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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)
Are Birth Defects More Prevalent along the Texas-Mexico Border?
Langlois PH, Canfield MA, Suarez L.
Texas Medicine. 2007 Nov;103(11):53-59.
The objective of this descriptive epidemiologic study was to determine if the
prevalence of birth defects in Texas is higher along the border with Mexico.
We used statewide Texas Birth Defects Registry data from Hispanic deliveries
from 1999 through 2002. Birth prevalence ratios were calculated to compare
border and nonborder occurrence of 165 birth defects as well as of “any
monitored birth defect.” Poisson regression was used to calculate the
prevalence ratio (PR) and its 95% confidence interval (CI) and to adjust for
potential confounders. Cases of “any birth defect” were 7% less
prevalent among border Hispanics than among Hispanics living elsewhere; the
PR was 0.93 (95% CI 0.91-0.96). The adjusted PR was 1.01. Isolated cases were
more prevalent in border areas (unadjusted PR = 1.07, 95% CI = 1.03-1.11) but
severe cases (which should be less susceptible to detection bias) were less
prevalent (unadjusted PR = 0.88, 95% CI = 0.83-0.93). In the crude analysis
of 165 birth defects, 2 defects were both strongly and significantly more prevalent
in border areas and 26 were less prevalent. Analysis of severe cases showed
3 defects were more prevalent and 19 were less prevalent. We concluded that
whether based on the analysis of “any birth defect” or counting
numbers of specific defects, birth defects in Texas are not more prevalent
along the border with Mexico.
Methicillin-resistant staphylococcus aureus nasal carriage
rate in Texas county jail inmates.
Felkner M, Rohde RE, Valle-Rivera AM, Baldwin T, Newsome LP.
Journal of Correctional Health Care. 2007;13:289-295.
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a health
issue in corrections. The Texas Department of State Health Services (DSHS)
partnered with an urban jail to investigate risk factors for MRSA carriage.
This study assessed nasal carriage rate and strainrelatedness of MRSA among
recently booked inmates. Of 403 inmates, 115 (28.5%) carried S. aureus; 18
were MRSA-positive (4.5%). Pulsed field gel electrophoresis identified 10 MRSA
strains. Previous health care exposures and history of skin infection were
more strongly associated with carriage risk than previous correctional facility
exposure, although none of these exposures was statistically significant after
adjustment. Our data suggest that MRSA is endemic in persons coming into correctional
facilities. Correctional health care workers should be prepared to treat MRSA
infections that arise from exposures before incarceration.
A Rapid, Standardized, Susceptibility Method for Mycobacterium
Tuberculosis using
Mycolic Acid Analysis.
Parrish N, Osterhout G, Dionne K, Sweeney A, Kwiatkowski N, Carroll K, Jost
KC Jr, Dick J.
J Clin Microbiol. 2007 Oct 3; [Epub ahead of print]
MDR- and XDR-TB are an emerging public health threat compounded by the fact
that
current susceptibility testing techniques for M. tuberculosis (MTB) require
several days to weeks to complete. We investigated the use of HPLC-based quantitation
of mycolic acids as a means to rapidly determine drug resistance and susceptibility
in MTB. Standard susceptibility testing and determination of minimal inhibitory
concentrations (MIC's) of drug susceptible (n=26) and drug resistant strains
of MTB including MDR-TB (n=34) was performed using the BACTEC radiometric growth
system as the reference method. HPLC-based susceptibilities were performed
using current first-line drugs: isoniazid (INH), rifampin (RIF), ethambutol
(EMB), and pyrazinamide (PZA). Vials were incubated for 72 hours and aliquots
removed for HPLC analysis using the Sherlock(R) Mycobacterial Identification
System. HPLC quantitation of total mycolic acids (TMAP) was determined for
treated and untreated cultures. At 72 hours HPLC agreement with the reference
method was 99.5% for INH, EMB, and PZA, and 98.7% for RIF. Inter- and intra-assay
reproducibility varied by drug with an average precision of 13.4%. In summary,
TMAP is a rapid, sensitive, and accurate method for antibiotic susceptibility
testing of all currently used first-line drugs against MTB and offers the potential
of susceptibility testing results within hours, rather than days or weeks,
for clinical isolates of MTB.
Pediatric Montelukast Ingestions Reported to Texas Poison
Control Centers, 2000-2005.
Forrester MB.
J Toxicol Environ Health A 2007;70:1792-1797.
Limited information exists on the toxicity of pediatric ingestions of the drug
montelukast used in the treatment of chronic asthma. All ingestions of montelukast
involving children age 0-5 years reported to Texas poison control centers during
2000-2005 were retrieved. For a subset of cases where the final medical outcome
and dose in mg or mg/kg were known, the pattern of exposures by final medical
outcome and management site was evaluated. There were a total of 3,698 cases.
Of those cases with a known final medical outcome and dose, the mean dose in
mg was 42.5 mg (range 0.4-536 mg) and the mean dose in mg/kg was 3.36 mg/kg
(range 0.18-33.71 mg/kg). The final medical outcome was no observed effect
in 95% of the cases and minor effect in remainder of cases. The patient was
managed on site in 80% of the cases. The proportion of cases with a minor effect
increased from 5% for ingested dose of <=100 mg to 10% for >100 mg but
was 5% for dose <=5 mg/kg and >5 mg/kg. The proportion of cases managed
with healthcare facility involvement increased from 15% for ingested dose of <=100
mg to 56% for >100 mg and rose from 10% for dose <=5 mg/kg to 47% for
dose >5 mg/kg. Pediatric montelukast ingestions of doses up to 536 mg or
33.71 mg/kg do not appear likely to result in serious adverse effects and usually
can be managed at home.
Using Geographic Information Systems and Spatial and
Space-Time Scan Statistics for a Population-Based Risk Analysis of the 2002
Equine West Nile Epidemic in Six Contiguous Regions of Texas.
Warner LM, Alexander JL, Dixon KR.
Int J Health Geogr. 2007 Sep 21;6(1):42 [Epub ahead of print]
BACKGROUND: In 2002, West Nile virus (WNV) first appeared in Texas. Surveillance
data were retrospectively examined to explore the temporal and spatial characteristics
of Texas equine WNV epidemic in 2002. Using Geographic Information Systems
(GIS) and the Spatial and Space-Time Scan statistics (SaTScan), we analyzed
1421 of the reported equine WNV cases from six contiguous state Health Service
Regions (HSRs), comprising 158 counties, in western, northern, central and
eastern Texas. RESULTS: Two primary epidemic peaks occurred in Epidemiological
(Epi) week 35 (August 25 to 31) and Epi week 42 (October 13 to 19) of 2002
that took place in west and east part of the study area, respectively. The
SaTScan statistics detected nine non-random spatio-temporal equine case aggregations
(mini-outbreaks) and five unique high-risk areas imbedded within the overall
epidemic. CONCLUSIONS: The 2002 Texas equine WNV epidemic occurred in a bi-modal
pattern. Some "local hot spots" of WNV epidemic developed in Texas.
The use of GIS and SaTScan can serve as valuable tools in analyzing on-going
surveillance data to identify high-risk areas and shifts in disease clustering
within a large geographic area. Such techniques should become increasingly
useful and important in future epidemics, as decisions must be made to effectively
allocate limited resources.
Voluntary Readmission among Schizophrenic Patients in
the Texas State Psychiatric Hospital System.
Becker EA, Shafer A.
Texas Medicine. 2007 Sep;103(9):54-59.
This study examined risk factors for hospital recidivism within the Texas state
psychiatric hospital system. Voluntary admissions of 5212 schizophrenic patients
were followed for five years after discharge. First, the study examined differences
between patients who were not readmitted and those who were. Second, readmissions
were examined in relation to demographics, diagnostic information, posthospital
discharge community aftercare, and other hospitalization information, such
as length of stay. Readmission predictors were being male, single, and Hispanic;
having an aftercare appointment; living in a county with a mental hospital;
and having comorbid personality disorder and alcohol and drug abuse diagnoses.
Longer index hospitalizations led to slightly few readmissions, but the total
length of stay of subsequent readmissions was longer. While our predictors
of readmission are mostly immutable, they can still be used to flag those at
risk for lengthy hospital reentry.
Adult Glyburide Ingestions Reported to Texas Poison Control
Centers, 1998-2005.
Forrester MB.
Hum Exp Toxicol 2007;26:563-571.
Limited information exists on potentially adverse adult glyburide ingestions
reported to poison control centers. Using adult glyburide ingestions reported
to Texas poison control centers during 1998-2005, 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). Of 126 cases identified, 49 (39%) involved
serious outcomes. Serious outcomes were significantly more likely to
occur with a maximum dose >24
mg (RR 4.74, 95% CI 1.74-14.90) or >4 tablets (RR 3.27, CI 1.57-7.31),
where the circumstances of the exposures involved self-harm or malicious
intent (RR 2.44, CI 1.33-4.46), or the patient was already at or en route
to a health care facility when the poison control center was contacted (RR
12.89, CI 4.00-66.12) or referred to a health care facility by the poison
control center (RR 12.21, CI 3.53-65.01). The severity of the outcome associated
with adult glyburide ingestions depended on the dose and the circumstances
of the ingestion. The management of patients with severe outcomes was more
likely to involve health care facilities. Such information is useful for
creating triage guidelines for the management of adult glyburide ingestions.
Wildfire-related deaths--Texas, March 12-20, 2006.
[LINK to Full-text: http://www.cdc.gov/mmwr//preview/mmwrhtml/mm5630a1.htm ]
Centers for Disease Control and Prevention (CDC). DSHS contributors: D Zane,
J Henry, C Lindley, P Pendergrass, L Mansolo. Also acknowledged: J Alexander,
B Hernandez, T Haywood, P Raimondo, J Walker, T Sidwa, S Elkins, D Johnson,
A Whitley, P Tabor, C Tuttle, D McLellan, R Apodaca, M Widtfeldt, S Prosperie,
B Ray, D Powell.
MMWR Morb Mortal Wkly Rep. 2007 Aug 3;56(30):757-60.
During March 12-20, 2006, wildfires burned approximately 1 million acres in
the Panhandle region of Texas, advancing 45 miles in 9 hours, with dense smoke
and flames up to 11 feet. The two largest fires, which together extended into
nine counties, resulted from power lines downed by sustained winds of 46 mph
and gusts up to 53 mph. The wildfires destroyed more than 89 structures, with
losses estimated at $16 million. The fires caused evacuations in eight communities
with a total population of 4,072. This report summarizes the circumstances
of 12 deaths and describes the five separate incidents caused by the two wildfires
that resulted in those deaths.
Pattern of Statin Exposures Reported to Texas Poison
Centers, 1998-2004.
Forrester MB.
J Toxicol Environ Health A 2007;70:1424-1432.
Information on the management of potentially adverse exposures to statins is
limited. This study examined the pattern of 2331 statin exposures reported
to Texas poison control centers during 1998-2004. In particular comparisons
were made between exposures among pediatric (age 5 yr) and adult (age 20 yr)
patients. The number of exposures increased from 134 in 1998 to 516 in 2004.
Of the total exposures, 55% were to statins alone. Of the exposures to statins
alone, 57% of the patients were 5 yr of age and 22% were 60 yr of age. The
majority of exposures to statins alone (a) involved female patients (53%),
(b) were unintentional (94%), (c) occurred at home (91%), (d) were managed
on-site/at home (89%), and (e) had a final medical outcome classified as no
effect (94%). Pediatric and adult patients differed with respect to patient
gender (45 versus 66% female), exposure reason (100 versus 88% unintentional,
1 versus 75% therapeutic error), exposure site (14 versus 2% at other residence),
final medical outcome (4 versus 11% minor effect, none versus 4% moderate effects),
report of specific adverse clinical exposures (0.2 versus 5% neurological effects,
none versus 1% cardiovascular effects), and listed treatments (60 versus 24%
decontamination by dilution, 13 versus 6% decontamination by food). In conclusion,
reported statin exposures are increasing. The majority of potentially adverse
statin exposures reported to poison control centers may be successfully managed
at home with favorable outcomes. The pattern of exposures differs with age.
Review of Sole Lamotrigine Exposures Reported to Texas Poison Centers
during a Seven-Year Period.
Baeza SH, Cleary JL, Forrester MB, Snodgrass W.
Clin Toxicol 2007;45:642.
Background: There is limited data reported on patients’ clinical effects
with adverse exposures of the anticonvulsant lamotrigine. The objective of this
study is to categorize these effects to enable poison center specialists to better
manage these ingestions. Methods: We performed a retrospective chart review of
all cases involving only lamotrigine with known outcomes that were reported to
a state-wide poison center network during 2000 through 2006. Results: A total
of 269 cases with known outcomes were identified, of which 151 (56%) had known
doses. For cases with a known dose, the mean dose was 980 mg (range 2.5 to 10,000
mg). Suspected suicides accounted for 38% of cases, while general unintentional
and unintentional therapeutic errors represented 33.1% and 22% respectively.
Only 32% were managed on site as 55% were already in/enroute to a health care
facility when the poison center was contacted and 12% were referred to a health
care facility by the poison center. Half of all identified cases had no effects
reported, 32% had only minor effects, 14% had moderate effects, and only 4% had
major effects. There were no deaths reported from isolated lamotrigine ingestions
during this seven-year time frame. The most common clinical effects reported
include drowsiness/letharginess (23%), vomiting (10%), tachycardia (9%), nausea
(7%), dizziness/lightheadedness (6%), ataxia (6%) and agitation/irritability
(4%). Discussion: CNS effects are most prevalent with lamotrigine ingestions
followed by nausea/vomiting and tachycardia. A limitation of this study is that
it excluded cases with mixed ingestions. The potential for drug-drug interactions
and increased severity or duration of clinical effects with other CNS depressant
agents is possible. Conclusion: Although we were able to identify the most likely
clinical effects noted with lamotrigine exposures, further research is required
in order to determine if it is possible to predict risk of toxicity based on
a mg/kg dosage or other dosing parameter.
Escitalopram Ingestions Reported to Texas Poison Control
Centers, 2002-2005.
Forrester MB.
Hum Exp Toxicol 2007;26:473-482.
Limited information exists on potentially adverse escitalopram ingestions reported
to poison control centers. Using isolated escitalopram ingestions reported
to Texas poison control centers during 2002-2005, the proportion of cases involving
serious medical outcomes was determined for selected variables and evaluated
for statistical significance by calculating the rate ratio (RR) and 95% confidence
interval (CI). Of 1179 cases identified, 234 (20%) involved serious outcomes.
Serious outcomes were significantly more likely to occur with a maximum dose
of >100 mg (RR 4.69, CI 2.52-9.29) or >5 tablets (RR 4.96, CI 2.94-8.93),
where the circumstances of the exposures involved self-harm or malicious intent
(RR 3.21, CI 2.42-4.29), or when the patient was already at or en route to
a health care facility when the poison control center was contacted (RR 7.88,
CI 4.31-15.79) or referred to a health care facility by the poison control
center (RR 15.91, CI 8.78-31.64). The severity of the outcome associated with
isolated escitalopram ingestions depended on the dose and the circumstances
of the ingestion. The management of patients with serious outcomes were more
likely to involve health care facilities. Such information is useful for creating
triage guidelines for the management of escitalopram ingestions.
Adult Lisinopril Ingestions Reported to Texas Poison
Control Centers, 1998-2005.
Forrester MB.
Hum Exp Toxicol 2007;26:483-489.
There is limited information on potentially adverse lisinopril ingestions reported
to poison control centers. Using adult lisinopril ingestions reported to Texas
poison control centers during 1998-2005, 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). Of 468 cases identified, 43 (9%) involved serious outcomes. The severity
of the outcome associated with adult lisinopril ingestions depended on the
dose and the circumstances of the ingestion. Thus, serious outcomes were significantly
more likely to occur with a maximum dose >80 mg (RR 5.69, CI 2.43-13.33)
or, if the dose was unknown, >3 tablets (RR 9.57, CI 2.39-54.97), where
the circumstances of the exposures involved self-harm or malicious intent (RR
6.96, CI 3.65-13.31), or the patient was already at or en route to a health
care facility when the poison control center was contacted (RR 7.33, CI 3.09-17.85)
or referred to a health care facility by the poison control center (RR 23.76,
CI 10.62-55.67). The management of patients with severe outcomes was more likely
to involve health care facilities. Such information is useful for creating
of triage guidelines for the management of adult lisinopril ingestions.
Maternal Thyroid Disease as a Risk Factor for Craniosynostosis.
Rasmussen SA, Yazdy MM, Carmichael SL, Jamieson DJ, Canfield MA, Honein MA;
for
the National Birth Defects Prevention Study.
Obstet Gynecol. 2007 Aug;110(2):369-377.
OBJECTIVE: To study the relationship between maternal thyroid disease and craniosynostosis
using data from the National Birth Defects Prevention Study, a multisite, case-control
study. METHODS: Case infants (n=431) were identified through population-based
birth defects surveillance systems at eight sites and had craniosynostosis
verified by radiographic imaging. Control infants (n=4,094) consisted of a
random sample of live births with no major birth defects from the same population
as the case infants. Information on thyroid disease was based on self-report:
mothers who reported either a thyroid disorder or use of a medication to treat
a thyroid disorder during pregnancy were considered to have thyroid disease.
Using an unconditional logistic regression model, we considered potential confounding
factors (maternal age, race or ethnicity, smoking, body mass index, preexisting
diabetes, plurality, gravidity, family history, infant sex). RESULTS: Among
case mothers, 19 (4.4%) were classified as having thyroid disease, compared
with 65 (1.6%) of control mothers. Maternal thyroid disease was associated
with craniosynostosis after controlling for maternal age (adjusted odds ratio
2.47, 95% confidence interval 1.46-4.18), the only factor that remained significant
in the final model. CONCLUSION: These data provide additional evidence that
maternal thyroid disease (most likely Graves' disease) or its treatment is
associated with craniosynostosis. Given the frequency of maternal thyroid disease,
this association warrants further investigation. LEVEL OF EVIDENCE: II.
Neural tube defects, micronutrient deficiencies, and Helicobacter
pylori: A new hypothesis.
Felkner M, Suarez L, Liszka B, Brender JD, Canfield M.
Birth Defects Res A Clin Mol Teratol. 2007 Aug;79(8):617-21.
BACKGROUND: Previous findings for the Texas Neural Tube Defects Project suggested
that while maternal access to nutrients is adequate, bioavailability of nutrients
to the fetus is compromised in NTD-affected pregnancies. Helicobacter pylori
could cause nutrient loss to the fetus. Folate, B(12,) and ferritin are depleted
in H. pylori infection; these same deficiencies are related to NTD risk. METHODS:
Using H. pylori IgG ELISA Test System, we tested for H. pylori serum antibodies
in participants in the population-based case-control study component of the Texas
Neural Tube Defect Project conducted along the Texas-Mexico border. Case-women
had pregnancies affected by NTD (anencephalus, spina bifida, encephalocele) and
resided and delivered in one of the 14 Texas-Mexico border counties from 1995
through 2000. Control-women were study area residents delivering normal live
births during the same period. RESULTS: Of 225 case- and 378 control-women, 103
cases and 156 controls provided questionnaire and H. pylori antibody data. H.
pylori seropositivity was modestly associated with NTD-affected pregnancies (OR
1.4; 95% CI: 0.8-2.4). ORs of 2.0 or greater were seen in women younger than
age 25 and with less than 7 years education. CONCLUSIONS: Our findings intimate
that H. pylori could play a role in NTD causation in certain populations. While
results did not provide compelling support for this proposal, subgroup findings
prompt us to advocate an evaluation of this hypothesis in developing nations
among populations with higher prevalence of H. pylori, marginal nutrient intake,
and young childbearing age.
Folic Acid Supplementation among Diabetic, Overweight, or Obese Women of Childbearing
Age.
Case AP, Ramadhani TA, Canfield MA, Beverly L, Wood R.
J Obstet Gynecol Neonatal Nurs. 2007 Jul-Aug;36(4):335-41.
OBJECTIVE: To examine whether obese, overweight, or diabetic women were equally
likely to supplement with folic acid as normal-weight or nondiabetic women.
DESIGN: Texas Behavioral Risk Factor Surveillance System was used to compare
folic acid supplementation rates among obese, overweight, or diabetic women
to those of normal-weight or nondiabetic women. PARTICIPANTS: Responses from
nonpregnant Texas women of ages 18 to 44 were analyzed. MAIN OUTCOME MEASURES:
Odds ratios were calculated for association between diabetes, body mass index,
and folic acid supplementation. RESULTS: Of 6,835 participants, 35% reported
daily folic acid supplementation. Obese women were less likely to supplement,
even after adjustment for other factors. CONCLUSIONS: All women of childbearing
age, but especially those who are obese or diabetic, should be encouraged to
take folic acid daily to reduce the risk of neural tube defects.
Primary Cesarean Deliveries Prior to Labor in the United States, 1979-2004.
Joesch JM, Gossman GL, Tanfer K.
Matern Child Health J. 2007 Jul 24; [Epub ahead of print]
Objectives: To provide for the United States yearly estimates of first-time (primary)
cesareans prior to labor and to examine factors associated with 1979-2004 trends.
Methods: We estimated the annual percent of total, primary, and repeat cesareans
with and without labor for 15- to 44-year-old women with live births in the 1979-2004
National Hospital Discharge Survey (NHDS; N = 706,062). For women without prior
cesareans (N = 628,064), we used logistic regression to examine whether trends
in primary cesarean before labor are explained by changes over time in: (1) the
frequency of pregnancy complications, women's age, principal source of payment
for delivery, hospital ownership, size, and region; and (2) the decision to deliver
by cesarean when complications are present. Results: Annually 4.5-6.6% of women
delivered by primary cesarean prior to labor in 1979-2004. Recently, there has
been a rise. An increase in reported pregnancy complications contributed to more
primary cesareans before labor in 1979-2004. Changes in women's age, principal
payment source, and hospital characteristics do not explain 1979-2004 trends.
Changes in delivery practices with respect to seven complications increased primary
cesareans before labor in the 1980s. Conclusions: From 1979 to 2004, primary
cesareans before labor contributed less to total cesareans than primary cesareans
during labor and repeat cesareans without labor. Since 1998, primary cesareans
pre-labor have increased less than previously reported. The recent increase is
not explained by changes in the frequency of pregnancy complications, women's
age, insurance, or delivery hospital characteristics. Changes in delivery practices
regarding pregnancy complications may have contributed to the recent increase.
Maternal Exposures to Cigarette Smoke, Alcohol, and Street Drugs and Neural
Tube Defect Occurrence in Offspring.
Suarez L, Felkner M, Brender JD, Canfield M, Hendricks K.
Matern Child Health J. 2007 Jul 20; [Epub ahead of print]
OBJECTIVES: Cigarettes, alcoholic beverages, and street drugs contain substances
potentially toxic to the developing embryo. We investigated whether maternal
cigarette smoking, secondhand smoke exposure, and alcohol or street drug use
contributed to neural tube defect (NTD) occurrence in offspring. METHODS: We
conducted a population-based case-control study among Mexican American women
who were residents of the 14 Texas counties bordering Mexico. Case women had
an NTD-affected pregnancy and delivered during 1995-2000. Control women were
those who delivered live born infants in the same study area, without an apparent
congenital malformation, randomly selected by year and facility. We interviewed
women in person, 1-3 months postpartum, to solicit relevant information. RESULTS:
Nonsmoking mothers exposed to secondhand smoke during the first trimester had
an NTD odds ratio (OR) of 2.6 (95% confidence interval (CI) = 1.6, 4.0) compared
to those who neither smoked nor were exposed to secondhand smoke. Compared
to the referent, the OR among women who smoked less than half a pack a day
during the first trimester was 2.2 (95% CI = 1.0, 4.8) and 3.4 (95% CI = 1.2,
10.0) among those who smoked a half pack or more. Adjustment for maternal age,
education, body mass index, and folate intake had a negligible effect on results.
Alcohol and street drug use had no relation to NTD risk when adjusted for cigarette
smoking. CONCLUSIONS: This study suggests that cigarette smoke including secondhand
exposure is not only hazardous to the mother but may also interfere with neural
tube closure in the developing embryo.
Compendium of Measures to Prevent Disease Associated with Animals
in Public Settings, 2007.
[LINK to Full-text: http://www.cdc.gov/mmwr//preview/mmwrhtml/rr5605a1.htm ]
National Association of State Public Health Veterinarians, Inc. (NASPHV) and
Centers for Disease Control and Prevention. DSHS member of NASPHV: James H.
Wright.
MMWR Recomm Rep. 2007 Jul 6;56(RR-5):1-13.
Certain venues encourage or permit the public to contact animals, resulting
in millions of human-animal interactions each year. These settings include
county or state fairs, petting zoos, animal swap meets, pet stores, zoologic
institutions, circuses, carnivals, farm tours, livestock-birthing exhibits,
educational exhibits at schools, and wildlife photo opportunities. Although
multiple benefits of human-animal contact exist, infectious diseases, rabies
exposures, injuries, and other human health problems associated with these
settings are possible. Infectious disease outbreaks reported during the previous
decade have been caused by Escherichia coli O157:H7, Salmonella, Cryptosporidium,
Coxiella burnetii, Mycobacterium tuberculosis, ringworm, and other pathogens.
Such incidents have substantial medical, public health, legal, and economic
effects. This report provides recommendations for public health officials,
veterinarians, animal venue staff, animal exhibitors, visitors to animal venues,
physicians, and others concerned with minimizing risks associated with animals
in public settings. The recommendation to wash hands is the single most important
prevention step for reducing the risk for disease transmission. Other critical
recommendations are that venues not allow food in animal areas, venues include
transition areas between animal areas and nonanimal areas, visitors be educated
about disease risk and prevention procedures, and animals be properly cared
for and managed.
The State Policy Context of Implementation Issues for
Evidence-Based Practices in Mental Health.
Isett KR, Burnam MA, Coleman-Beattie B, Hyde PS, Morrissey JP, Magnabosco J,
Rapp CA, Ganju V, Goldman HH.
Psychiatr Serv. 2007 Jul;58(7):914-21.
OBJECTIVES: This study analyzed implementation issues related to several evidence-based
practices for adults with serious mental illness that were included in a national
demonstration project. The five evidence-based practices included in this investigation
are assertive community treatment, family psychoeducation, illness management
and recovery, integrated dual diagnosis treatment, and supported employment.
The objective of the study was to assess the role of state mental health authorities
as agents of change. METHODS: Two-person teams conducted interviews with state
mental health authorities, consumers, families, representatives of local mental
health authorities, and representatives of other relevant state agencies-more
than 30 individuals at each of the eight sites. Interviews took place at two
time points at least one year apart and probed the facilitators and barriers
to implementation at the state level. Data were assessed qualitatively to identify
common trends and issues across states related to leadership, training, and
regulatory issues for each evidence-based practice. RESULTS: Each of the five
practices has different critical contingencies for statewide implementation
and requires unique assets to address those contingencies by the state mental
health authorities. The contingencies are related to these critical areas:
financing and regulations, leadership, and training and quality. CONCLUSIONS:
States are key to implementing evidence-based practices, but state mental health
authorities should note that each of the practices requires different skill
sets and involves different stakeholders. Thus implementing many evidence-based
practices at once may not yield economies of scale.
Prevalence of Multiple Sclerosis in 19 Texas Counties,
1998-2000.
Williamson DM, Henry JP, Schiffer R, Wagner L.
J Environ Health. 2007 Jun;69(10):41-5.
The study reported here determined the prevalence of multiple sclerosis (MS)
between January 1, 1998, and December 31, 2000, for a 19-county study area
surrounding Lubbock, Texas. The primary data source for case ascertainment
was medical records from the offices of neurologists practicing in the study
area. The study found that the overall prevalence for the 19-county study area
was 42.8 per 100,000 population (95 percent CI = 36.8-49.5). The prevalence
estimate for females was 68.6 per 100,000 (95 percent CI = 58.0-80.6), and
for males it was 16.6 per 100,000 (95 percent CI = 11.6-23.1). The prevalence
estimate for non-Hispanic whites was 56.0 per 100,000 (95 percent CI = 47.1-66.1);
the next highest prevalence was among non-Hispanic blacks at 22.1 per 100,000
(95 percent Cl = 8.1-48.1), and Hispanics at 11.2 per 100,000 (95 percent CI
= 6.4-18.2). This project generated the first Texas-specific population-based
MS prevalence estimates, including prevalence estimates specific to Hispanics
and blacks in Texas. The results underscore the need for additional epidemiologic
information on the distribution of MS in other areas of Texas and the United
States, as well as information on the underlying etiology of the disease.
Investigation of a Cluster of Multiple Sclerosis in Two
Elementary School Cohorts.
Henry JP, Williamson DM, Schiffer R, Wagner L, Shire J, Garabedian M.
J Environ Health. 2007 Jun;69(10):34-8.
The authors investigated a cluster of multiple sclerosis (MS) among people
who had attended two elementary schools in El Paso, Texas, from 1948 through
1970. The community was concerned about the possibility of childhood exposure
to heavy metals from a large nearby smelter because historical environmental
and biological sampling data demonstrated the potential for study cohort members
to have been exposed to heavy metals during their pre-adolescent years. One
cohort had no reported cases of MS. In the second cohort, 22 members self-reported
a diagnosis of MS, and 16 of these cases were confirmed as MS by an independent
board-certified neurologist. The crude MS prevalence estimate was 411 per 100,000
(95 percent confidence interval [CI] = 197-603), Prevalence estimates from
four different populations were used for calculation of standardized morbidity
ratios (SMRs). At the extremes, the study cohort represents a deficit of cases
(SMR= 0.9; 95 percent CI = 0.51-1.44) or a four-fold excess (SMR = 4.0; 95
percent Cl = 2.29-6.5).
Potential Effect of Over-the-Counter Sales on Omeprazole
Calls to Texas Poison Centers.
Forrester MB.
Texas Medicine 2007 Jun;103(6):48-51.
Omeprazole exposures reported to Texas poison centers before over-the-counter
(OTC) approval (January 1998 through June 2003) and after OTC approval (July
2003 through December 2005) were compared. The mean number of human exposures
per month declined from 12 before OTC approval to 8 after OTC approval. For
exposures involving omeprazole alone, the calls before and after OTC approval
were similar with respect to the exposure being unintentional (93% vs 92%),
management occurring outside of a health care facility (90% vs 86%), and final
medical outcome classified as no effect (95% vs 95%). During both time frames,
no specific category of adverse clinical effect was reported in more than 6%
of the exposures. Decontamination was the most common method of treatment both
before (54%) and after (42%) OTC approval. In conclusion, approval of omeprazole
did not alter the pattern of the potentially adverse omeprazole exposures reported
to Texas poison centers.
Pediatric Atomoxetine Ingestions Reported to Texas Poison
Control Centers, 2003-2005.
Forrester MB.
J Toxicol Environ Health A 2007;70:1064-1070.
ABSTRACT: Limited information exists on potentially adverse consequences following
pediatric atomoxetine ingestions reported to poison control centers. Using
pediatric atomoxetine ingestions reported to Texas poison control centers during
2003-2005, the proportion of cases involving serious outcomes (medical outcomes
classified as moderate effects, major effects, death, or judged as potentially
toxic exposures) was determined for selected variables and evaluated for statistical
significance by calculating the rate ratio (RR) and 95% confidence interval
(CI). Of 501 cases identified, 31 (6%) involved serious outcomes. Higher serious
outcome rates were found with a maximum dose of >2.8 mg/kg or >200 mg
or >4 tablets. Serious outcome rates were also higher if the exposure involved
intentional self-harm or the patient was already at or en route to a health
care facility when the poison control center was contacted or referred to a
health care facility by the poison control center. The severity of the outcome
associated with pediatric atomoxetine ingestions was dependent upon the dose
and the circumstances of the ingestion (whether intentional self-harm was involved).
The management of patients with serious outcomes was more likely to involve
health care facilities. This information is useful for creating triage guidelines
for the management of pediatric atomoxetine ingestions.
Availability of Lactation Counseling Services Influences Breastfeeding among
Infants Admitted to Neonatal Intensive Care Units.
Castrucci BC, Hoover KL, Lim S, Maus KC.
Am J Health Promot. 2007 May-Jun;21(5):410-5.
PURPOSE: To assess the association between the presence of international board-certified
lactation consultant (IBCLC) services at a delivery hospital and the breastfeeding
practices of women whose infants required neonatal intensive care unit (NICU)
admission. DESIGN: Cross-sectional study using population-level data. SETTING:
Philadelphia, Pennsylvania. SUBJECTS: 2132 infants admitted to the NICU. MEASURES:
Breastfeeding at hospital discharge was measured with the question, "Is
the infant being breastfed?" Delivery hospitals were dichotomized as to
the presence or absence of an IBCLC on staff ANALYSIS: Logistic regression
was used to assess the relationship between breastfeeding at discharge and
the presence of an IBCLC at the delivery facility while adjusting for maternal
characteristics and birth outcomes. RESULTS: Among mothers of infants admitted
to the NICU, breastfeeding rates among mothers who delivered at hospitals with
an IBCLC were nearly 50% compared with 36.9% among mothers who delivered at
hospitals without an IBCLC. The adjusted odds of breastfeeding initiation prior
to hospital discharge were 1.34 (95% confidence interval = 1.03, 1.76) times
higher for women who delivered at a facility with an IBCLC. CONCLUSIONS: To
increase breastfeeding rates among the NICU population, these findings support
the need for universal availability of IBCLCs at delivery facilities that have
NICUs.
Texas Statewide Hepatitis C Counseling and Testing, 2000-2005.
Heseltine G, McFarlane J.
Public Health Reports; 2007 May/Jun;122(2 Suppl):6-11.
In 1999, the Texas legislature funded a statewide hepatitis C education and
prevention program. Hepatitis training was incorporated into training for all
human immunodeficiency virus (HIV), sexually transmitted disease (STD), and
substance abuse counselors. Hepatitis C virus (HCV) counseling and HCV-antibody
(anti-HCV) testing services were integrated into 20 HIV/STD service provider
programs. Hepatitis C counseling and testing became available in 2000. Through
2005, 38,717 tests were administered, with 8,964 (23.2%) anti-HCV positive.
Injection drug use was reported by 7,105 people (79.3%) who tested positive.
In Texas, a state-initiated and almost entirely state-funded program supported
statewide HCV counseling and anti-HCV testing among high-risk adults.
Financing Newborn Screening: Sources, Issues, and Future
Considerations.
Therrell BL, Williams D, Johnson K, Lloyd-Puryear MA, Mann MY, Ramos LR.
J Public Health Manag Pract. 2007 March/April;13(2):207-213.
Newborn screening (NBS) programs are population-based public health programs
and are uniquely financed footline compared with many other public health programs.
Since they began more than 45 years ago, the financing issues have become more
complex for NBS programs. Today, almost all programs have a portion of their
costs paid by fees. The fee amounts vary from program to program, with little
standardization in the way they are formulated, collected, or used. We previously
surveyed 37 of the 51 dried blood spot screening programs throughout the United
States, and confirmed an increasing dependence on NBS fees. In this study,
we have collected responses from all 51 programs (100%), including updated
responses from the original 37, and updated our fee listings. Comments from
those surveyed indicated that the lack of a national standardized procedural
coding system for NBS contributes to billing complexities. We suggest one coding
possibility for discussion and debate for such a system. Differences in Medicaid
interpretations may also contribute to financing inequities across NBS programs
and there may be benefit from certain clarifications at the national level.
Completed survey responses accounted for few changes in the conclusions of
our original survey. We confirmed that 90 percent of all NBS programs have
a fee paid by parents or a third party payer. Sixty-one percent reported receiving
some funds from the Maternal and Child Health Services Title V block grant,
33 percent reported some funding from state general revenue/general public
health appropriations; and 24 percent reported obtaining direct reimbursement
from Medicaid (without passing through a third party). A majority of programs
(63%) reported budget increases between 2002 and 2005, with increases primarily
from fees (72%) and to a lesser extent from Medicaid, the Title V block grant,
and state general revenues.
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.
Geographic Disparities in Diabetes-Related Amputations
- Texas-Mexico Border 2003.
Huang P, Bensyl D, Miller EA.
JAMA. 2007 Mar 14;297(10):1051-2.
The article discusses the greater occurrence of diabetes-related amputations
of the lower extremities in patients in Texas along the Texas-Mexico border
than the rest of the state. The number of lower extremity amputations in people
with diabetes was calculated using the 2003 Texas Inpatient Hospital Discharge
Data. There are barriers to health care among people living along the Texas-Mexico
border, including lower levels of education, lower incomes, and no health insurance.
The authors state that measures to prevent diabetes and improve education about
diabetes are needed to reduce diabetes-related lower extremity amputations.
Effectiveness and Tolerability of Aripiprazole in Child
and Adolescent Inpatients: A Retrospective Evaluation.
Gibson AP, Lynn Crismon M, Mican LM, Fischer C.
Int Clin Psychopharmacol. 2007 Mar;22(2):101-105.
The objective of this study was to evaluate the effectiveness and tolerability
of aripiprazole use in child and adolescent psychiatric inpatients. This was
a naturalistic, retrospective evaluation of the discharged patients treated
with aripiprazole on the child and adolescent unit at the Austin State Hospital.
To be included, patients had to be <18 years of age and treated with aripiprazole
for at least two consecutive weeks during their hospital stay. We used a chart
extracted Clinical Global Impression of Improvement, and a chart extracted
Clinical Global Impression of Severity of Illness score to determine their
effectiveness. Adverse events and side effects recorded in the physician or
nursing notes were collected to establish tolerability. Forty-five patients
met the criteria and were included in this analysis. Average clinical global
impression of severity of illness scores at baseline and endpoint were 5.04+/-0.91
and 3.33+/-1.24 respectively. This difference was statistically significant
(Wilcoxon's signed-rank test: Z=-5.179, P<0.001). Fifty-one percent of the
youth had a clinical global impression of severity of illness score that was
much improved or very much improved (clinical global impression of improvement
score of 1 or 2). Significant reduction in clinical global impression of severity
of illness scores suggests a decline in the symptom severity for patients treated
with aripiprazole. On the basis of the reported adverse events and side effects,
aripiprazole was generally well tolerated. Randomized controlled trials of
aripiprazole in childhood mental disorders are warranted.
Fatal Pneumonia among Metalworkers Due to Inhalation
Exposure to Bacillus cereus Containing Bacillus anthracis Toxin Genes.
Avashia S, Riggins WS, Lindley C, Hoffmaster A, Drumgoole R, Nekomoto T, Jackson
PJ, Hill KK, Williams K, Lehman L, Libal MC, Wilkins PP, Alexander J, Tvaryanas
A, Betz T.
Clin Infect Dis. 2007 Feb 1;44(3):414-6.
Bacillus cereus pneumonia is unusual in nonimmunocompromised hosts. We describe
fatal cases in 2 metalworkers and the associated investigation. Anthrax toxin
genes were identified in B. cereus isolates from both patients using polymerase
chain reaction. Finding anthrax toxin genes in non-Bacillus anthracis isolates
has, to our knowledge, only been reported once previously.
Pediatric Lisinopril Ingestions Reported to Texas Poison
Control Centers.
Forrester MB.
Hum Exp Toxicol. 2007 Feb;26(2):83-9.
Lisinopril is not recommended for use by young children. This study attempted
to identify factors associated with serious outcomes in pediatric lisinopril
ingestions. Cases for this study were lisinopril ingestions by children age < or
=5 years reported to Texas poison control centers during 1998-2005. The percentage
of cases involving serious medical outcomes was identified for selected variables
and evaluated for statistical significance by calculating the rate ratio (RR)
and 95% confidence interval (CI). Of 691 total cases, 26 (3.8%) involved a
serious outcome. Higher serious outcome rates were found with a maximum dose
of >4 mg/kg (RR: 2.54, CI: 0.05-25.62), or >80 mg (RR: 7.85; CI: 1.73-29.29),
or five or more tablets (RR: 8.18; CI: 2.73-22.54), or the patient was already
at or en route to a health care facility when the poison control center was
contacted (RR: 13.93; CI: 3.68-77.78), or referred to a health care facility
by the poison control center (RR: 33.49; CI: 9.04-194.94). The management
of patients with severe outcomes was more likely to involve health care facilities.
This information is useful for drafting triage guidelines for the management
of pediatric lisinopril ingestions.
Pattern of Proton Pump Inhibitor Calls to Texas Poison
Centers, 1998-2004.
Forrester MB.
J Toxicol Environ Health A 2007;70:705-714.
There is little information on the management of potentially adverse exposures
to proton pump inhibitors. This study examined the distribution of 2943 proton
pump inhibitor exposures reported to Texas poison control centers during 1998-2004.
In particular comparisons were made between exposures among pediatric (age
5 yr) and adult (age 20 yr) patients. Of the total exposures, 1813 (62%) were
to the proton pump inhibitor alone. Of exposures to proton pump inhibitors
alone, 66% were age 5 yr, 7% 6-19 yr, and 27% 20 yr. Pediatric and adult patients
differed with respect to patient gender, exposure reason, exposure site, management
site, final medical outcome, report of specific adverse clinical exposures,
and listed treatments. Proton pump inhibitor exposures differed with patient
age. In the majority of instances, potentially adverse proton pump inhibitor
exposures reported to poison control centers may be successfully managed at
home with favorable outcome.
Adderall Abuse in Texas, 1998-2004.
Forrester MB.
J Toxicol Environ Health A 2007;70:658-664.
Adderall is used in the treatment of attention deficit hyperactivity disorder
(ADHD) in children and is subject to abuse. This study describes the patterns
of Adderall abuse calls received by several poison control centers in Texas
during 1998-2004. 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 all Adderall exposure calls, 12%
involved abuse. The number of drug abuse calls received per year increased
during the first part of 7-yr period but then declined. Male patients accounted
for almost 60% of both drug abuse and nonabuse calls. Adolescent patients comprised
69% of drug abuse calls and children less than 13 yr old comprised 66% 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 nonabuse calls
to involve exposures at another residence (6% vs. 3%), school (22% vs. 5%)
and public areas (2% vs. 0.4%). Drug abuse calls were less likely than nonabuse
calls to be managed outside of a health care facility (18% vs. 51%) and to
be classified as no adverse effect (23% vs. 48%). Adderall abusers are more
likely to be adolescents. Adderall abuse as compared to other exposures is
more likely to occur outside of the person's home and involve more serious
medical outcomes.
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.
A Large, Travel-Associated Outbreak of Legionellosis
among Hotel Guests: Utility of the Urine Antigen Assay in Confirming Pontiac
Fever.
Burnsed LJ, Hicks LA, Smithee LM, Fields BS, Bradley KK, Pascoe N, Richards
SM,
Mallonee S, Littrell L, Benson RF, Moore MR
Clin Infect Dis. 2007 Jan 15;44(2):222-8.
Background. During March 2004, a large outbreak of legionnaires disease and
Pontiac fever occurred among hotel guests in Oklahoma. An investigation was
conducted to identify the source and evaluate the utility of the Legionella
urine antigen assay and serologic testing for the identification of Pontiac
fever Methods. A retrospective cohort investigation of hotel guests and employees
and an environmental evaluation were performed. Participants were interviewed,
and clinical specimens were collected from consenting individuals. Results.
Six cases of legionnaires disease and 101 cases of Pontiac fever were identified.
Exposure to the indoor pool and hot tub area was associated with legionellosis
(relative risk, 4.4; 95% confidence interval, 2.8–6.9). Specimens from
the pool and hot tub tested positive for Legionella pneumophila serogroup 1
by polymerase chain reaction. For Pontiac fever, the sensitivity and positive
predictive value were 35.7% and 100%, respectively, for the urine antigen assay,
and 46.4% and 90%, respectively, for serologic testing. The specificity and
negative predictive value were 100% and 47.8%, respectively, for the urine
antigen assay, and 89.3% and 45.5%, respectively, for serologic testing.Conclusions.
Urine antigen testing, with or without serologic testing, can be used to confirm
outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup
1.
Association of Paternal Age with Prevalence of Selected Birth Defects.
Archer NP, Langlois PH, Suarez L, Brender J, Shanmugam R.
Birth Defects Res A Clin Mol Teratol. 2007 Jan;79(1):27-34.
BACKGROUND: Unlike maternal age, the effect of paternal age on birth defect prevalence
has not been well examined. We used cases from the Texas birth defect registry,
born during 1996-2002, to evaluate the association of paternal age with the prevalence
of selected structural birth defects. METHODS: Poisson regression was used to
calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) associated
with paternal age for each birth defect, adjusting for maternal age, race/ethnicity,
and parity. RESULTS: Relative to fathers ages 25-29 years, fathers 20-24 years
of age were more likely to have offspring with gastroschisis (PR 1.47, 95% CI:
1.12-1.94), and fathers 40+ years old were less likely to have offspring with
trisomy 13 (PR 0.40, 95% CI: 0.16-0.96). No association was seen between paternal
age and prevalence of anencephaly and encephalocele. A selection bias was observed
for the other birth defects in which cases of younger fathers were more often
excluded from study. CONCLUSIONS: In studies of birth defect risk and paternal
age, the source of information may affect the validity of findings.
2006
Articles (in date order with most recent first)
Characteristics of an Outbreak of West Nile Virus Encephalomyelitis
in a Previously Uninfected Population of Horses.
Ward MP, Schuermann JA, Highfield LD, Murray KO.
Vet Microbiol. 2006 Dec 20;118(3-4):255-9.
Equine West Nile virus (WNV) encephalomyelitis cases – based on clinical
signs and ELISA serology test results – reported to Texas disease control
authorities during 2002 were analyzed to provide insights into the epidemiology
of the disease within a previously disease-free population. The epidemic occurred
between June 27 and December 17 (peaking in early October) and 1698 cases were
reported. Three distinct epidemic phases were identified, occurring mostly
in southeast, northwest and then central Texas. Significant (P <0.05) disease
clusters were identified in northwest and northern Texas. Most (91.1%) cases
had no recent travel history, and most (68.9%) cases had not been vaccinated
within the previous 12 months. One-third of cases did not survive, 71.2% of
which were euthanatized. The most commonly reported presenting signs included
ataxia (69%), abnormal gait (52%), muscle fasciculations (49%), depression
(32%) and recumbency (28%). Vaccination status, ataxia, falling down, recumbency
and lip droop best explained the risk of not surviving WNV disease. Results
suggest that the peak risk period for encephalomyelitis caused by WNV may vary
substantially among regions within Texas. Recumbent horses have a poor prognosis
for survival. Vaccines, even if not administered sufficiently in advance of
WNV infection within a district, may reduce the risk of death by at least 44%.
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.
Mental Health Quality and Accountability: The Role of
Evidence-Based Practices and Performance Measurement.
Ganju V.
Adm Policy Ment Health. 2006 Nov;33(6):659-65.
Both evidence-based practices and performance measurement in mental health
systems have been implemented as largely independent initiatives, each facing
issues related to system-wide, sustained implementation. A major thrust of
this article is that a broader quality and accountability framework is critical
for obtaining better outcomes and for incorporating these initiatives into
business as usual. This article provides an overview of national initiatives
in these areas, lessons learned from implementation efforts, and problems encountered.
Building on these experiences, a model for a quality and accountability framework
is proposed in which evidence-based practices and performance measurement systems
can together provide productive and ongoing synergy.
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 Nov;76(11):747-56.
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.
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 Nov;16(6):538-43
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.
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 Nov;16(11):842-9.
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 Plague--Four States, 2006.
MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):940-3.
Centers for Disease Control and Prevention (CDC). DSHS contributors: B Nix,
R Jones, T Sidwa, J Walker.
[LINK to Full-text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5534a4.htm ]
Plague is a zoonotic disease caused by the bacterium Yersinia pestis. In 2006,
a total of 13 human plague cases have been reported among residents of four
states: New Mexico (seven cases), Colorado (three cases), California (two cases),
and Texas (one case). This is the largest number of cases reported in a single
year in the United States since 1994. Dates of illness onset ranged from February
16 to August 14; two (15%) cases were fatal. The median age of patients was
43 years (range: 13-79 years); eight (62%) patients were female. Five (38%)
patients had primary septicemic plague, and the remaining eight (62%) had bubonic
plague. Two (15%) patients developed secondary plague pneumonia, leading to
administration of antibiotic prophylaxis to their health-care providers. This
report summarizes six of the 13 cases, highlighting the severity and diverse
clinical presentations of plague and underscoring the need for prompt diagnosis
and treatment when plague is suspected.
Interdigital Skin Lesions of the Lower Limbs among Patients
with Lymphoedema in an Area Endemic for Bancroftian Filariasis.
Dreyer G, Addiss D, Gadelha P, Lapa E, Williamson J, Dreyer A.
Trop Med Int Health. 2006 Sep;11(9):1475-81.
OBJECTIVES: An estimated 15 million persons suffer from lymphoedema of the
leg in filariasis-endemic areas of the world. A major factor in the progression
of lymphoedema severity is the incidence of acute dermatolymphangioadenitis
(ADLA), which is triggered by bacteria that gain entry through damaged skin,
especially in the toe web spaces ('interdigital skin lesions'). Little is known
about the epidemiology of these skin lesions or about patients' awareness of
them. METHODS: We interviewed and examined 119 patients (89% women) with lymphoedema
of the leg in Recife, Brazil, an area endemic for bancroftian filariasis. RESULTS:
We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5
lesions per patient, range 0-8). The number of interdigital skin lesions was
significantly associated with lymphoedema stage (P<0.001) and frequency
of ADLA (P<0.0001). Only 20 (16.8%) patients detected their own interdigital
skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA
episodes during the previous 12 months (range, 0-20); reported ADLA incidence
was associated with lymphoedema stage (P<0.0001) and the number of interdigital
skin lesions detected by the examining physician (P<0.0001). CONCLUSIONS:
These data suggest that interdigital skin lesions are a significant risk factor
for ADLA and that persons with lymphoedema in filariasis-endemic areas are
unaware of their presence or importance. Prevention of ADLA through prompt
recognition and treatment of interdigital skin lesions will require that patients
be taught to identify lesions, especially between the toes and to recognize
them as abnormal.
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.
Dengue and South Texas: Information for Clinicians.
Ramos M, Abell A, Smith B.
Tex Med. 2006 Aug;102(8):56-8.
Dengue is a mosquito-transmitted, acute viral disease caused by any of four
dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). Dengue is endemic
in most tropical and subtropical areas of the world. Since 1980, outbreaks
of dengue and dengue hemorrhagic fever have been increasingly common in Mexico.
South Texas has experienced five outbreaks of dengue since 1980, corresponding
with periods of epidemic dengue in Mexico. The most recent dengue outbreak
in South Texas occurred in the summer and fall of 2005. This article summarizes
the current situation of dengue in South Texas and provides a concise clinical
review for the health care practitioner.
Addressing Asthma in Texas: Development of a School-Based
Asthma Surveillance Program for Texas Elementary Schools.
Petronella SA, Bricker SK, Perrotta D, Brown C, Brooks EG
J Sch Health. 2006 Aug;76(6):227-34.
To address asthma in the state, in October 2000, the Texas Department of State
Health Services (DSHS) and the American Lung Association of Texas held a joint
meeting of asthma professionals from across the state, with a primary purpose
of identifying major issues and potential strategies and actions to be taken.
These discussions became the basis of the 2001 Texas State Asthma Plan, which
has since been adopted to guide state efforts in asthma surveillance, management,
education, and advocacy. The primary purpose of this project, which was conducted
with and funded by the DSHS and the Centers for Disease Control and Prevention,
has been to develop and implement an asthma surveillance program for Texas
school-aged children. The program has been implemented with a sample (n = 42,409)
of students from the Texas Education Agency's region IV. An important goal
has been to determine the feasibility of conducting school-based statewide
asthma surveillance and assist with establishing a network for ongoing, systematic
collection, analysis, interpretation, and dissemination of asthma data. This
project is expected to become part of a wider asthma surveillance network that
will include mortality, hospital discharge, and Behavioral Risk Factor Surveillance
System (BRFSS) data. It will also provide information not typically captured
by surveillance programs, including the BRFSS, which rely heavily upon a previous
diagnosis of asthma to determine both lifetime and current prevalence of asthma.
Results from this project indicate that such reliance on a previous diagnosis
may considerably underestimate the prevalence of disease-particularly in the
Latino population.
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.
A Large Outbreak of Brainerd Diarrhea Associated with
a Restaurant in the Red River Valley, Texas.
Kimura AC, Mead P, Walsh B, Alfano E, Gray SK, Durso L, Humphrey C, Monroe
SS,
Visvesvera G, Puhr N, Shieh WJ, Eberhard M, Hoekstra RM, Mintz ED.
Clin Infect Dis. 2006 Jul 1;43(1):55-61.
BACKGROUND: In June 1996, an outbreak of chronic diarrhea was reported to the
Texas Department of Health (Austin). METHODS: We initiated active case finding,
performed 2 case-control studies, and conducted an extensive laboratory and
environmental investigation. RESULTS: We identified 114 persons with diarrhea
that lasted > or = 4 weeks. Symptoms among 102 patients who were studied
included urgency (87%), fatigue (86%), fecal incontinence (74%), and weight
loss (73%); the median maximum 24-h stool frequency was 15 stools. Diarrhea
persisted for > 6 months in 87% and for > 1 year in 70% of patients who
were observed. Fifty-one (89%) of 57 ill persons had eaten at a particular
restaurant within 4 weeks before onset, compared with 8 (14%) of 59 matched
control subjects (matched odds ratio [OR], undefined; 95% confidence interval
[CI], 11.2-infinity). At the restaurant, patients were more likely than their
unaffected dining companions to have drunk tap water (OR, 2.8; 95% CI, 1.0-9.9)
and to have eaten several specific food items, and they were less likely to
have drunk iced tea made from boiled water and store-bought ice (OR, 0.3; 95%
CI, 0.05-1.0). A multivariable model that included consumption of tap water
and salad bar tomatoes best fit the data. The restaurant had multiple sanitary
and plumbing deficiencies. Extensive laboratory and environmental testing for
bacterial, parasitic, mycotic, and viral agents did not identify an etiologic
agent. CONCLUSIONS: The clinical, laboratory, and epidemiologic findings are
consistent with those of previous outbreaks of Brainerd diarrhea. To our knowledge,
this is the largest reported outbreak of Brainerd diarrhea associated with
a restaurant.
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.
The Texas Children's Medication Algorithm Project: Revision
of the Algorithm for Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder.
Pliszka SR, Crismon ML, Hughes CW, Corners CK, Emslie GJ, Jensen PS, McCracken
JT, Swanson JM, Lopez M.
J Am Acad Child Adolesc Psychiatry. 2006 Jun;45(6):642-57.
OBJECTIVE: In 1998, the Texas Department of Mental Health and Mental Retardation
developed algorithms for medication treatment of attention-deficit/hyperactivity
disorder (ADHD). Advances in the psychopharmacology of ADHD and results of
a feasibility study of algorithm use in community mental health centers caused
the algorithm to be modified and updated. METHOD: We convened a consensus conference
of academic clinicians and researchers, practicing clinicians, administrators,
consumers, and families to revise the algorithms for the pharmacotherapy of
ADHD itself as well as ADHD with specific comorbid disorders. New research
was reviewed by national experts, and rationales were provided for proposed
changes and additions to the algorithms. The changes to the algorithms were
discussed and approved both by the national experts and experienced clinicians
from the Texas public mental health system. RESULTS: The panel developed consensually
agreed-upon algorithms for ADHD with and without comorbid disorders. The major
changes included elimination of pemoline as a treatment option, adding atomoxetine
to the algorithm, and refining guidelines for treating ADHD with comorbid depression,
aggressive behaviors, and tic disorders. CONCLUSIONS: Medication algorithms
for ADHD can be modified to keep abreast of developments in the field. Although
these evidence- and consensus-based treatment recommendations may be a useful
approach to guide the treatment of ADHD in children, additional research is
needed to determine how these algorithms can be used to maximally benefit child
outcomes.
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.
Ethnic Variation in Symptoms and Response to Risperidone
in Youths with Schizophrenia-Spectrum Disorders.
Patel NC, Crismon ML, Shafer A, De Leon A, Lopez M, Lane DC.
Soc Psychiatry Psychiatr Epidemiol. 2006 May;41(5):341-6.
BACKGROUND: Evaluation of symptom presentation and antipsychotic response based
on ethnicity in children and adolescents with schizophrenia is limited. The
purpose of this naturalistic, retrospective database study was to compare symptom
presentation of children and adolescents of different ethnicities with schizophrenia-spectrum
disorders, and response to risperidone. METHOD: African-American (n = 38),
Caucasian (n = 30), or Hispanic (n = 37) youths started on risperidone were
eligible. Child Behavior Checklist (CBCL) total, internalizing, and externalizing
scores were evaluated at baseline, 90 days, 1 year, and 2 year intervals. RESULTS:
At baseline, Hispanic patients had lower CBCL externalizing scores than African-Americans
or Caucasians. African-Americans showed significant differences in CBCL total,
internalizing, and externalizing scores at 90 days compared to baseline. Hispanics
showed improvement in CBCL internalizing scores over the 2 year period. No
significant improvements were observed in Caucasians. African-American patients
had significantly lower CBCL total at 90 days compared to Hispanic patients.
No significant difference existed in 2 year hospitalization rates between groups.
CONCLUSIONS: These findings suggest that ethnicity may play a role in symptom
presentation and treatment response to risperidone for children and adolescents
with schizophrenia-spectrum disorders. Future studies in children and adolescents
are necessary to examine ethnospecific differences in antipsychotic use and
treatment response.
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.
The Enduring Effects of Abuse and Related Adverse Experiences
in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology.
Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield Ch, Perry BD, Dube ShR,
Giles WH.
Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174-86.
BACKGROUND: Childhood maltreatment has been linked to a variety of changes
in brain structure and function and stress-responsive neurobiological systems.
Epidemiological studies have documented the impact of childhood maltreatment
on health and emotional well-being. METHODS: After a brief review of the neurobiology
of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as
an epidemiological "case example" of the convergence between epidemiologic
and neurobiological evidence of the effects of childhood trauma. The ACE Study
included 17,337 adult HMO members and assessed 8 adverse childhood experiences
(ACEs) including abuse, witnessing domestic violence, and serious household
dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative
childhood stress and hypothesized a "dose response" relationship
of the ACE score to 18 selected outcomes and to the total number of these outcomes
(comorbidity). RESULTS: Based upon logistic regression analysis, the risk of
every outcome in the affective, somatic, substance abuse, memory, sexual,and
aggression related domains increased in a graded fashion as the ACE score increased
(P <0.001). The mean number of comorbid outcomes tripled across the range
of the ACE score. CONCLUSIONS: The graded relationship of the ACE score to
18 different outcomes in multiple domains theoretically parallels the cumulative
exposure of the developing brain to the stress response with resulting impairment
in multiple brain structures and functions.
Seasonal Variations in the Initiation of Smoking among
Adolescents.
Colwell B, Ramirez N, Koehly L, Stevens S, Smith DW, Creekmur S.
Nicotine Tob Res. 2006 Apr;8(2):239-43.
Numerous studies have identified a variety of reasons that youths give for
starting smoking. Few efforts have been made, however, to identify seasonal
variations in initiation. This study was an attempt to fill that void. We examined
data from 342 youths participating in a mandated smoking education and cessation
program in Texas. Data were collected based on responses to questions in participant
workbooks, including an item asking participants about the month in which they
started smoking. A total of 47% of the participants indicated that they started
smoking in May through August (chi2 = 91.42, df = 3). Post-hoc analyses indicated
that significantly more youths than expected began smoking in May and June,
whereas significantly fewer youths than expected began smoking in September
and November. Unsupervised time out of school during the first months of summer
vacation is a period of increased danger for smoking initiation. The significantly
lower rates during September seem to be related to the beginning of school.
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.
Integrated Versus Parallel Treatment of Co-Occurring
Psychiatric and Substance Use Disorders.
Mangrum LF, Spence RT, Lopez M.
J Subst Abuse Treat. 2006 Jan;30(1):79-84.
The study examines 1-year treatment outcomes of 216 individuals with co-occurring
severe and persistent mental illness and substance use disorders who were assigned
to an integrated or parallel treatment condition. Comparisons indicated that
the integrated group achieved greater reductions in the incidence of psychiatric
hospitalization and arrest. The results of this study support the enhanced
effectiveness of integrated treatment in decreasing the use of higher cost
crisis-oriented services in clients with severe mental illness and substance
use disorders.
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.
Drug Adherence: Effects of Decreased Visit Frequency
on Adherence to Clozapine Therapy.
Patel NC, Crismon ML, Miller AL, Johnsrud MT.
Pharmacotherapy. 2005 Sep;25(9):1242-7.
OBJECTIVE: To study the effects of visit frequency on drug-adherence parameters
subsequent to the change in the United States Food and Drug Administration
(FDA)-mandated monitoring of white blood cell counts from weekly to every 2
weeks (biweekly) after 6 months of clozapine therapy. METHODS: Paid prescription
claims records for clozapine from September 1, 1995-August 31, 2001, were extracted
from the Texas Medicaid Vendor Drug Program database. Two groups of subjects
were identified: subjects treated before and those treated after the FDA labeling
change in monitoring frequency, which occurred on April 1, 1998. Prescription
claims records for each subject were assessed for 365 days after the initial
6 months of therapy. Adherence measures included persistence, medication possession
ratio (MPR), and time taking clozapine. RESULTS: Subjects receiving weekly
hematologic monitoring had significantly higher rates of persistence (0.79
+/- 0.35 vs 0.70 +/- 0.38, p < 0.001) and MPRs (0.75 +/- 0.36 vs 0.66 +/-
0.38, p < 0.001) and continued to take clozapine longer (p < 0.002) compared
with subjects receiving biweekly monitoring. Fewer subjects in the weekly monitoring
group discontinued clozapine therapy during the 1-year study period (49.4%
vs 57.9%, p = 0.008). Similar results were observed when cohorts were matched
according to age, sex, and index clozapine dosage. CONCLUSION: Significant
effects of visit frequency on adherence to clozapine therapy were noted. For
patients inadequately adherent to therapy, an increase in visit frequency may
improve adherence, and based on these results, the extra visits do not need
to be with a physician or have any specific purpose other than contact with
a provider.
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.
Duloxetine Hydrochloride: A New Dual-Acting Medication
for the Treatment of Major Depressive Disorder.
Hunziker ME, Suehs BT, Bettinger TL, Crismon ML.
Clin Ther. 2005 Aug;27(8):1126-43.
BACKGROUND: Duloxetine hydrochloride has recently been approved by the US Food
and Drug Administration for the treatment of major depressive disorder (MDD).
Duloxetine is a potent inhibitor of serotonin and norepinephrine reuptake,
with weak effects on dopamine reuptake. OBJECTIVE: This article reviews the
literature on duloxetine with regard to its pharmacodynamics, pharmacokinetics,
clinical efficacy, and tolerability. METHODS: A comprehensive search of MEDLINE
was performed using the terms duloxetine, Cymbalta, and major depressive disorder,
with no restriction on year. The Eli Lilly and Company clinical trial registry,
and abstracts and posters from recent American Psychiatric Association meetings
were also reviewed. RESULTS: Duloxetine exhibits linear, dose-dependent pharmacokinetics
across the approved oral dosage range of 40 to 60 mg/d. No dose adjustment
appears to be needed based on age. Duloxetine has shown efficacy in reducing
depressive symptoms compared with placebo, and duloxetine recipients have shown
significant improvements in global functioning compared with placebo (both,
P < 0.05). Response and remission rates have been comparable to or greater
than those seen with fluoxetine or paroxetine. Duloxetine is generally well
tolerated, with nausea, dry mouth, and fatigue being the most common treatment-emergent
adverse effects. Cardiovascular adverse effects do not appear to result in
sustained blood pressure elevations, QTc-interval prolongation, or other electrocardiographic
changes. CONCLUSIONS: Based on the available evidence, duloxetine is a well-tolerated
and effective treatment for MDD in adults. Randomized head-to-head comparisons
against established antidepressants are needed to determine the relative safety
and efficacy of duloxetine.
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.
Deaths of Clients in Methadone Treatment in Texas: 1994-2002.
Maxwell JC, Pullum TW, Tannert K.
Drug Alcohol Depend. 2005 Apr 4;78(1):73-81.
This study analyzes causes of deaths of 766 patients who died while in methadone
treatment in Texas between 1994 and 2002. Compared with deaths in the general
population of Texas, deaths of clients in methadone treatment were 4.6 times
more likely to be from a drug overdose, 3.4 times more likely to be from liver
disease, 1.7 times more likely to be from a respiratory disease, 1.5 times
more likely to be from a homicide and 1.4 times more likely to be from AIDS,
but less likely to be from suicide, motor vehicle accidents, cardiovascular
diseases or cancer. Of the clients, 20% died of liver disease, 18% of cardiovascular
disease and 14% of drug overdose. An older cohort had been in treatment longer,
had more take-homes, were on higher doses and tended to die of chronic diseases.
A younger cohort tended to die from traumas, including drug overdose. Time
in treatment was 43.3 months; mean daily dose was 77.3mg; number of days/month
dosed in the clinic was 13.9. Given these rates, the scope of services should
include on-site treatment for other medical conditions and staff should be
educated about and counsel about the risk of death for new patients.
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.
Transmission of Rabies Virus from an Organ Donor to Four
Transplant Recipients.
Srinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, Sutker WL, Ksiazek TG,
Paddock CD, Guarner J, Shieh WJ, Goldsmith C, Hanlon CA, Zoretic J, Fischbach
B,
Niezgoda M, El-Feky WH, Orciari L, Sanchez EQ, Likos A, Klintmalm GB, Cardo
D,
LeDuc J, Chamberland ME, Jernigan DB, Zaki SR.
N Engl J Med. 2005 Mar 17;352(11):1103-11.
BACKGROUND: In 2004, four recipients of kidneys, a liver, and an arterial segment
from a common organ donor died of encephalitis of an unknown cause. METHODS:
We reviewed the medical records of the organ donor and the recipients. Blood,
cerebrospinal fluid, and tissues from the recipients were tested with a variety
of assays and pathological stains for numerous causes of encephalitis. Samples
from the recipients were also inoculated into mice. RESULTS: The organ donor
had been healthy before having a subarachnoid hemorrhage that led to his death.
Encephalitis developed in all four recipients within 30 days after transplantation
and was accompanied by rapid neurologic deterioration characterized by agitated
delirium, seizures, respiratory failure, and coma. They died an average of
13 days after the onset of neurologic symptoms. Mice inoculated with samples
from the affected patients became ill seven to eight days later, and electron
microscopy of central nervous system (CNS) tissue demonstrated rhabdovirus
particles. Rabies-specific immunohistochemical and direct fluorescence antibody
staining demonstrated rabies virus in multiple tissues from all recipients.
Cytoplasmic inclusions consistent with Negri bodies were seen in CNS tissue
from all recipients. Antibodies against rabies virus were present in three
of the four recipients and the donor. The donor had told others of being bitten
by a bat. CONCLUSIONS: This report documenting the transmission of rabies virus
from an organ donor to multiple recipients underscores the challenges of preventing
and detecting transmission of unusual pathogens through transplantation.
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.
slo K(+) Channel Gene Regulation Mediates Rapid Drug
Tolerance.
Ghezzi A, Al-Hasan YM, Larios LE, Bohm RA, Atkinson NS.
Proc Natl Acad Sci U S A. 2004 Dec 7;101(49):17276-81.
Changes in neural activity caused by exposure to drugs may trigger homeostatic
mechanisms that attempt to restore normal neural excitability. In Drosophila,
a single sedation with the anesthetic benzyl alcohol changes the expression
of the slo K(+) channel gene and induces rapid drug tolerance. We demonstrate
linkage between these two phenomena by using a mutation and a transgene. A
mutation that eliminates slo expression prevents tolerance, whereas expression
from an inducible slo transgene mimics tolerance in naive animals. The behavioral
response to benzyl alcohol can be separated into an initial phase of hyperkinesis
and a subsequent phase of sedation. The hyperkinetic phase causes a drop in
slo gene expression and makes animals more sensitive to benzyl alcohol. It
is the sedative phase that stimulates slo gene expression and induces tolerance.
We demonstrate that the expression level of slo is a predictor of drug sensitivity.
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
November 19, 2007
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