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PubMed2004

The infectious disease profile of Texas prison inmates.

PURPOSE: Prison inmates present with higher rates of disease morbidity and mortality than the general population. The rates of certain infectious diseases such as hepatitis C, HIV/AIDS, and tuberculosis are reported to be particularly elevated in prison systems. Scarce information, however, exists on the overall infectious disease profile of inmate populations. The present study examined the prevalence of major infectious diseases in one of the nation's largest prison populations. METHODS: The study population consisted of 336,668 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions, sentencing factors, and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Latent tuberculosis infection constituted the most prevalent infectious disease reported among inmates. This was followed in frequency by hepatitis C, HIV/AIDS, and syphilis. Prevalence estimates for most of the infectious diseases under study exhibited substantial differences across gender, age, and ethnicity. CONCLUSION: The present study shows that the prison population had prevalence rates that were substantially higher for latent TB, HIV/AIDS, and hepatitis C than those reported for the general population and some incarcerated populations. The rate of active TB among TDCJ inmates, however, was comparable to that of the general population and other incarcerated populations.

Adolescent↗
PubMed2005

Primary care physicians' awareness and adherence to cervical cancer screening guidelines in Texas.

BACKGROUND: Cervical cancer screening guidelines were created to help healthcare professionals in appropriate screening utilizing the PAP test. However, significant variation in cervical cancer screening among primary care physicians has been noted. Knowledge of the awareness of and adherence to cervical cancer screening guidelines by primary care physicians will help determine how best to disseminate and educate these physicians regarding the guidelines in hopes of reducing unnecessary screening and improving screening for under screened populations. METHODS: A cross-sectional, mailed survey involving Family Medicine (FP), Community Internal Medicine (CIM), and Obstetrics/Gynecology (OB) physicians practicing in a large University-affiliated, multi-specialty group practice associated with an 186,000-member HMO in Central Texas (n = 177) was conducted in 2001-2002. RESULTS: Most physicians performed PAP testing (50.4%). PAP screening was noted to vary significantly by specialty (P < 0.0001). All OBs were aware of at least one published guideline, compared to 96% of FPs and 91% of CIMs (P < 0.05). A wide variation was reported regarding adherence to published guidelines. In addition, there was significant intraspecialty variation regarding adherence to the physicians' own specialty's guidelines. CONCLUSIONS: While most physicians in the primary care setting perform PAP tests and are aware of published guidelines for PAP screening, adherence to the published guidelines varies considerably even in the same clinical setting.

Adult↗
PubMed2003

Cross-border procurement of contraception. estimates from a postpartum survey in El Paso, Texas.

Along the US-Mexico border, US residents have the option of crossing to Mexico in order to purchase hormonal contraception sold over-the-counter at very low prices in pharmacies. We investigated the prevalence of cross-border contraceptive procurement by way of a survey of 3134 women who delivered in a large public hospital in El Paso, Texas, between 1996 and 1997. Pills, injectables, condoms and IUDs were the most commonly used methods by women in the birth interval preceding delivery. Among multiparous women, 41% of pills and 54% of injectables were obtained in Mexico. However, almost all condoms were obtained in the United States. In this largely Hispanic population, the prevalence of cross-border procurement was highest among women who were born and educated in Mexico. Discontinuation of pills and injectables was lower when obtained across the border than in the United States. These findings support the proposition that reducing the medical requirements to acquire pills and injectables and making them available at low cost would augment their use in low-income populations.

Contraceptives, Oral, Combined↗
PubMed2003

Hepatitis C seroprevalence among newly incarcerated inmates in the Texas correctional system.

The seroprevalence of hepatitis C (HCV) infection was examined among a sample of incoming inmates in the Texas Department of Criminal Justice (TDCJ) prison system. Rates were compared across demographic factors and three types of prison facilities: substance abuse felony punishment units (SAFPs), state jails and prisons. The study sample consisted of 3712 incoming inmates incarcerated for any duration, dating from 1 November 1998 to 31 May 1999. Among males, inmates entering SAFPs and state jails had comparable HCV infection rates (29.7 and 27.0%, respectively) to those entering prisons (27.3%). Among females, inmates entering prisons had a higher rate of infection (48.6%) than those entering state jails (35.1%) or SAFPs (38.3%). For both genders, blacks exhibited a lower overall infection rate than whites and Hispanics, and HCV seroprevalence increased in a stepwise fashion with age. All subgroups of TDCJ inmates, including those held in alternative correctional facilities, exhibited HCV infection rates that were comparable with previous reports of inmate populations, but dramatically higher than general community samples. Given that most inmates held in alternative facilities will return to the general community in a short period of time, understanding the HCV infection rates in these subgroups holds particular public health relevance.

Adolescent↗
PubMed1996

Incarceration and the acquired immunodeficiency syndrome: autopsy results in Texas prison inmates.

The Texas Department of Criminal Justice (TDCJ) houses many subjects with acquired immunodeficiency syndrome (AIDS) who receive medical care in a comprehensive AIDS treatment center. In this case-control autopsy survey, we compared pathological outcomes of TDCJ inmates treated at the center (n = 155) with nonincarcerated patients who died during the same period (n = 155). Using multiple regression analysis and a proportional hazards model, survival time in the prisoners was equivalent to that in the controls. With few exceptions, the prevalences of opportunistic viral, fungal, protozoal, and bacterial infections contributing to mortality were equivalent between groups. Mycobacterium tuberculosis was isolated more frequently in the inmates, and M avium intracellulare was isolated less frequently (P < .0001). The inmates had a higher prevalence of bacterial infection of the central nervous system (CNS) (9.1% v 1.4%; P < .006); half of all CNS bacterial infections were caused by M tuberculosis. Inmates had significantly lower prevalences of vacuolar myelopathy (P < .006) and severe wasting disease (P < .0009). We conclude that survival of prison inmates with AIDS treated in a comprehensive AIDS treatment center was equivalent to that of nonincarcerated subjects with AIDS. Prevalences of certain complications of AIDS differed in the inmates, showing that the prison environment influenced some of the underlying causes of AIDS morbidity and mortality.

AIDS-Related Opportunistic Infections↗
PubMed2000

Occurrence of cotton herbicides and insecticides in playa lakes of the High Plains of West Texas.

During the summer of 1997, water samples were collected and analyzed for pesticides from 32 playa lakes of the High Plains that receive drainage from both cotton and corn agriculture in West Texas. The major cotton herbicides detected in the water samples were diuron, fluometuron, metolachlor, norflurazon, and prometryn. Atrazine and propazine, corn and sorghum herbicides, were also routinely detected in samples from the playa lakes. Furthermore, the metabolites of all the herbicides studied were found in the playa lake samples. In some cases, the concentration of metabolites was equal to or exceeded the concentration of the parent compound. The types of metabolites detected suggested that the parent compounds had been transported to and had undergone degradation in the playa lakes. The types of metabolites and the ratio of metabolites to parent compounds may be useful in indicating the time that the herbicides were transported to the playa lakes. The median concentration of total herbicides was 7.2 microg/l, with the largest total concentrations exceeding 30 microg/l. Organophosphate insecticides were detected in only one water sample. Further work will improve the understanding of the fate of these compounds in the playa lake area.

Fresh Water↗
PubMed2003

Satisfaction with health care and cancer screening practices among women in a largely rural region of West Texas.

BACKGROUND: Satisfaction with medical care has been shown to influence patient behavior, but its effect on the use of preventive services is largely unstudied. This study examined whether women's satisfaction with the accessibility and quality of care was associated with the odds of receiving an annual clinical breast examination, conducting a monthly self-breast examination, or receiving an annual Pap smear. METHODS: A telephone survey was conducted among 675 women in West Texas, an area with a relatively high proportion of rural residents and Hispanics. Multiple logistic regression analyses were performed to model the odds of each screening practice. RESULTS: Women who rated the overall quality of their health care as excellent had a higher odds of receiving an annual clinical breast examination, conducting a monthly self-breast examination, and receiving an annual Pap smear. No rural/urban differences were revealed, but Hispanic women had a lower odds of conducting a self-breast examination than non-Hispanic Whites. CONCLUSIONS: Rural residence and Hispanic ethnicity were largely unassociated with cancer screening practices. Rather than directing outreach programs toward these subgroups, efforts to increase cancer screening among women may need to focus more on improving the quality of primary health care.

Adult↗
PubMed1986

Considerations of hospital viability in rural Texas.

The rural hospitals in Texas face the same situation as rural hospitals throughout the country. Unfortunately, little data are available to define the scope or possible duration of the problem. However, rural hospital administrators currently believe that their facilities are being hurt by increased government regulation and that today's figures on average daily census indicate that the problem could threaten their hospital's long-term viability. Initial investigations have shown that the problem of casualty is a complex one; multiple factors interact to exacerbate the situation, such as more stringent enforcement of Medicare certification standards, review of claims and quality of care by PROs, and the use of PPS. Other factors cited include the economic recession, the exodus of young people from rural areas to urban areas, the high cost of technology, and the preadmission review by insurance companies. A study that will both sample and survey rural hospital viability using financial ratio analysis and service utilization data is presently being undertaken to provide some responses to these concerns. Further, it will later examine how rural hospital administrators are responding to the problem of decreased hospital viability. It is possible that new coping strategies may be developed from the study results that will change present modes of health care delivery and result in regional networks and more diversified health care services.

Cost Control↗
PubMed1985

Self-esteem, ethnic identity, and behavioral adjustment among Anglo and Chicano adolescents in West Texas.

This study provides a comparison of similarities and differences with respect to ethnic identity between Anglo and Chicano adolescents from Texas. A path analysis model was used to test a theoretical assumption concerning proposed antecedents and consequences of self-esteem. Research instruments included the Rosenberg Self Esteem Scale, the Semantic Differential (scales for Myself and My Ethnic Group) and the McGuire White Measure of Social Status. Results were consistent with the interpretation that there is a relationship between being Chicano and having lower self-esteem, lower behavioral adjustment, and higher ethnic esteem. The prediction that ethnic esteem would mediate between ethnic group and self-esteem was upheld. Variables such as ethnic group membership per se and sex appear as or more important to the prediction of behavioral level. Clinical implications include recognizing that Chicanos low in self-esteem or behavioral adjustment should not automatically be considered unusual. The problems faced by this group are considered as having something in common with other groups of people who have more problems, lesser status, fewer resources, and fewer sources of available help.

Adolescent↗
PubMed2003

Air quality in the 21st century: community outreach in North Central Texas.

Public education campaigns, to be successful, must repeat simple, consistent messages over time, using various sources and media. During the 2000, 2001, and 2002 ozone seasons, the North Central Texas Council of Governments (NCTCOG) employed a four-pronged, multimedia approach to educate the public about air quality in the Dallas/Fort Worth (DFW) region. The four-pronged approach included several varied information sources:The new Air Pollution Watch/Warning system based on public health and designed using standard meteorological terminology with notices delivered via e-mail, over the radio, during TV weather forecasts, and on electronic road signs.A revamped Web page, including information about current air quality, ozone exceedances, clean air public meetings, and how to "Do Your Share for Cleaner Air".A PowerPoint presentation used to explain the basics of ozone air pollution, the new Air Pollution Watch/Warning system, and the new Dallas/Fort Worth Clean Air Plan to a variety of constituencies, including the media, scientific/technical/academic groups, elected officials, and community/civic organizations. Newsletter updates, published in the Environmental Resources Department's InsidER (with a circulation of around 1500), to educate and keep the public up-to-date about various air quality issues. This paper provides details about the four-pronged approach, and how it incorporates principles of successful public education campaigns.

Air Pollutants↗
PubMed1981

Hereditary benign intraepithelial dyskeratosis. A report of two cases from Texas.

Hereditary benign intraepithelial dyskeratosis (HBID) is a rare disorder characterized by autosomal dominant inheritance, onset in childhood, bilateral limbal conjunctival plaques, chronic relapsing course of ocular irritation and photophobia, and oral lesions resistant to medical and surgical therapy. The lesions are characterized histologically by dyskeratosis, acanthosis, parakeratosis, and a variable amount of subepithelial inflammation. The patients in all previously reported cases have been descendants of Halowar Indians from North Carolina. This report illustrates the typical clinical and histologic findings of HBID in two siblings who, along with their parents and grandparents, were born in Texas.

Adult↗
PubMed1985

Clinical aspects of cutaneous leishmaniasis acquired in Texas.

Five patients with cutaneous leishmaniasis are described. Four of these patients acquired leishmaniasis in Texas. Four cases represent acute cutaneous leishmaniasis, and one case probably represents chronic cutaneous leishmaniasis. The classification and treatment of cutaneous leishmaniasis are reviewed. One patient in this report was successfully treated with topical antimony cream. Cutaneous leishmaniasis must be considered in the differential diagnosis of nonhealing ulcerated papules and nodules even in patients who do not have a foreign travel history.

Acute Disease↗
PubMed2002

Syringe type and drug injector risk for HIV infection: a case study in Texas.

Studies of accidental needlestick exposure to blood containing human immunodeficiency virus (HIV) have shown that the volume of blood in an exposure is a strong predictor of subsequent infection. Illicit drug injectors, a group at elevated risk for HIV transmission, use syringes manufactured in two styles, one of which (the integral cannula type) retains substantially less blood after intravenous use than the other (the detachable needle type). In this report, we examine some of the factors associated with use of syringes with detachable needles among drug injectors in San Antonio, Texas using data from epidemiological surveys, ethnographic studies, and historical observations. We compare personal history of syringe type use with HIV serostatus in a sample of 501 active drug injectors interviewed and screened for HIV in 1997-1998. Ninety-nine percent of these respondents reported that they currently used only integral cannula syringes, but 13% had used a syringe with a detachable needle within the past 2 years, and 37% had used one in their lifetime. Only 9% had ever used one > or = 20 times in a year. Hispanic (Mexican American) respondents were significantly less likely than other ethnic groups to have ever used a detachable needle syringe. HIV seroprevalence was < 1% among heterosexual injectors who had never used a detachable needle syringe compared to 4% among those who had used one (p<0.05).

Adolescent↗
PubMed2003

Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA.

Several recent articles have pointed to the effect of social context on heart disease mortality after adjusting for individual level indicators. This study investigates the contributions of individual socioeconomic factors (sex, race, and education) and social context at the neighborhood level (wealth, education, social capital, and racial/ethnic composition), and the county level (social inequality, human and social capital, economic and demographic characteristics) on premature cardiovascular mortality. Death certificate information was obtained for all those who died of heart disease in Texas, USA, in 1991. Deaths were geocoded to obtain block-group, census tract, and county social context from the census. Multilevel hierarchical models quantified the contributions of individual characteristics and block-group, tract, and county social context on years of potential life lost to heart disease. Cross-level analyses investigated the interaction between individual and contextual factors. Being female, having more education, and residing in areas with higher median house value were associated with less premature mortality. Although blacks and Hispanics lost more years of life to heart disease than whites, blacks and Hispanics living in tracts with higher own racial/ethnic group density lost fewer years of life than their peers living in less homogenous tracts. At the county level, premature mortality was negatively associated with social capital. The tract and county level variances were statistically significant indicating the importance of social context to premature heart disease mortality. Plausible mechanisms through which these effects operate are explored. Social context at the block-group, tract, and county level played an important role, though a smaller role than individual factors, in explaining years of life lost to heart disease.

Black or African American↗
PubMed2000

Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center.

PURPOSE: Superior sulcus tumors (SST) of the lung are uncommon and constitute approximately 3% of non-small cell lung cancer (NSCLC). These tumors cause specific symptoms and signs, and are associated with patterns of failure that differ from those seen for NSCLC tumors in other nonapical locations. Prognostic factors and most effective treatments are controversial. We conducted a retrospective study at The University of Texas M. D. Anderson Cancer Center to identify outcome predictors for patients with SST treated by a multidisciplinary approach. METHODS AND MATERIALS: This retrospective review of 143 patients without distant metastasis at presentation is a continuation of a previous M. D. Anderson study now updated to 1994. In this study, we examine the 5-year survival rate by pretreatment tumor and patient characteristics and by the treatments received. Strict criteria were used to define SST. Actuarial life-table analyses and Cox proportional hazard models were used to compare survival rates. RESULTS: Overall predictors of 5-year survival were weight loss (p < 0.01), supraclavicular fossa (p = 0. 03), or vertebral body (p = 0.05) involvement, stage of the disease (p < 0.01), and surgical treatment (p < 0.01). Five-year survival for patients with Stage IIB disease was 47% compared to 14% for Stage IIIA, and 16% for Stage IIIB. For patients with Stage IIB disease, surgical treatment (p < 0.01) and weight loss (p = 0.01) were significant independent predictors of 5-year survival. Among patients with Stage IIIA disease, the only predictor of survival was Karnofsky performance score (KPS) (p = 0.02). For patients with Stage IIIB disease, the only independent predictor of survival was a right superior sulcus location, which was associated with a worse 5-year survival rate than that for patients with tumors in the left superior sulcus (p = 0.02). More patients with adenocarcinoma than with squamous cell tumors experienced cerebral metastases within 5 years (p < 0.01). Patients without gross residual disease after surgical resection who received postoperative radiation therapy with total doses of 55 to 64 Gy had a 5-year survival rate of 82% as compared with the 5-year survival rate of 56% in patients who received 50 to 54 Gy. Twenty-three patients survived for longer than 3 years. Of these, 4 patients (17%) received radiation therapy alone or in combination with chemotherapy without surgical resection. The other 19 patients (83%) had resection combined with radiation therapy and/or chemotherapy. CONCLUSIONS: The findings from this study confirm the importance of the new staging system, separating T3 N0 M0 (Stage IIB) from Stage IIIA, since there was a significant difference in the 5-year survival (p < 0.01). Interestingly, there was no significant 5-year survival difference between Stage IIIA (N2) and Stage IIIB (T4 or N3). This study also suggests that surgery is an important component of the multidisciplinary approach to patients with SST if their nodes were negative. Disease that is minimally invading surrounding normal structures can be resected followed by radiation therapy in doses of 55 to 64 Gy. Further investigation of treatment strategies combining high-dose radiation therapy (>/=66 Gy) with chemotherapy is indicated for patients with unresectable and/or node-positive (N2) SST.

Adult↗
PubMedDate not supplied

The Sam and Ann Barshop Center for Longevity and Aging Studies: the University of Texas Health Science Center at San Antonio.

The Sam and Ann Barshop Center for Longevity and Aging Studies is a focal point for advanced research designed exclusively to study the genes involved in aging and the diseases of aging. The research performed at the Barshop Center is based on a solid foundation of nearly twenty-five years of aging research at The University of Texas Health Science Center at San Antonio. Internationally recognized scientists in aging are now leading innovative research programs using state-of-the-art technologies in molecular and cellular biology to explore aging processes at the gene level in the four major programs that comprise the research at the Barshop Center: the Cellular Aging Program, the Invertebrate Aging Program, the Rodent Models of Aging Program, and the Human Genetics of Aging Program. The researchers involved in these programs share a common purpose in an atmosphere of collaboration to gain the scientific insights necessary to understand the molecular basis of aging. Their long-term goal is to gain the knowledge that will give rise to the development of interventions that retard or arrest the debilitating conditions associated with aging. February or March 2003 marks the groundbreaking for the first building of Barshop Center's new stand-alone facility. This is the initial step toward a $70 million, world-class research complex dedicated to the study of aging and healthy longevity.

Academic Medical Centers↗
PubMed2001

The impact of Put Prevention into Practice on selected clinical preventive services in five Texas sites.

OBJECTIVE: To determine whether the implementation of the Put Prevention Into Practice (PPIP) office-based system would increase the delivery rates of specific clinical preventive services among demonstration clinics. METHODS: Chart review was conducted before (n=372) and 33 to 39 months after (n=376) the implementation of the PPIP office-based system in two community health centers and three family practice residency programs in Texas. The population included all adult patients aged > or = 19 years who had presented to the clinic during the study periods. RESULTS: Documentation of timely cholesterol screening increased from 70% to 84%; smoking assessment, from 56% to 80%; for women, up-to-date Papanicolaou smear, from 70% to 81%; annual mammograms (women aged > or =51), from 30% to 48%; and up-to-date tetanus-diphtheria immunizations, from 19% to 59%. For adults aged > or =66 years, documentation of pneumococcal immunization increased from 22% to 48%, while influenza immunizations improved, although not significantly (45% to 49%). Blood pressure screening was almost universal (99%) at baseline and at 33- to 39-month follow-up. CONCLUSION: PPIP system changes were associated with an observed increase in delivery of selected clinical preventive services.

Aged↗
PubMed2001

HIV Seroprevalence among newly incarcerated inmates in the Texas correctional system.

PURPOSE: The seroprevalence of HIV infection was examined among a sample of incoming inmates in the Texas Department of Criminal Justice prison system. Rates were compared across sociodemographic factors and three types of prison facilities: substance abuse felony punishment units (SAFPs), state jails, and prisons. METHODS: The study sample consisted of 4386 incoming inmates incarcerated for any duration, dating from November 1, 1998, to May 31, 1999. RESULTS: Among males, inmates entering state jails had a higher HIV infection rate (3.7%) than either inmates entering prisons (1.9%) or those entering SAFPs (0.5%). Among females, inmates entering prisons had a higher rate of infection (9.3%) than those entering state jails (2.5%) or SAFPs (4.5%). CONCLUSIONS: Although a number of blinded HIV seroprevalence studies have been conducted in U.S. prison systems, scarce information is currently available on HIV infection rates in alternative correctional facilities. The present study shows that HIV seropositivity varied substantially according to race, gender, and prison facility type. Given the shorter incarceration periods for inmates held in alternative facilities, understanding how infection rates vary according to type of incarceration facility holds particular public health relevance.

Adolescent↗