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PubMed1991

The enforcement of regulations restricting expanded duties by dental auxiliaries: an analysis of the recent disciplinary actions of the Texas State Board of Dental Examiners.

The issue of delegation of dental procedures (expanded duties) to auxiliaries continues to be controversial. Although it has been shown that these practices are usually beneficial to the public, many states continue to maintain laws prohibiting expanded duties. In Texas, auxiliaries are not allowed to perform many simple functions, and dentists who supervise these acts are tried and sentenced by the Texas State Board of Dental Examiners. Although one might expect that more serious categories of offenses would be treated in a harsher manner, this study indicates that this is not the case in Texas. The disciplinary actions of the Texas State Board of Dental Examiners were analyzed, and the rate of conviction and severity of penalty for three types of offenses: supervising auxiliaries in the performance of unauthorized expanded duties, malpractice/negligence, and drug offenses were compared. The results revealed that dentists who were convicted for unauthorized auxiliary expanded duty use were assigned harsher penalties than those given to dentists convicted for other classes of offenses (P = .02, Fisher's exact test). This study indicates that, at least for the dentists of Texas, the punishment may not always fit the crime.

Data Interpretation, Statistical↗
PubMed1999

Evidence from molecular fingerprinting of limited spread of drug-resistant tuberculosis in Texas.

To determine the contribution of recent transmission to spread of drug-resistant tuberculosis in Texas, we performed IS6110-based and pTBN12-based restriction fragment length polymorphism (RFLP) analyses on Mycobacterium tuberculosis isolates. Isolates collected from 201 patients in Texas between 1992 and 1994 were studied. The distribution of cases was strikingly focal. All cases were reported from 35 of the 254 counties in Texas, and 74% (148 of 201) were reported from only 9 counties. One hundred sixty-one (80%) of the patients had M. tuberculosis isolates with unique RFLP patterns, and 41 (20%) patients were in 20 clusters, each comprising 2 to 3 patients. The largest number of cases of drug-resistant tuberculosis were reported in counties bordering Mexico, but the percentage of clustered cases was highest in northeast Texas and in counties that included the cities of Dallas, Fort Worth, and Houston. Compared to nonclustered patients, clustered patients were more likely to be African American and to have been born in the United States. Clustered patients were significantly more likely to be from the same geographic area, and clustered patients from the same geographic area were more likely to have isolates with identical drug susceptibility patterns, suggesting that they were linked by recent transmission. In 11 of 20 clusters, clustered patients were from geographically separate regions, and most isolates did not have identical drug susceptibility patterns, suggesting that tuberculosis was contracted from a common source in the remote past. Based on the low percentage of clustered cases and the small cluster size, we conclude that there is no evidence for the extensive transmission of drug-resistant tuberculosis in Texas.

Adolescent↗
PubMed2002

Transmission of drug-resistant tuberculosis in Texas and Mexico.

To examine the transmission of drug-resistant (DR) tuberculosis between Texas and Mexico, Mycobacterium tuberculosis isolates resistant to one or more of the first-line antimycobacterial drugs were obtained from 606 patients who resided in Texas and 313 patients who resided in Mexico, primarily within the state of Tamaulipas. The isolates were genotyped by IS6110-based restriction fragment length polymorphism (RFLP) analysis and spoligotyping. Of the 919 isolates genotyped, 413 (45%) grouped into 105 clusters containing 2 or more isolates with identical genotypes. In addition to having identical genotypes, identical drug resistance patterns were identified in 250 isolates in 78 clusters (DR clusters). Twenty DR clusters, containing isolates from 32% of the total number of patients infected with DR strains, were geographically distributed across Mexico and Texas. Within this population of 919 patients infected with DR isolates, the probability of being in a DR cluster was the same for residents of Mexico and Texas. In Texas, the significant independent predictors of clustering within DR clusters as opposed to genotype clusters were found to be race, age, country of birth, human immunodeficiency virus (HIV) infection status, and resistance to more than one drug. Specifically, isolates from African Americans, individuals under age 65, individuals born in the United States, and HIV-positive individuals were each more likely to be associated with a DR cluster. By contrast, no significant independent predictors of clustering in a DR cluster were identified in Mexico. Although some DR M. tuberculosis strains are geographically restricted, this study suggests that a number of strains are transmitted between Mexico and the United States.

Adolescent↗
PubMed1995

Air toxics: sources and monitoring in Texas.

Since the late 1980s, federal legislation has required industries to publicly report their annual emissions of toxic compounds. Industry reports show the largest contributor to toxic emission levels in Texas is the massive concentration of petrochemical industries along the Gulf Coast. It is interesting to note that although Texas produces over 50% of the nation's synthetic chemicals, it discharges less than 8% of the nation's toxic emissions. However, in response to growing concerns about the effects of these toxic emissions, the Texas Natural Resource Conservation Commission (TNRCC) initiated a long-term program for monitoring toxic chemicals in the air. This article provides details of this monitoring program as well as industry-funded toxic monitoring networks in Texas. This includes information on the technology currently being used for sample collection and analysis as well as plans for implementing methods that are on the technological horizon. Finally, details of some key measurements from the state's air toxics monitoring network will be provided along with an explanation of how they impact current air quality trends in Texas.

Air Pollutants↗
PubMed1991

Characterization of a Leishmania isolate from the rodent host Neotoma micropus collected in Texas and comparison with human isolates.

We report the biological and biochemical parameters of Leishmania parasites (MNEO/US/90/WR972) isolated from a rodent host, Neotoma micropus, collected in Texas. Footpad inoculations of WR972 promastigotes into BALB/c mice and Syrian hamsters resulted in ulcerating lesions six and eight weeks post-inoculation, respectively. Using monoclonal antibody-stained touch preparations, amastigotes were found in the liver of both laboratory hosts. Infection of J774 macrophages with WR972 promastigotes supported the growth of amastigotes for 12 days at 35 degrees C. The WR972 parasite was identified by enzyme electrophoresis as L. mexicana. Isozyme comparison of WR972 with 42 L. mexicana isolates (from humans and rodents) from four different endemic areas, including Texas, suggest that these parasite populations are identical for approximately 97% of their genetic loci. Pulse field gel electrophoresis (PFGE) of WR972 resolved 18 chromosomes with a size range of 300- greater than 2,000 kb. The karyotype strongly resembles that of two other Texas L. mexicana isolates from humans. Taken together, the PFGE, hybridization, and isoenzyme data suggest that the wood rat isolate (WR972) is identical to parasites from human cutaneous lesions isolated in Texas and Central America. In addition, the biological characteristics of WR972, its infectivity of BALB/c mice and the Syrian hamster, and the potential of the isolate to infect, transform, and divide in J774 macrophages indicate that WR972 will be pathogenic in humans if transmission occurs. Health care providers should consider this possibility when studying the epidemiology and control of cutaneous leishmaniasis in Texas.

Animals↗
PubMed1999

Tarasoff in Texas.

Texas physicians do not have a statutory duty to warn potential victims of their patients' violent conduct but may warn medical or law enforcement authorities if the patient is a danger to himself, to the treating physician, or to others. Moreover, the Medical Practice Act of Texas does not authorize even permissive exceptions to confidentiality, thereby preventing physicians from legally warning victims. Nonetheless, 5 Texas appellate courts already have addressed a clinician's duty to issue protective warnings to reasonably identifiable victims. The approaches of these 5 courts have been similar, but important differences warrant attention. In 1998, the Supreme Court of Texas, in a fact-specific decision, did not adopt a duty for physicians to protect third persons from their patients' violent acts. All Texas physicians should become familiar with the emerging jurisprudence of professional protective responsibilities and liabilities to third persons who can be harmed physically by their patients' violent conduct.

Duty to Warn↗
PubMed2001

Texas Medication Algorithm Project: development and feasibility testing of a treatment algorithm for patients with bipolar disorder.

BACKGROUND: Use of treatment guidelines for treatment of major psychiatric illnesses has increased in recent years. The Texas Medication Algorithm Project (TMAP) was developed to study the feasibility and process of developing and implementing guidelines for bipolar disorder, major depressive disorder, and schizophrenia in the public mental health system of Texas. This article describes the consensus process used to develop the first set of TMAP algorithms for the Bipolar Disorder Module (Phase 1) and the trial testing the feasibility of their implementation in inpatient and outpatient psychiatric settings across Texas (Phase 2). METHOD: The feasibility trial answered core questions regarding implementation of treatment guidelines for bipolar disorder. A total of 69 patients were treated with the original algorithms for bipolar disorder developed in Phase 1 of TMAP. RESULTS: Results support that physicians accepted the guidelines, followed recommendations to see patients at certain intervals, and utilized sequenced treatment steps differentially over the course of treatment. While improvements in clinical symptoms (24-item Brief Psychiatric Rating Scale) were observed over the course of enrollment in the trial, these conclusions are limited by the fact that physician volunteers were utilized for both treatment and ratings. and there was no control group. CONCLUSION: Results from Phases 1 and 2 indicate that it is possible to develop and implement a treatment guideline for patients with a history of mania in public mental health clinics in Texas. TMAP Phase 3, a recently completed larger and controlled trial assessing the clinical and economic impact of treatment guidelines and patient and family education in the public mental health system of Texas, improves upon this methodology.

Adolescent↗
PubMed1975

Epizootic of anthrax in Falls County, Texas.

An epizootic of anthrax in Eastern Falls County, Texas, killed at least 238 animals during a 6-week period ending July 31, 1974. Infection appeared to be caused by the ingestion of contaminated soil and grass in the drought-stricken central Texas area. The participation of the Texas Department of Agriculture, the Texas National Guard, and other state agencies was of great assistance to the Texas Animal Health Commission in handling the epizootic and panic stricken public. Use of the unencapsulated Sterne strain spore vaccine was credited with preventing many livestock losses in the area. Contaminated city water was detected during the epizootic but human disease did not result.

Animals↗
PubMed2002

How well prepared are Texas dental hygienists to recognize and report elderly abuse?

The elderly are the nation's fastest-growing population, and the number of elder abuse victims has reached epidemic proportions. In Texas, dentists and dental hygienists are mandated by law to report suspected abuse. This study surveyed Texas dental hygienists regarding elder abuse education received in dental hygiene school and post-graduation. Respondents were also asked to self-assess their knowledge level in recognizing the six types of elder abuse and to answer questions regarding Texas law and mandatory reporting of abuse. A survey designed for this study was mailed to 780 Texas licensed dental hygienists, representing 10 percent of the Texas dental hygiene population. Respondents were selected using a computer-generated random sample. A second mailing was sent to nonrespondents to prevent response bias. Results were analyzed using Statistical Programs for Social Scientists (SPSS). Over one-half of the respondents (56 percent) stated that abuse education was not part of their dental hygiene school curriculum. Only 46 percent of the respondents who replied that abuse education had been included in the curriculum were educated on elder abuse. A majority of respondents stated they lacked knowledge in recognizing the six types of elder abuse, and 81 percent of respondents reported being unknowledgeable about reporting elder abuse. The current status of elder abuse education in dental hygiene programs and post-graduation is insufficient. Dental hygienists have an obligation to become knowledgeable in recognizing and reporting elder abuse in order to provide complete care for their patients.

Adult↗
PubMed2002

The civil commitment of sexually violent predators: a unique Texas approach.

Numerous states have enacted statutes focusing on the civil commitment of sexually violent predators. The Texas statute, like many others, calls for the involuntary commitment of those with a mental abnormality--specifically in Texas, a behavioral abnormality--who are likely to engage in predatory acts of sexual violence. All of these states, except Texas, have passed legislation creating inpatient treatment for those persons committed. Texas, instead, has focused exclusively on the use of outpatient treatment and supervision as an alternative to the route of inpatient commitment This article is focused on the development and implementation of the Texas statute with an emphasis on forensic assessment, expert testimony, and risk assessment.

Commitment of Persons with Psychiatric Disorders↗
PubMed2004

Epidemiology of scorpion envenomations in Texas.

About 90 scorpion species occur in the US, and scorpion stings accounted for over 15,600 calls to poison centers in the US in 2002. However, epidemiologic information on scorpion envenomations in the US, and Texas in particular, is limited. This study investigated the relationship between epidemiological factors and the scorpion stings reported to the Texas poison centers. Cases consisted of all human exposure calls of scorpion stings to Texas poison centers during 1998-2003; there were 11,545 total cases. The reported scorpion envenomation penetrance increased during 1998-2002. Among cases with a known patient age, 10.9% were < 6 y of age, 21.7% were age 6-19 y and 67.3% were > 19 y of age. Females accounted for 55.8% of the cases and males for 44.2% of the cases. Scorpion stings were most frequently reported in May and June with envenomation penetrance lowest in northeast Texas and highest in west Texas. The exposure site was the patient's own residence for 93.9% of the cases. The management site was not a health care facility for 95.8% of cases, and there were minor effects in 88.4% of cases with a known clinical outcome.

Adolescent↗
PubMed2006

Geographic disparities in diabetes-related amputations--Texas-Mexico border, 2003.

The risk for lower extremity amputation (LEA) is estimated at 15 to 40 times higher among persons with diabetes than among persons without diabetes. In Texas, the prevalence of diabetes is higher near the Mexico border, where persons are more likely to have lower levels of education, lower incomes, no health insurance, and other barriers to obtaining health care. To determine whether diabetes-related LEA rates are higher near the Texas-Mexico border, rates were calculated, in both the general population and among persons with diabetes, for diabetes-related LEAs in border and nonborder counties. Data used for this analysis included 2003 Texas Inpatient Hospital Discharge Data (TIHDD), 2003 Texas population estimates, and data from the 2003 Texas Behavioral Risk Factor Surveillance System (BRFSS). The results of the analysis indicated that the age- and sex-adjusted rate of diabetes-related LEAs in the general population along the border was nearly double the rate of nonborder counties. Among persons with diabetes, the rate along the border also was significantly higher than among those in nonborder counties, but the rate differences were primarily among men aged > or =45 years. Additional measures to prevent diabetes and improve education regarding diabetes care are needed to reduce the excess burden of LEAs among persons with diabetes along the border.

Adult↗
PubMed1995

Physician work force in Texas: planning for the future.

A number of proposals have been advanced to solve the shortage of primary care physicians in the United States. We analyzed the supply of primary care and nonprimary care physicians in Texas and contrasted work force supply with projected need. Texas has a serious shortage of primary care physicians and an adequate supply of nonprimary care specialists only in major urban areas. We also analyzed attitudes of medical students in and graduates of The University of Texas medical schools to assess factors that influenced their career choices. The most influential factors were remarkably similar among all groups and were related primarily to personal attributes and experience. This study assesses the current physician work force in Texas and suggests means by which policy can be decided to affect the supply and distribution of physicians in Texas.

Health Workforce↗
PubMed1995

Mortality preventable by medical intervention: ethnic and regional differences in Texas.

An examination of mortality from 12 causes of death was tabulated for the state of Texas for residents in the Lower Rio Grande Valley; for residents of border counties; for residents of Dallas, Harris, and Tarrant counties, along with residents of east Texas from 1980 to 1989. The ninth revised edition of the International Classification of Diseases was used to categorize causes of mortality. The mortality data were obtained from mortality data tapes obtained from the Texas Department of Health and archived at the University of Texas School of Public Health. From 1980 to 1989, an average of 1543 deaths per year was attributed to these 12 selected causes in Texas. Thirty-two percent of deaths were due to hypertensive heart disease, 30% to pneumonia and bronchitis, 11% to cervical cancer, and 6% to rheumatic fever. Pneumonia and bronchitis were the leading causes of death among those aged 15 to 44 years.

Adolescent↗
PubMedDate not supplied

Cooperative state-federal turkey ornithosis task force, Texas, 1974.

Ornithosis was suggested by a routine analysis of tissue specimens from Texas turkey flocks submitted to the Texas A&M University Poultry Disease Laboratory at Gonzales on April 30, 1974, and of subsequent specimens from four additional flocks. Subsequently, illness in humans at turkey processing plants in Texas, Nebraska, and Missouri, implicating turkeys from Texas, was confirmed as ornithosis in July 1974; and, associated with this outbreak, ornithosis was suspected as the cause of the death of one human. Action was taken by state and federal poultry disease control and inspection officials, public health agencies, and the turkey industry in Texas.

Animals↗
PubMed1997

Texas dental hygienists benefits and satisfaction survey.

The purpose of this study was to determine the satisfaction and fringe benefits of Texas dental hygienists and compare the data to a recent national study. A blind survey was forwarded to 5,294 active, licensed dental hygienists to obtain data for Texas. Responses were received from 2,172 dental hygienists, a 41 percent response rate. The greatest number of responses came from the larger cities in Texas: Dallas, Houston, Austin, and San Antonio. Fifty-eight percent of Texas hygienists receive paid vacation, 25 percent medical insurance, 37 percent sick pay, and 26 percent receive some type of retirement. Nationally, the figures are higher. The survey also sought to determine satisfaction levels. Most dental hygienists are satisfied with their salary (65%), their career (85%), and feel secure in their employment (92%), while only 46 percent are satisfied with benefits. The survey results are inconclusive for hygienists' in the state of Texas based on the 41 percent response rate. Practical information may assist employers in recruitment and retention of a dental hygienist into the practice.

Adult↗
PubMed1998

Boat-propeller-related injuries--Texas, 1997.

Approximately 78 million persons engage in recreational boating annually in the United States. Several types of injury can occur during boating recreation, including drowning, falls, burns, and propeller-related injuries. Injuries from the propeller are typically multiple, deep, parallel lacerations that can result in permanent scarring, substantial blood loss, traumatic or surgical amputation, or death. Persons sustaining injuries from boat propellers can require long periods of hospitalization, recovery, and rehabilitation. In Texas, the extent of boat-propeller-related injuries is unknown; however, the existence of approximately 600,000 motorboats in the state exposes many Texans to the potential risk for propeller-related injury. To characterize the occurrence of boat-propeller-related injuries in Texas, the Texas Department of Health (TDH) and the Texas Parks and Wildlife Department (TPWD) investigated boat-propeller-related injuries that occurred in four lakes in Texas during May 24 -September 1, 1997, the time of year when boating activities are most common. This report summarizes the results of the investigation.

Accidents↗
PubMed1999

Producing physicians for south Texas.

South Texas, one of the fastest growing regions in the country, remains among the most medically underserved, in part, because few students from South Texas enter medical school. To address this issue and to increase the diversity of the matriculant pool, Baylor College of Medicine (BCM) and The University of Texas-Pan American (UT-PA) established in 1994 the Premedical Honors College (PHC), a rigorous undergraduate program at UT-PA for students from South Texas high schools. Students who complete all PHC requirements and BCM prerequisites are accepted into BCM upon graduation from UT-PA. Those in good standing receive counseling, enrichment experiences, and tuition and fee waivers from UT-PA and BCM. The program is increasing the number of students from South Texas universities matriculating into medical school, and is expanding the involvement of local physicians in undergraduate education, heightening visibility for partner institutions, and becoming an effective, replicable bachelor of science/doctor of medicine model.

Curriculum↗