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The mode of transmission of Helicobacter pylori, a bacterium causing gastric cancer and peptic ulcer disease, is unknown although waterborne transmission is a likely pathway. This study investigated the hypothesis that access to treated water and a sanitary sewerage system reduces the H. pylori incidence rate, using data from 472 participants in a cohort study that followed children in Juarez, Mexico, and El Paso, Texas, from April 1998, with caretaker interviews and the urea breath test for detecting H. pylori infection at target intervals of six months from birth through 24 months of age. The unadjusted hazard ratio comparing bottled/vending machine water to a municipal water supply was 0.71 (95% confidence interval (CI): 0.50, 1.01) and comparing a municipal sewer connection to a septic tank or cesspool, 0.85 (95% CI: 0.60, 1.20). After adjustment for maternal education and country, the hazard ratios decreased slightly to 0.70 (95% confidence interval: 0.49, 1.00) and 0.77 (95% confidence interval: 0.50, 1.21), respectively. These results provide moderate support for potential waterborne transmission of H. pylori.

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Postpartum Hispanic women in the USA are at elevated risk for neural tube defects in subsequent pregnancies from the combined effects of ethnicity, folate depletion from the prior pregnancy and lactation, and high parity rates with short inter-birth intervals. This study evaluated an education programme and distribution of a 3-month starter package of multivitamins among Hispanic women attending nutrition clinics for low-income women in El Paso, Texas. At 1-6 weeks postpartum, 329 subjects were selected to receive education only, multivitamins only, education and multivitamins, or no intervention. Multivariable regression obtained odds ratios (OR) and 95% confidence intervals [CI] to measure the association between intervention status and self-reported multivitamin use at least four times per week at 6 and 12 months postpartum, while controlling for potential confounding variables. Multivitamin distribution was related to consumption at both 6 months (OR = 3.5 [95% CI 1.1, 11.2]) and 12 months (OR = 6.5 [95% CI 1.5, 28.3]). Multivitamins plus education was most effective in increasing multivitamin use at both periods: 6 months (OR = 4.0 [95% CI 1.53, 11.7]) and 12 months (OR = 6.4 [95% CI 1.7, 24.2]). At enrolment, 66% of women regularly took vitamins, and approximately 35% took them at both 6 and 12 months postpartum. The education intervention alone was not associated with multivitamin use at either 6 months (OR = 0.79 [95% CI 0.3, 2.4]) or 12 months (OR = 3.1 [95% CI 0.8, 12.1]). Multivitamin use declines precipitously during postpartum at the time Hispanic women may be susceptible to a subsequent pregnancy. This study provides evidence that multivitamin starter packs sustain multivitamin usage up to 1 year postpartum for a specific high-risk group, but the effect of educational intervention alone should be further studied.

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OBJECTIVE: To study risk and protective factors for alcohol-related problems among high schools students in El Paso, Tex. METHODS: A total of 1366 high school students from 16 different high schools in El Paso, Tex, participated in an anonymous questionnaire regarding alcohol use and alcohol-related behaviors. The sample was 70% Hispanic. RESULTS: Results showed that academic performance, peer influence, parental attitudes, and age at first consumption of alcohol were important predictors of drinking among border youth. CONCLUSION: Risk factors contribute to alcohol use among high school students.

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OBJECTIVE: High parity and short birth intervals among Hispanic women may deplete their folic-acid levels and place them at risk for neural tube defects (NTDs). The purposes of this study were to evaluate factors associated with multivitamin supplementation rates during the early (one to six weeks) postpartum period among Mexican-origin women and present their implications in preventing NTDs in subsequent pregnancies. DESIGN: A cross-sectional study was conducted among Hispanic mothers attending women, infant, and children (WIC) clinics in El Paso, Texas. Information was ascertained via interview on regular multivitamin use, and independent variables including sociodemographic characteristics, multivitamin knowledge, obstetric and health history, and birth control and infant feeding methods. RESULTS: Only 66% of 329 mothers took postpartum multivitamins. Multivitamin consumption declined by 29% for each postpartum week (P=.0003). Adjusted odds ratios indicated positive associations between multivitamin supplementation and prenatal care exclusively in the United States (P=.007), breastfeeding (P=.071), preconceptional (P=.005) and prenatal multivitamin use (P=.0002), and multivitamin recommendation from a healthcare provider (P < or = .0001). The majority of 247 women with multivitamin counsel (59%) were told to finish prenatal vitamins or to continue use while breastfeeding. Smokers were less likely to take multivitamins than nonsmokers (P=.007). CONCLUSIONS: A provider recommendation highly motivates early postpartum women to consume multivitamins. Since most women have more than one child, this period likely represents an interpregnancy interval and is an opportune time to educate and encourage women to take multivitamins. This simple and inexpensive measure could prevent birth defects in future pregnancies.

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BACKGROUND: The Pasitos Cohort Study has followed children in El Paso, Texas and Ciudad Juarez, Mexico since 1998 to identify determinants of Helicobacter pylori infection. This paper describes patterns of acquisition and elimination of H. pylori infection in 468 children from birth to 24 months. METHODS: Mothers were recruited during pregnancy at maternal-child clinics; children were targeted for follow-up examinations every 6 months after birth. H. pylori infection was detected using the 13C-urea breath test, corrected for age-dependent variation in CO2 production. RESULTS: Test results were available for 359, 341, 269, and 215 children around target ages of 6, 12, 18, and 24 months, respectively. The person-time at risk of a first detectable infection was 7742 person-months; 128 first infections were detected, thus the incidence rate was 1.7% per month (95% confidence interval 1.4-2.0%). Rates were similar in boys and girls and on both sides of the border; evidence suggests, however, that this similarity could be due to selection bias. Among children with follow-up after a positive test, 77% tested negative at a later visit. CONCLUSIONS: The initial acquisition of detectable H. pylori infection occurred at a rate of 20% per year among Pasitos Cohort children from birth to 24 months of age. A key finding, with implications for clinical, community health, and research settings, is that most of these infections did not persist. The transient nature of early H. pylori infection should be considered when designing research or contemplating therapeutic intervention for this age group.

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PURPOSE: To determine the rates of alcohol consumption and alcohol-related risk behaviors among a sample of high school students living on the U.S.-Mexico border, as well as to investigate factors associated with alcohol use among this population. METHODS: A self-administered anonymous questionnaire was administered to students in grades 9-12 during Fall and Spring semesters of 2001 (n = 1366; 639 males and 722 females) in 16 high schools in a community along the U.S.-Mexico border. The questionnaire addressed demographic factors, alcohol consumption, and alcohol-related behaviors. Surveys were completed by Chi-square tests for homogeneity of the odds ratio and logistic regression models were used to identify factors significantly associated with the outcome variables. RESULTS: Rates of binge drinking (45%), drinking and driving (19%), and riding with a driver who had been drinking (46%) were higher for our study population when compared with state and national rates. Students who consumed alcohol were more likely to report alcohol-related problems and lower academic grades. Drinking while in Mexico was significantly associated with binge drinking (OR = 6.44), drinking and driving (OR = 5.39), and riding with a driver who has been drinking (OR = 3.12). CONCLUSIONS: The high rates of alcohol risk behaviors among students living on the U.S.-Mexico border underscore the need to develop and implement culturally appropriate prevention programs that address alcohol consumption in Mexico, particularly in terms of students driving back home.

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Rates of Helicobacter pylori infection are traditionally higher in developing countries than in developed countries, but the specific reasons for these differences are not fully clear. While chronic diseases resulting from H. pylori are generally of adult onset, chronic infection usually begins in childhood. In this cross-sectional study (1998-2000), the authors compared prevalences of H. pylori infection among children under age 6 years on both sides of the Rio Grande. Participants included 264 children of women from low-income families who were receiving services at health clinics in Juarez, Mexico, or El Paso, Texas, from April 1998 through October 2000. Data were collected through personal interviews and serologic testing for H. pylori antibodies. The crude odds ratio for H. pylori prevalence among Mexican children as compared with US children was 3.94 (95% confidence interval: 1.72, 9.06). After adjustment for covariates, the odds ratio decreased to 1.70 (95% confidence interval: 0.64, 4.52). The adjustments that produced the greatest reduction in the odds ratio for location were those for household crowding and maternal education. This study identified specific factors that may explain geographic variation in H. pylori prevalence among children.

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Helicobacter pylori infection causes chronic digestive diseases that disproportionately affect Hispanics and other immigrant groups in the United States. Information on the epidemiology of H. pylori infection in pregnant women who reside along the U.S.-Mexico border is critical to understanding the dynamics of current H. pylori transmission patterns within families along the border. We describe the epidemiology of H. pylori infection in pregnant women recruited from Women, Infants, and Children (WIC) clinics in El Paso, Texas, and Mexican Social Security Institute maternal-child clinics in Ciudad Juarez, Mexico, from April 1998 to October 2000. We interviewed participants regarding environmental factors and tested their serum for IgG antibodies. We used logistic regression to estimate associations between environmental exposures and the odds of H. pylori prevalence. Definitive serological tests were available from 751 women. Seroprevalence was 74% in Juarez women and 56% in El Paso women. Prevalence increased with age, crowding, poor sanitation, and residence in Mexico, decreased with education, and was not associated with the woman's number of living children. In the U.S.-Mexico border region, women of reproductive age have a high prevalence of H. pylori infection, apparently related to poor socioeconomic conditions.

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Chronic Helicobacter (H.) pylori infection, typically of childhood onset, causes upper digestive tract diseases of major impact among socioeconomically marginalized populations. This infection is common in children from ethnic minorities in the United States, and particularly so in immigrant children from Mexico. Prevention measures for H. pylori infection do not yet exist, given limited understanding of what causes either acute or persistent infection. To address this gap, we initiated the Pasitos Cohort Study to follow children from low-income families in the border region that includes El Paso County, Texas, and Ciudad Juarez, Chihuahua. The children were enrolled prior to birth, and are examined at 6-month intervals to observe the natural history of H. pylori infection, and to identify risk factors for acquisition, recurrence, and persistence. This report details the study methods, describes how the cohort was established, and discusses the challenges of compliance with follow up in the border setting. Between April 1998 and October 2000, 1,288 pregnant women were screened for eligibility; 807 of 994 eligible women consented to participate. Birth documentation was obtained for 615 infants, and 472 entered follow up. Successful follow up of this cohort requires resources, including a well-trained, dedicated staff, and incentives, to facilitate and motivate long-term participation. Future findings from this ongoing study will help to fill critical gaps in knowledge regarding the epidemiology of H. pylori infection, and will contribute to the identification of prevention strategies.

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Alcohol abuse is a serious problem for students on college campuses. The authors conducted a cross-sectional study to (1) compare measures of alcohol-risk behaviors among college students attending a university on the US-Mexico border with other students and (2) identify factors associated with risk behaviors among border students. They used a self-administered survey to collect data from 286 freshman and sophomore students. Rates of binge drinking were higher among study respondents than among respondents in a national survey of freshman and sophomore college students (46% vs 42% to 45%, respectively). Drinking in high school and drinking in Mexico were significantly associated with all outcomes (binge drinking, drinking and driving, and riding with a drinker). The findings underscore the need for targeted prevention programs among this high-risk population.

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An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiating and strengthening women's organizations, developing women's skills in problem identification and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1000 births before the intervention to 43.8 deaths per 1000 births after. There was a significant increase in the number of women participating in women's organizations following the intervention, as well as in the number of organizations. The proportion of women receiving prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organization can improve maternal and child health in remote areas

Se llevó a cabo una intervención destinada a mejorar la salud materna e infantil en una provincia aislada de Bolivia con acceso limitado a instalaciones de salud modernas. La intervención se centró en la creación y el fortalecimiento de organizaciones para mujeres, en el desarrollo de habilidades entre las mujeres, en la identificación de problemas y la determinación de prioridades y en el adiestramiento de habitantes de la comunidad en la aplicación de técnicas seguras para la atención del parto. Para evaluar su impacto se compararon las tasas de mortalidad perinatal y las prácticas obstétricas de 409 mujeres antes y después de la intervención. La mortalidad perinatal bajó de 117 defunciones por 1 000 nacimientos antes de la intervención a 43,8 defunciones por 1 000 nacimientos después de ella. Se produjo un aumento significativo del número de mujeres que participaron en organizaciones femeninas después de la intervención, así como del número de dichas organizaciones. Asimismo, hubo un aumento significativo de la proporción de mujeres que recibieron atención prenatal y que iniciaron la lactancia materna desde el primer día después del parto. El número de neonatos atendidos inmediatamente después del alumbramiento también aumentó, pero el cambio no fue estadísticamente significativo. Este estudio demuestra que la organización comunitaria puede mejorar la salud materna e infantil en lugares aislados.

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En 1992 se desarrolló en Quetzaltenango, Guatemala, un programa de capacitación de parteras tradicionales con objeto de mejorar la identificación y el tratamiento de trastornos neonatales y de alto riego para las madres. Este programa se evaluó comparando la forma como las parteras referían a las madres al hospital antes y después de la capacitación. El diseño consistió en una intervención de la comunidad evaluada mediante varias encuestas transversales. Para realizar las com paraciones, se seleccionaron un grupo de parteras tradicionales que recibieron capacitación (grupo de intervención) y otro de parteras que procedídan de comunidades cercanas a las de las mujeres del grupo anterior, que no recibieron capacitación (grupo control). Las variables del desenlace incluyeron la capacidad de las parteras para identificar correctamente las complicaciones obstétricas, el momento en que enviaron a las madres al hospital y la mortalidad perinatal de los niños cuyas madres fueron enviadas al hospital. En el estudio participaron 845 de las 854 mujeres elegibles. Tras finalizar el programa de capacitación, se observó un aumento de 200 por ciento en el número de mujeres remitidas al hospital por las parteras. También se constató una mejora en la capacidad de las parteras del grupo de intervención para enviar al hospital a las mujeres con complicaciones obstétricas. El programa parece haber tenido un efecto mínimo en dicha capacidad y en reducir la mortalidad perinatal. No obstante, este último efecto ha de precisarse, ya que se observó un descenso de la mortalidad perinatal tanto en en grupo de intervención como en el de control, si bien la diferencia no fue estadísticamente significativa (AU)

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La mortalidad perinatal es un grave problema de salud en Guatemala, en particular en las zonas rurales, donde la mayoría de los partos son asistidos en los domicilios por parteras tradicionales que actúan como comadronas. Este estudio tuvo tres objetivos: determinar los factores predictivos importantes de mortalidad perinatal en una zona rural de Guatemala, evaluar los efectos de los agentes tradicionales y modernos de atención de salud sobre esa mortalidad y encontrar formas de detectar a las mujeres expuestas a un alto riesgo, que podrían beneficiarse de la transferencia a un hospital o clínica. Para esos propósitos se realizó un estudio de casos y testigos que incluyó a 120 mujeres del departamento rural de Quetzaltenango, todas las cuales habían perdido a sus hijos entre la semana 20 de embarazo y el día 28 después del parto. Estas mujeres y otras 120 que constituyeron el grupo testigo o control fueron entrevistadas en sus hogares por múdicos adiestrados que usaron cuestionarios en español o en la lengua indígena apropiada; los resultados se analizaron mediante una serie de pruebas estadísticas. Las complicaciones del embarazo y el parto asociadas con mortalidad de mayor significación estadística fueron el parto prematuro, la presentación anómala y el trabajo de parto prolongado. Los riesgos atribuibles poblacionales revelaron que estas complicacionese explicaban proporciones considerables de la mortalidad perinatal observada. Estas circunstancias no pueden eliminarse, pero en el contexto de las zonas rurales de Guatemala derivar lo antes posible a las mujeres que tienen esas complicaciones a centros de atención más especializada podría mejorar los resultados obstétricos.

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La mortalidad perinatal es un grave problema de salud en Guatemala, en particular en las zonas rurales, donde la mayoría de los partos son asistidos en los domicilios por parteras tradicionales que actúan como comadronas. Este estudio tuvo tres objetivos: determinar los factores predictivos importantes de mortalidad perinatal en una zona rural de Guatemala, evaluar los efectos de los agentes tradicionales y modernos de atención de salud sobre esa mortalidad y encontrar formas de detectar a las mujeres expuestas a un alto riesgo, que podrían beneficiarse de la transferencia a un hospital o clínica. Para esos propósitos, se realizó un estudio de casos y testigos que incluyó a 120 mujeres del departamento rural de Quetzaltenango, todas las cuales habían perdido a sus hijos entre la semana 20 de embarazo y el día 28 después del parto. Estas mujeres y otras 120 que constituyeron el grupo testigo o control fueron entrevistadas en sus hogares por médicos adiestrados que usaron cuestionarios en español o en la lengua indígena apropiada; los resultados se analizaron mediante una serie de pruebas estadísticas. Las complicaciones del embarazo y el parto asociados con mortalidad de mayor significación estadística fueron el parto prematuro, la presentación anómala y el trabajo de parto prolongado. Los riesgos atribuibles poblacionales revelaron que estas complicaciones explicaban proporciones considerables de la mortalidad perinatal observada. Estas circunstancias no pueden eliminarse, pero en el contexto de las zonas rurales de Guatemala derivar lo antes posible a las mujeres que tienen esas complicaciones a centros de atención más especializada podría mejorar los resultados obstétricos

Publicado en inglés en: Bull. PAHO. Vol. 28(3), 1994

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