Thomas M. Becker

The New Mexico experiment: educational innovation and institutional change.

Over the past ten years the University of New Mexico School of Medicine has conducted an educational experiment featuring learner-centered, problem-based, community-oriented learning. The experiment was introduced into an established institution by means of an innovative educational track running parallel to the more conventional curriculum. Students in the innovative track, compared with those in the conventional tract, tended to score lower on the National Board of Medical Examiners (NBME) Part I examination (basic sciences) and higher on NBME Part II (clinical sciences), received higher clinical grades on clinical clerkships, and experienced less distress. They were more likely than conventional-track students to retain their initial interest in or switch their preference to careers in family medicine. The parallel-track strategy for introducing curriculum reform succeeded in fostering institutional acceptance of continuing educational innovation. Generic steps in overcoming institutional barriers to change are identified.

Ischemic heart disease mortality in Hispanics, American Indians, and non-Hispanic whites in New Mexico, 1958-1982.

To describe trends in mortality from ischemic heart disease in New Mexicos Hispanic, American Indian, and non-Hispanic white populations, we used vital records data collected from 1958 through 1982. We calculated age-adjusted and age-specific mortality rates for ischemic heart disease for each of the states principal ethnic groups. Death certificate data were used in combination with population estimates based on the censuses of 1960, 1970, and 1980. Age-adjusted mortality rates for ischemic heart disease among Hispanics, American Indians, and non-Hispanic white men were consistent with nationwide patterns of rising mortality rates during the 1960s followed by declining rates. Mortality rates from ischemic heart disease in all three ethnic groups in New Mexico were lower than national rates for whites. Rates for Hispanics in New Mexico were lower than for non-Hispanic whites; rates for American Indians were the lowest among the three groups. These data support previous observations that Hispanics and American Indians in the Southwest are at decreased risk for mortality from ischemic heart disease in comparison with U.S. whites.

Grappling with herpes: Herpes gladiatorum

Initial reports of herpes gladiatorum, a skin infection of wrestlers caused by herpes simplex virus (HSV), fo cused on case histories and clinical presentations of this disease. To more adequately address broader ep idemiologic questions concerning this skin infection, we surveyed members of four southeastern college wres tling teams, sampled high school and college athletic trainers nationwide, and obtained serum specimens from members of one college wrestling team for HSV antibody studies. Nine of 48 (18.8%) college wrestlers in the southeastern athletic conference reported histo ries of herpes gladiatorum. Wrestlers with a prior history of oral HSV infection (cold sores) were less likely to report HSV skin infection than wrestlers without cold sores (RR = 0.25; 95% C.I. 0.03 to 1.8), while wrestlers with exposure to opponents with cutaneous HSV le sions were at high risk to develop herpes gladiatorum (RR = 9.4; 95% C.I. 2.2 to 40.0). The national survey of athletic trainers indicated that 7.6% of college wres tlers and 2.6% of high school wrestlers had HSV skin infection during the 1984-85 season. Herpes gladiato rum is a common problem among college wrestlers, and morbidity associated with this skin disease can be significant.

Cervical papillomavirus infection and cervical dysplasia in Hispanic, Native American, and non-Hispanic white women in New Mexico.

BACKGROUNDnHuman papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities.nnnMETHODSnWe 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.nnnRESULTSnNine 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.nnnCONCLUSIONSnCervical 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.

Decreasing rates of cervical cancer among American Indians and Hispanics in New Mexico (United States)

Minority women in New Mexico (United States)—including American Indian and Hispanic women—have shown disproportionately high incidence rates of invasive cervical cancer during the 1960s and 1970s. Several public health programs in New Mexico were directed toward early detection of cervical cellular abnormalities, particularly targeting the states minority women. To evaluate the effectiveness of these programs, we examined the New Mexico Surveillance, Epidemiology, and End Results (SEER) data collected from 1969–92, and calculated average annual, age-specific, and age-adjusted incidence rates by ethnic group (American Indian, Hispanic, and non-Hispanic White) for five-year time intervals. We also calculated age-adjusted mortality rates for cervical cancer in the same ethnic groups using state vital records. Age-adjusted incidence rates for invasive cervical cancer show substantial temporal decreases, especially for minority women in the state. The age-adjusted incidence rate decreased by 66 percent, from 30.3 to 10.3 per 100,000 for American Indian women, and by 61 percent, from 26.1 to 10.2 per 100,000 for Hispanic women. A stage shift to earlier stages of cervical neoplasia occurred over the study period, with a substantially higher proportion of in situ compared with invasive cancers diagnosed in the most recent cf the most remote time period. The ratio of incidence rates of in situ to invasive cancers changed dramatically for both American Indian and Hispanic women. Cervical cancer mortality rates decreased steadily among Hispanic women from 1958 to 1992; the decrease among American Indian women was less stable and fluctuated due to small numbers. Ongoing targeted sceening programs should help to reduce cervical cancer incidence and mortality further in New Mexico.

Mortality from lung cancer and chronic obstructive pulmonary disease in New Mexico, 1958-82

We examined mortality from lung cancer and from chronic obstructive pulmonary disease in Hispanic White, Other White, and Native American residents of New Mexico during the period 1958-82. Age-specific mortality was calculated by combining death certificate data with population estimates based on the 1960, 1970, and 1980 censuses that were adjusted for inconsistencies in the designation of race and ethnicity. In Other Whites, age-adjusted mortality rates from lung cancer and from chronic obstructive pulmonary disease increased progressively in males and females. Mortality rates for both diseases also increased in Hispanics during the study period, but the most recent rates for Hispanics were well below those for Other Whites. Age-specific mortality rates for lung cancer declined for more recently born Hispanic women at older ages. In Native Americans, rates for both diseases were low throughout the study period and did not show consistent temporal trends.

Seroprevalence of and Risk Factors for Antibodies to Herpes Simplex Viruses, Hepatitis B, and Hepatitis C among Southwestern Hispanic and Non-Hispanic White Women

Background and Objectives: Few published data describe the seroprevalence of antibodies to herpes viruses and hepatitis viruses among Southwestern minority women. Goals: To determine the prevalence of antibodies to herpes simplex virus type‐1 and type‐2, hepatitis B, and hepatitis C among 595 southwestern Hispanic and non‐Hispanic white patients seeking gynecologic care; and to investigate risk factors associated with seropositivity. Study Design: Analysis of serologic and interview data. Antibody assays were based on purified glycoprotein assays (herpes simplex virus), and commercial assays for hepatitis B virus and hepatitis C virus. Results: Hispanic ethnicity was a risk factor for herpes simplex virus type‐1 (age‐adjusted odds ratio, 3.1; 95% confidence interval, 1.8–5.3) but was not associated with antibodies to herpes simplex virus type‐2, hepatitis B virus, or hepatitis C virus. Risks associated with seropositivity to herpes simplex virus type‐2 included a high lifetime number of sex partners, history of any sexually transmitted disease, and increasing age. Among all patients with herpes simplex virus type‐2 antibodies, only 11.1% gave histories of genital herpes infection. For women with antibodies to hepatitis B virus, 31.1% gave histories of hepatitis during adulthood. Conclusions: The seroprevalence of antibodies to herpes simplex virus type‐1 and herpes simplex virus type‐2 was high in this clinic population; the prevalence of antibodies to herpes simplex virus type‐1 was significantly higher in Hispanics than in non‐Hispanic whites. Antibodies to herpes simplex virus type‐2 and hepatitis B virus were associated with most indicators of sexual behavior. The high prevalence of antibodies to herpes simplex virus type‐2 and the infrequent reporting of histories of genital herpes suggest that asymptomatic infection with herpes is common among these clinic patients.

Contrasting trends of prostate cancer incidence and mortality in New Mexico's hispanics, non-hispanic whites, American Indians, and blacks

Background. Prostate cancer has increased in epidemic proportions during the 1980s. Although marked differences in ethnic and racial temporal trends for prostate cancer have been observed both in the United States and internationally, the trends in Hispanics and American Indians have not been described extensively.

Introducing residents to a career in management: the Physician Management Pathway.

To prepare their students and residents for the practice of medicine in a rapidly changing environment, medical educators must teach the business of medicine as well as the science and art of medicine. Recognizing the value of and demand for physician leaders, the authors sought to introduce residents to diverse aspects of medical administration within the context of an academically rigorous internal medicine residency program. The Physician Management Pathway (PMP) was developed in 1997 to expose interested residents to the management concepts employed by physician managers; to help physician trainees begin to develop the leadership and technical skills they will use as physician managers; to provide career mentoring; to provide experiences that enrich the residents training in clinical medicine; to enhance resident-directed educational activities; and to produce physicians who can successfully work in any health care environment. The PMP curriculum consists of a monthly seminar series, a preceptorship experience in the second year of residency, and a supervised project in the third year. The program was not designed to provide competency in management, but rather is intended to provide an opportunity for new physicians to explore options in this exciting and changing profession.

Diabetes mortality among New Mexico's American Indian, hispanic, and non-hispanic white populations, 1958-1987

OBJECTIVE— To determine the diabetes-related mortality rates among New Mexicos 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 states American Indians, increasing 550% among women and 249% among men. Hispanic women and men experienced increases of 112 and 140%, respectively. CONCLUSIONS–New Mexicos 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.