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Medicaid. Can it meet the needs of Texas' indigents?

Whether doctor or patient, Democrat or Republican, regulatory official or hospital administrator, there is one thing almost everyone agrees on: some changes to the Medicaid system are in order. Established in 1965, Medicaid was created to provide medical care to the poor in this country, to underwrite the care of the poor, the disabled, low-income elderly, blind and those otherwise disenfranchised from the mainstream of modern health care. As with any new understanding, there was little certainty about how many people Medicaid would serve, how it would work or how much it would cost. Egregious errors were made in the structure and process, and attempts to correct them have not been effective. Texas Hospitals asked a cross-section of people and institutions, "What would you change about Medicaid?" A variety of different ideas were put forth; some obviously self-serving answers emerged. But no one asked failed to have an answer to the question. We all agree; Medicaid needs some changes.

Aid to Families with Dependent Children↗

Texas' war against substance abuse.

Texas ranks 53rd in funding for services to help alcohol and drug abusers. Studies show that one of every ten Texans are chemically dependent. The problems incurred by these abusers touches many--family, coworkers, treatment providers and more.

Alcoholism↗

Illnesses associated with occupational use of flea-control products--California, Texas, and Washington, 1989-1997.

Dips, shampoos, and other insecticide-containing flea-control products can produce systemic illnesses or localized symptoms in the persons applying them. Although these products may pose a risk to consumers, they are particularly hazardous to pet groomers and handlers who use them regularly. Illnesses associated with flea-control products were reported to the California Department of Pesticide Regulation, the Texas Department of Health, and the Washington State Department of Health, each of which maintains a surveillance system for identifying, investigating, and preventing pesticide-related illnesses and injuries. This report describes cases of occupational illnesses associated with flea-control products, summarizes surveillance data, and provides recommendations for handling these products safely.

Adolescent↗

Revision of Bursacetabulus (Diplostomidae: Diplostominae) with the proposal of Bursatintinnabulus n. gen., and description of Bursatintinnabus bassanus n. sp. and Bursacetabulus morus n. sp. from northern gannet, Morus bassanus (Aves), from the Texas gulf coast.

During a study of digeneans of shorebirds from the Texas gulf coast, 2 undescribed species of diplostomes were found in northern gannet, Morus bassanus. Bursatintinnabulus n. gen. (Diplostomidae) is established with reassignment of Bursacetabulus macrobursus Dronen et al., 1999, as type species, and the second species in the proposed genus is described, Bursatintinnabulus bassanus n. sp. Generic diagnosis of Bursacetabulus Dronen et al., 1999, is emended to include a conical hindbody, an inconspicuous pouchlike or conspicuous well-developed tribocytic organ, and digitiform vitellaria distributed mainly in the hindbody with processes extending into the tribocytic organ and ventrolaterally in the hindbody to the level of the testes. Bursacetabulus morus n. sp. is described as the second species in that genus. In Diplostominae, Bursacetabulus and Bursatintinnabulus n. gen. are most similar to Tylodelphys Diesing 1850, but can be distinguished by having smooth testes and vitellaria that extend ventrolaterally into the hindbody to the level of the posterior testis; and the absence of a genital cone, an acetabulum, and a prepharynx. Bursatintinnabulus n. gen. is different from Bursacetabulus and all other genera of Diplostominae by a well-developed, bell-like skirt surrounding the bursa.

Animals↗

Hal Harrison Ramsey: pioneer Texas dentist of the Big Country.

Smaller cities and rural communities often have limited information regarding their early health care practioneers. This is even more evident for dentists, especially those on the frontier. The obstacles those dentists overcame while practicing their profession are interesting by today's standards and their historical contributions to the profession and their local communities are worth preserving. Hal Harrison Ramsey was a circuit riding dentist during the settlement days of the West Central region of Texas often referred to as the Big Country by its present day residents. His story begins in the 1880s and covers the evolution of dentistry practiced by preceptor trained individuals to a profession of graduates from accredited dental institutions of the early 20th century. A legacy of dentists and physicians have continued through each generation of the Ramsey family and will do so into the 21st century. Dr. Ramsey's dentistry exemplifies the profession as practiced on the frontier of the late 19th century, and the heritage of contributions to the Big Country by his family are noteworthy.

Dental Equipment↗

Legal issues associated with sexual activity between adults and minors in Texas: a review.

Recent research on adolescent mothers and the age of their sexual partners has stimulated discussion of whether legal action should be taken against adult men who engage in sexual intercourse with minors. A nonrandom poll that started as casual questions but extended over 6 months to 52 doctors initiated this review. It became apparent that the primary care physicians (pediatrics, family medicine, and internal medicine) had little, if any, understanding of some key legal facts in Texas associated with adolescent sexuality and pregnancy, especially when adult partners are involved. This article provides a legislative overview for practitioners in an attempt to clarify the law, remediate any deficiency of knowledge, and remind physicians of their role in reporting sexual abuse of minors.

Adolescent↗

Orthopedic patients' satisfaction with their health care plan: a study performed by the Research and Education Committee of the Texas Orthopaedic Association.

To determine the satisfaction of orthopedic patients in regards to their health care plan, a four-page questionnaire was designed, pilot tested, and sent to 200 orthopedic surgeons randomly selected from members of the American Academy of Orthopaedic Surgeons in Texas. Fifty-seven orthopedic surgeons were not eligible to participate; our eligible cohort was 143 orthopedic surgeons. These surgeons were asked to administer the questionnaire to 20 randomly selected patients. Fifty-six of the 143 orthopedic surgeons participated, and surveys were completed by 939 patients. Patients were asked to rate their satisfaction with their health insurance, access to primary care physicians, and access to orthopedic surgeons. Although satisfaction was generally high, the patients with a gate-keeper (no direct access to specialists) were significantly less satisfied with their access to primary care physicians and orthopedic surgeons than those without a gatekeeper.

Female↗

"High-tech" home care at the VNA of Texas.

The term "high tech" was made popular in the United States by John Naisbitt in his book, Mega Trends. Today, advanced technology may allow an individual to be cared for at home, although often both professional and family support is required to utilize the technology. The VNA of Texas is using high tech applications in the home to better serve its patients.

Community Health Nursing↗

Physician collective bargaining: all eyes are on Texas.

In June of 1999, Texas became the first state to pass a law allowing physicians to collectively bargain with managed care plans for fee-related activities. Whether this law will give physicians renewed control over patient care remains to be seen. Notwithstanding the intention of its drafters, it is likely that the law and its proposed regulations may only provide physicians with costly and time-consuming procedures that present multiple risks instead of renewed power.

Antitrust Laws↗

Nutritional rickets still afflict children in north Texas.

Nutritional rickets is uncommon in North America, particularly in regions where sunlight is plentiful. Recent epidemics in North America occurred in dark-skinned toddlers with poor nutrition who had insufficient exposure to sunlight and whose parents were members of ethnic, social, and socioeconomic groups with predisposing practices. Nine children (8 toddlers and 1 infant) were referred to the Bone Metabolic Clinic at Texas Scottish Rite Hospital for suspected rickets between October 1997 and October 1998. The diagnosis of nutritional rickets was based on clinical, biochemical, and radiological evidence. All children were dark-skinned: 8 were African Americans and 1 was of Hispanic parentage. All children were breast-fed with minimal intake of dairy products; none received vitamin supplementation. All children were followed up by health care professionals. Two patients were children of upper-middle class parents. Birth order was not a contributing factor in the development of nutritional rickets. Radiological and biochemical rachitic changes remitted within 3 months of vitamin D therapy combined with dietary modification. Primary care providers should consider vitamin D supplementation in all infants with increased skin pigmentation and especially in those who are primarily breast-fed. Nutritional rickets can develop in dark-skinned infants of any social or ethnic background. Residing in a geographical area with abundant sunlight is not a guarantee against the development of nutritional rickets in dark-skinned children.

Female↗

A pilot study comparing the level of sickle cell disease knowledge in a university in southeastern Texas and a university in Enugu, Enugu State, Nigeria, West Africa.

Sickle cell disease is the most commonly inheritable blood disorder in man. Sickle cell anemia affects approximately one in 375 Blacks in the United States. There is yet no known cure for this disease. Families of sickle cell patients continue to be financially and emotionally devastated by sickle cell disease complications. A high level of sickle cell disease knowledge will encourage non-directional sickle cell disease counseling that would reduce the incidence of this disease. A pilot study to determine the level of sickle cell disease knowledge in a university in southeastern Texas and a university in Enugu, Enugu State, Nigeria, West Africa found that there was a need to improve retention of sickle cell disease factual information.

Adult↗

Sensation seeking as it relates to burnout among emergency medical personnel: a Texas study.

INTRODUCTION: Burnout among emergency medical personnel (EMP) is suspected, but largely unsupported in the literature. An investigation of the phenomenon of burnout and factors contributing to its existence are essential steps in designing effective interventions. RESEARCH QUESTIONS: Three research questions were proposed: 1) Are EMP sensation seekers as measured by Arnett's Inventory of Sensation Seeking? 2) Are EMP burnt out as measured by Revicki's Work-Related Strain Inventory? 3) Is there a relationship between sensation seeking and burnout among EMP? METHODS: Emergency medical personnel attending a statewide conference in Texas, USA in late 1996 completed 425 survey instruments measuring sensation seeking and burnout as well as demographic items. Survey instruments were included in each registrant's conference package. Completed surveys were deposited anonymously in labeled receptacles throughout the statewide conference site. Data collection ceased at the end of the conference. RESULTS: EMP had significantly higher sensation-seeking total and intensity subscale scores than the general public. Full-time employees reported more sensation-seeking than volunteers or part-time employees. The younger the EMP, the greater were their reported sensation seeking tendencies. EMP reported more burnout in 1996 than in 1991. The older the EMP, the lower was the reported level of burnout. EMP who sought counseling for a work-related event reported more burnout than those who did not. Paid full-time EMP reported higher burnout than did volunteers. There was a weak but positive correlation between sensation seeking and burnout, suggesting that these two dimensions may be unrelated. CONCLUSIONS: The field of emergency medical services attracts sensation seekers, and EMP today report more burnout than their counterparts did in 1991. Although EMP appear to be high in sensation seeking, this dimension alone does not protect them from the effects of burnout.

Adult↗

Insecticide resistance status, esterase activity, and electromorphs from mosquito populations of Culex quinquefasciatus Say (Diptera: Culicidae), in Houston (Harris County), Texas.

Culex quinquefasciatus Say is a vector of St. Louis encephalitis (SLE) in Texas. This disease is endemic and prevalent in the Houston area. Disease prevention through mosquito control is mainly targeted against adults by application of a resmethrin-piperonyl butoxide formulation (Scourge). Immature mosquitoes were collected from eight areas in Harris County during 1998. The susceptibility status of these populations to Scourge, malathion, and resmethrin, the latter alone or with an esterase inhibitor as a synergist, was determined using a bottle assay with females. The population structure was investigated by electrophoretic analysis of esterases and their activity. Individual females were also analyzed for esterase activity by plate assay and for isoenzyme pattern by native PAGE. Bioassays indicated high levels of resistance to malathion in all areas. In addition, the effectiveness of Scourge in mosquitoes from area 51 deteriorated throughout the season. A localized, distinctive esterase pattern and activity level was observed in mosquitoes from different areas. Overall, the frequency of esterases Est alpha 2 (A2)/Est beta 2 (B2) was higher than that of Est beta 1 (B1). Altogether, these results indicate the onset of a fragile situation for mosquito control that should be further analyzed to effectively maintain the SLE prevention program for Harris County.

Animals↗

Health-related quality of life among persons with epilepsy--Texas, 1998.

Epilepsy is a central nervous system disorder characterized by unprovoked, recurrent seizures that may affect physical, mental, or behavioral functioning. In 1995, approximately 2.3 million persons residing in the United States had epilepsy. Approximately 181,000 new cases of epilepsy are diagnosed each year, with annual estimated costs of $12.5 billion in medical care and lost productivity. Because epilepsy has a substantial impact on health (e.g., physical and psychosocial difficulties, side effects of anticonvulsant therapy, lifestyle restrictions, and perceived stigmatization), self-reported physical and mental health-related quality of life (HRQOL) measures are useful in gauging the impact of epilepsy on persons with the disorder. Persons with chronic health disorders are at risk for impaired HRQOL. Few studies have examined the HRQOL of persons with epilepsy, and none has used a representative sample of adults residing in the United States. This report examines data from the 1998 Texas Behavioral Risk Factor Surveillance System (BRFSS) that included a question about epilepsy; findings indicate that persons with epilepsy reported substantially worse HRQOL than persons without epilepsy. Community-based interventions such as the Sepulveda Epilepsy Education Program that address medication self-management, psychosocial self-management, and other education interventions can improve the quality of life for persons with epilepsy.

Epilepsy↗

Two new species and new records of nasal mites of the genus Sternostoma (Acarina: Rhinonyssinae) from birds in Texas.

Two new species and new host and locality records are established for nasal mites of the genus Sternostoma from birds in Texas. Sternostoma tracheacolum Lawrence is reported for the first time from Pipilo fuscus and Pyrrhuloxia sinuata, respectively. Additionally, a new host record for Sternostoma porteri Hyland from Centurus aurifrons and a new locality record for Sternostoma pirangae Pence from Piranga rubra are established. A redescription is provided for Sternostoma augei Amaral from Speotyto cunicularia. Sternostoma crotophagae sp. n. is described from Crotophaga sulcirostris. It differs from the other species of the genus by the heavily sclerotized margins of the anal plate and tiny cribrum, the two small rounded bifuractions of the movable digit of the chelicerae, abscence of dorsal opisthosomal setae (J, Z, and R series), and chaetotaxy of tarsi II, III, and IV which have only 3 ventral club-shaped setae in the distal row (al1, av2, and pl1 with pv1 apparently absent) and 2 club-shaped setae in the more proximal row (al2 and av3 with pv3 modified into a spinelike seta in the more proximal row and al2 and av3 with pv3 modified into a spinelike seta having an enlarged base and pl2 shorter and with a rounded tip). Sternostoma sayornis sp. n. is described from Sayornis nigricans. The new species is most similar to Sternostoma hedonophilum Fain but differs in the absence of enlarged punctate areas around the stigmata, 5 additional pairs of seta on dorsal opisthosoma (Z and R series), absence of gnathosomal and capitular setae, and slight differences in the leg chaetotaxy with al1 and pl1 on tarsi II, III, and IV very long and whip-like and slight differences in the solenidia on and adjacent to the sensorial area of tarsus I. The host-parasite relationships and affinities of the species of Sternostoma from the host family Tyrannidae are briefly discussed and Sternostoma callithrix Fain and Aitken is reduced as a synonym of Sternostoma longisetosa Hyland on the basis of their existing descriptions.

Animals↗