Point prevalence of tuberculosis among central Americans sheltered in Houston

A study to determine the point prevalence of tuberculosis, as defined by a positive tuberculin skin test, was conducted among the inhabitants of a Central American shelter. The point prevalence was found to be 50% (17/34). This high point prevalence demonstrates the need to test Hispanics who have recently arrived in the United States for tuberculosis. The difficulty in completing evaluations of those with positive skin tests makes tuberculin skin testing ineffective in controlling tuberculosis in this population and setting. To improve control, local, state, and federal health agencies will need to coordinate their efforts and increase the accessibility of health care to populations at high risk.

Communication between Spanish-speaking patients and their doctors in medical encounters

Little research in patient-doctor communication addresses the profound difficulties that emerge as Spanish-speaking patients seek medical services in the U.S. This study examines the interaction of language and culture in medical encounters between Spanish-speaking Latino patients and their doctors who have a range of Spanish language ability and a variety of cultural backgrounds. Initial ethnographic fieldwork investigated Spanish-speaking patients' perceptions of doctors' Spanish language skill as it relates to their medical service. To elaborate on these fieldwork findings, medical encounters were audiotaped for detailed conversational analysis. Data from the two methods illustrate how language and culture interact in accomplishing communicative tasks as doctors attend Spanish-speaking patients.

Psychosocial and cognitive correlates of alcohol use in younger adult immigrant and U.S.-born Hispanics

Hispanic groups, taken together, constitute nearly 9% of the U.S. population. Research undertaken in the last decade has demonstrated that segments of the Hispanic male population are particularly heavy drinkers and are at high risk for alcohol-related problems. This article reviews several of the most important studies of alcohol use and its consequences among Hispanics, and reports new data from a study of alcohol use and its correlates among 452 young adult men and women in Los Angeles. The findings show important differences between immigrants and U.S.-born Hispanics as well as clear gender differences in terms of alcohol use patterns, expectations about the benefits of alcohol consumption, and depressive symptomatology associated with the use of alcohol. These differences have implications for the design of prevention and treatment services for Hispanics and these are discussed.

Health care needs of Central American refugees

Public health nurses working with undocumented refugees from Central America encounter afflictions ranging from parasitic infection, emotional trauma, and homelessness. Helping this population requires the skills of a diplomat, advocate, and public health professional--as the experience of one Los Angeles public health nurse demonstrates.

Tropical pyomyositis. Demonstration of extent and distribution of disease by gallium scintigraphy

Pyomyositis is a Staphylococcus aureus infection of muscles reported primarily in tropical countries but seen with increasing frequency in temperate climates. Because of its rarity in the United States, the diagnosis may not be considered immediately, and involved muscles may break down and become abscessed. Diagnosis is most reliably made by the recovery of pus from a muscle aspirate. Ga-67 scan findings of an interesting case of pyomyositis involving many muscle groups in both upper and lower extremities is reported. Despite arthralgias and complicating adult respiratory distress syndrome, Ga-67 correctly localized the infection to muscles in the shoulders, upper thorax, buttocks, and thighs. A bone scan was negative, excluding the possibility of extension of the infection to bone.

Intestinal parasites in Central American immigrants in the United States

We describe the results of ova and parasite examinations of 216 Central Americans who were seen at a Los Angeles, Calif, clinic during an 8-month period. Among the 125 immigrants from Central America, intestinal parasitic prevalence was 53%. Pathogens were found in 45% and multiple pathogens in 21%. Of the 91 US born Central American children, parasite prevalence was 14%. Pathogens were found in 12%. The most common pathogens were Trichuris trichiura, Giardia lamblia, and Ascaris lumbricoides. Giardia lamblia was more prevalent in the younger than 5-year-old age group, and helminths were more prevalent in the 6- to 10-year-old age group. No helminths were found in immigrants who had been in the US for more than 3 years. Gastrointestinal symptoms did not correlate with prevalence of parasites. The high prevalence of intestinal parasites supports previous recommendations for screening; decisions for screening should be based on morbidity (probably low), efficacy and safety of treatment (good), and costs.

[Migration and post-traumatic stress disorders: the case of Mexicans and Central Americans in the United States]

The process of international migration has been associated with increased levels of psychological disturbance and recently investigators have noted the experience of PTSD symptoms among recent war refugees from Southeast Asia. This study sought to first examine the overall impact of migration in a large sample of immigrants from Central America and Mexico in terms of symptoms related to depression, anxiety, somatization and generalized distress. A second aim of the study was to note the existence of specific symptoms related to PTSD diagnoses as related to self-reported reasons for migration. Immigrants were found to have overall higher levels of generalized distress symptoms when compared to non-immigrants, and self-reported reasons for migration were highly related to PTSD diagnosis, with 52% of Central American war refugees in this sample meeting the DSM-III criteria for the disorder. Results are discussed in terms of sensitizing mental health professionals to the psychological sequelae of forced migration.

Cultural considerations in the treatment of Latinos with craniofacial malformations

Latinos are expected to form the largest ethnic minority in the United States by the year 2000. Although there is considerable diversity within this group, a number of similarities prevail. Folk theories of etiology and treatment, family loyalties, attitudes toward health professionals, and hospitals appear similar across Latino subgroups. Successful treatment requires the knowledge and appreciation of cultural attitudes.

Sexual behavior among Hispanic female adolescents in the United States

The purpose of this study was to identify factors associated with sexual activity in a national representative sample of Hispanic female adolescents. The subjects included all (n = 202) 15- to 19-year-old Hispanic female adolescents from the 1982 National Survey of Family Growth subdivided into Mexican-American (n = 119), Puerto Rican (n = 34), Central/South American (n = 23), Cuban (n = 9), and other Hispanic (n = 17) background groups. A total of 42% of the young women were sexually active. More Cubans (69.0%) and Central/South Americans (55.6%) reported sexual activity than the other groups, but the differences were not statistically significant. With multiple regression analysis, a significant amount of variation (total R2 = 0.367, P less than or equal to .001) in sexual activity was explained by the following variables: not being in school (22.5%), no religious affiliation (4.4%), age (3.3%), less church attendance (3.0%), older age at menarche (1.9%), and not living with both parents at age 14 years (1.9%). These findings suggest that maintaining social continuity in the areas of school, church affiliation and involvement, and family structure, as well as physical maturity are associated with Hispanic adolescent girls not becoming sexually active.

Improving the adherence of urban women to mammography guidelines: strategies for radiologists

Only 16% of women over 40 years of age are being screened regularly with mammography. To learn what radiologists and technologists can do to increase patient adherence to the screening guidelines of the American Cancer Society, especially by poor, urban women, the authors surveyed patients at a county facility immediately after mammography to document the patients' experiences with technologists and the procedure. Analysis of these data led to the conclusion that the radiologist should encourage an expanded role for the technologist as a breast health educator. By incorporating the use of a well-designed patient brochure, technologists can greatly enhance their effectiveness by decreasing the patient's anxiety and increasing her understanding of the procedure and of the importance of screening. Radiologists need to appreciate the potential of an expanded technologist's role for increasing future referrals.

Posttraumatic stress in immigrants from Central America and Mexico

International migration has been associated with increased levels of psychological disturbance, particularly among refugees who have fled from war or political unrest. This study examined self-reported symptoms of depression, anxiety, somatization, generalized distress, and posttraumatic stress disorder (PTSD) in a community sample of 258 immigrants from Central America and Mexico and 329 native-born Mexican Americans and Anglo Americans. Immigrants were found to have higher levels of generalized distress than native-born Americans. Fifty-two percent of Central American immigrants who migrated as a result of war or political unrest reported symptoms consistent with a diagnosis of PTSD, compared with 49 percent of Central Americans who migrated for other reasons and 25 percent of Mexican immigrants. The authors call for more research to document the psychosocial aspects of migration.

The multiple meanings of ataques de nervios in the Latino community

Ataques de nervios ("attacks of nerves") have been discussed in the psychiatric and anthropological literature for over thirty years. The early psychiatric articles focused on the pathology expressed by the ataque. More recent articles by anthropologists and Latino mental health professionals have reconceptualized the ataque through understanding its cultural meaning and the social factors which provoke an ataque de nervios. This article is a contribution to this reinterpretation of the ataque de nervios among Latinos. Through a series of case studies, we argue that the ataque is an expression of anger and grief resulting from the disruption of family systems, the process of migration, and concerns about family members in peoples' countries of origin.

Meeting minority health needs through special MCH projects

The maternal and child health programs of the Public Health Service have always been directed to minority populations; however, the recent surges of immigrants from Asian and Central American countries have caused the agency to appraise its efforts to meet the special health needs of these people. Through grants for special projects of regional and national significance (SPRANS), the Office of Maternal and Child Health is funding projects to break down language, culture, and access barriers to health services for pregnant women, infants, and children. Recent and current SPRANS projects have taken innovative approaches to solving the special health problems of the minority populations. They range from a breastfeeding initiative in the Commonwealth of the Northern Mariana Islands to an areawide genetic service program in the Virgin Islands. Examples of projects that have been conducted are presented.

[Hemoglobinopathies in Caribbean Basin countries]

A review of hemoglobinopathies in the Caribbean basin, shows a clear association with race: In Costa Rica, evidence suggests two geographic origins for populations of African origin.

Prevalence of hepatitis B markers among pregnant Hispanic women in migrant/seasonal work in Oregon

We screened 303 Hispanic pregnant women who were migrant or seasonal agricultural workers in Oregon for the presence of Hepatitis B serological markers. One carrier was identified (0.3 per cent, 95% confidence interval [CI] .02%, 2.1%). Evidence of previous HB infection was present in 5.3 per cent (16/303) of the women (95% CI 3.2%, 8.6%), rates similar to those for the general US population.

The social meanings of nervios: a case study of a Central American woman

This paper analyzes nervios among Central American refugees living in the United States. Nervios is analyzed as personal descriptions of distress, statements about family relations, and commentaries on the broader social forces affecting people's lives. A description of the clinical presentations of 28 Salvadorans who suffer from nervios and an indepth analysis of an extended interview with a nervios sufferer are presented to examine the multiple meanings of nervios. Nervios is identified as a powerful idiom of distress used by Latinos to express concerns about physical symptoms, emotional states, and changes both in the family and in the broader society.

Pernicious anemia in Latin Americans is not a disease of the elderly

Pernicious anemia is widely regarded as a disease of the elderly. However, it is expressed differently in black women, among the most striking differences being their younger age at presentation of the disease compared with whites. We now compared 92 Latin-American patients with 115 white and 100 black patients to see if similar age differences occur in other racial groups. Latin-American men and women were both significantly younger than white men and women, and were similar in age to blacks. Only 21% of Latin-American patients were 70 years of age or older, compared with 49% of whites. It is apparent that pernicious anemia is indeed predominantly a disease of the elderly in whites but that this is not the case in other racial groups.

Prevalence of antibody to hepatitis B virus in foreign-born hospital employees

Hepatitis B surface and core antibodies were measured in 512 community hospital employees at increased risk for developing infection with hepatitis B virus. Antibody was detected in 140 (27 percent) participants. Multivariate logistic regression analysis indicated that seropositivity was strongly associated with the prevalence of hepatitis B in an employee's country of birth and with age. These results suggest that reported differences among hospitals in hepatitis B seropositivity may in part be a reflection of the national origin of its employees. These data also indicate that each hospital should assess its own risk for hepatitis B infection and that prevaccination serologic testing is particularly worthwhile in hospitals having large numbers of foreign-born employees.

Factors associated with retinal-vein occlusion in Hispanics

Sixty-eight foreign-born Hispanic patients with angiography-proven retinal-vein occlusion (RVO) and 50 age-, sex-, and race-matched controls were evaluated for systemic disease. Thirty of the RVO patients had central retinal-vein occlusion, and 38 had branch retinal-vein occlusion. Hypertension, the most commonly associated factor, was present in 66.2% of the RVO patients in contrast to 18% of the controls (P less than .001). Other factors which were more common in the RVO population included open-angle glaucoma (19.1% vs 8%), diabetes mellitus (16.2% vs 12%), and atherosclerotic heart disease (14.7% vs 10%); these, however, were not statistically significant (P greater than .05). Hyperlipidemia was present in 12% of the controls and 10.3% of the RVO group (P greater than .50). This is in direct contrast to reports of nonHispanic populations where hyperlipidemia has been reported to be present in up to 60% of RVO patients.

Amebic abscess of the liver. Diagnostic features

The continued influx of immigrants from Mexico, Central America, and Southeast Asia to the United States has resulted in an increased incidence of several diseases not generally seen in industrialized nations in the twentieth century. One of these is amebic abscess of the liver. This review of the diagnostic features of 57 patients with amebic abscess of the liver treated in one Los Angeles County hospital emphasizes the diagnosis and the versatility of the various roentgenologic approaches and serologic tests.

Tuberculin reactivity in United States and foreign-born Latinos: results of a community-based screening program

Because of the concern that we were underestimating the prevalence of tuberculosis within the Latino community in San Francisco, we undertook a community-based screening program directed largely towards recent immigrants. Of 1,871 intermediate-strength (5 TU) tuberculin tests applied and read, 37 per cent of the reactions were greater than or equal to 10 mm. Significant reactions were found in 53 per cent of foreign-born persons compared to 7 per cent of those born in the United States. Persons older than 20 years of age were more likely to have significant reactions compared to younger Latinos. Among the foreign-born, the frequency of significant reactions was not influenced by the length of stay in the US or a history of BCG (bacille Calmette-Guérain) vaccination. Two foreign-born children were found to have current tuberculosis. The prevalence of tuberculin reactors among US-born Latino children was 3 per cent, which suggests that undetected transmission of tuberculosis may be occurring. We conclude that Latino immigrants should be systematically screened for tuberculosis.