MexicoNew MexicoIndians, North American: Individual members of North American ethnic groups with ancient historic ancestral origins in Asia.Southwestern United States: The geographic area of the southwestern region of the United States. The states usually included in this region are Arizona, California, Colorado, Nevada, New Mexico, Texas, and Utah.Hispanic Americans: Persons living in the United States of Mexican (MEXICAN AMERICANS), Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. The concept does not include Brazilian Americans or Portuguese Americans.Gulf of Mexico: A body of water located at the southeastern corner of North America. It is bordered by the states to the north of Florida, Alabama, Mississippi, Louisiana, Texas; by five Mexican states to the west: Tamaulipas, Veracruz, Tabasco, Campeche, Yucatan; and by Cuba to the southeast.Plague: An acute infectious disease caused by YERSINIA PESTIS that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form.ArizonaTexasChronology as Topic: The temporal sequence of events that have occurred.Cosmetics: Substances intended to be applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body's structure or functions. Included in this definition are skin creams, lotions, perfumes, lipsticks, fingernail polishes, eye and facial makeup preparations, permanent waves, hair colors, toothpastes, and deodorants, as well as any material intended for use as a component of a cosmetic product. (U.S. Food & Drug Administration Center for Food Safety & Applied Nutrition Office of Cosmetics Fact Sheet (web page) Feb 1995)Tattooing: The indelible marking of TISSUES, primarily SKIN, by pricking it with NEEDLES to imbed various COLORING AGENTS. Tattooing of the CORNEA is done to colorize LEUKOMA spots.Bird Diseases: Diseases of birds not considered poultry, therefore usually found in zoos, parks, and the wild. The concept is differentiated from POULTRY DISEASES which is for birds raised as a source of meat or eggs for human consumption, and usually found in barnyards, hatcheries, etc.Coroners and Medical Examiners: Physicians appointed to investigate all cases of sudden or violent death.Siphonaptera: An order of parasitic, blood-sucking, wingless INSECTS with the common name of fleas.ColoradoAnthropology, Cultural: It is the study of social phenomena which characterize the learned, shared, and transmitted social activities of particular ethnic groups with focus on the causes, consequences, and complexities of human social and cultural variability.Small Business: For-profit enterprise with relatively few to moderate number of employees and low to moderate volume of sales.AlaskaHorse Diseases: Diseases of domestic and wild horses of the species Equus caballus.Yersinia pestis: The etiologic agent of PLAGUE in man, rats, ground squirrels, and other rodents.European Continental Ancestry Group: Individuals whose ancestral origins are in the continent of Europe.United StatesHantavirus Pulmonary Syndrome: Acute respiratory illness in humans caused by the Muerto Canyon virus whose primary rodent reservoir is the deer mouse Peromyscus maniculatus. First identified in the southwestern United States, this syndrome is characterized most commonly by fever, myalgias, headache, cough, and rapid respiratory failure.Health Level Seven: An American National Standards Institute-accredited organization working on specifications to support development and advancement of clinical and administrative standards for healthcare.Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.Culicidae: A family of the order DIPTERA that comprises the mosquitoes. The larval stages are aquatic, and the adults can be recognized by the characteristic WINGS, ANIMAL venation, the scales along the wing veins, and the long proboscis. Many species are of particular medical importance.Rural Population: The inhabitants of rural areas or of small towns classified as rural.Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.Death Certificates: Official records of individual deaths including the cause of death certified by a physician, and any other required identifying information.Disease Outbreaks: Sudden increase in the incidence of a disease. The concept includes EPIDEMICS and PANDEMICS.Population Surveillance: Ongoing scrutiny of a population (general population, study population, target population, etc.), generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy.SEER Program: A cancer registry mandated under the National Cancer Act of 1971 to operate and maintain a population-based cancer reporting system, reporting periodically estimates of cancer incidence and mortality in the United States. The Surveillance, Epidemiology, and End Results (SEER) Program is a continuing project of the National Cancer Institute of the National Institutes of Health. Among its goals, in addition to assembling and reporting cancer statistics, are the monitoring of annual cancer incident trends and the promoting of studies designed to identify factors amenable to cancer control interventions. (From National Cancer Institute, NIH Publication No. 91-3074, October 1990)Rural Health: The status of health in rural populations.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.Birds: Warm-blooded VERTEBRATES possessing FEATHERS and belonging to the class Aves.West Nile Fever: A mosquito-borne viral illness caused by the WEST NILE VIRUS, a FLAVIVIRUS and endemic to regions of Africa, Asia, and Europe. Common clinical features include HEADACHE; FEVER; maculopapular rash; gastrointestinal symptoms; and lymphadenopathy. MENINGITIS; ENCEPHALITIS; and MYELITIS may also occur. The disease may occasionally be fatal or leave survivors with residual neurologic deficits. (From Joynt, Clinical Neurology, 1996, Ch26, p13; Lancet 1998 Sep 5;352(9130):767-71)Rural Health Services: Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.Phylogeny: The relationships of groups of organisms as reflected by their genetic makeup.West Nile virus: A species of FLAVIVIRUS, one of the Japanese encephalitis virus group (ENCEPHALITIS VIRUSES, JAPANESE). It can infect birds and mammals. In humans, it is seen most frequently in Africa, Asia, and Europe presenting as a silent infection or undifferentiated fever (WEST NILE FEVER). The virus appeared in North America for the first time in 1999. It is transmitted mainly by CULEX spp mosquitoes which feed primarily on birds, but it can also be carried by the Asian Tiger mosquito, AEDES albopictus, which feeds mainly on mammals.Seasons: Divisions of the year according to some regularly recurrent phenomena usually astronomical or climatic. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed)Geography: The science dealing with the earth and its life, especially the description of land, sea, and air and the distribution of plant and animal life, including humanity and human industries with reference to the mutual relations of these elements. (From Webster, 3d ed)Blood DonorsCaliforniaHorses: Large, hoofed mammals of the family EQUIDAE. Horses are active day and night with most of the day spent seeking and consuming food. Feeding peaks occur in the early morning and late afternoon, and there are several daily periods of rest.Incidence: The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Health Services Accessibility: The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers.Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease.Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.Program Evaluation: Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.Petroleum Pollution: Release of oil into the environment usually due to human activity.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Central AmericaMexican Americans: Persons living in the United States of Mexican descent.Breast Neoplasms: Tumors or cancer of the human BREAST.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Molecular Sequence Data: Descriptions of specific amino acid, carbohydrate, or nucleotide sequences which have appeared in the published literature and/or are deposited in and maintained by databanks such as GENBANK, European Molecular Biology Laboratory (EMBL), National Biomedical Research Foundation (NBRF), or other sequence repositories.Latin America: The geographic area of Latin America in general and when the specific country or countries are not indicated. It usually includes Central America, South America, Mexico, and the islands of the Caribbean.Travel: Aspects of health and disease related to travel.
Old Portal de Mercaderes (Mexico City): Old Portal de Mercaderes in the historic center of Mexico City was and is the west side of the main plaza (otherwise known as the "Zócalo"). This side of the plaza has been occupied by commercial structures since the Spanish Conquest of Mexico in 1521.Albuquerque IsotopesRobinson Rancheria of Pomo Indians of California: The Robinson Rancheria of Pomo Indians of California is a federally recognized tribe of Eastern Pomo people in Lake County, California.California Indians and Their Reservations.Southwestern United States: The Southwestern United States (also known as the American Southwest) is the United States portion of the Southwest (which is situated in both the United States and Mexico). It is a region of the United States defined in different ways by different sources.Septicemic plague: Septicemic (or septicaemic) plague is one of the three main forms of plague. It is caused by Yersinia pestis, a gram-negative species of bacterium.Arizona State Prison Complex – Perryville: Arizona State Prison Complex – Perryville is one of 13 prison facilities operated by the Arizona Department of Corrections (ADC)."Arizona State Prison Complex- Perryville.University of Texas Health Science Center at HoustonSunday Bloody SundayList of cosmetic ingredients: Ingredients of cosmetic products are listed following International Nomenclature of Cosmetic Ingredients (INCI).List of tattoo artists: This is a list of notable tattoo artists.Christine Maggiore: Christine Joy Maggiore (July 25, 1956 – December 27, 2008) was an HIV-positive activist and promoter of AIDS denialism (the belief that HIV is not the cause of AIDS). She was the founder of Alive & Well AIDS Alternatives, an organization which disputes the link between HIV and AIDS and urges HIV-positive pregnant women to avoid anti-HIV medication.Northern rat flea: The northern rat flea (Nosopsyllus fasciatus) is a species of flea found on domestic rats and house mice. Northern rat fleas are external parasites, living by hematophagy off the blood of rodents.Uranium mining in Colorado: Uranium mining in Colorado, United States, goes back to 1872, when pitchblende ore was taken from gold mines near Central City, Colorado. The Colorado uranium industry has seen booms and busts, but continues to this day.Dell Hymes: Dell Hathaway Hymes (June 7, 1927, Portland, OregonNovember 13, 2009, Charlottesville, Virginia) was a linguist, sociolinguist, anthropologist, and folklorist who established disciplinary foundations for the comparative, ethnographic study of language use. His research focused upon the languages of the Pacific Northwest.ADP National Employment Report: The ADP National Employment Report (also popularly known as the ADP Jobs Report or ADP Employment Report) is sponsored by ADP, and was originally developed and maintained by Macroeconomic Advisers, LLC. The report's methodology was revised in November 2012 by Moody's Analytics.List of nature centers in Alaska: This is a list of nature centers and environmental education centers in the state of Alaska.Depth Charge (horse): Depth Charge (1941–1965) was a Thoroughbred son of Bold Venture who went on to become an outstanding sire of American Quarter Horse racehorses.Simmons Legends: Outstanding Quarter Horse Stallions and Mares p.LcrV: In molecular biology, LcrV is a protein found in Yersinia pestis and several other bacterial species. It forms part of the Yersinia pestis virulence protein factors that also includes all Yop's, this used to stand for Yersinia outer protein, but the name has been kept out of convention.List of Parliamentary constituencies in Kent: The ceremonial county of Kent,METeOR: METeOR (Metadata Online Registry), Australia’s repository for national metadata standards for health, housing and community services statistics and information. METeOR is a Metadata registry based on the 2003 version of the ISO/IEC 11179 Information technology - Metadata registries standard.Psorophora howardiiRock 'n' Roll (Status Quo song)Certificate of relief from disabilities: A Certificate of relief from disabilities is issued by a state of the United States of America to a person who has committed a felony or misdemeanor but has subsequently shown that he or she has been rehabilitated. The closely related "Certificate of good conduct" is given to a person who has committed two or more felonies and has demonstrated rehabilitation.National Outbreak Reporting System: ==The National Outbreak Reporting System (NORS)==Proportional reporting ratio: The proportional reporting ratio (PRR) is a statistic that is used to summarize the extent to which a particular adverse event is reported for individuals taking a specific drug, compared to the frequency at which the same adverse event is reported for patients taking some other drug (or who are taking any drug in a specified class of drugs). The PRR will typically be calculated using a surveillance database in which reports of adverse events from a variety of drugs are recorded.Comprehensive Rural Health Project: The Comprehensive Rural Health Project (CRHP) is a non profit, non-governmental organization located in Jamkhed, Ahmednagar District in the state of Maharashtra, India. The organization works with rural communities to provide community-based primary healthcare and improve the general standard of living through a variety of community-led development programs, including Women's Self-Help Groups, Farmers' Clubs, Adolescent Programs and Sanitation and Watershed Development Programs.Bird trapping: Bird trapping techniques to capture wild birds include a wide range of techniques that have their origins in the hunting of birds for food. While hunting for food does not require birds to be caught alive, some trapping techniques capture birds without harming them and are of use in ornithology research.List of West Nile virus outbreaks: *United States: From 1999 through 2001, the CDC confirmed 149 West Nile virus infections, including 18 deaths. In 2002, a total of 4,156 cases were reported, including 284 fatalities.Society for Education Action and Research in Community Health: Searching}}Branching order of bacterial phyla (Gupta, 2001): There are several models of the Branching order of bacterial phyla, one of these was proposed in 2001 by Gupta based on conserved indels or protein, termed "protein signatures", an alternative approach to molecular phylogeny. Some problematic exceptions and conflicts are present to these conserved indels, however, they are in agreement with several groupings of classes and phyla.West Nile virus in the United States: The West Nile virus quickly spread across the United States after the first reported cases in Queens, New York in 1999. The virus is believed to have entered in an infected bird or mosquito, although there is no clear evidence.Four Seasons Baltimore and Residences: Four Seasons Hotel Baltimore is currently a 22 story highrise hotel complex building which opened on November 14, 2011. The building's construction began back in 2007 and went through several changes.Health geography: Health geography is the application of geographical information, perspectives, and methods to the study of health, disease, and health care.World Blood Donor Day: Every year on 14 June, countries around the world celebrate World Blood Donor Day (WBDD). The event, established in 2004, serves to raise awareness of the need for safe blood and blood products, and to thank blood donors for their voluntary, life-saving gifts of blood.San Diego County, California Probation: The San Diego County Probation Department is the body in San Diego County, California responsible for supervising convicted offenders in the community, either who are on probation, such as at the conclusion of their sentences, or while on community supervision orders.Canadian Thoroughbred Horse Society: The Canadian Thoroughbred Horse Society (CTHS) is an organization headquartered in Toronto, Canada that was founded in 1906 to assist Thoroughbred horse breeders. Since 1982, there have been provincial divisions in Alberta, British Columbia, Manitoba, Ontario, Quebec and Saskatchewan.Incidence (epidemiology): Incidence is a measure of the probability of occurrence of a given medical condition in a population within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Age adjustment: In epidemiology and demography, age adjustment, also called age standardization, is a technique used to allow populations to be compared when the age profiles of the populations are quite different.QRISK: QRISK2 (the most recent version of QRISK) is a prediction algorithm for cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood pressure, smoking status and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with body mass index, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.Disease registry: Disease or patient registries are collections of secondary data related to patients with a specific diagnosis, condition, or procedure, and they play an important role in post marketing surveillance of pharmaceuticals. Registries are different from indexes in that they contain more extensive data.Cancer screeningStandard evaluation frameworkUnified Command (Deepwater Horizon oil spill): The Unified Command provides Incident Command System/Unified Command (ICS) for coordinating response to the Deepwater Horizon oil spill.Athletics at the 2002 Central American and Caribbean GamesBreast cancer classification: Breast cancer classification divides breast cancer into categories according to different schemes, each based on different criteria and serving a different purpose. The major categories are the histopathological type, the grade of the tumor, the stage of the tumor, and the expression of proteins and genes.Temporal analysis of products: Temporal Analysis of Products (TAP), (TAP-2), (TAP-3) is an experimental technique for studyingPrenatal nutrition: Nutrition and weight management before and during :pregnancy has a profound effect on the development of infants. This is a rather critical time for healthy fetal development as infants rely heavily on maternal stores and nutrient for optimal growth and health outcome later in life.Coles PhillipsLiliana Rojas-Suarez: Liliana Rojas-Suarez is a Peruvian-born economist, specializing in financial regulatory policy and the impact of global capital flows on development, especially in Latin American countries. She is currently a senior fellow at the Center for Global Development and serves as the chair of the Latin-American Shadow Financial Regulatory Committee (CLAAF).Carte Jaune: The Carte Jaune or Yellow Card is an international certificate of vaccination (ICV). It is issued by the World Health Organisation.
(1/443) Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999.
Products containing gamma-butyrolactone (GBL) are marketed for many claimed purposes, including to induce sleep, release growth hormone, enhance sexual activity and athletic performance, relieve depression, and prolong life. GBL is converted by the body into gamma-hydroxybutyrate (GHB), a drug banned outside of clinical trials approved by the Food and Drug Administration (FDA). Recognized manifestations of GHB toxicity include bradycardia, hypothermia, central nervous system depression, and uncontrolled movements. This report describes seven cases of GBL toxicity involving the product "Revivarant," which is labeled as containing 1.82 g of GBL per fluid ounce, reported from two hospital emergency departments (EDs) in Minnesota during October-December 1998 and summarizes an additional 34 cases of GBL toxicity reported to poison centers in New Mexico and Texas during October 1998-January 1999. (+info)
(2/443) Statistical sensitivity for detection of spatial and temporal patterns in rodent population densities.
A long-term monitoring program begun 1 year after the epidemic of hantavirus pulmonary syndrome in the U.S. Southwest tracked rodent density changes through time and among sites and related these changes to hantavirus infection rates in various small-mammal reservoir species and human disease outbreaks. We assessed the statistical sensitivity of the program's field design and tested for potential biases in population estimates due to unintended deaths of rodents. Analyzing data from two sites in New Mexico from 1994 to 1998, we found that for many species of Peromyscus, Reithrodontomys, Neotoma, Dipodomys, and Perognathus, the monitoring program detected species-specific spatial and temporal differences in rodent densities; trap-related deaths did not significantly affect long-term population estimates. The program also detected a short-term increase in rodent densities in the winter of 1997-98, demonstrating its usefulness in identifying conditions conducive to increased risk for human disease. (+info)
(3/443) A social systems model of hospital utilization.
A social systems model for the health services system serving the state of New Mexico is presented. Utilization of short-term general hospitals is viewed as a function of sociodemographic characteristics of the population and of the supply of health manpower and facilities available to that population. The model includes a network specifying the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply of health manpower and facilities and to their utilization. Inclusion of feedback into the model as well as lagged values of physician supply variables permits examination of the dynamic behavior of the social system over time. A method for deriving the reduced form of the structural model is presented along with the reduced-form equations. These equations provide valuable information for policy decisions regarding the likely consequences of changes in the structure of the population and in the supply of health manpower and facilities. The structural and reduced-form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services. (+info)
(4/443) Using feedback letters to influence the use of antiulcer agents in a Medicaid program.
OBJECTIVE: To determine the impact of printed patient-specific feedback regarding potential misprescribing of antiulcer agents (AUAs). Measures of impact included improvements in patients' dispensing profiles, assessed according to predetermined criteria, and decreases in cost and quantity of AUAs dispensed. DESIGN: Controlled study. After evaluation for compliance with predetermined criteria, prescribers identified as having one or two patient profiles with potential errors were assigned alternatively to control or experimental groups. An intervention was mailed to the experimental group. SETTING: Outpatient setting in the New Mexico Medicaid population. PARTICIPANTS: Patients and prescribers identified as having potential misprescribing of AUAs. INTERVENTION: The intervention consisted of a cover letter describing the purpose of the drug utilization review program, an educational fact sheet regarding prescribing AUAs, patient profiles with potential misprescribing, and physician response forms. MEASUREMENTS AND MAIN RESULTS: There were greater improvements in dispensing to patients in the intervention group (chi2, p <.001). Significant odds ratios for the intervention group were 2.29 for AUAs discontinued, 1.98 for all improvements combined, 13.13 for improvement in listing of proper diagnosis for AUAs, and 2.84 for appropriate indication when prescribing the higher acute daily dosage. Using data from 3 months before and after the intervention, we found greater decreases in mean monthly costs (p =.044) and mean monthly quantity of AUAs dispensed (p =.049) in the intervention group. CONCLUSIONS: This intervention significantly decreased AUA dispensing to patients whose prescribers were mailed the patient-specific feedback intervention. (+info)
(5/443) PCR detection of Yersinia pestis in fleas: comparison with mouse inoculation.
The "gold standard" for identifying Yersinia pestis-infected fleas has been inoculation of mice with pooled flea material. Inoculated mice are monitored for 21 days, and those that die are further analyzed for Y. pestis infection by fluorescent-antibody assay and/or culture. PCR may provide a more rapid and sensitive alternative for identifying Y. pestis in fleas. To compare these assays, samples were prepared from 381 field-collected fleas. Each flea was analyzed individually by both PCR and mouse inoculation. Sixty of the 381 flea samples were positive for Y. pestis by PCR; 48 of these PCR-positive samples caused death in mice (80.0% agreement). None of the 321 PCR-negative samples caused death. Among the 12 mice that survived inoculation with PCR-positive samples, 10 were later demonstrated by serology or culture to have been infected with Y. pestis. This suggests that death of inoculated mice is less reliable than PCR as an indicator of the presence of Y. pestis in flea samples. Mouse inoculation assays produce results that are comparable to PCR only when surviving as well as dead mice are analyzed for infection. The rapidity and sensitivity (10 to 100 CFU of Y. pestis) of PCR suggest that it could serve as a useful alternative to mouse inoculation for routine plague surveillance and outbreak investigations. (+info)
(6/443) Relationship of compliance with hormone replacement therapy to short-term healthcare utilization in a managed care population.
OBJECTIVE: To identify healthcare utilization characteristics that distinguish female members of a managed care organization (MCO) who remained compliant with hormone replacement therapy (HRT) from those who had poor compliance during an 18-month period and to estimate the cost of HRT to an MCO. STUDY DESIGN: A retrospective cohort design in a population of continuously enrolled female members of an MCO. METHODS: All female members of the Lovelace Health Plan 40 years of age or older who began HRT between January 1, 1993, and June 30, 1994 (n = 1158). Compliance was determined by calculating an estrogen medication possession ratio based on pharmacy fills over 18 months. "High compliers" (n = 427) were defined as those purchasing at least 80% of their recommended days supply, and "low compliers" (n = 269) as those purchasing less than 20%. Healthcare encounters and costs of high and low compliers were compared. RESULTS: High compliers were younger (P < 0.01), more likely to be non-Hispanic white than Hispanic (P < 0.0001), and had higher costs for obstetric/gynecologic care (P < 0.0001) and non-HRT prescriptions (P < 0.0001). Low compliers had higher point estimates of costs and encounters for all other categories of care, but differences were statistically significant only for emergency department visits (P < 0.001). CONCLUSIONS: The added cost of HRT did not result in higher total healthcare utilization and costs, as women who complied well with therapy had decreased utilization and costs in other categories of care. Differences in subcategories of healthcare utilization suggest that level of HRT compliance reflects differences in how women access healthcare. (+info)
(7/443) Type 2 diabetes mellitus in Navajo adolescents.
Diabetes mellitus afflicts over one-fifth of the Navajo population aged over 20 years, but the prevalence of diabetes in Navajo adolescents is unclear. We conducted voluntary testing for diabetes mellitus at two high schools on the Navajo reservation to clarify the prevalence as well as to assess the utility of a high-school based screening program. Body mass index measurements (BMI), oral glucose tolerance tests, and hemoglobin A1C measurements were obtained in consenting high school students. Of the 276 students that participated, 234 were Navajo. Only one Navajo student (0.4%) had diabetes mellitus, although eight (3%) had impaired glucose tolerance or impaired fasting glucose. Participant BMI did not differ significantly from nonparticipant BMI. No correlation existed between BMI or impaired glucose handling, and significant overlap existed between the hemoglobin A1C values of students with impaired glucose handling and students without impaired glucose handling. Increased participation in screening programs may reveal higher disease prevalence, but high school-based screening is not justified by this study, despite the high rates of diabetes mellitus in the Navajo population. (+info)
(8/443) Management of diabetes mellitus in the Lovelace Health Systems' EPISODES OF CARE program.
OBJECTIVE: To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. DESIGN: Observational study. SETTING: Lovelace Health Systems, the second-largest and most fully integrated health care delivery system in New Mexico. The main facility is located in Albuquerque. PARTICIPANTS: Lovelace Health Plan members with type 2 diabetes. INTERVENTIONS: Physician-provider interventions included practice guidelines medical profile screens, and provider support reports. Patients interventions included diabetes education; improved access to care, with focused diabetes clinic visits and "Diabetes Days"; and reminder systems. MAIN OUTCOME MEASURES: Glycohemoglobin values, dilated eye examination rates, and access to education. RESULTS: Significant lowering of glycohemoglobin values, dilated eye examination rates exceeding benchmark measures, and increases in educational access rates have occurred since the Lovelace Diabetes EPISODES OF CARE program was implemented. CONCLUSIONS: An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes. (+info)