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Objective: About one-half of all U.S. counties lack obstetrician-gynecologist (ob-gyns) physicians especially in rural areas. The objective of this study was to use experience in our state to identify demographic and practice characteristics distinguishing ob-gyns in general practice (general ob-gyns) in rural and metropolitan settings. Materials and Methods: This retrospective observational study used self-reported responses by physicians to a mandated survey about demographics and practice patterns at the time of New Mexico medical relicensing. Included in the study were all general ob-gyns in 2016 and 2017. Information about subspecialist ob-gyns and residents who graduated that year was obtained from the American College of Obstetricians and Gynecologists and the Accreditation Council for Graduate Medical Education from 2016 to 2019. Results: Nearly 1 in 3 (84 of 273, 30.8%) general ob-gyns practiced in a rural county. Those in rural settings tended to be older (p = 0.02) and male (p = 0.04). Most had practices in both obstetrics and gynecology. Compared with those in metropolitan counties, general ob-gyns in rural counties practiced in smaller groups (p = 0.0003) and worked 40 hours or more weekly (p = 0.0003). All subspecialists practiced in the most populous metropolitan county. No recent residency graduate practiced rurally in New Mexico. Conclusions: General ob-gyns in New Mexico's rural counties practiced in smaller groups and for longer work hours. Rural ob-gyns tended to be older and male.
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The objectives of this study were to ascertain the prevalence and potential sources of lead exposure among pregnant women residing in a socially-disadvantaged immigrant community in Albuquerque, New Mexico. Pregnant women (n = 140) receiving prenatal care through a community clinic participated in a structured interview and screening to measure their blood lead levels (BLLs). Potential sources of lead exposure were ascertained by the CDC and New Mexico Department of Health questionnaires. Self-reported risk factors were examined as predictors of BLLs using multiple linear regression and partial least squares discriminant analysis. Most patients were Spanish-speaking (88.6%), Latina (95%), foreign-born (87.1%), lacked health insurance (86.4%), and had a high school education or lower (84.3%). While risk factors were prevalent in this population, only three women (2.1%) had BLLs ≥3 µg/dL. Results of multivariate analyses demonstrated that pica symptoms in pregnancy, history of elevated BLLs before pregnancy, use of non-commercial pottery, and living in older houses were important predictors of elevated BLLs. Although the prevalence of other risk factors relevant to immigrant communities (i.e., use of traditional/folk remedies and cosmetics, seasonings and food products from Mexico) was high, they were not predictive of elevated BLLs. Clinics providing prenatal care to immigrant Hispanic communities should carefully assess patients' pica symptoms, use of non-commercial pottery, and a history of elevated BLLs. Moreover, additional efforts need to focus on the development of screening questionnaires which better reflect exposures of concern in this population.
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Hispánicos o Latinos/estadística & datos numéricos , Intoxicación por Plomo/etiología , Conducta Materna/etnología , Exposición Materna/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Emigrantes e Inmigrantes , Femenino , Humanos , Entrevistas como Asunto , Intoxicación por Plomo/epidemiología , Intoxicación por Plomo/prevención & control , Tamizaje Masivo , Análisis Multivariante , New Mexico/epidemiología , Pica , Embarazo , Mujeres Embarazadas , Prevalencia , Análisis de Regresión , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Binge drinking during pregnancy might lead to the development of Fetal Alcohol Spectrum Disorders in the offspring. Latinas are often considered a low-risk group for alcohol abuse, although recent reports indicate that the prevalence of alcohol consumption in this group is increasing due to changing cultural norms. The predictors of alcohol consumption during pregnancy among Latinas are largely unknown. We explored predictors of periconceptional drinking among Latinas (n=155) recruited into an ongoing cohort study at the University of New Mexico. Women were interviewed by a bilingual trained interviewer about any episodes of binge drinking (>or=4 drinks/occasion) a month around their last menstrual period (LMP) and were administered a TWEAK questionnaire. Sociodemographic, lifestyle, and reproductive health characteristics were also ascertained. Predictors of binge drinking were identified by Chi-square test and logistic regression in univariate and multivariable analyses, respectively. Backward selection procedure was used to identify covariates that were independently associated with binge drinking in the final model. The mean age of participants was 27.0+/-5.8 years and 69% were foreign born. In the entire sample, 17.4% of pregnant Latinas admitted at least one binge-drinking episode in the month around their LMP. Results of multivariate analysis indicate that Latinas born in the United States have a much greater risk of binge drinking in the periconceptional period (odds ratio [OR]=3.2; 95% confidence interval [CI]: 1.2, 8.9) compared with foreign-born Latinas. Similarly, Latinas who primarily speak English at home were at much greater risk (OR=3.6; 95% CI: 1.3, 10.5) compared with primarily Spanish-speaking women. No other variables were identified as significant predictors in multivariable models. Our results indicate that more acculturated Latinas are at much greater risk of binge drinking before conception and in early pregnancy compared with less acculturated Latinas. Culturally sensitive interventions should be developed to address risky alcohol consumption among Latinas of reproductive age.
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Aculturación , Consumo de Bebidas Alcohólicas/etnología , Etanol/envenenamiento , Hispánicos o Latinos , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , New Mexico/epidemiología , EmbarazoRESUMEN
OBJECTIVE: The purpose of this study was to identify the maximum tolerable dose and to determine the efficacy of different misoprostol dose reservoirs in an intravaginal controlled-release hydrogel polymer. STUDY DESIGN: Nulliparous women at > or = 37 weeks' gestation requiring cervical ripening and induction of labor were treated with misoprostol in a controlled-release, retrievable hydrogel polymer vaginal insert. Sequential cohorts of 6 patients were to be treated with escalating dose reservoirs of 25, 50, 100, 200, and 300 mug. The insert was to be removed upon onset of active labor, at 24 hours, or earlier if treatment-related adverse events occurred. The safety end point was determination of the maximum tolerable dose (MTD) based on occurrence of hyperstimulation syndrome. Our primary efficacy end point was time to vaginal delivery. RESULTS: Increasing reservoir doses of misoprostol up to 100 microg produced more rapid increases in modified Bishop scores, less need for oxytocin, and a shorter time to vaginal delivery. Doses above 100 microg did not further enhance cervical ripening or shorten time to vaginal delivery. The median time to vaginal delivery was 14.2 hours using the 100 microg dose. Uterine hyperstimulation and adverse fetal heart rate effects occurred with the 200 and 300 microg inserts. CONCLUSION: The 100 microg vaginal insert resulted in successful cervical ripening and rapid vaginal delivery with an acceptable safety profile for future randomized clinical trials.
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Trabajo de Parto Inducido/métodos , Misoprostol/administración & dosificación , Oxitócicos/administración & dosificación , Administración Intravaginal , Maduración Cervical/efectos de los fármacos , Preparaciones de Acción Retardada , Femenino , Humanos , Hidrogeles , Paridad , EmbarazoRESUMEN
OBJECTIVE: The purpose of this study was to compare gestational trophoblastic disease incidence rates with the use of population-based data. STUDY DESIGN: All incident cases between 1973 and 1997 and live birth, pregnancy, and women at risk were tabulated with the use of data that were derived from the New Mexico Tumor Registry and Vital Records and Health Statistics Annual Reports. Statistical methods included trends analyses, odds ratios, and Poisson regression. RESULTS: Of 939 total cases, 312 non-Hispanic white women, 399 Hispanic white women, 201 American Indian women, and 27 other women were affected. Age-adjusted incidence rates were significantly higher for American Indian women (11.16%) compared with non-Hispanic (3.57%) or Hispanic white women (5.32%); the probability value was <.001. When live birth (1:438 women) and pregnancy (1:486 women) denominators were considered, American Indian women alone were at increased risk, and the ratio increased by 56% over 25 years. American Indian women were also at increased risk for partial mole (relative risk, 4.03; 95% CI, 2.57-6.31), invasive mole (relative risk, 26.7; 95% CI, 7.81-93.14), and choriocarcinoma (relative risk, 6.29; 95% CI, 1.81-22.66) variants. CONCLUSION: American Indians are at increased risk relative to the other predominant ethnic groups in New Mexico. Age-adjusted standardization provided a reproducible measurement that may be applicable across other registries.