The following list includes peer-reviewed research articles 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 e-mail at library@dshs.state.tx.us by calling (512) 776-7559.
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2012 Articles (in date order with most recent first)
Temporal and Geographic Patterns in Opioid Abuse in Texas.
Forrester MB.
J Addict Dis 2012;31:93-99.
Opioid analgesic abuse is an increasing problem in the United States. All opioid analgesic abuse exposures reported to Texas poison centers during 2000-2010 were identified and annual and geographic patterns were examined. The annual number of opioid analgesic abuse cases increased 160% from 441 in 2000 to 1,145 in 2010. The proportion of total opioid analgesic exposures reported to be due to abuse increased 55% from 11.4% in 2000 to 17.8% in 2010. The opioid analgesic rate per 100,000 was highest (90.15) in northeastern Texas and lowest (27.91) in the southern part of the state.
Synthetic Cathinone Exposures Reported to Texas Poison Centers.
Forrester MB.
Am J Drug Alcohol Abuse 2012 [Epub ahead of print]
Background: Among the novel classes of synthetic “designer” drugs that have become increasingly popular among recreational drug users are synthetic cathinones. There is limited information on exposures to these substances. Objective: The objective of this investigation was to describe the pattern of synthetic cathinone exposures reported to a statewide poison center network. Methods: Synthetic cathinone exposures reported to Texas poison centers during 2010–2011 were identified and the distribution by various demographic and clinical factors determined. Results: Of 362 total calls, 84.5% of the patients were 20 years or older and 74.0% male. The route of exposure was 47.8% by inhalation alone and 28.7% by ingestion alone. Other substances were involved in 19.3% of the exposures. The patient was already at or en route to a health-care facility in 75.1% of the exposures. The outcome was serious (moderate, major, potentially toxic, or death) in 74.0% of the exposures. The most frequently reported clinical effects were tachycardia (45.9%), agitation (39.2%), hypertension (21.0%), hallucinations (17.7%), and confusion (13.0%). The most common treatments were IV fluids (53.6%), benzodiazepines (40.9%), oxygen (11.0%), and other sedatives (7.5%). Conclusion: Synthetic cathinone exposures reported to Texas poison centers tended to occur through inhalation or ingestion, involve adult and male patients, be managed at health-care facilities, and involve potentially serious outcomes. Scientific Significance: This study adds to the limited information currently available on synthetic cathinone exposures.
Mortality of Public Mental Health Clients Treated at the Local Mental Health Authorities of Texas.
Reynolds RJ, Shafer AB, Becker EA.
TPHJ 2012;64(2):35-40.
Objective: To catalog and compare the mortality experience of Public Mental Health Clients (PHMCs) in the 38 Local Mental Health Authorities (LMHAs) of Texas in the years 2006-2008. Methods: Client service records for PHMCs from the Mental Health and Substance Abuse Division of the Texas Department of State Health Services (DSHS) were linked to death records from the DSHS Center for Vital Statistics. Age-adjusted death rates (AADRs) per 100,000 person years were calculated for PHMCs and for the general population in each of the LMHAs in Texas. Frequencies were computed for the most common causes of death in each LMHA. Results: PHMCs had increased mortality in comparison to the general population across the three years studied in each of the 38 Texas LMHAs. Rates ranged from 645-2060 compared to 586-929 deaths per 100,000 person years. Higher rates for four of the LMHAs approached statistical significance when compared to the general population. Though there was a wide range in the magnitude of excess death, the most frequent causes of death were consistently external causes and diseases of the circulatory system. Conclusions: Care providers in the LMHAs should focus more attention on the assessment and management of non-psychiatric medical conditions, especially circulatory diseases. Care providers in non-psychiatric settings should also learn to better assess and refer patients with psychiatric and substance abuse diagnoses to appropriate treatment programs. Such interventions may complement existing public health prevention programs in the effort to lower death rates in this vulnerable population.
An Assessment of the Distribution of Physicians in Texas.
King B, Menon R.
TPHJ 2012;64(2):31-34.
Objective: It has often been reported that Texas has a shortage of physicians. However, analyzing shortages based on the overall number of physicians does not paint a complete picture of the problem or fully suggest remedies. In a state as geographically large and culturally diverse as Texas, it is important to know exactly where the shortages are and which specific physician specialties are experiencing shortages, and highlight the issue of inequitable distribution of physicians statewide. Method: We obtained data on health professionals from the licensing boards for the year 2010 and conducted statistical analyses. Physicians were grouped by county and specialty, and the population composition of counties was analyzed by county, gender, and age. Other indicators that could affect demand were considered, such as death rates and birth rates, and the supply of other health professionals such as mid-level providers. The findings are presented in a series of maps. Results: Outside of the major metropolitan areas, Texas has high population-to-provider ratios for many health professionals; and, there are many counties, mostly rural, that do not have any of certain types of specialists. In particular, as indicated through a series of maps, the areas west of I-35 face shortages, in some cases requiring patients to travel significant distances to see a specialist. Conclusions: Simply increasing the number of doctors in Texas will not fully address the problem of shortages. While physicians need to be incentivized to practice in the rural and underserved areas, they should also be encouraged to practice in the areas that have a higher need for that type of specialist and where indicators show a high need for their services.
Data to Action: Reducing Adult Potentially Preventable Hospitalizations in Texas.
Gilliam M.
TPHJ 2012;64(2):29-30.
Rates, statistical significance, and confidence intervals are all important measures to describe data. However, these data measures may not be the most effective in engaging community health stakeholders and policymakers who do not have a working knowledge of statistical methodology. This article outlines how the Texas Department of State Health Services (DSHS) transformed data on adult potentially preventable hospitalizations, a major financial burden, into more user-friendly information to use in improving community health and reducing healthcare costs. By transforming the data, DSHS significantly increased the engagement of local elected officials and community groups to deal with the problem of adult potentially preventable hospitalizations. Transformation of the data focused on making the information easier to understand and more relevant to these stakeholders. For example, policymakers are more engaged when data is presented in financial perspectives rather than risk-adjusted rates. A key example of transforming data into action was when the 82nd Texas Legislature appropriated funding for DSHS to implement interventions to target adult potentially preventable hospitalizations.
The Importance of Data to Public Health: An Introduction.
Medina C.
TPHJ 2012;64(2):25-28.
Data is crucial to the creation of evidence-based public health practices. This article explains what data are available from the Texas Dept. of State Health Services. It introduces several articles from the same journal issue showing the use of these data in the public health setting, as well as giving other examples of the importance of data to create knowledge and wise choices within public health.
Potassium Iodide and Its Use in Radiation Protection.
Forrester MB.
TPHJ 2012;64(2):41.
Product Recalls as a Public Health Problem.
Forrester MB.
TPHJ 2012;64(2):41-42.
Bacillus Thuringiensis Pesticide Exposures Reported to Texas Poison Centers.
Forrester MB.
Toxicol Environ Chem 2012;94:799-804
One of the most common types of microbial pesticides uses Bacillus thuringiensis. Although generally considered safe, exposures to B. thuringiensis pesticide do occur where management by healthcare providers is sought. The objective of this investigation was to describe B. thuringiensis pesticide exposures reported to Texas poison centers. Cases were all B. thuringiensis pesticide exposures reported to Texas poison centers during 2000-2010. The distribution of cases was determined for various demographic and clinical factors. Of 155 total cases, 64% occurred during May-July. The rate per 1,000,000 population was 14.3 in central Texas and 4.4 in the rest of the state. Of the patients, 56% were of an age 20 years or older and 55% were male. The exposure routes were 57% by ingestion, 30% by dermal contact, and 11% by inhalation. The patient was managed on site in 93% of the exposures and only 1 exposure was judged to be potentially serious. B. thuringiensis pesticide exposures reported to Texas poison centers were more frequently reported from the central region of the state. The majority of exposures occurred during April-July, involved adults and males, occurred by ingestion or dermal route, were managed on site and did not result in serious outcomes.
Ramelteon Ingestions Reported to Texas Poison Centers, 2005-2009.
Todd CM, Forrester MB.
J Emerg Med 2012 [Epub ahead of print]
Background: The only data that currently exist on ramelteon (Rozerem®; Takeda Pharmaceuticals North America, Inc., Deerfield, IL) ingestions is from clinical trials. To fill this gap, data on ramelteon ingestions reported to Texas poison centers during 2005-2009 were collected and analyzed. Objectives: The objective of this study was to describe how reported ramelteon ingestions were handled by Texas poison center staff and when known, the patient's final medical outcome. In cases where the dosage was significant enough to refer the patient to a health care facility, adverse clinical reactions and treatments are also described. Methods: Cases were analyzed for selected demographic and clinical factors. Of 222 total patients, 67.6% were women and 73.9% were over the age of 19 years. Cases were analyzed by motivating factors (e.g., unintentional, intentional), management site, adverse reactions, and final medical outcome. Results: Of the ramelteon ingestions reported to Texas poison centers, 67.6% involved adult women and were suspected attempted suicides; 75% of ramelteon ingestions not involving other substances were managed at a health care facility. However, 88.3% of these ingestions resulted in no significant clinical effect. Conclusion: The management strategies used by Texas poison centers for the 56 cases reported in this study were adequate.
Urban-Rural Differences in Attitudes and Practices toward Long-Acting Reversible
Contraceptives among Family Planning Providers in Texas.
Vaaler ML, Kalanges LK, Fonseca VP, Castrucci BC.
Women’s Health Issues. 2012 Jan 20. [Epub ahead of print]
Background: Despite the elevated rates of teen and unplanned pregnancies across the United States, long-acting reversible contraceptives (LARCs) remain a less utilized birth control method. The present study investigated family planning providers' attitudes and considerations when recommending family planning methods and LARCs to clients. Additionally, this study explored whether urban-rural differences exist in providers' attitudes toward LARCs and in clients' use of LARCs. Methods: Data were collected using an online survey of family planning providers at Title X clinics in Texas. Survey data was linked to family planning client data from the Family Planning Annual Report (2008). Results: Findings indicated that, although providers were aware of the advantages of LARCs, clients' LARC use remains infrequent. Providers reported that the benefits of hormone implants include their effectiveness for 3 years and that they are an option for women who cannot take estrogen-based birth control. Providers acknowledged the benefits of several types of LARCs; however, urban providers were more likely to acknowledge the benefits of hormone implants compared with their rural counterparts. Results also indicated barriers to recommending LARCs, such as providers' misinformation about LARCs and their caution in recommending LARCs to adolescents. However, findings also indicated providers lack training in LARC insertion, specifically among those practicing in rural areas. Conclusions: In light of the effectiveness and longevity of LARCs, teenagers and clients living in rural areas are ideal LARC candidates. Increased training among family planning providers, especially for those practicing in rural areas, may increase their recommendations of LARCs to clients.
Predictors of Trisomy 21 in the Offspring of Older and Younger Women.
Agopian AJ, Marengo LK, Mitchell LE.
Birth Defects Res A Clin Mol Teratol. 2012 Jan;94(1):31-5.
Background: Advanced maternal age is the only well-established risk factor for trisomy 21, yet the majority of affected individuals are born to younger women. To identify factors associated with the risk of trisomy 21 in the offspring of younger and older women, we analyzed data for cases with trisomy 21 from the Texas Birth Defects Registry for 1999 to 2007. Methods: Data were analyzed separately for younger (i.e., <35 years of age at delivery; n = 2306) and older (i.e., ≥35 years of age at delivery; n = 1811) women using Poisson regression. Results: After adjustment for maternal age and several other covariates, the prevalence of trisomy 21 in the offspring of women in both maternal age groups was higher in male than in female infants and in offspring of women who were Hispanic (compared with non-Hispanic white women) or who had at least one previous liveborn child compared to those with none. In the offspring of older women only, the prevalence of trisomy 21 was also significantly higher when the father was 20to 24 years old (compared with 25 to 29 years old; adjusted prevalence ratio [aPR], 2.27; 95% confidence interval [CI], 1.47-3.49) and Hispanic (compared with non-Hispanic white; aPR, 1.34; 95% CI, 1.13-1.58) and among women with less than a high school education (compared with greater than high school). Conclusions: This study identified several factors, in addition to maternal age, that were associated with trisomy 21 risk. In general, these factors were similar for both maternal age groups, although paternal characteristics were significantly associated with risk of trisomy 21 only in offspring of older women.
Valentine’s Day Is Not Just for Chocolate Anymore.
Forrester MB.
TPHJ 2012;64(1):15-16. (No abstract available.)
Did a Digoxin Recall Result in an Increase in Digoxin Exposures Reported to Texas Poison Centers?
Forrester MB.
TPHJ 2012;64(1):16-17. (No abstract available)
All-Terrain Vehicle Injuries in Texas, Mapping the Path to Intervention with a Geographic Information System.
Huff SD, McGaha PK, Reed M, Kratz M, Peters JA, Atkinson V.
J Agromedicine. 2012 Jan;17(1):51-62.
The state of Texas was ranked 10th for all-terrain vehicle-related deaths among all states from 2007-2009. Health Service Region 4/5N of eastern Texas has a statistically significant higher rate of all-terrain vehicle-related injuries in children under the age of 18 than Texas as a whole (p < 0.001.) It is unknown why east Texas has a higher all-terrain vehicle-related injury rate. A retrospective analysis of the registry of the Texas Trauma Service Area G, which serves the east Texas area, from the years 2004-2010 was performed. Variations within the region were assessed using a geographic information system and the analysis demonstrated that the highest rates of all-terrain vehicle-related injuries in east Texas are found in two neighboring rural eastern counties. Recording mechanism of injury was an important adjunct to identifying all-terrain vehicle-related injuries. Using E-codes alone underestimated the actual injuries. Other findings demonstrated that children under age 16 had a high rate of injury, one third of those injured sustained a head injury, and helmet use was very low. This analysis can be used by the Texas Department of State Health Services in conjunction with key regional partners to direct further investigation in these areas into the role of the rural environment, other factors associated with the high injury rates, and to plan and conduct preventive intervention at the community level.
How We Didn't Clean Up until We Washed Our Hands: Shigellosis in an Elementary and Middle School in North Texas.
Schulte JM, Williams L, Asghar J, Dang T, Bedwell S, Guerrero K, Hamaker D, Stonecipher S, Zoretic J, Chow C.
South Med J. 2012 Jan;105(1):1-4.
Background: Shigella outbreaks often continue for months and are linked frequently to poor hygiene and hand washing. Such outbreaks are found often in day care facilities, but rarely are reported in schools. We present the investigation of an outbreak in autumn 2007 at a building that housed an elementary school and a middle school in separate wings in a small Texas city north of Dallas-Fort Worth. Methods: We canvassed local hospitals, school attendance records, and physician offices for cases. Ill individuals were interviewed using a standard questionnaire for symptoms, disease onset, and the presence of the illness in an ill person's household. Results: A music teacher was the index case for this outbreak of gastrointestinal illness caused by S. sonnei. Ten percent of the students in the school building were ill, and 15 households had secondary cases. Installing liquid soap in dispensers in student restrooms was the initial control measure, followed by sustained instruction in hand washing, scheduled hand washing times, and monitored cleaning and disinfection procedures for surfaces and inanimate objects. Enhanced surveillance detected no new cases in the school district. Conclusions: Appropriate soap supplies and repeated instruction in hand washing and its monitoring were needed to control the outbreak.