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PubMed2003

An environmental assessment of mold concentrations and potential mycotoxin exposures in the greater Southeast Texas area.

An assessment of indoor air quality in homes from the greater Houston and Southeast Texas area was sampled over a three-month period to ascertain the potential toxic exposure to molds and mycotoxins. In 2001 Houston experienced widespread flooding due to Tropical Storm Allison. The slow receding waters allowed molds to proliferate to great levels and affected many homes and businesses in and around the Houston area. Source (air) and surface (swab, tape, and bulk) samples were taken in fungal contaminated residences to measure the amounts of airborne and surface contaminants. Indoor airborne counts of fungal spores that were identified to be 80% or more of the outside counts of similar fungal genera were classified as indoor air contaminants. This study identified species of Aspergillus, Penicilliulm, and Cladosporium at levels ranging from 80% to 20 times greater than the corresponding outdoor readings in the greater Southeast Texas area. Aspergillus and Penicillium species are considered potentially toxic to humans at elevated levels due to their ability to produce mycotoxins. Cladosporium is considered nonpathogenic, but can still cause allergenic reactions from hyphal fragments. Surface sampling which is utilized for identification of visible mold contaminants, identified species of Aspergillus. Penicillium, Chaetomium, Cladosporium, and Stachybotrys ranging from 1 to 100 total colony counts (1-100% for tape and bulk noncultured assays) contingent upon the extent of visual contamination. The numerical values from surface sampling were used primarily to identify the degree of visual contamination, as well as, identify any molds that may have been too heavy to become aerosolized.

Air Pollution, Indoor↗
PubMed2000

Distinct distribution of rare US genotypes of Kaposi's sarcoma-associated herpesvirus (KSHV) in South Texas: implications for KSHV epidemiology.

Genotypes of Kaposi's sarcoma (KS)-associated herpesvirus (KSHV) from patients with KS in South Texas were examined. Open-reading frame (ORF)-K1 and ORF-K15 DNA segments from 16 KSHV isolates were amplified by polymerase chain reaction, and KSHV subtypes were assigned on the basis of sequence variations. K1 genotyping showed that 75% exhibited C subtype and 25% exhibited A subtype. K15 genotyping showed that 56% exhibited M form, of which 89% exhibited C3 K1 subtype and 44% exhibited P form. A unique isolate was found and was classified as C6 clade. All of the M KSHV isolates had been obtained from human immunodeficiency virus-negative classic KS patients >50 years of age, of whom 78% were Hispanic. Conversely, all KS patients with AIDS were <36 years of age and exhibited P form KSHV. These findings indicate that C3/M KSHV genotypes are more prevalent in South Texas (50%) than in other US regions (3%) and that M form KSHV likely existed in this region long before the AIDS epidemic.

Adult↗
PubMed2002

Trends in antipsychotic use in a Texas medicaid population of children and adolescents: 1996 to 2000.

The purpose of this study was to examine the current trends in prescribing antipsychotics to children and adolescents within the Texas Medicaid Program. Total enrollments of children and adolescents, ranging from infants to 19-year-olds, in the Texas Medicaid Program were determined for each calendar year from 1996 to 2000. Prevalence was defined as the number of children and/or adolescents with at least one Medicaid prescription claim for an antipsychotic per 1,000 enrollees. Trends in prevalence were assessed over a 5-year period using annual descriptive analyses. In addition, total expenditures for antipsychotics were evaluated within this population. Over the 5-year period, an additional 12.25 children and adolescents per 1,000 enrollees (+160%) were prescribed antipsychotics. The prevalence of atypical antipsychotics increased by 13.29 per 1,000 enrollees (+494%) over the same period. In children and adolescents above 2 years of age, the prevalence of antipsychotic use increased in all groups. Antipsychotic usage was more common in children and adolescents between the ages of 10 and 14 years compared to other age groups. Male and female antipsychotic prevalence rates increased during the 5-year period. The increase in total expenditures was related to the increased utilization of atypical antipsychotics.

Adolescent↗
PubMed2006

Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001.

OBJECTIVE: The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis. METHODS: Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR = 6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR = 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR = 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race. CONCLUSIONS: SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival.

Adult↗
PubMed1995

Texas Telemedicine Project: a viability study.

OBJECTIVE: The purpose of this research was to investigate viability factors in the implementation of telemedicine systems. The Texas Telemedicine Project examined the viability of a rural network where multiple facilities shared a switchable long-distance network rather than using fixed point-to-point connections. METHODS: During Phase I, conducted in 1989, staff at participating institutions analyzed applications for the proposed network and developed methodologies for data collection. The capital costs and potential savings of a telemedicine network linking institutions in Austin and Giddings, Texas, were estimated. In April of 1991, Phase II of the system was implemented, and the first year's actual capital expenditures and savings (e.g., trips avoided, salaries of traveling specialists saved, reduced mileage and patient transport expenses, redundant tests avoided, reduced long distance telephone charges) attributed to the network were calculated. RESULTS: On the basis of the data collected in Phase I, it was projected that each $1.00 applied toward installation and operation of the network should yield $1.50 in benefits, with return on investment (break-even) within 1 year. In practice, there was a net deficit during the first year, although linear extrapolation predicted return on investment in 2.7 years. CONCLUSION: Linking multiple users over a shared infrastructure has the benefit of distributing cost among the participants and achieving an economy of scale for telecommunications services. The chief barriers to greater savings were the failure of five of the six network sites to design mission-oriented telemedicine policies and the absence of Medicare reimbursement.

Cost-Benefit Analysis↗
PubMed2003

Access to prescription drugs among noninstitutionalized elderly people in west Texas.

The determinants of realized, perceived, and potential access to prescription drugs among an elderly population were studied. Data were derived from telephone interviews of 3498 noninstitutionalized elderly persons living in west Texas. Access indicators examined were whether the respondents were taking prescription drugs, had perceived problems in obtaining prescription drugs, had comprehensive prescription drug insurance, and had a usual pharmacy. On the basis of the behavioral model of health services, multivariate logistic regression analysis was performed to determine whether predisposing, enabling, and need factors were associated with each access indicator. Approximately 14% of the patients were not taking prescription drugs at the time of the interview. Of the patients who were taking prescription drugs, about 16% reported having problems obtaining prescription drugs and 24% primarily used a single pharmacy. Nearly 36% did not have comprehensive prescription drug coverage. Among the four indicators of prescription drug access, lack of prescription drug insurance was the most prevalent barrier. Employer-provided insurance improved access more than any other type of coverage. Elderly consumers taking more medications reported more problems accessing prescriptions than those taking fewer medications. Among the indicators of access to prescription drugs among noninstitutionalized elderly people in west Texas, lack of prescription drug insurance was the most prevalent barrier.

Aged↗
PubMed1991

An evaluation of the effectiveness of a planned diffusion process: the Smoke-Free Class of 2000 project in Texas.

The first year of the Texas Triagency Coalition Smoke-Free Class of 2000 project (SFC2000) in Texas was evaluated using a descriptive model developed from diffusion theory. Tobacco-prevention education (TPE) materials were to be made available to all first grade teachers within the state. A random sample survey of 213 teachers indicated that 96 (44.7%) had received the materials. Adoption and implementation were high. By May of 1989, 64.2% of those teachers receiving materials had adopted and already implemented the program, and 25.3% had adopted and intended to use the materials. Almost all (96.8%) of those teachers who received the kit indicated that they would maintain the first grade program in the coming school year. Of respondents to a 1 year follow-up survey, 41.1% used it the first year only, 27.3% used it both years, 12.5% used it only in year 2 and 18.2% did not use it either year. Of those receiving the kits, 48% indicated that they had not previously taught TPE and thus were introduced to the concept of TPE through the SFC2000 kits. Receptivity was highest (over 90% agreement) for including TPE in elementary school curricula, with fewer teachers strongly agreeing with items tapping personal involvement with TPE. This evaluation of a statewide component of a national initiative reinforces the need to consider the dissemination and implementation of materials when planning large-scale interventions and evaluating their impact.

Adult↗
PubMed2004

Long-term seasonal abundance patterns of Helicoverpa zea and Heliothis virescens (Lepidoptera: Noctuidae) in the Texas High Plains.

Bollworm, Helicoverpa zea (Boddie), and tobacco budworm, Heliothis virescens (F.), male adult (moth) activities were monitored between 1982 and 1995 by using sex pheromone traps in the Texas High Plains. Moths were monitored weekly from early March to mid-November near Lubbock and Halfway, two prominent cotton production areas in the Texas High Plains region. Based on trap captures, the bollworm-budworm complex consisted of approximately 98% bollworms and approximately 2% tobacco budworms. Seasonal activity patterns varied between location for bollworm but not for tobacco budworm. The 14-yr average (+/- SE) bollworm moth abundance (moths per trap per week) at Lubbock was significantly higher (226.5 +/- 10.4) compared with that at Halfway (153.7 +/- 8.1). Correlation analyses showed a significant positive relationship between moth abundance and average weekly temperatures, whereas a significant negative relationship was observed between moth abundance and average weekly wind velocity for both species. Analyses also showed a positive correlation between moth abundance and cumulative degree-days (> 0.0 degrees C) from 1 January. A strong positive relationship was observed between moth abundance and weekly average precipitation for both species. Average weekly abundances were positively correlated between adjacent months during most of the active cotton fruiting season (June-September). However, the relationship between populations that contributed to the overwintering generation and the following spring populations varied between species and study sites. Nevertheless, data from this study indicated that late-season moth catches could be indicative of the dynamics of the early-season moth catches the following year in the High Plains. The mean population abundance curve based on 14-yr averages showed two bollworm population peaks at Lubbock, but only one peak at Halfway. Separate degree-day-based models were developed to describe long-term seasonal abundance patterns of bollworm moths for the Lubbock and Halfway sites.

Animals↗
PubMed1994

Prevalence of Borrelia (Spirochaetaceae) spirochetes in Texas ticks.

Between 1990 and 1992, ticks from eight Texas parks were collected and analyzed to determine the prevalence of spirochete-infected ticks. Borrelia spirochetes were detected in 1.03% of 5,141 Amblyomma americanum (L.) adults examined, a species Texas residents often encounter. No spirochetes were observed in the other tick species tested.

Animals↗
PubMed1998

Detection of a spotted fever group rickettsia in Amblyomma cajennense (Acari: Ixodidae) in south Texas.

Thai tick typhus rickettsia (strain TT-118), a spotted fever group rickettsia of indeterminant pathogenicity, was isolated from a mixed pool of larval Ixodes and Rhipicephalus ticks collected from Thailand in 1962. Here we report the surprising finding of a spotted fever group rickettsia with closest sequence homology to the Thai tick typhus rickettsia in Amblyomma cajennense (F.) ticks from south Texas. Sequence analysis was performed on segments of 3 genes that differentiate rickettsial species; all 3 genes sequenced, the 17-kDa, glta, and rompA, when compared with those of other rickettsiae, showed the highest degree of similarity to the Thai tick typhus rickettsia with 99.5, 99.5, and 100% homology, respectively. This is the 1st finding of a rickettsial species in A. cajennense ticks in Texas and the United States. If this rickettsia is pathogenic, exposure to infected A. cajennense ticks may pose a previously unrecognized health risk to people who have been fed upon by these ticks.

Animals↗
PubMed1989

Smoking policies among private employers and public agencies in Texas: a statewide analysis.

The present study examined the prevalence, correlates, and perceived impact of smoking policies among private employers and public agencies in Texas. An identical survey instrument was administered to two groups of Texas employers: a random sample of private industries and all state agencies (excluding universities). Response rates were 62% (n = 420) for private industries and 73% (n = 130) for public agencies. Fifty-two percent of state agencies and 53% of private employers reported having a smoking policy, with the majority of policies having been implemented since 1986. Concern about employees' health or comfort was the most important reason for implementing a policy for both state agencies and private employers. Both groups believed that implementation of a policy resulted in fewer complaints from employees and less smoking in the workplace but had less impact on productivity or morale. This study on the prevalence of smoking policies in the workplace is the first to document that the majority of surveyed employers have a restrictive smoking policy in place. In addition, this study found minimal differences in the prevalence, rationale, and perceived benefits of smoking policies between private employers and state agencies.

Humans↗
PubMed1996

Hispanic origin and neural tube defects in Houston/Harris County, Texas. I. Descriptive epidemiology.

High prevalences of anencephaly and neural tube defects (NTDs) have recently been recorded for several Texas counties bordering Mexico. In addition, a few investigators have reported Hispanics to be at elevated risk for NTDs (anencephaly and spina bifida). Factors contributing to this risk have not been established. The authors conducted a study of NTDs in Harris County, Texas, to determine the prevalence of each defect. Prevalence was established by identifying cases among resident live births and fetal deaths (stillbirths at > or = 20 weeks) occurring from April 1, 1989, through December 31, 1991. Using multiple case ascertainment methods, 59 cases of anencephaly and 32 cases of spina bifida were detected, resulting in prevalences of 3.8 (95% confidence interval 2.9-4.9) and 2.0 (95% confidence interval 1.4-2.8) per 10,000 live births, respectively. The ratio of anencephaly prevalence to spina bifida prevalence was 2:1 in 1989, 1:1 in 1990, and 3:1 in 1991, with a significant difference in 1991. The female:male prevalence ratio was 1.0 for spina bifida and 2.2 for anencephaly, and was higher still for anencephaly among non-Hispanics (prevalence ratio = 5.6). For each defect, Hispanics experienced a prevalence approximately three times that of non-Hispanics. This ethnic difference was greater for males with anencephaly and for females with spina bifida. For anencephaly, the Hispanic:white/Anglo prevalence ratio (4.2) and the African-American:white/Anglo prevalence ratio (1.9) were greatly elevated and the Hispanic:African-American prevalence ratio (2.2) was similar, relative to comparable studies from the past two decades. The prevalence of anencephaly recorded for public hospitals (7.0 per 10,000) was three times greater than that for private hospitals (2.4 per 10,000). Spina bifida figures were similar for public (prevalence = 2.2 per 10,000) and private (prevalence = 2.0 per 10,000) hospitals. A significantly higher prevalence of both defects was documented among Hispanics in Harris County. The higher anencephaly rates among Hispanics, African-Americans, and those using public hospitals in an era of NTD screening, prenatal diagnosis, and elective pregnancy termination suggest that socioeconomic and perhaps cultural/religious factors might influence the recorded birth prevalence of this defect in particular groups.

Anencephaly↗
PubMed1996

Hispanic origin and neural tube defects in Houston/Harris County, Texas. II. Risk factors.

Several investigators have reported Hispanics to be at elevated risk for neural tube defects (anencephaly and spina bifida). Factors contributing to this risk have not been established. The authors conducted a case-control study of neural tube defects (NTDs) among births occurring in Harris County, Texas, from April 1, 1989, through December 31, 1991. Through the use of multiple ascertainment methods, 59 cases of anencephaly and 32 cases of spina bifida were detected. Controls (n = 451) were sampled for the same time period from Harris County vital records. Regardless of how Hispanic ethnicity was classified, having a Hispanic parent was a risk factor for both anencepahly and spina bifida. The primary etiologic question was whether increased NTD risk in Hispanics is explained by maternal diabetes or by other factors (e.g., maternal birthplace, prenatal care, reproductive history, age, socioeconomic status). Mexico-born Hispanics were no more likely than Texas-born Hispanics to deliver a fetus or infant with an NTD. Having a Hispanic mother was a risk factor for anencephaly among infants born to women with early prenatal care (odds ratio (OR) = 4.54, 95% confidence interval (CI) 2.21-9.40) but not for those born to latecomers. Earlier prenatal care seemed "protective" for non-Hispanics (OR = 0.18, 95% CI 0.06-0.65) but not for Hispanics. After simultaneous adjustment for eight variables in multivariate analysis, having a Hispanic (versus non-Hispanic) mother remained a strong risk factor for both anencephaly (OR = 2.58, 95% CI 1.19-5.61) and spina bifida (OR = 3.71, 95% CI 1.48-9.31). Any previous pregnancy termination/fetal loss was also associated with anencephaly in a final logistic regression model (OR = 2.48, 95% CI 1.20-5.10), and having a teenage mother (aged < 20 years) approached significance (OR = 2.21, 95% CI 0.92-5.31). "Hispanic mother" was the only study variable significantly associated with spina bifida in multivariate analysis. Results for diabetes suggested no association with anencephaly (OR = 1.24, 95% CI 0.25-6.17). An increased risk of NTDs among Hispanics remained after controlling for other factors. For anencephaly, this risk might be partially explained by economic and cultural differences between Hispanics and non-Hispanics, and the effect of these factors on rates of prenatal diagnosis and elective pregnancy termination.

Adult↗
PubMed1999

Incidence of neonatal seizures in Harris County, Texas, 1992-1994.

This study estimated the incidence of clinical neonatal seizures among infants born between 1992 and 1994 in Harris County, Texas, a county with a large and ethnically diverse population. Infants with neonatal seizures were ascertained from four sources: hospital discharge diagnoses, birth certificates, death certificates, and a study of neonatal seizures conducted concurrently with this study at a large tertiary care center in Houston, Texas. There were 207 cases of clinical neonatal seizures among 116,048 live births (an incidence of 1.8 per 1,000 live births). The incidence was highest among infants weighing less than 1,500 g (19/1,000) and decreased as birth weight increased. There was no significant difference in incidence by ethnicity. Twenty-six percent of the seizures (54/207) occurred after the infants had been discharged from the hospital where they were born. The incidence of neonatal seizures in Harris County was lower than the incidence reported recently for Fayette County, Kentucky, for 1985-1989 (3.5/1,000) and for Newfoundland, Canada, for 1990-1995 (2.5/1,000), but was higher than the incidence estimated for Rochester, Minnesota, for 1935-1984 (1/1,000).

Age Factors↗
PubMed1983

Diabetes among Mexican Americans in Starr County, Texas.

An increasing body of evidence suggests that diabetes mellitus constitutes a major health burden among the Mexican-American population. For example, county-wide death rates in Texas attributable to diabetes from 1970-1981 range from 2.5-52.0 diabetes deaths per 1000 total deaths with the highest rates generally occurring in counties whose populations are more than 75% Spanish ancestry. To assess the prevalence and morbidity of noninsulin-dependent diabetes mellitus among Mexican Americans, 14% of the Starr County, Texas, population (97% Mexican-American) was randomly sampled. The reference population, sampling strategy, and screening results are described. Age-specific prevalences of diabetes for males ranged from 0% in males aged 15-24 years to 17.6% in those above 75 years of age. Rates for females ranged from 0.4% in those aged 15-24 years to a high of 19.0% in the 55- to 64-year age group. In both sexes, the rates are relatively low for persons under age 45 with a sharp increase in those aged 45-54 years and high rates prevailing in the older age groups. Comparisons of the rates in Starr County to those of the general US population indicate a two- to fivefold greater risk in Starr County. In terms of impact on this community, these results imply that over 50% of individuals older than 35 years are directly affected by diabetes by virtue of their having the disease or by being a first-degree relative of a diabetic.

Adolescent↗
PubMed1985

Gallbladder disease epidemiology in Mexican Americans in Starr County, Texas.

The prevalence of gallbladder disease (surgery or complaints) among Mexican Americans in Starr County, Texas, is demonstrated to be some threefold higher than in Framingham, with 13% and 26% of males and females, respectively, over the age of 35 years having the disease. The population aggregation of gallbladder disease in Amerindian groups and those genetically admixed with them (as the present case) is consistent with an underlying genetic mechanism which is further substantiated here by examining relative risks in sibs, offspring, and spouses of individuals with gallbladder disease. It is shown that in females under the age of 45 years, there is evidence for a significant association between gallbladder disease and diabetes beyond that which could be explained by body mass. Significant gallbladder disease by nonlinear age interaction effects was detected for serum cholesterol. The predicted regression lines of cholesterol by age were uniformly lower for individuals with gallbladder disease than those without it except for ages 40-55 years, in which the lines were equal. When coupled with previous results on diabetes, the results presented document the extent to which diabetes and gallbladder disease dominate the health status of Mexican Americans in southern Texas and likely elsewhere.

Adolescent↗
PubMed1988

Air pollution and lung cancer mortality in Harris County, Texas, 1979-1981.

Elevated lung cancer mortality rates in Harris County, Texas compared with other US counties and previously published reports that suggested a causal relation between air pollution and lung cancer in Houston prompted this ecologic analysis. A weighted regression analysis was used to examine the air pollution-lung cancer mortality relation for white males in Harris County, Texas, 1979-1981. The regression model included the following census tract-specific characteristics: median age for white males, two social and demographic factors not strongly correlated with pollution (family life cycle and migration), an age-dependent smoking index, and a pollution measure based on total suspended particulates. This model indicated a statistically significant contribution of the pollution measure in explaining the intracounty variation in lung cancer mortality rates. The relation between air pollution and lung cancer mortality, however, appeared to be highly dependent on which social and demographic factors were selected for inclusion in the analysis. Air pollution was not demonstrated to be a strong determinant of lung cancer mortality in this study in that the presence of air pollution accounted for less than 5% of the total variation in intraurban lung cancer mortality. In addition, the interpretation of geographic analysis must be guarded due to the introduction of potential bias due to aggregation. The hypothesis that air pollution is contributory to lung cancer cannot be tested until other, stronger individual risk factors for lung cancer can be better measured and controlled in studies of this association.

Adult↗
PubMed1990

Factors influencing the development of area health education centers with Texas-Mexico border populations.

Area Health Education Centers (AHECs) have been viewed as an appropriate vehicle for implementing new initiatives for training health professionals who will work along the U.S.-Mexico border. Perceptions about this program in Texas were evaluated from July 1988 to June 1989 to identify problems and formulate suggestions that might be of use to academic health science centers (HSCs)--and in particular medical schools--working with Hispanic populations. Interviews were conducted with 116 people: the presidents and/or deans of all eight Texas HSCs and/or medical schools, other deans and faculty, community leaders in five border counties, and state officials. The school and community perspectives about past and present AHEC activities were compared. Some of the barriers were: insufficient components of the health care delivery system to support medical education in severely underserved areas; differing school and community priorities; cultural differences between the school faculty and the community; and feeling among community physicians and dentists that AHECs were a source of competition. The school and community respondents agreed that the AHEC program needs more cooperative planning and training that emphasizes public health education for future AHEC-like activities with border populations.

Academic Medical Centers↗