A comparison of healthcare access, healthcare utilization and asthma self-management for Hispanic children in border and non-border regions of Texas

The purpose of this culminating experience was to investigate the relationships between healthcare utilization, insurance coverage, and socioeconomic characteristics of children with asthma along the Texas-Mexico Border. A secondary data analysis was conducted on cross-sectional data from the Texas Child Asthma Call-back Survey, a follow-up survey to the random digit dialed Behavior Risk Factor Surveillance Study (BRFSS) conducted between 2006-2009 ( n = 556 adults living in households with a child with asthma).^ The proportion of Hispanic children with asthma in Border areas of Texas was more than twice that of non-Border areas (84.8% vs. 28.8%). Parents in Border areas were less likely to have their own health insurance (OR = 0.251, 95% C.I. = 0.117-0.540) and less likely to complete the survey in English than Spanish (OR = 0.251 95% C.I. = 0.117-0.540) than parents in non-Border areas. No significant socio-economic or health care utilization differences were noted between Hispanic children living in Border areas compared to Hispanic children living in non-Border areas. Children with asthma along the Texas-Mexico Border, regardless of ethnicity and language, have insurance coverage rates, reported cost barriers to care, symptom management, and medication usage patterns similar to those in non-Border areas. When compared to English-speakers, Spanish-speaking parents in Texas as a whole are far less likely to be taught what to do during an asthma attack (50.2% vs. 78.6%).^ Language preference, rather than ethnicity or geographical residence, played a larger role on childhood asthma-related health disparities for children in Texas. Spanish-speaking parents in are less likely to receive adequate asthma self-management education. Investigating the effects of Hispanic acculturation rates and incongruent parent-child health insurance coverage may provide better insight into the health disparities of children along the Texas-Mexico Border.^

Pre-pregnancy obesity on the border and pregnancy complications: A secondary analysis comparing post-natal adult women in Matamoros, Mexico and Cameron County, Texas

Obesity during pregnancy is a serious health concern which has been associated with many adverse health outcomes for both the mother and the infant. In addition, data on the prevalence of obesity and its effects on pregnant women living in the border region are limited. This goal of this study was to examine the prevalence of preconception obesity among women living on each side of the Brownsville-Matamoros border who have just given birth, the relationship between obesity and pregnancy complications for the total population, and these associations by location. Study participants were drawn from a sample (n=947) from the Brownsville-Matamoros Sister City Project which included women from 10 border region hospitals (6 in Matamoros, 4 in Cameron County) who were recruited based on hospital log records indicating they had given birth to a live infant. De-identified data from verbal questionnaires administered within twenty-four hours after birth were analyzed to determine prevalence of preconception obesity on both sides of the border, and associated pregnancy outcomes for women residing in the United States and those in Mexico. Participants with missing height or weight data were excluded from analyses in this study, resulting in a final sample of 727 women. Significant associations were found between pre-pregnancy obesity and adverse pregnancy outcomes (OR=1.85, CI=1.30–2.64), hypertensive conditions (OR=2.76, CI=1.72–4.43), and macrosomia (OR=6.77, CI=1.13–40.57) using the total sample. Comparisons between the United States and Mexico sides of the border showed differences; associations between preconception obesity and adverse pregnancy outcomes were marginally significant among women in the United States (p=0.05), but failed to reach significance within this group for each individual complication. However, significant associations were found between obesity and preeclampsia (OR=3.61, CI=2.14–6.10), as well as obesity and the presence of one or more adverse pregnancy outcome (OR=2.29, CI=1.30–4.02), among women in Mexico. The results from this analysis provide new information specific to women on the Texas and Mexico border, a region that had not previously been studied. These significant associations between preconception obesity and adverse birth outcomes indicate that efforts to prevent obesity should focus on women of childbearing age, especially in Mexico.^

Performance of HbA1c for classifying diabetes and diagnostic threshold for diabetes among the Mexican American border community

Objective. In 2009, the International Expert Committee recommended the use of HbA1c test for diagnosis of diabetes. Although it has been recommended for the diagnosis of diabetes, its precise test performance among Mexican Americans is uncertain. A strong “gold standard” would rely on repeated blood glucose measurement on different days, which is the recommended method for diagnosing diabetes in clinical practice. Our objective was to assess test performance of HbA1c in detecting diabetes and pre-diabetes against repeated fasting blood glucose measurement for the Mexican American population living in United States-Mexico border. Moreover, we wanted to find out a specific and precise threshold value of HbA1c for Diabetes Mellitus (DM) and pre-diabetes for this high-risk population which might assist in better diagnosis and better management of patient diabetes. ^ Research design and methods. We used CCHC dataset for our study. In 2004, the Cameron County Hispanic Cohort (CCHC), now numbering 2,574, was established drawn from randomly selected households on the basis of 2000 Census tract data. The CCHC study randomly selected a subset of people (aged 18-64 years) in CCHC cohort households to determine the influence of SES on diabetes and obesity. Among the participants in Cohort-2000, 67.15% are female; all are Hispanic. ^ Individuals were defined as having diabetes mellitus (Fasting plasma glucose [FPG] ≥ 126 mg/dL or pre-diabetes (100 ≤ FPG < 126 mg/dL). HbA1c test performance was evaluated using receiver operator characteristic (ROC) curves. Moreover, change-point models were used to determine HbA1c thresholds compatible with FPG thresholds for diabetes and pre-diabetes. ^ Results. When assessing Fasting Plasma Glucose (FPG) is used to detect diabetes, the sensitivity and specificity of HbA1c≥ 6.5% was 75% and 87% respectively (area under the curve 0.895). Additionally, when assessing FPG to detect pre-diabetes, the sensitivity and specificity of HbA1c≥ 6.0% (ADA recommended threshold) was 18% and 90% respectively. The sensitivity and specificity of HbA1c≥ 5.7% (International Expert Committee recommended threshold) for detecting pre-diabetes was 31% and 78% respectively. ROC analyses suggest HbA1c as a sound predictor of diabetes mellitus (area under the curve 0.895) but a poorer predictor for pre-diabetes (area under the curve 0.632). ^ Conclusions. Our data support the current recommendations for use of HbA1c in the diagnosis of diabetes for the Mexican American population as it has shown reasonable sensitivity, specificity and accuracy against repeated FPG measures. However, use of HbA1c may be premature for detecting pre-diabetes in this specific population because of the poor sensitivity with FPG. It might be the case that HbA1c is differentiating the cases more effectively who are at risk of developing diabetes. Following these pre-diabetic individuals for a longer-term for the detection of incident diabetes may lead to more confirmatory result.^

Improving care of women at risk of unsafe abortion: implementing a risk-reduction model at the Uruguayan-Brazilian border

OBJECTIVE: To describe the initial stages of the implementation of a risk-reduction model designed by Iniciativas Sanitarias to shield women from unsafe abortion in a traditional community on the Uruguay-Brazil border. METHODS: This mixed-design study was conducted first between 22 and 26 March 2010, and then between 2 and 7 May 2011, in Rivera, Uruguay, to gather information from women seen at health centers, healthcare providers, and local policy makers before the project started and midway through the project. RESULTS: At baseline most women and providers considered abortion justifiable only on narrow grounds, yet favored the implementation of a risk-reduction model that would include preabortion as well as postabortion counseling, the former providing information on different abortion methods and their risks. By the midterm assessment, the counseling service had assisted 87 women with unwanted pregnancies. Of the 52 who came for a postabortion visit, 50 had self-administered misoprostol, with no complications. Women were highly satisfied with the counseling. At baseline, misoprostol seemed to be available from both pharmacists and informal sellers. At midterm, it was still available from informal vendors but pharmacists said they did not provide misoprostol. The risk-reduction initiative heightened public attention to the abortion issue but the controversy it generated did not seriously impede its implementation. CONCLUSION: It is feasible to implement the proposed risk-reduction model in a traditional community such as Rivera, not only in Uruguay but in any country irrespective of its abortion laws.

Imágenes de la edición border y sudaca : El entre-catálogos de Eloísa Cartonera

Este artículo analiza un corpus literario en el cual se construyen ciertas imágenes de la edición "border" y "sudaca" de Eloísa Cartonera. Las autobiografías de editores de proyectos editoriales independientes, alternativos y autogestivos discuten modos de organización y asociación en el marco de la transnacionalización editorial. La temporalidad inscrita en estas imágenes permite observar las tensiones, movimientos, desplazamientos, estabilizaciones y cristalizaciones que se producen en sus instancias de organización, afiliación y desafiliación.

Imágenes de la edición border y sudaca : El entre-catálogos de Eloísa Cartonera

Este artículo analiza un corpus literario en el cual se construyen ciertas imágenes de la edición "border" y "sudaca" de Eloísa Cartonera. Las autobiografías de editores de proyectos editoriales independientes, alternativos y autogestivos discuten modos de organización y asociación en el marco de la transnacionalización editorial. La temporalidad inscrita en estas imágenes permite observar las tensiones, movimientos, desplazamientos, estabilizaciones y cristalizaciones que se producen en sus instancias de organización, afiliación y desafiliación.

Imágenes de la edición border y sudaca : El entre-catálogos de Eloísa Cartonera

Este artículo analiza un corpus literario en el cual se construyen ciertas imágenes de la edición "border" y "sudaca" de Eloísa Cartonera. Las autobiografías de editores de proyectos editoriales independientes, alternativos y autogestivos discuten modos de organización y asociación en el marco de la transnacionalización editorial. La temporalidad inscrita en estas imágenes permite observar las tensiones, movimientos, desplazamientos, estabilizaciones y cristalizaciones que se producen en sus instancias de organización, afiliación y desafiliación.

Border Industry in Myanmar: Turning the Periphery into the Center of Growth

The Myanmar economy has not been deeply integrated into East Asia’s production and distribution networks, despite its location advantages and notably abundant, reasonably well-educated, cheap labor force. Underdeveloped infrastructure, logistics in particular, and an unfavorable business and investment environment hinder it from participating in such networks in East Asia. Service link costs, for connecting production sites in Myanmar and other remote fragmented production blocks or markets, have not fallen sufficiently low to enable firms, including multi-national corporations to reduce total costs, and so the Myanmar economy has failed to attract foreign direct investments. Border industry offers a solution. The Myanmar economy can be connected to the regional and global economy through its borders with neighboring countries, Thailand in particular, which already have logistic hubs such as deep-sea ports, airports and trunk roads. This paper examines the source of competitiveness of border industry by considering an example of the garment industry located in the Myanmar-Thai border area. Based on such analysis, we recognize the prospects of border industry and propose some policy measures to promote this on Myanmar soil.

Development of Border Economic Zones in Thailand: Expansion of Border Trade and Formation of Border Economic Zones

In the wake of economic globalization and development in Thailand, movement of people and commodities at the Thai borders is also becoming pronounced. Economic interdependence between Thailand and neighboring countries is growing through border customhouses. As a policy, Thailand is trying to stimulate trade and investment with neighboring countries following the ACMECS (Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy) scheme. In this report, first, movement of people and goods at the borders will be examined. Second, clarification of where and how development is proceeding will be presented. Last, this study will attempt to review the perspectives of policies on neighboring countries after Thaksin.

Border Barriers in Agricultural Trade and the Impact of their Elimination: Evidence from East Asia

Abstract: By means of a GTAP based-CGE model, we investigate the impact of the elimination of import tariffs and non-tariff policy barriers (NTPBs) on agricultural trade towards East Asian FTAs. To do that, we first measure the NTPBs by employing a widely-used method derived from the literature on border effects. Next, by adding into the GTAP database our estimates on the NTPBs, which the original GTAP database by its nature does not succeed in incorporating, we compute the impact of the entire elimination of policy barriers (the complete reduction of import tariffs and of NTPBs) on GDP.

Border Trade and Economic Zones on the North-South Economic Corridor: Focusing on the Connecting Points between the Four Countries

The North-South Economic Corridor (NSEC), the road between Bangkok and Kunming, China, including the Laos route (R3B) and the Myanmar route (R3B), has been developed since 1998 following the GMS program. The region covering Yunnan Province in China, Shan State in Myanmar, Northern Laos and Northern Thailand has historical and ethnic closeness, and is a comparatively poor mountainous, boundary area. In the wake of the development of the NSEC, however, the region has started to show signs of change. Consequently, a review is to be carried out concerning the movement of people and cars, border trade and the situation concerning the progress of border economic zones at the five nodal border points in the four countries, and over three routes: R3A, R3B, and the Mekong River route.

Domestic and international border effects

Previous studies in the border-effect literature surprisingly found that domestic border effects are larger than international border effects (e.g., in the United States or Brazil). One interpretation of this result is that these estimates include the effects of producer agglomeration. Therefore, in this study, we estimate those border effects exclusively for transactions for final consumption, in which such agglomeration forces will be weak, in China and Japan. As a result, we found larger international border effects and could not find a significant role for producer agglomeration in the estimates of border effects. We also found that China's accession to the World Trade Organization reduces border effects in trading between China and Japan but does not decrease domestic border effects.