Percepción etnobotánica de los campesinos sobre la flora arvense en fincas de la agricultura suburbana en Santiago de Cuba, Cuba / Ethnobotanical perception of the farmers about the weed flora in farms of suburban agriculture in Santiago de Cuba, Cuba

Currently the weed species are a resource to conserve. The objective was to evaluate the ethnobotanical perception of the peasants about the weed flora in farms of suburban agriculture in Santiago de Cuba, Cuba. An ethnobotanical study was developed and the percentage of known species, percentage of species per management action and the percentage of weed species with potential utility was determined. The spectrum of use, the categories of use and the species richness by category were also taken into account. The weed species found in each of the farms were identified by at least 60% of the producers conferring more than 70% of this flora potential utilities such as medicinal, animal feed and agricultural. Although different forms of management for these species were identified, more than 40% are eliminated regardless of the potential benefits that productive systems can bring to this.

Actualmente las especies arvenses son un recurso a conservar. El objetivo fue evaluar la percepción etnobotánica de los campesinos sobre la flora arvense en fincas de la agricultura suburbana en Santiago de Cuba, Cuba. Se desarrolló un estudio etnobotánico y se determinó el porcentaje de especies conocidas, porcentaje de especies por acción de manejo y el porcentaje de especies arvenses con utilidad potencial. También se tuvo en cuenta el espectro de uso, las categorías de uso y la riqueza de especies por categoría. Las especies arvenses que se encuentran en cada una de las fincas fueron identificadas por al menos el 60% de los productores confiriéndoles a más del 70% de esta flora utilidades potenciales como medicinal, alimento animal y agrícola. Aunque se identificaron diferentes formas de manejo para estas especies, más del 40% resultan eliminadas independientemente de los beneficios potenciales que puedan aportar a estos sistemas productivos.

Yellow Oleander Seed, or "Codo de Fraile" (Thevetia spp.): A Review of Its Potential Toxicity as a Purported Weight-Loss Supplement.

The Dietary Supplements and Health Education Act (DSHEA), passed by the United States Congress in October of 1994, defines herbal products as nutritional supplements, not medications. This opened the market for diverse products made from plants, including teas, extracts, essential oils, and syrups. Mexico and the United States share an extensive border, where diverse herbal products are available to the public without a medical prescription. Research undertaken in the neighboring cities of Ciudad Juarez, Mexico, and El Paso, Texas, USA, shows the use of herbs is higher in this border area compared to the rest of the United States. A portion of the population is still under the erroneous impression that "natural" products are completely safe to use and therefore lack side effects. We review the dangers of ingesting the toxic seed of Thevetia spp. (family Apocynaceae), commonly known as "yellow oleander" or "codo de fraile," misleadingly advertised on the Internet as an effective and safe dietary supplement for weight loss. Lack of proper quality control regarding herbs generates a great variability in the quantity and quality of the products' content. Herb-drug interactions occur between some herbal products and certain prescription pharmaceuticals. Certain herbs recently introduced into the U.S. market may not have been previously tested adequately for purity, safety, and efficacy. Due to the lack of reliable clinical data regarding the safe use of various herbal products currently available, the public should be made aware regarding the possible health hazards of using certain herbs for therapeutic purposes. The potentially fatal toxicity of yellow oleander seed is confirmed by cases reported from various countries, while the purported benefits of using it for weight loss have not been evaluated by any known clinical trials. For this reason, the use of yellow oleander seed as a dietary supplement should be avoided.

Development of a community pharmacy human papillomavirus vaccine program for underinsured university students along the United States/Mexico border.

OBJECTIVE: To describe the development and implementation of a human papillomavirus (HPV) vaccine patient assistance program (PAP) for university students, and to acquire information on the number who accessed the program and completed the series. SETTING: University of Texas at El Paso University Student Health Clinic Pharmacy, Fall 2011-Spring 2014. PRACTICE DESCRIPTION: A community pharmacy located within the university student health clinic providing services to an underinsured student population. PRACTICE INNOVATION: Existing evidence shows the benefit of using PAP in community pharmacies but is nonspecific regarding the use of PAP for vaccines in an uninsured and underinsured Hispanic student population. The implementation of this unique HPV vaccine program in a community setting aims to increase awareness, access, and rates. MAIN OUTCOME MEASURES: Primary measures included results from a needs-assessment questionnaire that were used to implement the HPV vaccine program. After implementation, utilization data were collected on the number of students who qualified and enrolled in the HPV PAP and the number of students who completed the HPV series. RESULTS: The preliminary data from a needs assessment indicated that a majority (72.1%, n = 80) of students did not understand how HPV is transmitted. A total of 89 students qualified for PAP. The majority were women (81%). A total of 71 students (79.8%) received their second dose and 43 (48.3%) completed the series. CONCLUSIONS: Although pharmacists continue to provide vaccine services, minorities such as the Hispanic population continue to be underimmunized. Students may not be taking the proper precautions to prevent the acquisition of HPV. For these reasons services such as this HPV vaccine program are warranted. Pharmacists need to continue to educate and advocate on the importance of vaccines and how they prevent disease.

Use of complementary and alternative medicines and supplements by Mexican-origin patients in a U.S.-Mexico border HIV clinic.

This article draws from a study investigating the influence of institutional and psychosocial factors on adherence to antiretroviral (ARV) medications by Mexican-origin persons living with HIV (PWLH) on the U.S.-Mexico border and seeking treatment at a clinic in El Paso, Texas. Among 113 participants, many individuals reported using complementary and alternative medicines (CAM) to support general health and their immune systems and to address symptoms of HIV-related diseases and ARV side effects. CAM were seen as complementing ARV treatment; however, CAM use was often not reported to health care providers out of concern about disapproval and loss of care privileges. This finding challenges researchers and providers to consider seriously how Hispanic populations, with their CAM use, may exhibit the hybridization of health and healing. Information on CAM use needs to be available to providers to assess the benefits and contraindications of use and to develop realistic and effective care strategies.

Medication use practices and perceptions among patients in a U.S.-Mexico border community.

OBJECTIVE: To identify themes surrounding medication use practices and perceptions among individuals from a U.S.-Mexico border community recruited to participate in focus groups. METHODS: This study was conducted in El Paso, TX. Adult participants considered to be at risk for medication therapy problems (i.e., older adults, pregnant or breast-feeding women, parents of young children) were recruited for participation. Focus groups and a survey were used to evaluate perceptions, concerns, and patterns of use of U.S. medications, Mexican medications, and herbal products. RESULTS: A sample of 73 adults, most of whom were Hispanic women (n = 60 [82%]), were recruited for participation in seven focus groups. Across groups, the majority participated in the older adult cohort (n = 42 [58%]), reported having an annual household income of less than $15,000 (n = 57 [78%]), and identified that they had less than a high school education (n = 40 [55%]). Four dominant themes emerged from the participants who completed both the survey and focus groups: (1) a "comfort" level for using a combination of U.S. medications, Mexican medications, and herbal products; (2) customary use of different drug information sources including physicians, Mexican pharmacy staff, U.S. pharmacists, and family members; (3) inconsistent levels of confidence in interpreting, measuring, and using medications; and (4) a sense of frustration regarding medication costs, which led participants to seek alternative options. CONCLUSION: These qualitative results provide an increased understanding of medication use practices and perceptions in this population. Findings such as these can provide guidance and insight into the development of interventions to improve safe and effective medication use.

Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border: a descriptive, questionnaire-based study.

BACKGROUND AND OBJECTIVE: The use of multiple medications, herbs or nutritional supplements can lead to adverse consequences, particularly in the elderly. A significant consequence resulting from polypharmacy, polyherbacy and nutritional supplement use is the potential for interactions to occur among the various products. The primary objective of this study was to estimate the prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the US-Mexico border. METHODS: This was a descriptive study that involved the administration of a bilingual (English/Spanish) questionnaire to a convenience sample of adults aged >or=60 years recruited from senior centres located within the most populated US-Mexico border region from June 2005 to March 2006. Participant demographics were collected in addition to information about current use of prescription medications, over-the-counter (OTC) medications, herbal products and nutritional supplements (i.e. nutraceuticals and vitamins or minerals). The outcomes measured were the number of prescription medications, OTC medications, herbal products, vitamins/minerals and nutraceuticals per participant. Furthermore, the number of potential interactions and major interactions between drugs, herbal products and nutritional supplements were identified for each participant. Additionally, product use patterns between men and women and among locations within the border region were compared. RESULTS: One-hundred-and-thirty participants (mean age 71.4 years) were recruited to complete the questionnaire. The prevalence of polypharmacy among all participants was 72.3% (n = 94), with 38.5% (n = 50) taking five or more concomitant medications (major polypharmacy). Twenty-one participants (16.2%) in the study sample reported taking two or more herbal products (polyherbacy). Thirty-four participants (26.2%) reported taking two or more vitamin/mineral supplements and nine (6.9%) reported using two or more nutraceuticals. Participants living on the US side of the border had higher rates of major polypharmacy, polyherbacy and use of nutritional supplements than those living on the Mexican side of the border. Overall, there were no significant differences in medication, herbal product and nutritional supplement use patterns between men and women. Evaluation of potential interactions revealed that 46.2% (n = 60) of participants were at risk of having at least one potential drug-drug interaction. Regarding drug and herbal product-supplement interactions, 31.5% (n = 41) of participants were at risk of having at least one possible interaction. CONCLUSIONS: The prevalence of polypharmacy among older adults living on the US side of the border was similar to national trends (estimates suggest that one-quarter to one-half of US adults aged >or=65 years take five or more medications). However, polypharmacy was less common in older adults living on the Mexican side of the border. Additionally, herb use was higher in older adults living on the US-Mexico border than has been reported in national surveys of US adults, which indicate that less than one-quarter of adults have used a herbal product within the previous 12 months. Furthermore, this study demonstrated that older adults living on the US side of the border consumed more herbs and nutritional supplements than their Mexican counterparts. In addition to describing product use patterns on the border, these findings suggest that almost half of the older adult participants were at risk for a potential drug-drug interaction, with approximately one-third having a potential interaction between their medications, herbs or nutritional supplements.

Cross-border purchase of medications and health care in a sample of residents of El Paso, Texas, and Ciudad Juarez, Mexico.

BACKGROUND: We examined data from a US-Mexico bi-national survey conducted among adult residents of El Paso, Texas, and Ciudad Juarez, Mexico, to assess frequency of purchase of medications and use of health care services across the border. METHODS: We analyzed questionnaire data from face-to-face interviews of 1000 randomly selected adults on both sides of the border to assess prevalence and prevalence ratios using log binomial logistic regression analysis. RESULTS: One-third of adult residents of El Paso and 5% of those in Ciudad Juarez reported crossing the border to purchase medications (P < .001). Lack of health insurance in the United States was associated with crossing the border to purchase medications. Nine percent and 7% of US residents traveled to Mexico seeking dental and medical care, respectively. Mexican nationals traveling to the United States to purchase medications or health care services were more likely to be uninsured and more-educated men. CONCLUSION: US residents of areas along the border in close proximity to Mexico often travel south to purchase medications. Other health care services are also utilized, although at lower rates. These patterns may be attributed to a number of barriers to health care in the United States.

Study of methicillin-resistant Staphylococcus aureus on the U.S./Mexico border.

BACKGROUND: El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population. METHODS: Bacterial samples were collected from two hospitals in El Paso and two in Ciudad Juarez and transported to a reference microbiology laboratory in El Paso for microbial identification and antimicrobial susceptibility testing according to NCCLS standards. The presence of the MecA gene, and the prevalence of both the SSCmec IV element and the Panton-Valentine leukocidin were investigated by PCR in all MRSA isolates. RESULTS: A total of 201 isolates in El Paso and 128 in Ciudad Juarez of Staphylococcus aureus were identified, of those, MRSA were significantly more prevalent in El Paso than in Ciudad Juarez [89 (44.3%) versus 10 (7.8%) respectively (p<0.0001)]. Thirty one (35%) of MRSA strains isolated in El Paso were community associated. CONCLUSION: Significantly higher prevalence of MRSA infections was documented in El Paso compared to Ciudad Juarez.

Adequacy of outpatient care among hospitalized adult asthmatics in a southwest US border city.

Over 3 years we studied the baseline degree of asthma severity and the adequacy of the usual medical management among asthmatics admitted to a large US-Mexican border county hospital. The study design consisted of 2 years of retrospective chart review and 1 year of prospective semistructured interview collection. Patients were at least 18 years of age and required acute care and hospital admission for asthma exacerbations. The 127 patients studied accounted for 166 hospital admissions for asthma related primary diagnoses. Most were Hispanic and medically indigent, and only 39% of patients whose asthma severity indicated the use of inhaled corticosteroid medications reported taking them. Most of the hospitalized asthmatic patients studied were on inadequate outpatient medical regimens for the baseline severity of their asthma. Underuse of inhaled corticosteroids was the predominant medication deficiency. Other shortcomings identified in their routine management included a lack of pulmonary function testing, basic asthma education, and treatment by a practitioner qualified in the care of chronic asthma.

Bi-national evaluation of herbal product use on the United States/México border.

The study objective was to compare the prevalence of herbal product use between El Paso, Texas, and Ciudad Juárez, Chihuahua, the largest U.S./México border population. 500 households on each side of the border were randomly selected following a strict procedure for household and participant selection. 1001 adult residents of selected households participated. Trained bi-lingual interviewers conducted semistructured interviews using a bi-lingual questionnaire. A chi-square test was used to compare populations when considering discrete variables and a t test was used for continuous variables. There was no significant difference in the overall prevalence of herbal product (HP) use between the El Paso (68%) and Ciudad Juárez samples (65%). El Paso residents used a greater number of HPs compared to Ciudad Juárez residents (P = 0.001). The most common HPs used in El Paso were chamomile, aloe vera, garlic, peppermint and lime. In Ciudad Juárez, they were chamomile, eucalyptus, garlic, linden tree flower and peppermint. In addition, intra-city variation in the use of HPs was observed. On both sides of the border, relatives were the most common source of advice regarding HP use, and most HPs were reportedly used in raw form. While participants in both groups believed that the HPs were effective and safe, a large number of HPs that could potentially be responsible for drug interactions, and side effects were identified. Very low disclosure rates to physicians were reported (33% in El Paso and 14% in Ciudad Juárez). A high prevalence of HP use was documented on both sides of the U.S./México border. Some significant variations in HP use were also identified. The possibilities of HP-related problems combined with low disclosure rates are of significant concern.

Providers of herbal products in the largest US-Mexico border community.

We surveyed providers of herbal products in El Paso, Texas, and Ciudad Juárez, México, to find out which herbal products they used, the content and place of origin of the products, and the illnesses for which the products were recommended. Providers were selected randomly from Ciudad Juárez and El Paso. Most of the herbal products sold in El Paso (98%) are from the United States, whereas most sold in Ciudad Juárez (89.6%) are from México. People in El Paso tend to consume herbal or natural supplements for weight loss or muscle enhancement; those in Ciudad Juárez use herbal products (mostly crude plants) to treat specific illnesses. Ciudad Juárez and El Paso are bordering cities; however, the herbal products consumed by their respective populations are distinct, both in content and method of use.

Guide for herbal product use by Mexican Americans in the largest Texas-Mexico border community.

Use of herbal products is a very common practice among Mexican Americans living in the El Paso, Texas, region. Although medicinal plants are generally assumed to be a safe and natural alternative to conventional medications, some herbal products could pose a potential health risk to the consumer. Currently, only a few studies focus on herbal product use by Mexican Americans, and no studies have focused on its use by patients with human immunodeficiency virus (HN) living on the US-Mexico border. A prospective observational study was conducted in 439 non-HIV patients, as well as in 35 patients suffering from HIV Findings showed that 347 out of 439 (79%) of non-HIV patients and 25 out of 35 (71%) of HIV patients reported using herbal products.

Herbal product use by hispanic surgical patients.

We hypothesized that the use of herbal products is highly prevalent in Hispanic surgical patients on both sides of the U.S./México border. One hundred fifteen patients were interviewed in El Paso and 112 in Ciudad Juárez from December 2001 to June 2002. This prospective, randomized study evaluated patients aged 18 years or older that were scheduled for surgery. Sixty-two per cent of our sample in the United States and 81 per cent of patients in Mexico reported using herbal products in the past year. About 58 per cent of patients in the United States and 49 per cent in Mexico rated the products as "excellent" in treating their conditions. Ninety-two percent of U.S, and 93 per cent of Mexican patients did not inform their physician of their herbal use. Preoperative assessment of patients did not include inquiries about herbal products in either hospital. With the growing use of herbal products and because most users do not inform their physician, there is increasing concern related to the possible occurrence of herbal-related adverse events during and after surgery. The fact that health care personnel did not inquire about herbal product use before surgery is an added concern.

Evaluation of the use of complementary and alternative medicine in the largest United States-Mexico border city.

STUDY OBJECTIVE: To evaluate the use of complementary and alternative medicine (CAM) in the El Paso, Texas, region. DESIGN: Prospective observational study conducted from April-October 2000. SETTING: Several hospitals and clinics. SUBJECTS: Five hundred forty-seven participants. INTERVENTION: Semi-structured interview with a bilingual questionnaire. MEASUREMENTS AND MAIN RESULTS: Complementary and alternative medicine was used in 77% of our population. The most common CAM providers were massage therapists (19.4%) and herbalists (12.4%). The most common herbal or home remedies were chamomile (13.1%) and aloe vera (8.5%). The most common nutritional or commercial products were multivitamins (16%), ginseng (3.6%), and ginkgo biloba (2.8%). We identified 599 CAM usages that could result in drug interactions, disease interactions, or adverse reactions. CONCLUSIONS: A wide range of CAM use was documented in this study. Our results indicate that Hispanics in this area use CAM at a higher rate than national trends. Many of these therapies can adversely affect a variety of disease states and drug therapies.