CLHIN eNewsletter for September, 2013
Crossing the Border for Health Services
An article published earlier this year provides new data from El Paso and Ciudad Juarez on the frequency of border crossings for health services. Free full text available from the Journal of the National Medical Association.
Diabetes Hospitalization Along the US”Mexico Border
A study published earlier this year in Preventing Chronic Disease, conducted an analysis of discharge data from hospitals in Arizona, California and Texas. Compared to residents of non-border counties, residents of border counties had significantly higher diabetes discharge rates – corroborating findings from a recent PAHO-sponsored study, noted on this blog last month.
Effect of Acculturation on Drinking Along the Border
Acculturation to American society has often come with a price for immigrants, and that is the use of alcohol and the accompanying problems. This fact has been proven through research conducted primarily in metropolitan areas. But for the first time, research has focused on the use of alcohol on the Texas/Mexico border. Using information gathered during 2002-2003, among an almost even split of men and women, conclusions have been drawn on the effect of alcohol on the genders.
According to Raul Caetano, professor of epidemiology and regional dean (Dallas) at the University of Texas School of Public Health:
“There is a clear differential effect of acculturation by gender. While this was shown in previous research, the effects on the border seem to be more accentuated. Men drank less as they acculturated, and had a lower prevalence of alcohol-use disorders. Women drank more with acculturation, but this did not seem to lead to a higher rate of alcohol use disorders.”
The full report has been published in the February issue of Alcholism: Clinical & Experimental Research
EpiLink on Stress Among Latino Adolescents
The Texas Department of Health published the semimonthly Disease Prevention News for many years, but publication stopped abruptly back in 2003 in the middle of Volume 63. Under the auspices of the new Texas Department of State Health Services’ Infectious Disease Control Unit (ICDU), publication resumed with Volume 64 Issue 1 in January 2007 and continuing on a roughly monthly publication schedule with a new name: EpiLink Online Bulletin.
An article from the November issue of EpiLink has received some attention in the Spanish-language press after coverage by the Mexican news agency Notimex. The paper in question, “Current perspectives on stress among Latino adolescents” [PDF full text] was prepared by Richard C Cervantes and colleagues for the Annual Conference of the National Hispanic Network on Drug Abuse which took place in September. The paper is a review of research into the stressful living conditions that disproportionately affect Latino youth — including poverty, lack of health insurance, high school drop-out rates, increasing health problems (e.g., obesity), high teenage pregnancy rates, sexually transmitted diseases, increasing rates of HIV infections, substance abuse, and violence — and the present and future effects of that increasing stress on the health of an entire generation of Latinos.
According to the United States Department of Health and Human Services (DHHS) (Freid et al., 2003), … the highest rates of suicide consideration (26.5%) were for female Latinas. Latino and Latina youth from 9th to 12th grade overall had higher rates of attempted suicide than any other group; the male students were at 8.0% while, again, the female Latina rates (15.9%) were much higher. In an older survey, injurious suicide attempt rates were higher for Latina females 4.2%, followed by Latino males (2.5%), and then African Americans (DHHS, 1990). A study conducted by Rew et al. (2001) revealed that Latina adolescents had the highest rate of suicide attempts compared to other ethnic-gender groups. In addition, Latinas in the study also had relatively high reports of sexual abuse and suicide attempts by family members and friends. Latinas also have alarmingly higher rates of depression (27%). Latinas were the second highest ethnic group to report depressive symptoms. Acculturation stress due to conflictive gender roles in adolescent Latinas is believed to be the driving force of their higher rates of stress, depression and suicidality (National Coalition of Hispanic Health and Human Services Organization, 1999).
Although the reference list for the review article is impressive and very helpful, it also lays out a compelling case for a more comprehensive research agenda for studying issues such as intergenerational differences in acculturation and their effect on intrafamilial stress, differences between the mental and physical health of “acculturated” vs. “bicultural” Latino adolescents, and the relationship of gender differences in Latino adolescents to stressors, coping skills, resiliency, and mental and physical health.
Here’s an example of the Notimex coverage in Spanish: “Adolescentes hispanos afectados por el estrés” from MetroLatinoUSA, 2007-11-21; and here’s a blog post that reprints English-language coverage of the report from the 2007-11-09 issue of the Rio Grande Guardian (unfortunately, the original article does not appear on the Guardian‘s site now).
Exercise plus resistance training = increased fitness for people with diabetes
A new article in the current issue of JAMA reports on a randomized controlled trial that compared the effects of different types of exercise on people with type 2 diabetes. The objective of the study was to examine the benefits of aerobic training alone, resistance training alone, and a combination of both on hemoglobin A1c (HbA1c). The study group of 262 sedentary men and women was enrolled in a 9-month exercise program with random assignment to one of four groups. Forty-one participants were assigned to the non-exercise control group, 73 to resistance weight-training 3 days a week, 72 to aerobic exercise in which they walked on a treadmill for the equivalent to a brisk, 4 mph walk for 50 minutes 3 times per week, and 76 to combined aerobic and resistance training in which they walked on the treadmill 3 times per week and did two weight lifting sessions each week. The workouts were designed so that each would take about the same amount of time at 140-150 minutes per week.
Results indicated that participants in all exercise groups reduced their waist circumference and lost weight compared with the control group. Only the combination group improved maximum oxygen consumption. Although HbA1c didn’t change significantly for people who did aerobic training only or resistance training only, it fell by 0.34 percent in the combination exercise group, which would translate to a decreased risk of heart disease and microvascular complications.
Dr. Timothy Church, the study’s author, noted that their findings support the 2008 federal physical activity guidelines, which recommend that people get at least 150 minutes of walking or 75 minutes of running a week, along with two or more days a week of resistance training.
1) Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes
Timothy S. Church, MD, MPH, PhD; Steven N. Blair, PED; Shannon Cocreham, BS; Neil Johannsen, PhD; William Johnson, PhD; Kimberly Kramer, MPH; Catherine R. Mikus, MS; Valerie Myers, PhD; Melissa Nauta, BS; Ruben Q. Rodarte, MS, MBA; Lauren Sparks, PhD; Angela Thompson, MSPH; Conrad P. Earnest, PhD
JAMA. 2010;304(20):2253-2262. doi:10.1001/jama.2010.1710
2) Weights plus walking equals more fit in less time.
http://www.cnn.com/2010/HEALTH/11/23/weights.plus.walking/index.html?hpt=Sbin. Accessed 11/24/10.
February 2012: National Children’s Dental Health Month
In 2002, the Urban Institute reported that one of the most prevalent chronic illnesses facing children in the United States today is tooth decay. It is astounding that oral health problems persist among children in spite the fact that tooth decay is largely preventable through regular dental cleanings and checkups. Still, 24 percent of children ages 5 to 17 account for 80 percent of the tooth decay disease in permanent teeth among this age group. Socioeconomic disparities are blamed for these oral health burdens and low-income children are disproportionately affected. Inadequate access to dental care can be cited as the problem. Please read the report: http://www.urban.org/publications/309527.html
It is with this problem in mind that the Texas Health and Human Services Commission (HHSC) offers Children’s Health Insurance Program (CHIP) Dental Services though a managed care model. Beginning March 1, 2012, HHSC will expand managed care dental services to include Medicaid. The goal of this expansion is to provide quality, comprehensive dental services to eligible recipients. HHSC will select two or more dental contractors to provide services to both Medicaid and CHIP Members. Please read the report:
It is good to remember also, that we can help protect our children’s teeth and diminish the growth of caries with various applications of dental sealants and with topical and systemic fluoride, but most importantly, a sound education and a good oral hygiene program will go a long way to help maintain healthy teeth and gums for a long, long time.
“Something Fun” from the American Dental Association in honor of National Children’s Dental Health Month:
Full Text of the Report on San Antonio Health Systems
Full text of the report on San Antonio health systems mentioned in the San Antonio Express News, “Urgent Matters: An Assessment of the Safety Net in San Antonio” is available online.
Gum Disease Linked with Gestational Diabetes Risk
Researchers have found that pregnant women with gum disease may be more at risk of developing gestational diabetes than pregnant women with healthy gums. Findings from the study show the 8 percent who developed gestational diabetes had higher levels of gum-disease-causing bacteria and inflammation. The study group consisted of 265 women, of which 83 percent were Hispanic…..a group already at higher risk to gestational diabetes and type 2 diabetes.
Preterm birth has also been linked to gum disease in previous studies.
“In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant,” said lead researcher, Dr. Ananda P. Dasanayake.
Health Lotería #12: La garza
This week on the Health Lotería, “llegaron los picos largos de la feria de San Juan…” ["here comes long-bill from the fair of St John..."] — that’s right, it’s la garza [the heron]! And the heron brings along the health topic of clean drinking water.
For an introduction, we recommend the Environmetal Protection Agency website titled “Drinking water and health: what you need to know.” Also, the page on “Drinking Water” in medlineplus.gov is very full of information and important links.
Of course, a natural disaster — like Hurricane Dolly that affected the Valley this past week — can quickly change the stability of the drinking water system. According to this news which came out yesterday around 5pm, there are various parts of the Valley where health officials are currently recommending that residents boil their water before drinking it, to prevent the spread of possible water-born illnesses as a result of flooding and other problems in the wake of the hurricane:
- North Alamo Water Supply Corporation (Includes parts of Donna, Weslaco, Elsa, Edcouch y La Blanca)
- La Villa
- Laguna Madre Water Supply (includes South Padre Island, Military Highway WSC, only those served by Las Rusias Plant)
- Sebastian Municipal Utility District
- Port Mansfield
- Santa Rosa
If you live in one of those areas or know someone who does, it’s important to verify with the authorities (the water service provider) that your water is safe to drink; if not, you should boil it for at least a minute before drinking it.