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PubMed1996

Use of Texas birth certificate data to predict measles immunization status.

Inadequate immunization has been a major cause of epidemic measles, but risk factors for inadequate immunization are poorly characterized. By using measles data bases and computerized birth certificate files, we identified a retrospective cohort of 1,070 Texas-born children who were aged 15 months to 10 years when they had measles during the 1988 to 1991 epidemics. We used measles and birth certificate data, including prenatal care and demographic information, to determine immunization status and risk factors for inadequate measles immunization. Risk factors predicting lack of immunization in children with measles in stepwise logistic regression were black ethnicity, urban residence, poor prenatal care, preschool age, and an unknown father. Birth certificates contain information that can predict inadequate measles vaccination and should be evaluated prospectively.

Birth Certificates↗
PubMed1997

Privatizing maternal and child health services in Texas: reinventing Title V programs.

In November 1994, the Texas Department of Health embarked upon a major initiative to "reinvent" maternal and child health services funded through the Title V Maternal and Child Health Block Grant and related state general revenue. This article describes the rationale, planning process, and implementation issues associated with the initiative to redefine the fundamental roles and priorities of the department and traditional public health entities in the delivery of maternal and child health services.

Aid to Families with Dependent Children↗
PubMed2004

Correlative analysis of the results of surgical treatment of thoracolumbar injuries with long Texas Scottish rite hospital construct: is the use of pedicle screws versus hooks advantageous in the lumbar spine?

This is a prospective, randomized study to compare the efficacy of two similar "long-segment" Texas Scottish Rite Hospital instrumentations with the use of hooks in the thoracic spine and pedicle screws versus laminar hook claw in the lumbar spine for thoracolumbar A3, B, and C injuries. Forty consecutive patients with such thoracolumbar fractures (T11-L1) associated with spinal canal encroachment underwent early operative postural reduction and stabilization. The patients were randomly sampled into two groups: Twenty patients received hooks in "claw configuration" in both the thoracic and the lumbar spine (group A), and 20 patients received hooks in the thoracic vertebrae and pedicle screws in the lumbar vertebrae (group B). Pre- and postoperative plain roentgenograms and computed tomography scans were used to evaluate any changes in Gardner post-traumatic kyphotic deformity, anterior and posterior vertebral body height at the fracture level, and spinal canal clearance (SCC). All patients were followed for an average period of 52 months (range 42-71 months). The correction of anterior vertebral body height was significantly more (P < 0.01) in the spines of group B (33%) than in group A (16%), with a subsequent 11% loss of correction at the latest evaluation in group A and no loss of correction in group B. There were no significant differences in the changes of posterior vertebral body height and Gardner angle between the two groups. The SCC was significantly more (P < 0.05) immediately postoperatively in the spine of group B (32%) than in group A (19%). In the latest evaluation, there was a 9% loss of the immediately postoperatively achieved SCC in group A, while SCC was furthermore increased at 10.5% in group B. All patients with incomplete neurologic lesions in groups A and B were postoperatively improved at 1.1 and 1.7 levels, respectively. There were two hook dislodgements in the thoracic spine, one in each group, while there was no screw failure in group B. There was neither pseudarthrosis nor neurologic deterioration following surgery. Visual Analog Pain Scale and Short Form-36 scores were equally improved and did not differ between the two groups. The use of pedicle screws in the lumbar spine to stabilize the lowermost end of a long rigid construct applied for A3, B, and C thoracolumbar injuries was advantageous when compared with that using hook claws in the lumbar spine because the constructs with screws restored and maintained the fractured anterior vertebral body height better than the hooks without subsequent loss of correction and safeguarded postoperatively a continuous SCC at the injury level.

Adolescent↗
PubMed2000

Prevalence of antibody to hepatitis A virus in drinking water workers and wastewater workers in Texas from 1996 to 1997.

To determine if wastewater workers had a higher prevalence of antibody to hepatitis A virus (anti-HAV) than drinking water workers, a convenience sample of Texas wastewater and drinking water workers was evaluated for risk factors by questionnaire and tested for anti-HAV. A total of 359 wastewater and 89 drinking water workers participated. Anti-HAV positivity was 28.4% for wastewater and 23.6% for drinking water workers. After adjustment for age, educational attainment, and Hispanic ethnicity, the odds ratio for the association between anti-HAV positivity and wastewater industry employment was 2.0 (95% confidence interval, 1.0 to 3.8). Among wastewater workers, never eating in a lunchroom, > or = 8 years in the wastewater industry, never wearing face protection, and skin contact with sewage at least once per day were all significantly associated with anti-HAV positivity in a model that adjusted for age and educational attainment. Wastewater workers in this study had a higher prevalence of anti-HAV than drinking water workers, which suggested that wastewater workers may have been at increased risk of occupationally acquired hepatitis A. Work practices that expose workers to wastewater may increase their risk.

Adult↗
PubMed2001

An updated mortality study of workers at a petroleum refinery in Beaumont, Texas, 1945 to 1996.

The present investigation represents an update of a previous cohort mortality study of 7543 workers who were employed at a petroleum refinery in Beaumont, Texas, for at least 1 year between 1945 and 1996. The updated study covered an observation period of 51 years, from 1946 to 1996, with a total of 208,627 person-years of observation. A total of 3020 (40.0%) cohort members were known to have died. The mortality data were analyzed in terms of cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs). The overall mortality of the cohort was significantly lower than expected when compared with that of the general US population (SMR, 95.7; 95% CI, 92.3 to 99.2). Overall cancer mortality was also lower than expected (SMR, 85.8; 95% CI, 79.4 to 92.5). For specific cancer sites, significant mortality deficits were observed for the following: buccal cavity and pharynx, esophagus, large intestine, rectum, larynx, lung, and bladder and other urinary organs. No significant increase was reported for any site-specific cancer. A non-significant increase in acute myeloid leukemia was observed among male employees (SMR, 147.2; 95% CI, 76.1 to 257.2). Detailed analyses indicated that the excess was restricted to workers hired before 1950. No increase was detected for other leukemia cell-types, non-Hodgkin's lymphoma, or multiple myeloma. For non-malignant diseases, the majority of SMRs were below 100, and no significant increase was observed for any cause. In particular, significant mortality deficits were reported for ischemic heart disease (SMR, 91.0; 95% CI, 85.4 to 96.9), non-malignant respiratory disease (SMR, 61.5; 95% CI, 52.2 to 72.0), pulmonary fibrosis (SMR, 51.0; 95% CI, 22.0 to 100.4), cirrhosis of the liver (SMR, 47.2; 95% CI, 30.6 to 69.7), and accidents (SMR, 81.7; 95% CI, 66.3 to 99.6). Separate analyses of male workers by job classification (process and maintenance) were conducted. Mortality from acute myeloid leukemia was elevated among employees in maintenance jobs (8 observed deaths vs 4.31 expected; SMR, 185.5; 95% CI, 80.1 to 365.6). However, no upward trend by length of service was found. A detailed analysis indicated that the acute myeloid leukemia mortality excess was limited to maintenance workers who were hired before 1950. No other significant excess was detected for any cause among maintenance or process workers. These findings from the present study were discussed in conjunction with results from previous investigations of employees at the Beaumont refinery and with results from other refinery studies. Potential limitations of the study were also discussed.

Adult↗
PubMed1996

Improving the reporting of notifiable diseases in Texas: suggestions from an Ad Hoc Committee of providers.

In an effort to increase passive surveillance in Texas, an ad hoc committee of private and public health providers met to suggest changes in the list of reportable diseases and ways to improve provider participation. This group noted several reasons to make changes in the list of reportable diseases. Deletion was suggested for diseases whose reports did not warrant action from public health authorities or for previously common diseases, which were now rare and occurred as isolated events. Reasons to add a disease were recognition of new conditions of public health importance or the observation that a previously rare disease was now becoming common. It was the group's consensus that diseases reportable by law need to reflect realistic public health responses.

Disease Notification↗
PubMed1999

The role of private physicians in STD control in two inner-city communities in Houston, Texas.

Although sexually transmitted diseases (STDs) are particularly widespread in poor, largely minority, inner-city areas, little is known about the role private physicians play in these communities in STD control. A cross-sectional mail survey of private physicians potentially involved in STD management in two inner-city communities in Houston, Texas with STD prevalence rates well above city, state, and national averages was conducted to find the level and type of STD care provided. Twenty-seven of 65 physicians completed the survey. The survey found that the preventive orientation among private providers of medical care in these inner-city communities has to be increased to effectively control STDs.

Cross-Sectional Studies↗
PubMed2001

Comparison of vaccine coverage levels from the National Immunization Survey and the Texas Retrospective Immunization Survey.

The purpose of this study was to compare National Immunization Survey (NIS) vaccine coverage rates with Texas Retrospective Immunization Survey (TRIS) vaccine coverage levels. Up-to-date rates for children 19 through 35 months of age as of October 1, 1994, were calculated for single vaccines and two vaccine combinations. The TRIS weighted statewide up-to-date rates for 4-3-1 and 4-3-1-3 were 66 percent and 60 percent, respectively, versus 71 percent and 68 percent for the NIS. Existing retrospective survey procedures can be modified to produce results that may be compared with the NIS.

Child, Preschool↗
PubMed2001

Mumps surveillance: results of improved case investigation and serologic testing of suspected cases, Texas, 1995-1996.

Mumps, one of several once common childhood diseases, is targeted for elimination in the United States by 2010. To improve its ability to monitor mumps cases, the Texas Department of Health began requiring investigation and serologic testing of all mumps reports. During 1995-1996, of 500 mumps reports, only 14.4 percent were confirmed cases and they had a different demographic profile than unconfirmed cases. To accurately assess whether the nation achieves the Year 2010 mumps elimination goal, and to effectively direct elimination efforts, states must investigate and serologically confirm all mumps reports and use the case definition for public health surveillance.

Adolescent↗
PubMedDate not supplied

A study of local public health system performance in Texas.

In summer 2001, 47 local public health agencies in Texas evaluated their public health systems using a modified version of the Local Public Health System Performance Assessment Instrument. A concurrent investigation sought to describe the performance of these systems in the aggregate and identify local health agency characteristics and other factors associated with system performance. High system performance was associated with larger community size, higher community socioeconomic status, greater public health agency capacity, and agency contribution to system performance. These findings raise questions concerning the expectation that all local public health systems, regardless of the core agency's capacity, should be able to attain the performance standards.

Catchment Area, Health↗
PubMedDate not supplied

Ensuring quality preventive care: the Texas Department of Health's Put Prevention into Practice initiative.

In the current public health arena, assurance of quality clinical preventive services to all populations will be possible only if collaborations are nurtured between public health and the private sector health care delivery systems. This article explores key preventive health programs that serve as the historical context for the evolution of the Texas Department of Health-Put Prevention Into Practice (TDH-PPIP) initiative, outlines documented barriers to implementation of preventive services in primary care, and reviews national public health programs launched to reduce these barriers. Lastly, a discussion regarding the joint responsibilities of the public health and the private sector professionals in assuring quality preventive services to all populations is initiated. Collaborative efforts, such as the TDH-PPIP, initiative improve the availability and quality of clinical preventive services and, thus, result in significant advances in the public health goal of ensuring conditions in which people can be healthy.

Delivery of Health Care↗
PubMed2007

Microbial keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban county hospital in north Texas.

PURPOSE: To review the epidemiology, risk factors, microbiologic spectrum, and outcomes of microbial keratitis and to compare cases in which a causative organism is identified to those determined to be sterile during a 5-year period at a large county hospital in north Texas. METHODS: A retrospective chart review of cases of microbial keratitis at Parkland Memorial Hospital between January 2000 and December 2004. RESULTS: During this 5-year period, 132 eyes of 131 patients underwent 139 corneal scrapings for presumed microbial keratitis and an organism was reported in 73 (52.5%) cultures. Including abnormal confocal microscopy results, a causative organism was determined in 78 (56.1%) cases. At least one risk factor was present in 115 (87.1%) cases, with the most common risk factors being preexisting ocular disease, contact lens wear, and a history of trauma. Nearly 5% of patients reported a history of cocaine use. Gram staining correctly identified the organism in 20 (28.6%) culture-positive cases, and Pseudomonas aeruginosa was the most common isolate, followed by Staphylococcus aureus. The rate of S. aureus resistance to fluoroquinolones (15.4%) was similar to rates previously reported from the early to mid 1990s, but less than those reported from the late 1990s. Severe complications were more common in the nonsterile subgroup (34.2%) than in the sterile (16.9%) subgroup (P=0.041). Although the rate of acute intervention was higher in the nonsterile subgroup (27.4%) than in the sterile subgroup (20.3%), this difference was not statistically significant (P=0.461). Mean logMAR visual acuity was 1.451 (Snellen equivalent, 20/563) at presentation and 1.062 (20/231) at the last follow-up visit (P<0.001). Presenting and final visual acuities were significantly better in the sterile subgroup than in the nonsterile subgroup (P<0.001 and P=0.002, respectively). CONCLUSIONS: When a causative organism is not identified in microbial keratitis, visual acuity is not as severely affected, and fewer severe complications occur. Antibiotic resistance to fluoroquinolones and aminoglycosides, though not common, still deserves consideration in the treatment of microbial keratitis.

Adolescent↗
PubMed2005

Emergence of a predominant clone of community-acquired Staphylococcus aureus among children in Houston, Texas.

BACKGROUND: Community-acquired (CA), methicillin-resistant Staphylococcus aureus (MRSA) infections among children are increasing in the United States. At Texas Children's Hospital (TCH), surveillance has been in place since August 2001. The objectives of this study were to describe the distribution of CA S. aureus among patients at TCH and to study genomic relationships of isolates collected between August 2001 and July 2003. METHODS: Genomic relationships were determined with repetitive element-polymerase chain reaction (PCR). Multilocus sequence typing was performed for selected strains representing major clones. Molecular characterization of CA-MRSA was performed with PCR, including staphylococcal cassette chromosome (SCCmec), pvl (lukS-PV plus lukF-PV), hla, hlb and selected microbial surface components recognizing adhesive matrix molecule genes, ie, cna, clfA, fnbA and fnbB. RESULTS: A 62% increase was observed in CA S. aureus infections from year 1 (2001-2002) to year 2 (2002-2003), whereas the annual number of hospital admissions was unchanged. CA methicillin-sensitive S. aureus isolates were more likely to be associated with invasive infections than were CA-MRSA isolates (P < 0.01). TCH clone A, sequence type (ST) 8, was responsible for approximately 94% of all CA-MRSA isolated from children in the greater Houston area. Clone A differed from clones B (ST30) and C (ST1) by lacking the cna gene while carrying the fnbB gene. CONCLUSIONS: One CA-MRSA clone, TCH clone A, has become the predominant cause of CA S. aureus infections among children in the Houston area. It causes a wide spectrum of diseases, including complicated pneumonia.

Bacteremia↗
PubMed2006

Patients who leave our emergency department without being seen: the Texas Children's Hospital experience.

OBJECTIVES: As the number of individuals seeking emergency care has increased during the last decade, the challenges facing emergency departments (EDs) have grown. These include overcrowding, increasing wait times, and an increasing number of patients who leave without being seen by a medical professional. We sought to describe the clinical characteristics of patients leaving the Texas Children's Hospital (TCH) ED without being seen during 1.5-year period as well as the predictors of further treatment received by these patients. METHODS: We prospectively conducted a simple random sample of patients who left the TCH ED without being seen to determine their demographic and clinical characteristics as well as their clinical outcomes. Frequencies and measures of central tendency were used to describe the study population. Univariate and multivariate analyses were conducted to determine the predictors of receiving treatment elsewhere after leaving the TCH ED. RESULTS: Almost all study patients identified a primary care provider (PCP), and the most patients who left sought care with their PCP within 8 hours. Almost half the patients arrived during the busy evening hours between 7 and 11 pm, and the median wait time before leaving was 3 hours. Almost half of the patients reported receiving treatment elsewhere, and 4% were admitted elsewhere. Those ill longer than 24 hours were almost 3 times as likely to receive treatment elsewhere. Almost all patients were clinically better by the time of telephone follow-up, and no patient had died. CONCLUSIONS: Our findings suggest that most patients who leave the ED without being seen have PCPs and seek care elsewhere after they leave. However, most patients are not sick enough to warrant admission elsewhere and probably could have waited to see their PCP rather than come to the ED.

Adolescent↗
PubMed2003

Work-related injury among south Texas middle school students: prevalence and patterns.

BACKGROUND: Work experiences among early adolescents are largely undocumented. Our purpose was to document the prevalence of work and work-related injury among lower-income Hispanic South Texas middle school students. METHODS: Anonymous surveys were conducted in classrooms of sixth- through eighth-grade students, and 3,008 students reported current or recent employment. RESULTS: The prevalence of work was 56%; mean weekly work hours were 7.7. Increasing weekly work hours were significantly related to work injury (11-20 hours, odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-1.9; 21+ hours, OR, 2.4; 95% CI, 1.8-3.2, compared with 1-10 hours). The odds of injury were highest for agriculture (OR, 4.4; 95% CI, 3.3-6.0), followed by restaurant (OR, 3.8; 95% CI, 2.7-5.4), construction (OR, 3.6; 95% CI, 2.4-5.2), and yard work (OR, 1.7; 95% CI, 1.4-2.2). CONCLUSION: Working more than 20 hours weekly increased the likelihood of injury among middle school students. Parents and professionals should monitor weekly school-year work hours.

Accidents, Occupational↗
PubMed2003

Oil production and groundwater quality in the Edwards-Trinity Plateau Aquifer, Texas.

Chloride concentrations and chloride/bromide ratios from 198 water wells in the Edwards-Trinity Plateau Aquifer were compiled, mapped, and evaluated within the context of regional geology and land use. The study area occupies eight counties in west-central Texas, within which oil production and agriculture are predominant land uses. Samples from 49 wells had chloride concentrations above the 250 mg/l secondary drinking water standard, 22 samples had greater than 500 mg/l chloride, and 9 samples exceeded 1000 mg/l chloride. Of the 22 samples above 500 mg/l chloride, 10 had relatively low chloride/bromide ratios of less than 300, consistent with oilfield brine, and 2 had ratios above 2000, consistent with groundwater impacted by evaporite dissolution. The remaining ten samples had chloride/bromide ratios ranging from 300 to 2000, consistent with partial mixing of unimpaired groundwater with evaporite-laden water. There were no significant correlations between chloride concentration and well depth, inconsistent with contaminants originating at the land surface. Results of this study suggest that evaporite dissolution and oilfield brine locally impact the Edwards-Trinity Plateau Aquifer, but the problem is not regionally pervasive.

Bromides↗
PubMed1996

Measuring service quality at the University of Texas M.D. Anderson Cancer Center.

Evaluates the service quality of four clinics at the University of Texas M.D. Anderson Cancer Center using a questionnaire methodology. The SERVQUAL instrument was administered to patients of the Medical Breast, Leukemia, Medical Gastroenterology and Bone Marrow Aspiration clinics. Results show that, according to the service gap methodology of comparing expectations and perceptions, across all four clinics the issues of billing accuracy and waiting times are deemed by patients as significant problems. In comparing the individual clinics, the Medical Gastroenterology and Leukemia clinics are best performers and the Medical Breast clinic is the worst. However, these differences in performance are due to differences in patients' expectations of service quality, rather than differences in perceptions. Concludes that customer expectations can have a strong impact on a firm's evaluation of its service quality.

Bone Marrow Neoplasms↗
PubMed2004

Texas physicians' perceptions of genomic medicine as an innovation.

Primary care providers (PCPs) are believed to be the professionals who, in the near future, will be responsible for incorporating genomic medicine (GM) into primary care. Given the dearth of empirical data describing PCPs' beliefs about GM and the relationship between beliefs and the incorporation of GM into practice, this study assessed whether (and to what extent) PCPs' perceptions of GM as an innovation influence their likelihood of adopting this innovation into primary care. The study utilized diffusion of innovations theory as a framework. A state-wide representative sample of PCPs practicing in Texas responded to a mailed survey. The survey measured PCPs' perceptions of five characteristics of GM as an innovation. Findings suggest that among the five characteristics examined GM's relative advantage, compatibility with current practice, its complexity, and observability were the strongest predictors of likelihood to adopt GM tasks into primary care practice.

Adult↗