RESUMEN

BACKGROUND: Organophosphate, pyrethroid, and neonicotinoid insecticides have resulted in adrenal and gonadal hormone disruption in animal and in vitro studies; limited epidemiologic evidence exists in humans. We assessed relationships of urinary insecticide metabolite concentrations with adrenal and gonadal hormones in adolescents living in Ecuadorean agricultural communities. METHODS: In 2016, we examined 522 Ecuadorian adolescents (11-17y, 50.7% female, 22% Indigenous; ESPINA study). We measured urinary insecticide metabolites, blood acetylcholinesterase activity (AChE), and salivary testosterone, dehydroepiandrosterone (DHEA), 17ß-estradiol, and cortisol. We used general linear models to assess linear (ß = % hormone difference per 50% increase of metabolite concentration) and curvilinear relationships (ß2 = hormone difference per unit increase in squared ln-metabolite) between ln-metabolite or AChE and ln-hormone concentrations, stratified by sex, adjusting for anthropometric, demographic, and awakening response variables. Bayesian Kernel Machine Regression was used to assess non-linear associations and interactions. RESULTS: The organophosphate metabolite malathion dicarboxylic acid (MDA) had positive associations with testosterone (ßboys = 5.88% [1.21%, 10.78%], ßgirls = 4.10% [-0.02%, 8.39%]), and cortisol (ßboys = 6.06 [-0.23%, 12.75%]. Para-nitrophenol (organophosphate) had negatively-trending curvilinear associations, with testosterone (ß2boys = -0.17 (-0.33, -0.003), p = 0.04) and DHEA (ß2boys = -0.49 (-0.80, -0.19), p = 0.001) in boys. The neonicotinoid summary score (ßboys = 5.60% [0.14%, 11.36%]) and the neonicotinoid acetamiprid-N-desmethyl (ßboys = 3.90% [1.28%, 6.58%]) were positively associated with 17ß-estradiol, measured in boys only. No associations between the pyrethroid 3-phenoxybenzoic acid and hormones were observed. In girls, bivariate response associations identified interactions of MDA, Para-nitrophenol, and 3,5,6-trichloro-2-pyridinol (organophosphates) with testosterone and DHEA concentrations. In boys, we observed an interaction of MDA and Para-nitrophenol with DHEA. No associations were identified for AChE. CONCLUSIONS: We observed evidence of endocrine disruption for specific organophosphate and neonicotinoid metabolite exposures in adolescents. Urinary organophosphate metabolites were associated with testosterone and DHEA concentrations, with stronger associations in boys than girls. Urinary neonicotinoids were positively associated with 17ß-estradiol. Longitudinal repeat-measures analyses would be beneficial for causal inference.

Asunto(s)

Biomarcadores , Insecticidas , Humanos , Adolescente , Femenino , Masculino , Ecuador , Insecticidas/orina , Insecticidas/sangre , Biomarcadores/orina , Biomarcadores/sangre , Niño , Hidrocortisona/orina , Deshidroepiandrosterona/orina , Deshidroepiandrosterona/sangre , Estradiol/sangre , Estradiol/orina , Agricultura , Acetilcolinesterasa/sangre , Acetilcolinesterasa/metabolismo , Testosterona/sangre , Testosterona/orina , Saliva/química , Malatión/orina

RESUMEN

The recent outbreaks of the dengue fever and West Nile viruses and the looming threats of the Zika and chikungunya viruses highlight the importance of establishing effective, proactive arboviral surveillance in communities at high risk of transmission, such as those on the Texas– Mexico border. Currently, there are no approved human vaccines available for these mosquito-borne diseases, so entomological control and case management are the only known methods for decreasing disease incidence. The principal vectors, which include Culex quinquefasciatus, Aedes aegypti, and Ae. Albopictus, all have an established presence in South Texas. The public health response to most arbovirus outbreaks in the region has been reactionary rather than proactive. However, after the 2005 dengue outbreak and subsequent fatality, the City of Brownsville Public Health Department began collecting data on mosquito vector abundance and incidence. The objective of this study was to describe the various species of mosquitoes found in vector surveillance in Brownsville, Texas, during 2009–2013; quantify their prevalence; and identify any associations with temporal or weather-related variations. The results confirm a significant mosquito population in Brownsville in late winter months, indicating a high risk of arbovirus transmission in South Texas year-round, and not just until November, previously considered the end date of arbovirus season by state health services. The data from Brownsville’s surveillance program can help characterize local vector ecology and facilitate more proactive mitigation of future arboviral threats in South Texas.

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Los últimos brotes de los virus del dengue y del Nilo Occidental y la inminente amenaza del virus del Zika y el chikunguña ponen de relieve la importancia de instaurar un sistema eficaz y proactivo de vigilancia de los arbovirus en las comunidades expuestas a un riesgo alto de transmisión, como las ubicadas en la frontera entre Texas y México. Actualmente no se dispone de ninguna vacuna humana aprobada contra estas enfermedades transmitidas por mosquitos, de manera que el control entomológico y el manejo de los casos son los únicos métodos conocidos para reducir la incidencia de estas enfermedades. Está comprobada la presencia de los princi-pales vectores, entre los que se cuentan las especies Culex quinquefasciatus, Aedes aegypti y Ae. albopictus, en la zona sur de Texas. La respuesta de salud pública a la mayoría de los brotes de arbovirus en la región ha sido reactiva en lugar de proactiva. Sin embargo, después del brote de dengue registrado en el 2005 y dada su letalidad, el Departamento de Salud Pública de la Ciudad de Brownsville empezó a recopilar datos sobre la abundancia de los mosquitos vectores y la incidencia de las enfermedades que transmi-ten. El objetivo de este estudio fue describir las diversas especies de mos-quitos encontrados mediante la vigilancia de vectores realizada en Brownsville (Texas) entre los años 2009 y 2013, cuantificar su prevalencia y determinar si hay alguna relación con las variaciones temporales o climáti-cas. Los resultados confirman que Brownsville tiene una población signifi-cativa de mosquitos en los últimos meses del invierno, lo que indica un alto riesgo de transmisión de arbovirus en la zona sur de Texas durante todo el año y no solo hasta noviembre, mes en el que los servicios de salud del estado solían considerar que culminaba la temporada de arbovirus. Los datos del programa de vigilancia de Brownsville pueden ayudar a caracte-rizar la ecología local de los vectores y propiciar una mitigación más proac-tiva de las futuras amenazas arbovirales en la zona sur de Texas.

Asunto(s)

Control de Vectores de las Enfermedades , Arbovirus , Aedes , Salud Fronteriza , Estados Unidos , México , Arbovirus , Control de Vectores de las Enfermedades , Salud Fronteriza , Vigilancia Sanitaria , Vigilancia Sanitaria

RESUMEN

AIM: Studies examining the association between mortality and anticholinergic burden in the geriatric population are conflicting and are absent in the Mexican American population. The present study aimed to determine whether higher anticholinergic burden increases mortality in a cohort representative of community-based older Mexican Americans in the USA. METHODS: This retrospective cohort database study used the Hispanic Established Populations for the Epidemiologic Study of the Elderly cohort. The primary outcome, mortality, was assessed beginning at the second interview in 1995 until the fifth interview in 2005. Medications were classified for anticholinergic burden according to the modified-Anticholinergic Drug Scale and were summed across all reported medications creating a measure of total anticholinergic burden. Anticholinergic burden was tested for association with mortality using survival analysis. RESULTS: The 1497 older adults reporting medication usage were included. Survival analysis showed a statistically significant (P < 0.05) relationship between anticholinergic burden and increased mortality. CONCLUSIONS: Anticholinergic burden is associated with increased mortality in Southwestern Mexican American older adults who report taking prescription or non prescription medications. These findings suggest that anticholinergic burden might be a risk factor for mortality in this selected population, with additional studies required to further define the risk. Geriatr Gerontol Int 2017; 17: 1515-1521.

Asunto(s)

Antagonistas Colinérgicos/uso terapéutico , Americanos Mexicanos , Factores de Edad , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Sudoeste de Estados Unidos , Análisis de Supervivencia , Tasa de Supervivencia

RESUMEN

AIMS: To describe the collective costs of vitamin K antagonist (VKA) treatment for stroke prevention in non-valvular atrial fibrillation (NVAF). VKA drug costs are relatively low, but they necessitate frequent international normalized ratio (INR) monitoring. There are currently minimal data describing the economic impact of this in Mexico. MATERIALS AND METHODS: Cardiologists provided data on their NVAF patients (n = 400) to quantify direct medical costs (INR testing, appointments, drug costs). A sub-set of patients (n = 301) completed a patient questionnaire providing data to calculate direct non-medical costs (travel and other expenses for attendance at VKA-associated appointments) and indirect costs (opportunity cost and reduced work productivity associated with VKA treatment). RESULTS: Estimated annual direct medical costs totaled $753.6 per patient. Annual direct non-medical and indirect costs were USD$149.8 and $132.1, respectively. LIMITATIONS: Recruited patients were those who consulted with a cardiologist during the study period and selected due to inclusion criteria. All had received uninterrupted treatment for 12-24 months. Consequently, the results are not fully generalizable to all VKA treated NVAF patients. CONCLUSIONS: The true cost of VKA treatment cannot be appreciated by a consideration of drug costs alone. Ongoing monitoring appointments incur additional expenses for both patients and the healthcare system.

Asunto(s)

Anticoagulantes/administración & dosificación , Anticoagulantes/economía , Fibrilación Atrial/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Warfarina/administración & dosificación , Warfarina/economía , Anciano , Femenino , Costos de la Atención en Salud , Encuestas de Atención de la Salud , Humanos , Masculino , México , Persona de Mediana Edad

RESUMEN

BACKGROUND AND AIMS: Use of percutaneous endoscopic gastrostomy (PEG) tubes in older adults remains controversial. This cross-sectional study examines community-dwelling Mexican American older adults' attitudes toward PEG tube placement in the hypothetical event of a terminal illness. METHODS: Interviews were conducted with 100 community-dwelling Mexican American (MA's) adults, age 60 and over, in San Antonio, Texas. Subjects were screened for cognitive competence using Folstein's mini-mental examination. This was followed by an evaluation of socioeconomic status, depressive symptoms, religiosity, health status and attitudes toward end-of-life care, including PEG tube feeding. RESULTS: Higher income MA's, professionals, those without a living will, those who saw religious belief as not important and those who attended church less than once a month were more likely to agree with PEG placement (all P < 0.05). Logistic regression analysis revealed that higher income (OR = 3.16, CI = 1.13-8.83), lack of a living will (OR = 3.34, CI = 1.03-20.87) and low importance of religious beliefs (OR = 7.14, CI = 1.25-41.67) were all independently associated with the desire for insertion of a PEG tube at the end of life. CONCLUSIONS: This is the first community-based study to describe older Mexican American's attitudes toward PEG tube placement at the end of life. Older community-dwelling Mexican Americans with higher incomes, lack of a living will or low religious involvement might be more likely to choose PEG tube placement even in the context of a terminal condition.

Asunto(s)

Gastrostomía/psicología , Cuidado Terminal/psicología , Anciano , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Americanos Mexicanos/psicología , Americanos Mexicanos/estadística & datos numéricos , Proyectos Piloto

RESUMEN

OBJECTIVES: The purpose of the current study was to describe the factors associated with Mexican American elders in the Southwestern United States who have spent time in a skilled nursing facility (SNF) compared with those who have not. DESIGN: Data were collected on the Mexican American elders who reported an SNF stay within 10 years of baseline. PARTICIPANTS: A probability sample of 3050 Mexican American elders from five Southwestern states followed from 1993 to 2005 were examined. MEASURES: Variables examined included sociodemographics, language of interview, disabilities with instrumental activities of daily living, activities of daily living, self-reported health, cognitive status, and depression. RESULTS: A total of 78 (3.9%) of 2020 subjects resided in SNFs. Using univariate analyses, older age, English-language interview, poorer cognitive status, and functional disabilities were independently associated with SNF admissions. Logistic regression analyses controlling for age revealed that SNF patients were older (OR = 1.08, P = .001), had an activities of daily living disability (OR = 4.94, P < .001), scored in the depressed range in the Geriatric Depression Scale (OR = 2.72, P = .001), and were more likely to interview in English (OR = 1.95, P = .042), when compared with community counterparts. CONCLUSIONS: Mexican American elders who resided in an SNF at some point in the previous 10 years were older, and were more likely to be functionally impaired. They also were more likely to prefer English as their primary language, indicating they were more likely to agree to an SNF stay than their Spanish-speaking counterparts.

Asunto(s)

Americanos Mexicanos , Casas de Salud , Admisión del Paciente/estadística & datos numéricos , Actividades Cotidianas , Anciano , Trastornos del Conocimiento/epidemiología , Demografía , Depresión/epidemiología , Evaluación de la Discapacidad , Femenino , Evaluación Geriátrica , Humanos , Modelos Logísticos , Masculino , Factores de Riesgo , Sudoeste de Estados Unidos/epidemiología , Encuestas y Cuestionarios

RESUMEN

PURPOSE: To determine the factors that are associated with Mexican Americans' preference for ventilator support, given a supposed terminal diagnosis. METHODS: 100 Mexican Americans, aged 60-89, were recruited and screened for MMSE scores above 18. Eligible subjects answered a questionnaire in their preferred language (English/Spanish) concerning ventilator use during terminal illness. Mediator variables examined included demographics, generation, religiosity, occupation, self-reported depression, self-reported health, and activities of daily living. RESULTS: Being first or second generation American (OR = 0.18, CI = 0.05-0.66) with no IADL disability (OR = 0.11, CI = 0.02-0.59) and having depressive symptoms (OR = 1.43, CI = 1.08-1.89) were associated with preference for ventilator support. IMPLICATIONS: First and second generation older Mexican Americans and those functionally independent are more likely to prefer end-of-life ventilation support. Although depressive symptoms were inversely associated with ventilator use at the end of life, scores may more accurately reflect psychological stress associated with enduring the scenario. Further studies are needed to determine these factors' generalizability to the larger Mexican American community.

Asunto(s)

Actitud Frente a la Salud , Americanos Mexicanos/estadística & datos numéricos , Estrés Psicológico/epidemiología , Cuidado Terminal/estadística & datos numéricos , Ventiladores Mecánicos/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Actitud Frente a la Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Texas/epidemiología

RESUMEN

Little is known about attitudes toward physician-assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non-Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non-Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community-based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity. Older Mexican Americans (52.7%) reported stronger agreement than non-Hispanic whites (33.7%) with PAS. Male sex (odds ratio (OR)=2.62, 95% confidence interval (CI)=1.09-6.35) predicted agreement with legalization in Mexican Americans, whereas lower religiosity scores (OR=0.84, 95% CI=0.75-0.94) were predictive of agreement in older non-Hispanic whites. This study is the first to find positive attitudes among community-dwelling older Mexican Americans toward PAS that are higher than those of older non-Hispanic white adults. Sex and religious views were important determinants of positive attitudes toward PAS. Larger, more-generalizable studies should be conducted to confirm the attitudinal patterns that have been identified in this study.

Asunto(s)

Actitud/etnología , Americanos Mexicanos/psicología , Suicidio Asistido/etnología , Población Blanca/psicología , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Religión , Factores Sexuales , Factores Socioeconómicos , Texas

RESUMEN

BACKGROUND: Current studies indicate that older Mexican Americans take fewer calcium or calcium/vitamin D supplements than do older non-Hispanic whites. Factors associated with calcium supplement use are not completely understood in this ethnic group. OBJECTIVE: The purpose of this article was to determine the prevalence of calcium or calcium/vitamin D supplementation and factors associated with their use in older Mexican Americans. METHODS: A cross-sectional survey was conducted in a random sample of older Mexican Americans residing in the southwestern United States who had participated in the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Self-identified Mexican Americans >or=75 years of age were enrolled through household interviews in 2004-2005. Each subject was asked to bring all prescription and nonprescription medications that they had used regularly during the previous 2 weeks to allow the interviewer to record the product names. Dosages were not recorded. Subjects were assigned to 1 of 3 categories based on their use of calcium or calcium/vitamin D supplements during the previous 2 weeks: (1) calcium supplement only, (2) calcium/vitamin D supplement, or (3) vitamin D supplement only. The subjects' sociodemographic and cultural factors, self-reported health and functional status, cognitive status, number of comorbidities, and use of antiosteoporosis medications were recorded. RESULTS: A total of 2069 older Mexican Americans (1272 women, 797 men; mean age, 81.9 years) were enrolled. The overall prevalence of calcium supplement use was 10.6% (weighted). Calcium supplements were used more often by women (odds ratio [OR] = 1.76; 95% CI, 1.17-2.63), subjects with multiple comorbidities (OR = 1.29; 95% CI, 1.10-1.50), those who interviewed in English (OR = 1.59; 95% CI, 1.06-2.40), and those who used antiosteoporosis medications (OR = 3.57; 95% CI, 1.85-6.89). CONCLUSIONS: Use of calcium or calcium/vitamin D supplements was low (<60%) among this group of older Mexican Americans. Men are particularly at risk. More should be done to raise awareness regarding the benefits of calcium supplementation in this ethnic group.

Asunto(s)

Calcio/uso terapéutico , Suplementos Dietéticos , Vitamina D/uso terapéutico , Anciano , Anciano de 80 o más Años , Estudios Transversales , Recolección de Datos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , Factores Sexuales , Sudoeste de Estados Unidos

RESUMEN

BACKGROUND AND AIMS: To identify the prevalence and characteristics of gall bladder disease (GBD) that has been self-reported in Mexican American Elders. METHODS: A prospective survey of a regional probability sample of self-identified Mexican Americans aged 65 and over. The Hispanic Established Population for the Epidemiologic Studies of the Elderly (H-EPESE), a probability sample of non-institutionalized, Mexican Americans, aged 65 and over, residing in Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. In 1993- 1994 (Wave 1), 3050 Mexican Americans, aged 65 and over, were selected at baseline as a weighted probability sample. In 1995-1996 (Wave 2), 2895 remained. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest United States. Self-reported GBD was collected via in-home interviews. RESULTS: The prevalence of self-reported GBD in Mexican American elders was found to be 18.8% with an average age of 75.05 years. The findings indicate that older Mexican Americans have an increased rate of GBD if they are female, have history of arthritis or hypertension and have more acculturation to the United States. However, the rate decreases when they score poorly on the Mini Mental State Exam. One major limitation was reliance on self-report, as GBD and other co-morbid illnesses may be under-, or overestimated. CONCLUSIONS: Age is not protective in the prevalence of GBD in elder Mexican Americans. Persistent underlying genetics and dietary habits most likely attribute to this consistent high percentage, even in the elderly.

Asunto(s)

Enfermedades de la Vesícula Biliar/epidemiología , Encuestas Epidemiológicas , Americanos Mexicanos/estadística & datos numéricos , Aculturación , Anciano , Anciano de 80 o más Años , Artritis/complicaciones , Artritis/epidemiología , Femenino , Enfermedades de la Vesícula Biliar/complicaciones , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Entrevistas como Asunto , Masculino , Competencia Mental , Obesidad/complicaciones , Obesidad/epidemiología , Prevalencia , Estudios Prospectivos , Factores Sexuales , Sudoeste de Estados Unidos/epidemiología

RESUMEN

BACKGROUND AND AIMS: Hip fractures are a major cause of morbidity and mortality in the older adult population. The evidence of the incidence of morbidity and mortality in Mexican Americans compared to other ethnic groups is mixed. This study aims to examine characteristics and utilization patterns of older Mexican Americans compared to Whites and Blacks, hospitalized for hip fracture in the Southwestern United States. METHODS: Retrospective analysis of the Medicare and Medicaid claims data for the southwestern states of California, Arizona, Colorado, New Mexico and Texas. All Medicare beneficiaries aged 65 and above, hospitalized for non-pathologic hip fractures, participated in the study. Mexican Americans were directly identified from the H-EPESE database. The primary outcome measures were length of stay, total charges and number of diagnoses. RESULTS: The total proportion of hospital encounters related to hip fractures within each ethnic group was 3.7% for Whites, 2.0% for Mexican Americans and 1.2% for Blacks. The mean patient age for the hip fracture was 82.5 years while the non-hip fractures encounters had a mean age of 76.6 years. A higher percentage of Mexican Americans who suffered fracture were female. Although length of stay for Mexican Americans was equivalent to Whites, comparative total charges for Mexican Americans were lower. Mexican Americans also have lower mean number of diagnoses at admission than the other groups (MA=5.5, B=6.2, W=5.9: p<0.001). CONCLUSIONS: Mexican American elders in the southwestern United States who are hospitalized for hip fractures are more likely to be female, relatively healthier, and have lower health care costs when compared to Whites and especially to Blacks in the same region.

Asunto(s)

Fracturas de Cadera/etnología , Seguro de Hospitalización/estadística & datos numéricos , Medicare , Americanos Mexicanos/etnología , Anciano , Anciano de 80 o más Años , Femenino , Fracturas de Cadera/clasificación , Humanos , Masculino , Sudoeste de Estados Unidos , Estados Unidos

Asunto(s)

Humanos , Técnicas de Cierre de Heridas , Cuidados Paliativos , Terapéutica

RESUMEN

Desde hace algún tiempo se aplica la profilaxis antirrábica previa a la exposición por inyección subcutánea de vacuna en embrión de pato, para lograr una reacción inmunógena. Con objeto de comprobar si era eficaz la vía intradérmica o si resultaba más una combinación de vía intradérmica y subcutánea, se inmunizó a alumnos de veterinaria por vía subcutánea, vía intradérmica o una combinación de ambas. Se consideró que 1 ml por vía subcutánea o 0,1 ml por vía intradérmica eran igualmente eficaces. Solo se recomienda el método intradérmico cuando existe personal competente para administrar la inyección (AU)

Asunto(s)

Vacunas Antirrábicas , Estados Unidos