , Leucemia Promielocítica Aguda/epidemiología , Leucemia Promielocítica Aguda/etnología , Leucemia Promielocítica Aguda/mortalidad , Masculino , México/etnología , Persona de Mediana Edad , Síndromes Mielodisplásicos/epidemiología , Síndromes Mielodisplásicos/etnología , Síndromes Mielodisplásicos/mortalidad , Trastornos Mieloproliferativos/epidemiología , Trastornos Mieloproliferativos/etnología , Trastornos Mieloproliferativos/mortalidad , Pobreza , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/etnología , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Sistema de Registros , Análisis de Regresión , Población Rural , Factores Sexuales , Texas , Adulto JovenRESUMEN
BACKGROUND: Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city. METHODS: We conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance. RESULTS: Overall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval. CONCLUSIONS: Compared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (≤ 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.
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Prueba de Papanicolaou , Neoplasias del Cuello Uterino , Anciano , Colposcopía , Femenino , Estudios de Seguimiento , Hispánicos o Latinos , Humanos , México , Embarazo , Estudios Retrospectivos , Texas , Neoplasias del Cuello Uterino/diagnóstico , Frotis VaginalRESUMEN
INTRODUCTION AND HYPOTHESIS: The majority of epidemiologic studies of urinary incontinence (UI) have been conducted in non-Hispanic populations. We conducted a case-control study to identify factors associated with delayed care-seeking behavior in adult Mexican American women with UI. METHODS: Cases were women with UI who sought care >2 years after the onset of symptoms (delayed care group). Controls were women with UI who sought care ≤2 years after the onset of symptoms. Participants were women who self-identified as Mexican American, Hispanic, Chicana or Latina, and were 18 years of age or older. RESULTS: A total of 209 records (107 cases and 102 controls) were available for analysis. Of the women in the delayed care and control groups, 32% and 23%, respectively, were ≥66 years of age (P = 0.12). Women in the delayed care group were less likely than those in the control group to report that the following item was a barrier (adjusted OR = 0.54, P = 0.06): "The wait is too long to the appointment". Women in the delayed care group were twice as likely as those in the control group (adjusted OR = 2.17, P = 0.03) to agree that lack of interest on the part of the health-care practitioner and staff was a barrier. In addition to standardized responses, open-ended responses were solicited and the most frequent barrier was lack of knowledge. CONCLUSIONS: Among Mexican American women with UI, those who delayed seeking care for their UI were more likely than those who sought care promptly to cite lack of interest on the part of a health-care provider as a barrier to seeking care in a timely fashion.
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Conocimientos, Actitudes y Práctica en Salud , Americanos Mexicanos/psicología , Aceptación de la Atención de Salud/psicología , Incontinencia Urinaria/psicología , Anciano , Estudios de Casos y Controles , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
This study investigated the prevalence of gestational dysglycemia in a largely Hispanic population in a U.S.-Mexico border city and the influence of single plasma glucose (PG) result on the identification of gestational carbohydrate intolerance. Gestational dysglycemia was studied in a largely Mexican-American population using retrospective data. Gestational diabetes (GDM), gestational impaired fasting glucose (GIFG), and gestational impaired glucose tolerance (GIGT) were identified with Carpenter-Coustan thresholds. Glucose challenge test result was abnormal in 32.7% of 18307 women screened; 47% of them had one or more dysglycemic results in the confirmatory oral glucose tolerance test (OGTT). The prevalence of GDM, GIFG, and GIGT in these women was 8.7, 2.2, and 4.5%, respectively. Fasting, 1-hour, 2-hour, and 3-hour PGs were elevated in 20.5, 28.5, 25.0, and 15.0% of OGTT, respectively (GIFG: 6.0%; 1-hour GIGT: 6.5%; 2-hour GIGT: 4.4%; and 3-hour GIGT: 3.1%). Twelve percent of OGTTs showed dysglycemia at 1 hour with normal 2-hour PG. Isolated dysglycemia, similar to GDM, is prevalent in Mexican-American women. The minimal impact of 3-hour PG supports a 2-hour OGTT. But our results question the use of an "OGTT protocol without a first-hour specimen."