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It is only fitting that a state as large and ethnically diverse as Texas should have such a broad array of home care programs delivered through licensed home and community support services agencies. Over the past 20 years, Texas has moved from a one-third community/two-thirds nursing home mix of long-term care clients to the exact opposite. The personal care programs have provided a stable base for expansion into the waiver programs.
What makes the VNA of Texas so special? After researching these questions for the better part of eight months, the author has concluded that there are seven reasons why the VNA of Texas is regarded as the home care agency that international experts wish to model.
OBJECTIVES: This study uses the counties of Texas to empirically test the predictions of Wilkinson's theory on the role of income and inequality in explaining health differentials in populations. Wilkinson predicts (1) that health is affected more by income inequality than average income in areas with large population, and (2) that health is affected more by average income than income inequality in areas with small population. We investigate how large the population of a unit must be for income inequality within the unit to affect mortality. METHODS: Measures of income inequality were computed from the 1990 U.S. census data and mortality was computed from Vital Statistics data. Poisson regressions estimated the age-adjusted relative risk of the top quintile relative to the bottom quintile for equality and for income among selections of Texas counties based on population size. County ethnic composition, educational level, and health care access were controlled for. RESULTS: Among counties with populations greater than 150,000, the risk of death was lower in counties with more equal income distribution than in counties with less equal income distribution. Among counties with population less than 150,000, median income affected relative risk in counties with less than 30 percent Hispanics, but not in those with more than 30 percent Hispanics. CONCLUSIONS: This study provides some support for the predictions of Wilkinson's theory.
To determine the usual approach to management of traumatic hyphema in Texas, we mailed a survey to ophthalmologists in the state who indicated a practice focus of either general ophthalmology or pediatric ophthalmology. The survey included inquiries regarding type of practice, patient population, frequency of traumatic hyphema, laboratory investigations, treatment precautions, medical and surgical treatment, criteria for hospitalization, and criteria for surgical intervention. Of the 495 surveys mailed out, 169 (response rate = 34.1%) were returned and filled out completely. More than half of the respondents do not routinely consider sickle cell testing in traumatic hyphema cases. We found no consensus regarding use of systemic antifibrinolytic agents, indications for hospitalization, or timing of surgical intervention. The results of this survey emphasize the lack of consensus surrounding treatment of traumatic hyphema. The relative paucity of sickle cell testing among Texas ophthalmologists, however, appears inconsistent with recommendations in the medical literature.
Coricidin products seemed to be one of the over-the-counter medications being reportedly abused by adolescents, as observed from the Texas Poison Center Network data. This retrospective chart review investigated the occurrence of abuse, developed a patient profile, and defined the clinical effects resulting from the abuse of Coricidin products. Data collected from the Texas Poison Center Network Toxic Exposure Surveillance System database included human exposures between 1998 and 1999, patients > or = 10y old, intentional use or abuse, and single substance ingestion of I of the tablet formulations of Coricidin. Thirty-three cases from 1998 and 59 cases from 1999 were reviewed. Of these cases, 85% met the inclusion criteria. Of the 7 medications searched, only 4 substances were coded for: Coricidin D, Coricidin D (long acting), Coricidin D (cold, flu & sinus) and Coriciding HBP. These contain a combination of dextromethorphan hydrobromide, chlorpheniramine maleate, phenylpropanolamine hydrochloride, and acetaminophen. Of the 78 cases, 63% were male and 38% were female. The mean age was 14.67 years, 77% being between 13 to 17 years old. Eighteen different symptoms were reported: tachycardia 50%, somnolence 24.4%, mydriasis and hypertension 16.7%, agitation 12.8%, disorientation 10.3%, slurred speech 9%, ataxia 6.4%, vomiting 5.1%, dry mouth and hallucinations 3.9%, tremor 2.6%, and headache, dizziness, syncope, seizure, chest pain, and nystagmus each 1.3%; 12.8% of the calls originated from the school nurse. The incidence of abuse reported increased 60% from 1998 to 1999. This worrisome trend suggests increased abuse of these products.
A ruling by a federal judge reinstating the tax exemption of St. David's Health Care System in Austin, Texas, has taught the Internal Revenue Service a hard lesson about the toughness of Texas. No one was happier with the judge's decision than St. David's President and Chief Executive Officer.
The Texas Department of Health's Newborn Screening Program screens for five inherited disorders: phenylketonuria (PKU), congenital adrenal hyperplasia (CAH), congenital hypothyroidism (CH), galactosemia (GAL), and sickle cell disease (SCD). The objective of this study was to determine the prevalence of these disorders and to describe ethnic and gender patterns in their distribution. Cases were identified from blood specimens collected at birth from live births in Texas from 1992 through 1998. During this time, the overall prevalence of these disorders per 10,000 live births was 0.70 for PKU, 0.21 for GAL, 4.18 for CH, 1.03 for CAH, and 3.92 for SCD. Ethnic and gender disparities were observed among PKU, CH, CAH, and SCD prevalence. Results suggest that unidentified mutations and environmental factors may exist that contribute to these patterns. This warrants further investigation to determine possible modifiable risk factors for populations with higher prevalence.
The Texas-Mexico border population has a high prevalence of neural tube defects (NTDs). In 1998, in an effort to reduce the risk of NTD-affected pregnancies, the US Food and Drug Administration mandated folic acid fortification of enriched grain products. Since then, the median serum folate and red blood cell (RBC) folate levels of US women aged 15 through 44 years has risen. During 1995 through 2000, serum and RBC folate levels of 170 Mexican American women residing on the Texas-Mexico border who had delivered live, normal infants within the previous 3 months were tested. The median serum folate levels rose 46%, and RBC folate levels rose 44%. The increase suggests that food fortification may be affecting folate levels among populations with economic and cultural barriers to consuming fortified foods. However, more data are needed before we can assess the impact of food fortification on NTD rates on the border.
The purpose of this study was to determine the amount of time Texas pediatric dentists spent, as both residents and in their professional position, in the treatment of special needs patients. In addition, an attempt was made to determine the dental services offered to these patients along with the barriers to obtaining care. A survey was mailed to the 334 members of the Texas Academy of Pediatric Dentistry. From the returned surveys (61.9% or 207/334) the following conclusions were drawn: 1) Most respondents had a significant portion of their training program devoted to special patient care, 2) Virtually all reported treating some special needs patients in their professional position, 3) Most provided conscious sedation and general anesthesia and adjuncts to behavior management for these patients, 4) Insufficient financial reimbursement was a major reason cited for not providing dental services to more of these patients.
Hip fracture, the most serious complication of osteoporosis, is associated with considerable morbidity and mortality. Knowledge of hip fracture-related mortality rates by age, sex, and ethnicity as well as temporal changes in mortality are important for health planners to implement programs aimed at awareness and prevention of hip fractures. This study determines adjusted death rates in Texas by age, sex, and ethnic group from 1990 through 1998 and describes trends in mortality during the 9-year period. Upward trends in mortality were observed for both sexes in whites and blacks. Hispanics showed trends toward decreasing mortality rates. The highest mortality rates were observed in whites, predominantly in persons 80 years and older. Furthermore, rates in men by ethnic group consistently exceeded those in women. As the population ages, hip fractures are becoming a major public health problem in Texas that will likely increase unless fall prevention strategies and treatment of osteoporosis in elderly people are improved.
From studying the deaths of Texas adolescents from injury during 1996 through 1998, we compiled data showing major causes. Injuries accounted for 3760 deaths and 75% of all adolescent deaths. Unintentional injuries (accidents) accounted for 65% of injury deaths and 49% of all deaths. Motor vehicle traffic accidents accounted for 74% of deaths from unintentional injuries and 36% of all deaths. Homicide accounted for 18% of deaths from injury and 14% of all deaths. Suicide accounted for 15% of deaths from injury and 11% of all deaths. The major single cause of adolescent death, assault with unspecified firearm, accounted for 483 deaths, 13% of injury deaths, and 10% of all deaths. Several age, gender, and ethnic differences were identified in risk of death from the various causes of injury, and these analyses may help target specific populations of Texas adolescents for strategies to prevent injuries.
We identified and followed 27,795 Texas-based employees of The Dow Chemical Company from 1940 through 1996. Overall, the study population experienced favorable mortality patterns when compared with external populations. We observed lower death rates for several major causes of death, including heart disease and many cancers, which may be indicative of the "healthy worker effect" and the absence of major health hazards from these manufacturing facilities. Previous studies of the chemical company found higher-than-expected rates of lung, kidney, and brain cancer. More lung cancer deaths than expected continue to occur when the plant population is compared with the US and Texas populations but not with the local 5-county region. The numbers of brain and kidney cancers were also greater than expected, but the risk is attenuating. These findings, taken together with previously reported studies that examined these lung, kidney, and brain cancers relative to exposures to specific hazardous agents, do not suggest an occupational etiology.
To assess attitudes toward and practices of complementary and alternative medicine (CAM) in Texas, a survey was developed and sent to 143 community preceptor physicians in September 2001. The results of the survey represent what the physicians of Texas believe about CAM as a practice and about the relationship of CAM to the medical community. Results indicate that the concept of CAM is relatively well accepted, continuing education is enthusiastically accepted, and support for medical school education is strong; however, physicians also report concerns over the attitudes of their colleagues toward CAM as well as a wide range of concerns about CAM therapy in general. The physicians verify that patients seem to expect them to be knowledgeable about CAM therapies and note some frustrations with the lack of opportunity for fact-based continuing education.
Do the personality styles of dentists significantly influence their sense of well-being in their profession? A recent study using the Bi/Polar Inventory of Core Strengths differentiated 218 Texas dentists into eight personality profiles. Patterns VII and V (both risking and practical) as a group reported significantly higher self-esteem, higher ability to cope with stress, lower psychological distress, higher satisfaction with dentistry, and greater likelihood of choosing dentistry again as a career, than did Patterns III and IV (both thinking and theoretical). The results suggest that Patterns VII and V may be the most compatible with dentistry, and Patterns III and IV the least compatible. Also, the practical orientation (preferred by nearly 80% of the Texas dentists sample over the theoretical orientation) may be the single most influential personality trait in terms of compatibility with dentistry. Implications arise in career counseling, dental school admissions committees, and counseling dentists dissatisfied with.
There is overwhelming evidence that all types of pain, either of malignant or nonmalignant origin, are undertreated. This is especially true of patients whose pain can only be relieved by strong narcotics. The disciplinary section of the Texas Medical Practice Act (MPA) contains ambiguous language that makes determining proper standards for the use of narcotics difficult. To clarify this, the Intractable Pain Treatment Act (IPTA) allows the use of narcotics to treat intractable pain, without regard to the etiology of the pain, and clarifies narcotic use standards by defining intractable pain. The IPTA brings Texas law more into conformity with federal law, which clearly states that narcotics have a proper place in the treatment of intractable pain even if the etiology is not established. Reluctance to use narcotics for selected patients with nonmalignant painful medical conditions stems from the mistaken belief that they will become narcotic "addicts." Data from the medical literature do not support such a contention; in fact, just the opposite is supported.
Four hundred sixty-nine serum samples were obtained from horses admitted to the internal medicine service of the Texas Veterinary Medical Center between Jan 1 and Dec 31, 1990. Serum samples were tested by ELISA for antibody to Borrelia burgdorferi. Of these 469 samples, 1 (0.2%) was repeatedly seropositive for the organism by ELISA. Confirmatory testing by protein immunoblot was negative. The observed seroprevalence was 0%; the upper bound of the 95% confidence interval was 0.6%. These findings indicate the evidence of infection with B burgdorferi is presently uncommon in horses in central Texas.
The prevalence of infection with human immunodeficiency virus (HIV) among hospitalized adults at a teaching hospital in West Texas was estimated by conducting a serological survey. Of the 2,458 patients tested, 12 (0.5%) were seropositive. All 12 were men of ages 28 through 50 years; 11 were white and 1 was Hispanic. Eleven were previously known to be HIV positive and were hospitalized for illnesses related to acquired immunodeficiency syndrome (AIDS). All seropositive patients were hospitalized on nonsurgical services of internal medicine, medical-surgical neurology, and family practice. These results indicated that the sampled population in West Texas showed a relatively low prevalence of HIV infection and that seropositive patients were predominantly white men hospitalized for AIDS-related illnesses.
Expenditures for health care in Texas during 1988 totaled $32.4 billion. Health spending by category of service and sources of payment was estimated and compared with estimates for prior years and with national trends. Texas differed from the nation as a whole in average annual increases in total spending, the percentage of spending for prepayment and administration, and the percentage of spending paid by consumers, the federal government, and private insurance. Proposed expansions in insurance coverage for the large proportion of uninsured Texans will probably require strong efforts to contain costs.