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Helminths of the ocelot from southern Texas.

In the USA, the ocelot (Leopardus pardalis) is a highly endangered felid found only in a few remaining vestiges of native thornshrub brushland in the Lower Rio Grande Valley (LRGV) of extreme southern Texas. From 1987-1998, carcasses of 15 adult ocelots that died of vehicular accidents or natural causes were examined for helminths. All cats had 1-8 (mean = 3) helminth species. All were infected with 1-101 (mean +/- SE = 32 +/- 7) Toxascaris leonina. Other helminths from these ocelots were Alaria marcianae, Brachylaima sp., Mesocestoides lineatus, Taenia rileyi, Oncicola canis, Dirofilaria immitis, Physaloptera rara, Ancylostoma tubaeformae, Cylicospirura chevreuxi, Vogeloides felis, and Metathelazia californica. Additionally, two cats had scarring of the aorta with lesions typical of those caused by Spriocerca lupi, although larval nematodes were not seen. A clinal variation in size of nearly three orders of magnitude was noted in the diplostomatid trematodes in the small intestine of one adult male ocelot. Despite the differences in size, all specimens appeared morphologically identical and were regarded as A. marcianae. Helminth prevalences and abundances, including those of potentially pathogenic species like D. immitis, were low. Although a single heartworm infection may have contributed to the death of one ocelot, helminth infections in general seemed to be of no great consequence to this endangered ocelot population. The helminth fauna of ocelots in the LRGV is reflective of that from wild felids in general; all have been reported previously from the bobcat (Lynx rufus) and mountain lion (Puma concolor) elsewhere in Texas.

Animals↗

Serologic evidence of bunyamwera group arbovirus infections in Wisconsin and texas deer.

Sera of 81 white-tailed deer from south Texas and 283 white-tailed deer from Wisconsin were tested for neutralizing and hemagglutination-inhibiting antibodies to arboviruses of the Bunyamwera group. Neutralizing antibodies were detected in 100% of the Texas deer sera and hemagglutination-inhibiting antibodies were detected in 61% of those sera collected in 1969 and 78% of those sera collected in 1963. The prevalence of both neutralizing and hemagglutination-inhibiting antibodies in Wisconsin deer sera varied from 72-100% and 42-79% respectively depending on the geographic area tested in the years 1963 and 1969.

Animals↗

Practice patterns of rural Texas physicians trained in a full-service family practice residency program.

The family practice residency program of John Peter Smith Hospital (JPSH) emphasizes "full-service" training to enable its graduates to provide a wide range of services to underserved areas, particularly rural communities. The purpose of this study was to investigate the practice patterns of rural JPSH family practice graduates. Of 180 identified JPSH family practice residency graduates who currently practice in rural Texas, 102 (57%) responded to a postcard survey. Data were analyzed by decade of graduation. Recent graduates were more likely to provide obstetrical care than were older graduates. The proportion of graduates providing obstetrical care at some time during their careers was similar. Recent graduates were more likely to perform office-based procedures such as colonoscopy and esophagogastroduodenoscopy. Rural JPSH family practice graduates provided more obstetrical care, critical care, and office-based procedures than did other rural members of the American Academy of Family Physicians. Practice patterns of JPSH family practice graduates have changed little over the past 30 years, except that recent graduates do more obstetrics and perform more endoscopies. These data show that the skills and knowledge of full-service family physicians are still needed in rural Texas.

Clinical Competence↗

Organophosphate and pyrethroid susceptibilities of Culex salinarius adults from Texas and New Jersey.

Susceptibilities of adults from newly established colonies of Culex salinarius from New Jersey and Texas to commonly used mosquito adulticides were assessed using the insecticide-coated vial bioassay technique. Females from both colonies were similar in their susceptibilities to naled, chlorpyrifos, resmethrin, and permethrin. However, females from the New Jersey colony (established from collections made in Cape May County, NJ) were found to be 9 times more tolerant to malathion than were those from the Texas colony (established from collections made in Chambers County, TX), with median lethal concentration values for malathion tested against these 2 colonies of 0.70 and 0.08 microgram malathion/vial, respectively. The differences between these 2 colonies with respect to their tolerances to malathion may be a product of the age of each colony at the time assessments were made and/or the degree to which the parent stock used to start each colony was previously exposed to malathion in the field.

Animals↗

Emergency care. Texas hospitals to the rescue.

An average of 17 Texans die every day as a result of accidental injuries. Our ability to respond to trauma in Texas will be a high priority issue in the upcoming Legislative session. In the meantime, metropolitan areas and remote rural locations across Texas have had to come up with ways to handle what is often a trauma crisis. Efforts are also underway to reduce the number of accidents and injuries in the first place. This month, HealthTexas takes a look at these trauma issues.

Disaster Planning↗

An analysis of predictors of prescription drug costs among Medicaid nursing home residents in Texas.

A study was conducted to examine the relations among patient-specific demographic characteristics, previous prescription costs and utilization, and subsequent prescription costs for a population of 55,677 Medicaid nursing home residents in Texas. Patient-specific factors, based on previous patient utilization and cost levels, exist within the Texas Medicaid nursing home population that may serve as predictors of subsequent prescription costs. Although some statistically significant relations exist between prescription costs and patient demographic factors such as age, sex, and location, these demographic factors are of little or no practical value in prediction of prescription costs for subsequent periods of time.

Aged↗

Performance-based public health in Texas.

Responding to a 1987 state audit report, the Texas Department of Health began a performance-based objectives project to tie contract funds to local health departments (LHDs) to performance measures. The overall goal of the project is to improve public health practice in Texas. A major focus has been on having regional and LHD program staff develop realistic and measurable outcome and process objectives. Training on the planning and monitoring phases of the health program management cycle has been conducted, with future training planned on the evaluation phase. There are increasing reports on the value of the performance-based objectives process.

Humans↗

Illegal sales of cigarettes to minors--Ciudad Juárez, Mexico; El Paso, Texas; and Las Cruces, New Mexico, 1999.

In 1996, the United States-Mexico Binational Commission (US-MBC) Health Working Group identified prevention of tobacco use, particularly among adolescents, as a priority and subsequently recommended joint efforts toward reducing illegal sales of cigarettes to minors. A 1997 survey of 561 commercial cigarette outlets in Mexico City found that 79% of retailers sold cigarettes to minors. To assess the illegal sale of cigarettes to minors in other regions of Mexico and on both sides of the U.S.-Mexico border, during January-February 1999 the General Directorate of Epidemiology in Mexico, the Chihuahua State Department of Health Services (CDH), the Ciudad Juarez Department of Health (CJDH), the Texas Department of Health (TDH), and the New Mexico Department of Health (NMDH) surveyed cigarette outlets in Ciudad Juarez, Mexico; El Paso, Texas; and Las Cruces, New Mexico. This report summarizes the results of these surveys, which indicate that almost all retailers in the surveyed outlets in Ciudad Juarez sold cigarettes to minors and that sales rates to minors were substantially lower in El Paso and Las Cruces.

Adolescent↗

Searching for preventable causes of child mortality in Texas: trends in the major causes from 1987 through 1996.

We ranked the underlying causes of child deaths in Texas from 1989 through 1991 for the groups aged 1 through 4, 5 through 9, 10 through 14, and 15 through 19 years. External causes (injuries) accounted for 66% of child deaths, and 5 accounted for at least 100 deaths each: motor vehicle accidents, homicide, suicide, drowning, and burns. Of the deaths that had potential for primary prevention, more than 95% involved accidents, suicide, and homicide. Of the smaller number of deaths that had potential for secondary prevention, treatment of infectious conditions had the greatest potential. From 1987 through 1996, child deaths from all causes averaged 2498 per year. Natural causes averaged 871 per year; external causes averaged 1627 per year. Among the external causes, annual averages for accidents were 1089 deaths; for motor vehicle accidents, 703; for homicide, 334; and for suicide, 187. We used linear regression analyses to estimate trends in deaths and mortality rates. The only categories that experienced an increased number of deaths, despite a 12% increase in the population, were deaths from all causes in the adolescent age groups; from natural causes in all but the group aged 1 through 4 years; from external causes in the adolescent age groups; from suicide in all but the group aged 1 through 4 years; and from homicide in all age groups. The increased number of deaths was often lower than the increase in the population, resulting in lower mortality rates. The only mortality rates that increased were those from all causes in the group aged 15 through 19 years; from natural causes, in both adolescent age groups; from suicide, in the group aged 10 through 14 years; and from homicide, in all but the group aged 5 through 9 years. These trends suggest that primary prevention of child deaths in Texas should focus on external causes, particularly motor vehicle accidents, homicides, and suicides.

Adolescent↗

Chart documentation of clinical preventive services at 9 Texas clinics.

Documentation of clinical preventive services at 9 Texas family practice residency programs, community health centers, and public health regional clinics was examined. Assessment of 11 risks, counseling on those risks, and timeliness of 8 screening tests and immunizations were abstracted. Documentation of clinicians' risk assessment focused on tobacco use (56.4%), alcohol/drug abuse (45.8%), and excess weight (21.6%). Counseling was documented most often for nutrition (20.5%), family planning (11.6%), and physical activity (10.3%). Of the sites studied, public health regional clinics had the highest documentation of assessment and counseling. Community health centers were most up-to-date for diabetes and cholesterol screening. Family practice residencies documented the highest rate of counseling for obesity risk. Clinicians do not document risk assessment, counseling, or up-to-date screening tests and immunizations for most of their adult patients. Texas practitioners may need support or assistance to provide universal access to clinical preventive services.

Adult↗

Rates of abnormalities and infectious agents in cervical smears from female inmates in Texas: comparison with private and university clinic patients.

Inmates are generally considered a high-risk population for gynecologic neoplasia and sexually transmitted diseases. Cervical smears from prisoners of the Texas Department of Corrections (TDC) were expected initially to have higher rates of cellular abnormalities and infectious agents than do smears from the general population. The cytologic findings from 25,522 TDC gynecologic smears were compared with those of 6883 cases from The University of Texas Medical Branch (UTMB) affiliated physician private clinics, and with 56,178 from the UTMB hospital clinics. The period of study was from September 1995 to February 1998. This study revealed a 5.23% higher rate of abnormalities for TDC gynecologic smears as compared with that for the private clinic smears. However, the TDC rate of abnormalities was unexpectedly 1.08% lower than that for the UTMB clinic smears. These unexpected findings were probably the result of a more selected high-risk population referred to the UTMB clinics. The TDC smears showed also the highest incidence of trichomoniasis.

Ambulatory Care Facilities↗

Immunization status of children born to human immunodeficiency virus (HIV)-infected mothers in two Texas cities.

BACKGROUND: Because HIV-infected and HIV-exposed children are at risk of acquiring infectious diseases, they should be immunized. METHODS: We abstracted charts at pediatric HIV clinics in Dallas and San Antonio, matched the children to birth certificates and assessed up-to-date immunization status. RESULTS: Of the 178 children, 108 (61%) were up to date for the diphtheria-tetanus-pertussis (DTP), polio, and measles-mumps-rubella (MMR) series. In multivariate analysis, predictors of delayed immunization included maternal high-risk sexual partners and infant antiretroviral therapy. CONCLUSION: In this population of children born to HIV-infected mothers, immunizations were up to date in 61%, a figure that exceeds or equals immunization levels for other Texas children. Texas falls short of the recommended goal of 90% immunization for children of HIV-infected mothers and healthy children.

Child, Preschool↗

Storm-related mortality--central Texas, October 17-31, 1998.

On October 17, 1998, a series of storms moved across the central and south regions of Texas, dropping up to 22 inches of rain in some areas and spawning several tornados. Sixty Texas counties (24%) reported flooding during October 17-19. Thirty-six counties became eligible for federal and/or state assistance as a result of damages suffered from this storm system during October 17-31. Estimated flood damage was approximately $900 million, including damage to 12,000 homes, 700 businesses, and public property. This report summarizes findings of an epidemiologic investigation of 31 deaths associated with the storm system.

Adolescent↗

Escherichia coli O111:H8 outbreak among teenage campers--Texas, 1999.

In June 1999, the Tarrant County Health Department reported to the Texas Department of Health (TDH) that a group of teenagers attending a cheerleading camp during June 9-11 became ill with nausea, vomiting, severe abdominal cramps, and diarrhea, some of which was bloody. Two teenagers were hospitalized with hemolytic uremic syndrome (HUS), and two others underwent appendectomies. Routine stool cultures from eight ill persons failed to yield a pathogen. Stools subsequently were sent to laboratories at the Texas Department of Health and CDC, where Escherichia coli O111:H8 was isolated from two specimens. This report summarizes the investigation of this outbreak.

Adolescent↗

Prevalence of dyslexia among Texas prison inmates.

Approximately 80% of prison inmates are reported to be functionally illiterate. We hypothesized that poor single word decoding (the chief feature of dyslexia) accounts for a significant percentage of that rate. We studied 253 subjects selected randomly from more than 130,000 Texas prison inmates. Among them, we conducted a cross-sectional sample survey of recently admitted Texas inmates, beginning with social and educational background and followed by an educational test battery that included measures of word attack skill and reading comprehension. Deficient performance was defined primarily as single word decoding performance that measured below the 25th percentile on the Woodcock Reading Mastery Test. We found that 47.8% of the inmates were deficient in word attack skills. Word attack skills were detected in each group defined by gender and ethnicity. Nearly two thirds of the subjects scored poorly in reading comprehension.

Adolescent↗

Hoping for improved outcomes, Texas hospital aligns staffing for developmentally supportive care.

Take better care of fragile babies with a staff structure that encourages bonding. Texas Children's Hospital in Houston has been making big efforts to provide developmentally supportive care for babies since 1996. Still, neither staff nor physicians thought nurses knew their tiny charges well enough. Texas Children's hopes a new staffing structure will change all that. Discover the details.

Child Development↗

Underdiagnosis of dengue--Laredo, Texas, 1999.

Dengue outbreaks have been reported in communities along the Mexico-U.S. border since 1980; however, during 1987-July 1999, no cases were reported from Laredo, Texas (1999 population: 162,000). During January-July 1999, approximately 300-325 dengue cases were reported from Nuevo Laredo, Tamaulipas, Mexico (1999 population: 274,000), a city across the Rio Grande from Laredo. To determine whether undiagnosed or unreported dengue cases had occurred in Laredo, the Texas Department of Health (TDH) reviewed medical records from five Laredo health facilities (the two city hospitals and the three largest of five community clinics). This report summarizes the findings of the review, which indicated that during July 23-August 20, 1999, 50% of suspected case-patients had undiagnosed dengue infection. Recognition of the diagnosis of dengue can be improved through heightened surveillance, professional and public education, and prompt reporting of cases by the health-care providers to local or state health departments.

Antibodies, Viral↗

Do "conditions contributing to the death" clarify the predictors of infant mortality in Texas?

Predictors of infant mortality are usually based on the underlying causes reported on infant death certificates. Death certificates also contain space for "Other significant conditions contributing to the death but not resulting in the underlying cause." We investigated whether these "contributing conditions" might clarify the predictors of infant death in Texas or interventions that might reduce deaths from the underlying causes. A "multiple cause of death" file converted the underlying causes and contributing conditions associated with each infant death in 1996 into International Classification of Diseases codes. We ranked the major underlying causes, the conditions contributing to those causes, the conditions contributing to all infant deaths, and the effect of combining the underlying causes with contributing conditions to determine the main predictors of infant mortality. We found that extreme immaturity was the most common condition, causing or contributing to 604 of the 2081 deaths in 1996. We conclude that the underlying causes provide a misleading perception of the major predictors of infant death in Texas; combining them with the conditions contributing to those deaths provides a clearer picture. Given the powerful predictive value of preterm birth for infant mortality, the limited current ability to prevent preterm birth, and the cost of its complications, expanded efforts to improve understanding of its causal processes and develop preventive strategies should be top national and state priorities.

Cause of Death↗