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Perception of learning needs and preferred learning methods about AIDS/HIV among registered nurses working in the community in Texas.

It is important for nurses and other healthcare workers to recognize that patients who present themselves for health care could already be infected with human immunodeficiency virus (HIV). Therefore, appropriate and sensible infection control precautions should be taken at all times. An assessment of nurses' knowledge of acquired immunodeficiency syndrome (AIDS)/HIV provides information to guide further continuing education efforts. This study describes the learning needs and preferred learning methods regarding AIDS/HIV among registered nurses working in a community in Texas. Respondents confirmed the need for important content areas regarding primary, secondary, and tertiary prevention such as universal precautions, protection from infectious diseases, and occupational hazards for healthcare providers. Several teaching methodologies were included. Self-paced instruction was the least preferred teaching-learning method; hands-on methodology was most preferred for the topics of clinical manifestations, long-term care, testing, and counseling.

Attitude of Health Personnel↗

Texas nurses respond to mandatory continuing education.

This study investigated Texas nurses' attitudes toward mandatory continuing education, and their perceptions of skill improvement, knowledge enrichment, and improvement of health care to the public as a result of participation in continuing education programs. Seventy-two percent of the respondents had a positive attitude toward mandatory continuing education. Significant relationships were present between the attitudes and the perceptions of psychomotor skills improvement, cognitive improvement, affective skills improvement, and health care to the public. Four variables were predictive of the attitude toward mandatory education. In addition, the nurses preferred lecture or discussion formats and independent providers of continuing education.

Adult↗

Changing populations in the public sector: responding to the needs of Texas youth.

Treatment of sexually abused and abusing youth requires careful program planning and implementation. Led by its Quality Improvement Council and with considerable staff involvement, Waco Center for Youth in Waco, Texas developed a dual-track approach to treatment of this underserved, often misunderstood, adolescent client population. The sexual abuse survivors' program focuses on the issues of trust, safety, self-esteem, assertiveness, and education. The sex offender program is built on the concepts of self-responsibility; diminishing cognitive distortions; identification of stressors, and their relationship to the offending cycle; and relapse prevention. The staff of Waco Center for Youth are engaged in ongoing analysis of behavioral indicators for successful treatment of sexually abused and abusing adolescents.

Adolescent↗

Medication treatment for the severely and persistently mentally ill: the Texas Medication Algorithm Project.

This article provides an overview of the issues involved in developing, using, and evaluating specific medication guidelines for patients with psychiatric disorders. The potential advantages and disadvantages, as well as the essential elements in the structure of algorithms, are illustrated by experience to date with the Texas Medication Algorithm Project, a public-academic collaboration. Phase 1 entailed assembling research findings on the efficacy of medications for schizophrenic, bipolar, and major depressive disorders. This knowledge was evaluated for its quality and relevance, integrated with expert clinical judgment as well as input by practicing clinicians, family advocates, and patients. Phase 1 (the design and development of the algorithms) was followed by a feasibility test (Phase 2). Phase 3 is an ongoing evaluation comparing the clinical and economic effects of using specific medication guidelines (algorithms) versus treatment as usual in public sector patients with severe and persistent mental illnesses.

Algorithms↗

The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms.

BACKGROUND: In the Texas Medication Algorithm Project (TMAP), detailed guidelines for medication management of schizophrenia and related disorders, bipolar disorders, and major depressive disorders have been developed and implemented. DISCUSSION: This article describes the algorithms developed for medication treatment of schizophrenia and related disorders. The guidelines recommend a sequence of medications and discuss dosing, duration, and switch-over tactics. They also specify response criteria at each stage of the algorithm for both positive and negative symptoms. The rationale and evidence for each aspect of the algorithms are presented.

Algorithms↗

The Texas Medication Algorithm Project Patient and Family Education Program: a consumer-guided initiative.

Educating patients with mental illness and their families about the illness and its treatment is essential to successful medication (disease) management. Specifically, education provides patients and families with the background they need to participate in treatment planning and implementation as full "partners" with clinicians. Thus, education increases the probability that appropriate and accurate treatment decisions will be made and that a treatment regimen will be followed. The Texas Medication Algorithm Project (TMAP) has incorporated these concepts into its philosophy of care and accordingly created a Patient and Family Education Program (PFEP) to complement the utilization of medication algorithms for the treatment of schizophrenic, bipolar, and major depressive disorders. This article describes how a team of mental health consumers, advocates, and professionals developed and implemented the PFEP. In keeping with the TMAP philosophy of care, consumers were true partners in the program's development and implementation. They not only created several components of the program and incorporated the consumer perspective, but they also served as program trainers and advocates. Initially, PFEP provides basic and subsequently more in-depth information about the illness and its treatment, including such topics as symptom monitoring and management and self-advocacy with one's treatment team. It includes written, pictorial, videotaped, and other media used in a phased manner by clinicians and consumer educators, in either individual or group formats.

Algorithms↗

Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design.

BACKGROUND: Medication treatment algorithms may improve clinical outcomes, uniformity of treatment, quality of care, and efficiency. However, such benefits have never been evaluated for patients with severe, persistent mental illnesses. This study compared clinical and economic outcomes of an algorithm-driven disease management program (ALGO) with treatment-as-usual (TAU) for adults with DSM-IV schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD) treated in public mental health outpatient clinics in Texas. DISCUSSION: The disorder-specific intervention ALGO included a consensually derived and feasibility-tested medication algorithm, a patient/family educational program, ongoing physician training and consultation, a uniform medical documentation system with routine assessment of symptoms and side effects at each clinic visit to guide ALGO implementation, and prompting by on-site clinical coordinators. A total of 19 clinics from 7 local authorities were matched by authority and urban status, such that 4 clinics each offered ALGO for only 1 disorder (SCZ, BD, or MDD). The remaining 7 TAU clinics offered no ALGO and thus served as controls (TAUnonALGO). To determine if ALGO for one disorder impacted care for another disorder within the same clinic ("culture effect"), additional TAU subjects were selected from 4 of the ALGO clinics offering ALGO for another disorder (TAUinALGO). Patient entry occurred over 13 months, beginning March 1998 and concluding with the final active patient visit in April 2000. Research outcomes assessed at baseline and periodically for at least 1 year included (1) symptoms, (2) functioning, (3) cognitive functioning (for SCZ), (4) medication side effects, (5) patient satisfaction, (6) physician satisfaction, (7) quality of life, (8) frequency of contacts with criminal justice and state welfare system, (9) mental health and medical service utilization and cost, and (10) alcohol and substance abuse and supplemental substance use information. Analyses were based on hierarchical linear models designed to test for initial changes and growth in differences between ALGO and TAU patients over time in this matched clinic design.

Adolescent↗

Rio Grande--a new phlebotomus fever group virus from south Texas.

Three strains of a new Phlebotomus fever group virus were isolated from pack rats (Neotoma micropus) collected in south Texas during 1973--1974; the name Rio Grande was proposed for this virus. The virus is pH 3.0 labile, sensitive to the action of sodium deoxycholate and heat (56 degrees C) labile. The results of a serosurvey indicated that pack rats are probably the principal vertebrate host for Rio Grande virus and that year-round transmission of the virus may occur. Because no isolations of this virus were made from hematophagous insects, the vector, if any, remains undetermined.

Animals↗

Aedes aegypti in a Texas coastal county as an index of dengue fever receptivity and control.

Since Galveston County, Texas, is one of the high risk areas for the reintroduction of dengue, we have maintained an Aedes aegypti surveillance program since 1977 by using ovitraps to determine the density and distribution of this species in 17 communities. A. aegypti adults were present primarily from May thrugh November, with higher positive ovitrap rates associated with periods of low rainfall. Larvae collected from six different communities, when compared with a standard, insecticide-susceptible strain exhibited only 2 X greater tolerance to malathion and chlorpyrifos. Similar results were obtained with malathion susceptibility tests of adults. Ultra-low volume malathion treatments of caged A. aegypti in a residential city block yielded good kills in the proximal but not the distal half of the block. Ovitraps in a two square-block area, treated with single pellets of chlorpyrifos, were less frequently positive and contained a smaller average number of eggs per trap than untreated traps in the surrounding area.

Aedes↗

Dermal leishmaniasis in a Texas cat.

Leishmaniasis was diagnosed by demonstrating amastigotes of Leishmania from dermal lesions on the ear of a male long-haired domestic cat from Uvalde, Texas. Leishmania from the cat were propagated in Syrian hamsters, bovine macrophages, and in NNN medium. The organism, in the L. mexicana complex, is apparently the same as that reported from recent human cases in the same area.

Animals↗

Isolation of Borrelia burgdorferi from arthropods collected in Texas.

The Texas Department of Health Laboratory cultured arthropods from November 1988 through December 1989 in an attempt to isolate Borrelia burgdorferi, the etiologic agent of Lyme disease. Spirochetes were isolated from eight of 1,093 pools of arthropods cultured. The spirochetal isolates were from several tick and one flea species, including Amblyomma americanum, A. maculatum, Ixodes scapularis, and Ctenocephalides felis. These 8 isolates reacted specifically when treated with monoclonal antibodies to B. burgdorferi. Polyacrylamide gel electrophoresis of six lysates showed them to be virtually identical with strain B31 of B. burgdorferi.

Animals↗

Cocirculation of multiple hantaviruses in Texas, with characterization of the small (S) genome of a previously undescribed virus of cotton rats (Sigmodon hispidus).

An environmental and laboratory investigation was conducted after a fatal childhood case of hantavirus pulmonary syndrome occurred in Deaf Smith County, Texas in May 1995. A trapping campaign was conducted to identify possible rodent carriers. Six species of murid and heteromyid rodents were collected, and at least one hantavirus-seropositive specimen was found in each of the five murid species. Tissues from a selection of 11 seropositive specimens were examined by the polymerase chain reaction (PCR) and sequencing of viral genetic material. The predominant hantavirus was El Moro Canyon virus (ELMCV), which occurred in three of three harvest mice (Reithrodontomys megalotis) and in three of four deer mice (Peromyscus maniculatus) examined. Sin Nombre virus (SNV) was found in one deer mouse and one white-footed mouse (P. leucopus). A seropositive house mouse (Mus musculus) was negative by PCR. Two cotton rats (Sigmodon hispidus) were infected by a virus of novel genotype (Muleshoe virus [MULEV]) that bears closet resemblance to Bayou hantavirus. The sequence of the complete small genomic segment was determined for one MULEV, and high-level expression of its nucleocapsid protein was induced in Escherichia coli. Serologic studies indicated that the most likely etiologic agent in the human infection was SNV.

Adolescent↗

Pediatric malaria in Houston, Texas.

We retrospectively reviewed the medical records of all infants and children (< 18 years of age) with the discharge diagnosis of malaria who were admitted to the four major pediatric teaching hospitals in Houston, Texas from January 1988 through December 1993. Thirty-four cases of pediatric malaria were identified in three newborns, 22 travelers, and nine recent immigrants. The travel destination was West Africa in 68%, Central America in 14%, India in 14%, and unknown in 4%. The location of the child's and parents' birthplace was available in 77% of the travel-related cases and in all cases the destination of travel was the parents' country of origin. The peak incident of the travel-related cases was late summer and early January corresponding to return from summer or Christmas vacation. Sixteen (75%) of the 22 travel-related cases had received either no prophylaxis (12 of 22) or inadequate (4 of 22) chemoprophylaxis. Half of the patients who were given appropriate chemoprophylaxis admitted to poor compliance. The clinical presentation was usually nonspecific. Fever was the most common symptom (97%) and was paroxysmal in one-third. Splenomegaly was the most common physical finding (68%). The malaria species identified included Plasmodium falciparum (56%), P. vivax (23%), P. malariae (3%), and unidentified (18%). Moderate anemia (hemoglobin level = 7.0-10 g/dL) occurred in 38% and severe anemia (hemoglobin level < 7.0 g/dL) in 29%. Three patients required transfusion. There were no end-organ complications. In summary, pediatric malaria in Houston was primarily seen in immigrants or children of immigrants who returned to their native country. Education and preventive strategies should target these families and should be part of the routine well child care of these children.

Adolescent↗

Epidemiology of human immunodeficiency virus infection in Central Americans treated in Harris County, Texas Hospital District facilities.

The prevalence of human immunodeficiency virus (HIV) infection among Central Americans is increasing. The purpose of this study was to describe the epidemiology of HIV infection among local Central American immigrants in the United States. Medical records of HIV-infected Central Americans treated at Harris County Hospital District (HCHD) facilities, the major source of indigent care in Houston, Texas, were retrospectively reviewed. Between January 1, 1990 and February 28, 1995, 18,156 Central Americans were seen at HCHD facilities, of whom 56 (13 females and 43 males) were identified as HIV-infected (0.3% versus 1.3% of all locally treated patients; P < 0.001, by test of binomial proportions). Most were from Honduras (n = 25) or El Salvador (n = 23). The mean age was 28.7 years, the mean CD4+ lymphocyte count at presentation was 173 cells/mm3, and 36 (64%) had acquired immunodeficiency syndrome (AIDS) at presentation. The 13 women (23% versus 22% for all locally treated HIV patients) were disproportionately Honduran (10 of 25 Hondurans versus 3 of 31 other Central Americans; P = 0.011). The HIV risk factors included heterosexuality in 46%, homosexuality in 29%. and a history of injection drug use in 7% (versus 10%, 57%, and 34%, respectively, for all locally treated HIV patients). The 76 diagnosed opportunistic infections (OIs) included a disproportionately greater number of patients with tuberculosis (n = 14, 33% versus 6% of all locally treated AIDS patients), toxoplasmosis (n = 10, 24% versus 7%), and cryptococcal meningitis (n = 9, 21% versus 7%), and a lower number of patients with pneumocystosis (n = 12, 29% versus 43%) and candida esophagitis (n = 2, 5% versus 16%). Central American immigrants infected with HIV present with relatively advanced disease, and the most frequent OIs are diseases for which effective prophylaxis exists. Targeted HIV screening and early intervention in this group are warranted.

AIDS-Related Opportunistic Infections↗

Prevalence of Cryptosporidium parvum infection in children along the Texas-Mexico border and associated risk factors.

We examined the epidemiology of Cryptosporidium parvum in children aged 6 months to 13 years living in 1) colonias along the border (n = 105), 2) a clinic in an urban border community (n = 65), and 3) clinics in a large urban nonborder area (n = 109). Serum IgG and IgA anticryptosporidial antibodies were measured by enzyme-linked immunosorbent assay (ELISA). Overall, 70.2% (196/279) of subjects had detectable C. parvum antibodies. Prevalence rates were higher (93/105 [89%]) in the colonias and urban border community (53/65 [82%]) compared to the urban nonborder community (50/109 [46%]). Within colonias, independent risk factors for C. parvum infection included consumption of municipal water instead of bottled water, older age, and lower household income. Children living along the Texas-Mexico border have a higher rate of infection with C. parvum compared to children living in a large nonborder urban area. Within colonias, C. parvum infection was associated with source of water supply, age, and socioeconomic status.

Adolescent↗

Multiple genotypes of St. Louis encephalitis virus (Flaviviridae: Flavivirus) circulate in Harris County, Texas.

St. Louis encephalitis (SLE) is endemic in Harris County, Texas. The disease is a public health concern in Houston, the largest city in Harris County, and in the state. Consequently, intensive surveillance for SLE virus in local mosquito populations is carried out by the Harris County Mosquito Control Division each year. In this study, we examined genetic variation among SLE isolates obtained during routine virus surveillance over a 13-year time period (1986-1999). St. Louis encephalitis virus isolates were tested for genetic variation using reverse transcription-polymerase chain reaction followed by single-strand conformation polymorphism (SSCP). The results indicated that multiple genotypes of the virus circulate in Harris County. During several years, the genotypes were restricted in their location, i.e., each general area within the county had a specific genotype of the virus. In other years, the various genotypes were widely distributed throughout the county. The presence of multiple distinct genotypes suggests that viruses with different biological characteristics may be circulating in Harris County, and that discrete foci of SLE virus activity occur simultaneously.

Animals↗

Automated ribotyping differentiates vibrio parahaemolyticus O3:K6 strains associated with a Texas outbreak from other clinical strains.

Automated ribotyping with a Qualicon Riboprinter was used to determine whether clinical isolates of Vibrio parahaemolyticus O3:K6 recovered during two U.S. outbreaks of oyster-associated gastroenteritis in 1998 were related to each other and to a previously identified highly virulent Asian clone of this serotype. The patterns produced using the restriction enzymes Eco RI and Pst I suggest that the outbreak in the Northeastern United States was caused by a single strain closely related to the Asian clone. In contrast, it appears that multiple strains were involved in the Texas outbreak and that the predominant type was genetically distinct from the Northeastern and Asian clone.

Animals↗

Determination of the occurrence of Arcobacter butzleri in beef and dairy cattle from Texas by various isolation methods.

Arcobacter butzleri is a pathogenic bacterium that has been found in dairy cattle, pigs, poultry, and humans. As of this writing, there are no data on the incidence of A. butzleri in beef cattle. Given the differences in rearing practices used for feedlot cattle and those used for dairy cattle, differences in the incidences of this organism in various types of cattle may also exist. Numerous culture methods have been used to isolate A. butzleri, but there are few data on the comparative efficacies of these methods. The objectives of this study were to determine the incidence of A. butzleri in cattle from Texas and to compare the effectiveness levels of the Johnson-Murano (JM) method (consisting of enrichment in JM broth followed by plating on JM agar) and the Collins method (consisting of enrichment in EMJH-P80 broth followed by plating on Cephalothin, Vancomycin, and Amphotericin B [CVA] agar) in the isolation of this organism. Fifty cattle each from two feedlots, a dairy, and a stocker yard were sampled. Fecal swabs were obtained from cattle, and each sample was cultured by the JM method, the Collins method, and combinations of the two methods with the broth of one method being used with the agar of the other. Polymerase chain reaction was used to identify the isolates for confirmation of A. butzleri. Samples from 18 of 200 cattle tested positive for A. butzleri. This organism was detected by the JM method in 4.5% of the samples and by the Collins method in 2.5% of the samples. An incidence of 4.0% was found when JM broth was used with CVA agar, while no samples tested positive for A. butzleri when EMJH-P80 broth was used with JM agar.

Agar↗