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PubMed2002

Continuity and quality of care in type 2 diabetes: a Residency Research Network of South Texas study.

OBJECTIVE: We investigated the relationship between continuity of care and the quality of care received by patients with type 2 diabetes mellitus. STUDY DESIGN: We used a cross-sectional patient survey and medical record review. POPULATION: Consecutive patients with an established diagnosis of type 2 diabetes mellitus presented to 1 of 6 clinics within the Residency Research Network of South Texas, a network of 6 family practice residencies affiliated with the University of Texas Health Science Center at San Antonio. OUTCOMES MEASURED: Continuity was measured as the proportion of visits within the past year to the patient's usual primary care provider. A quality of care score was computed based on the American Diabetes Association's Provider Recognition Program criteria from data collected through medical record review and patient surveys. Each patient was awarded points based on the presence or absence of each criterion. RESULTS: The continuity score was associated significantly with the quality of care score in the anticipated direction (r =.15, P =.04). Patients who had seen their usual providers within the past year were significantly more likely to have had an eye examination, a foot examination, 2 blood pressure measurements, and a lipid analysis. CONCLUSIONS: Continuity of care is associated with the quality of care received by patients with type 2 diabetes mellitus. Continuity of care may influence provider and patient behaviors in ways that improve quality. Further research on how continuity contributes to improved quality is needed.

Academic Medical Centers↗

PubMed2000

Adolescent obesity in a low-income Mexican American district in South Texas.

BACKGROUND: The Third National Health and Nutrition Examination Survey, 1988-1994(NHANES III) revealed that 11.5% of adolescents were obese. The NHANES III sample size for Mexican Americans was small. OBJECTIVE: To determine the prevalence of adolescent obesity in a South Texas population that is preponderantly low-income Mexican Americans. DESIGN: Cross-sectional prevalence study. SETTING: All secondary school campuses of one rural independent school district with a low-income Mexican American population. SUBJECTS: Four thousand three hundred seventy-five students, aged between 12 and 17 years, enrolled in 4 secondary school campuses of 1 Rio Grande Valley, South Texas, independent school district for academic year 1998-1999. MAIN OUTCOME MEASURES: Body mass index (BMI) was calculated for all 4375 students using weights and heights measured by school nurses on enrollment. Each student's BMI was then plotted on a sex-specific chart and the percentile range for age was determined. Those within the 85th to the 95th percentile were classified as at risk for obesity and those above the 95th percentile were classified as obese. RESULTS: Of 2149 adolscent girls and 2226 adolescent boys, 18% were at risk for obesity and 22. 1% were obese. A total of 40.1% had a BMI at the 85th percentile or higher for age and sex. The prevalence of obesity also continues to rise even after puberty more markedly in adolescent girls than adolescent boys. Furthermore, the mean BMI progressively increases with age and is generally at the 85th percentile or higher. CONCLUSIONS: Our data revealed a much higher prevalence rate of obesity in this adolescent Mexican American population than the rate obtained in NHANES III. It is even higher than the rate specific for Mexican American adolescents in NHANES III. The NHANES III significantly underestimates the prevalence of adolescent obesity in preponderantly impoverished Mexican American adolescents. This consequently leads to underestimation of the public health risks as well as the present and future cost of health care associated with obesity in this population. Arch Pediatr Adolesc Med. 2000;154:837-840

Adolescent↗

PubMed1998

Human dental microwear caused by calcium oxalate phytoliths in prehistoric diet of the lower Pecos region, Texas.

Recent research demonstrates that silica phytoliths of dietary origin are associated with microwear of human teeth. Previous research has shown that severe enamel microwear and dental wear characterizes Archaic hunter-gatherers in the lower Pecos region of west Texas. Calcium oxalate crystals are especially common in Archaic coprolites. The vast majority are derived from prickly pear and agave, which were the dietary staples in west Texas for 6,000 years. The calcium oxalate phytoliths are harder than enamel. Therefore, calcium oxalate crystals are the most likely source of previously documented dental microwear and wear in the lower Pecos region.

Calcium Oxalate↗

PubMed1988

Occupational exposures and brain cancer mortality: a preliminary study of east Texas residents.

The relationship between various occupational exposures and brain cancer was investigated in a case-control study using mortality data from 202 males who died in East Texas from gliomas in 1969-1978 and 238 male controls randomly selected from all deaths in East Texas in 1969-1978. Using the occupational classification scheme of the U.S. Bureau of the Census, the risk for brain cancer was significantly increased for male workers employed in the transportation, communication, and utilities industries [odds ratio (OR) = 2.26, confidence intervals (CI) = 1.18-4.32]. Further examination of this finding showed that male workers employed in occupations associated with electricity or electromagnetic (EM) fields had an elevated risk for brain cancer (OR = 3.94, CI = 1.52-10.20). In addition, there was a linear relationship between the probability of exposure to EM fields and brain cancer. Significantly elevated risk for brain cancer was also found among male workers in the trucking industry.

Adult↗

PubMed2005

Idiopathic talipes equinovarus (ITEV) (clubfeet) in Texas.

Idiopathic talipes equinovarus (ITEV) is the most common form of clubfoot with a birth prevalence of 1 per 1,000 births. Serial casting and surgical correction impose a substantial financial burden on families and the health care system. While the etiology of ITEV is considered to be complex, the causes remain elusive. Genetic, maternal, and environmental factors have been suggested to play an etiologic role. This study was undertaken to determine the prevalence of ITEV and define maternal and environmental factors associated with ITEV in Texas from 1996 to 1999. Data on 682 cases of nonsyndromic ITEV were compared with all births (n = 923,543) in Texas during the same period. The overall prevalence and prevalence odds ratios (PORs) were calculated for gender, year of birth, public health region (PHR), race, maternal age, education, folic acid fortification, and parity. The overall prevalence of ITEV was 0.74/1,000 or 1/1,354 live births. Adjusted PORs were similar among blacks and US and foreign-born Hispanics (POR = 0.92, 95% CI = 0.69-1.21; POR = 0.99, 95% CI = 0.79-1.25; and POR = 0.94, 95% CI = 0.74-1.19), respectively, compared to whites. College education and higher parity were significantly associated with a lower risk of giving birth to offspring with ITEV. Babies born after folic acid fortification of grains had a very small decrease in ITEV that may be due to chance.

Adolescent↗

PubMed1980

Secular trend in the stature and weight of Mexican-American children in Texas between 1930 and 1970.

Statures and weights for four samples of Mexican-American children in Texas, measured in 1929-1931 and 1968-1972, were evaluated for evidence of a secular trend. The age range was 6 to 18 years, with more complete data from 8 through 15 years. There is no secular increase in the statures and weights of 6 year old children, a small increase in 8 year old children, and a larger secular increase at 10, 12, 14, and 15 years of age. From about 9 or 10 years of age on, the more recent Mexican-American children tend to have greater weights for their heights. The magnitude of the secular change per decade, however, is considerably smaller than rates for US black, white, European, and Japanese children. The estimated rates of secular change in stature for Mexican-American children approximate about one-fourth to one-half of the generalized rates for European and North American children offered by Meredith ('76) and Tanner ('77). Reasons for a limited secular trend in Texas Mexican-American children are probably bound to the matrix of lower socioeconomic circumstances, poorer health conditions, and marginal nutritional status.

Adolescent↗

PubMed1997

A triethnic comparison of intracerebral hemorrhage mortality in Texas.

Intracerebral hemorrhage (ICH) is a significant cause of stroke death. Little is known about the relative risk of Hispanic Americans (HAs), African Americans (AAs), and non-Hispanic whites (NHWs) for ICH mortality. Based on the high prevalence of hypertension in AAs and the low prevalence of hypertension in HAs, we expected AAs to have the highest ICH mortality rates and HAs the lowest. Race/ethnic age-specific ICH mortality rates were calculated from Texas vital statistics for the years 1980 through 1995. Rate ratios (RRs) are reported with NHWs as the referent group. There were 15,042 deaths due to ICH in Texas during this time. In the 45- to 59-year age group, AAs had an RR of 4. The RR for HAs was 1.9. In the 60- to 74-year age range, AAs had an RR of 1.7 and HAs had an RR of 1.3. In the 75+ age group, the rates were similar among all three race/ethnic groups. We conclude that there is a significant interaction of age and race/ethnicity for ICH. At younger ages, AAs and HAs have the highest ICH mortality rates. Access to care and socioeconomic status may play a role in the unexpectedly high ICH mortality rates in HAs.

Black or African American↗

PubMed2004

Prevalence of craniorachischisis in a Texas-Mexico border population.

BACKGROUND: The most severe neural tube defect (NTD), craniorachischisis, is characterized by anencephaly confluent with spina bifida open from the cervical to the lumbar region. We describe the prevalence of craniorachischisis among the Texas-Mexico border population during the period 1993-1999. METHODS: An active surveillance system identified all clinically apparent NTD-affected fetuses and infants born to mothers residing and delivering in any of the 14 Texas-Mexico border counties. Craniorachischisis cases included live-born, stillborn, and therapeutic abortions. RESULTS: A total of 16 craniorachischisis cases were identified for a total prevalence of 0.51 per 10,000 live births (Mexican American prevalence, 0.52 per 10,000) and a prevalence of 0.28 per 10,000 live births for cases of 20 weeks gestation or greater. CONCLUSIONS: The prevalence of craniorachischisis was higher than that reported in Atlanta (0.1 per 10,000 live births), but much lower than that reported in Northern China (10.7 per 10,000 births). In this high NTD prevalence region, it is possible that a multiplicity of risk factors, mostly related to poverty, contribute to a high prevalence of craniorachischisis.

Black or African American↗

PubMed2005

Epidemiology of noncomplex left ventricular outflow tract obstruction malformations (aortic valve stenosis, coarctation of the aorta, hypoplastic left heart syndrome) in Texas, 1999-2001.

BACKGROUND: The left ventricular outflow tract (LVOT) malformations aortic valve stenosis (AVS), coarctation of the aorta (CoA), and hypoplastic left heart syndrome (HLHS) contribute significantly to infant mortality due to birth defects. Previous epidemiology data showed rate differences between male and female and white and black ethnic groups. The Texas Birth Defects Registry, an active surveillance program, enables study in a large, diverse population including Hispanics. METHODS: Records of children up to 1 year old with AVS, CoA, and HLHS born in Texas from 1999 to 2001, were collected from the registry. Those including additional heart defects or a chromosomal anomaly were excluded. Multivariate analysis included: infant sex; United States-Mexico border county residence; and maternal age, race/ethnicity, birthplace, and education. RESULTS: There were 910 cases among 1.08 million live births, of which 499 met inclusion criteria. Multivariate modeling of all LVOT malformations combined demonstrated lower prevalence rate ratios (PRRs) for black males (0.26) and Hispanic males (0.70). Similar results were found for CoA but not AVS or HLHS. Higher PRRs were noted for increased maternal age for LVOT (1.3 for 24-34 years; 1.7 for >34 years), AVS, and HLHS, but not CoA, and higher PRRs across all diagnoses for males (LVOT PRR, 2.4) were noted. CoA PRRs were higher in border county vs. non-border county residents (PRR, 2.1). Maternal education and birthplace were not significant factors. CONCLUSIONS: There are rate differences for males among all 3 ethnic groups. Sex and ethnic differences suggest genetic etiologies, where the ethnic differences could be used to find susceptibility loci with mapping by admixture linkage disequilibrium. Increased CoA rates along the U.S.-Mexico border suggest environmental causes that will require further monitoring.

Aortic Coarctation↗

PubMed2002

Molecular analysis in newborns from Texas affected with galactosemia.

The spectrum of mutations in the Galactose-1-phosphate uridyl transferase (GALT) gene is described in 11 cases of classic galactosemia and 38 of Duarte-2 type identified by the Texas Newborn Screening Program. Blinded studies were done by automated DNA sequencing of all the 11 exons and the exon-intron boundaries of the GALT gene using genomic DNA isolated from dry blood spots. Fourteen different mutations (11 missense mutations, 2 nonsense mutations and 1 splicing mutation) were detected in 94 of the 98 mutant alleles (diagnostic efficiency of 96%). The prevalent mutations were N314D (41%), Q188R (37%) and K285N (4%). The other less frequent mutations were IVS2-2A>G and S135L (3% each), T138M (2%) and T23A, H184Q, Y251S, L195P, Q207X, L264X, Q344K, and A345D (1% each). Three novel mutations, T23A, Q207X, and A345D, were identified. Our study supports previous findings that N314D and Q188R are prevalent in Hispanics and Whites and K285N was only observed in Whites. The IVS2-2A->G mutation is probably ethnic specific because it was identified exclusively in Hispanics. S135L, a prevalent mutation in Blacks, was also present in 3 Hispanics. Two unusual genotypes were observed in 2 patients homozygous for the Duarte-2 N314D allele and heterozygous for a novel mutation (Q207X- N314D/N314D in a classic galactosemia and T23A- N314D/N314D in a Duarte-2 case). The detection of GALT gene mutations in newborns from Texas should focus first on N314D, Q188R, K285N, IVS2-2A>G, S135L and T138M. Other exons and exon-intron boundaries would have to be studied if either one or no mutations are found in the primary screening.

DNA Mutational Analysis↗

PubMed2000

Investigation of folate pathway gene polymorphisms and the incidence of neural tube defects in a Texas hispanic population.

Neural tube defects (NTDs) are multifactorial in their etiology, having both genetic and environmental factors contributing to their development. Recent evidence demonstrates that periconceptional supplementation of the maternal diet with a multivitamin containing folic acid significantly reduces the occurrence and recurrence risk for having a pregnancy complicated by NTDs. Unfortunately, the mechanism underlying the beneficial effects of folic acid remains unknown. NTD surveillance data from the Texas-Mexico border show that the high NTD rate (28/10,000 live births) noted during the 1990-1991 Cameron county NTD cluster was superimposed on a background Cameron county NTD rate (16/10,000 live births) which is considerably higher than that generally noted in the United States (8-10/10,000 live births). These data suggest that genetic factors as well as transient environmental factors may contribute to the etiology of the NTDs. Furthermore, clinical and experimental evidence imply that allelic forms of genes involved with folate metabolism and/or transport may explain some of the observed variation in the NTD rates found across different populations. Two folate pathway genes were selected for evaluation in this study. The loci investigated included two known alleles of the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene, as well as the promoter region of the folate receptor-alpha (FR-alpha) gene. Odds ratios (ORs) for the C677T polymorphism in the MTHFR gene were 1.8 (CI 0.47-6.8) for heterozygosity and 1.8 (CI 0.35-9.4) for homozygosity for the mutant 677T allele, relative to wildtype homozygotes. The odds ratio for the heterozygosity for the A1298C polymorphism in the same gene was 1.1 (CI 0.09-14). No individuals homozygous for the 1298C allele were observed. The OR for heterozygosity of FR-alpha gene polymorphisms detected at nucleotide 762 and at nucleotides 610/631 was 1.4 and 0.7, respectively. Neither of the FR-alpha polymorphisms was observed in the homozygous condition. No statistically significant associations were observed for any of the polymorphisms examined, as the 95% confidence intervals for all of the ORs included one. However, the frequency of the MTHFR 677T allele in the largely Hispanic control group from Texas was significantly different from other populations (P < 0.005), and among the highest reported for any control populations examined.

Adult↗

PubMed1994

p53 mutations in gastric and colorectal cancers in Texas Hispanics versus Anglos.

Gastric cancer is more than twice as common in Hispanics as in Anglos in Texas, while colorectal cancer is almost twice as common in Anglos as Hispanics. To test the hypothesis that mutations in the p53 tumour suppressor gene are involved in these differences, we examined 131 gastric and 138 colorectal cancers from Hispanic and Anglo patients from South Texas and Mexico using immunohistochemistry (IHC) as a screening assay for p53 mutations. The fraction of p53 positive cases was not significantly different in gastric cancers from Hispanics compared to Anglos (43% versus 61%, respectively, p = 0.13) or in colorectal cancer (57% versus 58%, respectively, p = 1.0), suggesting that p53 mutations are not involved in causing the different incidences of these cancers in these populations. In addition, the types of p53 mutations arising in gastric tumours from Hispanic patients were consistent with those reported in gastric tumours in other populations. Sequencing of mutations in five gastric cancers revealed two G:C to A:T transitions, two A:T to G:C transitions and one complex deletion. In contrast with findings in studies in other tumour types, neither stage nor survival was associated with p53 positive staining by IHC in either gastric or colorectal tumours in this study. Positive p53 immunostaining was associated with the diffuse histological subtype in gastric carcinoma (p = 0.05) and high histological grade in colorectal carcinoma (p = 0.04).

Base Sequence↗

PubMed2006

Identifying potential conflict associated with oil and gas exploration in Texas state coastal waters: A multicriteria spatial analysis.

Recent interest in expanding offshore oil production within waters of the United States has been met with opposition by groups concerned with recreational, environmental, and aesthetic values associated with the coastal zone. Although the proposition of new oil platforms off the coast has generated conflict over how coastal resources should be utilized, little research has been conducted on where these user conflicts might be most intense and which sites might be most suitable for locating oil production facilities in light of the multiple, and often times, competing interests. In this article, we develop a multiple-criteria spatial decision support tool that identifies the potential degree of conflict associated with oil and gas production activities for existing lease tracts in the coastal margin of Texas. We use geographic information systems to measure and map a range of potentially competing representative values impacted by establishing energy extraction infrastructure and then spatially identify which leased tracts are the least contentious sites for oil and gas production in Texas state waters. Visual and statistical results indicate that oil and gas lease blocks within the study area vary in their potential to generate conflict among multiple stakeholders.

Conflict, Psychological↗

PubMed2001

A baseline study of pediatric dialysis in Texas.

This study provides a cross-sectional view of the management of 94 Texas children with end-stage renal disease in 1996 and serves as a point of comparison for future changes in management practice. Data collected in 6 pediatric and 18 adult dialysis facilities in Texas revealed that a greater proportion of younger pediatric patients received peritoneal dialysis (PD). Patients on PD had a significantly lower serum albumin level than those on hemodialysis (HD). HD and PD patients were 2.3 and 1.7 standard deviation scores (SDS) below the average height of the age- and gender-matched populations, respectively. There was no significant difference in hematocrit, use of growth hormone, parathyroid hormone level, weight SDS, or bone age by treatment modality. However, patients dialyzed in pediatric facilities were more likely to receive growth hormone and to be regularly evaluated for Tanner stage and bone age than those in adult facilities. Measurement of creatinine clearance as a measure of adequacy of PD in young children was not a common practice. Instead pediatric nephrologists tended to rely more on anthropometric measurements, developmental maturation, and serum albumin to assess adequacy. Opportunities remain to maximize the growth potential and to develop standards for the adequacy of dialysis in the younger patient.

Adolescent↗

PubMed2005

After the innovation: outcomes from the Texas behavioral data project.

The Texas Department of Health and University of Texas Southwestern staff, using formative assessment data, developed a set of innovative methods and tools to increase the use of behavioral and epidemiologic data in decision-making about HIV prevention interventions by HIV prevention community planning groups (CPGs) and HIV prevention providers. Semistructured interviews, mail surveys, meeting observations, and content analysis of funding proposals were used to measure the results of the multifaceted intervention. Compared to baseline measures, CPG members reported that data played a more central and desired role in their decision-making. HIV prevention providers exposed to the project's materials were more likely to choose evidence-based interventions to conduct. The tools and structural intervention methods of this project were diffused and had an impact on the use of behavioral data by community planning groups and HIV prevention providers. The structural interventions were not sufficient without the additional effect of the trained peers acting as advocates and intervention innovators.

Community Health Planning↗

PubMed2007

Efficacy of strips coated with Metarhizium anisopliae for control of Varroa destructor (Acari: Varroidae) in honey bee colonies in Texas and Florida.

Strips coated with conidia of Metarhizium anisopliae (Metschinkoff; Deuteromycetes: Hyphomycetes) to control the parasitic mite, Varroa destructor (Anderson and Trueman) in colonies of honey bees, Apis mellifera (Hymenoptera: Apidae) were compared against the miticide, tau-fluvalinate (Apistan) in field trials in Texas and Florida (USA). Apistan and the fungal treatments resulted in successful control of mite populations in both locations. At the end of the 42-day period of the experiment in Texas, the number of mites per bee was reduced by 69-fold in bee hives treated with Apistan and 25-fold in hives treated with the fungus; however mite infestations increased by 1.3-fold in the control bee hives. Similarly, the number of mites in sealed brood was 13-fold and 3.6-fold higher in the control bee hives than in those treated with Apistan and with the fungus, respectively. Like the miticide Apistan, the fungal treatments provided a significant reduction of mite populations at the end of the experimental period. The data from the broodless colonies treated with the fungus indicated that optimum mite control could be achieved when no brood is being produced, or when brood production is low, such as in the early spring or late fall. In established colonies in Florida, honey bee colony development did not increase under either Apistan or fungal treatments at the end of the experimental period, suggesting that other factors (queen health, food source, food availability) play some major role in the growth of bee colonies. Overall, microbial control of Varroa mites with fungal pathogens could be a useful component of an integrated pest management program for the honey bee industry.

Animals↗

PubMed2006

Mercury concentrations in fish from Lake Meredith, Texas: implications for the issuance of fish consumption advisories.

We examined how length of fish is related to mercury concentrations in muscle tissue of seven species of fish from Lake Meredith, Texas and determined how sex and growth rate are related to mercury concentration in walleye (Sander vitreus). Flathead catfish (Pylodictis olivaris), walleye and white bass (Morone chrysops) had the highest concentrations of mercury and channel catfish (Ictalurus punctatus), common carp (Cyprinus carpio), river carpsucker (Carpiodes carpio) and gizzard shad (Dorosoma cepedianum) had the lowest concentrations of mercury. Mercury concentrations were positively correlated with total length (TL) of fish for all species except gizzard shad, which exhibited a negative correlation between mercury concentration and TL. Male walleye grew more slowly than females, and males had higher concentrations of mercury than females. We also assessed the differences in fish consumption advisories that would be issued using Texas Department of State Health Services (DSHS) guidelines versus United States Environmental Protection Agency (USEPA) recommendations. Using DSHS guidelines, no fish species in Lake Meredith would be issued a fish consumption advisory. Nevertheless, DSHS has issued an advisory for walleye in Lake Meredith, possibly due to an inadequate sample size of fish. Using USEPA guidelines, a fish consumption advisory would be issued for the largest size class of flathead catfish but no advisory exists for flathead catfish in Lake Meredith. We suggest that when fish in a lake may be contaminated with mercury, all game fish in the lake should be assessed, and mercury advisories should take fish size into account.

Animals↗

PubMed1985

Anthropology and the study of chronic disease: adolescent blood pressure in Corpus Christi, Texas.

In this anthropological study, the influence of psychosocial adaptation, and social and biological factors upon the blood pressures of Mexican-American adolescents and adolescents of European descent (Anglo-Americans) in Corpus Christi, Texas were examined. Black Americans have one of the highest rates of hypertension of any population in the world. The reasons for this are not entirely clear. Epidemiologic studies have shown that although clinically defined hypertension usually does not appear until adulthood, systematic differences in the average blood pressures of black and white history of discrimination and prejudice are in some way related to the prevalence of hypertension among black Americans, then Mexican-Americans of south Texas, who also have experienced a high rate of poverty and a history of discrimination, might also be expected to have a higher rate of hypertension than other Americans. Mexican-American youths were found to have a significantly higher mean systolic pressure than Anglo youths. Mexican-Americans also were found to have significantly more problematic psychosocial adaptation. There was little relationship, however, between problematic psychosocial adaptation and high blood pressure. Subsequent statistical analyses, including an analysis of covariance, indicated that other variables, including the heaviness of body build and length of residences in Corpus Christi, were of much greater importance in predicting blood pressure. Implications of these findings for social epidemiology and health promotion are discussed.

Adaptation, Psychological↗