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Background/objective: By having a better understanding of transitions in osteosarcopenia, interventions to reduce morbidity and mortality can be better targeted. The aim of this study was to show the rationale and method of using minimal clinically important differences (MCID's) to classify transitions, and the effects of demographic variables on transitions in a 9-year follow-up data from the New Mexico Aging Process Study (NMAPS)., Methods: Transitions were identified in four aspects of osteosarcopenia: bone mineral density (BMD), appendicular skeletal muscle mass/body mass index ratio (ASM/BMI), grip strength and gait speed. Transitions were identified using a MCID score. As there is currently no available MCID for BMD and ASM/BMI, those were determined using a distribution-based and an anchor-based method. Total transitions were calculated for all four measures of osteosarcopenia in all transition categories (maintaining a health status, beneficial transition, harmful transitions). Poisson regression was used to test for effects of demographic variables, including age, sex, physical activity, medication, and health status, on transitions., Results: Over the 9-year follow-up, a total of 2163 MCID-derived BMD transitions were reported, 1689 ASM/BMI transitions, 2339 grip strength transitions, and 2151 gait speed transitions. Additionally, some MCID-derived transition categories were associated with sex, age, and health status., Conclusion: Use of MCID-derived transitions reflected the fluctuation and the dynamic nature of health in older adults. Future research should focus on transitions of modifiable markers in osteosarcopenia to design intervention trials., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Mentors are in short supply at academic health centers (AHCs). The effectiveness of training mentors (without preselection for their research skills) to support faculty mentees in scholarly activities at AHCs is not well known., Methods: The University of New Mexico Health Sciences Center has a two-component program to develop effective mentors for scholarship for faculty mentees. It has an online component supplemented by an optional face-to-face (F2F) component. Study outcomes included changes in self-reported knowledge scores for online users and Mentoring Competency Assessment scores for F2F users., Results: One hundred five mentors, mostly women associate professors, used the online program. Online users demonstrated improvement in self-reported knowledge scores. Thirty-eight users additionally completed the F2F program-63% on a clinician-educator track and none with a National Institutes of Health-funded K-award mentee. The self-reported Mentoring Competency Assessment composite score rose from 4.3 ± 1.0 to 5.5 ± 0.8 (paired t = 7.37, df = 37, P < .001) for the F2F participants, with similar improvement noted in the clinician-educator subgroup., Discussion: Users of the online and F2F components of the program improved their self-assessed knowledge and mentoring skill, respectively, demonstrating the effectiveness of the program. Such programs may help AHCs enhance the scholarship and the diversity of their scientific and clinician-educator workforce.

Background: Spirometrically-defined chronic obstructive pulmonary disease (COPD) is considered progressive but its natural history is inadequately studied. We hypothesized that spirometrically-defined COPD states could undergo beneficial transitions., Methods: Participants in the Lovelace Smokers' Cohort (n = 1553), primarily women, were longitudinally studied over 5 years. Spirometric states included normal postbronchodilator spirometry, COPD Stage I, Unclassified state, and COPD Stage II+, as defined by GOLD guidelines. Beneficial transitions included either a decrease in disease severity, including resolution of spirometric abnormality, or maintenance of non-diseased state. 'All smokers' (n = 1553) and subgroups with normal and abnormal spirometry at baseline (n = 956 and 597 respectively) were separately analyzed. Markov-like model of transition probabilities over an average follow-up period of 5 years were calculated., Results: Among 'all smokers', COPD Stage I, Unclassified, and COPD Stage II+ states were associated with probabilities of 16, 39, and 22 % respectively for beneficial transitions, and of 16, 35, and 4 % respectively for resolution. Beneficial transitions were more common for new-onset disease than for pre-existing disease (p < 0.001). Beneficial transitions were less common among older smokers, men, or those with bronchial hyperresponsiveness but more common among Hispanics and smokers with excess weight., Conclusions: This observational study of ever smokers, shows that spirometrically-defined COPD states, may not be uniformly progressive and can improve or resolve over time. The implication of these findings is that the spirometric diagnosis of COPD can be unstable. Furthermore, COPD may have a pre-disease state when interventions might help reverse or change its natural history., Trial Registration: NA.

Objective: Maternal expulsive efforts are thought to damage the pelvic floor. We aimed to compare pelvic floor function and anatomy between women who delivered vaginally (VB) versus those with caesarean delivery (CD) prior to the second stage of labour., Design: Prospective cohort., Setting: University Hospital Midwifery practice., Population: Nulliparas., Methods: Pregnant nulliparas were recruited during pregnancy and women who underwent CD prior to the 2nd stage of labour at birth were recruited immediately postpartum. Both groups were followed prospectively to 6 months postpartum., Main Outcome Measures: POPQ, perineal ultrasound (U/S) and Paper Towel Test (PTT), an objective measure of stress incontinence; Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire (PFIQ-7), Wexner Fecal Incontinence Scale (W) and Female Sexual Function Index (FSFI)., Results: 336/448 (75%) VB and 138/224 (62%) CD followed up. The VB group was younger (23.9 ± 4.9 versus 26.6 ± 6.1 years, P < 0.001) and less overweight/obese (38 versus 56%, P < 0.001); baseline functional measures were similar (all P > 0.05). At follow-up, urinary incontinence (UI) (55 versus 46% ISI > 0, P = 0.10), fecal incontinence (FI) (8 versus 13% FI on W, P = 0.12), sexual activity rates (88 versus 92%, P = 0.18) and PFIQ-seven scores were similar. Positive PTT tests (17 versus 6%, P = 0.002) and ≥ Stage 2 prolapse (22 versus 15%, P = 0.03) were higher with VB; differences were limited to points Aa and Ba. U/S findings were not different between groups. Stepwise multivariate analyses controlling for age, body mass index, and non-Hispanic White race for prolapse of points Aa and Ba did not alter conclusions (all P < 0.004)., Conclusions: VB resulted in prolapse changes and objective UI but not in increased self-report pelvic floor dysfunction at 6 months postpartum compared with women who delivered by CD prior to the second stage of labour. The second stage of labour had a modest effect on postpartum pelvic floor function., (© 2014 Royal College of Obstetricians and Gynaecologists.)

Among U.S. male Vietnam veterans, Hispanics have been shown to have higher rates of posttraumatic stress disorder (PTSD) than African Americans and non-Hispanic Whites (Kulka et al., 1990). In terms of gender, Tolin and Foa's (2006) meta-analysis suggested women experience higher rates of PTSD than men. This study examined ethnic differences in PTSD and other symptomatology among 398 female veterans (63% non-Hispanic White, 28% Hispanic, 9% African American) seeking treatment for PTSD from 1995 to 2009 at a Veterans Administration (VA) behavioral health clinic. The following symptom clusters were examined: anxiety/PTSD, depression, anger/hostility, and psychotic/dissociative symptoms. Few differences were found among the groups, suggesting the 3 ethnic groups studied were more similar than different. African American female veterans, however, scored higher on measuring ideas of persecution/paranoia, although this may reflect an adaptive response to racism. These findings warrant further investigation to elucidate this relationship., (Copyright © 2012 International Society for Traumatic Stress Studies.)

Purpose: To evaluate the relative influences of several demographic, ocular, and systemic parameters on corneal hysteresis (CH)., Methods: This is a prospective, observational, cross-sectional study using subjects recruited from consecutive Albuquerque VAMC eye clinic patients. We classified eligible subjects as primary open-angle glaucoma (POAG), ocular hypertension, glaucoma suspect, or normal. We used the Ocular Response Analyzer, Pascal Dynamic Contour Tonometer, and Goldmann applanation tonometer to obtain intraocular pressure (IOP), CH, corneal resistance factor, and ocular pulse amplitude values. We also obtained corneal curvature, central corneal thickness (CCT), axial length, retinal nerve fiber layer thickness, clinical cup/disc ratio (CDR) estimates, and standard automated perimetry metrics (mean defect, pattern standard deviation). We gathered glycosylated hemoglobin (A1C) data through chart review. Multivariate regression analyses were used to determine independent relationships between CH and the other parameters., Results: Three hundred seventeen eyes in 317 subjects were studied (116 POAG, 87 ocular hypertension, 47 glaucoma suspect, and 67 normal). In univariate regression analysis, CH varied directly with CCT (β = 0.39, p < 0.001), corneal curvature (β = 0.16, p = 0.01), corneal resistance factor (β = 0.57, p < 0.001), A1C (β = 0.15, p = 0.01), mean defect (β = 0.29, p < 0.001), and retinal nerve fiber layer (β = 0.31, p < 0.001). Factors inversely related to CH were age (β = -0.22, p < 0.001), IOP (β = -0.29, p < 0.001), ocular pulse amplitude (β = -0.11, p = 0.04), CDR (β = -0.34, p < 0.001), and pattern standard deviation (β = -0.29, p < 0.001). CH was lower in POAG compared with the other diagnostic groups. In multivariate analysis, CH was independently associated with age, IOP, CCT, A1C, glaucoma diagnosis, and CDR. Of these factors, CCT and IOP demonstrated twice as much influence on CH compared with the other four factors., Conclusions: Although this study identified six separate variables that independently influence CH values, the overall r value indicates that these variables together only explain 40% of CH variability. These results suggest that other significant sources of variability exist and deserve investigation.

Objectives: Ethnicity has been shown to play an important role in hepatitis C virus (HCV) treatment response. However, few studies have examined the treatment response of Hispanics to combination therapy with pegylated interferon and ribavirin. The aim of this study was to compare the treatment responses of Hispanics and non-Hispanic whites (NHW) treated with pegylated interferon and ribavirin for chronic HCV., Methods: A retrospective review was conducted of all treatment-naive Hispanics and NHW with HCV who were treated at the University of New Mexico Hospital or Albuquerque VA Medical Center between October 2001 and January 2007. Genotype 1 patients received 48 weeks of therapy with pegylated interferon and ribavirin; genotype 2 and 3 patients received 24 weeks of treatment., Results: A total of 396 patients were included in the analysis, consisting of 179 Hispanics and 217 NHW. Overall, fewer Hispanics completed therapy compared with NHW (64.8% vs. 80.2%, P<0.001). In genotype 1 patients, early virologic response (EVR), end-of-treatment response (ETR), and sustained virologic response (SVR) did not differ significantly between the two ethnic groups. In genotype 2 and 3 patients, Hispanics had similar EVR compared with NHW (81.3% vs. 88.2%, P=0.25), but lower ETR (64.1% vs. 83.1%, P=0.01) and SVR (45.3% vs. 75.3%, P<0.001). After correcting for patients who prematurely discontinued therapy, genotype 2 and 3 Hispanics continued to have a reduced SVR compared with NHW (65.9% vs. 87.3%, P=0.014). The attenuated SVR in Hispanics was because of a higher relapse rate after achieving ETR compared with NHW (25% vs. 7.5%, P=0.02)., Conclusions: Hispanics with genotype 2 and 3 HCV infection treated with pegylated interferon and ribavirin are less likely to achieve SVR compared with NHW. The lower rate of SVR in Hispanic patients is, in part, because of an increased rate of relapse after ETR.

Objective: New Mexico enacted a law in 2003 requiring that emergency departments (EDs) offer emergency contraception (EC) to survivors of sexual assault and that both doses be administered in the ED. This investigation sought to examine practices and knowledge of ED providers about EC in the setting of sexual assault., Methods: We visited hospitals in New Mexico from July 2005 to December 2005 and administered an 18-item questionnaire to three providers-a physician, a nurse, and a clerk-in the ED. The questionnaire included items related to characteristics of the hospital, knowledge of providers about EC and the law, and ED practices relevant to EC for sexual assault survivors as well as for women who had consensual unprotected intercourse., Results: Surveys were completed at 33 of 38 hospitals (87%). Overall, 52% of respondents reported that EC was routinely offered to sexual assault survivors, and 33% reported that both doses were administered in the ED. Forty-one percent of RNs, MDs, and clerks reported that EC was offered to sexual assault survivors who were minors regardless of age. Overall, 64% of respondents knew that EC may prevent pregnancy up to 72 hours after unprotected intercourse, and only 12% of respondents reported awareness of any requirements to offer EC to sexual assault survivors. Respondents reported that physicians in the ED more often routinely offered EC to sexual assault survivors (52%) than to women who requested it after consensual sex (20%). Thirty-three percent of respondents indicated parental consent was necessary for minors in the setting of sexual assault, although there is no requirement for parental notification in New Mexico., Conclusions: EDs in New Mexico are not universally complying with the law. Better dissemination of the law and education about EC could improve care of sexual assault survivors in New Mexico.

Purpose: To clinically characterize blepharoptosis in Hispanic New Mexicans with oculopharyngeal muscular dystrophy and examine eyelid surgery outcomes., Methods: A retrospective noncomparative case series and retrospective, nonrandomized, comparative interventional case series was performed on medical records from 86 patients. Main outcome measures included preoperative correlations between margin reflex distance, palpebral fissure height, levator function, and age and postoperative change in palpebral fissure height and time to reoperation for recurrent blepharoptosis after blepharoplasty, levator advancement, or frontalis sling surgery., Results: Preoperative measurements between the right and left eye were symmetrical with respect to margin reflex distance, palpebral fissure height, and levator function (all p < 0.001). There were correlations between age and margin reflex distance, palpebral fissure height, and levator function (all p < or = 0.02). There was no gender difference detected with respect to age, margin reflex distance, palpebral fissure height, and levator function (p > 0.39). Eighty-three patients underwent eyelid surgery. As initial surgery, 15 underwent blepharoplasty, 17 levator advancement, and 51 frontalis suspension. Overall, 93.3% of blepharoplasty patients, 47.1% levator advancement patients, and 7.84% undergoing frontalis suspension had additional surgery for recurrent ptosis (rates differed, p < 0.001). Postoperative change for palpebral fissure height was 0.33 +/- 1.83 mm OD and 1.1 +/- 0.86 mm OS for levator advancement and 2.63 +/- 1.34 mm OD and 2.68 +/-1.47 mm OS for frontalis suspension (p = 0.03, OD and p = 0.004, OS)., Conclusions: Oculopharyngeal muscular dystrophy in Hispanic New Mexicans is a symmetrical, progressive disease that affects men and women similarly. Frontalis suspension is an effective primary surgery with respect to upper eyelid elevation, need for reoperation, and time to reoperation in this patient population.

Purpose: Accumulation of mitochondrial DNA deletions and the resultant impaired oxidative phosphorylation may play a pathogenic role in the mediation of age-related sarcopenia., Methods: Twenty four participants of the New Mexico Aging Process Study were classified as normal lean (n = 15) or sarcopenic (n = 9) based on body composition determined by Dual Energy x-ray Absorptiometry. Complex I and Complex IV activities were measured in the skeletal muscle samples obtained from gastrocnemius muscle. A two-stage nested polymerase chain reaction strategy was used to identify the mitochondrial DNA deletions in the entire mitochondrial genome in the skeletal muscle samples., Results: Although Complex I activity was not significantly different (5.5 +/- 0.9 vs. 4.6 +/- 0.7 mU/mg protein, P > 0.05), Complex IV activity was higher in sarcopenic subjects (1.4 +/- 0.3 vs. 1.0 +/- 0.1 mU/mg protein, P < 0.05). Mitochondrial DNA deletions were mostly located in the region of Complex I and spanned from nicotinamide adenine dinucleotide dehydrogenase 1 to nicotinamide adenine dinucleotide dehydrogenase 6. Deletions in the 8,577-10,407 bp and 10,233-11,249 bp regions were associated with a significant decrease in Complex I activity (P < 0.05 and P = 0.02, respectively). Total cumulative deletion, defined as the sum of individual length of deletions in a subject, was comparable in subjects with and without sarcopenia (1760 +/- 726 vs. 1782 +/- 888 bp, P > 0.05). The magnitude of mitochondrial DNA deletion, however, correlated positively with lean body mass (r = 0.43, P < 0.05)., Conclusion: Thus, mitochondrial DNA deletions are common in elderly subjects and are negatively related to Complex I activity. The positive association between mitochondrial DNA deletions and lean body mass needs to be confirmed by studies in a larger study population.

Objective: To estimate outcomes, to determine whether appropriate follow-up was performed for pregnant patients with hepatitis C virus (HCV), and to show that maternal and neonatal complications would be higher in the HCV-positive group., Methods: We compared pregnant women from a drug dependence and treatment program who were HCV antibody-positive with those who were HCV antibody-negative using the University of New Mexico Perinatal Database. Maternal and neonatal outcomes were evaluated, including cholestasis of pregnancy, preterm birth, low birth weight, neonatal intensive care unit admissions, and neonatal methadone withdrawal. Variables were compared using Student t, Fisher exact, and chi(2) tests., Results: Among 351 pregnancies between January 2000 and 2006, 159 (53%) were HCV antibody reactive, 141 (47%) tested nonreactive, and 51 (15%) were not screened. Hepatitis C reactivity was more common among Hispanics. Cholestasis of pregnancy was increased in HCV antibody reactive (Ab+) pregnancies (10 of 159, 6.3% compared with 0 of 141, P=.002). Among women taking methadone, there was a significantly higher incidence of neonatal withdrawal (P=.001). This was significant in mothers on low (0-30 mg) and moderate (31-90 mg) methadone doses. Despite the high cure rate with intensive therapy, only 5.7% of HCV Ab+ mothers and 1.9% of their neonates received gastroenterology referrals., Conclusion: In pregnant women involved in this drug treatment program, HCV reactivity was associated with Hispanic ethnicity, cholestasis of pregnancy, and increased neonatal methadone withdrawal regardless of maternal methadone dose. Gastroenterology consultation was inadequate.

Virtual reality (VR) simulation provides a means of making experiential learning reproducible and reusable. This study was designed to determine the efficiency and satisfaction components of usability. Previously, it was found that first year medical students using a VR simulation for medical education demonstrated effectiveness in learning as measured by knowledge structure improvements both with and without a head mounted display (HMD) but students using a HMD showed statistically greater improvement in knowledge structures compared to those not using a HMD. However, in this current analysis of other components of usability, there were no overall significance differences in efficiency (ease of use), nor in satisfaction, within this same group of randomized subjects comparing students using a HMD to those not using a HMD. These types of studies may be important in determining the most appropriate, cost effective VR simulation technology needed to achieve specific learning goals and objectives.

Background: National and international contraceptive guidelines reflect expert opinion that recommends against the use of estrogen-containing hormonal contraception in the early postpartum period. This study was undertaken to estimate providers' practices in prescribing hormonal contraception to breastfeeding women., Methods: A 19-item survey was mailed to 397 obstetrician gynecologists, midwives and family physicians in the state of New Mexico. The survey included items covering attitudes about the impact of hormonal contraception on breastfeeding and prescribing practices. One hundred ninety-nine (50%) providers completed the survey., Results: The majority (70%) of providers prescribe progestin-only contraceptive methods to breastfeeding women within the first 6 weeks. Despite these recommendations, a sizable minority of providers prescribe combined pills in the early postpartum period: 27% of providers have prescribed combined pills and 13% of providers, mostly those in a university setting, routinely recommend them within the first 6 weeks postpartum., Conclusion: Most providers follow expert recommendations regarding the initiation of hormonal contraception for breastfeeding women.

The assessment of combat-related post-traumatic stress disorder (PTSD) relies upon self-reported symptoms and the need for indicators of valid reporting is critical. The Trauma Symptom Inventory (TSI) is a testing instrument specific to PTSD which includes validity scales. In a pilot study examining the use of the TSI with combat veterans, 50 male veterans diagnosed with PTSD were administered the TSI. Nineteen percent of the profiles were invalid, all but one based on the Atypical Response Scale. Differences between veterans with valid and invalid TSI profiles are examined in terms of demographic and historical factors, TSI profiles, and individual scale items. The model best able to predict invalid profiles included high scores on subscales measuring dissociative experiences and tension reduction behaviors. Implications for the interpretation of TSI validity scales in assessing combat-related PTSD are discussed.

This pilot study was conducted to identify the metals used by home-based Native American jewelry makers, to quantify the metals in dust samples taken from jewelers' homes, and to compare these concentrations with background levels from control homes in which jewelry was not made. Participants were recruited from Zuni Pueblo, New Mexico. Surface dust samples were collected from the work and living areas of 20 jewelers' homes, and from the living areas of 20 control homes. Silver, copper, tin, boron, nickel, zinc, lead, and cadmium were significantly higher in work areas than in living areas of jewelry-making homes (p < or = 0.02). Silver, copper, nickel, and antimony were significantly higher in living areas of jewelers' homes compared with control homes (p < or = 0.04). Ventilation measures did not effectively reduce metal concentrations in jewelers' homes; concentrations in nonwork areas remained elevated.

Objective: To develop a validated Spanish version of the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ)., Methods: The PISQ is a previously described validated and reliable questionnaire. We used a back-translation method to develop a Spanish-language version. Twenty-six bilingual patients with pelvic organ prolapse and/or urinary incontinence were randomized to complete either the original English version or the final Spanish version of the PISQ first, followed by the other questionnaire. Scores of the two versions were compared. Paired t test for total PISQ and its three domain scores and Wilcoxon signed rank test for each item assessed the bias between the two equivalent versions. Agreement between the two versions was assessed by weighted kappa statistics, with 95% confidence intervals for each item. P values of .05 or less were considered significant, and kappa values of .75 or greater were considered to indicate good agreement., Results: English and Spanish versions demonstrated no differences for each of the factors and total scores (P = .15, .83, .28, and .56, respectively). Wilcoxon signed rank test demonstrated that one item was answered differently in the English and Spanish versions. Good agreement between Spanish and English versions in 30 of the 31 items was demonstrated by weighted kappa statistics. Overall, 72% of women scored both versions of the questionnaire equivalently., Conclusions: We have developed a validated and reliable Spanish questionnaire to evaluate sexual functioning in Spanish-speaking patients with pelvic organ prolapse and/or urinary incontinence.

Objective: To determine if the apolipoprotein E E4 (APO E4) allele is associated with cognitive performance in New Mexico Hispanic elderly., Method: We performed a cross-sectional survey of 105 community volunteers, aged 60 years and older, born in New Mexico, with both parents of Hispanic descent. Subjects were excluded for medical conditions that could influence cognitive performance. We also performed a longitudinal analysis on 18 participants who were re-tested over a 3-year interval. The main outcome measures for both the cross-sectional and longitudinal analysis were scores on 5 cognitive tests comparing subjects with the E4 allele to those without the E4 allele., Results: The mean age was 69 years, with a range of 60 to 91. For the cross-sectional analysis, there were no significant differences between the 2 groups on the cognitive tests, although subjects with an E4 allele did not perform as well on color trails A (P=.09). In the longitudinal analysis we found that the variability of cognitive test scores tended to be higher in the E4 group on most cognitive measures. The time needed to complete color trails A (indicating slower performance) was significantly greater (P<.05) in the E4 group. For the total recall portion of the Fuld Object Memory test, the E4 group did not perform as well on follow-up (P=.08)., Conclusion: We found no significant cross-sectional association between the APO E4 allele and cognitive performance. In our longitudinal analysis, the time needed to complete color trails A was significantly greater in the E4 group, and the E4 group did not perform as well on total recall.

Objective: To investigate the effects of cigarette smoking and alcohol consumption on the development of systemic lupus erythematosus (SLE)., Methods: We interviewed 125 patients with SLE and 125 controls in a case-control study. Demographically similar controls randomly selected from outpatient clinics were matched to SLE cases for sex and age. Clinical data, including cigarette smoking, drinking habits, and other demographic variables, were collected by an interview-administered questionnaire., Results: To minimize bias associated with reactive habits induced by disease, cigarette smoking before the diagnosis of SLE was the primary variable for subsequent analysis. Analysis of the data by multivariate conditional logistic regression revealed that both cigarette smoking before SLE diagnosis and ex-smoking before SLE diagnosis significantly increased the risk of development of SLE (OR 6.69, 95% CI 2.59, 17.28, p < 0.001; and OR 3.62, 95% CI 1.22, 10.70, p = 0.02, respectively). This association remained even when statistically controlling for the effects of family history and education, indicating an independent effect. Alcohol did not place an individual at increased risk nor did it have a protective role., Conclusion: The results of this study provide further evidence that cigarette smoking may be an associated risk factor for the development of SLE.

Objective: To analyze lymph node status and survival rates of women with microinvasive cervical adenocarcinoma (International Federation of Gynecology and Obstetrics stages IA(1) and IA(2))., Methods: The Surveillance, Epidemiology, and End Results (SEER) Public-Use Database was used to identify cases of microinvasive cervical adenocarcinoma diagnosed between 1988 and 1997. Variables analyzed included stage, extent of surgery, lymph node status, radiation therapy, and age. Statistics included analysis of trends, analysis of variance, log-rank test, one-sided binomial confidence interval estimation, and power analysis., Results: Among 301 reported cases, 131 had stage IA(1) and 170 IA(2) disease. Simple hysterectomies were done in 54 women with IA(1) and 64 with IA(2) disease and radical hysterectomies were done in 50 and 83 women, respectively. Only one of 140 women who had lymphadenectomy had a single positive lymph node. There were four tumor-related deaths (one with IA(1), and three with IA(2) disease). There were no deaths among 96 women (47, IA(1); 49, IA(2)) treated by simple hysterectomy alone. The mean follow-up was 46.5 months (range 1--119). The censored survival rate was 98.7% overall (99.2% IA(1), 98.2% IA(2)). Power analysis estimated that 720 patients would be required in each group to detect a 2% difference in survival. Using one-sided 95% confidence interval estimations, the risk-adverse events rate for IA(1) was no more than 3.57%, and 4.50% for IA(2) disease., Conclusion: Prognosis is excellent for microinvasive adenocarcinoma of the uterine cervix. In 96 cases (31.9%), simple hysterectomy alone proved adequate.

Objective: To determine whether high-dose (100 microg) misoprostol was able to increase the rate of successful labor induction and lower the incidence of Cesarean section without adverse fetal effects., Methods: A total of 360 women were randomized to receive either oxytocin (n = 192) by intravenous infusion, or misoprostol (n = 168) 100 microg intravaginally every 4 h. The Cesarean section rate was the primary end-point. Incidences of uterine and fetal heart rate abnormalities during labor and adverse neonatal outcomes were assessed as secondary end-points., Results: Compared with those women receiving oxytocin, patients given misoprostol had a significantly shortened labor (10.7+/-6.0 vs. 15.4+/-10.4 h, p < 0.001). The Cesarean section rate did not differ between patients receiving misoprostol or oxytocin (36 (21.4%) vs. 38 (19.8%), p = 0.79) despite a sample size adequate to detect a 13 percentage point difference in this outcome. Patients receiving misoprostol had a higher incidence of the hyperstimulation syndrome (27 (16.1%) vs. 9 (4.7%), p < 0.001), and of fetal intolerance of labor as an indication for Cesarean delivery (23 (63.9%) vs. 15 (39.5%), p = 0.06), and had a greater number of umbilical artery cord blood pH findings of< 7.20 (20 (43.5%) vs. 6 (17.1%), p = 0.02). These worrisome trends on interim analysis resulted in our prematurely terminating the study., Conclusion: High-dose intravaginal misoprostol did not reduce the Cesarean section rate and was associated with a greater hazard of fetal intolerance of labor.

Objectives: To compare clinical features of spontaneous intracerebral hemorrhage (ICH) between Hispanics and non-Hispanic Whites in Albuquerque, New Mexico, occurring during the year 1993., Design: Analysis of data collected during a study of ICH incidence in a community., Methods: Review medical records with multiple relevant cerebrovascular diagnostic discharge codes in all 9 acute care hospitals in Albuquerque, and in the records of the State Medical Examiner. All suspected cases were verified by cerebral computed tomography or autopsy. Vascular risk factors, test results, and acute outcome were abstracted., Results: There were 38 Hispanics and 46 non-Hispanic Whites with ICH. We found no statistically significant differences between these two ethnic groups in the prevalence of hypertension or diabetes mellitus, in hematoma volume, in seasonal fluctuation of ICH incidence, or in acute mortality. However, based on our sample size, only large differences in the prevalence of risk factors between these two ethnic groups could be detected with statistical significance (>20-30 percentage points). There was a trend toward a higher proportion of subcortical ICH (centered in the basal ganglia, brainstem, or cerebellum) in Hispanics (82%) than in non-Hispanic Whites (62%, P=.09)., Conclusions: The higher proportion of subcortical ICH among the Hispanics suggests that chronic hypertension may play a greater role as a risk factor for ICH in this ethnic group than in non-Hispanic Whites in New Mexico. Our findings should be confirmed by larger community studies.

Background and Objective: A higher incidence of spontaneous intracerebral and subarachnoid hemorrhage among Hispanics than non-Hispanic whites has been measured in Bernalillo County, New Mexico. In an attempt to explain these differences, we compared historical vascular risk factors between Hispanics and non-Hispanic whites living in this community., Methods: An ongoing telephone survey, the Behavioral Risk Factor Surveillance System, collected annual data about vascular risk factors among non-institutionalized, randomly selected adults. Data covering 6 years, 1988-1993, were analyzed., Results: There were 843 Hispanic and 1,635 non-Hispanic white residents of Bernalillo County, New Mexico, who participated in this survey. Because Hispanics were significantly younger than non-Hispanic whites (37.7 vs. 43.4 years, p < 0.001), all other comparisons were adjusted for age. Prevalence of hypertension was similar between these ethnic groups (15-17%). Prevalence of alcohol drinking considered risky for abuse was similar between these ethnic groups (5-6%), but was significantly higher among Hispanic men than women (8.5 vs. 1.6%, p < 0.001). The quantity of alcohol consumption among those at risk for abuse was similar between these ethnic groups. Prevalence of current cigarette smoking was similar between these ethnic groups (22-23%), but Hispanics smoked significantly less than non-Hispanic whites (11.4 vs. 15.2 cigarettes per day, p < 0.001) and among non-Hispanic whites, men smoked significantly more than women (17.0 vs. 13.4 cigarettes per day, p = 0.001)., Conclusion: The vascular risk factors which we compared between Hispanics and non-Hispanic whites do not help to explain the higher incidence of hemorrhagic strokes among the Hispanics in Bernalillo County, New Mexico. Additional risk factors for hemorrhagic strokes in these two ethnic groups should be studied., (Copyright 2000 S. Karger AG, Basel)

Background: The purpose of this study was to prospectively compare patient outcomes based on the presence of in-house versus on-call attending trauma surgeons at comparable Level I trauma centers., Methods: Two designated Level I trauma centers agreed to prospectively review trauma admissions over a 6-month period, one institution with 24-hour in-house trauma attending surgeons (IH), and the other with trauma-attending surgeons taking call from home (OC) available to the hospital within 15 minutes of notification. A 6-month prospective study was conducted reviewing all trauma patients admitted to both trauma centers with an Injury Severity Score > or =16. Comparisons were made between institutions utilizing admission demographics, clinical presentation, times to clinical care, and mortality rates., Results: In comparison, OC and IH institutions were distinctly different in geographic environment, size, and number of patients admitted. As a group, IH patients were significantly older, with higher Injury Severity Scores and lower Glasgow Coma Scale scores than the OC group. In all comparisons, OC trauma attending surgeons responded to the trauma room with equal speed or more rapidly when compared with IH trauma attending surgeons. There were no other significant differences in either population in times to provision of clinical care or in clinical outcome., Conclusion: The ability of the OC institution to be similar to the IH institution in its provision of clinical care and mortality rate is accomplished in an environment where trauma attending surgeons live within a 15-minute response time to the trauma center. Using a voice-paged trauma alert activation with accurate information and sufficient warning, evaluation, provision of care, and clinical outcome of the acutely injured patient can be provided equally by in-house trauma attending surgeons and trauma attending surgeons on-call from home.

Objective: Because hypoparathyroidism is a serious complication of thyroidectomy, we attempted to elucidate factors determining the risk of this postoperative outcome., Setting: Four tertiary care hospitals in Albuquerque, New Mexico., Patients: A retrospective study of 142 patients who underwent total or subtotal thyroidectomy between 1988 and 1995., Measurements and Main Results: Permanent hypoparathyroidism was defined as hypocalcemic symptoms plus a requirement for oral vitamin D or calcium 6 months after thyroidectomy. Factors analyzed to determine their contribution to the risk of persistent postoperative hypoparathyroidism were the indication for thyroidectomy, performance of a preoperative thyroid needle biopsy, type of surgery, postoperative pathology, presence and stage of thyroid carcinoma, resident surgeon involvement, and specialty of the surgeon performing the procedure. Surgical specialty and stage of thyroid carcinoma were independent risk factors for persistent postoperative hypoparathyroidism by multivariate analysis. Nine (29%) of 31 patients who had thyroidectomy by otolaryngologists met criteria for permanent hypoparathyroidism, and 6 (5%) of 111 patients who had thyroidectomy by general surgeons met the same criteria (p < .001). Adjustment for the effect of stage did not eliminate the effect of specialty (p = .006), and adjustment for the effect of specialty did not eliminate the effect of stage (p = .02), on the occurrence of postoperative hypoparathyroidism., Conclusions: We conclude from our data that patients undergoing thyroidectomy by an otolaryngologist may be at a higher risk of permanent postoperative hypoparathyroidism than patients who undergo thyroidectomy by a general surgeon. This may reflect differences in case selection or surgical approach or both.

Background and Purpose: There are differences in cerebrovascular disease incidence between racial and ethnic groups. Little is known about cerebrovascular disease among Hispanics living in the southwestern United States as compared to non-Hispanic whites. This is the first study which measures and compares the incidence of spontaneous subarachnoid hemorrhage (SAH) among Hispanics and non-Hispanic whites living in Bernalillo County, New Mexico. This information may help reduce the risk and incidence of SAH., Methods: Medical records of all possible cases of spontaneous SAH occurring during a two-year period (January 1, 1993 to December 31, 1994) among residents of Bernalillo County, New Mexico, were reviewed in all local hospitals. Hospital records were identified by ICD-9-CM codes. Medical examiner records were also reviewed for additional SAH cases occurring during the same time period. The 1990 U.S. census provided the population base., Results: There were 22 spontaneous SAHs among 267,965 non-Hispanic whites and 25 spontaneous SAHs among 178,310 Hispanics. Incidence of SAH increased with age in both groups. The age- and sex-adjusted total annual incidence of SAH per 100,000 people was 3.73 among non-Hispanic whites and 9.19 among Hispanics (relative risk for Hispanics 2.46, 95% confidence interval 1.37-4.43, P = 0.003). The incidence rates among men and women were not significantly different in either ethnic group., Conclusions: The incidence of SAH among Hispanic residents of Bernalillo County, New Mexico, is approximately two and a half times higher than that among non-Hispanic whites. This suggests a higher prevalence or a greater tendency to rupture of berry aneurysms among Hispanics as compared to non-Hispanic whites. The reasons for this difference require further investigation.

The objective of this study was to determine if the 2 h value of the glucose tolerance test (GTT) is as reliable as the complete GTT in identifying risk for excessive fetal growth. Five hundred eighty-eight patients underwent a 3 h oral GTT at 26-28 weeks' gestation. The 2 h value of the test was compared to the results of the GTT. The incidence of large for gestational age (LGA) infants was compared for patients who had an abnormal GTT or an abnormal 2 h value only. A normal 2 h value was associated with a normal GTT in 98.5% of cases, while an abnormal 2 h value was associated with an abnormal GTT in 70% of cases. An abnormal GTT was associated with a 22% incidence of LGA, while a 2 h value > or = 165 mgm/dl was associated with a 20% incidence of LGA. This difference was not statistically significant. A single 2 h value GTT is more cost-effective and as predictive as a complete 3 h GTT in identifying risk for excessive fetal growth.

Objective: To compare the incidence of spontaneous intracerebral hemorrhage (ICH) among Hispanics and non-Hispanic whites living in Bernalillo County, NM., Background: There are differences in cerebrovascular disease incidence between racial and ethnic groups. Knowing these differences is likely to optimize stroke prevention and evaluation., Methods: Medical records review of all possible cases of ICH occurring between January 1, 1993 and December 31, 1993 among residents of Bernalillo County, NM, in all local hospitals. Hospital records were identified by ICD-9-CM codes. Also, State Medical Examiner records review for additional ICH cases occurring during the same time interval. The 1990 U.S. census provided the population base., Results: There were 47 spontaneous ICHs among 267,965 non-Hispanic whites and 39 spontaneous ICHs among 178,310 Hispanics. Incidence of ICH rises exponentially with age in both groups. The age- and sex-adjusted total annual incidence of ICH per 100,000 people is 16.6 among non-Hispanic whites and 34.9 among Hispanics (relative risk for Hispanics 2.10, 95% confidence interval 1.35 to 3.26, p = 0.001). The age-adjusted incidence rates among men and women are not significantly different in either ethnic group., Conclusion: The incidence of spontaneous ICH among Hispanic residents of Bernalillo County, NM, is approximately twice that among non-Hispanic whites. The reasons for this difference require further investigation.

This study was undertaken to determine whether there are any differences in the clinical features of ischemic stroke between Hispanics and non-Hispanic whites in New Mexico. From August 1988 to August 1990, one investigator prospectively evaluated consecutive patients who presented within 30 days of onset of stroke or transient ischemic attack and entered data into a computerized stroke registry. Several important vascular factors were recorded. Patients presented to either a Veterans Affairs Medical Center or a University Medical Center (a county facility). There were 112 Hispanics and 229 non-Hispanic whites with ischemic stroke or transient ischemic attack. Non-Hispanic whites were more likely to have ischemic heart disease (P = .01) and ischemic (vs nonischemic) causes of potential cardiogenic emboli (p = .05) than were Hispanics. The following were not significantly different between Hispanics and non-Hispanic whites: prevalence of vascular risk factors, death within 30 days of stroke, vascular territory involved, infarct location, prevalence of extracranial carotid stenosis, or cardiac sources of emboli. Our study does not show an obvious difference in the clinical features of ischemic stroke between Hispanics and non-Hispanic whites in New Mexico.