Fasting total homocysteine (tHcy) concentration and mortality in older Mexican Americans.

OBJECTIVES: This study examines the association between tHcy on cardiovascular and noncardiovascular mortality. DESIGN: Longitudinal study of 1,633 Mexican Americans age>60 years recruited in 1998. SETTING: Sacramento, California. MEASUREMENTS: Cox proportional models were used to estimate the effects of tHcy on mortality rate in the total sample and in a subgroup of subjects without a history of cardiovascular disease at baseline. RESULTS: About half of the cohort was born in Mexico. Among Mexican-born participants, high tHcy (>11.0 micromol/L) was associated with a higher rate of cardiovascular mortality compared to those with low tHcy concentration

Acculturation and the prevalence of depression in older Mexican Americans: baseline results of the Sacramento Area Latino Study on Aging.

OBJECTIVE: To determine the association between acculturation, immigration, and prevalence of depression in older Mexican Americans. DESIGN: Cross-sectional analysis from a cohort study. SETTING: Urban and rural counties of the Central Valley of Northern California. PARTICIPANTS: One thousand seven hundred and eighty-nine Latinos recruited from a population-based sample (85% Mexican Americans) with a mean age of 70.6 (range 60-100; standard deviation (SD) = 7.13); 58.2% were women. MEASUREMENTS: Depressive symptoms were assessed with the Center for Epidemiologic Studies--Depression scale (CES-D). Acculturation was measured with the Acculturation Rating Scale for Mexican Americans--II. Psychosocial, behavioral, and medical histories were also obtained. RESULTS: The prevalence of depression (CES-D > or = 16) was 25.4%. Women were at greater risk (32.0%) than men (16.3%; male/female odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.90-3.09). The prevalence of depression was higher among immigrants (30.4%, OR = 1.70, 95% CI = 1.36-2.13), bicultural participants (24.2%, OR = 1.66, 95% CI = 1.24-2.24), and less-acculturated participants (36.1%, OR = 2.95, 95% CI = 2.22-3.93) compared with U.S.-born (20.5%) and more-acculturated groups (16.1%). When adjustments for education, income, psychosocial, behavioral, and health-problem factors were made, the least-acculturated participants were at significantly higher risk of depression than highly acculturated Mexican Americans (OR = 1.56, 95% CI = 1.06-2.31). CONCLUSIONS: These findings are consistent with previously reported estimates of a higher prevalence of depression for older Mexican Americans than non-Hispanic Caucasians and African Americans and are the first to report the prevalence and risk of depression for older U.S.-born and immigrant Mexican Americans. The high prevalence of depression of the least acculturated group may be related to cultural barriers encountered by immigrants and less-acculturated older Mexican Americans and to poorer health status.

Outcome for children treated with fetal intravascular transfusions because of severe blood group antagonism.

OBJECTIVE: To describe the outcome for 92 fetuses treated between May 1987 and January of 1993 with intrauterine (intravascular) transfusions for severe hemolytic disease in comparison with a high-risk and a healthy control group. STUDY DESIGN: Information on the perinatal period was obtained from the patient records. The children regularly attended the outpatient clinic, and a general pediatric examination was performed on each visit. The psychometer development of the child until age 4 1/2 years was assessed according to Gesell. At the age of 5 years, the adaptation part of the Denver Developmental Screening Test and a Dutch-language test were used. A neurologic examination was performed according to Touwen. RESULTS: In our study, 77 (83.7%) of 92 fetuses were born alive after intravascular transfusions. The overall survival rate was 79.3%. The follow-up group included 69 infants, with an age range of 6 months to 6 years. Correlation between antenatal and perinatal features showed a significant negative relationship between the number of intrauterine transfusions and the duration of phototherapy (p = 0.002). The probability that neurologic abnormalities would occur was significantly greater when perinatal asphyxia had been present (p < 0.05) and with a lower cord hemoglobin level at birth (p = 0.03). The total number of children with disabilities was 10.1% (7/69). CONCLUSIONS: The neurodevelopmental outcome for the group of survivors compared favorably with a group of high-risk, very low birth weight infants (10.1% to 18%), and less favorably with a healthy control group (10.1% to 6%).