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PubMed2003

Understanding differences in influenza immunization rates: a survey of African-American and caucasian medicare beneficiaries in Texas.

A goal of Healthy People 2010 is to increase the influenza immunization rate among high-risk populations to at least 90 percent. This article presents the results of a survey on influenza immunizations among African-Americans and Caucasian Medicare beneficiaries in a 25-county project intervention area in Texas. Information on the burden of suffering from pneumonia and influenza, the benefits of influenza immunization, and recommendations are included. Data are presented on the characteristics of the African-American and Caucasian Medicare beneficiary survey respondents, their influenza immunization rates, health status and sources of health care, and factors that influence them to obtain an annual influenza immunization.

Black or African American↗
PubMed2003

Liver transplantation at the University of Texas Health Science Center/University Hospital in San Antonio.

Liver transplantation is the only potentially curative treatment for patients with end-stage liver disease. An extensive medical and psychosocial evaluation is performed in an attempt to determine which patients are likely to have acceptable outcomes with the procedure. The limited number of donor livers relative to patients that need a liver transplant, and the occurrence of significant deaths in the waiting group, has motivated many transplant programs to agree to put living donors at risk to help solve this problem. Other complex operative techniques such as splitting livers for use in 2 patients have improved the organ availability for pediatric and adult patients. Growth of a liver transplant program from a small program to a large program necessitates institutional, hospital capacity and infrastructure support at many levels to be successful. This requires a strong partnership between the physicians and the hospital system. 1. The University of Texas Health Science Center/University Hospital in San Antonio has performed 610 liver transplants over ten years. Overall one- and 5-year patient survival rates were 88% and 75%, respectively, despite transplanting a relatively advanced population of patients based on MELD scoring. 2. The most frequent indication for liver transplantation was hepatitis C (52% of patients) and the one-, 5-, and 10-year survival rates for transplantation for hepatitis C was equivalent to survival rates after liver transplantation for other indications, despite significant recurrent hepatitis C liver injury. 3. Technical refinements have decreased operative times and immunosuppressive advances have decreased the side effects while maintaining excellent outcomes. Veno-venous bypass and the placement of biliary T-tubes are not currently used. Standard immunosuppression is lower dose Prograf, Cellcept and steroids with Cellcept being weaned off at 3 months and steroids weaned off by one year. 4. Strategies to increase the donor pool including the use of older donors, the use of steatotic livers, the use of split livers and living liver donors for children and adults are all being used successfully at UTHSCSA.

Adolescent↗
PubMed2004

Boron and selenium contamination in south Texas groundwater.

Boron and selenium concentrations from 112 water wells in an irrigated agricultural region of south Texas were compiled, mapped, and statistically analyzed. Wells in the study area produce water from the Gulf Coast Aquifer System, comprising coastward sloping beds of clay, silt, sand, and gravel. Nearly 84 percent of boron observations exceeded the 600 ug/L advisory level for drinking water, 70% exceeded the 1250 ug/L level for sensitive crops, and 24% exceeded the 3750 ug/L level for tolerant crops. Additionally, 21% of selenium observations exceeded the 20 ug/L advisory level for irrigation water, and five percent surpassed the 50 ug/L standard for drinking water. Many wells with high boron concentrations also had high selenium concentrations, and several clusters of high concentrations were in irrigated parts of the study area. However, there was no association between selenium and well depth, and a direct rather than inverse association between boron and well depth. Progressively brackish water in downdip reaches of the aquifer largely controls observed boron patterns. Both irrigation practices and prevailing groundwater chemistry significantly influence selenium concentrations in the study area.

Aluminum Silicates↗
PubMed1992

Years of potential life lost: an evaluation of premature cancer deaths in Texas from 1981 through 1988.

Death rates are traditional public health measures used to assess the health status of a population. Several types of cancer are examined in this report, and the indicator for years of potential life lost is used to estimate the number of years of life lost per disease type in Texas during the years from 1981 through 1988. For both males and females, the resulting ranking of cancer types was quite different from those obtained with death rates. Among males, testicular cancer and Hodgkin's disease ranked first and second for years of potential life lost while lung cancer and colorectal cancer ranked first and second for deaths. Most men who die with testicular cancer are young, with each death representing an average of 42 years of life lost. Among females, each death from four cancer types--leukemia, brain, cervix uteri, and malignant melanoma skin--results in more than 20 years of lost life.

Adult↗
PubMed2004

Mortality updates (1970-1997) of two refinery/petrochemical plant cohorts at Baton Rouge, Louisiana, and Baytown, Texas.

OBJECTIVE: The purpose of this retrospective cohort study is to update mortality experience at refinery/petrochemical plant facilities in Baton Rouge, Louisiana, and Baytown, Texas. METHODS: Standardized mortality ratios (SMRs) were calculated for 1970-1997 based on death rates in the respective states. RESULTS: SMRs are near or below unity for most causes of death. Among elevations, Baton Rouge has an SMR of 2.42 (95% CI = 1.16-4.45) for chronic lymphocytic leukemia, 1.58 (95% CI = 1.17-2.08) for hypertension with heart disease, and 1.47 (95% CI = 0.98-2.11) for non-Hodgkin's lymphoma. Baytown has an SMR of 2.13 (95% CI = 1.10-3.73) for acute nonlymphocytic leukemia (ANLL) and 3.11 (95% CI = 1.01-7.26) for unspecified brain/spinal cord neoplasms. The above findings pertain to pre-1950 hires and exhibit no apparent job-related patterns. Both cohorts have approximately twofold increases in mesothelioma deaths, similar to the last update, with most decedents having held maintenance jobs. CONCLUSIONS: Periodic examination of mortality patterns has an important role in assessing overall employee health status and identifying potential areas of increased risk. Mortality surveillance will continue to monitor these outcomes among more recent workers.

Adult↗
PubMed1992

Lead chromate exposures and elevated blood lead levels in workers in the plastics pigmenting industry--Texas, 1990.

In June 1990, the Dallas (Texas) County Health Department received a physician's report of an elevated blood lead level (BLL) (52 micrograms/dL) for an employee of a company that formulates color concentrates for the plastics industry. The physician had been evaluating the employee for severe headaches of uncertain etiology; however, he requested a BLL analysis when the employee's occupational history suggested possible lead exposure.

Air Pollutants, Occupational↗
PubMed2004

Ethics questions raised by the neuropsychiatric, neuropsychological, educational, developmental, and family characteristics of 18 juveniles awaiting execution in Texas.

Eighteen males condemned to death in Texas for homicides committed prior to the defendants' 18th birthdays received systematic psychiatric, neurologic, neuropsychological, and educational assessments, and all available medical, psychological, educational, social, and family data were reviewed. Six subjects began life with potentially compromised central nervous system (CNS) function (e.g., prematurity, respiratory distress syndrome). All but one experienced serious head traumas in childhood and adolescence. All subjects evaluated neurologically and neuropsychologically had signs of prefrontal cortical dysfunction. Neuropsychological testing was more sensitive to executive dysfunction than neurologic examination. Fifteen (83%) had signs, symptoms, and histories consistent with bipolar spectrum, schizoaffective spectrum, or hypomanic disorders. Two subjects were intellectually limited, and one suffered from parasomnias and dissociation. All but one came from extremely violent and/or abusive families in which mental illness was prevalent in multiple generations. Implications regarding the ethics involved in matters of culpability and mitigation are considered.

Adolescent↗
PubMed2005

Pseudomonas bloodstream infections associated with a heparin/saline flush--Missouri, New York, Texas, and Michigan, 2004-2005.

On January 26, 2005, CDC was notified of four cases of Pseudomonas fluorescens bloodstream infection among patients at an oncology clinic in Missouri. All patients had received a heparin/saline flush to prevent clotting of indwelling, central venous catheters. The flushes were preloaded in syringes by IV Flush and distributed by Pinnacle Medical Supply (Rowlett, Texas). On January 31, a nationwide alert against use of all heparin or saline flushes preloaded in syringes by IV Flush was issued by the Food and Drug Administration; the company recalled these products. As of February 15, state and local health departments and CDC had identified a total of 36 Pseudomonas species infections in patients in four states who were administered the heparin/saline flushes from multiple lots. This report describes the ongoing investigation and provides recommendations for investigation and management of potential cases.

Adolescent↗
PubMedDate not supplied

The Texas model of differentiated entry-level competencies of graduates of nursing programs.

The Board of Nurse Examiners and the Board of Vocational Nurse Examiners for the State of Texas updated the state's competency-based education model in collaboration with stakeholders in nursing service, state nursing organizations, and the deans and directors of the state's 82 board-accredited professional nursing programs. Based on this collaborative effort, 14 differentiated entry-level competencies with associated knowledge and clinical behaviors/judgments were identified that set standards for graduates of vocational, diploma, associate, and baccalaureate degree programs.

Attitude of Health Personnel↗
PubMed2005

Substance use and occupational injuries among high school students in South Texas.

This cross-sectional study examined the association between self-reported nonfatal occupational injuries among high school students in South Texas and their self-reported general use of substances. Data were collected using a self-administered, anonymous questionnaire (n = 3365). The independent variables included alcohol, marijuana, cocaine, inhalant, and steroid use. The dependent variable was occupational injury. Adjusting for grade, sex, ethnicity, and work intensity, odds ratios were calculated using logistic regression. Supporting an association with each substance, odds ratios consistently strengthened as use increased. Additional research is merited given the scant number of previous studies. The associations for inhalant (OR, 5.61) and steroid (OR, 7.63) use argue for their inclusion in future research.

Adolescent↗
PubMed2005

Poisoning hospitalizations among Texas adolescents: age and gender differences in intentional and unintentional injury.

Using 1999 Hospital Discharge Data, this study examines age and gender differences in the pattern of poisoning hospitalizations of Texas youngsters (N = 1246) aged 10 through 17 years and investigates self-inflicted poisoning as a function of age and gender. Nearly three quarters of poisoning admissions are girls and two thirds of admissions are older children (aged 15 through 17 years). Analgesics and psychotropic drugs are the two most common agents used. Nearly 1 in 3 admissions among younger children aged 10 through 14 years and 1 in 2 among older children are due to analgesics, with a higher proportion of female admissions. One quarter of admissions among both age groups are due to psychotropic drugs, with nearly equal proportions of boys and girls. Intentional poisoning admissions are significantly higher among girls in both age groups. Older children are 1 1/2 times more likely than younger children, and girls are 2 times more likely than boys to be at risk for self-inflicted poisoning admissions. Fifty-three percent of female and 39% of male self-inflicted poisoning admissions are due to analgesics. Psychotropic drugs caused 29% of male and 21% of female self-inflicted admissions. Accidental and intentional poisoning is a public health concern requiring intervention. Residents in family practice and pediatrics need increased training to become proactive in educating adolescents and their parents about the dangers of drug overdosing.

Accidents↗
PubMed1992

Black, middle-class women in San Antonio, Texas.

Fifty-six African-American women between the ages of 20 and 84 who had completed a minimum of 4 years of college and were employed in professional positions (eg, teacher, technician, lawyer, and physician) were identified in San Antonio, Texas. Specific information concerning marital status, income, home ownership, family of origin, presence of professional siblings, husbands' characteristics, medical and psychiatric health, and significant influences in their lives were obtained by a semistructured interview. This article summarizes the results of these interviews and presents the techniques used to identify this sample of African-American, middle-class women.

Adult↗
PubMed1992

The cost of cancer in Texas.

Direct and indirect costs of cancer for Texas are estimated for 1988 and are compared to costs for 1980. The distribution of these costs by age group and type of cancer is presented and discussed. Conceptual and methodological issues underlying the estimates are explained to assist the reader in interpretation. The authors conclude that future collection of more specific data at the state level would greatly assist policymakers dealing with cancer issues.

Adolescent↗
PubMed2005

Perceptions of neighborhood characteristics and leisure-time physical inactivity--Austin/Travis County, Texas, 2004.

Regular physical activity improves quality of life and reduces risk for coronary heart disease, colon cancer, hypertension, diabetes, and overall mortality. Physical activity also has been associated with reduced symptoms of depression and greater independence. A sedentary lifestyle is associated with obesity. However, despite the health benefits of physical activity, 23.1% of adults in the United States report they do not engage in any leisure-time physical activity. Neighborhood environment (e.g., sidewalks and street lighting), perceived trustworthiness of neighbors, and perceptions of neighborhood safety all have been associated with levels of physical activity. During 2004, to assess the association between these factors and leisure-time physical inactivity in eastern Travis County, Texas, the local health department collected and analyzed data by using the methodology of the Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that persons who perceived their neighborhoods as less than extremely safe were more than twice as likely to have no leisure-time physical activity, and those who perceived their neighborhoods as not at all safe were nearly three times as likely to have no leisure-time physical activity. Public health agencies promoting physical activity in neighborhoods should consider how residents perceive their safety and design programs that specifically address those safety concerns.

Adult↗
PubMed2005

Epidemiology of neurocysticercosis in Houston, Texas.

We identified 114 patients with neurocysticercosis admitted to Ben Taub General Hospital in Houston, Texas between January 1994 and June 1997. Most of these patients were born in Mexico (78%) or Central America (16%), but 6% were born in the United States. Review of neurology clinic records identified 54 patients diagnosed with neurocysticercosis, representing 2% of all neurology clinic patients and 16% of all Hispanics diagnosed with seizures. Forty-one patients were interviewed and all reported significant risk factors for infection, including ingestion of undercooked pork, pig husbandry, immigration from and frequent travel to villages in disease-endemic areas, or personal/family history of taeniasis. Among Mexican immigrants, most were born in rural areas in Central (31%) or north central Mexico (38%). Significantly fewer of the patients were from the border states (15%). The median period from immigration to diagnosis was 58 months, but it was 28 months for the 13 patients who had not left the United States after immigration. Although neurocysticercosis is being diagnosed with increasing frequency in the United States, acquisition of infection is still strongly associated with pig husbandry in rural Latin America, with little evidence of local transmission. Even among urban immigrants to the United States and United States-born cases, there is close ongoing contact with disease-endemic villages.

Animal Husbandry↗
PubMedDate not supplied

Correlates of medication knowledge and adherence: findings from the residency research network of South Texas.

BACKGROUND: Medication adherence is a complex phenomenon, influenced by a variety of factors. Most adherence research focuses on one medicine and does not represent the realities of clinical family medicine. This analysis examined factors associated with medication knowledge and adherence in family medicine patients with chronic conditions. METHODS: The Residency Research Network of South Texas (RRNeST) enrolled 150 patients with chronic disease who "sometimes have trouble taking medicines." Seventy-five percent were Latinos. This cross-sectional analysis used baseline survey data from an intervention study. Investigators correlated medication knowledge and adherence with known predictors--patient, health, medication, economic, and physician factors. New variables related to patients' motivation to change treatment behaviors ("importance" and "confidence") were also included. RESULTS: Linear regression analysis demonstrated that patient satisfaction, education level, and confidence were associated with better medication knowledge. Higher confidence, Spanish language, better functional and health status, and more prescription medicines were correlated with medication adherence. CONCLUSIONS: We recommend that family physicians enhance medication adherence by providing good information about treatment and counseling strategies to build patients' confidence. Our findings suggest that poor health status can be a barrier to, rather than a motivator for, treatment adherence.

Adult↗
PubMed2005

HIV infection and risk behavior of Hispanic farm workers at the west Texas-Mexico border.

This study investigated the risk behaviors and HIV infection rate in a sample of 210 migrant and seasonal farm workers (MSFW) working in the border city of El Paso, Texas and nearby communities. Surveys and structured interviews collected data on sexual behavior, drug use, condom use, and other potential risk behaviors associated with HIV infection. In addition, all subjects were tested for HIV exposure by using commercial kits. The MSFW participants were all Hispanic and comprised 156 males and 54 females. Only a small minority of the subjects reported engaging in same-sex (1.4%) or bisexual relations (2.8%). Most reported vaginal intercourse (94.7%), while 9% of males and 7.4% of females also reported anal intercourse. Forty-eight percent of the sample reported having sexual activity under the influence of alcohol (44%) and/or other drugs (14%). In this study, only 3.8% admitted to intravenous drug use. Furthermore, most reported that they never used any barrier method during vaginal (71.7%), anal (72.0%), or oral intercourse (87.5%). Only one subject, a male with multiple sex and needle-sharing partners was HIV positive. Although a low level (.47%) of HIV infection was detected in the MSFW population tested, this rate is much higher than that reported for the rest of the county (.0099%) and indicates that this population is at a higher risk of HIV infection.

Adult↗
PubMed2006

Rapid assessment of health needs and resettlement plans among Hurricane Katrina evacuees--San Antonio, Texas, September 2005.

Hurricane Katrina struck the coastal regions of Alabama, Florida, Louisiana, and Mississippi on August 29, 2005, resulting in one of the worst natural disasters in U.S. history. The city of New Orleans, Louisiana, was further damaged by severe flooding when major levees broke and released water from Lake Pontchartrain. Residents were evacuated to neighboring states and cities, including San Antonio, Texas. On September 3, 2005, approximately 12,700 evacuees arrived in San Antonio and were housed in four primary evacuation centers (ECs). Although many evacuees in San Antonio soon found other accommodations, as of September 16, 2005, approximately 3,700 evacuees remained in ECs awaiting resumption of public services in New Orleans. To assess evacuee needs for clinical care, public health services, and housing assistance, the San Antonio Metropolitan Health District (Metro Health) requested CDC assistance to conduct a needs assessment of heads of households in the ECs. This report summarizes the findings of that survey, which identified substantial numbers of evacuees with chronic health conditions, physical or mental disabilities, and needs for counseling and housing assistance. The findings underscore the need to augment local public health and public assistance resources to address ongoing health and housing needs of evacuee populations.

Disasters↗