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Adherence to diabetic care guidelines among US immigrants remains low. This study assesses adherence to diabetic care guidelines by country-of-origin and language among a limited English-proficient (LEP) population. Timely completion of diabetic measures and acceptable levels of hemoglobin A1c (A1c), low density lipoprotein (LDL) cholesterol, and blood pressure (BP) were compared between LEP and English-proficient (EP) patients in this 2013 retrospective cohort study of adult diabetics. More LEP patients met BP targets (83 vs. 68 %, p < 0.0001) and obtained LDL targets (89 vs. 85 %, p = 0.0007); however, they had worse LDL control (57 vs. 62 %, p = 0.0011). Ethiopians and Somalians [adjusted OR (95 % CI) = 0.44 (0.30, 0.63)] were less likely than Latin Americans to meet BP goals. LEP patients outperformed EP peers on several diabetic outcomes measures with important variation between groups. These data highlight the success of a safety net hospital in improving diabetes management among diverse populations. [ABSTRACT FROM AUTHOR]

This piece considers the deseos -- wants, desires, needs -- and dolores -- pain or sorrow -- of individuals in US-Mexico transnational partnerships. For transnational Mexicans, 'desire' manifests as diverse, even contradictory, expressions of emotion. Migration is intertwined with multiple desires within intimate relationships, but is also tied to suffering across borders. Conflicting articulations of deseos y dolores reveal gender politics as well as the broader socioeconomic inequalities that drive migration and result in the transborder movement that separates couples and family members in a transnational space. [ABSTRACT FROM AUTHOR]

This article considers diverse migrations from Mexico to the United States, driven by a range of factors, in the context of violence that circulates transnationally. Throughout Mexico violence and kidnappings, increasingly targeted at migrants or their family members, are motivating increased or new flows to the north. Meanwhile, in the United States, nativism is fostering anti-immigrant policies and practices – also framed by violence – aimed at “returning” Mexican nationals south. Such processes are resulting in a simultaneous blurring and reassertion of categories: distinctions between individuals with different motivations to migrate are not easily delineated, and in this case, individuals themselves often experience a form of “mixed migration”, with people migrating both for economic reasons and because they fear for their safety. Drawing on ongoing ethnographic research about migration and deportation, I outline recent experiences of transnational Mexicans to highlight contradictions within United States–Mexico migration and consider the implications for policy. In the current climate of United States immigration control, the possibility of claiming asylum within the United States is unlikely for nearly all Mexicans, underscoring the limitations of categorisation within refugee protection and immigration regimes. [ABSTRACT FROM PUBLISHER]

This paper considers the deportation of Mexican nationals from the United States, focusing on migrants with ties to a small, rural community in the Mexican state of San Luis PotosI and several locations throughout the U.S. West and Southwest. I trace the imagined futures of deportees, situating their forced removal within past returns and contemporary transnational lives. The narratives of deportees and those close to them repeatedly focus on uncertainty and insecurity: "¿Quien sabe? [Who knows?]" is a common refrain among deportees, family and friends of those deported, and undocumented migrants fearing deportation. While the U.S. state deports Mexican nationals with a sense of finality, those affected by deportation, including even deportees themselves, have few options outside of future migration to the United States. Agricultural hardship in home communities, a global economic crisis, and increasing violence throughout Mexico are likely to link the trajectories of deportees to continued transnational movement. [ABSTRACT FROM AUTHOR]

In this article, I examine the impact of neoliberalism and welfare reform on the delivery of Medicaid, specifically how the advent of Medicaid managed care (MMC) has been wrought with contradictions, placing increased burdens on primary safety-net organizations and impacting the many communities they serve. I argue that federally qualified health centers (FQHCs) operate as a primary safety net among safety-net providers, supporting and subsidizing New Mexico's MMC program financially and administratively. By presenting ethnographic data, I will demonstrate how FQHCs pay many of the hidden financial and institutional costs of the shift to managed care. Such findings uncover paradoxes inherent to neoliberal ideologies and privatization, raising questions about the efficacy of a managed care system for Medicaid as well as the future of the health care safety net and access to health care for the diverse populations it serves. [ABSTRACT FROM AUTHOR]

Background: We wanted to examine the association between Medicaid managed care (MMC) and changing immunization coverage in New Mexico, a predominantly rural, poor, and multiethnic state.Methods: As part of a multimethod assessment of MMC, we studied trends in quantitative data from the National Immunization Survey (NIS) using temporal plots, Fisher's exact test, and the Cochran-Armitage trend test. To help explain changes in immunization rates in relation to MMC, we analyzed qualitative data gathered through ethnographic observations at safety net institutions: income support (welfare) offices, community health centers, hospital emergency departments, private physicians' offices, mental health institutions, managed care organizations, and agencies of state government.Results: Immunization coverage decreased significantly after implementation of MMC, from 80% in 1996 to 73% in 2001 for the 4:3:1 vaccination series (Fisher's exact test, P = .031). New Mexico dropped in rank among states from 30th for this vaccination series in 1996 to 50th in 2001. A significant decreasing trend (Cochran-Armitage P = .025) in coverage occurred between 1996 and 2001. Findings from the ethnographic study revealed conditions that might have contributed to decreased immunization coverage: (1) reduced funding for immunizations at public health clinics, and difficulties in gaining access to MMC providers; (2) informal referrals from managed care organizations and contracting physicians to community health centers and state-run public health clinics; and (3) increased workloads and delays at community health centers, linked partly to these informal referrals for immunizations.Conclusions: Medicaid reform in New Mexico did not improve immunization coverage, which declined significantly to among the lowest in the nation. Reduced funding for public health clinics and informal referrals may have contributed to this decline. These observations show how unanticipated and adverse consequences can result from policy interventions in complex insurance systems. [ABSTRACT FROM AUTHOR]