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DSHS Authors: Research Articles by DSHS Staff

The following list includes peer-reviewed research articles or academic textbooks that have been written by staff of the Texas Department of State Health Services since its formation in September 2004. For more information about these articles or for a full-text copy, please contact the Medical and Research Library by or by calling (512) 458-7559.

If you are a DSHS author and have published a research article or textbook since September 2004 and you would like it to be included in this list, please contact the Medical and Research Library.

2007 Articles
2006 Articles
2005 Articles
2004 Articles
Textbooks

2007 Articles (in date order with most recent first)

Acute Pesticide Poisoning in the U.S. Retail Industry, 1998–2004.
Calvert GM, Petersen AM, Sievert J, Mehler LN, Das R, Harter LC, Romoli C, Becker A, Ball, C, Male D, Schwartz A, Lackovic M.
Public Health Rep. 2007 March-April;122:232-44.
Objective. This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments. Methods. Analyses included retail employees 15–64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated. Results. A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR50.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004. Conclusions. Preventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prevention.

Oxycodone Abuse in Texas, 1998-2004.
Forrester MB.
J Toxicol Environ Health A 2007;70:534-538.
Oxycodone is frequently abused, and this abuse appears to be increasing. The purpose of this study was to describe the patterns of oxycodone abuse identified by Texas poison control centers. All oxycodone calls received by Texas poison control centers during 1998-2004 were identified. Annual trends and geographic distributions were determined for drug identification (ID) calls and abuse calls. The distribution of abuse calls was then compared to the distribution of all other types of human exposure calls for a variety of factors. Both drug ID and abuse calls involving oxycodone increased over the 7-yr period. The numbers of abuse calls were higher than expected in the central part of Texas, while drug ID calls were higher than expected in eastern and central Texas. A higher proportion of oxycodone abuse than other types of oxycodone exposures involved males, adolescents, exposures at other residences and public areas, referral by the poison control center to a health care facility, and some sort of clinical effect. Oxycodone abuse calls in Texas are increasing. The proportion of calls varies by geographic region. Oxycodone abuse calls differ from other types of exposures with respect to both demographic factors and clinical management and outcome.

2006 Articles (in date order with most recent first)

Adult Atomoxetine Ingestions Reported to Texas Poison Control Centers, 2003-2005.
Forrester MB.
Ann Pharmacother. 2006 Dec;40(12):2136-41.
BACKGROUND: Limited information exists on outcomes from adult ingestions of atomoxetine reported to poison control centers. OBJECTIVE: To identify factors that might affect the outcome of adult atomoxetine ingestions reported to poison control centers. METHODS: Using adult ingestions of atomoxetine alone reported to Texas poison control centers during 2003-2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). RESULTS: Of 64 cases identified, 9 (14%) involved serious outcomes. No serious outcomes were reported with a maximum dose of 100 mg or less. Serious outcomes were significantly more likely to occur with a maximum dose of more than 2 capsules (RR 8.25; 95% CI 1.48 to 83.58), where the circumstances of the exposures involved self-harm or malicious intent (RR 6.02; 95% CI 1.30 to 30.35) or when the patient was already at or en route to a healthcare facility when the poison control center was contacted (RR 18.75; 95% CI 2.10 to 886.83) or was referred to a healthcare facility by the poison control center (RR 22.50; 95% CI 1.81 to 1181.19). CONCLUSIONS: The severity of the outcomes associated with adult atomoxetine ingestions depended on the dose taken and the circumstances of the ingestion. The management of patients with serious outcomes was more likely to involve healthcare facilities. Such information is useful in creating triage guidelines for the management of adult atomoxetine ingestions.

Lupine Calls to Texas Poison Control Centers, 1998–2005.
Forrester MB
Toxicol Environ Chem. 2006;88:739-743.
Many lupine species (Genus Lupinus) contain toxic compounds, although the amount of these substances varies by the plant part and species. This investigation described the epidemiology of 138 lupine exposures reported to Texas poison centers during 1998–2005. Almost 88% of the lupine exposure calls occurred in March and April, and 90% of the calls came from the central portions of the state. Sixty-one percent of the calls involved female patients, and 91% of the patients were age <6 years. The lupine exposure occurred at the patient's own residence in 79% of the cases. Of the reported lupine exposures, 93% were handled outside of health care facilities, and, of those cases with a known medical outcome, few moderate or major effects, and no deaths, were reported. The most frequently noted clinical effect among cases during 2000–2005 was vomiting, affecting 8% of the cases. In conclusion, most reported lupine exposures in Texas came from the central parts of the state, occurred in spring, and involved young children. Typical reported lupine exposures in Texas were not likely to have adverse outcomes.

Pattern of Thiazolidinedione Exposures Reported to Texas Poison Centers During 1998-2004.
Forrester MB.
J Toxicol Environ Health A. 2006 Dec;69(23):2083-93.
Information on the management of potentially adverse exposures to thiazolidinediones, a class of oral antihyperglycemic, is limited. This study examined the distribution of thiazolidinedione exposures reported to Texas poison control centers from 1998 through 2004. There were a total of 581 exposures reported, increasing from 31 in 1998 to 140 in 2004. Of the 286 exposures to thiazolidinediones alone, 60% involved patients age 5 yr or younger and 34% patients age 20 yr or greater. Fifty-four percent of the patients were female. The exposure was unintentional in 94% of the exposures, with therapeutic errors accounting for 26% of the exposures reported. Management of 61% of the exposures occurred on site and 39% at a health care facility. Of those exposures with a final medical outcome, 94% were classified as no effect and no cases with major effects or deaths were reported. An adverse clinical effect was reported for 7% of the exposures, the most frequent of which were hypoglycemia (2%), hyperglycemia (1%), and drowsiness (1%). A treatment was reported for 76% of the exposures. The most frequent treatments were decontamination by being given some sort of food (38%), dilution with substances such as milk (34%), and activated charcoal (20%). In conclusion, this study found that the number of reported potentially adverse thiazolidinedione exposures in Texas increased in recent years. Such exposures generally found few adverse clinical effects and were reversible, although some sort of treatment, particularly decontamination, was administered and a large proportion of exposures were managed at or referred to health care facilities.

Evaluation of the Texas Birth Defects Registry: An Active Surveillance System.
Miller E.
Birth Defects Res A Clin Mol Teratol. 2006 Nov;76(11):787-92.
BACKGROUND: Evaluations of surveillance systems are necessary to determine if the goals of the system are being met, how efficiently the surveillance is being implemented, and if resources are being used appropriately. An evaluation of the Texas Birth Defects Registry was conducted to assess the overall quality of data collection and to examine variations across regions of the state. METHODS: The registry was evaluated by using published guidelines for evaluating public health surveillance systems; the evaluation included staff interviews, process observation, and secondary data analysis. RESULTS: The registry monitors >370,000 births/year through active surveillance, with considerable disparities in workload across regions of the state. Because of the geographic size and substantial population of Texas, data collection is complex. However, the estimated sensitivity of the system appears sufficient, and rates for selected defects are highly comparable with other U.S. active birth-defect surveillance systems. Registry staff continually monitor the quality of data collection and provide additional training. Amid unstable funding, the registry staff have demonstrated optimal foresight and flexibility to adapt and continue quality data collection. Timeliness needs to be improved and more consistent quality assurance is needed across regions of the state. Retaining staff and increasing visibility are essential to providing more stability. CONCLUSIONS: Active surveillance for birth defects is labor-intensive but provides invaluable data for its stakeholders. The Texas Birth Defects Registry has proven to be a quality surveillance system and a beneficial resource for Texas.

A Comparison of Breastfeeding Rates in an Urban Birth Cohort among Women Delivering Infants at Hospitals that Employ and Do Not Employ Lactation Consultants.
Castrucci BC, Hoover KL, Lim S, Maus KC.
J Public Health Manag Pract. 2006 Nov-Dec;12(6):578-85.
OBJECTIVE: To compare rates of breastfeeding at hospital discharge between facilities that employ and do not employ International Board Certified Lactation Consultants (IBCLCs). METHODS: This study used a cross-sectional design. Data from 11,525 birth certificates of Philadelphia residents who delivered in 2003 were used. Breastfeeding was assessed using a question included on the Pennsylvania birth record, "Is the infant being breastfed at discharge?" The Philadelphia Department of Public Health's lactation consultants collected information on number of hours worked annually by IBCLCs by facility. RESULTS: After adjusting for race/ethnicity, education, insurance status, age, marital status, route of delivery, birth weight, and gestational age, delivering in a hospital that employed an IBCLC was associated with a 2.28 (95% confidence interval [CI] =1.98,2.62) times increase in the odds of breastfeeding at hospital discharge. Among women receiving Medicaid, delivering at a hospital that employed IBCLCs was associated with a 4.13 (95% CI =3.22,4.80) times increase in the odds of breastfeeding at hospital discharge. CONCLUSIONS: The findings presented here identify an association between delivering at a facility that employs IBCLCs and breastfeeding at hospital discharge. As the strength of this association is not negligible, particularly for women on Medicaid, these findings may be used to encourage widespread use of IBCLCs.

Drug Identification Calls from Law Enforcement Received by Texas Poison Control Centers, 2002-2004.
Forrester MB.
J Toxicol Environ Health A. 2006 Nov;69(22):2041-9.
Aside from calls involving human exposures to potentially toxic substances, poison control centers handle other types of calls such as drug identifications (drug IDs). A portion of drug ID requests originates from law enforcement. The objective of this study was to describe such drug ID requests from law enforcement received by Texas poison control centers during 2002-2004. These calls were examined with respect to year of call, location of caller, and type of drug. There were in total 26,752 drug ID calls (involving 27,800 individual drug ID requests) from law enforcement, representing 3% of total calls and 16% of all drug ID calls received. The number of drug ID calls received from law enforcement and the proportion of total calls and all drug ID calls these represented increased from 2002 to 2004. A disproportionate number of the drug ID requests originated from eastern-central Texas. The most frequently involved drugs were analgesics (particularly acetaminophen and hydrocodone), sedatives and related drugs (particularly alprazolam), and muscle relaxants (particularly carisoprodol).

National Estimates and Race/Ethnic-Specific Variation of Selected Birth Defects in the United States, 1999-2001.
Canfield MA, Honein MA, Yuskiv N, Xing J, Mai CT, Collins JS, Devine O, Petrini J, Ramadhani TA, Hobbs CA, Kirby RS.
Birth Defects Res A Clin Mol Teratol. 2006 Oct 18; doi: 10.1002/bdra.20294 [Epub ahead of print]
BACKGROUND: In the United States, birth defects affect approximately 3% of all births, are a leading cause of infant mortality, and contribute substantially to childhood morbidity. METHODS: Population-based data from the National Birth Defects Prevention Network were combined to estimate the prevalence of 21 selected defects for 1999-2001, stratified by surveillance system type. National prevalence was estimated for each defect by pooling data from 11 states with active case-finding, and adjusting for the racial/ethnic distribution of US live births. We also assessed racial/ethnic variation of the selected birth defects. RESULTS: National birth defect prevalence estimates ranged from 0.82 per 10,000 live births for truncus arteriosus to 13.65 per 10,000 live births for Down syndrome. Compared with infants of non-Hispanic (NH) white mothers, infants of NH black mothers had a significantly higher birth prevalence of tetralogy of Fallot, lower limb reduction defects, and trisomy 18, and a significantly lower birth prevalence of cleft palate, cleft lip with or without cleft palate, esophageal atresia/tracheoesophageal fistula, gastroschisis, and Down syndrome. Infants of Hispanic mothers, compared with infants of NH white mothers, had a significantly higher birth prevalence of anencephalus, spina bifida, encephalocele, gastroschisis, and Down syndrome, and a significantly lower birth prevalence of tetralogy of Fallot, hypoplastic left heart syndrome, cleft palate without cleft lip, and esophageal atresia/tracheoesophageal fistula. CONCLUSIONS: This study can be used to evaluate individual state surveillance data, and to help plan for public health care and educational needs. It also provides valuable data on racial/ethnic patterns of selected major birth defects.

Match Rate and Positional Accuracy of Two Geocoding Methods for Epidemiologic Research.
Zhan FB, Brender JD, De Lima I, Suarez L, Langlois PH.
Ann Epidemiol. 2006 Oct 4; doi: 10.1016/j.annepidem.2006.08.001 [Epub ahead of print]
PURPOSE: This study compares the match rate and positional accuracy of two geocoding methods: the popular geocoding tool in ArcGIS 9.1 and the Centrus GeoCoder for ArcGIS. METHODS: We first geocoded 11,016 Texas addresses in a case-control study using both methods and obtained the match rate of each method. We then randomly selected 200 addresses from those geocoded by using both methods and obtained geographic coordinates of the 200 addresses by using a global positioning system (GPS) device. Of the 200 addresses, 110 were case maternal residence addresses and 90 were control maternal residence addresses. These GPS-surveyed coordinates were used as the "true" coordinates to calculate positional errors of geocoded locations. We used Wilcoxon signed rank test to evaluate whether differences in positional errors from the two methods were statistically significantly different from zero. In addition, we calculated the sensitivity and specificity of the two methods for classifying maternal addresses within 1500 m of toxic release inventory facilities when distance is used as a proxy of exposure. RESULTS: The match rate of the Centrus GeoCoder was more than 10% greater than that of the geocoding tool in ArcGIS 9.1. Positional errors with the Centrus GeoCoder were less than those of the geocoding tool in ArcGIS 9.1, and this difference was statistically significant. Sensitivity and specificity of the two methods are similar. CONCLUSIONS: Centrus GeoCoder for ArcGIS for geocoding gives greater match rates than the geocoding tool in ArcGIS 9.1. Although the Centrus GeoCoder has better positional accuracy, both methods give similar results in classifying maternal addresses within 1500 m of toxic release inventory facilities when distance is used as a proxy of exposure.

Comparison of zolpidem and zaleplon exposures in Texas, 1998-2004.
Forrester MB.
J Toxicol Environ Health A. 2006 Oct;69(20):1883-92.
Zolpidem and zaleplon are used for the treatment of insomnia. The objective of this study was to compare the patterns of zolpidem and zaleplon exposures reported to Texas poison control centers during 1998-2004. There were 5842 total reported zolpidem exposures, of which 2918 (50%) were isolated exposures, and 467 total reported zaleplon exposures, of which 201 (43%) were isolated exposures. Zolpidem patients were 62% male and 67% adult. Zaleplon patients were 67% male and 34% adult. The exposure was intentional in 62% of zolpidem and 58% of zaleplon exposures. The exposure occurred at the patient's own residence in 94% of zolpidem and 97% of zaleplon exposures. Management occurred outside of a health care facility for 29% of zolpidem and 32% of zaleplon exposures. The medical outcome involved no symptoms due to exposure for 29% of zolpidem and 44% of zaleplon exposures, a statistically significant difference. Although many of the most frequently reported adverse clinical effects for the two drugs were similar (drowsiness, slurred speech, hallucinations, ataxia, tachycardia, dizziness, confusion, vomiting), the proportion of exposures with a given adverse clinical effect was generally lower for zaleplon. Thus, although zolpidem and zaleplon exposures were generally similar with respect to patient gender and age, exposure reason and site, and management site, zaleplon exposures were less likely to result in minor medical outcomes or manifest as adverse clinical effects.

Pattern of dipyrone exposure in Texas, 1998 to 2004.
Forrester MB.
J Med Toxicol 2006;2(3):101-107.
Introduction: Dipyrone is an analgesic and antipyretic agent. The purpose of this study was to describe the pattern of dipyrone exposures reported to poison centers. Methods: Human dipyrone exposures reported to 6 Texas poison centers from 1998 to 2004 were identified. Isolated and non-isolated cases were compared with respect to various factors. Results: When compared to the Census, dipyrone exposures were significantly more likely to have been reported from regions closer to the Mexican border (53% vs 9%). Of 81 dipyrone exposures, 52 (64%) were isolated and 29 (36%) were non-isolated. Most of the dipyrone exposures occurred at the patient’s own residence (72/76 or 95%) and the patients were more likely to be female (54/81 or 67%). Although the majority of both types of dipyrone exposures were adults (47/78 or 60%), children, less than 6 years of age, accounted for a higher proportion of isolated exposures (33% vs 10%) while a higher proportion of non-isolated exposures involved older children (28% vs 8%). Twenty-two percent (11/51) of isolated cases were intentional while 59% (17/29) of non-isolated cases were intentional. Of those cases with a known medical outcome, the medical outcome was no adverse clinical effect for 76% (16/21) of isolated exposures and 42% (8/19) of non-isolated exposures. The specific adverse clinical effects reported for isolated exposures were primarily neurological (n=6), gastrointestinal (n=4), and dermal (n=3). The most frequently reported treatment for isolated exposures was some form of decontamination (n=11). Conclusions: Isolated and non-isolated dipyrone exposures varied with respect to patient age, exposure reason, management site, and medical outcome.

Jimsonweed (Datura stramonium) exposures in Texas, 1998-2004.
Forrester MB.
J Toxicol Environ Health A 2006 Oct;69(19):1757-1762.
For centuries, jimsonweed, Datura stramonium, was known to produce hallucinogenic effects. Jimsonweed is easily obtained and may be abused by adolescents. This investigation examined the patterns of jimsonweed exposures reported to Texas poison control centers during 1998–2004. A total of 188 reported human exposures were identified. Seventy-six percent of the exposures occurred in June–October. For those cases where the information was known, the majority were male (82%) and age 13–19 yr (72%). Intentional abuse or misuse accounted for 78% of reported exposures. Eighty-two percent of the reported exposures were at, en route to, or referred to health care facilities, and 89% of those cases with a known medical outcome had moderate or major effects. The most frequently reported clinical effects were hallucination, tachycardia, agitation, mydriasis, and confusion; the most frequently reported treatments were intravenous fluids replacement, activated charcoal, cathartic, and benzodiazepines. The pattern of reported jimsonweed exposures in Texas was consistent with previously published literature.

Human West Nile virus neuroinvasive disease in Texas, 2003 epidemic: regional differences.
Warner RD, Kimbrough RC, Alexander JL, Rush Pierce J Jr, Ward T, Martinelli LP.
Ann Epidemiol. 2006 Sep 12;16(10):749-755.
PURPOSE: Arboviral diseases, such as West Nile virus (WNV) epizootics, tend to be geographically unique because of the biomes that support the vector(s) and reservoir host(s). Understanding such details aids in preventive efforts. We studied the 2003 epidemic of human West Nile neuroinvasive disease (WNND) in Texas because it initially appeared that incidence was not uniform across regions of the state. METHODS: The epidemic was described by age, sex, and region of residence. These variables were used to compare age-specific incidence, standardized cumulative incidence, and age-adjusted relative risk (RR). We verified case data and used routine software, with population estimates from the US Census Bureau. RESULTS: Regardless of sex, risk increased with age. Males had the greater risk (RR, 1.69); however, males aged 5 to 17 years had the greatest RR. Of the five regions compared, two posed more (RRs, 7.98 and 2.14) and one posed less (RR, 0.40) risk than the remainder of the state. Proportions of Culex vector species differed significantly between regions. CONCLUSIONS: During 2003, the risk for WNND varied considerably across Texas. This suggests that various risks for WNV infection deserve additional research for preventive interventions to be regionally appropriate and effective.

Annual Report to the Nation on the Status of Cancer, 1975-2003, Featuring Cancer among U.S. Hispanic/Latino Populations.
Howe HL, Wu X, Ries LA, Cokkinides V, Ahmed F, Jemal A, Miller B, Williams M, Ward E, Wingo PA, Ramirez A, Edwards BK.
Cancer. 2006 Sep 6;107(8):1711-1742.
BACKGROUND: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos. METHODS: Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated. RESULTS: The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages. CONCLUSIONS: The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.

Geographic variation in the incidence of colorectal cancer in the United States, 1998-2001.
Lai SM, Zhang KB, Uhler RJ, Harrison JN, Clutter GG, Williams MA.
Cancer. 2006 Sep 1;107(5 Suppl):1172-80.
BACKGROUND: This study examined the incidence rates and risk factors for colorectal cancer in 9 geographic divisions in the United States. METHODS: The colorectal cancer cases were diagnosed between 1998 and 2001 in 39 states and the District of Columbia (grouped into 9 geographic divisions in the United States). The association between colorectal cancer and geographic division was analyzed using the Poisson regression model controlling for demographics and ecologic measures of education, behavioral factors and colorectal cancer screening data extracted from the Behavioral Risk Factor Surveillance System. RESULTS: The age-adjusted incidence rates of colorectal cancer were highest in the Middle Atlantic division, followed by New England division, East and West North Central divisions, East South Central and South Atlantic divisions, West. South Central and Pacific divisions, with the lowest rate observed in the Mountain division. Old age, male gender, black race, less than a twelfth-grade education, smoking, and no physical activity were significantly associated with higher incidence rates of colorectal cancer, whereas having sigmoidoscopy/colonoscopy in the past 5 years, fecal occult blood test in the past year, and obesity were associated with lower incidence rates of colorectal cancer. The relative ranking of incidence rates of colorectal cancer across divisions changed after adjusting for these factors. CONCLUSIONS: Significant geographic variation in colorectal cancer exists in the United States. Risk factors, including demographics, education, behavior, and screening use, can only partially explain the differences across geographic divisions.

Aripiprazole exposures reported to Texas poison control centers during 2002-2004.
Forrester MB.
J Toxicol Environ Health A 2006 Sep;69(18):1719-1726.
Aripiprazole is an oral atypical antipsychotic drug used in the treatment of schizophrenia and potentially other behavior disorders. The purpose of this study was to describe the epidemiology of aripiprazole exposures reported to Texas poison control centers. Human aripiprazole exposures reported to six Texas poison control centers were identified and comparisons were made between isolated and nonisolated cases with respect to various demographic and clinical factors. Of 280 human exposures involving aripiprazole, 35% were isolated and 65% were nonisolated. The patients were female in 52% of isolated and 60% of nonisolated cases. Isolated cases were significantly more likely to involve children <6 yr of age. Fifty-eight percent of isolated cases were unintentional while 68% of nonisolated cases were intentional. Nonisolated cases were much more likely to already be at or en route to a health care facility when the poison control center was contacted. Of those cases with a known medical outcome, no adverse clinical effect was reported in 52% of isolated cases and 35% of nonisolated cases. The adverse clinical effects associated with isolated aripiprazole exposures were mainly neurological, cardiovascular, and gastrointestinal, with the most frequently reported adverse clinical effect being drowsiness or lethargy. The most commonly reported treatments for isolated aripiprazole exposures were single dose of activated charcoal, cathartic, intravenous fluids, dilution, lavage, and antihistamines. In conclusion, isolated and nonisolated aripiprazole exposures varied with respect to patient age, exposure reason, management site, and clinical outcome.

Adaptation and implementation of an evidence-based prevention counseling intervention in Texas.
Hitt JC, Robbins AS, Galbraith JS, Todd JD, Patel-Larson A, McFarlane JR, Spikes P, Carey JW.
AIDS Educ Prev. 2006 Aug;18(4 Suppl A):108-18.
HIV prevention counseling linked with testing has been shown to reduce high-risk behaviors and new sexually transmitted diseases in public clinic settings. However, few studies have been conducted evaluating the implementation of such models outside a research setting. This study sought to determine the extent to which the introduction of a standard protocol based on Project RESPECT improves the achievement of HIV prevention counseling goals of existing counseling and testing programs. Four prevention counseling programs contracting with the Texas Department of State Health Services completed a standardized 5-day training and implemented the protocols, counseling tools, and quality assurance (QA) procedures developed for the project. Introduction of the protocol was accomplished with existing program resources and significantly improved prevention counseling. Direct observation of counseling sessions demonstrated a significant improvement in attainment for eight of the nine counseling goals of initial sessions and for all counseling goals of follow-up sessions after the protocol was introduced. Client exit questionnaires reinforced this finding. Significant improvement was also found in use of counseling skills, with improvements in 6 of 10 skills observed in initial sessions and 4 of 10 skills in follow-up sessions. Challenges identified through semistructured interviews with counselors and supervisors included serving non-English-speaking and low-risk clients, mastery of the protocol, the amount of time required for QA, and implementation in settings with severe time constraints.

Unauthorized border crossings and migrant deaths: Arizona, New Mexico, and El Paso, Texas, 2002-2003.
Sapkota S, Kohl HW, Gilchrist J, McAuliffe J, Parks B, England B, Flood T, Sewell CM, Perrotta D, Escobedo M, Stern CE, Zane D, Nolte KB.
American Journal of Public Health, 2006 July;96(7):1-6.
LINK to Full-text: http://www.ajph.org/cgi/reprint/AJPH.2005.075168v1
Objectives. We examined the major causes of and risk factors for death among migrants who died while making unauthorized border crossings into the United States from Mexico. Methods. Decedents were included in the study if (1) their remains were found between January 1, 2002, and December 31, 2003, in any US county along the 650-mi (1040-km) section of the US-Mexico border from Yuma, Ariz, to El Paso, Tex; (2) their immigration status was unauthorized; and (3) they were believed to have died during transit from Mexico to the United States. Characteristics of the decedents and causes of and risk factors for their deaths were examined. Results. Among the 409 decedents meeting our inclusion criteria, environmental heat exposure (n=250; 61.1%) was the leading cause of death, followed by vehicle crashes (n=33; 8.1%) and drownings (n=24; 5.9%). Male decedents (n=298; 72.8%) outnumbered female decedents (n=105; 25.6%) nearly 3 to 1. More than half of the decedents were known to be Mexican nationals (n=235; 57.5%) and were aged 20 to 39 years (n=213; 52.0%); the nationality of 148 (36.2%) decedents was undetermined. Conclusions. Deaths among migrants making unauthorized US-Mexico border crossings are due to largely preventable causes. Prevention strategies should target young Mexican men, and focus on preventing them from conceiving plans to cross the border, discouraging them from using dangerous routes as crossing points, and providing search-and-rescue teams to locate lost or injured migrant crossers.

Folic acid awareness and supplementation among Texas women of childbearing age.
Canfield MA, Przybyla SM, Case AP, Ramadhani T, Suarez L, Dyer J.
Prev Med. 2006 Jul;43(1):27-30.
OBJECTIVE: Neural tube defects (NTDs) affect about seven of every 10,000 deliveries in Texas. To reduce the risk for NTDs, women are encouraged to supplement with 400 mcg folic acid daily during their reproductive years. This study examines folic acid awareness, knowledge, and supplementation practices among women of childbearing age (WCBA), including residents of Texas-Mexico border as well as women of Hispanic origin/ethnicity, populations that have NTD rates up to three times higher than the national average. METHODS: We conducted a statewide multistage sample telephone survey among Texas women of childbearing age in 2001. In total 1,196 women age 18 to 44 were interviewed. RESULTS: About 78% of WCBA knew about folic acid, 28% knew that folic acid prevents birth defects, and 25% knew to take folic acid before pregnancy. The prevalence of daily folic acid supplementation among all women of childbearing age was 33%. Education was the strongest predictor of folic acid awareness followed by race/ethnicity and age. Significant predictors of daily folic acid supplementation were education and ethnicity. CONCLUSIONS: Our findings suggest the need for more emphases on strategies to improve the level of folic acid supplementation among low educated women, and race ethnic minority populations.

A low-intensity intervention to prevent annual weight gain in active duty Air Force members.
Robbins AS, Chao SY, Baumgartner N, Runyan CN, Oordt MS, Fonseca VP.
Mil Med. 2006 Jun;171(6):556-61.
Elevated body weight among active duty Air Force (ADAF) members is a substantial and growing problem, and typically results from gaining small amounts of weight each year over many years. We designed a strategy to prevent annual weight gain in ADAF members using self-directed behavior change booklets followed by weekly e-mails about diet and physical activity for a year. The intervention was universally offered to ADAF members meeting selection criteria at five U.S. Air Force bases (n = 3,502); members at 60 other U.S. Air Force bases served as controls (n = 65,089). The intervention was completely effective at preventing weight gain in a subgroup of men (those above the lowest three ranks, with baseline weight above maximum allowable) and in women, while controls continued to gain weight. Since the intervention did not require personalized contact, this approach has promise for large-scale population-based efforts aimed at preventing weight gain in working adults.

Epidemiology of centipede exposures reported to Texas poison control centers, 1998–2004.
Forrester MB.
Toxicol Environ Chem 2006;88(2):213-218.
Centipedes are found globally, including the southern United States. Although centipede bites may cause pain, the bite is generally not considered life threatening. The present retrospective investigation studied the epidemiology of centipede exposures reported to Texas poison control centers. Cases were all human exposures reported during 1998–2004 that involved centipedes. There were totally 851 cases. Among the cases with a known patient age, 16% were less than 6 years of age, 19% were 6–19, and 65% were greater than 19 years. Females accounted for 55% of the patients with known gender. The reported centipede exposures were managed on site (outside of a health care facility) in 93% of the cases. Of the 305 cases with a known clinical outcome, 82% had minor effects. Cases exhibited a seasonal trend, with most of the reports occurring during July–September. There was no clear geographic pattern to the reported centipede exposures, although the highest rate occurred in West Texas. Dermal irritation or pain was reported in 73% of cases and the treatment by decontamination via irrigation was reported for 76% of the cases during 2000–2004.

Maternal residential proximity to waste sites and industrial facilities and oral clefts in offspring.
Brender JD, Zhan FB, Suarez L, Langlois PH, Moody K.
J Occup Environ Med. 2006 Jun;48(6):565-72.
OBJECTIVE: This study examined the association between oral clefts and maternal residential proximity to waste sites or industries. METHODS: In a case-control study, maternal residences at birth of 1781 births with oral clefts and 4368 comparison births were related to locations of waste sites and industrial facilities in Texas through geographic information systems. RESULTS: Compared with women who lived farther, women who lived within a mile of these sites or facilities were not more likely to have offspring with oral clefts. Among women > or =35 years, oral clefts in offspring were associated with living within a mile of industrial facilities (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.3-4.2), especially smelters (OR = 15.0, 95% CI = 2.8-151). CONCLUSION: These findings suggest that maternal residential proximity to industries might be associated with oral clefts in births to older mothers.

Comparison of residential geocoding methods in population-based study of air quality and birth defects.
Gilboa SM, Mendola P, Olshan AF, Harness C, Loomis D, Langlois PH, Savitz DA, Herring AH.
Environ Res. 2006 Jun;101(2):256-62. Epub 2006 Feb 17.
Our population-based case-control study of air quality and birth defects in Texas relied on the geocoding of maternal residence from vital records for the assignment of air pollution exposures during early pregnancy. We attempted to geocode the maternal addresses for 5,338 birth defect cases and 4,574 frequency-matched controls using an automated procedure with standard matching criteria in ArcGIS 8.2 and 8.3. Initially, we matched 7,266 observations (73%). To increase the proportion of successful matches, we used an interactive procedure for the 2,646 addresses that were initially not geocoded by the software. This yielded an additional 985 matches (37%). Using the same 2,646 initially unmatched addresses, we compared the results of this interactive procedure to those of an automated procedure using lower standards. The automated procedure with lower standards yielded more matches (n=1,559, 59%) but with questionable accuracy. We included the interactively geocoded observations in our final data set. Their inclusion did not affect the estimates of air pollution exposure but increased our statistical power to detect associations between air quality and risk of selected birth defects. The geocoded and not geocoded populations differed in the distribution of Latino ethnicity (51% vs 59%) and ethnicity was independently associated with air pollution exposures (P<0.05). Geocoding status also appeared to modify the association between ethnicity and risk of birth defects; Latina women appeared to have a slightly lower risk of birth defects than non-Latina women in the geocoded population and to have a slightly higher risk in the not geocoded population. Incomplete geocoding may have resulted in a selection bias because of the under-representation of Latinas in our study population.

Methylphenidate abuse in Texas, 1998-2004.
Forrester MB.
J Toxicol Environ Health A 2006;69:1145-53.
Abstract: Methylphenidate is a stimulant used in the treatment of attention deficit hyperactivity disorder in children and is subject to abuse. This study describes the patterns of methylphenidate abuse and drug identification (ID) calls received by several poison control centers in Texas. Cases were calls involving methylphenidate received by Texas poison control centers during 1998-2004. Drug ID and drug abuse calls were assessed by call year and geographic location. Drug abuse calls were then compared to all other human exposure (nonabuse) calls with respect to various factors. Of 6798 calls received involving methylphenidate, 35% were drug IDs and 56% human exposures. Of the human exposures, 9% involved abuse. The number of drug ID calls and drug abuse calls received per year both declined during the first part of 7-yr period but then increased. Male patients accounted for approximately 60% of both drug abuse and nonabuse calls. Adolescent patients comprised 55% of drug abuse calls and children less than 13 yr old comprised 62% of nonabuse calls. Although the majority of both types of human exposures occurred at the patient's own residence, drug abuse calls were more likely than non-abuse calls to involve exposures at school (15% vs. 6%) and public areas (3% vs. 0.4%). While drug abuse calls were less likely than nonabuse calls to present with no clinical effects (29% vs. 52%), they were more likely to show more serious medical outcomes. Methylphenidate abusers are more likely to be adolescents. Methylphenidate abuse as compared to other exposures is more likely to occur outside of the person's home and to involve more serious medical outcomes.

Valdecoxib exposures reported to Texas poison centers during 2002-2004.
Forrester MB.
J Toxicol Environ Health A 2006;69:899-905.
Abstract: Valdecoxib is a drug possessing anti-inflammatory and analgesic properties and acts by binding to cyclo-oxygenase-2. The objective of this study was to describe the epidemiology of valdecoxib exposures reported to Texas poison centers. Human valdecoxib exposures reported to six Texas poison centers were identified and comparisons were made between isolated and nonisolated cases with respect to various demographic and clinical factors. Of 328 human valdecoxib calls, 55% were isolated and 45% were nonisolated. Fifty-eight percent of isolated cases involved female patients while 69% of nonisolated cases involved females. Fifty-three percent of isolated cases involved patients of age less than 6 yr, whereas 71% of nonisolated cases involved patients age 20 yr or greater. Eighty-four percent of isolated cases were unintentional and 67% of nonisolated cases were intentional. The patient was managed outside of health care facilities in 84% of isolated cases and 26% of nonisolated cases. Of those cases with a known medical outcome, 92% of isolated cases had no effect and 35% of nonisolated cases had no effect. Among isolated valdecoxib exposures, no particular clinical effect was reported in more than five cases. Isolated and nonisolated valdecoxib exposures varied with respect to patient gender and age, exposure reason, and clinical outcome. Adverse effects for isolated valdecoxib exposure involved only a small portion of patients that reported to the Texas poison control centers.

Uptake and elimination of perchlorate in eastern mosquitofish.
Bradford CM, Park JW, Rinchard J, Anderson TA, Liu F, Theodorakis CW.
Chemosphere. 2006 Jun;63(9):1591-7.
The purpose of this study was to investigate the uptake and elimination of perchlorate in eastern mosquitofish (Gambusia holbrooki). Fish were exposed to 0.1-1000mg/l sodium perchlorate for 12h, 1, 2, 5, 10, and 30days, and perchlorate was determined in whole body extracts. Perchlorate was not detected in mosquitofish exposed to the low concentrations of perchlorate (0, 0.1, and 1mg/l sodium perchlorate), regardless of the exposure time, whereas it was detected when fish were exposed to 10, 100, and 1000mg/l. The tissue concentrations were approximately 10 times less than that in the water. There was no difference in the uptake of perchlorate depending upon the exposure time, however, a difference in perchlorate uptake depending upon the concentration of the exposure dose (P<0.001) was observed. Uptake (K(u)) and elimination (K(e)) rate constants were 0.09l/mgday and 0.70day(-1), respectively. The half-life (T(1/2)) of perchlorate was 0.99day. Thus, it appears that perchlorate is rapidly taken up and eliminated in eastern mosquitofish. These results are critical and may be used to develop models of fate, effects, and transport of perchlorate in natural systems, as well as to assess ecological risk in affected ecosystems.

Health department costs of managing persons with suspected and noncounted tuberculosis in New York City, three Texas counties, and Massachusetts.
Manangan LP, Moore M, Macaraig M, MacNeil J, Shevick G, Northrup J, Pratt R, Adams LV, Boutotte J, Sharnprapai S, Qualls N.
J Public Health Manag Pract. 2006 May-Jun;12(3):248-53.
OBJECTIVES: To describe persons with suspected (did not meet the national tuberculosis [TB] surveillance case definition) and noncounted TB (met the TB case definition but transferred and were counted by another jurisdiction) and estimate costs incurred by public health departments for managing them. METHODS: We reviewed TB registry, medical records, budgets, bills, salaries, organizational charts, and travel/activity logs from the year 2000 at health departments in New York City (NYC), three Texas (TX) counties (El Paso, Hidalgo, and Webb), and Massachusetts (MA). We also interviewed or observed personnel to estimate the time spent on activities for these patients. RESULTS: In 2000, NYC and MA had more persons with suspected (n = 2,996) and noncounted (n = 163) TB than with counted (n = 1,595) TB. TX counties had more persons with counted TB (n = 179) than with suspected (n = 55) and noncounted (n = 15) TB. Demographic and clinical characteristics varied widely. For persons with suspected TB, NYC spent an estimated $1.7 million, with an average cost of $636 for each person; TX counties spent $60,928 ($1,108 per patient); and MA spent $1.1 million ($3,330 per patient). For persons with noncounted TB, NYC spent $303,148 ($2,180 per patient), TX counties spent $40,002 ($2,667 per patient), and MA spent $84,603 ($3,525 per patient). CONCLUSIONS: Health departments incurred substantial costs in managing persons with suspected and noncounted TB. These costs should be considered when allocating TB program resources.

Residential Mobility Patterns and Exposure Misclassification in Epidemiologic Studies of Birth Defects.
Canfield MA, Ramadhani TA, Langlois PH, Waller DK.
J Expo Sci Environ Epidemiol. 2006 May 31; doi: 10.1038/sj.jes.7500501 [Epub ahead of print]
Many studies of environmental exposures and birth defects use mothers' addresses at delivery as a proxy for the exposure. The validity of these studies is questionable because birth defects generally occur within 8 weeks of conception and the mother's address at delivery may differ from her address early in pregnancy. In order to assess the extent of this bias, we examined the pattern of maternal residential mobility over the span of 3 months prior to conception through delivery, and associated maternal socio-demographic characteristics. We linked Texas subjects from a national case-control study of birth defects with their corresponding records from the Texas Birth Defects Registry and the Texas live birth certificates. Logistic regression analyses were conducted to assess maternal socio-demographic factors related to mobility during pregnancy. Overall, 33% of case and 31% of control mothers changed residence between conception and delivery. The pattern of mobility was similar for both case and control mothers for each pregnancy period. Multivariate analyses indicated that for case mothers, older age (OR=0.39, 95% CI=0.21-0.70), higher household income (OR=0.35, 95% CI=0.18-0.68), Hispanic ethnicity (OR=0.64, 95% CI=0.44-0.92), and higher parity (OR=0.59, 95% CI=0.38-0.94) were indicators of lower mobility during pregnancy. For control mothers, the same pattern of association was present, however, only older age was significantly associated with low rates of mobility. Studies of birth defects using maternal address at delivery as a proxy for maternal environmental exposures during pregnancy may be subject to considerable nondifferential exposure misclassification due to maternal mobility during pregnancy.

Investigation of Texas poison center calls regarding a chlorine gas release: implications for terrorist attack toxicosurveillance.
Forrester MB.
Texas Medicine, 2006 May;102(5):52-57.
The investigation reported here was conducted to describe the pattern of calls received by the Texas Poison Center Network (TPCN) in relation to a chlorine gas release that resulted from a train collision in Bexar County, Texas, on June 28, 2004, and to test various methods for conducting toxicosurveillance. TPCN received a total of 42 calls; the first call was received approximately 35 minutes after the collision. Calls continued for 10 days after the collision. Comparison of the number of calls received from Bexar County on the collision date with the number of similar calls received in the past revealed that numbers for this collision date were elevated for total calls, total information calls, total human exposure calls, chlorine gas calls, and calls involving coughing or choking, headache, throat irritation, or bronchospasm. When a similar analysis was performed for the entire state, call numbers were elevated only for chlorine gas calls and calls involving bronchospasm.

Risk behaviors by ethnicity and Texas-Mexico border residence.
Sanderson M, Fernandez ME, Dutton RJ, Ponder A, Sosa D, Peltz G.
Ethnicity and Disease, 2006 Spring;16:514-520.
Objective: To determine whether residence on the Texas-Mexico border would modify the effect of ethnic differences on risk behaviors. Design: We performed an analysis of 1999-2003 cross-sectional data from the Texas Behavioral Risk Factor Surveillance System (BRFSS). Setting: Fifteen Texas-Mexico border counties compared with 239 Texas non-border counties. Participants: 521 White and 1722 Hispanic residents of Texas-Mexico border counties and 16,904 White and 4933 Hispanic residents of Texas non-border counties. Main Outcome Measures: Health risk behaviors including overweight, obesity, physical inactivity, fruit or vegetable consumption, heavy drinking, binge drinking, and smoking. Results: Hispanic women and men were more likely to be overweight, obese, and physically inactive, and less likely to consume fewer than five fruits or vegetables per day than Whites regardless of residence. Ethnic differences in heavy and binge drinking differed by residence and sex. After adjustment for age, educational level, annual household income, perceived general health, and diabetes, most behaviors that were higher or lower remained significant among non-border residents but were no longer significant among border residents. Conclusions: The only evidence of effect modification was binge drinking among males and most associations were weaker among border residents than among non-border residents.

Settlement-funded tobacco control in Texas: 2000-2004 pilot project effects on cigarette smoking.
LINK to Full-text: http://www.publichealthreports.org/userfiles/121_3/121235.pdf
McAlister AL, Huang P, Ramirez AG.
Public Health Reports 2006 May-June;121:235-238.
Because settlement proceeds allocated for tobacco control in Texas are insufficient for statewide activity at federally recommended funding levels, the Texas Department of State Health Services has used the available funds in quasi-experimental pilot studies in which varying amounts of support are provided for selected parts of the state. Trends in tobacco use were measured in telephone surveys of 7,998 (2000), 5,150 (2002), and 5,721 (2004) adults. Prevalence of cigarette smoking declined by almost one-third in the pilot area where comprehensive and sustained pilot activities to reduce tobacco use were organized at close to the federally recommended funding level. Significantly smaller reductions were observed in other parts of the state. In the group with the highest use, white non-Hispanic men, cigarette consumption declined by half in the pilot area. It is reasonable to expect similar reductions in tobacco use if funds are provided for statewide expansion of the pilot activities.

Celecoxib exposures reported to Texas poison control centers from 1999 to 2004.
Forrester MB.
Hum Exp Toxicol 2006;25:261-266.
Concerns have been raised about the safety of celecoxib. This study described the pattern of exposures involving only celecoxib (isolated exposures) reported to Texas poison control centers from 1999 to 2004. The mean dose was 701 mg. The patient age distribution was ?5 years (48%), 6–19 years (8%), and ?20 years (44%). In 78% of cases, exposure was unintentional. Of the exposures, 74% were managed outside of health care facilities. The final medical outcome was classified as no effect for 82% of the cases, and minor effects for 12% of the cases. Adverse clinical effects were listed for 5% of the patients, the most frequently reported being rash (3%), drowsiness (3%), pruritis (2%), and vomiting (2%). The most frequently listed treatment was decontamination by dilution (43%) or food (32%). The majority of isolated celecoxib exposures could be managed outside of health care facilities, and the outcome was generally favorable.

Acute pesticide-related illness among emergency responders, 1993-2002.
Calvert GM, Barnett M, Mehler LN, Becker A, Das R, Beckman J, Male D, Sievert J, Thomsen C, Morrissey B.
Am J Ind Med. 2006 May;49(5):383-93.
BACKGROUND: Emergency responders are among the first to arrive at a pesticide-related release event. Magnitude, severity, and risk factor information on acute pesticide poisoning among those workers is needed. METHODS: Survey data collected from the SENSOR-Pesticides, CDPR and HSEES programs between 1993 and 2002 from 21 states were reviewed. Acute occupational pesticide-related illness incidence rates for each category of emergency responder were calculated, as were incidence rate ratios (IRR) among emergency responders compared to all other workers employed in non-agricultural industries. RESULTS: A total of 291 cases were identified. Firefighters accounted for 111 cases (38%), law enforcement officers for 104 cases (36%), emergency medical technicians for 34 cases (12%), and 42 cases (14%) were unspecified emergency responders. Among the 200 cases with information on activity responsible for exposure, most were exposed while performing activities related to a pesticide release event (84%) and not involving patient care, while the remainder involved exposure to pesticide- contaminated patients. A majority of cases were exposed to insecticides (51%). Most had low severity illnesses (90%). The incidence rate was highest for firefighters (39.1/million) and law enforcement officers (26.6/million). The IRRs were also elevated for these professions (firefighters, IRR = 2.67; law enforcement officers, IRR = 1.69). CONCLUSIONS: The findings suggest the need for greater efforts to prevent acute occupational pesticide-related illness among emergency responders.

High school athletic departments as sentinel surveillance sites for community-associated methicillin-resistant staphylococcal infections.
Barr B, Felkner M, Diamond PM.
Texas Medicine, April 2006:102(4):56-61.
Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging infection in athletes. Our study assessed MRSA burden in Texas 4A and 5A high school athletic departments by contacting 447 licensed athletic trainers (LATs) regarding skin infections in athletes; 186 (41.6%) responded. Sixty LATs reported MRSA in their athletic departments. The largest MRSA outbreak (23 infected persons) occurred in football players. The trainers also reported MRSA in wrestlers, volleyball players, cross-country runners, nonathlete students, and adults. Students and adults involved in high school athletics require MRSA intervention because of their large numbers and extensive contacts. Physicians should be aware of the potential for MRSA and should culture rather than treat empirically, communicate with school health staff to maximize surveillance for affected students when MRSA occurs in their student community, and contact their health department when the number of students with MRSA meets the unusual group expression, outbreak, or unusual severity criteria.

Epidemiology of jellyfish stings reported to poison centers in Texas.
Forrester, M.B.
Human & Experimental Toxicology, 2006 April, 25(4):183-186.
This study examined the relationship between selected factors and all human exposures involving jellyfish stings reported to Texas poison centers. Cases were obtained retrospectively from calls to poison centers in Texas and included all reported human exposures during 1998–2004 involving jellyfish stings. The distribution of cases was determined for a variety of demographic and clinical parameters. There were 423 total cases. Among the cases with a known patient age, 19.8% were <6 years of age, 53.5% were age 6–19 years, and 26.7% were >19 years of age. Males accounted for 52% of the cases. Of the 118 cases with a known clinical outcome, 0.8% had no effect, 80.5% had minor effects, and 18.6% had moderate effects. Counties along the Gulf Coast accounted for 72.3% of the calls. This information can be used to identify those portions of the population most at need of education regarding the prevention and treatment of jellyfish stings.

Maternal exposure to arsenic, cadmium, lead, and mercury and neural tube defects in offspring.
Brender JD, Suarez L, Felkner M, Gilani Z, Stinchcomb D, Moody K, Henry J, Hendricks K.
Environmental Research, 2006;101(1):132-139.
Arsenic, cadmium, lead, and mercury are neurotoxins, and some studies suggest that these elements might also be teratogens. Using a case-control study design, we investigated the relation between exposure to these heavy metals and neural tube defects (NTDs) in offspring of Mexican-American women living in 1 of the 14 Texas counties bordering Mexico. A total of 184 case-women with NTD-affected pregnancies and 225 control-women with normal live births were interviewed about their environmental and occupational exposures during the periconceptional period. Biologic samples for blood lead and urinary arsenic, cadmium, and mercury were also obtained for a subset of these women. Overall, the median levels of these biomarkers for heavy metal exposure did not differ significantly (P>0.05) between case- and control-women. However, among women in the highest income group, case-women were nine times more likely (95% confidence interval (CI) 1.4-57) than control-women to have a urinary mercury 5.62mug/L. Case-women were 4.2 times more likely (95% CI 1.1-16) to report burning treated wood during the periconceptional period than control-women. Elevated odds ratios (ORs) were observed for maternal and paternal occupational exposures to arsenic and mercury, but the 95% CIs were consistent with unity. The 95% CIs of the ORs were also consistent with unity for higher levels of arsenic, cadmium, lead, and mercury in drinking water and among women who lived within 2 miles at the time of conception to industrial facilities with reported emissions of any of these heavy metals. Our findings suggest that maternal exposures to arsenic, cadmium, or lead are probably not significant risk factors for NTDs in offspring. However, the elevated urinary mercury levels found in this population and exposures to the combustion of treated wood may warrant further investigation.

Carbon monoxide poisonings after two major hurricanes--Alabama and Texas, August-October 2005.
[LINK to Full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5509a4.htm]
Centers for Disease Control and Prevention (CDC). DSHS contributors: J Villanacci, PhD, J Ryan, MD, C Barton, DVM, PhD, P McGaha, DO
MMWR Morb Mortal Wkly Rep. 2006 Mar 10;55(9):236-9.
Hurricanes Katrina and Rita struck the U.S. Gulf Coast on August 29, 2005, and September 24, 2005, respectively, causing widespread damage and leaving approximately 4 million households without electrical power. Despite public health measures to prevent carbon monoxide (CO) poisonings after major power outages, multiple CO poisonings were reported in Gulf Coast states in the wake of these hurricanes. The Alabama Department of Public Health and Texas Department of State Health Services asked CDC to assist in investigating the extent and causes of these hurricane-related CO poisonings. The investigation identified 27 incidents of CO poisoning resulting in 78 nonfatal cases and 10 deaths in hurricane-affected counties in Alabama and Texas, nearly all of which were caused by gasoline-powered generators. Most of the generators involved were placed outside but close to the home to power window air conditioners (ACs) or connect to central electric panels. Few homes had functioning CO detectors. CDC continues to recommend that generators be placed far from homes, away from window ACs, and that CO detectors be used by all households operating gasoline-powered appliances (e.g., generators and gas furnaces), with batteries replaced yearly. Although the risk for CO poisoning likely decreases as generators are placed further from the home, additional studies are needed to establish a safe distance for generator placement.

Hepatitis C virus seroprevalence: selected health care settings in Texas.
Melville SK, Heseltine G, Delamater E, Gilani Z, Hendricks K, Suarez L.
Texas Medicine, March 2006;102(3):56-61.
This study describes the burden of hepatitis C virus (HCV) infection in Texas through a series of seroprevalence studies in various health care settings. We assessed antibodies to HCV on excess blood samples from clients attending drug treatment centers (DTCs), sexually transmitted disease (STD) clinics, and publicly funded HIV (human immunodeficiency virus) testing sties. Clients attending DTCs had the highest seroprevalence at 73.0%, followed by those presenting at HIV testing sites (10.9%) and STD clinics (5.8%). Injection drug users had much higher seroprevalence than nonusers. Hepatitis C infection seroprevalences were higher in older clients than in younger clients. This investigation supports integrating HCV counseling and testing services into existing HIV and STD services since these populations share risk factors for bloodborne and sexually transmitted diseases. The reported prevalence of HCV can be used as a baseline measurement to monitor the effectiveness of screening for HCV.

Deaths associated with hypocalcemia from chelation therapy--Texas, Pennsylvania, and Oregon, 2003-2005.
[LINK to full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a3.htm]
Centers for Disease Control and Prevention (CDC). DSHS contributors: RA Beauchamp, MD, TM Willis, TG Betz, MD, J Villanacci, PhD
MMWR Morb Mortal Wkly Rep. 2006 Mar 3;55(8):204-7.
Chelating agents bind lead in soft tissues and are used in the treatment of lead poisoning to enhance urinary and biliary excretion of lead, thus decreasing total lead levels in the body. During the past 30 years, environmental and dietary exposures to lead have decreased substantially, resulting in a considerable decrease in population blood lead levels (BLLs) and a corresponding decrease in the number of patients requiring chelation therapy. Chelating agents also increase excretion of other heavy metals and minerals, such as zinc and, in certain cases, calcium. This report describes three deaths associated with chelation-therapy--related hypocalcemia that resulted in cardiac arrest. Several drugs are used in the treatment of lead poisoning, including edetate disodium calcium (CaEDTA), dimercaperol (British anti-Lewisite), D-penicillamine, and meso-2,3-dimercaptosuccinic acid (succimer). Health-care providers who are unfamiliar with chelating agents and are considering this treatment for lead poisoning should consult an expert in the chemotherapy of lead poisoning. Hospital pharmacies should evaluate whether continued stocking of Na2EDTA is necessary, given the established risk for hypocalcemia, the availability of less toxic alternatives, and an ongoing safety review by the Food and Drug Administration (FDA). Health-care providers and pharmacists should ensure that Na2EDTA is not administered to children during chelation therapy.

Tuberculosis control activities after Hurricane Katrina--New Orleans, Louisiana, 2005.
[LINK to full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5512a2.htm]
Centers for Disease Control and Prevention. DSHS contributors: C Wallace, PE Cruise
Morb Mortal Wkly Rep. March 31, 2006 / 55(12);332-335.
On August 29, 2005, when Hurricane Katrina struck the U.S. Gulf Coast, 130 Louisiana residents in the greater New Orleans area were known to be undergoing treatment for tuberculosis (TB) disease. Standard treatment and cure of TB requires a multidrug regimen administered under directly observed therapy (DOT) for at least 6 months (1). This report updates previous information (2) and summarizes TB cases reported as of December 31, 2005, among persons undergoing TB treatment in the New Orleans area when Hurricane Katrina made landfall and among persons who were evacuated and subsequently received a diagnosis of TB in other parts of the country. By October 13, 2005, through intensive local, state, and national efforts involving both government and private sector partners, all 130 TB patients from the New Orleans area had been located and, if still indicated, had resumed TB treatment. As a result of heightened public health surveillance among Hurricane Katrina evacuees, six other New Orleans evacuees began treatment (i.e., two persons with known TB and four with previously undiagnosed TB) after arriving in other states. The success of these post-disaster TB control measures affirms the utility of alternative data sources during health-related emergencies and the importance of maintaining a strong TB control component in the public health sector.

Pattern of sildenafil calls to Texas poison control centers, 1998-2004.
Forrester MB, Artalejo L.
J Toxicol Environ Health A. 2006 Mar;69(6):497-503.
Sildenafil, a popular medication approved for the treatment of erectile dysfunction, is often misused. This study sought to describe the patterns of sildenafil calls to poison control centers in Texas during 1998-2004. Data on all sildenafil calls reported to the Texas Poison Center Network were analyzed. There were 628 sildenafil calls, 36% of which were human exposures and 44% were drug identifications. The number of calls increased during 1998-2003 but leveled off in 2004. The sildenafil exposure was isolated in 70% of the human exposure calls and involved other substances in 30% of the calls. Nonisolated exposures were more likely than isolated exposures to be intentional, involve males, occur in adults, and involve more serious problems as reflected by higher rates of health care facility treatment usage and more severe medical outcomes. The most frequently reported clinical effects were dizziness, tachycardia, erythema, and drowsiness. Most sildenafil calls were for human exposures or drug identification. The characteristics of human exposures such as the exposure reason and medical outcome were dependent on the presence of other substances.

Exposure to fumonisins and the occurrence of neural tube defects along the Texas-Mexico border.
[LINK to full-text at http://www.ehponline.org/members/2005/8221/8221.html]
Missmer SA, Suarez L, Felkner M, Wang E, Merrill AH Jr, Rothman KJ, Hendricks KA.
Environ Health Perspect. 2006 Feb;114(2):237-41.
Along the Texas-Mexico border, the prevalence of neural tube defects (NTDs) among Mexican-American women doubled during 1990-1991. The human outbreak began during the same crop year as epizootics attributed to exposure to fumonisin, a mycotoxin that often contaminates corn. Because Mexican Americans in Texas consume large quantities of corn, primarily in the form of tortillas, they may be exposed to high levels of fumonisins. We examined whether or not maternal exposure to fumonisins increases the risk of NTDs in offspring using a population-based case-control study. We estimated fumonisin exposure from a postpartum sphinganine:sphingosine (sa:so) ratio, a biomarker for fumonisin exposure measured in maternal serum, and from maternal recall of periconceptional corn tortilla intake. After adjusting for confounders, moderate (301-400) compared with low (< or = 100) consumption of tortillas during the first trimester was associated with increased odds ratios (ORs) of having an NTD-affected pregnancy (OR = 2.4; 95% confidence interval, 1.1-5.3). No increased risks were observed at intakes higher than 400 tortillas (OR = 0.8 for 401-800, OR = 1.0 for > 800). Based on the postpartum sa:so ratio, increasing levels of fumonisin exposure were associated with increasing ORs for NTD occurrences, except for the highest exposure category (sa:so > 0.35). Our findings suggest that fumonisin exposure increases the risk of NTD, proportionate to dose, up to a threshold level, at which point fetal death may be more likely to occur. These results also call for population studies that can more directly measure individual fumonisin intakes and assess effects on the developing embryo.

Flunitrazepam abuse and malicious use in Texas, 1998-2003.
Forrester MB.
Subst Use Misuse. 2006;41(3):297-306.
Flunitrazepam is a potent benzodiazepine that is subject to abuse and malicious use. This study describes the patterns of flunitrazepam abuse and malicious use calls received by Texas poison centers during 1998-2003. The distribution of calls by year of call, geographic location of caller, patient gender and age, exposure site, and medical outcome were determined. There was no clear annual trend for abuse calls, but there was a consistent decline in the number of malicious use calls. A significantly higher percentage of abuse calls originated in south and west Texas and of malicious use calls in west Texas. Most abuse patients were males (55%) and adolescents (76%), and most of the exposures occurred in patient's own residence (68%), followed by school (16%). Most of the malicious use patients were females (93%) and adults (74%), and the greatest proportion of the exposures occurred in public areas (47%), followed by the patient's own residence (26%). The highest percentage of both abuse (48%) and malicious use (55%) involved minor effects. However, malicious use calls were significantly less likely to involve no effect (2% vs. 21%) and more likely to involve moderate effects (36% vs. 23%). Reported flunitrazepam abuse and malicious use calls in Texas differed with respect to geographic location of the caller, patient gender and age, exposure site, and medical outcome. Poison centers and health care providers might want to consider these differences when targeting populations for education and prevention efforts.

Alprazolam abuse in Texas, 1998-2004.
Forrester MB.
J Toxicol Environ Health A. 2006 Feb;69(3):237-43.
Alprazolam (Xanax) is used in the treatment of anxiety, depression, and panic attacks, and is subject to abuse. The objective of this study was to describe the patterns of alprazolam abuse and drug identification (ID) calls received by several poison control centers. Cases were alprazolam calls received by 6 poison control centers during 1998-2004. Of 25,954 alprazolam calls received, 42% were drug ID calls and 51% were human exposure calls, of which 18% were abuse calls. The number of drug ID calls and the number of abuse calls both increased during the 7-yr period. Male patients accounted for 54% of abuse calls and females for 66% of nonabuse calls. Adolescent patients comprised 43% of abuse calls but only 12% of nonabuse calls. Although the majority of both types of human exposures occurred at the patient's own residence, abuse exposures were more likely than other exposures to occur at school (9% vs. 1%) and public areas (6% vs. 1%). While abuse calls were less likely than nonabuse calls to have no adverse clinical effects (19% vs. 23%), they were more likely to have minor medical outcomes (60% vs. 50%). Alprazolam abuse in Texas appears to be increasing. Alprazolam abusers are more likely to be male and often adolescent. Alprazolam abuse as compared to other exposures is more likely to occur outside of the person's home. Alprazolam abuse is more likely to involve some sort of adverse medical outcome.

Screwworms.
Alexander JL.
J Am Vet Med Assoc. 2006 Feb 1;228(3):357-67.
New World and Old World screwworms pose threats to the livestock industry in the United States and other countries. Diligence on the part of veterinarians, physicians, and their respective staffs is essential to protect the livestock industry.

Linking teratogen information service and birth defects registry databases to improve knowledge of birth defect status.
Archer NP, Langlois PH, Case AP, Wolfe LJ.
Birth Defects Res A Clin Mol Teratol. 2006 Feb;76(2):126-8.
BACKGROUND: Although teratogen information services (TISs) obtain maternal exposure information from their callers, such services often do not know if the pregnancies were affected by a birth defect. This study attempted to improve the completeness of this information for Texas Teratogen Information Service (TTIS) callers by linking their records with the Texas Birth Defects Registry (TBDR) and Texas birth certificates (TBCs). METHODS: A total of 344 expectant mothers called TTIS with expected dates of delivery between 1 January 2000 and 31 December 2001. These pregnancies were linked with TBDR and TBC data. The percentages of pregnancies with known birth defect information both before and after the linkage were compared. RESULTS: The TTIS originally collected birth defect status information for 101 of the 344 callers (29.4%) and 0.6% of all 344 callers or 2.0% of callers with birth defect status information had a pregnancy affected by a birth defect. Linking TTIS records with TBDR and TBC data helped to raise the percentage of callers with birth defect status information from 29.4% to 71.5%. Among those callers, the percentage known to have birth defects increased from 2.0% to 4.1%. The sensitivity of TTIS follow-up calls in identifying birth defects was 50%, and the specificity was 100%. CONCLUSIONS: Linking TTIS caller records with TBDR and TBC data significantly increased both the percentage of pregnancies with birth defect status information and the percentage of pregnancies identified as affected by birth defects. Such linkage may be a good approach by which TISs can increase the completeness of their birth defect status information. Birth Defects Research (Part A), 2006. (c) 2006 Wiley-Liss, Inc.

Patterns of exposures at school among children age 6-19 years reported to Texas poison centers, 1998-2002.
Forrester MB.
J Toxicol Environ Health A. 2006 Feb;69(4):263-8.
Although children and adolescents spend a large amount of time in school, there is little information on the factors involved in school exposures that are reported to poison centers. This study used data involving exposures among children age 6-19 yr reported to 6 Texas poison centers during 1998-2002. The distribution of school and nonschool exposures was determined for various demographic and other factors, and comparisons were made between the two types of exposures. The lowest proportion of reported school exposures occurred in June-August and the next lowest proportion occurred in December-January; nonschool exposures were more constant throughout the year. Males accounted for 58% of school exposures and 49% of nonschool exposures. The exposure was unintentional in 74% of school and 67% of nonschool exposures. Ingestion was the most frequently reported exposure route for school (64%) and nonschool (76%) exposures. Among those cases with known medical outcome, the most frequently reported medical outcome involved minor effects for both school exposures (58%) and nonschool exposures (46%). Nonpharmaceuticals were involved in 75% of school exposures and 48% of nonschool exposures. The most frequently reported substances involved in school exposures were arts, crafts, and office supplies (18%), while the most frequently reported substances involved in nonschool exposures were analgesics (17%). This information may allow school administrators and health care providers to implement prevention strategies.

A pandemic flu: not if, but when. SARS was the wake-up call we slept through.
Pascoe N.
Texas Nursing 2006 Jan;80(1):6-10.
If an influenza pandemic struck today, borders might close, the global economy would be severely impacted, international vaccine supplies and health are systems would be overwhelmed, and some people might panic. To limit the fallout, the industrialized world must create a detailed response strategy involving the public and private sectors. Some experts feel we are overdue for a flu pandemic and the SARS pandemic of 2003 could have been the wake up call to begin preparations. Fortunately there is some assistance coming from the federal government. On January 12, U.S. Department of Health & Human Services Secretary Mike Leavitt announced funding to assist in the preparation for a pandemic flu response. $100 million is being provided initially with another $250 million due later this year to assist states in pandemic flu preparedness. Texas' initial allocation is $5,875,044. While some believe that the AI (H5N1) causing illness and deaths in Asia and Turkey will be the pandemic flu strain, there is no guarantee that will occur. Thus, without knowing which strain may lead to a pandemic, development and manufacturing of a vaccine is delayed.

Improved national prevalence estimates for 18 selected major birth defects -- United States, 1999 -- 2001.
[LINK to full-text: http://www.cdc.gov/mmwr//preview/mmwrhtml/mm5451a2.htm]
Centers for Disease Control and Prevention (CDC). DSHS contributors: Canfield MA, Ramadhani TA
MMWR Morb Mortal Wkly Rep. 2006 Jan 6;54(51&52);1301-5.
Continuing efforts are needed to improve surveillance for birth defects, which are the leading cause of infant mortality in the United States (1). Although state and local surveillance data indicate that approximately 3% of births are affected by any of 45 birth defects, no national estimates based on population-based birth defects surveillance have been available for specific types of birth defects other than neural tube defects (spina bifida and anencephaly). This report describes estimates of national prevalence and number of affected births in the United States each year during 1999--2001 for 18 selected major birth defects. The findings indicated that 10 of the 18 defects affected more than 1,000 infants each year in the United States. The conditions with the highest prevalence included orofacial clefts, which affect approximately 6,800 infants annually, and Down syndrome, which affects approximately 5,500 infants annually. Population-based national prevalence estimates of birth defects can help determine resource needs for basic and public health research and assist in planning for the health-care and educational needs of the U.S. population.

Correlates of intake of folic acid-containing supplements among pregnant women.
Carmichael SL, Shaw GM, Yang W, Laurent C, Herring A, Royle MH, Canfield M; National Birth Defects Prevention Study.
Am J Obstet Gynecol. 2006 Jan;194(1):203-10.
OBJECTIVE: This study describes the timing and correlates of folic acid supplement intake among pregnant women. STUDY DESIGN: Data from 2518 women with estimated delivery dates from 1997 to 2000, collected for the National Birth Defects Prevention Study, a population-based case-control study, were analyzed. Multinomial logistic regression was used to identify correlates of supplement intake. RESULTS: Fifty-three percent of women began taking folic acid supplement during the periconceptional period, 35% during early pregnancy, and 8% during late pregnancy (ie, 3 months before through 1 month after conception, 2-3 months after conception, or more than 3 months after conception, respectively). Women who did not take folic acid supplement periconceptionally tended to be nonwhite, speak Spanish, have low education, be younger than 25 years old, be nulliparous, smoke, have no previous miscarriage and no fertility treatments, begin prenatal care and become aware of their pregnancy after the first trimester, have nonplanned pregnancies, and eat less breakfast cereal. CONCLUSION: This study identifies correlates of folic acid supplement intake, which may contribute to the design of interventions to improve intake during early pregnancy.

Characteristics that predict locating and interviewing mothers identified by a state birth defects registry and vital records.
Gilboa SM, Mendola P, Olshan AF, Savitz DA, Herring AH, Loomis D, Langlois PH, Keating K.
Birth Defects Res A Clin Mol Teratol. 2006 Jan;76(1):60-5.
BACKGROUND: State vital records are often used to select population-based controls in record-linkage studies of birth defects. However, locating and contacting individuals based on these data sources to collect additional data can be a challenge. METHODS: A large case-control study of air quality and birth defects was conducted in 7 Texas counties in which cases were selected from the Texas Birth Defects Registry and controls from state vital records. In 2004, data from these sources were used to trace mothers of cases and controls who delivered babies in the year 2000 (n=2477) for participation in a computer-assisted telephone interview. A number of factors that predicted whether an individual would be located and interviewed were identified. RESULTS: Between March and August 2004, 38% of the mothers were located, and 38% of the located mothers were interviewed. Case mothers were more likely than control mothers to be located (44 vs. 30%) and, if located, to be interviewed (43 vs. 31%). We compared the characteristics of mothers who were not located (case n=760; control n=777), mothers who were located but not interviewed (case n=344; control n=236), and mothers who were interviewed (case n=256; control n=104). Among both cases and controls, older mothers (>or=30 years) were more likely than younger mothers to be located, and non-Hispanic black mothers were least likely to be located and interviewed. CONCLUSIONS: Despite the utility of vital records as a source of population-based controls in record-linkage analyses, the poor response rate discourages the use of these data sources to contact individuals for a follow-up study 4 years after delivery. Copyright (c) 2005 Wiley-Liss, Inc.

Carisoprodol abuse in Texas, 1998-2003.
Forrester MB.
J Med Toxicol 2006;2:8-13.
ABSTRACT: Introduction: Texas poison centers identified carisoprodol as a skeletal muscle relaxant that is subject to abuse, and this investigation explores the abuse reported by Texas poison centers. Methods: This study used data from six Texas poison centers to describe the epidemiology of carisoprodol abuse and drug identification (ID) calls from 1998 to 2003. Results: Drug ID and abuse calls were 217% higher in 2003 than in 1998. Although eastern and central Texas contains 43% of the state’s population, this region reported 77% of all drug ID calls and 64% of abuse calls. Male patients accounted for 51% of abuse calls and 37% of other human exposure calls. Patients from 13 to 19 years of age accounted for 17% of abuse calls and 9% of other human exposure calls. Among those human exposure calls with a known medical outcome, a higher percentage of abuse calls involved minor effects while a greater proportion of other human exposure calls involved outcomes that ranged from moderate effects to death. Conclusions: Carisoprodol abuse is increasing in Texas and is substantially more common in the eastern part of the state. Carisoprodol abuse is much more likely, than other types of adverse carisoprodol exposures, to involve males and adolescents; and it less likely to involve adverse medical outcomes.

2005 Articles (in date order with most recent first)

Pattern of stingray injuries reported to Texas poison centers from 1998 to 2004.
Forrester MB.
Hum Exp Toxicol. 2005 Dec;24(12):639-42.
This study examined the relationship between selected factors and all human exposures involving stingray injuries reported to Texas poison centers. Cases were obtained retrospectively from calls to poison centers in Texas and included all reported human exposures involving stingray injuries from 1998 to 2004. The distribution of cases was determined for a variety of demographic and clinical parameters. A total of 153 cases were identified. The reported stingray injury penetrance increased during the 7-year period. Of the cases with a known patient age, 2% were <6 years, 25% were 6-19 years and 73% were >19 years. The stingray injuries occurred in public areas in 54% of the cases. In 61% of cases, the management site was reported not to be a health care facility. Of the cases with a known clinical outcome, none involved no effects and 53% involved minor effects. The highest proportion of stingray injuries occurred during the summer months, particularly August. In 60% of the cases, the calls originated from counties along the coast. This information can be used to identify those portions of the population most in need of education regarding the prevention and treatment of stingray injuries.

Iron status indicators in women with prior neural tube defect-affected pregnancies.
Felkner MM, Suarez L, Brender J, Scaife B, Hendricks K.
Matern Child Health J. 2005 Dec;9(4):421-8.
OBJECTIVES: Iron deficiency is the most common nutrient deficiency in pregnant women and has been linked to negative impacts on the fetus. We describe the association of various iron-deficiency indices with risk of neural tube defect (NTD) among a high-risk Mexican-American population. METHODS: The study included 158 case-women (NTD-affected pregnancies) and 189 control-women (normal births) who were residents of the 14 Texas-Mexico border counties and delivered or terminated pregnancies during 1995-2000. In-person interviews and laboratory assays provided data. RESULTS: Case-women had higher odds of having minimal or no iron stores (serum ferritin <30 microg/L) compared to control-women (OR = 1.8, 95% CI = 1.0-3.3). The risk effect was not explained by low folate or B12 or other risk factors. CONCLUSION: Low serum ferritin may reflect the additive effect of multiple long-term factors, many of them related to poverty such as poor quality diet, lack of supplementation, and frequent pregnancies. Interpartum care is indicated in this population.

2005 Robley D. Evans Commemorative Medal.
Fogle D, Jablonski S.
Health Phys. 2005 Dec;89(6):609-12.
This medal is given in memory of Dr. Robley D. Evans who, over a period of more than 50 years, was exemplary as a physics educator, scientist, author, and humanitarian. His contributions and dedication to radiation safety and to the health physics profession were extraordinary in practice and outstanding in intellectual acumen. The 2005 recipient is John W. Poston, Sr.

Texas' community health workforce: from state health promotion policy to community-level practice.
[LINK to full-text: http://www.cdc.gov/pcd/issues/2005/nov/05_0059.htm]
Nichols DC, Berrios C, Samar H.
Prev Chronic Dis. 2005 Nov;2 Spec no:A13. Epub 2005 Nov 1.
BACKGROUND: Imagine yourself in Texas as a newly arrived immigrant who does not speak English. What would you do if your child became ill? How would you find a doctor? When you find one, will the doctor speak your native language or understand your culture? In a state of approximately 22 million people, many Texas residents, marginalized by poverty and cultural traditions, find themselves in this situation. To help them, some communities across Texas offer the services of promotores, or community health workers, who provide health education and assist with navigating the health care system. CONTEXT: In 1999, Texas became the first state in the nation to recognize these workers and their contributions to keeping Texans healthy. This paper examines a state health promotion policy that culminated in a training and certification program for promotores and the impact of this program on the lay health education workforce in Texas. METHODS: In 1999, the Texas legislature established the 15-member Promotor(a) Program Development Committee to study issues involved in developing a statewide training and certification program. During its 2-year term, the committee met all six of its objectives toward establishing and maintaining a promotor(a) certification program. CONSEQUENCES: By the end of December 2005, it is estimated that there will be more than 700 certified promotores in Texas. State certification brings community health workers into the public health mainstream as never before. INTERPRETATION: Promotores, a community health safety net and a natural extension of the health and human services agencies, improve health at the neighborhood level. Certification brings renewed commitment to serving others and a distinction to those who have been the unsung heroes of public health for decades.

Nutmeg intoxication in Texas, 1998-2004.
Forrester MB.
Hum Exp Toxicol. 2005 Nov;24(11):563-6.
Nutmeg is a spice that contains volatile oils comprised of alkyl benzene derivatives (myristicin, elemicin, safrole, etc.), terpenes and myristic acid. Nutmeg has a long history of abuse. This study describes the nutmeg ingestion calls received by Texas poison centers from 1998 to 2004. There were 17 calls involving nutmeg ingestion, of which 64.7% involved intentional abuse. When abuse and non-abuse ingestions were compared, abuse ingestions were more likely to involve males (100 versus 66.7%) and adolescents (55.6 versus 16.7%). The majority of both abuse and non-abuse calls were managed outside of health care facilities (54.5 and 66.7%, respectively). None of the ingestions resulted in more than moderate clinical effects or death.

Texas poisonings at the beginning of the 21st century: 2000 through 2002.
Morgan DL, Forrester MB.
Texas Medicine, November 2005;101(11):72-78.
Human exposure calls to poison centers may vary by geographic region. This investigation compared the pattern of human exposure calls to Texas poison centers with calls to those in other states from 2000 through 2002. Although the total number of human exposure calls increased for both Texas and non-Texas poison centers, the increase was twice as great for those in Texas. Patients in Texas human exposure calls tended to be younger. Texas calls were more likely to involve bites and stings, suspected suicides, and intentional abuse exposures and were less likely to involve unintentional environmental exposures. Texas exposures were less likely to occur by dermal, inhalation, and ocular routes. Texas patients were more likely to be treated with decontamination. The death rate from poisoning was slightly lower in Texas. Knowledge of the human exposure calls to particular poison centers allows the poison centers to use their resources most efficiently.

Changes in the birth prevalence of selected birth defects after grain fortification with folic acid in the United States: findings from a multi-state population-based study.
Canfield MA, Collins JS, Botto LD, Williams LJ, Mai CT, Kirby RS, Pearson K, Devine O, Mulinare J; National Birth Defects Prevention Network.
Birth Defects Res A Clin Mol Teratol. 2005 Oct;73(10):679-89.
BACKGROUND: Observational studies and clinical trials have suggested that periconceptional use of folic acid can reduce the risk of birth defects other than neural tube defects (NTDs). Using data reported by states to the National Birth Defects Prevention Network, we examined whether folic acid fortification might have decreased the prevalence of other specific birth defects. METHODS: For each of 16 birth defect categories selected for study, birth prevalence for two time periods was calculated with data submitted from a number of states in 1995-1996 ("pre-fortification") and 1999-2000 ("post-fortification"). Changes in birth prevalence between the two time periods were assessed by calculating prevalence ratios and 95% confidence intervals for each defect, and compared by maternal race/ethnicity and availability of prenatally diagnosed cases. RESULTS: We confirmed previously reported reductions in the birth prevalence of NTDs. In addition, we found modest, yet statistically significant, decreases in the birth prevalence for transposition of the great arteries(12%), cleft palate only (12%), pyloric stenosis (5%), upper limb reduction defects (11%), and omphalocele (21%). More substantial subgroup decreases were observed for renal agenesis among programs that conduct prenatal surveillance (28%), for common truncus among Hispanics (45%), and for upper limb reduction defects among Hispanics (44%). There were modest yet significant increases in the prevalence of obstructive genitourinary defects (12%) and Down syndrome (7%), but not among programs conducting prenatal surveillance for these defects. CONCLUSIONS: These results suggest some modest benefit from the folic acid fortification on the prevalence of a number of non-NTD birth defects.

Prevalence is the preferred measure of frequency of birth defects.
Mason CA, Kirby RS, Sever LE, Langlois PH.
Birth Defects Res A Clin Mol Teratol. 2005 Oct;73(10):690-2.
Researchers and other public health professionals continue to debate the use of prevalence versus incidence as the preferred term to represent the frequency of birth defects. This paper addresses this question by noting that incidence—the number of new cases of a disorder in a given at-risk population during a specified time period--cannot be reliably estimated with existing data. Consequently, it is not appropriate to use the term "incidence" in reporting the frequency of birth defects, and the term prevalence is recommended. The basis for this recommendation, and issues involved in calculating both measures, are discussed.

Pesticide-related illness and injury surveillance: a how-to guide for state-based programs.
[LINK to full-text at http://www.cdc.gov/niosh/docs/2006-102/pdfs/2006-102a.pdf]
National Institute for Occupational Safety and Health. DSHS contributor: R Rosales
DHHS (NIOSH) Publication No. 2006-102, October 2005.

Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina -- multiple states, August -- September, 2005.
Centers for Disease Control and Prevention. DSHS contributors: BR Smith, MD, C Wallace
[LINK to full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5438a6.htm]
Morb Mortal Wkly Rep. September 30, 2005 / 54(38);961-964.
On August 29, 2005, Hurricane Katrina struck states along the Gulf Coast of the United States. In the days after the hurricane struck, approximately 750 evacuation centers were established in at least 18 states to accommodate more than 200,000 evacuees (1). State and local health departments, with assistance from CDC, initiated enhanced infectious disease surveillance and outbreak response activities, implemented by teams of public health and rescue workers, including military personnel. Outbreak monitoring included direct reporting of conditions of public health significance to public health agencies; daily contact between CDC and local public health officials; canvassing of reports from CDC, public health departments, and news media for potential infectious disease outbreaks; and investigation of reports of infectious disease with outbreak potential. This report summarizes infectious disease and dermatologic conditions reported during the first 3 weeks after the hurricane, before effective local surveillance was fully implemented. One outbreak of norovirus was reported among evacuees in Texas; no other outbreaks requiring unusual mobilization of public health resources were reported among evacuees or rescue workers.

Evaluation of oral rabies vaccination programs for control of rabies epizootics in coyotes and gray foxes: 1995-2003.
Sidwa TJ, Wilson PJ, Moore GM, Oertli EH, Hicks BN, Rohde RE, Johnston DH.
J Am Vet Med Assoc. 2005 Sep 1;227(5):785-92.
OBJECTIVE: To evaluate the effectiveness of intervention efforts to halt 2 wildlife rabies epizootics from 1995 through 2003, including 9 oral rabies vaccination campaigns for coyotes and 8 oral rabies vaccination campaigns for gray foxes. DESIGN: Retrospective study. ANIMALS: 98 coyotes during prevaccination surveillance and 963 coyotes and 104 nontarget animals during postvaccination surveillance in south Texas, and 699 gray foxes and 561 nontarget animals during postvaccination surveillance in west-central Texas. PROCEDURES: A recombinant-virus oral rabies vaccine in edible baits was distributed by aircraft for consumption by coyotes and gray foxes. Bait acceptance was monitored by use of microscopic analysis of tetracycline biomarker in upper canine teeth and associated bone structures in animals collected for surveillance. Serologic responses were monitered by testing sera for rabies virus-neutralizing antibodies by use of the rapid fluorescent focus inhibition test. The incidence of rabies in the distribution area was recorded via active and passive surveillance activities; tracking of rabies virus variants in confirmed rabid animals was used to determine the number and type of rabies cases before and after distributions of the vaccine. RESULTS: The expansion of both epizootics was halted as a result of the vaccine bait program. The number of laboratory-confirmed rabid animals attributable to the domestic dog-coyote rabies virus variant in south Texas declined to 0, whereas the number of laboratory-confirmed rabid animals attributable to the Texas fox rabies virus variant in west-central Texas decreased. CONCLUSIONS AND CLINICAL RELEVANCE: Data indicated that oral rabies vaccination resulted in protective immunity in a sufficient percentage of the target wildlife population to preclude propagation of the disease and provided an effective means of controlling rabies in these species.

Epidemiology of noncomplex left ventricular outflow tract obstruction malformations (aortic valve stenosis, coarctation of the aorta, hypoplastic left heart syndrome) in Texas, 1999-2001.
McBride KL, Marengo L, Canfield M, Langlois P, Fixler D, Belmont JW.
Birth Defects Res A Clin Mol Teratol. 2005 Aug;73(8):555-61.
BACKGROUND: The left ventricular outflow tract (LVOT) malformations aortic valve stenosis (AVS), coarctation of the aorta (CoA), and hypoplastic left heart syndrome (HLHS) contribute significantly to infant mortality due to birth defects. Previous epidemiology data showed rate differences between male and female and white and black ethnic groups. The Texas Birth Defects Registry, an active surveillance program, enables study in a large, diverse population including Hispanics. METHODS: Records of children up to 1 year old with AVS, CoA, and HLHS born in Texas from 1999 to 2001, were collected from the registry. Those including additional heart defects or a chromosomal anomaly were excluded. Multivariate analysis included: infant sex; United States-Mexico border county residence; and maternal age, race/ethnicity, birthplace, and education. RESULTS: There were 910 cases among 1.08 million live births, of which 499 met inclusion criteria. Multivariate modeling of all LVOT malformations combined demonstrated lower prevalence rate ratios (PRRs) for black males (0.26) and Hispanic males (0.70). Similar results were found for CoA but not AVS or HLHS. Higher PRRs were noted for increased maternal age for LVOT (1.3 for 24-34 years; 1.7 for >34 years), AVS, and HLHS, but not CoA, and higher PRRs across all diagnoses for males (LVOT PRR, 2.4) were noted. CoA PRRs were higher in border county vs. non-border county residents (PRR, 2.1). Maternal education and birthplace were not significant factors. CONCLUSIONS: There are rate differences for males among all 3 ethnic groups. Sex and ethnic differences suggest genetic etiologies, where the ethnic differences could be used to find susceptibility loci with mapping by admixture linkage disequilibrium. Increased CoA rates along the U.S.-Mexico border suggest environmental causes that will require further monitoring. Copyright 2005 Wiley-Liss, Inc.

Folic acid calls to poison centers in Texas, 1998-2003.
Forrester MB.
Hum Exp Toxicol. 2005 Aug;24(8):423-7.
Folic acid (folacin, pteroylglutamic acid) is a monoglutamate form of the water-soluble B vitamin that is involved in the synthesis of nucleotides and amino acids and the normal maturation of red blood cells. This study describes the folic acid calls received by Texas poison centers during 1998-2003. There were 650 calls involving folic acid as a single-ingredient product, of which 55.1% were human exposures. Children age <6 years accounted for 80.1% of the human exposures. Patients were managed outside of the health care facilities in 92.1% of the cases. Of those cases with a known medical outcome, 94.8% had no clinical effects. This study found folic acid exposures reported to poison centers were unlikely to have more than minor adverse affects.

An exploration of self-reported negative affect by adolescents as a reason for smoking: implications for tobacco prevention and intervention programs.
Stevens SL, Colwell B, Smith DW, Robinson J, McMillan C.
Prev Med. 2005 Aug;41(2):589-96.
BACKGROUND: Negative affect is related to initiation and maintenance of smoking among youth and understanding its role is important when developing effective prevention and cessation programs. This study investigates the relationship between adolescent negative affect and smoking dependence, behaviors, attitudes, and self-efficacy in order to shed light on differences in adolescent smoking maintenance and cessation. METHODS: 721 smoking youth participated in a cognitive-behavioral smoking cessation program. Reasons for smoking were categorized (alpha = 0.87) and youth were placed into one of two groups based on presence or absence of negative affect. One-way repeated measures ANOVA determined if differences existed between the groups on smoking behaviors, attitudes, and self-efficacy. One-way ANOVA determined if differences existed on Fagerstrom Nicotine Tolerance Dependence (FTND) scores. RESULTS: Adolescents indicating negative affect for smoking were significantly more likely to have future smoking intentions and had significantly less self-efficacy to quit smoking than adolescent reporting other reasons. CONCLUSIONS: This study supports the need to address negative affect among adolescents participating in prevention and cessation programs. An examination of negative affect will provide program developers and facilitators with information to improve their interventions, assist with cessation, and provide an avenue to access other needed health services.

Relation between ambient air quality and selected birth defects, seven county study, Texas, 1997-2000.
Gilboa SM, Mendola P, Olshan AF, Langlois PH, Savitz DA, Loomis D, Herring AH, Fixler DE.
Am J Epidemiol. 2005 Aug 1;162(3):238-52. Epub 2005 Jun 29.
A population-based case-control study investigated the association between maternal exposure to air pollutants, carbon monoxide, nitrogen dioxide, ozone, sulfur dioxide, and particulate matter <10 microm in aerodynamic diameter during weeks 3-8 of pregnancy and the risk of selected cardiac birth defects and oral clefts in livebirths and fetal deaths between 1997 and 2000 in seven Texas counties. Controls were frequency matched to cases on year of birth, vital status, and maternal county of residence at delivery. Stationary monitoring data were used to estimate air pollution exposure. Logistic regression models adjusted for covariates available in the vital record. When the highest quartile of exposure was compared with the lowest, the authors observed positive associations between carbon monoxide and tetralogy of Fallot (odds ratio = 2.04, 95% confidence interval: 1.26, 3.29), particulate matter <10 microm in aerodynamic diameter and isolated atrial septal defects (odds ratio = 2.27, 95% confidence interval: 1.43, 3.60), and sulfur dioxide and isolated ventricular septal defects (odds ratio = 2.16, 95% confidence interval: 1.51, 3.09). There were inverse associations between carbon monoxide and isolated atrial septal defects and between ozone and isolated ventricular septal defects. Evidence that air pollution exposure influences the risk of oral clefts was limited. Suggestive results support a previously reported finding of an association between ozone exposure and pulmonary artery and valve defects.

Exposure to polychlorinated biphenyls and risk of neural-tube defects in a Mexican American population.
Suarez L, Gilani Z, Felkner M, Brender J, Henry J, Hendricks K.
Int J Occup Environ Health. 2005 Jul-Sep;11(3):233-7.
The authors examined the association between maternal polychlorinated biphenyl (PCB) levels and risk of neural tube defects (NTDs) in Mexican American women with NTD-affected pregnancies who resided in the 14 Texas-Mexico border counties during 1995-2000 (cases). Controls were randomly selected from study area women delivering normal live births. For PCB congeners with sufficient numbers of detectable values (PCB 99, 101, 110, 118, 138, 153, 180), there was little association between the proportions with detectable PCB levels in cases and controls. Odds ratios were <1 or compatible with the null, but power was low for some congeners. An index of seven PCB congeners (105, 118, 138, 153, 170, 180, 194) was also not associated with NTD risk. The maternal serum PCB levels in this study population (median PCB 153 level: 18 ng/g) were comparable to those with background exposure and do not appear to have contributed to the high prevalence of NTDs in this population.

Assessment of adherence measures with different stimulants among children and adolescents.
Sanchez RJ, Crismon ML, Barner JC, Bettinger T, Wilson JP.
Pharmacotherapy. 2005 Jul;25(7):909-17.
STUDY OBJECTIVE: To examine adherence measures with different stimulants in children and adolescents. DESIGN: Retrospective analysis. DATA SOURCE: Texas Medicaid prescription claims database. PATIENTS: A total of 9549 patients aged 5-18 years with attention-deficit-hyperactivity disorder. MEASUREMENTS AND MAIN RESULTS: Paid prescription claims for newly started stimulants during the 2001-2002 school year were extracted from a database; 28,344 prescriptions (9549 patients) were available for analysis. Adherence was evaluated based on the drug therapy prescribed (i.e., mixed amphetamine salts, immediate-release methylphenidate, and extended-release methylphenidate-OROS [oral-osmotic formulation]) and the age and sex of the patient. Adherence measures were persistence and medication possession ratio (MPR). Persistence was higher for extended-release methylphenidate-OROS (0.50 +/- 0.33) than for mixed amphetamine salts (0.42 +/- 0.29) or immediate-release methylphenidate (0.37 +/- 0.26; p < 0.001). The MPR was also higher for extended-release methylphenidate-OROS (0.76 +/- 0.37) than for mixed amphetamine salts (0.73 +/- 0.37) or immediate-release methylphenidate (0.69 +/- 0.37; p < 0.001). Patients aged 5-9 years had equal or better persistence and MPR than those aged 10-14 and 15-18 years (p < 0.001). No sex-related differences in adherence were observed. CONCLUSION: Adherence measures in our study were low. Although they were significantly better for extended-release methylphenidate-OROS than the other stimulants, the clinical significance of these differences are unclear. Further research should be conducted regarding pharmaceutical products, administration methods, and clinical interventions that may enhance adherence.

Acute illnesses associated with pesticide exposure at schools.
Alarcon WA, Calvert GM, Blondell JM, Mehler LN, Sievert J, Propeck M, Tibbetts DS, Becker A, Lackovic M, Soileau SB, Das R, Beckman J, Male DP, Thomsen CL, Stanbury M.
JAMA. 2005 Jul 27;294(4):455-65.
CONTEXT: Pesticides continue to be used on school property, and some schools are at risk of pesticide drift exposure from neighboring farms, which leads to pesticide exposure among students and school employees. However, information on the magnitude of illnesses and risk factors associated with these pesticide exposures is not available. OBJECTIVE: To estimate the magnitude of and associated risk factors for pesticide-related illnesses at schools. DESIGN, SETTING, AND PARTICIPANTS: Analysis of surveillance data from 1998 to 2002 of 2593 persons with acute pesticide-related illnesses associated with exposure at schools. Nationwide information on pesticide-related illnesses is routinely collected by 3 national pesticide surveillance systems: the National Institute for Occupational Safety and Health’s Sentinel Event Notification System for Occupational Risks pesticides program, the California Department of Pesticide Regulation, and the Toxic Exposure Surveillance System. MAIN OUTCOME MEASURES: Incidence rates and severity of acute pesticide-related illnesses. RESULTS: Incidence rates for 1998-2002 were 7.4 cases per million children and 27.3 cases per million school employee full-time equivalents. The incidence rates among children increased significantly from 1998 to 2002. Illness of high severity was found in 3 cases (0.1%), moderate severity in 275 cases (11%), and low severity in 2315 cases (89%). Most illnesses were associated with insecticides (n = 895, 35%), disinfectants (n = 830, 32%), repellents (n = 335, 13%), or herbicides (n = 279, 11%). Among 406 cases with detailed information on the source of pesticide exposure, 281 (69%) were associated with pesticides used at schools and 125 (31%) were associated with pesticide drift exposure from farmland. CONCLUSIONS: Pesticide exposure at schools produces acute illnesses among school employees and students. To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended.

Implementation and outcomes of recommended folic acid supplementation in Mexican-American women with prior neural tube defect-affected pregnancies.
Felkner M, Suarez L, Hendricks K, Larsen R.
Prev Med. 2005 Jun;40(6):867-71.
BACKGROUND: Upon discovering an NTD incidence rate of 27/10,000 in a Texas border county, the Texas Department of Health initiated folic acid intervention for prevention of recurrent NTDs in this predominantly Mexican-American population. This paper describes compliance of this population with USPHS folic acid recommendations and the impact of supplementation on pregnancy outcomes. METHODS: Based upon information from active surveillance, field teams personally contacted women having NTD-affected pregnancies to enroll them in FA intervention. Enrollees were provided FA at home visits at 3-month intervals throughout the project. RESULTS: Of 405 women identified with NTD-affected pregnancies, 299 (73.8%) enrolled in the intervention. One hundred ninety-three pregnancies occurred among 138 women. FA supplementation of 0.4 mg/day or more occurred during the last month preconception in 161 (83.4%) of the 193 pregnancies. No NTDs were detected in the 130 livebirths to women who received supplementation nor were NTDs detected in the 23 supplemented women who experienced pregnancy loss. CONCLUSIONS: Supplementation was successful in preventing recurrent NTDs in Mexican-American women.

Improving the use of data for HIV prevention decision making: lessons learned.
Jenkins RA, Averbach AR, Robbins A, Cranston K, Amaro H, Morrill AC, Blake SM, Logan JA, Batchelor K, Freeman AC, Carey JW.
AIDS Behav. 2005 Jun;9(2 Suppl):S87-99.
HIV prevention community planning was developed to promote identification of local prevention priorities through a process that was evidence-based and provided community input. There are a variety of barriers to effective use of data in community planning which include characteristics of data (availability, timeliness, relevance to planning tasks), characteristics of planning group members and providers of data (e.g., skills in understanding and applying data), and social-organizational aspects of community-planning groups (CPGs). Lessons learned from this project illustrate how to create locally relevant sources of data, build data use skills of CPG members and data providers, and address social-organizational aspects of planning, while also better integrating community planning with implementation of prevention plans. Adaptation of tools and methods is discussed along with future considerations for research and planning practice.

After the innovation: outcomes from the Texas behavioral data project.
Batchelor K, Robbins A, Freeman AC, Dudley T, Phillips N.
AIDS Behav. 2005 Jun;9(2 Suppl):S71-86.
The Texas Department of Health and University of Texas Southwestern staff, using formative assessment data, developed a set of innovative methods and tools to increase the use of behavioral and epidemiologic data in decision-making about HIV prevention interventions by HIV prevention community planning groups (CPGs) and HIV prevention providers. Semistructured interviews, mail surveys, meeting observations, and content analysis of funding proposals were used to measure the results of the multifaceted intervention. Compared to baseline measures, CPG members reported that data played a more central and desired role in their decision-making. HIV prevention providers exposed to the project's materials were more likely to choose evidence-based interventions to conduct. The tools and structural intervention methods of this project were diffused and had an impact on the use of behavioral data by community planning groups and HIV prevention providers. The structural interventions were not sufficient without the additional effect of the trained peers acting as advocates and intervention innovators.

Bridging data and decision making: development of techniques for improving the HIV prevention community planning process.
Jenkins RA, Robbins A, Cranston K, Batchelor K, Freeman AC, Averbach AR, Amaro H, Morrill AC, Blake SM, Logan JA, Carey JW.
AIDS Behav. 2005 Jun;9(2 Suppl):S41-53.
Assessments of community planning in Massachusetts and Texas were used to develop tools for increasing the use of data by HIV prevention community planning groups (CPGs) and prevention providers while also increasing participation of CPG members. Barriers to data use included organizational problems in CPGs (e.g., lack of clear procedures, distrust of peers and leadership) and technical assistance needs for CPG members and researchers who provide data. The absence of data relevant to local epidemics was another barrier. Specific linkages are provided between the assessments of these needs and the development of a technical assistance tools (e.g., websites, templates for data presentation, experiential involvement in data use) and strategies for organizational change in CPGs, as well as efforts to better use available data and create or identify new sources of local data.

Formative assessment of use of behavioral data in HIV prevention: Texas.
Batchelor K, Freeman AC, Robbins A, Dudley T, Phillips N.
AIDS Behav. 2005 Jun;9(2 Suppl):S29-40.
A formative assessment was conducted with Texas HIV prevention community planning group (CPG) members, prevention provider staff, and supervisors of those staff to better understand how to enhance their use of epidemiologic and behavioral data in the selection and prioritization of prevention interventions. Semi-structured interviews, mail surveys, and content analysis of funding proposals were used to determine the current use of these data, their perceived value, and the most trusted sources for data. CPG members, prevention provider staff, and supervisors valued information from their peers and networking most, and made more use of socially available information than they did research or systematically collected assessment data. CPG members wanted more local data and data on specific sub-populations of interest. Prevention providers viewed the utility of behavioral data as limited, and were primarily concerned with the pragmatic aspects of fielding interventions; however, this group also expressed an interest in rapid community assessment methods and learning more about new and effective prevention interventions. These results led to the development of training and technical assistance materials.

CSHCN in Texas: meeting the need for specialist care.
Young MC, Drayton VL, Menon R, Walker LR, Parker CM, Cooper SB, Bultman LL.
Matern Child Health J. 2005 Jun;9(2 Suppl):S49-57.
OBJECTIVE: Assuring the sufficiency and suitability of systems of care and services for children with special health care needs (CSHCN) presents a challenge to Texas providers, agencies, and state Title V programs. To meet the need for specialist care, referrals from primary care doctors are often necessary. The objective of this study was to describe the factors associated with the need for specialist care and problems associated with obtaining referrals in Texas. METHODS: Bivariate and multivariate analyses were performed using the National Survey of Children with Special Health Care Needs (NS-CSHCN) weighted sample for Texas (n = 719,014) to identify variables associated with the need for specialist care and problems obtaining referrals for specialist care. RESULTS: Medical need of the CSHCN and sensitivity to family values/customs was associated with greater need for specialist care, and Hispanic ethnicity and lower maternal education were associated with less need. Medical need, amount of time spent with doctors and sensitivity to values/customs, living in a large metropolitan statistical area, and lack of medical information were associated with problems obtaining a specialist care referral. CONCLUSIONS: Findings revealed some similarities and differences with meeting the need for specialist care when comparing Texas results to other studies. In Texas, aspects of customer satisfaction variables, especially doctors' sensitivity to family values/customs and parents' not receiving enough information on medical problems, were significantly associated with problems obtaining specialist referrals. Findings indicate a need to further research relationships and communication among doctors, CSHCN, and their families.

Unintentional topical lindane ingestions -- United States, 1998-2003.
[LINK to full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5421a2.htm]
Centers for Disease Control and Prevention. DSHS contributor: J Sievert
Morb Mortal Wkly Rep. June 3, 2005 / 54(21);533-535.
Lindane is an organochlorine pesticide found in certain prescription-only shampoos and topical lotions used to treat pediculosis (i.e., lice infestation) and scabies; lindane has been associated with human neurologic toxicity (1,2). In 2004, CDC was alerted to cases of illness caused by unintentional ingestion of lindane by persons mistaking the product for a liquid oral medication (e.g., cough syrup). To assess the extent of illness from ingestion of lindane, CDC, with assistance from the U.S. Environmental Protection Agency, Food and Drug Administration (FDA), and state health departments, collected case reports and analyzed data from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) program and the Toxic Exposure Surveillance System (TESS). This report summarizes the results of that analysis, which identified 870 cases of unintentional lindane ingestion during 1998--2003, and describes two examples of lindane ingestions. To reduce the risk of lindane ingestion, public health authorities should alert clinicians to the hazards of lindane and the importance of following FDA usage guidelines, which include dispensing lindane in manufacturer-produced, 1- or 2-ounce single-use containers.

A national agenda for Latino cancer prevention and control.
Ramirez AG, Gallion KJ, Suarez L, Giachello AL, Marti JR, Medrano MA,
Perez-Stable EJ, Talavera GA, Trapido EJ.
Cancer. 2005 Jun 1;103(11):2209-15.
Although cancer is a leading cause of morbidity and premature death among Latinos, there is limited knowledge of cancer-related issues and priorities of greatest significance to the Latino population, the largest minority group in the nation. This information is vital in helping to guide Latino cancer research, training, and awareness efforts at national, regional, and local levels. To help identify cancer issues of greatest relevance to Latinos, Redes En Accion, The National Hispanic/Latino Cancer Network, a major network among the National Cancer Institute's Special Populations Networks, conducted a survey of 624 key opinion leaders from around the country. Respondents were asked to rank the three cancer sites most important to Latinos in their region and the five issues of greatest significance for this population's cancer prevention and control. Recommendations were prioritized for three specific areas: 1) research, 2) training and/or professional education, and 3) awareness and/or public education. Among cancers, breast carcinoma was ranked number one, followed in order by cervical and lung carcinomas. The issues of greatest significance to Latinos were 1) access to cancer screening and care, 2) tobacco use, 3) patient-doctor communication, 4) nutrition, and 5) risk communication. This survey solicited information from scientists, health care professionals, leaders of government agencies, professional and community-based organizations, and other stakeholders in Latino health. The results laid the foundation for a national Redes En Accion Latino cancer agenda, thus providing a useful tool for individuals and organizations engaged in cancer prevention and control efforts among the Hispanic-Latino population.

Rural residence is not a risk factor for frequent mental distress: a behavioral risk factor surveillance survey.
Rohrer JE, Borders TF, Blanton J.
BMC Public Health. 2005 May 16;5(1):46.
LINK to Full-text: http://www.biomedcentral.com/1471-2458/5/46
BACKGROUND: Residents of rural areas may be at increased risk of mental health problems. If so, public health programs aimed at preventing poor mental health may have to be customized for delivery to rural areas. The purpose of this study was to examine the relationship between residing in a rural area and frequent mental distress, which is one indicator of poor mental health. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) survey for the state of Texas was the source of information about obesity, demographic characteristics, and frequent mental distress (FMD). FMD was defined as poor self-rated mental health during at least half of the days in the last month. Adjusted odds for FMD were computed for rural and suburban respondents relative to urban respondents. RESULTS: FMD was found to be independently associated with lower education, being younger, being non-Hispanic, being unmarried, and being female. FMD also was associated with being obese or underweight and suburban residence (relative to metro-central city). FMD was not more common among rural respondents than in the metro-central city. CONCLUSION: Rural respondents were not at greater risk of frequent mental distress than urban respondents in this sample. Programs seeking to improve community mental health should target persons with less education and extremes in body weight, along with women and single persons, regardless of whether they live in rural or urban areas.

Prevalence of nonsyndromic oral clefts in Texas: 1995-1999.
Hashmi SS, Waller DK, Langlois P, Canfield M, Hecht JT.
Am J Med Genet A. 2005 May 1;134(4):368-72.
Nonsyndromic cleft lip with/without cleft palate (NSCLP) and nonsyndromic cleft palate only (NSCPO) are common complex birth defects affecting 4,000 newborns annually. We undertook a descriptive study of oral clefts in Texas, focusing on the effect of folic acid fortification and Hispanic ethnicity on the prevalence of oral clefts as these factors have not previously been described. Data on 896 infants with NSCLP and NSCPO born between 1995 and 1999 in Texas were compared to all births in Texas during the same period. Prevalence odds ratios (POR) were calculated for maternal ethnicity, race, age, parity, public health region of residence, highest level of education, and infant gender. The effect of folic acid fortification on oral clefts was also examined. Compared with whites, adjusted POR were 0.97 (95% CI = 0.77-1.23) and 0.90 (95% CI 0.72-1.14) for NSCLP and 0.46 (95% CI = 0.30-0.72) and 0.62 (95% CI = 0.42-0.90) for NSCPO in foreign-born and US-born Hispanics, respectively. After fortification was implemented, the rate of NSCLP did not decrease. However, there was a 13% decrease in the prevalence of NSCPO (adjusted POR = 0.87, 95% CI = 0.68-1.15). Compared to whites, the rates in US-born and foreign-born Hispanic women were similar for NSCLP and much lower for NSCPO. The small reduction of 13% in NSCPO after folic acid fortification is imprecise and should be interpreted cautiously. Overall, it appears that folic acid fortification has had very little or no effect on the prevalence of oral clefts in infants born in Texas. Copyright 2005 Wiley-Liss, Inc.

The wound care team: a new source of group a streptococcal nosocomial transmission.
Felkner M, Pascoe N, Shupe-Ricksecker K, Goodman E.
Infect Control Hosp Epidemiol. 2005 May;26(5):462-5.
BACKGROUND: In August 2001, the Centers for Disease Control and Prevention (CDC) notified the Texas Department of Health (TDH) of an unusually high number of wounds infected with group A streptococci (GAS) in an acute care facility. The TDH initiated an investigation, ultimately identifying 28 cases of non-pharyngeal, non-community-acquired GAS that had occurred between December 2000 and August 2001 and resulted in 3 deaths and 4 nonfatal cases of invasive disease. Ten specimens were sent to the CDC for emm typing; all isolates were emm type 114. However, the source of the outbreak could not be confirmed through laboratory testing at that time. METHODS: A case-control study was conducted comparing the 10 case-patients with 52 control-patients with wounds that were not infected with GAS. Age, gender, type of wound, underlying medical conditions, and treatment by the wound care team were examined for association with GAS infection. RESULTS: The odds of having wound care team treatment versus not having it were 424.2 (95% confidence interval, 19.0 to 9,495.2) among case-patients when compared with control-patients. No other risk factor showed this magnitude of association. CONCLUSIONS: This study provided overwhelming epidemiologic evidence that the wound care team was the means of transmission. One year later, when two patients receiving wound care were concurrently diagnosed as having GAS, a member of the wound care team was found to be GAS positive for the matching emm type. This is the first report of a GAS hospital outbreak linked to a wound care team.

Association between sociodemographic factors and exposures and utilization of poison centers in Texas, 1998-2002.
Forrester MB.
J Toxicol Environ Health A. 2005 May 28;68(10):755-61.
This study evaluated whether selected sociodemographic factors and exposures may be associated with utilization of poison centers in Texas during 1998-2002. Data were obtained from the six poison centers that service the entire state. Cases were all human exposures where the caller county was known. The utilization rate (calls per 1000 population) was calculated for the entire state and for each county. Counties were then grouped into those with utilization rates lower than the utilization rate for the entire state and those with utilization rates higher than the rate for the entire state. The two groups were then compared with respect to sociodemographic factors derived from the 2000 Census and exposure categories derived from the poison centers. The group of counties with lower utilization rates had a lower population density, higher African-American and Hispanic populations, lower median household incomes, and higher percentage of the population who spoke a language other than English at home and spoke English less than "very well." Gender, age, and education factors were not related to utilization rates, and the most frequently reported exposure categories were similar between counties with lower and higher utilization rates. This information can be used to focus education and prevention efforts at those populations with lower utilization of the Texas Poison Center Network.

Human exposures to tilmicosin reported to poison centres, Texas, 1998-2003.
Forrester MB.
Hum Exp Toxicol. 2005 May;24(5):275-8.
Tilmicosin, or 20-deoxo-20-(3,5-dimethylpiperidin-1-yl)-desmycosin, is a macrolide antibiotic primarily utilized in livestock. This study examined 46 human exposure calls involving tilmicosin received by Texas poison centres during 1998-2003. The majority (91%) of the calls were received from northern and central Texas. All of the cases were unintentional exposures. The most frequent route of exposure was parenteral (48%). The majority of the patients were males (80%) and adults (84%). Only 46% of the patients were managed outside of health care facilities. Some sort of adverse medical outcome was reported in 93% of parenteral exposures and 54% of other-route exposures. However, only 21% of parenteral exposures and 15% of other-route exposures involved medical outcomes that were judged to be moderate or worse. No deaths were reported. The most frequently reported clinical effects among parenteral cases were dermal (79%), while only 9% of other-route exposures had dermal effects. Cardiovascular clinical effects were observed in a single case of parenteral exposure and a single case of other-route exposure. Although the majority of cases were managed with the assistance of health care facilities, the medical outcomes were usually not serious. Outcome depended on the route of exposure.

Trends in antiretroviral therapy use and survival rates for a large cohort of HIV-infected children and adolescents in the United States, 1989-2001.
McConnell MS, Byers RH, Frederick T, Peters VB, Dominguez KL, Sukalac T, Greenberg AE, Hsu HW, Rakusan TA, Ortiz IR, Melville SK, Fowler MG; Pediatric Spectrum of HIV Disease Consortium.
J Acquir Immune Defic Syndr. 2005 Apr 1;38(4):488-94.
BACKGROUND: In the United States, HIV-infected children and adolescents are aging and using antiretroviral (ARV) therapy for extended periods of time. OBJECTIVE: To assess trends in ARV use and long-term survival in an observational cohort of HIV-infected children and adolescents in the United States. METHODS: The Pediatric Spectrum of HIV Disease Study (PSD) is a prospective chart review of more than 2000 HIV-infected children and adolescents. Patients were included in the analysis from enrollment until last follow-up. RESULTS: Triple-ARV therapy use (for 6 months or more) increased from 27% to 66% during 1997 to 2001 (P < 0.0001, chi for trend). The proportion of patients receiving 3 or more sequential triple-therapy regimens also increased from 4% to 17% during 1997 to 2001 (P < 0.0001, chi for trend), however, and the durability of triple-therapy regimens decreased from 13 to 7 months from the first to third regimen. Survival rates for the 1997 to 2001 birth cohorts were significantly better than for the 1989 to 1993 and 1994 to 1996 cohorts (P < 0.0001). CONCLUSIONS: Survival rates in the PSD cohort have increased in association with triple-ARV therapy use. With continued changes in ARV regimens, effective modifications in ARV therapy and the sustainability of gains in survival need to be determined.

Pseudomonas bloodstream infections associated with a heparin/saline flush--Missouri, New York, Texas, and Michigan, 2004-2005.
[LINK to full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a1.htm]
Centers for Disease Control and Prevention. DSHS contributor: N Pascoe, M Richardson
Morb Mortal Wkly Rep. March 25, 2005 / 54(11);269-272.
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 Psuedomonas 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.

Weight changes in teens on psychotropic medication combinations at Austin State Hospital.
Becker EA, Shafer A, Anderson R.
Texas Medicine, March 2005;101(3):62-70.
Psychiatrists commonly treat adolescents with multiple psychotropic medications simultaneously. We studied the effects of psychotropic medications on the weight of adolescent patients at Austin State Hospital between June 1997 and December 2001. The medication combinations that caused the largest weight increases were olanzapine with valproic acid, and olanzapine with venlafaxine. The biggest weight loss combinations were valproic acid with bupropion, and valproic acid with venlafaxine. Medications drove a substantial portion of the changes in weight, not other variables. The specific medication prescribed, rather than the total number of medications, predicted weight gain. As current inpatient adolescents are receiving multiple medications and their weight is subsequently being affected, more study is needed to better understand these effects.

A psychoeducational program for children with ADHD or depression and their families: results from the CMAP feasibility study.
Lopez MA, Toprac MG, Crismon ML, Boemer C, Baumgartner J.
Community Ment Health J. 2005 Feb;41(1):51-66.
For children and adolescents with behavioral and emotional disorders and their families, education about their disorders and the treatments is an essential component of a comprehensive approach to their care. Education can encourage active participation in treatment, enhance adherence to treatment regimens, and provide patients and families with important coping skills. Thus, the Children's Medication Algorithm Project (CMAP) incorporated a psychoeducational program into the medication algorithm created to improve treatment of children with ADHD and/or depression in the Texas public mental health sector. This article describes the process by which a comprehensive educational program was developed in partnership with parents and advocates. The final program is described, as well as a pilot study to examine the feasibility of implementation in four community clinics.

Idiopathic talipes equinovarus (ITEV) (clubfeet) in Texas.
Moorthi RN, Hashmi SS, Langois P, Canfield M, Waller DK, Hecht JT.
Am J Med Genet A. 2005 Feb 1;132(4):376-80.
Idiopathic talipes equinovarus (ITEV) is the most common form of clubfoot with a birth prevalence of 1 per 1,000 births. Serial casting and surgical correction impose a substantial financial burden on families and the health care system. While the etiology of ITEV is considered to be complex, the causes remain elusive. Genetic, maternal, and environmental factors have been suggested to play an etiologic role. This study was undertaken to determine the prevalence of ITEV and define maternal and environmental factors associated with ITEV in Texas from 1996 to 1999. Data on 682 cases of nonsyndromic ITEV were compared with all births (n = 923,543) in Texas during the same period. The overall prevalence and prevalence odds ratios (PORs) were calculated for gender, year of birth, public health region (PHR), race, maternal age, education, folic acid fortification, and parity. The overall prevalence of ITEV was 0.74/1,000 or 1/1,354 live births. Adjusted PORs were similar among blacks and US and foreign-born Hispanics (POR = 0.92, 95% CI = 0.69-1.21; POR = 0.99, 95% CI = 0.79-1.25; and POR = 0.94, 95% CI = 0.74-1.19), respectively, compared to whites. College education and higher parity were significantly associated with a lower risk of giving birth to offspring with ITEV. Babies born after folic acid fortification of grains had a very small decrease in ITEV that may be due to chance. (c) 2005 Wiley-Liss, Inc.

Unplanned pregnancy among active duty servicewomen, U.S. Air Force, 2001.
Robbins AS, Chao SY, Frost LZ, Fonseca VP.
Mil Med. 2005 Jan;170(1):38-43.
Unplanned pregnancy is a major public health problem in the United States. Although the U.S. Air Force has the highest proportion of active duty women of any of the U.S. military services, there are no published data on the occurrence of unplanned pregnancy among active duty Air Force (ADAF) women. Civilian female interviewers conducted telephone interviews with a random sample of 2,348 ADAF women during early 2002, using questions that were closely based on the 1995 National Survey of Family Growth. During 2001, approximately 12% of ADAF women had one or more pregnancies. By National Survey of Family Growth criteria, approximately 54% of these pregnancies were unplanned. Thus, approximately 7% of ADAF women had one or more unplanned pregnancies during 2001. Roughly one-half of unplanned pregnancies represented contraceptive nonuse and the other half represented contraceptive failure or misuse. Unplanned pregnancy is a serious and frequently occurring problem among ADAF women, with many opportunities for prevention.

Maternal obesity, gestational diabetes, and central nervous system birth defects.
Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM.
Epidemiology. 2005 Jan;16(1):87-92
BACKGROUND: Maternal obesity and diabetes are both associated with increased risk of congenital central nervous system (CNS) malformations in the offspring and may share a common underlying mechanism. Our objective was to evaluate whether gestational diabetes influenced the association of prepregnancy maternal obesity and risks for CNS birth defects. METHODS: This Texas population-based case-control study evaluated births occurring January 1997 through June 2001. Data came from structured telephone interviews. Cases (n=477) were mothers of offspring with anencephaly (n=120), spina bifida (n=184), holoprosencephaly (n=49), or isolated hydrocephaly (n=124). Controls (n=497) were mothers of live infants without abnormalities randomly selected from the same hospitals as cases. Response rates were approximately 60% for both cases and controls. We evaluated maternal obesity (body mass index > or =30.0 kg/m) and risks for CNS birth defects, as well as whether gestational diabetes influenced the risks. RESULTS: After adjusting for maternal ethnicity, age, education, smoking, alcohol use, and periconceptional vitamin use, obese women had substantially increased risks of delivering offspring with anencephaly (odds ratio=2.3; 95% confidence interval=1.2-4.3), spina bifida (2.8; 1.7-4.5), or isolated hydrocephaly (2.7; 1.5-5.0), but not holoprosencephaly (1.4; 0.5-3.8). Odds ratios were higher for the joint effects of maternal obesity and gestational diabetes, with evidence for interaction on a multiplicative scale. CONCLUSIONS: Maternal obesity and gestational diabetes may increase the risk of CNS birth defects through shared causal mechanisms.

Impact of legislation on illicit substance surveillance by poison centers in Texas.
Forrester MB.
J Registry Management 2005;32:118-123.
ABSTRACT: This study observed and compared surveillance of selected illicit substances by poison centers in Texas before and after a state law was enacted on September 1, 1999, requiring mandatory reporting of overdoses of certain controlled substances. Penetrance for cocaine, heroin, and marijuana calls received by the Texas Poison Center Network ( TPCN ) was compared for several time periods. The call distribution by various other factors was determined before and after legislation enactment and compared. The cocaine penetrance increased by 69%, heroin by 30%, and marijuana by 100% between 1999 and 2000. Comparing cases reported before and after legislation enactment, statistically significant differences were observed for exposure site, caller site, management site, medical outcome, and geography. While the evidence for proof is not present, these results are consistent with the premise that enactment of this legislation appears to have altered the types of cocaine, heroin, and marijuana exposures reported to the TPCN.

2004 Articles (in date order with most recent first)

Melatonin exposures reported to Texas poison centers in 1998-2003.
Forrester MB.
Vet Hum Toxicol. 2004 Dec;46(6):345-6.
Melatonin regulates circadian rhythms, and although widely used in the US, information on the public use of melatonin and patterns of reported adverse effects associated with the substance is limited. To describe the patterns of melatonin calls to poison centers in Texas during 1998-2003, data on all melatonin calls reported to the Texas Poison Center Network were analyzed. During 1998-2003, there were 779 identified human exposures to melatonin identified. Of those patients with a known age, 59.1% were < 6 y. Males accounted for 54.1% of preschool-age patients while more of the older patients were female. Melatonin exposures were unintentional in 99.3% of the cases among children less than 6y and unintentional in < 41% among the older age groups. While 92.4% of exposures involving the youngest age group were managed outside of a health care facility, 42% or less of the exposures occurring to patients > age 6 years were managed outside of a health care facility. Of those cases with a known outcome, the proportion of cases with at least minor effects rose with increasing age. The majority of melatonin exposures reported to Texas poison centers involved children < 6 y. Younger patients were more likely to be male, have unintentional exposures, have no clinical effect, and to not require management at health care facilities. The observed clinical effects and treatment methods were consistent with the literature.

Insight from a breastfeeding peer support pilot program for husbands and fathers of Texas WIC participants.
Stremler J, Lovera D.
J Hum Lact. 2004 Nov;20(4):417-22.
A Father-to-Father Breastfeeding Support Pilot Program conducted by the Texas Department of Health provides a model of a viable way to increase breastfeeding rates in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). The pilot concept was based on previous success with a breastfeeding peer counselor program and research documenting the father's attitude as an important influence on a mother's decision to breastfeed. Peer dads are fathers of breastfed infants participating in the WIC Program. They are recruited, trained, and hired to give breastfeeding and parenting information to other WIC fathers. WIC fathers rated the information they received as "very important" and indicated that counseling sessions would help them support their infants'mothers with breastfeeding and be better fathers. Breastfeeding initiation rates increased at clinics employing peer dads. Father-to-father breastfeeding education was successful in educating and empowering fathers, enabling them to support their breastfeeding family members.

Epidemiology of spider bites in Texas, 1998-2002.
Forrester MB, Stanley SK.
Public Health. 2004 Oct;118(7):506-7.

The effect of fever, febrile illnesses, and heat exposures on the risk of neural tube defects in a Texas-Mexico border population.
Suarez L, Felkner M, Hendricks K.
Birth Defects Res A Clin Mol Teratol. 2004 Oct;70(10):815-9.
BACKGROUND: Hyperthermia produces neural tube defects (NTDs) in a variety of animal species. Elevated maternal body temperatures may also place the developing human embryo at risk. We examined the relation between maternal hyperthermia and the development of NTDs in a high-risk Mexican-American population. METHODS: Case-women were Mexican-American women with NTD-affected pregnancies who resided and delivered in any of the 14 Texas counties bordering Mexico, during 1995-2000. Control-women were randomly selected from study area residents delivering normal live births, frequency-matched to cases by hospital and year. Information on maternal fevers, febrile illnesses, exposures to heat generated from external sources, and hyperthermia-inducing activities was gathered through in-person interviews, conducted about six weeks postpartum. RESULTS: The risk effect (OR) associated with maternal fever in the first trimester, compared to no fever, was 2.9 (95% CI, 1.5-5.7). Women taking fever-reducing medications showed a lower risk effect (OR, 2.4; 95% CI, 1.0-5.6) than those who did not (OR, 3.8; 95% CI, 1.4-10.9). First-trimester maternal exposures to heat devices such as hot tubs, saunas, or electric blankets were associated with an OR of 3.6 (95% CI, 1.1-15.9). Small insignificant effects were observed for activities such as cooking in a hot kitchen (OR, 1.6; 95% CI, 1.0-2.6) and working or exercising in the sun (OR, 1.4; 95% CI, 0.9-2.2). CONCLUSIONS: Maternal hyperthermia increases the risk for NTD-affected offspring. Women intending to become pregnant should avoid intense heat exposures, carefully monitor and manage their febrile illnesses, and routinely consume folic acid supplements. (c) 2004 Wiley-Liss, Inc.

Medical records vs. interview responses: a comparative analysis of selected variables for linked birth defect cases.
Ramadhani TA, Canfield MA, Waller DK, Case AP.
Birth Defects Res A Clin Mol Teratol. 2004 Sep;70(9):592-6.
BACKGROUND: Data pertaining to birth defects are subject to certain limitations depending on the collection method. This study compares the agreement of data from medical records and maternal interviews. METHODS: The medical records and maternal interviews were linked for 1017 deliveries. Prevalence, concordance and kappa coefficients were calculated for maternal gestational and non-gestational diabetes, insulin use, seizures/epilepsy, Hispanic ethnicity, and infant/fetus sex. RESULTS: The prevalence of non-gestational diabetes was 4.3% in the medical records and 3.4% in the maternal interviews, with 98.1% agreement. The prevalence of gestational diabetes was 7.9% in medical records and 9.2% in maternal interviews, with 94.3% agreement. Similar prevalences and high levels of agreement were observed between the two systems for infant/fetus sex and mother's Hispanic ethnicity. Although high concordance was observed for seizures/epilepsy, kappa value was moderate. CONCLUSIONS: The availability of two distinct sources of data provides an exceptional opportunity to compare and validate both data sources. We found that the data for certain variables from maternal interviews strongly agreed with information from medical records. However, the extent of that agreement depended on the type of variable measured. Our results suggest that for some variables such as demographic variables, researchers can use either of the two data sources. Copyright 2004 Wiley-Liss, Inc.

Epidemiology of snakebites reported to poison centers in Texas from 1998 through 2002.
Forrester MB, Stanley SK.
Tex Med 2004;100:64-70.
ABSTRACT: The 15 species and subspecies of poisonous snakes endemic to Texas include all of the major poisonous snakes in the United States. Rates of poisonous snakebites have been reported to be higher in Texas than in most other states. However, epidemiologic data on poisonous and nonpoisonous snakebites are limited. Using data on snakebites to humans reported to the six poison centers in Texas, we examined associations with various demographic and clinical factors. The reported snakebite penetrance increased from 1998 through 2002. Most of the reported snakebites involved adults. Males were more likely to have reported snakebites than females. Most reported snakebites had mild-to-moderate outcomes. Snakebites were reported more frequently in the spring and summer. The geographic pattern of reported snakebites was generally consistent with the reported distribution of the types of poisonous snakes.

Textbooks

Biostatistics for the health sciences by R. Clifford Blair and Richard A. Taylor. New York: Prentice Hall, 2007, 552 p.
This book provides a solid foundation in introductory biostatistics. It explains commonly used biostatistical methods and provides real-world data with case studies. It is aimed primarily at health science students and professionals who need to increase their understanding of biostatistics.

The Dental hygienist's guide to nutritional care by Cynthia A. Stegeman and Judi Ratliff Davis. St. Louis, MO : Elsevier Saunders, 2005, 540 p.
This textbook for dental hygienists covers the basics of nutrition, as well as relevant topics specific to different life stages and states of health. Readers learn how to assess clients' eating habits and learn all about the nutritional aspects of oral health.

Last updated February 16, 2007