Objectives We investigated ethnic differences in allostatic load in a population-based sample of adults living in Texas City, TX, and assessed the effects of nativity and acculturation status on allostatic load among people of Mexican origin. Methods We used logistic regression models to examine ethnic variations in allostatic load scores among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin. We also examined associations between measures of acculturation and allostatic load scores among people of Mexican origin only. Results Foreign-born Mexicans were the least likely group to score in the higher allostatic load categories. Among individuals of Mexican origin, US-born Mexican Americans had higher allostatic load scores than foreign-born Mexicans, and acculturation measures did not account for the difference. Conclusions Our findings expand on recent research from the National Health and Nutrition Examination Survey with respect to ethnicity and allostatic load. Our results are consistent with the healthy immigrant hypothesis (i.e., newer immigrants are healthier) and the acculturation hypothesis, according to which the longer Mexican immigrants reside in the United States, the greater their likelihood of potentially losing culture-related health-protective effects.

Background Adenosquamous carcinoma of the pancreas is rare. Our understanding of the disease and its prognosis comes mainly from small retrospective studies. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database (1988 to 2007), we identified patients with adenosquamous carcinoma (N=415) or adenocarcinoma (N=45,693) of the pancreas. The demographics, tumor characteristics, resection status, and survival were compared between the groups. Results Compared to patients with adenocarcinoma, patients with adenosquamous carcinoma were more likely to have disease located in the pancreatic body and tail (44.6% vs 53.5%, P<0.0001). While the stage distribution was similar between the two groups, adenosquamous carcinomas were more likely to be poorly differentiated (71% vs 45%, P<0.0001), node positive (53% vs. 47%, P<0.0001), and larger (5.7 vs. 4.3 cm, P<0.0001). For locoregional disease, resection increased over time from 26% in 1988 to 56% in 2007. The overall 2-year survival was 11% in both groups. Following resection, patients with adenosquamous carcinoma had worse 2-year survival (29% vs. 36%, P<0.0001). Resection was the strongest independent predictor of survival for patients with locoregional pancreatic adenosquamous carcinoma (HR 2.35, 95% CI=1.47-3.76). Conclusions This is the first population-based study to evaluate outcomes in adenosquamous carcinoma of the pancreas. When compared to pancreatic adenocarcinoma, adenosquamous carcinoma was more likely to occur in the pancreatic tail, be poorly differentiated, larger, and node positive. The long-term survival following surgical resection is significantly worse for adenosquamous cancers; however, patients with adenosquamous carcinoma can still benefit from surgical resection, which is the strongest predictor of survival.

In previous research on cognitive decline among older adults, investigators have not considered the potential impact of contextual variables, such as neighborhood-level conditions. In the present investigation, the authors examined the association between 2 neighborhood-context variables-socioeconomic status and percentage of Mexican-American residents-and individual-level cognitive function over a 5-year follow-up period (1993-1998). Data were obtained from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-dwelling older Mexican Americans (n = 3,050) residing in the southwestern United States. Individual records were linked with 1990 US Census tract data, which provided information on neighborhood characteristics. Hierarchical linear growth-curve models and hierarchical logistic models were used to examine relations between individual- and neighborhood-level variables and the rate and incidence of cognitive decline. Results showed that baseline cognitive function and rates of cognitive decline varied significantly across US Census tracts. Respondents living in economically disadvantaged neighborhoods experienced significantly faster rates of cognitive decline than those in more advantaged neighborhoods. Odds of incident cognitive decline decreased as a function of neighborhood percentage of Mexican-American residents and increased with neighborhood economic disadvantage. The authors conclude that neighborhood context is associated with late-life cognitive function and that the effects are independent of individual-level risk factors.

Background Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.