A state-based immunization campaign: the New Mexico experience

Hepatitis B prophylaxis in the form of immunization has become an increasingly effective protective measure across the United States. Various cohorts have been targeted and methodologies used by public health officials to attain optimal coverage of the population. New Mexico is in its third year of school-based hepatitis B immunization programs. New Mexico's approach to this issue is characterized by significant rates of participation (66% in middle schools and 56% in high schools), high vaccination series completion (88% in middle schools and 89% in high schools), and minimal financial investment (cost of vaccine). The "Roll Up Your Sleeves" campaign was piloted, modified, and adapted to New Mexico's multi-lingual and multi-cultural environment, resulting in these successes.

Masculinity, femininity, and Hispanic professional men's self-esteem and self-acceptance

Research suggests that in the United States, Hispanic professional women's self-esteem is affected by their unique challenge of balancing U.S. majority cultural values with their own, more family-oriented ethnic values. In the present study, the effect of this ethnic minority/majority cultural differential on U.S. Hispanic men's self-esteem was investigated. Differences in self-esteem, self-acceptance, masculinity, and femininity among U.S. Hispanic professional men, non-Hispanic professionals, scientists, college students, and clients seeking counseling were examined. Masculinity scores were significantly higher for Hispanic professional men than for all other groups of men, and self-acceptance scores were significantly lower for Hispanic professional men that for non-Hispanic professionals and students.

Promoting physician productivity through a variable compensation system

Integrated delivery systems must find ways to achieve optimal physician productivity and accountability, while fostering an entrepreneurial attitude among physicians. Lovelace Health Systems, Albuquerque, New Mexico, has implemented a variable compensation system designed for this purpose. An assessment of Lovelace's physician productivity had indicated performance well below national medians. To offer physicians a strong incentive to increase productivity, Lovelace developed a variable compensation system based on the resource-based relative value scale and relative value units. Lovelace also developed benchmark productivity targets.

Prescribing analgesics: the effect of patient age and physician specialty

To determine if patient age or physician specialty influences the willingness to prescribe pain medication, a mail survey was made of all emergency physicians, family practice physicians, and pediatricians listed as practicing in a single, middle sized, urban county in the southwest. The survey instrument presented a typical case of otitis media complicated only by pain so severe that the patient had been unable to sleep. Physicians were asked specifically if they would prescribe an analgesic and if so what kind. Emergency and family practice physicians were presented on a random basis with cases that were identical except the age was given at two or 22 years old. Pediatricians were given only the two year old. Eighty percent (137/165) of the surveys were completed and returned. Only 28% of the physicians would prescribe medications stronger than acetaminophen or nonsteroidal antiinflammatory drugs. There was a trend toward more narcotic analgesics for the 22 year old (41 vs 22% Fisher's exact test P = 0.03). Emergency physicians were the most generous, prescribing narcotics (codeine or oxycodone compounds) half the time (50%) versus one quarter of the time (22%) for family practice physicians and pediatricians (Fisher's exact test, P < 0.01). Pediatricians and family practice physicians did not differ (20 vs. 25%, P = 0.8). Potent analgesics are rarely prescribed by our sample physicians. Children are somewhat less likely to receive narcotics than adults with the same complaint. Emergency physicians are more likely to prescribe potent analgesics than are family practice physicians or pediatricians.

Sodium toxicity and pathology associated with exposure of waterfowl to hypersaline playa lakes of southeast New Mexico

Cause of mortality was studied in waterfowl in hypersaline playa lakes of southeast New Mexico during spring and fall migration. Mortality was not common in wild ducks resting on the playas during good weather. However, when birds remained on the lakes for prolonged periods of time, such as during experimental trials and stormy weather, a heavy layer of salt precipitated on their feathers. Sodium toxicity was the cause of death for all experimental mallards housed on playa water and for 50% of the wild waterfowl found moribund or dead during the spring of 1995. Gross lesions included heavy salt precipitation on the feathers, ocular lens opacities, deeply congested brains, and dilated, thin-walled, fluid-filled cloacae. Microscopic lesions in the more severely affected birds included liquefaction of ocular lens cortex with lens fiber swelling and multifocal to diffuse ulcerative conjunctivitis with severe granulocytic inflammation, edema, and granulocytic vasculitis resulting in thrombosis. Inflammation similar to that seen in the conjunctiva occasionally involved the mucosa of the mouth, pharynx, nasal turbinates, cloaca, and bursa. Transcorneal movement of water in response to the hypersaline conditions on the playa lakes or direct contact with salt crystals could induce anterior segment dehydration of the aqueous humor and increased osmotic pressure on the lens, leading to cataract formation.

Neural network and linear regression models in residency selection

For many years, multiple linear regression models have been used at a residency program to generate preliminary rank lists of residency applicants. These lists are then used by the admissions committee as an aid in developing a final ranking to submit to the National Residency Match Program (NRMP). A study was undertaken to compare predictions made using linear regression with those generated by a newer technique, an artificial neural network. A prospective cohort design was used. Seventy-four applicants to an emergency medicine program were evaluated by faculty and resident interviewers with regard to medical school grades, autobiography, interviews, letters of recommendation, and National Board scores. Normalization of these scores (by linear transformation of interviewer means) was used to correct for differences among interviewers. Multivariate linear regression and neural network models were developed using data from the previous 5 years' applicants. These models were used to forecast provisional rank orderings of the candidates. These rankings were combined into a single hybrid list that was used by the admissions committee as the starting point for development of the final rank list by consensus. Each model's predictions were tested for goodness of fit against the final NRMP rank using Wilks' test. Using the final submitted NRMP rank order as the dependent variable, the neural network yielded a correlation coefficient of 0.77 and an R2 of 59.4%. The linear regression model exhibited a correlation coefficient of 0.74 and an R2 of 54.0%. No significant difference was found (chi 2 = 1.08, P = .7). A neural network performs as well as a linear regression model when used for forecasting the rank order of residency applicants.

Environmental hazard of selenium in the Animals La Plata water development project

A hazard assessment of selenium was conducted for the Animas La Plata Project, a multiple-use water development proposed for Colorado and New Mexico by the United States Bureau of Reclamation. A published protocol for aquatic hazard assessment of selenium was applied to environmental monitoring data to assess current threats to biota in the water supply rivers (Animas, La Plata, and Mancos Rivers). Hazard evaluation were also made for two proposed reservoirs (Ridges Basin and Southern Ute Reservoirs) based on estimated concentrations of selenium. The assessment protocol indicated moderate hazard in the Animas and La Plata Rivers, and high hazard in the Mancos River and both of the proposed reservoirs. These ratings indicate that the risk of selenium poisoning in fish and aquatic birds is substantial. Moreover, the geology and climate of this site make it prone to irrigation-induced selenium contamination of water and biota. The water supplies already contain dangerously high concentrations of selenium that may increase further due to agricultural irrigation drainage. The stage is set for significant environmental problems unless a development scenario can be devised that will effectively reduce ecological risks.

Gestational diabetes is a herald of NIDDM in Navajo women. High rate of abnormal glucose tolerance after GDM

OBJECTIVE

To estimate the rate of deterioration of glucose tolerance and evaluate risk factors for development of NIDDM in Navajo women with a history of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

A retrospective analysis of 111 GDM deliveries over a 4-year period, 1983-1987, was conducted in 1994 to determine glucose tolerance status. Patients who had not developed NIDDM were recalled for a 2-h glucose tolerance test (GTT). Tested and non-tested patients were compared, as estimate of conversion to NIDDM was calculated, and risk factors for NIDDM were evaluated. A life-table analysis was developed to estimate the probability of NIDDM after GDM.

RESULTS

At the time of chart review, 32 patients (29%) had already been diagnosed with NIDDM. Of the patients, 79 were offered GTT testing, and 56 (71%) returned for follow-up; 15 were diagnosed with NIDDM and 17 with impaired glucose tolerance (IGT); 47 (42%) and 64 (58%) patients in the cohort had developed NIDDM or NIDDM/IGT at the conclusion of the study period. Patients who developed NIDDM had greater BMIs, parity, and infant weights. Fasting blood glucose > 5.83 mmol/l, GTT > 41.63 mmol/l, and recurrence of GDM were associated with later NIDDM. A life-table analysis estimated a 53% likelihood of having NIDDM at an 11-year follow-up; a second model, based only on patients with known NIDDM status, predicted a 70% rate of NIDDM at an 11-year follow-up.

CONCLUSIONS

A high proportion of Navajo women with GDM progressed to NIDDM. Postpartum counseling and periodic GTTs are recommended.

Parasites of mammals on the Sevilleta National Wildlife Refuge, Socorro, New Mexico: Cuterebra austeni and C. neomexicana (Diptera:Oestridae) from Neotoma and Peromyscus (Rodentia:Muridae), 1991-1994

In total, 6,486 rodents representing 3 families (Muridae, Heteromyidae, and Sciuridae) and 24 species were trapped May through August of 1991 through 1994. Of these, only the white-throated woodrat. Neotoma albigula Hartley; piñon mouse, Peromyscus truei Shufeldt; and white-footed mouse, P. leucopus Rafinesque, were infested with Cuterebra Clark larvae. Of the 594 N. albigula that were captured 103 (17.3%) were infested with 139 Cuterebra larvae with all infestations occurring in the throat region. N. albigula infestations were observed in 4 of 5 habitats sampled. The highest prevalence of infestation occurred during May-June (27.2%) versus July-August (9.1%) and in males (25.2%) versus females (18.3%). Prevalence of infestation was not significantly different between animals from the mark-release webs versus removal webs or adults versus juveniles. Also, there was no correlation between relative density of N. albigula and prevalence of infestation. Fifteen adults were reared from puparia and identified as C. austeni Sabrosky. Of 716 P. truei captured, 22 (3.1%) were infested with a total of 25 Cuterebra larvae with all infestations occurring in the scapular region. Although P. truei were captured in all 5 habitats, they were only infested in the piñon-juniper habitat: the highest prevalence of infestation occurred during July-August (10.9%) versus May-June (3.3%). Prevalence of infestation was not significantly different between animals from mark-release webs versus removal webs, males versus females, or adults versus juveniles. As in the N. albigula, there was no correlation between relative density of P. truei and prevalence of infestation. The adult reared from a puparium was identified as C. neomexicana Sabrosky. Of the 310 P. leucopus captured, only 3 (1%) were infested with Cuterebra larvae.

Quality improvement pitfalls and how to overcome them

Analysis of the quarterly quality improvement reports submitted by departments and teams at the University of New Mexico Hospital identified several common pitfalls: monitoring someone else's performance, choosing irrelevant or meaningless indicators, working with inadequate samples, changing measurement techniques or indicators too frequently, taking ineffective actions, and jumping to solutions. To overcome these pitfalls, managers and team leaders can use tools such as indicator worksheets, data collection plans, report forms, team-tracking mechanisms, and comprehensive guidelines as their guides through the quality improvement process.