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Study Objective: To explore the relationship between social conditions and fire mortality rates among children., Design: Retrospective analysis of fire fatalities in children 0 to 14 years old in New Mexico., Setting: State Office of the Medical Investigator., Type of Participants: All 57 New Mexico children 0 to 14 years old who died from fire-related injuries from 1981 through 1991., Interventions: Medical investigator and autopsy records were reviewed and abstracted. Demographic and housing figures were obtained from US Census reports. Data were analyzed by chi 2 or by Fisher's exact test, with Bonferroni correction for multiple comparisons., Results: Two thirds of decedents were male (P = .0014), and three fourths were less than 5 years old (P < .0001). Children living in mobile homes had triple the mortality rate of those in houses or apartments, and children in homes without plumbing (substandard) had more than ten times the mortality rate of those in houses or apartments (P < .0001). Two thirds of the victims in substandard homes were Native American (P < .0001). Errors or negligence of adults occurred in more than half of the deaths. Eighty-two percent of decedents died at the scene; only 11% reached a burn center., Conclusion: Substandard homes are associated with an increased fire mortality rate among children. Strategies to prevent childhood fire fatalities should address housing conditions and adult safety practices. Enhanced prehospital or burn unit care is unlikely to greatly affect childhood fire mortality rates.

We studied nosocomial infection in a group of 608 pediatric surgical patients over a 14-month period. All inpatients and outpatients who received an operation with an incision by the pediatric general surgical service were entered into the study. Demographic, nutritional, clinical, and laboratory data were collected. Surveillance was conducted for wound infection, septicemia, infections of the respiratory tract, urinary tract, and abdomen, and infectious diarrhea. A total of 676 operative procedures was performed. Nosocomial infection occurred in 38 of the 608 patients (6.2%). A total of 53 infectious complications was tabulated. The number and percent risk per operation were wound 17 (2.5%), septicemia 14 (2.1%), pulmonary 10 (1.5%), urinary tract 5 (0.7%), abdominal 5 (0.7%), diarrhea 2 (0.3%). Broviac catheter sepsis occurred in 7 of 61 lines (11.5%). The highest overall occurrence of infection was in the infant group (1 mo to 1 yr), (13/161, 8.1%). The probability of septicemia was highest in neonates (4.2%) compared with infants (3.1%) or older children (1.2%) (P < .05). The most common isolates were Staphylococcus epidermidis (10/17) from septic patients, and gram-negative enteric bacteria (27/50) from organ and wound infections. Infection was associated with impaired nutrition, multiple disease processes, and multiple operations. The risk of nosocomial infection in this population was comparable to that reported in adult surgical patients. These baseline data may aid the development of strategies to lower infection risk in children.

We examined the onsets of comorbid psychiatric disorders in patients with panic disorder (PD) (N = 54). In 42 patients (77.8%), PD was preceded by another psychiatric condition (secondary PD group), while in 12 patients (22.2%), PD occurred first or was the only diagnosed mental disorder (primary PD group). Patients with primary and secondary PD did not differ with respect to demographic variables, mean ages of onset of PD, mean duration of PD, number of patients with a personality disorder, and number of patients with different DSM-III-R subtypes of PD. Except for the anger and sleep scales of the Hopkins Symptom Checklist 90, patients with primary PD had significantly less self-rated psychopathology; they also displayed less extensive phobic avoidance, and had a lower rate of current psychiatric comorbidity. These findings are discussed in light of the value of the concepts of comorbidity and primary/secondary dichotomy.

Objective: To determine the diabetes-related mortality rates among New Mexico's American Indians, Hispanics, and non-Hispanic whites over a 30-yr period., Research Design and Methods: Death certificates were used to identify diabetes as an underlying cause of death by ethnic group in New Mexico during each 5-yr period from 1958 through 1987. The age-adjusted rates were calculated by ethnic group and sex, and temporal trends were examined. Comparison was made to U.S. white age-adjusted rates during the same time period., Results: Age-adjusted diabetes mortality rates for American Indians and Hispanics increased throughout the 30-yr period, and far exceeded rates for New Mexico non-Hispanic whites and U.S. whites by the 1983-1987 time period. The rates increased most dramatically among the state's American Indians, increasing 550% among women and 249% among men. Hispanic women and men experienced increases of 112 and 140%, respectively., Conclusions: New Mexico's American Indian and Hispanic populations have higher diabetes mortality rates than non-Hispanic whites, and American Indian mortality rates have risen dramatically over the 30-yr period included in our study. Although the high prevalence of diabetes in American Indians and Hispanics is a major contributor to these rates, other factors may also influence the reported mortality rates.

Objective: To determine if there were trends in underweight, short stature, and obesity among 1- through 5-year-old Mescalero (NM) Apache Indian children from 1968 through 1988., Design: Cross-sectional review of hospital clinic charts for five cohorts., Setting: General pediatric outpatient clinic at the Mescalero Indian Health Service Hospital., Participants: Sixty-nine patients aged 1 through 5 years in 1968, 1973, 1978, 1983, or 1988 for whom weight and height were recorded during a well-child visit that occurred in the respective year., Selection Procedures: Approximately half the charts were screened for eligibility through systematic sampling for all years except 1988; for 1988 all available charts were screened for eligibility for the study., Interventions: None., Measurements and Results: We found trends of decreasing prevalence of both underweight (defined as weight-for-height below the fifth percentile) and short stature (defined as height-for-age below the fifth percentile) based on the Centers for Disease Control/World Health Organization growth reference. We found no secular trends in obesity (weight-for-height above the 95th percentile), although the prevalences throughout the 21-year period were as much as two to four times higher than expected when compared with the Centers for Disease Control/World Health Organization reference. There has been an upward shift in both weight-for-height and height-for-age distributions since 1968, indicating that Mescalero children today are, on average, heavier and taller., Conclusions: Underweight and short stature decreased among Mescalero preschool children from 1968 through 1988, suggesting nutritional improvements. However, given the current high prevalence of obesity, it is recommended that surveillance of nutritional status be continued and appropriate interventions be developed to treat and prevent obesity in this population.

Diagnostic profiles of 400 adolescent and 1159 adult Navajo Indians consecutively admitted to a psychiatric unit between 1980 and 1989 are presented in this paper. The major discharge diagnoses for adolescents were as follows: adjustment reaction, mixed, and depression, not otherwise specified (NOS), with females accounting for two-thirds of either diagnosis; schizophrenia, with males accounting for 68% of all diagnoses, and personality disorder, NOS, with no gender differences. The four major discharge diagnoses for adults were schizophrenia and depression, NOS, in which there were no gender differences; alcohol withdrawal, syndrome, in which males accounted for 76% of those discharged; and adjustment reaction, mixed, in which females constituted 60% of those discharged. Over the 10-year period, there was a decrease in adult and an increase in adolescent admissions. During the last 2 years (1988 and 1989) adolescents accounted for almost 30% of all admissions compared with 14% during the first 2 years (1981 and 1982).

Diverticular disease in patients 40 years of age or younger has been described as rare but virulent. Previous studies, based on age, on diverticular disease are often confusing because of inexact definitions of the disease status. With these criticisms in mind, the authors studied 322 clinical records on patients admitted with a diagnosis of colonic diverticulosis or diverticulitis to the University of New Mexico Hospital and the Lovelace Medical Center. Of these patients, 285 had documented evidence of colonic diverticula with only 6 per cent of these being 40 years of age or younger. The criteria for acute diverticulitis were met by 86 patients, 17 of whom were 40 years of age or younger. The younger group had disproportionately more men, particularly Hispanics. The authors conclude that acute diverticulitis is more common in the young than suggested by previous reports, but the behavior of the disease is not distinctive.

Injuries are the second leading cause of death among American Indians and Alaskan Natives; during 1986-1988, injuries accounted for 22% of all deaths (1). The risk for motor-vehicle-related injury deaths is nearly threefold higher among American Indians and Alaskan Natives than among the total U.S. population (age-adjusted death rates: 57.5 per 100,000 versus 19.5 per 100,000) (1-3). For residents of many rural, western, Indian reservations, age-adjusted motor-vehicle-related death rates are substantially higher; in particular, the rates for Navajos* are fivefold greater than for the total U.S. population (97.9 per 100,000 versus 19.5 per 100,000) (1) and almost three times the rate for all New Mexico residents (35.2 per 100,000) (4). To increase safety-belt use by front-seat occupants and thereby reduce motor-vehicle-related injuries, the Navajo Area Indian HealtH Service (IHS) Office of Environmental Health and Engineering, the Navajo Department of Highway Safety, and the Navajo Nation implemented a primary enforcement safety-belt use law and educational campaign. This report summarizes results of their effort.

Exfoliation syndrome was found to occur much more frequently in the male Spanish American population of New Mexico. This was based on a Veterans Administration Medical Center study in Albuquerque, New Mexico. The prevalence of exfoliation in the Spanish Americans was estimated to be from 3-6 percent and this is consistent with many other such studies performed in the United States and other countries. The Spanish American population is 5.8 times more likely to develop exfoliation than the non-Spanish American population of New Mexico. Exfoliation was found on such eye structures as the lens, iris, ciliary processes, posterior capsule, vitreous face, posterior corneal surface, and arterial chamber angle. Glaucoma capsulare was also studied and it was found that there was not a significant difference between the Spanish American and the non-Spanish American population for developing the condition. However, there was a strong association of glaucoma with the presence of exfoliation in both groups. Based on our results, patients with exfoliation are 22 times more likely to develop glaucoma than are their age-matched controls. Also, 40 percent of the exfoliation patients had glaucoma compared with only 5 percent of the age-matched controls (p less than .001). The patients with glaucoma capsulare were found to have a more medically resistant type of glaucoma, which was consistent with other reports of this condition. There are two theories we propose for the existence of exfoliation in the Spanish American population of New Mexico. The first is a geographic climatic theory that relates exfoliation to greater solar radiation levels due to a high overall altitude and sunny weather in New Mexico.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Outbreaks of invasive group A beta-hemolytic streptococcal (GABS) infections have recently been reported. We observed a high incidence of invasive GABS disease among Native Americans at a small rural community hospital between 1982 and 1991., Methods: A retrospective chart review was performed, and all cases of invasive GABS disease were studied for their clinical features., Results: Sixteen cases of invasive GABS infection were identified during the 10-year study period. The rate of invasive GABS infection was 13.3 cases per 100,000 population per year. Mortality was 25%. Nearly half of the patients presented with systemic signs of sepsis without any obvious source of infection., Conclusions: Our experience documents a high rate of invasive GABS infections in a defined Native American population. To determine whether this population has a unique susceptibility to GABS disease requires further study.

A survey of persons soliciting sex in an area known to be frequented by prostitutes in Albuquerque, NM, included 43 females and 66 males. Seroprevalence rates found in this population-based study were as follows: human immunodeficiency virus type 1 (HIV-1), 3%; hepatitis B, 39%; hepatitis C, 45%. Increased age, intravenous drug use, and condom use were independent risk factors for hepatitis B. Female gender and intravenous drug use were independent risk factors for hepatitis C. Neither sharing injection equipment nor engaging in receptive anal intercourse was independently associated with hepatitis B or C.

From February 1988 to April 1990, we collected blood for hepatitis B surface antigen (HBsAg) from all women coming to the Texas Tech University Health Science Center in Lubbock for prenatal care. These patients were from rural western Texas and eastern New Mexico. They were also screened for hepatitis B risk factors, as outlined by the Centers for Disease Control. We reviewed the prenatal records of all HBsAg-positive women. Six of 4452 women (0.13%) had a positive HBsAg test. Four of the six women had identifiable risk factors and two did not; two were non-Hispanic caucasian (Anglo), two were Hispanic, and two were black. Anglos comprised 49.5% of the rural population, Hispanics 34.9%, blacks 12.8%, and Asians 2.8%. No Asian women were positive for HBsAg. The prevalence of HBsAg positivity was lower in this rural population than in previously reported urban populations. While the prevalence in the studied blacks and Hispanics was similar to that in previous reports, the prevalence in the rural Anglos was lower.

We reviewed the medical records of 27 patients with plague seen at the Gallup (NM) Indian Medical Center between 1965 and 1989. Nineteen patients had bubonic plague and eight had septicemic plague. Three patients with septicemic plague and three with bubonic plague died. The patients presented with five different clinical pictures. Ten patients presented with classic signs of plague, five with the appearance of an upper respiratory tract infection, five with a nonspecific febrile syndrome, four with the appearance of a gastrointestinal or urinary tract infection, and three with the appearance of meningitis. Blood cultures were positive in 24 of 25 cases, and bubo aspirate cultures were positive in 10 of 13 cases. All six patients who died were under 30 years old, and all the deaths were related to a failure to treat initially with an antibiotic appropriate for plague. Plague is a treatable disease, but clinicians must have a high index of suspicion and give appropriate antibiotics at the earliest possible time to patients whose presentation suggests plague.

Diagnoses of comorbid disorders were determined in a sample of 54 patients with panic disorder as defined in DSM-III-R. The sample was divided into the following three groups: (1) uncomplicated panic disorder (PDU); (2) panic disorder with mild agoraphobia (PDM); and (3) panic disorder with moderate to severe agoraphobia (PDA). In comparison with patients with PDU, patients with PDA had higher comorbidity rates in general, received multiple comorbid diagnoses more frequently, had a higher prevalence of major depression, dysthymia, social phobia, generalized anxiety disorder, and obsessive-compulsive disorder, and scored higher on most measures of self-rated psychopathology. These findings support the notion that PDA may be a disorder essentially different from PDU.

Objective: To determine the nature of excess injury mortality among Native Americans in New Mexico., Design: Retrospective review of death certificates for deaths from unintentional injuries., Setting: The state of New Mexico., Subjects: New Mexico residents who died of unintentional injuries between January 1, 1980, and December 31, 1989., Main Outcome Measure: Cause-specific mortality rates., Results: Over half of the excess mortality from all unintentional injuries among Native Americans resulted from hypothermia and from pedestrian-motor vehicle crashes. New Mexico Native Americans were nearly eight times more likely to die in pedestrian--motor vehicle crashes and were 30 times more likely to die of hypothermia compared with other New Mexico residents. At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 g/dL [corrected] for pedestrian and hypothermia deaths, respectively). Despite the fact that most Native Americans in New Mexico live on reservations, most deaths occurred at off-reservation sites in border towns and on roads leading back to the reservation., Conclusions: The possession and sale of alcohol is illegal on many Native American reservations. This policy forces Native Americans who want to drink to travel long distances to obtain alcohol. These data suggest that this policy is also the likely explanation for the markedly increased risk of death from hypothermia and pedestrian-motor vehicle crashes in this population.

Study Objective: To determine the relationship among helmet use, alcohol use, and ethnicity in people killed on motorcycles., Design: Retrospective review of all motorcycle fatalities in New Mexico from 1984 through 1988., Setting: Office of the Medical Investigator, State of New Mexico., Type of Participants: All decedents of motorcycle crashes in New Mexico from 1984 through 1988., Interventions: Review of all autopsies, medical investigator reports, traffic fatality reports, and toxicological studies on fatally injured motorcyclists., Results: Nine of the helmeted drivers (18%) were legally intoxicated compared with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42 of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and none of the Native-American decedents were wearing helmets. The head and neck region was the most severely injured body region in 42 of the nonhelmeted cases (84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less than .02)., Conclusion: There is an association between nonuse of helmets and alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies for preventing motorcycle fatalities should address alcohol abuse and ethnicity in conjunction with helmet use.

Surveys of cigarette smoking among Hispanics in the Southwest have shown a pattern of smoking distinct from that of non-Hispanic whites, but determinants of smoking by Hispanics remain inadequately characterized. We have assessed household income, education, and language preference as predictors of cigarette smoking in 1072 Hispanic adults residing in a community in New Mexico. Cigarette smoking status (never, former, or current smoker) varied strongly with educational attainment, showing the anticipated gradient of increasing smoking as level of education declined. In contrast, cigarette smoking status did not vary in a consistent pattern with reported language preference. A composite measure of socioeconomic status, combining education and household income, predicted continued smoking among ever smokers, whereas language preference had no effect. In males, the age at which subjects started to smoke increased significantly with increasing education; a similar trend in females did not reach statistical significance. Determinants of numbers of cigarettes smoked daily were not identified. The findings suggest that, as in other U.S. populations, Hispanics in the Southwest with lower education and less income should be targeted for smoking prevention and cessation.

Purpose: To develop and validate a multivariate model for predicting relapses after treatment of decompensated chronic obstructive pulmonary disease in an emergency department., Methods: A 5-year survey was conducted, including training and validation periods. Stepwise logistic regression was used to develop a multivariate predictive model using clinical data obtained at the time of each visit. A relapse was defined as an unscheduled return to the emergency department within 48 hours. SITE: The study was conducted in the emergency department of the Albuquerque (New Mexico) Veterans Affairs Medical Center., Subjects: The subjects were 289 patients with documented chronic obstructive pulmonary disease., Measurements and Main Results: During the first 3 years, there were 705 visits in which the patient was treated and released from the emergency department. Relapse occurred 82 times (11.6%). Logistic regression showed that the following variables had an effect on the risk of relapse: the relapse rate for previous visits, a previous visit within 7 days, long-term home oxygen therapy, the number of doses of nebulized bronchodilators, the administration of aminophylline, and the use of antibiotics and prednisone at the time of discharge from the emergency department. During the next 2 years, the 48-hour relapse rate was 9.9% (47 of 476 discharges). When the model was fitted to these data, all of the original variables contributed to the prediction of relapse except antibiotic use and long-term home oxygen therapy. The logistic model was used to categorize each visit during the validation phase. The relapse rate for "high-risk" visits was significantly higher than that for "low-risk" visits (18.4% vs 6.1%). The method identified 57.4% of visits that ended in relapse at 48 hours., Conclusions: A multivariate model can be used to identify patients with a poor prognosis after the outpatient treatment of decompensated chronic obstructive pulmonary disease.

In order to examine the relationship of dyspnea to anxiety and depression, the authors rated dyspnea using several methods in 50 patients with chronic respiratory impairment. Anxiety and depression were measured by the Symptom Checklist-90 and the Symptom Questionnaire. Results varied with the method of assessing dyspnea. Physician-rated dyspnea was significantly associated with patients' self-ratings of breathlessness as well as with pulmonary function tests, but not with any of the self-rating scales of emotions. Self-rated breathlessness was significantly associated with self-rated depression. In multiple regression analyses, depression was predictive of breathlessness. When the sample was limited to patients with chronic obstructive pulmonary disease, the results remained the same. The patients were significantly more depressed and anxious than matched family practice patients. In the study of the complex relationship of dyspnea to physical and emotional factors, it is desirable to use more than one measure of dyspnea because the results depend in part on the method of assessment.

Objective: To determine if total nutrient admixtures (TNAs) influence the rate of infection in clinical practice., Design: Prospective, randomized trial., Setting: Department of Veterans Affairs Medical Center., Patients: All patients were administered parenteral nutrition (PN) via a central venous catheter and received daily lipids., Intervention: Patients were randomized as to the mode of administration of lipids. Lipids were either administered with other PN components in a TNA or were piggybacked (PB) into the PN solution., Main Outcome Measures: Treatment groups were compared for the rate of occurrence of PN-related infections. Infections were classified as catheter infections or catheter sepsis., Results: Ninety-eight patients were entered into the trial. Data from 96 patients (44 TNA, 52 PB) were available for analysis. Treatment groups were well matched for age, baseline albumin, days of PN, predicted basal metabolic rate, and calorie and protein requirements. TNA patients received a significantly greater percentage of nonprotein calories as lipid. The incidence of infection was 12.6 and 10.3 per 1000 days of PN in the TNA and PB groups, respectively (p = 0.89). The microorganisms responsible for infection and the type of infections that developed were similar in both groups., Conclusions: Use of TNAs does not influence the rate of infection in patients receiving PN.

American Indian women in the Southwest have high rates of cervical cancer and cervical dysplasia in contrast to low rates of cancers for other sites. Despite their high rates of cervical disease, no published information has specifically examined risk factors for cervical cancer or cervical dysplasia among American Indian women. We carried out a pilot case-control study of cervical dysplasia in southwestern American Indian women to examine the relationship of dietary intake of vitamin C, folacin, vitamin E, carotenoids, and retinol with cervical cytological abnormalities. Twenty-four-hour dietary recalls were collected from women with cervical dysplasia (n = 42) and women with normal cervical cytologies (n = 58). Macro- and micronutrient intake was estimated from these recalls utilizing food and nutrient data from the USDA Survey Nutrient Database. Although mean differences between cases and controls were not statistically significant for any of the micronutrients examined, women with low intake of vitamin C, folacin, and vitamin E were at increased risk of having cervical dysplasia when the data were analyzed as stratified for level of intake (low vs. high intake odds ratios were 3.0 for vitamin C, 3.3 for folacin, and 1.7 for vitamin E). The relationship between dietary micronutrients and cervical dysplasia among American Indian women warrants further investigation using more refined measures of dietary micronutrient intake, together with consideration of other risk factors for cervical disease.

Objective: To estimate the prevalence of diabetes mellitus and impaired glucose tolerance and the incidence of clinically diagnosed diabetes in a community of Navajo Indians., Research Design and Methods: We conducted a survey of a representative Navajo community screened for diabetes 3 yr previously. We used 75-g oral glucose tolerance tests to determine the prevalence of diabetes mellitus and impaired glucose tolerance and conducted medical record reviews to identify cases of diabetes that were diagnosed during routine medical care after the earlier study., Results: By World Health Organization diagnostic criteria, the age-adjusted diabetes prevalence among 419 Navajo Indians 20-74 yr of age was 13.9% (95% confidence interval [CI] 9.2-18.5) for men and 18.4% (95% CI 14-22.8) for women. The ratio of the prevalence of diabetes among the Navajo population studied to that in the general United States population was 2.5. The prevalence of impaired glucose tolerance was 8% (95% CI 3.3-12.7) among men and 12.9% (95% CI 7.9-17.9) among women. Based on clinical diagnoses of diabetes made during routine medical care, mean +/- SE age-adjusted incidence of diagnosed diabetes among men was 8.6 +/- 4.3/1000 person-yr and 11.1 +/- 4.4/1000 person-yr among women., Conclusions: Although lower than that of some other tribes, the prevalence of diabetes among Navajo Indians is substantially higher than that in the general U.S. population. The high rate of clinical diagnoses suggests that the prevalence of the disease may continue to rise.

Navajo Indians have been reported by earlier investigators to have low concentrations of serum lipids and a low prevalence of hyperlipidemia, as well as low rates of ischemic heart disease. However, no data on serum lipid concentrations among Navajos have been reported for more than two decades. The authors conducted a study to determine the distribution of concentrations of serum total cholesterol (TC), high density lipoprotein cholesterol, low density lipoprotein cholesterol, and triglyceride among persons 25-74 years old living in a representative community on the Navajo Indian reservation. Data are reported for 255 subjects, 105 men and 150 women, ages 25-74 years. The authors compared these data to those for the general population as determined by the second National Health and Nutrition Examination Survey (NHANES II). TC concentrations among Navajo men were similar to those from NHANES II. TC concentrations among younger Navajo women were similar to those for women younger than 55 years from NHANES II, but were significantly lower among older Navajo women. While 27.6 percent of men ages 25-74 years studied in NHANES II had TC concentrations greater than 240 milligrams per deciliter, 33.8 percent of Navajo men had similarly elevated TC. However, the prevalence of serum TC concentrations greater than 240 milligrams per deciliter among Navajo women (17.5 percent) was about half that among women studied in NHANES II (32.9 percent). A similar pattern was found for low density lipoprotein cholesterol. The researchers concluded that Navajo Indians are no longer characterized by low serum lipid concentrations, that increased cholesterol concentrations may be a harbinger of increasing rates of atherosclerotic coronary heart disease among Navajos, and that attention should be directed to primary prevention of hyperlipidemia in Navajo Indian communities.

In order to evaluate the rates, causes, and clinical features of hospitalizations associated with hypoglycemia in a population with a high prevalence of non-insulin-dependent diabetes mellitus (NIDDM), a retrospective analysis of medical records was conducted in a multi-hospital primary care system on the Navajo Indian Reservation. During an estimated 26,125 person-years of observation among diabetic patients, there were 126 hypoglycemia-associated admissions related to diabetes among 109 diabetic patients, yielding a hospitalization rate of 4.7 per 1000 person-years (95% CI 4.1-5.7). Using estimates of drug utilization based on a defined daily dose, hospitalization rates were 5.8 per 1000 PY (95% CI 4.4-7.6) for chlorpropamide, 16.0 per 1000 PY (95% CI 9.5-26.9) for glyburide, and 9.1 per 1000 PY (95% CI 6.9-11.9) for insulin. After stratification by age, the relative risk for hypoglycemia-associated hospitalization among patients prescribed glyburide compared to those prescribed chlorpropamide was 2.8 (95% CI 1.6-4.9). Hypoglycemia-associated hospitalizations were relatively common among patients with NIDDM, particularly among those treated with glyburide.

The prevalence of obesity among native American children ranks with the highest in the United States. However, little is known about associated risk factors for obesity among these children. We conducted a medical record review of 261 preschool children enrolled in the Mescalero Apache tribe to determine the prevalence of obesity and associated risk factors. The prevalence of obesity (weight for height greater than 95th percentile) in this population was 19.5%. The prevalence of obesity (body mass index greater than 95th percentile) in their mothers was 23%. Children with obese mothers were more than twice as likely to be obese than children of nonobese mothers. Children with a high birth weight were three times as likely to be obese as children of low or normal birth weight. The high prevalence of obesity may be due to both life-style and dietary patterns on the reservation. Family-based interventions are needed to prevent obesity and its long-term consequences in this population.

The clinical, clinicopathologic, and pathologic features of 119 cases of plague in cats from 1977 to 1988 in New Mexico were reviewed. Fifty-three percent were bubonic, 10% were pneumonic, 8% were septicemic, and 29% with neither buboes nor pneumonia were unclassified (but presumed septicemic). Three quarters of the lymphadenopathy was submandibular, and almost half of this was bilateral. One third of all cats had the triad of lethargy, anorexia, and fever in addition to buboes; one quarter had this triad plus abscesses. The overall mortality rate was 33%, with the greatest risk of death in pneumonic cases. For confirmatory diagnosis with a single laboratory test, fluorescent antibody was most frequently used (39% of cases). Cultures and passive hemagluttination titers were also used for confirmation. Gross and histologic findings depended on the type of plague, with Yersinia pestis organisms visualized in buboes of cats with bubonic plague and in the alveolar spaces and respiratory tubules of cats with pneumonic plague.

Familial aggregation of ventilatory function has been described in several populations, but the effects of age and cigarette smoking on the extent of aggregation have not been well characterized. We used data from a survey of a Hispanic population in New Mexico to obtain estimates of heritability for FVC and FEV1 as percentages of predicted value. Product-moment correlations for FVC of spouse pairs were 0.18 (n = 90 pairs) if neither smoked, 0.013 (n = 45 pairs) if only the wife smoked, 0.18 (n = 118 pairs) if only the husband smoked, and -0.04 (n = 83 pairs) if both smoked. Correlations for FEV1 of spouse pairs were similar. Because parent-child correlations did not vary with sex, we calculated product-moment correlations from the pooled data. The parent-child correlations for nonsmoking parents with nonsmoking children 6 to 17 yr of age and living in the same house were 0.16 (n = 335 pairs) and 0.17 for FVC and FEV1, respectively. For parents whose children were 25 yr of age or older, the parent-child correlations for those living in different houses were 0.37 (n = 63 pairs) for FVC and 0.40 for FEV1 if neither smoked, and 0.24 (n = 27 pairs) for FVC and 0.14 for FEV1 if both smoked. Heritability estimates, estimated by path analysis, were 0.43 for FVC and 0.42 for FEV1 if neither family member smoked and 0.65 for FVC and 0.44 for FEV1 if both family members smoked. We conclude that there is a moderate degree of heritability of FVC and FEV1 with no substantial change based on age or smoking status.

Previous studies have identified a high incidence of severe combined immunodeficiency (SCID) among the Navajo Native American population. To determine the incidence and population genetics of this condition, we reviewed the death certificates of all children who died between 1969 and 1982, established the cases that met criteria identified in previously investigated cases, and interviewed the selected children's families. SCID cases were distributed spatially and temporally. Segregation parameter estimates of 0.27-0.38 were obtained from data from 24 interviewed families, suggesting an estimated gene frequency of 2.1% (arguing against a multifactorial inheritance). SCID cases referred to specialty centers lacked T and B cells in their blood, and their serum immunoglobulins ranged from absent to near normal.

This study represents the largest epidemiologic investigation of humans exposed to the radionuclide 210Po. In a cohort of 4402 white males employed by the Mound Facility, during the period when Po operations were conducted (1944-1972), no excess mortality was observed. Among workers initially hired during World War II, mortality was elevated, especially for deaths from all cancers, cancers of the lung, and cancers of the rectum. These adverse health events do not appear related to exposure to 210Po. Among workers monitored for 210Po, mortality was significantly less than expected, although more lung cancers were observed than expected. No significant dose-response trends were identified for all causes combined, all cancers combined, or for cause-specific cancers among the Po-monitored subcohort. Continued follow-up of this cohort is planned.

Childhood fatalities from unintentional poisoning are a substantial health problem in New Mexico, which ranks second in the nation in injury-related mortality rates. To determine the extent of poison-related mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexico's American Indian, Hispanic, and non-Hispanic white children aged 0 to 14 years, we analyzed vital records collected from 1958 to 1982. New Mexican children experienced higher mortality rates than US white children of similar age--approximately eight times higher for children under 5 years old. Of the three ethnic groups, American Indian children had the highest mortality rates from unintentional poisoning during the 25-year period. Children less than 5 years old were at the highest risk for poison-related fatalities among all three ethnic groups.

Cardiovascular disease is a significant health problem for the Zuni Indians of southwest New Mexico, in part because of high rates of non-insulin-dependent diabetes mellitus (NIDDM). The Zuni Diabetes Project was initiated in July 1983 to reduce rates of obesity and provide primary and secondary prevention of NIDDM. Two studies of the project's activities have been carried out to date. After 2 y of follow-up, diabetic participants in an exercise program compared with diabetic nonparticipants experienced weight loss, a drop in fasting blood glucose values, and reductions in the use of hypoglycemic medications. In a weight-loss competition, 45% (122/271) of the enrollees finished and lost greater than or equal to 2.3 kg. The results of these two studies demonstrate that 1) participation in a community-based exercise program can produce significant weight loss and improvement in glycemic control in Zuni Indians with NIDDM and 2) weight-loss competitions appear to be an important public health model for health-behavior change in communities similar to that of Zuni, NM.

In February 1990, a physician notified the Office of Epidemiology, New Mexico Department of Health (NMDH), of a possible cluster of suicides among high school students in Santa Fe County, New Mexico, after two male high school students committed suicide within a 4-day period. Because of concerns by school officials that the number of students attempting suicide in 1990 had increased, the NMDH began an epidemiologic investigation.

Pedestrian fatalities constitute approximately one seventh of all traffic-related deaths in the United States (1). In addition to the disproportionate numbers of pedestrian fatalities that occur among children and the elderly, minority populations are at increased risk for pedestrian deaths (2-4). In New Mexico, approximately half the population are minority persons--primarily Hispanics and American Indians. Injury fatality rates for these groups are substantially higher than national rates, especially for the state's American Indians (4,5). This report summarizes an analysis by the University of New Mexico School of Medicine of pedestrian fatalities among New Mexico's American Indians, Hispanics, and non-Hispanic whites.

Background: Human papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities., Methods: We studied 1,603 randomly selected Hispanic, Native American, and non-Hispanic White women in New Mexico to determine the prevalence of cervical HPV infection in these ethnic groups, and its association with Pap smear abnormalities, using a new commercial dot-blot hybridization assay., Results: Nine percent of all women screened had evidence of cervical HPV infection (13.7% of non-Hispanic White women, 9.7% of Hispanics, and 6.6% of Native American women). Prevalence was higher in younger women ages 14-19 years than in older age groups. Over half of women with cervical HPV infection (n = 145) had normal Pap smears. The proportion of infected women increased among those with more advanced cytopathologic abnormalities; 5.6 percent with normal Pap smears had cervical HPV vs 66.7 percent with moderate-severe dysplasia., Conclusions: Cervical HPV infection is common among New Mexico clinic attendees, varies in prevalence among the three major ethnic groups, and is strongly associated with cervical cytopathologic abnormalities.

Unlike human T cell leukemia-lymphoma virus type I (HTLV-I), HTLV-II has not been convincingly linked to a malignancy. In the first 10 months of serologic screening for HTLV-I/II among blood donors in New Mexico in 1988-1989, HTLV-I/II infection was found in 27 donors. HTLV-I/II infection was present in 1.0%-1.6% of American Indian and 0.16%-0.27% of Hispanic donors compared with 0.009%-0.06% of non-Hispanic white donors. HTLV-II was identified by DNA amplification in 12 of 13 samples from Indian and Hispanic seropositive donors. Despite apparent endemic HTLV-II infection in these populations, New Mexico Tumor Registry data showed that the incidences of hairy cell leukemia, mycosis fungoides, and chronic lymphocytic leukemia were comparable among the three ethnic groups. A population with endemic HTLV-II infection has been identified, and there is no evidence of increased risk for these three malignancies in the endemic groups.

We reviewed 21 cases of eosinophilia-myalgia syndrome to describe the range of clinical findings in these patients. Most patients were women (20 [95%]) and middle-aged (mean, 46 years) and had taken the food supplement L-tryptophan (95%). All cases involved eosinophilia (eosinophil count, greater than or equal to 2.0 x 10(9)/L) and incapacitating myalgias. Fourteen (88%) of the 16 patients tested had mild liver function abnormalities. Aldolase levels were abnormal in all patients tested. Muscle biopsies were done in five patients; four showed eosinophilic perimyositis, and one had interstitial inflammation. No physical finding was pathognomonic or universal, but muscle tenderness, tachycardia, and rash were the most common signs found during physical examinations. Seven patients were treated with prednisone, and six showed improvement in muscle pain and a decrease in eosinophilia. The cause of this disorder is still unknown.

Melioidosis, infection by the soil bacterium Pseudomonas pseudomallei, has the potential for prolonged latency with recrudescence into an acute, often fulminating, and fatal infection. Although the organism is never found in North America, infection is endemic in areas of southeast Asia, and populations of service personnel exposed during the Vietnam war and southeast Asian immigrants are at risk of severe recrudescent disease. Diagnosis, however, has been missed or delayed because of lack of familiarity with this disease. We present a case of recrudescent melioidosis that illustrates the difficulties encountered in diagnosis and treatment. This case involves a 76-year-old Vietnam veteran who presented with melioidosis of the bone 18 years after exposure to the organism and 10 years after a missed diagnosis of latent pulmonary disease. This case illustrates the protean nature of latent infection and the difficulty of selecting successful antibiotic therapy.

Study Hypothesis: Risk factors associated with unintentional gunshot fatalities among children include gender and race of the decedent, type of firearm used, and whether loaded guns are stored within the home., Study Population: All New Mexico children 0 to 14 years old unintentionally killed by a firearm between 1984 and 1988., Methods: The New Mexico Office of the Medical Investigator master mortality file was reviewed retrospectively to identify all unintentional firearm fatalities occurring in New Mexico children during a five-year period. Medical investigator, autopsy, and police reports were analyzed to identify epidemiologic factors associated with these deaths. Chi-square and Fisher's exact tests were used to analyze the data., Results: Twenty-five unintentional firearm fatalities were identified. These deaths occurred most frequently among children playing with loaded firearms found within the home. A disproportionate number involved handguns., Conclusions: The study results provide a basis for preventive strategies that limit accessibility or decrease lethality of loaded firearms within the home.

We examined New Mexico vital statistics data for suicides and homicides among the state's Hispanics, Native Americans, and non-Hispanic whites collected from 1958 to 1987. We found high age-adjusted rates for both suicides and homicides among Hispanic and Native American males, in comparison with rates for non-Hispanic white males. Suicide rates among Native American women were comparatively low, contrasting with their high homicide rates. Homicide rates for males in all three ethnic groups increased substantially over the 30-year study period. We conclude that death from violent causes, both suicide and homicide, is a major public health problem in New Mexico, and disproportionately affects minority males.

Breast tissue from a forensic autopsy series of 486 women (15 to 98 years of age) was studied radiographically and by histologic sampling. Prevalence of Wolfe P2/Dy parenchymal patterns decreased with age. Radiographic nonvascular microcalcification and histologic presence of marked ductal epithelial hyperplasia and lobular microcalcification increased with age. Both of these histologic parameters of increased risk for breast cancer correlated with the presence of radiographic microcalcification and Wolfe P2/Dy parenchymal pattern. The predictive value of the radiographic parameters for presence of "high-risk" proliferative fibrocystic change increased with age.