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PubMed1980

Acceptability of potatoes groun in West Texas.

This study indicated that methods used to prepare fresh potatoes were, in decreasing order: Baking, mashing, boiling, and frying. The two varieties of potatoes commonly grown in West Texas were acceptable and compared favorably with similar varieties available in a local supermarket. However, the potatoes grown in West Texas had lower specific gravity. The Norgold Russet variety was judged by a sensory panel to be more acceptable than the Viking. Baked potatoes had superior texture but poorer color than boiled potatoes. Storing potatoes under home-like conditions for twenty-eight days resulted in lower acceptability, weight loss, and lower specific gravity. Some Norgold Russet potatoes were rotten after twenty-eight days' storage. Specific gravity on the day of cooking was correlated with texture of cooked potatoes. Supermarket shoppers' comments suggest that research is needed on the acceptability of West Texas potatoes baked in microwave ovens.

Cooking↗
PubMed1994

Management of the third stage of labor: a survey of practice among Texas obstetricians.

Available evidence shows that the benefits of routine oxytocic administration in the third stage of labor far outweigh the potential risks. In 1990, T.F. Baskett, MD, reviewed the routine use of oxytocic drugs by Canadian obstetricians in the management of the third stage of labor. With Dr Baskett's permission, we sent a similar questionnaire to 1500 obstetricians in Texas: 1000 practiced in urban areas and 500 practiced in rural areas of the state. Ninety-four percent of Texas obstetricians answering the survey used oxytocics routinely in managing the third stage of labor. However, only 14.9% administered the oxytocics before delivery of the placenta, in contrast to 92.1% who gave oxytocics after the delivery of the placenta. Oxytocin was the chosen oxytocic drug for routine third-stage management (95%) as well as for postpartum hemorrhage (73.3%). Of the physicians surveyed, 55.9% used 15-methyl prostaglandin F2a (Hemabate) to treat postpartum hemorrhage refractory to other drugs within the past year. Of the respondents, 14.3% had managed acute uterine inversion during the past year. Thus, Texas obstetricians use Oxytocin routinely in the management of the third stage of labor, but few are converted to active management.

Attitude of Health Personnel↗
PubMed1995

Proportional differences in births and infant mortality rates among the triethnic population in Texas from 1984 through 1986.

Birth at preterm gestation and/or with low birth weight is a major predictor of the infant mortality rate, which is twice as high in African-American as in Anglo and Hispanic infants in Texas. This study examined the relative proportions of Anglo, African-American, and Hispanic births that occurred in Texas at specific gestational ages and birth weights, and the neonatal, postneonatal, and infant mortality rates associated with those births. African-American infants showed a systematic tendency to be born at earlier gestational ages and with lower birth weights than did Anglo infants, while Hispanic-Anglo differences were limited to a small excess of preterm but not low weight Hispanic births. Preterm and low-birth-weight African-American infants had neonatal and infant mortality rates that were lower than those of Anglo infants, but that benefit was inadequate to compensate for the greater proportion of African-American births that were at risk. No consistent difference could be identified between Hispanic and Anglo infant mortality rates. We conclude that the birth weight and gestational age predictors of infant mortality reflect the combined effects of two ethnic-specific factors: the mortality rates at specific birth weights and gestational ages, and the proportions of births that are at risk. The biological and/or sociological causes for these ethnic differences in pregnancy outcomes and mortality risk need to be identified if the mortality rate of African-American infants in Texas is to be reduced.

Black or African American↗
PubMed1994

Minors' access to cigarette vending machines--Texas.

The sale of tobacco products to persons aged < 18 years has been prohibited by law in Texas since September 1989*. This law requires cigarette vending machine owners to post signs on their machines stating the illegality of tobacco product sales to persons aged < 18 years and that merchants convicted for selling tobacco products to under-aged persons be fined a maximum of $500. In August 1991, Arlington, Texas, enacted legislation requiring installation of electronic locking devices on all cigarette vending machines. These devices render the vending machine inoperable until the store owner electronically unlocks the machine on customer request. To assess minors' access to cigarettes through vending machines, in October 1993 the Texas Department of Health conducted a study in Arlington and five neighboring communities. This report summarizes the study findings.

Adolescent↗
PubMed1994

Current issues in Texas neonatology.

Since almost 10% of the births in the United States occur in Texas, issues that affect neonatal care in Texas are important for both the state and the nation. Although overall statistics are similar for the state and nation, closer examination reveals a need for improvement in specific areas, namely prenatal care, black and Hispanic mortality, and low birth-weight rates. Lay midwifery regulation has been an important concern in Texas. Surfactant use and education to prevent birth asphyxia have had a positive impact on perinatal health, contributing to public health efforts to improve perinatal outcome.

Humans↗
PubMed1994

Access of health care for Texas children.

The failure of any group, either public or private, to meet the needs of the underserved is given as one of the reasons for the restructuring of health care in America. Children, by far, constitute the largest group of this population. The United States as a country, and Texas as a state, rank very poorly in addressing children's health and welfare. In this article, the problems of the health-care needs of the children of Texas are defined. Solutions are presented that are in varying stages of evolution in Texas and throughout the country.

Adolescent↗
PubMed1994

Financing health services for children in Texas.

In Texas, children's health services are financed by a bewildering combination of private and public sources, each of which employs different eligibility rules, benefit packages, and reimbursement methods. This article describes these financing mechanisms, underscoring their complexity and the need for consolidation and reform. As private coverage for children has declined, it has become less comprehensive with increased coinsurance and deductibles. Concurrently, due to a number of federal initiatives, Medicaid coverage has increased rapidly with new benefits, also now mandated. Levels and structure of payment have influenced variable participation in the program by physicians, rural health clinics, federally qualified health centers, and children's hospitals. The Texas Department of Health and the Texas Department of Mental Health and Mental Retardation have undertaken a number of initiatives to fill in the gaps and to serve mandated categorically eligible populations. Continuity of care is difficult to achieve. Comprehensive community-based care should be promoted with the goal of expanding the role of all types of providers.

Adolescent↗
PubMed1993

Annual economic costs attributable to cigarette smoking in Texas.

The costs attributable to smoking in Texas continue to rise. The most recent estimates show more than $4 billion in 1990 can be associated with the direct health-care costs from treatments for disease and the indirect costs associated with mortality and morbidity. The breakdown of these estimates for adults 35 years and older shows 61% of the total costs was due to premature death caused by smoking, 29% due to direct health-care costs, and 9% attributable to indirect morbidity costs, which indicate lost wages caused by smoking-related illness. The 1990 smoking-attributable deaths estimated at 24,600 far exceed the accumulated deaths, 9430 in 1991, caused by auto accidents, homicide, AIDS, alcohol, fires, cocaine, crack, heroin, and morphine. The estimates are prepared by The University of Texas M.D. Anderson Cancer Center Office of the Vice President for Health Policy for the Office of Smoking and Health, Bureau of Chronic Disease Prevention and Control, Texas Department of Health.

Adult↗
PubMed1977

New library buildings: the Houston Academy of Medicine--Texas Medical Center Library.

A historical account is given of the Houston Academy of Medicine--Texas Medical Center Library within its Texas Medical Center setting in Houston, Texas. Outlined are planning, financing, and construction of the new library, which consists in part of new building and in part of renovated interiors of an old building originally completed in 1954. A concise picture is given of the new library's interiors, showing its functional success for users and employees alike. An architectural summary is appended showing gross and net footages, source of funds, costs and capacities.

Facility Design and Construction↗
PubMed1996

An investigation of medical examiner cases in which methadone was detected, Harris County, Texas, 1987-1992.

In 1991, media reports of an increase in the number of deaths attributed to methadone toxicity in Harris County, Texas, raised public concern about the safety of methadone. This concern was heightened by publicity surrounding the closure of three Harris County methadone maintenance treatment programs due to their poor compliance with federal methadone regulations. In response to this concern, the Texas Department of Public Health requested that the Centers for Disease Control and Prevention (CDC) assist in an epidemiologic study to determine the extent of methadone-related mortality in Harris County during 1991 and to determine the role of methadone maintenance treatment in these deaths. We reviewed cases investigated by the Harris County Medical Examiner's Office from 1987 through 1992 in which methadone was detected by postmortem drug testing. The autopsy reports for cases occurring in 1991 were also reviewed by three independent forensic pathologists who were asked to determine the role of methadone in the death. In addition, we attempted to document Harris County methadone maintenance treatment program enrollment for each decedent. We identified 91 decedents in whom methadone was detected at the time of death, with the largest number of cases occurring in 1991 (n = 27). Other substances, including alcohol, were detected in 85% of the cases. The Harris County Medical Examiner attributed 11 of the deaths to methadone toxicity. No more than three cases per year from 1987 through 1992 were attributed to methadone toxicity. In contrast, 34 deaths were attributed to polydrug toxicity, the largest number occurring in 1991 (n = 11). There was good agreement between the results of the independent review and the opinions of the Harris County Medical Examiner. Only 20% of the decedents were found to have been enrolled in a Harris County methadone maintenance treatment program at the time of death. Four people died of drug toxicity shortly after enrolling in a methadone maintenance treatment program. We found an increase in the number deaths occurring in Harris County, Texas, in 1991 in which methadone was detected. We also found that methadone blood levels were higher among decedents identified for 1991 and 1992 than among those identified in the previous years studied. However, we did not find evidence that the cause of these deaths could be attributed solely to methadone toxicity. Instead, for all years studied, the use of multiple drugs was the leading cause of death among people in whom methadone was detected. This finding points out the difficulties involved in determining the role of methadone as a cause of death.

Adult↗
PubMed1996

Insecticide susceptibility of Aedes aegypti and Aedes albopictus in the Lower Rio Grande Valley of Texas and Mexico.

In response to a potential dengue fever outbreak in south Texas during 1995, the susceptibilities of Aedes aegypti and Aedes albopictus to commonly used mosquito adulticides were assessed. Larvae collected from the Lower Rio Grande Valley of Texas and Mexico were reared to adults and tested against susceptible laboratory strains at Texas A&M University. Resistance ratios at both the LC50 and LC95 rates were all less than 10, indicating that adult populations of both species are still susceptible to malathion, chlorpyrifos, resmethrin, and permethrin.

Aedes↗
PubMed1996

Screening for breast and prostate cancer: a survey of Texas primary care physicians.

Screening for breast and prostate cancer is underutilized, and according to previous studies, physicians often fail to comply with recommended screening guidelines. We surveyed Texas physicians to determine their screening behaviors and their compliance with National recommendations. For women aged 40 through 49 years, 75.5% of respondents recommend mammography every 1 to 2 years, and 8.4% suggest it annually. For women 50 years and older, 16.1% of clinicians screen every 1 to 2 years, and 81.4% recommend annual mammography. Thus, 71.7% of physicians match or exceed the American Cancer Society guidelines for screening mammography in women 40 years and older. Texas physicians also report a high rate of prostate cancer screening, with more than 90% of respondents offering testing by age 60 years. The screening method preferred by 72.0% of clinicians combines digital rectal examination and the prostate-specific antigen blood test. Overall, the screening practices reported by this sample of Texas physicians compare very favorably with those reported by other groups.

Adult↗
PubMed1997

Surveillance for silicosis, 1993--Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin.

PROBLEM/CONDITION: Silicosis is an occupational respiratory disease caused by the inhalation of respirable dust containing crystalline silica. Public health surveillance programs to identify workers at risk for silicosis and target workplace-specific and other prevention efforts are currently being field-tested in seven U.S. states. REPORTING PERIOD COVERED: Confirmed cases ascertained by state health departments during the period January 1, 1993, through December 31, 1993; the cases and associated workplaces were followed through December 1994. DESCRIPTION OF SYSTEMS: As part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program initiated by CDC's National Institute for Occupational Safety and Health (NIOSH), development of state-based surveillance and intervention programs for silicosis was initiated in 1987 in Michigan, New Jersey, Ohio, and Wisconsin and in 1992 in Illinois, North Carolina, and Texas. RESULTS: From January 1, 1993, through December 2, 1994, the SENSOR silicosis programs in Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin confirmed 256 cases of silicosis that were initially ascertained in 1993. Overall, 185 (72%) were initially identified through review of hospital discharge data or through hospital reports of silicosis diagnoses; 188 (73%) were associated with silica exposure in manufacturing industries (e.g., foundries; stone, clay, glass, and concrete manufacturers; and industrial and commercial machinery manufacture). Overall, 42 (16%) cases were associated with silica exposure from sandblasting operations. Among the 193 confirmed cases for which information was available about duration of employment in jobs with potential exposure to silica, 37 (19%) were employed < or = 10 years in such jobs and 156 (81%) were employed > or = 11 years. A total of 192 primary workplaces associated with potentially hazardous silica exposures were identified for the 256 confirmed silicosis cases. Of these, nine (5%) workplaces were inspected by state health department (SHD) industrial hygienists, 19 (10%) were referred to the Occupational Safety and Health Administration (OSHA) for follow-up, and seven (4%) were routinely monitored by the Mine Safety and Health Administration. Of the 157 (82%) remaining workplaces, follow-up activities determined that 82 were no longer in operation, eight were no longer using silica, 18 were assigned a lower priority for follow-up, six were associated with building trades and could not be inspected because of the transient nature of work in the construction industry, and 43 workplaces were not inspected for other reasons. Fourteen (7%) of the 192 workplaces were inspected. At 10 of the 14 workplaces, airborne levels of crystalline silica were measured; in nine, silica levels exceeded the NIOSH-recommended exposure level of 0.05 mg/m, and in six, airborne silica levels also exceeded federal permissible exposure limits. ACTIONS TAKEN: Employee-specific and other preventive interventions have been initiated in response to reported cases. In addition, special silicosis prevention projects have been initiated in Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin. To facilitate the implementation of silicosis surveillance by other states, efforts are ongoing to identify and standardize core data needed by surveillance programs to describe cases and the workplaces where exposure occurred. These core variables will be incorporated into a user-friendly software system that states can use for data collection and reporting.

Female↗
PubMed1997

Cancer mortality among petroleum refinery and chemical manufacturing workers in Texas.

Epidemiologic historical cohort studies of petroleum refinery and chemical manufacturing workers in Texas were reviewed to examine their cancer mortality in comparison to the U.S. and to assess the possible impact of cancer mortality among these workers on the State of Texas as a whole. Summary standardized mortality ratios and 95% confidence intervals were calculated for 20 cancer types, taking into account the heterogeneity of individual studies. There were 4314 cancer deaths among the 92,318 workers employed in 10 independent plant populations. Overall, there was a significant deficit in cancer mortality among petrochemical workers compared with the general U.S. population (SMR = 88, 95% CI = 80 to 96). Only the summary SMRs for brain cancer (SMR = 113, 95% CI = 96 to 133) and leukemias (SMR = 112, 95% CI = 94 to 130) approached statistical significance. Lung and liver cancer mortality excesses, noted for Texas as a whole, were decreased in these workers. Additional follow-up of these cohorts, their expansion to include minority and female workers, and additional study of possible occupational contributions to leukemia and brain cancer are recommended.

Chemical Industry↗
PubMed1998

Impact of the 1993 CDC surveillance definition of AIDS in Texas, 1991-1994.

In 1993, the Centers for Disease Control and Prevention (CDC) expanded the surveillance case definition of AIDS to include all individuals showing immune suppression, measured by absolute CD4 lymphocyte count or CD4/CD8 ratio, as well as those presenting with the 23 clinical conditions from previous case definitions or with three new indicator conditions (pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer). The greatest impact of the expanded definition is the dramatic increase in cases reported in 1993, largely due to a backlog of 1992-diagnosed cases that meet the new criteria. Texas reported a 136% increase in cases in 1993 compared with 1992. Despite a drop between 1993 and 1994, the number of reported cases increased 75% overall between 1992 and 1994. Most cases reported in 1993 and 1994 fall under the 1993 expanded surveillance case definition (59% and 60%, respectively). More than 90% of all cases reported under the new definition are classified under immunologic criteria. The Department of Health and Human Services (DHHS) Public Health Region 4 was the most affected, with a 213% increase in reported cases between 1992 and 1993, and a 163% increase between years 1992 and 1994. In Texas, the new definition shows the greatest impact among women, blacks, and "other" ethnic groups, persons 20 through 29 years of age, and cases attributable to heterosexual contact. From 1992 to 1993, cases reported in Texas increased 161% among females, 171% among blacks, 219% among persons 15 through 19 years old, and 189% among cases citing heterosexual contact. The new definition has successfully identified population subgroups affected most recently by the epidemic. The inflated growth in cases caused by the expanded case definition carries implications for program administrators and health care providers in both allocating resources and targeting prevention efforts.

Acquired Immunodeficiency Syndrome↗
PubMed1998

ECT in Texas: 19 months of mandatory reporting.

BACKGROUND: Texas law requires that all non-federal clinical facilities providing electroconvulsive therapy (ECT) report every treatment to the state's mental health agency. The resulting data provide total population information about treating physicians and hospitals; payment source; patient age, sex, ethnicity, diagnosis, and admission/consent status; symptom severity and response; numbers and types of treatments; and untoward events occurring within 14 days after treatment. METHOD: We reviewed all reports of ECT between September 1993 and April 1995 (2583 reports, approximately 15,240 treatments). RESULTS: About 6% (N = 117) of Texas psychiatrists performed ECT during the period, at 50 hospitals. One of 13 state-funded mental institutions performed ECT on-site; some occasionally contracted with private hospitals. Almost all patients (88.1%) were white. Some older age groups received proportionately more ECT than younger groups, but no sharp increase was associated with eligibility for Medicare. Five patients were less than 18 years of age; 70.3% were female. Virtually all patients (99.0%) consented to the treatment themselves (rather than by guardian), including committed-but-consenting patients (1.5%). Reports (5.8%) described multiple-monitored treatment (MMECT, not depatterning). Group data indicated generally good-to-excellent response, as measured by a five-point symptom-severity scale. Eight patients died within 14 days of a treatment, 2 possibly of anesthesia complications and 3 others in accidents or by suicide. Four were receiving maintenance treatments (generally about every other week). No death appeared related to ECT stimulus or seizure. CONCLUSION: ECT in Texas is performed by a small minority of psychiatrists and is unavailable to many patients who need it. It is most accessible to white patients who receive care outside the public sector. Our data support the common finding that ECT is generally safe and effective.

Adolescent↗
PubMed1998

Tuberculosis in adult beef cattle of Mexican origin shipped direct-to-slaughter into Texas.

OBJECTIVE: To evaluate differences in prevalence of tuberculosis (TB) in adult beef cattle that originated from different states in Mexico and were shipped direct-to-slaughter into Texas in 1995. DESIGN: Epidemiologic survey. ANIMALS: Approximately 65,000 adult beef cattle. PROCEDURES: Postmortem examinations of carcasses for detection of Mycobacterium bovis infection were conducted at slaughter plants in Texas. Specimens were collected from cattle with granulomatous lesions, stored in neutral-buffered 10% formalin or saturated sodium borate solution, and processed for histologic and bacteriologic diagnosis. Prevalence and 95% confidence intervals were estimated by state of origin. Difference between prevalences for different states was tested for significance (P < 0.05), using the proportion test. RESULTS: Overall prevalence of TB at slaughter in adult beef cattle that originated from Mexico was approximately 0.5/1,000 (34/65,233). Prevalence of TB in cattle that originated from Chihuahua (0.07) was significantly lower than that in cattle from Coahuila (0.80), Nuevo Leon (1.27), and Tamaulipas (1.81). CLINICAL IMPLICATIONS: Prevalence of M bovis infection in adult beef cattle may be significantly different between states in the northern border region of Mexico. On the basis of disease prevalence and numbers of exported cattle and provided safeguards such as TB testing are continued, cattle from Chihuahua may pose a lower risk of TB transmission to Texas cattle than do cattle from Coahuila, Nuevo Leon, and Tamaulipas. To allow interstate/international movement of cattle from northern border states of Mexico, TB testing requirements should be continued. In the context of international trade, southern border states of the United States should continue collaborating with northern border states of Mexico to control and eradicate this disease.

Abattoirs↗
PubMed1998

Methodology of quality improvement projects for the Texas Medicare population.

The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.

Angina Pectoris↗