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Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to characterize the notifications of malaria in pregnant women in the municipality of Oiapoque. Method: documentary, descriptive, retrospective and quantitative study, conducted from secondary data of the Epidemiological Surveillance System of Malaria in Oiapoque-Amapá, Brazil, from 2013 to 2017. The following variables of autochthonous cases of malaria in pregnant women are addressed: year, month of occurrence, gestational age, Plasmodium infecting species and notification unit. Data were presented and analyzed using descriptive statistics and formulation of spatial distribution maps, generated by ArcGIS software. Results: notifications predominated in urban areas, especially in the Paraíso neighborhood (74%), with Plasmodium Vivax being the main agent (88%), and with a higher incidence between October and December (33%), in the third gestational quarter (35%). Conclusion: the profile of reports of malaria in pregnant women of this municipality resembles previous studies in this region, regarding the place of concentration and period of greater occurrence. However, the gradual introduction of the protozoan Plasmodium falciparum brings an alert to the mobilization of managers and professionals. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El principal objetivo del Programa de Formación en Salud Pública para la Frontera Brasil-Uruguay fue fortalecer las capacidades formativas locales en salud pública a través del desarrollo de habilidades y competencias junto a trabajadores de salud de cuatro zonas fronterizas. El diseño metodológico del Programa, basado en talleres docentes con aplicación de metodologías activas de la formación en salud y mediados por tecnologías educacionales, favoreció la organización de un espacio dialógico permanente entre docentes, gestores y actores de la práctica de ambos países que, entre 2017 y 2018, resultó en: a) el desarrollo de capacidades locales para el mapeo de los principales problemas de vigilancia de la salud en las cuatro zonas fronterizas participantes; b) la discusión de los límites y perspectivas de acción de los servicios de salud existentes en ambos países, dentro de los principios y lineamientos del campo de la salud pública; c) la apropiación de herramientas y procesos pedagógicos que permitieron la incorporación del aspecto de salud pública y de la vigilancia de la salud en los diferentes procesos y espacios organizativos del sector salud local; y d) la construcción de una capacidad permanente para el desarrollo de habilidades y competencias junto a trabajadores del sector salud, en una lógica de educación permanente en salud. Los logros del Programa y sus contribuciones a los servicios de salud locales lo habilitan, de manera efectiva, como acción estratégica para el fortalecimiento de capacidades formativas y de investigación en la frontera Brasil-Uruguay.

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of SMAD Revista Electronica Salud Mental, Alcohol y Drogas is the property of Universidade de Sao Paulo, Escola de Enfermagem de Ribeirao Preto and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

RESUMEN Objetivo: el objetivo principal del estudio es conocer la prevalencia de los diferentes tipos de violencia en el noviazgo en jóvenes, y como objetivos específicos: analizar la asociación entre la violencia el nivel educativo, la edad y sexo de los participantes. Método: se realizó un estudio de tipo cuantitativo, transversal y correlacional, en el periodo de mayo a diciembre de 2016. Se evaluó a un total de 432 estudiantes de ambos sexos, provenientes de cinco instituciones educativas de la ciudad de Matamoros, Tamaulipas, México, mediante el CUVINO. Se consideraron tanto escuelas públicas como privadas de los niveles secundaria y preparatoria. El 53% de la muestra participante fue de estudiantes de nivel secundaria, el restante 47% de preparatorias. Resultados: se encontró una correlación positiva aunque baja entre la variable edad, y los diferentes subtipos de violencia. Se encontraron diferencias significativas en cuanto a sexo para casi todos los subtipos de violencia. No se encontraron diferencias significativas en cuanto a nivel educativo entre los diferentes tipos de violencia. Conclusión: se discute la complejidad del fenómeno de la violencia en parejas jóvenes, con relación a factores sociodemográficos e implicaciones para líneas de investigación futuras. RESUMO Objetivo: O principal objetivo do estudo é conhecer a prevalência de diferentes tipos de violência no namoro em jovens; e como objetivos específicos: analisar a associação entre violência, escolaridade, idade e sexo dos participantes. Método: estudo quantitativo, transversal e correlacional, realizado no período de maio a dezembro de 2016. Foram avaliados 432 estudantes de ambos os sexos, de cinco instituições de ensino da cidade de Matamoros, Tamaulipas, através do CUVINO. Foram consideradas escolas públicas e privadas dos níveis secundário e preparatório. 53% da amostra participante eram de estudantes do ensino secundário, os restantes 47% do ensino médio. Resultados: entre os achados do estudo, encontrou-se uma correlação positivo, embora baixe entre a variável idade e os diferentes subtipos de violência. Diferenças significativas foram encontradas em relação ao sexo para quase todos os subtipos de violência. Não foram encontradas diferenças significativas no nível educacional entre os diferentes tipos de violência. Conclusão: discute-se a complexidade do fenômeno da violência em jovens casais, em relação aos fatores sociodemográficos e suas implicações para futuras linhas de pesquisa.

Objective. To assess the association between intersectional disadvantage and clinically significant depressive symptoms (CSDS), describing the magnitude of social inequalities in the prevalence of symptoms among adult women in Tijuana, Mexico. Methods. This was a cross-sectional study. CSDS were assessed using the Centers for Epidemiological Studies Depression Scale among a probability sample of 2 345 women from 18 - 65 years of age in 2014. CSDS prevalence was calculated according to categories of three social stratifiers: socioeconomic status (SES), educational attainment, and fertility (number of children). Social inequality was measured with the slope index of inequality (SII) and the concentration index (CIx). Intersectionality among stratifiers was explored descriptively and with multivariable regression analysis. Results. CSDS prevalence was 17.7% (95%CI: 15.1% - 21.0%). The SII and CIx showed inequity in all social stratifiers. The absolute difference in CSDS prevalence between the lowest and highest ends of the SES gradient was 21.9% (95%CI: 21.5% - 22.4%). Among the most disadvantaged women, i.e., those at the intersection of lowest SES, lowest educational attainment, and highest fertility, the CSDS prevalence was 39.5% (95% CI: 26.0% -52.9%). Conclusions. Disadvantage along multiple axes was associated with CSDS. Efforts to improve the mental health of women should include equity-oriented policies that address its social determinants. [ABSTRACT FROM AUTHOR]

Resumo: Pesquisa de campo que objetivou identificar a integração em quatro cidades gêmeas do Paraná, Brasil, os determinantes no deslocamento de estrangeiros nas fronteiras e os entraves existentes para a sua efetivação. Os dados foram coletados por meio de entrevistas em profundidade com informantes-chave, utilizou-se a análise de conteúdo do tipo temática para o tratamento dos mesmos. Os resultados mostram que as assimetrias de estrutura, recursos, oferta e qualidade da rede de atenção à saúde são determinantes para as circulações transfronteiriças; as experiências de integração se limitam basicamente a ações emergenciais de vigilância em saúde; constituição de grupos de trabalho com pouca resolutividade, dependentes de iniciativas pessoais, não institucionalizadas; o subfinanciamento público é fator de restrição do acesso aos serviços de saúde. Destaca-se o protagonismo do gestor municipal nas regiões de fronteira e a necessidade de seu reconhecimento como ator político internacional.

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To compare drug use for cities along the USMexico border. Materials and methods. Data are from the US-Mexico Study on Alcohol and Related Conditions (UMSARC, 2011-2013), a survey of 4 796 randomly selected Mexican and of Mexican origin individuals on both sides of the border. Results. Higher rates of any past-year drug use and symptoms of drug use disorders were found only in the border city of Laredo, when compared to the non-border city of San Antonio. Nuevo Laredo and Reynosa/Matamoros showed higher rates of drug use than the non-border city of Monterrey. Much higher rates (OR's in the range of 4-11) were found in the US cities when compared to their acrossthe- border Mexican counterparts. Conclusions. Drug use is high on the border for the selected Mexican cities. Misuse of prescription drugs is nevertheless a concern in the south Texas border cities in our study. [ABSTRACT FROM AUTHOR]

Copyright of Journal Health NPEPS is the property of Journal Health NPEPS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

This report shares the challenges and opportunities encountered by a binational project that examined the availability of environmental and public health information for the United States-Mexico border area. The researchers interviewed numerous national and binational agencies on both sides of the border, endeavoring to develop a framework to advance the knowledge of academic and public health professionals in the area of environmental border health. However, the lack of standardized indicators and metrics in both countries validates the emergent need to establish a viable framework for the collection, analysis, and dissemination of environmental information. Recommendations for next steps are included. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivou-se avaliar a efetividade dos serviços de saúde no diagnóstico da tuberculose em Foz do Iguaçu-PR. Realizou-se uma pesquisa avaliativa, com desenho epidemiológico transversal. Foram entrevistados 101 doentes de tuberculose em 2009, utilizando um instrumento baseado no Primary Care Assessment Tool . A análise ocorreu a partir de proporções e respectivos intervalos de confiança (95%) e mediana. O Pronto Atendimento (37%) e a Atenção Básica à Saúde (ABS) (36%) foram os locais mais buscados. O acesso à consulta no mesmo dia alcançou 70%, mas a suspeição da doença foi menor que 47%; a baciloscopia realizada em 50% dos doentes. Concluiu-se que apesar desses serviços atenderem rapidamente, isso não determinou alcance do diagnóstico, levando o doente a procurar os serviços especializados, mais efetivos na descoberta dos casos. A busca pela ABS gerou maior tempo e maior número de retornos para o diagnóstico da tuberculose na tríplice fronteira.

OBJECTIVE: The goal of this study was to assess linkages between microclimate and longer-term ENSO-related weather forcing on the week-to-week changes in dengue prevalence in Matamoros, Tamaulipas, Mexico, over a recent decade of dengue observations. MATERIAL AND METHODS: An auto-regressive model to evaluate the role of climatic factors (sea-surface temperature) and weather (maximum temperature, minimum temperature, precipitation) on dengue incidence over the period 1995-2005, was developed by conducting time-series analysis. RESULTS: Dengue incidence increased by 2.6% (95% CI: 0.2-5.1) one week after every 1ºC increase in weekly maximum temperature and increased 1.9% (95% CI: -0.1-3.9) two weeks after every 1 cm increase in weekly precipitation. Every 1ºC increase in sea surface temperatures (El Niño region 3.4 ) was followed by a 19.4% (95% CI: -4.7-43.5) increase in dengue incidence (18 weeks later). CONCLUSIONS: Climate and weather factors play a small but significant role in dengue transmission in Matamoros, Mexico. This study may provide baseline information for identifying potential longer-term effects of global climate change on dengue expected in the coming decades. To our knowledge, this is the first study to investigate the potential associations between climate and weather events and dengue incidence in this geographical area.OBJETIVO: Evaluar los vínculos entre el microclima, las variables relacionadas al fenómeno de El Niño Oscilación del Sur (ENSO) y los cambios en el reporte semanal de casos de dengue en el área de Matamoros, Tamaulipas, México, a lo largo de una década de observaciones. MATERIAL Y MÉTODOS: Se desarrolló un modelo autorregresivo para evaluar la influencia de factores climáticos (temperatura superficial del mar) y tiempo (temperatura máxima, temperatura mínima y precipitación) sobre la incidencia de dengue, a lo largo de 11 años (1995-2005), empleando análisis de series de tiempo. RESULTADOS: La incidencia de casos de dengue aumentó 2.6% una semana después de cada 1ºC de incremento en la temperatura máxima semanal (95% IC: 0.2, 5.1); observamos también que los casos de dengue aumentaron 1.9% dos semanas después de cada centímetro de incremento en la precipitación semanal (95% IC: -0.1, 3.9). Cada 1ºC de aumento en la temperatura superficial del mar en la región Niño 3.4 fue seguida, 18 semanas después, de un aumento de 19.4% en la incidencia de casos de dengue (95% IC: -4.7, 43.5). CONCLUSIONES: Los factores de clima y tiempo tienen una influencia menor, aunque significativa, sobre la transmisión del dengue en la ciudad fronteriza de Matamoros, México. Este estudio aporta información basal para identificar efectos potenciales de mayor alcance, relacionados con el cambio climático global sobre los casos esperados de dengue en las próximas décadas. Hasta donde sabemos, este es el primer estudio que evalúa las posibles asociaciones entre los eventos climáticos y tiempos y la incidencia de casos de dengue en la frontera de México con Texas.

Objective. To describe the frequency, characteristics, and patient outcomes for women who accessed Emergency Medical Services (EMS) for obstetric emergencies at the ports of entry (POE) between El Paso, Texas, United States of America, and Ciudad Juárez, Chihuahua, Mexico. Methods. A descriptive study of women 12-49 years of age for whom an EMS ambulance was called to an El Paso POE location from December 2008-April 2011 was conducted. Women were identified through surveillance of EMS records. EMS and emergency department (ED) records were abstracted for all women through December 2009 and for women with an obstetric emergency through April 2011. For obstetric patients admitted to the hospital, additional prenatal and birth characteristics were collected. Frequencies and proportions were estimated for each variable; differences between residents of the United States and Mexico were tested. Results. During December 2008-December 2009, 47.6% (68/143) of women receiving EMS assistance at an El Paso POE had an obstetric emergency, nearly 20 times the proportion for Texas overall. During December 2008-April 2011, 60.1% (66/109) of obstetric patients with ED records were admitted to hospital and 52 gave birth before discharge. Preterm birth (23.1%; No. = 12), low birth weight (9.6%; No. = 5), birth in transit (7.7%; No. = 4), and postpartum hemorrhage (5.8%; No. = 3) were common; fewer than one-half the women (46.2%; No. = 24) had evidence of prenatal care. Conclusions. The high proportion of obstetric EMS transports and high prevalence of complications in this population suggest a need for binational risk reduction efforts. [ABSTRACT FROM AUTHOR]

This analysis reviews cooperation between the four border states of the United States of America (Arizona, California, New Mexico, and Texas) and international partners in Mexico with regard to type 2 diabetes among Latinos. Binational cooperation, academic collaboration, preventative health initiatives, and efforts to improve health care access for the border population are highlighted. This metaanalysis of the literature points out causative factors of the increased type 2 diabetes prevalence among Latinos in the United States; an inverse correlation between diabetes and education and socioeconomic level; contributing factors, including barriers with language, health care payment, transportation, and underestimating diabetes implications; and a lack of social and environmental support for disease management. Medical and indirect costs in socioeconomic terms are also included. Cooperation between the United States and Mexico may be beneficial to promoting further collaborative efforts between these nations, and serve as a template for greater cooperative efforts to mitigate the substantial public health and socioeconomic implications of type 2 diabetes globally. [ABSTRACT FROM AUTHOR]

Copyright of Rev Rene is the property of Rev Rene and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To identify the main strengths, weaknesses, and challenges of the Ecuador--Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. Methods. A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo--Macará binational micro-network. Results. The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1) the binational network and 2) a patient referral / counter-referral system that includes the transfer of patient clinical information. Conclusions. Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1) consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2) achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3) development of an integrated binational information system. [ABSTRACT FROM AUTHOR]

Objective. To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. Methods. A stratified two-stage randomized cross-sectional health survey was conducted in 2009-2010 among 1 002 Mexican American households. Results. Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 -2.76). Conclusions. Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management. [ABSTRACT FROM AUTHOR]

Objective. To analyze the profile of care for sexually transmitted infections (STIs) in health centers in border areas of Central America during 2007-2010. Materials and methods. Cross-sectional study in a sample of 3 357 patients. Doctors were trained and medicines, condoms and HIV testing (basic package of care [BPC]) were supplied. Sample was characterized according to sociodemographic variables. Factors associated with the probability of receiving the BPC were identified. Results. Sixty six percent were 25-59 years old, and 93.2% were women. The most frequently diagnosed syndrome was vaginal discharge associated with candidiasis, bacterial vaginosis, trichomoniasis and gonorrhea. Sixty six percent of prescriptions were adhered to the international recommendations. Only 10% received the complete BPC. The likelihood of receiving it was lower in women. Conclusions. It is not enough to increase service delivery capacity to change care practices. These are deeply rooted in the sociocultural context. Highlights gendered medical practices that adversely affect the profile of care. [ABSTRACT FROM AUTHOR]

Objective. To compare demographics and motivations for falls from bridges at the United States--Mexico border and in El Paso County, Texas, and to analyze injuries and injury patterns to support intentionality and to provide treatment recommendations. Methods. A retrospective observational review was conducted of hospital admissions to a trauma center after falls from bridges from 1995 to 2009. Statistical methods used were chisquare testing, T-test for means comparison, univariate correlations, and regression analysis. Results. Of the 97 evaluated patients, 81.4% fell from U.S.--Mexico border bridges, including one patient who fell from a railway bridge; 74.7% of those falling from border bridges had a non--U.S. address, contrasting with 22.2% of those who fell within the United States. Falls over the border were associated with more immigration-related motivations and fewer suicide attempts. Injuries included lower extremities in 76 (78.4%) and thoracolumbar spine in 27 (27.8%) patients; 16 patients with a thoracolumbar spine fracture (59.3%) also had a lower extremity injury. Mean hospital length of stay was 7.2 days. Mean injury severity score was 8.45 (range 1--43). Age, injury severity score, and pelvic fracture increased the hospital length of stay. Conclusions. Patients fell while emigrating--immigrating based on residence and motivating factors. A dyad of lower extremity and thoracolumbar spine injuries coincided in 59.3% of those with a thoracolumbar spine injury; thoracolumbar spine imaging of patients evaluated after falls from bridges is recommended. Proposed prevention strategies include posting signs on bridges and installing catch-net safety barriers. [ABSTRACT FROM AUTHOR]

Objective. To investigate the risk effects of poverty and exposure to collective violence attributed to organized crime on the mental health of children living on the United States-- Mexico border. Methods. A repeated, cross-sectional study measured risk effects by comparing scores of psychosocial and behavioral problems among children and adolescents living on the border in the United States or Mexico in 2007 and 2010. Patients living in poverty who responded once to the Pictorial Child Behavior Checklist (P+CBCL) in Spanish were randomly selected from clinics in El Paso, Texas, United States (poverty alone group), and Ciudad Juarez, Chihuahua, Mexico (poverty plus violence group). Only children of Hispanic origin (Mexican--American or Mexican) living below the poverty level and presenting at the clinic for nonemergency visits with no history of diagnosed mental, neurological, or life-threatening disease or disability were included. Results. Exposure to collective violence and poverty seemed to have an additive effect on children's mental health. Children exposed to both poverty and collective violence had higher problem scores, as measured by the P+CBCL, than those exposed to poverty alone. Conclusions. It is important to consider that children and adolescents exposed to collective violence and poverty also have fewer chances to receive treatment. Untreated mental health problems predict violence, antisocial behaviors, and delinquency and affect families, communities, and individuals. It is crucial to address the mental health of children on the border to counteract the devastating effects this setting will have in the short term and the near future. [ABSTRACT FROM AUTHOR]

This report describes the implementation process and functional structure of the Observatory of Security and Citizen Conviviality of the Juarez Municipality (Observatorio de Seguridad y Convivencia Ciudadanas del Municipio de Juárez) in Chihuahua, Mexico, and discusses the most relevant lessons learned and main challenges in the near future. The Observatory, created in 2008, is a joint effort of the Juarez Municipal Government, Autonomous University of Ciudad Juarez (Universidad Autónoma de Ciudad Juárez), and the Pan American Health Organization. The Observatory's main objective is to propose strategies and public policy recommendations to prevent and control violence and injuries in the Juarez Municipality. Most key federal, state, and local agencies have joined this independent autonomous citizen-based initiative, feed the databases, and benefit from the information produced by a multisectoral, multidisciplinary approach. The Observatory contributes far more than the technical data provided and its facilitating functions. The clear results obtained in such a short time--as seen in the preliminary results of the case study on road injuries from January 2009 to July 2011-- demonstrate the appropriateness of this course of action and should stimulate the creation of new observatories whenever and wherever needed. Lessons learned, as discussed here, can open the way to new endeavors, and current challenges show how much work remains to be done. [ABSTRACT FROM AUTHOR]

At meetings and workshops with Wayúu communities and government officials from Colombia and Venezuela, after validating the analysis of the health situation and its determinants, the components of a binational health care model for the Wayúu people living on the border between the two countries were identified. Although both countries have made progress in intercultural health care, some aspects of their legislation and service organization still need to be strengthened to make the guaranteed right to health a reality. The allocation of new national resources--or the redistribution of current resources--should be ensured, as well as the management of international resources for conducting a short-term pilot project and implementing the model in the medium term. [ABSTRACT FROM AUTHOR]

This study used a social-ecological framework to examine predictors of depression, diabetes self-management, and clinical indicators of health risk among Hispanics with type 2 diabetes residing in the United States (U.S.)--Mexico border region in San Diego County, California, United States of America. Important links were observed between greater social-environmental support for disease management and less depression, better diabetes self-management, and lower body mass index and serum triglyceride concentrations. Less depressive symptomatology was also related to lower hemoglobin A1c levels. Findings suggest that programs aiming to improve diabetes self-management and health outcomes in Hispanics with type 2 diabetes should consider multilevel, social, and environmental influences on health, behavior, and emotional well-being. [ABSTRACT FROM AUTHOR]

Objective. To examine the association between diabetes-related lower-extremity amputation (LEA) and ethnicity, age, source of payment, geographic location, diabetes severity, and health condition in adults with diabetes mellitus type 2 living in border and non-border counties in Texas, United States of America, and to assess intra-border region geographic differences in post-LEA treatment. Methods. This correlational study was based on secondary data from the 2003 Texas Inpatient Hospital Discharge Data. The sample consisted of individuals 45 years of age and older with type 2 diabetes who had undergone a nontraumatic LEA (n = 5 865). Descriptive statistics and logistic regression analyses were applied. Results. The following characteristics were predictors of LEA: being Hispanic or African American, male, ≥ 55 years old, and a Medicare or Medicaid user, and living in a border county. Persons with moderate diabetes and those who suffered from cardiovascular disease or stroke also had higher odds of undergoing an LEA. Post-LEA occupational therapy was significantly less prevalent among border residents (9.5%) than non-border residents (15.3%) (P < 0.001). Conclusion. Understanding the factors that influence diabetes-related LEA may lead to early detection and effective treatment of this disabling consequence of diabetes along the U.S.- Mexico border. [ABSTRACT FROM AUTHOR]

Objective. To assess and monitor the quality of care provided to Hispanics diagnosed with diabetes living in the border region between the United States of America and Mexico. Methods. From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, was conducted along the U.S.-Mexico border using two-stage cluster sampling of towns and households within towns. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. Of the 4 027 study participants, 521 (13.0%) reported receiving a pre-study diagnosis of diabetes. Of those, 466 were of Hispanic origin (226 on the Mexican side of the border and 240 on the U.S. side). Results. Results indicated 42.1% of Hispanics on the U.S. side of the border (95% confidence interval [CI] 35.8%-48.6%) and 37.6% of Hispanics on the Mexican side (95% CI 31.3%-44.3%) had controlled diabetes (defined as glycosylated hemoglobin A1c < 7.0 %), and only one (on the Mexican side of the border) received optimal diabetes care, defined according to international criteria for systolic blood pressure and body mass index as well as health provider provision of yearly examinations of foot and eyes as preventive care measures for early detection of diabetes complications. Conclusions. Adult Hispanics diagnosed with diabetes and living on the U.S.-Mexico border region are not receiving adequate diabetes-related care, and health care professionals are not following international recommendations for providing that care. To improve diabetes control in the region, health care providers must become more aware of the effect of education and culture on diabetes self-care as well as the provision of preventative measures by health care professionals. [ABSTRACT FROM AUTHOR]

Objective. To compare the prevalence of undiagnosed diabetes among populations with diabetes living on the United States (U.S.)--Mexico border, examine explanations for differences between groups, and investigate differences in metabolic outcomes by diagnosis status. Methods. Data come from the U.S.--Mexico Border Diabetes Prevention and Control Project survey (2001-2002), which used a stratified, multistage design. The sample included 603 adults (18 years or older) with diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose (FPG) value of ≥ 126 mg/dL and no report of diagnosis. Logistic regression was used to compare the odds of being undiagnosed among border populations with diabetes. Metabolic outcomes included FPG, glycosylated hemoglobin, and mean arterial blood pressure. Results. One in four adults with diabetes (25.9%) living on the U.S.--Mexico border was undiagnosed. Mexicans (43.8%) and Mexican immigrants (39.0%) with diabetes were significantly more likely to be undiagnosed than were U.S.-born Hispanics (15.0%; P < 0.05 for either comparison) or non-Hispanic whites (6.6%; P < 0.001 for either comparison). Mexicans were more likely to be undiagnosed than were all U.S. adults (14.7%; P < 0.001) with diabetes. Significant differences in the likelihood of being undiagnosed remained between all groups with diabetes after adjustment for sociodemographic and healthcare-related covariates, with the exception of that between Mexicans and U.S.-born Hispanics. Worse metabolic control and potentially greater benefits of diagnosis for control were observed for Mexicans in particular compared with U.S. groups with undiagnosed diabetes. Conclusions. Efforts to improve diabetes diagnosis should concentrate on Mexican and Mexican immigrant populations on the U.S.--Mexico border. [ABSTRACT FROM AUTHOR]

Objective. To explore the relationship between acculturation and healthy lifestyle habits in the largely Hispanic populations living in underserved communities in the United States of America along the U.S.-Mexico border. Methods. A cross-sectional study was conducted from April 2006 to June 2008 using survey data from the Alliance for a Healthy Border, a program designed to reduce health disparities in the U.S.-Mexico border region by funding nutrition and physical activity education programs at 12 federally qualified community health centers in Arizona, California, New Mexico, and Texas. The survey included questions on acculturation, diet, exercise, and demographic factors and was completed by 2 381 Alliance program participants, of whom 95.3% were Hispanic and 45.4% were under the U.S. poverty level for 2007. Chi-square (Χ²) and Student's t tests were used for bivariate comparisons between acculturation and dietary and physical activity measures. Linear regression and binary logistic regression were used to control for factors associated with nutrition and exercise. Results. Based on univariate tests and confirmed by regression analysis controlling for sociodemographic and health variables, less acculturated survey respondents reported a significantly higher frequency of fruit and vegetable consumption and healthier dietary habits than those who were more acculturated. Adjusted binary logistic regression confirmed that individuals with low language acculturation were less likely to engage in physical activity than those with moderate to high acculturation (odds ratio 0.75, 95% confidence interval 0.59-0.95). Conclusions. Findings confirmed an association between acculturation and healthy lifestyle habits and supported the hypothesis that acculturation in border community populations tends to decrease the practice of some healthy dietary habits while increasing exposure to and awareness of the importance of other healthy behaviors. [ABSTRACT FROM AUTHOR]

Objective. To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. Methods. Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3 470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. Results. People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0-6.6, and OR 4.5, 95% CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% CI 11.5%-46.3%, versus 9.1%, 95% CI 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made ? 4 visits (40.8%, 95% CI 19.6%-62.0%, and 23.4%, 95% CI 9.9%-36.9%, respectively, versus 2.4%, 95% CI-0.9%-5.7%) (all, P < 0.05). No similar pattern was found in Mexico. Conclusions. Limited access to health care--especially not having health insurance and/or not having a place to receive routine health services--was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region. [ABSTRACT FROM AUTHOR]

Objective. To estimate prevalence of type 2 diabetes (diabetes) and impaired fasting glucose (IFG) in the border region between the United States of America and Mexico, by ethnic origin and country of residence; identify risk factors associated with both conditions; and explore the extent to which these factors account for cross-border or ethnic disparities in prevalence. Methods. From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of diabetes and its risk factors, was conducted at the U.S.-Mexico border using multi-stage cluster sampling. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. A total of 4 027 adults participated in the study: 2 120 Hispanics from the Mexican side of the border and 1 437 Hispanics and 470 non-Hispanics (of whom 385 were classified as "white") from the U.S. side of the border. Results. The age-adjusted prevalence of self-reported and unrecognized diabetes in Hispanics was 15.4% (16.6% on the Mexican side of the border and 14.7% on the U.S. side). The ageadjusted prevalence of IFG was similar on both sides of the border (14.1% on the Mexican side and 13.6% on the U.S. side). Conclusions. Established risk factors for diabetes (e.g., age, obesity, and family history) were relevant and there was an inverse relationship between diabetes and education and socioeconomic level. While diabetes prevalence is high on both sides of the U.S.-Mexico border, onefourth of the cases remain undiagnosed, suggesting a need for development and implementation of a public health program for prevention, diagnosis, and control of diabetes in the region. [ABSTRACT FROM AUTHOR]

Objective. To determine prevalence of blood pressure control, hypertension, hypertension awareness, and antihypertensive treatment among adults (≥ 18 years old) with diabetes living in the border region between the United States of America and Mexico, and to explore variation in those variables between all adults on the Mexican side of the border ("Mexicans") and three groups on the U.S. side of the border ("all U.S. adults," "U.S.-born Hispanics," and "Mexican immigrants"). Methods. Using data from Phase I (February 2001-October 2002) of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, age-adjusted prevalence of hypertension-related variables was calculated for the sample (n = 682) and differences between the border groups were examined through logistic regression. Results. Less than one-third of the sample had controlled blood pressure (< 130/80 mm Hg), almost half had hypertension (≥ 140/90 mm Hg), and hypertension awareness and treatment were inadequate. After adjusting for demographics, body mass index, and access to health care, there were no differences in blood pressure control, hypertension, hypertension awareness, or treatment between Mexicans and both U.S. adults and Mexican immigrants. However, compared to Mexicans and Mexican immigrants, U.S.-born Hispanics, particularly younger individuals, had the lowest rates of blood pressure control (17.3%) and the highest rates of coexisting hypertension (54.8%). Compared to Mexicans, U.S.-born Hispanics had lower odds of controlled blood pressure (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.09-0.95) and greater odds of hypertension (OR 3.75, 95% CI 1.51-9.29) and hypertension awareness (OR 6.19, 95% CI 1.46-26.15). Conclusions. Co-occurrence of diabetes and hypertension is a major public health problem among U.S.-Mexico border residents. The low rate of blood pressure control among various border groups, especially younger U.S.-born Hispanics, suggests that initiatives should aggressively target blood pressure control. [ABSTRACT FROM AUTHOR]

Objective. To describe and analyze, utilizing a case study approach, the U.S.-Mexico Border Diabetes Prevention and Control Project, a health research cooperation initiative incorporating the participation of federal, state, and local institutions of both countries. Methods. A model of equal representation, participation, consensus, and shared leadership was used, with the participation of more than 130 institutions. A sample of 4 020 people over 18 years of age was obtained by a random, multistage, stratified, clustered design. A questionnaire about diabetes mellitus type 2 (DM2) and health was applied. The statistical analysis took into account the design effect. Results. The prevalence of diagnosed DM2 was 14.9% (95% confidence interval [95% CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5% (95% CI: 16.8-22.6) on the Mexican side of the border and 16.1% (IC95%: 13.5-19.2) on the U.S. border side. There were differences between the DM2 prevalence and risk factors along the border. Conclusions. The U.S.-Mexico Border Diabetes Prevention and Control Project allowed the border zone between the two countries to be considered, for the first time ever, as a unit for epidemiological research. A shared understanding among all participating institutions and entities of sociopolitical structures and procedures is required for effective border health cooperation initiatives. [ABSTRACT FROM AUTHOR]

This paper reviews and discusses the main procedures and policies that need to be followed when designing and implementing a binational survey such as the United States of America (U.S.)--Mexico Border Diabetes Prevalence Study that took place between 2001 and 2002. The main objective of the survey was to determine the prevalence of diabetes in the population 18 years of age or older along U.S.--Mexico border counties and municipalities. Several political, administrative, financial, legal, and cultural issues were identified as critical factors that need to be considered when developing and implementing similar binational projects. The lack of understanding of public health practices, implementation of existing policies, legislation, and management procedures in Mexico and the United States may delay or cancel binational research, affecting the working relation of both countries. Many challenges were identified: multiagency/multifunding, ethical/budget clearances, project management, administrative procedures, laboratory procedures, cultural issues, and project communications. Binational projects are complex; they require coordination between agencies and institutions at federal, state, and local levels and between countries and need a political, administrative, bureaucratic, cultural, and language balance. Binational agencies and staff should coordinate these projects for successful implementation. [ABSTRACT FROM AUTHOR]

Diabetes is a serious public health problem in the border region between the United States of America and Mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. The U.S.-Mexico Border Diabetes Prevention and Control Project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 U.S. and Mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. This report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned. [ABSTRACT FROM AUTHOR]

Objective. The goal of this study was to assess linkages between microclimate and longer-term ENSO-related weather forcing on the week-to-week changes in dengue prevalence in Matamoros, Tamaulipas, Mexico, over a recent decade of dengue observations. Material and Methods. An auto-regressive model to evaluate the role of climatic factors (seasurface temperature) and weather (maximum temperature, minimum temperature, precipitation) on dengue incidence over the period 1995-2005, was developed by conducting time-series analysis. Results. Dengue incidence increased by 2.6% (95% CI: 0.2-5.1) one week after every 1°C increase in weekly maximum temperature and increased 1.9% (95% CI: -0.1-3.9) two weeks after every 1 cm increase in weekly precipitation. Every 1°C increase in sea surface temperatures (El Niño region 3.4 ) was followed by a 19.4% (95% CI: -4.7-43.5) increase in dengue incidence (18 weeks later). Conclusions. Climate and weather factors play a small but significant role in dengue transmission in Matamoros, Mexico. This study may provide baseline information for identifying potential longer-term effects of global climate change on dengue expected in the coming decades. To our knowledge, this is the first study to investigate the potential associations between climate and weather events and dengue incidence in this geographical area. [ABSTRACT FROM AUTHOR]

Objectives. To examine physical and mental health domains of health-related quality of life (HRQL) in a binational adult population with type 2 diabetes at the Texas-Mexico border, and to explore individual and social correlates to physical and mental health status. Methods. Adults 18 years and older with type 2 diabetes residing in the South Texas Lower Rio Grande Valley and in Reynosa, Tamaulipas, Mexico, were recruited using a convenience sampling technique and interviewed face-to-face with a structured survey. HRQL was measured using physical and mental health summary components of the Medical Outcomes Study Short Form. HRQL correlates included demographic characteristics, health factors, access to healthcare, and family support. Samples characteristics were compared using the Student's ttest or Mann-Whitney U test. Associations between dependent and independent variables were examined using unadjusted and adjusted (multiple variable) logistic regression models. Results. There were no significant differences between Valley and Reynosa respondents in physical or mental health status scores. Valley participants with lower socioeconomic status and those perceiving their supportive relative's level of diabetes-related knowledge as "low" were more likely to report worse physical health than those lacking those characteristics. In the Reynosa group, lower physical health status was associated with duration of diabetes and insulin use. Both sample populations with clinical depressive symptoms were more likely to have worse physical and mental health than those without such symptoms. Conclusions. HRQL is an important outcome in monitoring health status. Understanding the levels and influences of HRQL in U.S.-Mexico border residents with diabetes may help improve diabetes management programs. [ABSTRACT FROM AUTHOR]