Manuel Bayona

High blood pressure in school children: prevalence and risk factors

BackgroundThe purpose of this study was to determine the prevalence of high blood pressure (HBP) and associated risk factors in school children 8 to 13 years of age.MethodsElementary school children (n = 1,066) were examined. Associations between HBP, body mass index (BMI), gender, ethnicity, and acanthosis nigricans (AN) were investigated using a school based cross-sectional study. Blood pressure was measured and the 95th percentile was used to determine HBP. Comparisons between children with and without HBP were utilized. The crude and multiple logistic regression adjusted odds ratios were used as measures of association.ResultsFemales, Hispanics, overweight children, and children with AN had an increased likelihood of HBP. Overweight children (BMI ≥ 85th percentile) and those with AN were at least twice as likely to present with HBP after controlling for confounding factors.ConclusionTwenty one percent of school children had HBP, especially the prevalence was higher among the overweight and Hispanic group. The association identified here can be used as independent markers for increased likelihood of HBP in children.

Using GIS technology to identify areas of tuberculosis transmission and incidence

BackgroundCurrently in the U.S. it is recommended that tuberculosis screening and treatment programs be targeted at high-risk populations. While a strategy of targeted testing and treatment of persons most likely to develop tuberculosis is attractive, it is uncertain how best to accomplish this goal. In this study we seek to identify geographical areas where on-going tuberculosis transmission is occurring by linking Geographic Information Systems (GIS) technology with molecular surveillance.MethodsThis cross-sectional analysis was performed on data collected on persons newly diagnosed with culture positive tuberculosis at the Tarrant County Health Department (TCHD) between January 1, 1993 and December 31, 2000. Clinical isolates were molecularly characterized using IS6110-based RFLP analysis and spoligotyping methods to identify patients infected with the same strain. Residential addresses at the time of diagnosis of tuberculosis were geocoded and mapped according to strain characterization. Generalized estimating equations (GEE) analysis models were used to identify risk factors involved in clustering.ResultsEvaluation of the spatial distribution of cases within zip-code boundaries identified distinct areas of geographical distribution of same strain disease. We identified these geographical areas as having increased likelihood of on-going transmission. Based on this evidence we plan to perform geographically based screening and treatment programs.ConclusionUsing GIS analysis combined with molecular epidemiological surveillance may be an effective method for identifying instances of local transmission. These methods can be used to enhance targeted screening and control efforts, with the goal of interruption of disease transmission and ultimately incidence reduction.

Risk Factors Associated with Obesity in Children of Different Racial Backgrounds.

Objective The purpose of this study is to determine specific risk factors associated with obesity among African American, Hispanic and Caucasian children. Design This is a cross-sectional study conducted on 1076 fifth grade children from 17 elementary schools at Fort Worth, Texas. Data were collected through questionnaires and physical assessments performed at schools. Crude and adjusted odds ratios were determined for the risk factors of obesity in each ethnic group. Results More African American (32.8 per cent) and Hispanic (31.9 per cent) children were overweight compared to Caucasians (23.5 per cent). A specific risk factor seen in the African American children was the frequent use of sweets and sugar-sweetened drinks, which increased the odds of obesity nearly three-fold. In the Caucasian children, the odds of obesity increased over two-fold as a result of frequent consumption of snacks with a high fat content. In Hispanic children, specific risk factors included physical inactivity and frequent consumption of multiple servings of fruit, which increased the odds of obesity approximately two-fold and 68 per cent, respectively. Although eating more fruits is usually considered a healthy behaviour, excessive fruit consumption appears to increase the likelihood of obesity among Hispanic children in this sample. Conclusion Risk factors associated with obesity are different in children of different ethnic backgrounds. Knowledge of these differences in risk factors may help design better targeted prevention approaches.

Measuring asthma disparities in Hispanics: adherence to the national guidelines for asthma treatment in emergency departments in Puerto Rico

BACKGROUND Puerto Rico has the highest prevalence of asthma in the United States. Currently, there are no data on actual care given to asthmatic patients. OBJECTIVE To determine the prevalence of documented adherence to the 1997 National Asthma Education Prevention Program guidelines regarding care given in emergency departments (EDs) in Ponce, Puerto Rico. METHODS A case series was conducted using 6,002 ED records with a physician-based diagnosis of asthma for 1999 through 2001. RESULTS A history of asthma attack was documented in 82.0% of the cases and in all age groups. In-home beta-agonist use was recorded in only 5.7% of the medical records. Documentation of previous admissions to the ED and the intensive care unit were found in 3.5% and 0.33% of the records, respectively. Nocturnal symptoms before the ED visit were found in only 6.4% of the records, and asthma treatment at home was found in 39.9%. Accessory muscle retraction was documented in 99.1% of the cases, and oxygen saturation was found in 23.2%. Treatment with nebulized beta-agonist was found in 72.1% of the records, and intravenous or oral corticosteroid use was found in 84.1%. Follow-up appointments were detected in 64.8% of the cases, and referrals to specialists were given in only 5.3%. Rate ratios between our data and those of other researchers indicate that there are geographical differences in compliance with the guidelines. CONCLUSION Of the variables tested, only one had acceptable levels of compliance, as evidenced in the patients records, indicating that there are alarming differences in ED evaluation and treatment compared with the 1997 National Asthma Education Prevention Program guidelines.