Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “TEXAS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources
PubMedDate not supplied

Predictors of breast and cervical screening in Vietnamese women in Harris County, Houston, Texas.

The Vietnamese are a quickly growing, important part of the Texas population. Breast cancer is known to have different biologic characteristics in Vietnamese women. In order to develop appropriate intervention and screening strategies, we conducted a study of barriers to cervical and breast screening in Vietnamese women in Harris County, Tex. Our objective was to characterize the demographic factors, beliefs, and barriers to cervical and breast cancer screening in our study population and test the effect of these on Papanicolaou test, breast self-examination (BSE), medical breast examination (MBE), and mammography use. The Health Belief Model Scales for Measuring Beliefs Related to Breast Cancer (Champion VL, Nursing Research 1993;42:139-143) was the framework used to assess attitudes regarding risk of breast cancer and to design a component assessing risk of cervical cancer. The questionnaire addressed susceptibility, seriousness, benefits, barriers, and health about screening for breast and cervical cancer. It was translated into Vietnamese and back-translated into English prior to use. The questionnaire was mailed to Harris County residents. Those returned were entered into a database. The data were analyzed for validity using Chronbach's alpha. Simple descriptive analyses and nominal logistic regression identified predictors of Papanicolaou test, BSE, MBE, and mammography use. Twelve hundred surveys were mailed out to Vietnamese women using the telephone directory and the church directories in Harris County; 209 were returned and entered into the database. Of the respondents, 67% had ever received a Papanicolaou test; of these, 89% had received a Papanicolaou test within the past year; 55% of respondents had performed a BSE, 45% of patients received an MBE, and 45% of respondents had ever received a mammogram (15% of respondents had a mammogram during the previous year). The most significant predictors of Papanicolaou test, BSE, MBE, and mammography use were marital status (being married), high educational level, lack of barriers, a family history of the cancer, older age, and increased perception of seriousness. Compared to other studies of Vietnamese women, the women in Texas are among the highest users of the Papanicolaou test, BSE, MBE, and mammography. Barriers and incentives to breast and cervical screening were similar to those in other studies.

Adult↗
PubMed2004

An analysis of 45 years of reported overexposure incidents in Texas, 1956 to 2001.

Sources of ionizing radiation are commonly encountered in a wide variety of modern work settings. The controls in place to ensure the safe use of these sources have proven to be quite effective, as events involving occupational doses in excess of established limits are quite rare. Nonetheless, instances of doses in excess of established limits, commonly referred to as "overexposures," do occur, but the rarity of such events has resulted in a body of scientific knowledge that consists essentially of sporadic case reports. In this study, incident reports describing radiation overexposure events recorded in Texas from the years 1956 to 2001 were obtained and recorded into a computerized database using a pre-established set of codes. The data were then analyzed for the identification of possible trends or commonalties. During the 45-y period of study, overexposure events accounted for 50% (n = 3,796) of all the radiation-related incidents recorded in Texas for the time period (n = 7,534). Of the overexposure events, 65% (n = 2,342) resulted in the actual deposition of energy in the individual exposed. The remainder were determined to be doses recorded only by a personal dosimetry device. In most of the cases where doses were actually delivered to an individual, the doses were less than 0.05 Sv (5 rem). In only 0.5% of the cases (n = 13) were doses greater than 1 Sv (100 rem). The predominant sources reported as involved in the events included 192Ir, 60Co, and 137Cs. The information derived from the analysis may serve as a basis for a variety of interventions, such as preventative education activities, regulatory modifications, and the possible re-design of equipment identified as commonly associated with such events. The results of the study can also assist in the training of health care providers, as the recognition of common causes and sources of overexposures and subsequent treatments can be forecasted and summary treatment protocols developed.

Accidents, Occupational↗
PubMed2004

A comparison of the results of regulatory compliance inspections in 1999 by the states of Texas, Maine, and Washington.

Inspection outcome data provided by the state of Washington Department of Health, Division of Radiation Protection, for licensees of radioactive materials was encoded according to a system established by the Texas Department of Health, Bureau of Radiation Control. The data, representing calendar year 1999 inspection activities, were then analyzed and the results compared to previously published studies for the same year in the states of Texas and Maine. Despite significant differences in regulatory program size, age, and geographic proximity, the most frequently cited violation for radioactive materials licensees were shown to be similar for all three states. Of particular note were the violations that were identified to be consistently issued in all three states. These included physical inventories and utilization logs not performed, not available, or incomplete; leak testing not performed or not performed on schedule; inadequate or unapproved operating and safety procedures; radiation survey and disposal records not available or incomplete; detection or measurement instrument calibration not performed or records not available; and radiation surveys or sampling not performed or performed with a noncalibrated instrument. Comparisons were made in an attempt to generate a summary of the most commonly issued violations that could be generalized to users of radioactive materials across the United States. A generalized list of common violations would be an invaluable tool for radiation protection programs, serving to aid in the reduction of the overall instance of program non-compliance. Any reduction in instances of non-compliance would result in the conservation of finite public health resources that might then be directed to other pressing public health matters.

Government Regulation↗
PubMed1977

Sociocultural barriers to medical care among Mexican Americans in Texas: a summary report of research conducted by the Southwest Medical Sociology Ad Hoc Committee.

This paper summarizes research findings from members of the Southwest Medical Sociology Ad Hoc Committee concerning sociocultural barriers to medical care among Mexican Americans in Texas. Committee members individually, or in two-person groups, studied a number of factors concerning Mexican-American medical care in Texas such as: 1) mortality, morbidity, and other health status indicators; 2) health manpower and educational needs; 3) political factors impeding economical health care; 4) alienation, familism, and their relationship to utilization of the health services; 5) language and communication barriers; and 6) folk medicine. Findings include documentation that structural alienation of Mexican-Americans from mainstream Anglo-American middle-class society is carried over into their relation with utilization of the health care delivery system; that their emphasis on familism works alternatively to encourage and discourage their seeking access to health care; the language differences serve to perpetuate certain cultural differences that are inimical to health care delivery; and that curanderismo can be seen as complementing other types of health care. The report concludes with a number of recommendations for accomplishing cultural integration that will lead to better care for this segment of the health population.

Communication↗
PubMed2000

Texas physician immunization practices.

INTRODUCTION: Immunization levels among young children could be improved if physicians administered immunizations at both well and urgent visits, provided simultaneous vaccinations, and knew the guidelines on valid contraindications, part of the Standards for Pediatric Immunization Practices (Standards). We report on a survey measuring the immunization knowledge and practice of Texas pediatricians, family practitioners, and general practitioners. METHODS: A survey was mailed to a random sample of physicians. Questionnaire items covered 8 of the 18 Standards. RESULTS: The response rate was 62% (608 of 976 eligible physicians). The mean summary adherence-to-Standards score was 4.1 for pediatricians, 3.6 for family practitioners, and 3.0 for general practitioners. Specialty and practice location were significant predictors of the summary score, whereas gender, managed-care participation, and graduation year were not. DISCUSSION: Our study results suggest that in Texas, pediatricians and rural physicians most often adhere to the Standards. Improving the reimbursement level of administrative costs for immunization delivery, educating physicians on the Standards, and encouraging the use of patient immunization tracking systems are actions that could potentially improve immunization rates.

Adult↗
PubMed2000

Murine typhus in South Texas children.

BACKGROUND: Murine typhus is a zoonotic infection caused by Rickettsia typhi. This illness used to be endemic in the southeastern and gulf coast of the United States and is now only rarely reported in South Texas and Southern California. Murine typhus causes a febrile illness with headache and rash that has been well-described in adults. OBJECTIVE: To define the epidemiologic and clinical characteristics, laboratory findings, hospital course and response to therapy of children discharged from our hospital with a diagnosis of murine typhus. METHODS: Retrospective chart review of all children discharged from Driscoll Children's Hospital, Corpus Christi, TX, from January 1, 1990, to June 30, 1998, with a diagnosis of murine typhus. Patients. Thirty children (17 females) ages 2 to 17 years (mean, 10 +/- 4 years). RESULTS: Eighty percent of the children were admitted between May and November, and 67% had a history of contact with or exposure to a potential animal reservoir. Children were admitted after a mean of 7 +/- 4 days. The most common clinical features were fever 100%, rash 80% and headache 77%. Laboratory abnormalities included elevated erythrocyte sedimentation rate (75%), elevated serum transaminases (67%), hyponatremia (66%) and increased immature leukocytes without leukocytosis (63%). Only one child had leukocytosis and 40% had leukopenia. Defervescence occurred a mean of 35 +/- 19 h after initiation of appropriate antibiotics. Hospitalization lasted for a mean of 7 +/- 3 days. There were no readmissions and no patients died as a result of the infection. CONCLUSIONS: Despite being rarely reported in this country now, murine typhus continues to be an important cause of fever and hospitalization for children in South Texas. Children with murine typhus develop an illness similar to that reported in adults with fever, rash and headache. Children respond quickly to therapy with doxycycline or tetracycline and recover completely from their illness.

Adolescent↗
PubMed1986

Influencing physician distribution in the South: lessons from a study in Texas.

Analysis of recent and projected trends in the geographic distribution of Texas physicians indicates that maldistribution may continue to be a problem into the foreseeable future. A survey of manpower officials in other southern states and a review of research on the effectiveness of various policy interventions reveals that programs involving preferential medical school admissions and Medicaid reimbursement levels may hold the most promise for Texas and other southern states seeking to alleviate physician maldistribution.

Delivery of Health Care↗
PubMed1994

Outbreaks of syphilis in rural Texas towns, 1991-1992.

Between 1986 and 1990, rates of primary and secondary syphilis increased 134% in rural counties in the South. Reasons for the increases are speculative. During the 14 months ending in October 1992, outbreaks in four eastern Texas counties provided an opportunity to characterize syphilis in rural Texas. We reviewed records for 118 patients and 339 sex partners. Three outbreaks were concentrated in neighborhoods where crack cocaine dealers conducted business and exchange of sex for drugs or money was common; the fourth outbreak involved out-of-town prostitutes who visited undocumented alien workers. Among the 118 syphilis cases, 15 (13%) were primary, 35 (30%) were secondary. Most patients were black (105, 89%); the male-female ratio was 1:1. One woman gave birth to an infant with congenital syphilis. Almost half of the sex partners were infected. HIV pretest counseling was completed for only 55 patients (47%), and only 23 (19%) were tested for the human immunodeficiency virus. These four rural outbreaks of syphilis associated with crack cocaine and the exchange of sex for drugs or money mirror recent urban syphilis outbreaks. Patients in these rural syphilis outbreaks are at risk for HIV infection, but HIV testing has not been emphasized by public health workers.

Adult↗
PubMed1997

Increased incidence of non-transitional cell carcinoma of the bladder in women of the Texas Gulf Coast region.

The objective of our study was to verify a suspected increased incidence of non-transitional cell carcinoma (TCC) of the bladder in female patients treated at our institution. The study included 169 patients, 83% of whom resided in the Texas Gulf Coast region. Tumors were considered TCC or non-TCC on the basis of their predominant histologic pattern. The incidence of non-TCC among men (8.1%) was comparable with data from American tumor registries and European studies. In contrast, our female patients exhibited a marked increased incidence of non-TCC (42.3%), which is approximately five times higher than that in other series. All male and female patients with non-TCC had invasive disease. History of urinary tract infections was strongly associated with non-TCC. Our results suggest that our sample of the female population in the Texas Gulf Coast region has a significantly high incidence of non-TCC. This unusual trend merits further investigation.

Adenocarcinoma↗
PubMed1996

A 50-year mortality follow-up of a large cohort of oil refinery workers in Texas.

To investigate further the possible role of occupational exposures on mortality, an update of a large Texas petroleum refinery cohort was undertaken. Between 1937 and 1987, 6799 deaths were identified among 17,844 employees. Relative to the general population of Texas, the overall standardized mortality ratio (SMR) showed a statistically significant deficit, as did nine other cause-of-death categories. Statistically significant mortality excesses were found for bone cancer (SMR = 207.8: 95% confidence interval [CI], 110.6 to 355.3), acute lymphocytic leukemia (ALL) (SMR = 259.6; 95% CI, 112.1 to 511.5), and benign/unspecified neoplasms (SMR = 194.9; 95% CI, 129.5 to 281.7). However, none of these diseases demonstrated an exposure-response relationship with length of employment. Subcohort mortality analyses by sex and race groups, length of employment, interval since hire, period of hire, and pay status were also performed. Overall, the update findings do not indicate that any excess mortality occurred as a result of employment at the refinery.

Cause of Death↗
PubMed2001

Dissemination and adoption of the Child and Adolescent Trial for Cardiovascular Health (CATCH): a case study in Texas.

The total impact of a health promotion program can be measured by the efficacy of the intervention multiplied by the extent of its implementation across the target population. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was a school-based health promotion project designed to decrease fat, saturated fat, and sodium in children's diets, increase physical activity, and prevent tobacco use. This article describes the dissemination of CATCH in Texas, including the theoretical framework, strategies used, and lessons learned. To date (Fall 2000), CATCH materials have been adopted by more than 728 elementary schools in Texas.

Adolescent↗
PubMedDate not supplied

Utilizing "PPIP Texas style!" in a medically underserved population.

Implementation models, such as the national Put Prevention Into Practice program, have produced small to moderate changes in the delivery of preventive services in primary care. More recently, researchers concluded that guides and tools, such as the PPIP toolkit, are helpful, but are not sufficient to facilitate substantive change in clinical preventive practice. Successful implementation of clinical preventive services, according to the Texas Department of Health-PPIP (TDH-PPIP) initiative, involves creating or altering systems to produce change in service delivery for a specific setting. This article describes the ways in which the guidelines and instruments that were developed and refined through the collaborative efforts among public and private health systems were used to implement systems change and improve clinical preventive services at one community primary health care clinic in Texas. The process and empirical results of using the TDH-PPIP Implementation Model in the field are also presented, as well as a discussion of one-year evaluation data.

Adult↗
PubMed2006

Complying with ACGME resident duty hours restrictions: restructuring the 80-hour workweek to enhance education and patient safety at Texas A&M/Scott & White Memorial Hospital.

Compliance with the Accreditation Council for Graduate Medical Education resident duty hours rules has created unique educational and patient-care challenges for the general medicine inpatient teaching (GMIT) teams at Texas A&M/Scott & White Memorial Hospital, including multiple patient hand-offs, multiple resident absences during teaching time, and loss of continuity of care for individual patients, all of which may have compromised patient safety. The Texas A&M/Scott & White Memorial Hospital internal medicine residency program initially complied with the duty hours rules by having residents take call every fourth night, followed by a six-hour post-call day. This system proved to be inefficient because it significantly disrupted patient care and resident education. Residents reported that this call system frequently caused them to approach the 80-hour limit and that they had difficulty leaving post-call because of unfulfilled responsibilities. They also reported sleep interruption and inadequate time to prepare for and attend educational conferences.After determining the peak admission times at the hospital, program leaders designed a call system during which the primary call team takes admissions from 12:00 pm to 8:00 pm each day, then leaves by 10:00 pm and returns after 10 hours for a full post-call day. After-hours admissions are managed by hospitalists. The solution did require hiring additional hospitalists for night-call coverage. The new structure has greatly improved the residents' experience on the GMIT teams. The entire team works together on call and post-call. Rounds and inpatient teaching continue normally on post-call days. Residents attend clinics and conferences post-call. Hand-offs are reduced greatly, and residents report that they are better rested. Residents also state that the new call system significantly enhances their education, patient care, and personal life.

Accreditation↗
PubMed2006

Reported events of stolen radioactive sources in Texas from 1956 to 2000.

Incident reports describing stolen source events in Texas from the years 1956 to 2000 were obtained from the Texas Department of Health-Bureau of Radiation Control and recorded into a computerized database using a pre-established set of codes. The data were then analyzed for the identification and characterization of trends. Over the 45-y period of analysis, 113 sources were reported as stolen. The radionuclides most commonly reported in theft events were Am, Cs, and Ir. The proportion of sources including Am as the sole source or Am combined with Be, or as a companion source with Cs, represented 56% of the total reported as stolen. Key risk factors identified as associated with source theft appear to include portability status, transportation status, transporter status, and radionuclide type. Based on the observations noted, suggested improved security measures are postulated including additional permitting controls, enhanced inspections, improved locking and storage procedures, and steps for communication to the public to enhance the prospects for recovery. Suggested enhancements to further improve data collection are proposed so that crime prevention information can be derived in future research.

Americium↗
PubMedDate not supplied

Texas certified volunteer Long-Term Care Ombudsmen: perspectives of role and effectiveness.

BACKGROUND: Under the federally mandated Long-Term Care Ombudsman Program (LTCOP), certified volunteer ombudsmen (CVO) advocate for the welfare and rights of residents in nursing facilities. In Texas, the Department on Aging contracts with 28 agencies to deliver the LTCOP in respective regions. Regional ombudsman staff in charge of a group of CVOs administers each local program. The volunteer ombudsman role is threefold: advocate, mediator, and friendly visitor. METHODS: This descriptive study used a 75-item mail survey designed to gain a better understanding of CVOs' perspectives of their role and effectiveness. A total of 361 active, certified volunteers participated, representing all of the 28 regional Texas ombudsman programs. A series of focus groups was used to amplify survey data. RESULTS: Findings indicate overall role satisfaction, although perception of satisfaction varied with volunteers' age, length of service, level of education, and work experience. Volunteers felt most effective in promoting residents' rights and welfare, and least effective in dealing with financial exploitation, nutrition, and hydration issues. Although not always able to achieve desired changes, most volunteers believed that the ombudsman presence was a positive force. A need for improved understanding and support of the ombudsman role among facility staff and regulatory agents was exposed. DISCUSSION: CVOs' potentially favorable impact on the institutional setting in general, and facility personnel in particular, is dependent on the support from state personnel and regional ombudsman staff as well as the willingness of nursing facility staff to cooperate. Volunteers' sense of performance effectiveness is essential to the success of the LTCOP. Specific recommendations based on study findings are intended to assist in assuring continuous program quality improvement purposed to ensure residents' quality of life.

Adult↗
PubMed2003

Use of birth certificates and surveillance data to characterize reported pertussis among Texas infants and young children, 1995 to 2000.

BACKGROUND: Pertussis morbidity is increasing, especially among young infants and children, who are more likely to be hospitalized and have more severe complications. Maternal and pediatric factors associated with underimmunization and hospitalization for pertussis are poorly understood, but young maternal age and low birth weight have been associated with pertussis among young infants. METHODS: We used pertussis surveillance data, matching cases to the birth certificates of 416 Texas infants and children reported as pertussis cases during 1995 to 2000. Maternal/pediatric information gathered from birth certificates included birth weight, gestational age, and maternal factors (age, birthplace and education level, prenatal care, and previous live births). We assessed the immunization status of the cases and maternal/pediatric factors associated with underimmunization with a pertussis-containing vaccine and hospitalization using descriptive statistics and logistic regression. RESULTS: The 416 cases represented 20% of the pertussis morbidity in Texas from 1995 through 2000. Most children had not been vaccinated (275 [66%]), even though 374 (90%) were old enough for at least one dose. Among those 374 children, only those younger than 6 months were associated with underimmunization (odds ratio [OR], 9.98; 95% confidence interval [CI], 6.24-15.97). Most patients (253 [61%]) were hospitalized. Hospitalization was associated with complications of apnea (OR, 2.13; 95% CI, 1.39 2.38), pneumonia (OR, 5.26; 95% CI, 2.94-11.59), and age younger than 6 months (OR, 2.11; 95% CI, 1.38-3.23). CONCLUSION: More than two-thirds of the children reported as pertussis cases were old enough to have at least one dose of a pertussis-containing vaccine but were not immunized. Maternal and pediatric characteristics on birth certificates were not useful in predicting either underimmunization or hospitalization for pertussis complications. More current assessments of maternal and pediatric characteristics should be part of pertussis contact investigations.

Adolescent↗
PubMed2003

Catching up on health outcomes: the Texas Medication Algorithm Project.

OBJECTIVE: To develop a statistic measuring the impact of algorithm-driven disease management programs on outcomes for patients with chronic mental illness that allowed for treatment-as-usual controls to "catch up" to early gains of treated patients. DATA SOURCES/STUDY SETTING: Statistical power was estimated from simulated samples representing effect sizes that grew, remained constant, or declined following an initial improvement. Estimates were based on the Texas Medication Algorithm Project on adult patients (age > or = 18) with bipolar disorder (n = 267) who received care between 1998 and 2000 at 1 of 11 clinics across Texas. STUDY DESIGN: Study patients were assessed at baseline and three-month follow-up for a minimum of one year. Program tracks were assigned by clinic. DATA COLLECTION/EXTRACTION METHODS: Hierarchical linear modeling was modified to account for declining-effects. Outcomes were based on 30-item Inventory for Depression Symptomatology-Clinician Version. PRINCIPAL FINDINGS: Declining-effect analyses had significantly greater power detecting program differences than traditional growth models in constant and declining-effects cases. Bipolar patients with severe depressive symptoms in an algorithm-driven, disease management program reported fewer symptoms after three months, with treatment-as-usual controls "catching up" within one year. CONCLUSIONS: In addition to psychometric properties, data collection design, and power, investigators should consider how outcomes unfold over time when selecting an appropriate statistic to evaluate service interventions. Declining-effect analyses may be applicable to a wide range of treatment and intervention trials.

Adult↗
PubMed2004

Outcomes of congenital heart surgery patients after extracorporeal life support at Texas Children's Hospital.

The objective of this study was to investigate the outcomes of children with heart failure of various etiologies requiring temporary use of currently available technology in the U.S.A. after extracorporeal life support (ECLS) [left ventricular assist device (LVAD) or extracorporeal membrane oxygenation (ECMO)] at Texas Children's Hospital. Between July of 1995 and October of 2002, 2847 patients underwent congenital heart surgical repairs with the aid of cardiopulmonary bypass at Texas Children's Hospital. During this period, 17 patients required chronic mechanical circulatory assistance with Biomedicus centrifugal pump (n=8) or Thoratec LVAD (n=4), and ECMO (n=5). Six out of 17 patients required ECLS for postcardiotomy heart failure. Seven of the 17 patients had congenital heart disease, six had cardiomyopathy, three had late acute rejection following heart transplantation, and one had myocardial infarction. Twelve patients survived and five patients expired. Six of 12 survivors recovered sufficient cardiac function to allow device removal; and the remaining six patients underwent heart transplantation. Three out of five deaths were ECMO patients. The need for ECLS following repair of congenital heart disease is extremely rare in our institution. The requirement for the use of ECMO confers a significantly higher mortality presumably because of associated combined cardiopulmonary failure. Congenital heart disease appears to be associated with significantly higher mortality.

Adolescent↗