Texas Residents Research Articles

Acute and Delayed Deaths after West Nile Virus Infection, Texas, USA, 2002-2012.

Infection with West Nile virus (WNV) has a well-characterized acute disease process. However, long-term consequences are less understood. We searched death records for 4,142 residents of Texas, USA, infected with WNV during 2002-2012 and identified 557 (13%) deaths. We analyzed all-cause and cause-specific deaths after WNV infection by calculating standardized mortality ratios and using statewide mortality data. Acute-phase deaths (<90 days after symptom onset) occurred in 289 (7%) of case-patients; of those deaths, 289 (92%) were cases of West Nile neuroinvasive disease (WNND). Convalescent-phase deaths (>90 days after symptom onset) occurred in 268 (7%) of the remaining 3,853 case-patients; 210 (78%) of these deaths occurred in patients with WNND. Convalescent-phase WNND case-patients showed excess deaths from infectious and renal causes; case-patients <60 years of age had increased risk for all-cause death, specifically from renal, infectious, digestive, and circulatory causes. We provide population-level evidence of increased risk for death after WNV infection resulting in WNND.

Cutaneous Mucormycosis in Solid Organ Transplant Recipients after Hurricane Harvey: Short- and Long-term Management.

Summary:In the fall of 2017, Hurricane Harvey, one of the most costly hurricanes in American history, ravaged the Texas Gulf Coast, interrupting basic sanitation systems to hundreds of thousands of Texas residents. In the aftermath of Hurricane Harvey, our Houston hospitals noted an uptick in the incidence of cases of mucormycosis. Among the most vulnerable and affected have been immunocompromised transplant recipients. Here, we describe the successful management of 2 patients with atypical presentations of mucormycosis, 2 cutaneous infections after liver transplantation. Our comprehensive treatment strategy based upon guidelines and experience included coordinating aggressive surgical and medical therapies. We discuss our approach to surgical management including the extent and frequency of debridement, the methods of assessing disease-free margins, and minimizing the morbidity of radical debridement with temporary coverage and forethought to long-term reconstruction. Additionally, we describe the concurrent medical management, including type, route, and duration of antifungal therapy, minimizing suppression of the innate immune system, and optimizing the wound healing environment through maintaining nutritional status.

Evacuation Shelter Deficits for Socially Vulnerable Texas Residents During Hurricane Harvey.

Background:Socially vulnerable residents of US Gulf Coast counties have higher exposure to physical hazards and disaster-associated risks. Evacuation is one way to mitigate the consequences of disaster exposure among socially vulnerable populations. However, it is unknown whether existing evacuation shelter capacity and locations in designated hurricane evacuation zones of Texas are adequate to accommodate persons with housing and transportation needs. This study estimated the evacuation shelter deficit arising from demand from socially vulnerable residents of the Houston-Galveston area.Methods:Spatial statistical methods including Global Moran’s I and Getis-Ord (Gi*) were used to measure spatial autocorrelation and identify census tracts in the study area with high (hot spots) and low (cold spots) social vulnerability in both housing and transportation domains. The shelter deficit in each county within the study area was estimated as well as for the entire Houston-Galveston Metropolitan Statistical Area.Results:Designated evacuation zones in the Houston-Galveston area have an overall shelter deficit of 163 317 persons. Shelters in the area can only accommodate 36% of evacuees with significant housing and transportation needs, while 3 of 4 counties had county-specific evacuation shelter deficits. The highest deficits were in Harris County, where Houston is located, and the lowest were in Matagorda County, a rural county southwest of Harris County.Conclusion:Emergency managers and other authorities should consider data related to demand from socially vulnerable residents for public shelters during disasters and increase shelter capacity in certain locations to address evacuation shelter shortage for vulnerable persons in designated evacuation zones of Texas.

The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases

Between 2011 and 2014, Texas enacted three pieces of legislation that significantly reduced funding for family planning services and increased restrictions on abortion clinic operations. Together this legislation creates cross-county variation over time in access to abortion and family planning services, which we leverage to understand the impact of family planning and abortion clinic access on abortions, births, and contraceptive purchases. In response to these policies, abortions to Texas residents fell 16.7% and births rose 1.3% in counties that no longer had an abortion provider within 50 mi. Changes in the family planning market induced a 1.2% increase in births for counties that no longer had a publicly funded family planning clinic within 25 mi. Meanwhile, responses of retail purchases of condoms and emergency contraceptives to both abortion and family planning service changes were minimal.

Monitoring Out-of-State Patients during a 2017 Hurricane Response using ESSENCE

ObjectiveTo demonstrate the use of ESSENCE in the BioSense Platform to monitor out-of-State patients seeking emergency healthcare in Tennessee during Hurricanes Harvey and Irma.IntroductionSyndromic surveillance is the monitoring of symptom combinations (i.e., syndromes) or other indicators within a population to inform public health actions. The Tennessee Department of Health (TDH) collects emergency department (ED) data from more than 70 hospitals across Tennessee to support statewide syndromic surveillance activities. Hospitals in Tennessee typically provide data within 48 hours of a patient encounter. While syndromic surveillance often supplements disease- or condition-specific surveillance, it can also provide general situational awareness about emergency department patients during an event or response.During Hurricanes Harvey (continental US landfall on August 25, 2017) and Irma (continental US landfall on September 10, 2017), TDH supported all hazards situational awareness using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in the BioSense Platform supported by the National Syndromic Surveillance Program (NSSP). The volume of out-of-state patients in Tennessee was monitored to assess the impact on the healthcare system and any geographic- or hospital-specific clustering of out-of-state patients within Tennessee. Results were included in daily State Health Operations Center (SHOC) situation reports and shared with agency response partners such as the Tennessee Emergency Management Agency (TEMA).MethodsData were monitored from August 18, 2017 through September 24, 2017. A simple query was established in ESSENCE using the Patient Location (Full Details) dataset. Data were limited to hospital ED visits reported by Tennessee (Site = “Tennessee”). To monitor ED visits among residents of Texas before, during, and after Major Hurricane Harvey, data were queried for a patient zip code within Texas (State = “Texas”). ED visits among Florida residents were monitored similarly (State = “Florida”) before, during, and after Major Hurricane Irma. Additionally, a free text chief complaint search was implemented for the terms “Harvey”, “Irma, “hurricane”, “evacuee”, “evacuate”, “Florida”, and “Texas”. Chief complaint search results were then filtered to remove encounters with patient zip codes within Tennessee.ResultsFrom August 18, 2017 through September 24, 2017, Tennessee hospital EDs reported 277 patient encounters among Texas residents and 1,041 patient encounters among Florida residents. The number of encounters among patients from Texas remained stable throughout the monitoring period. In contrast, the number of encounters among patients from Florida exceeded the expected value on September 7, peaked September 10 at 116 patient encounters, and returned to expected levels on September 16 (Figure 1). The increase in patients from Florida was evenly distributed across most of Tennessee, with some clustering around a popular tourism area in East Tennessee. No concerning trends in reported syndromes or chief complaints were identified among Texas or Florida patients.The free text chief complaint query first exceeded the expected value on September 9, peaked on September 11 with 5 patient encounters, and returned to expected levels on September 14. From August 18 through September 24, 21 of 30 visits captured by the query were among Florida residents. One Tennessee hospital appeared to be intentionally using the term “Irma” in their chief complaint field to indicate patients from Florida impacted by the hurricane.ConclusionsThe ESSENCE instance in the BioSense platform provided TDH the opportunity to easily locate and monitor out-of-state patients seen in Tennessee hospital EDs. While TDH was unable to validate whether all patients identified as residents of Florida were displaced because of Major Hurricane Irma, the timing of the rise and fall of patient encounters was highly suggestive. Likewise, seeing no substantial increase ED patients with residence in Texas reassured TDH that the effects of Hurricane Harvey were not impacting hospital emergency departments in Tennessee.TDH used information and charts from ESSENCE to support situational awareness in our SHOC and at TEMA. Use of patient zip code to identify out-of-state residents was more sensitive than chief complaint searches by keyword during this event. ESSENCE allowed TDH to see where out-of-state patients appeared to be concentrating in Tennessee and monitor the need for targeting messaging and resources to heavily affected areas. Additionally, close surveillance of chief complaints among out-of-state patients provided assurance that no unusual patterns in illness or injury were occurring.ESSENCE is the only TDH information source capable of rapidly collecting health information on out-of-state patients. ESSENCE allowed TDH to quickly identify a change within the patient population seen at Tennessee emergency departments and monitor the situation until the patient population returned to baseline levels.

Identification of novel circulatory microRNA signatures linked to patients with ischemic stroke.

MicroRNAs (miRNAs) are involved in growth, development, and occurrence and progression of many diseases. MiRNA-mediated post-transcriptional regulation is poorly understood in vascular biology and pathology. The purpose of this is to determine circulatory miRNAs as early detectable peripheral biomarkers in patients with ischemic stroke (IS). MiRNAs expression levels were measured in IS serum samples and healthy controls using Illumina deep sequencing analysis and identified differentially expressed miRNAs. Differentially expressed miRNAs were further validated using SYBR-green-based quantitative real-time PCR (qRT-PCR) assay in postmortem IS brains, lymphoblastoid IS cell lines, oxygen and glucose deprivation/reoxygenation -treated human and mouse neuroblastoma cells, and mouse models of hypoxia and ischemia (HI)-induced stroke. A total of 4656 miRNAs were differentially expressed in IS serum samples relative to healthy controls. Out of 4656 miRNAs, 272 were found to be significantly deregulated in IS patients. Interestingly, we found several novel and previously unreported miRNAs in IS patients relative to healthy controls. Further analyses revealed that some candidate miRNAs and its target genes were involved in the regulation of the stroke. To the best of our knowledge, this is the first study identified potential novel candidate miRNAs in IS serum samples from the residents of rural West Texas. MiRNAs identified in this study could potentially be used as a biomarker and the development of novel therapeutic approaches for stroke. Further studies are necessary to better understand miRNAs-regulated stroke cellular changes.

Cultural Analysis and Demographics of Caprine Consumption among Texas Residents

BackgroundAccording to report, nearly 1.5 million heads of goat are consumed annually within the US. The popularity of goat meat is increasing due to the increase in consumption from the immigrant population according to D'Rozario and Gaung, (2015), with this increase in demand for goat meat, the purpose of this research was to study the current and projected consumption patterns of Caprine products in Texas and identify target populations for the distribution of value‐added caprine products.MethodsA survey was developed, validated and piloted to measure food acceptability, cultural influences, demographics, generational acceptance, and geographic influences. Communities were selected by stratified sampling. Individuals were selected to participate through community outreach activities. Data were collected by trained research personnel.Data AnalysisThe data were analyzed using the statistical package for the Social Sciences (SPSS)ResultsThe sample size consisted of 79 study participants, with the majority (48%) being African Americans. When combined with participants who identified as African or Caribbean, blacks accounted for 58% of the total participants. This was followed by whites with 24% and Hispanics with 13% of the sample. Of the 79 participants who participated in the study, 44 (56%) reported having tasted goat meat before and 35 (44%) said they had never tasted it. Of the 44 who reported having tasted goat meat, only 15 (19%) reported actually eating it. The majority of the participants, 69, reported not seeing goat meat in their local grocery stores. Only 7 (9%) reported having seen goat meat in the grocery store.Support or Funding InformationEvans Allen Capacity Funds, NIFAThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Abstract P279: Workplace Facilities and Policies Associated With Bicycling to Work Among Adults

Introduction: Bicycling to work is a mode of transportation that provides regular physical activity and has been associated with mental and physical well-being. Limited research has examined what facilities, such as bike racks, and policies within the workplace are associated with bicycling to work. Hypothesis: Access to workplace facilities and policies will be associated with higher odds of bicycling to work. Methods: In 2016/17, a convenience sample of adult residents of Travis County (Austin), Texas, and Jefferson County (Birmingham), Alabama who had ridden a bicycle at least once in the past year responded to an Internet-based questionnaire assessing correlates of bicycling. Participants who self-reported that a purpose of their bicycle trips was commuting to/from work were categorized as a bicycle commuter. Workplace facilities/policies included (a) bicycle lockers, (b) locked rooms/cages, (c) clothes storage, (d) bike racks, (e) showers, and (f) policies that supported bicycling to work. A summary score ordinal variable, (g) total facilitators, was derived by adding the total number of reported policies/facilities per participant. Multivariable logistic regression models adjusting for age, race, education, income, number of motor vehicles, relationship status, children in household, and sex were used to estimate the association between individual workplace facilities and policies, as well as total facilitators, and bicycle commuting. Interactions were tested between sex and each of the workplace variables. Analyses was limited to participants who were employed. Results: The final analytic sample was 771; 45% were categorized as a bicycle commuter (n=344). Access to workplace facilities/policies ranged from 7% (bike lockers) to 50% (bike racks). Bike lockers (OR 5.6; 95% CI 4.5,6.8), locked rooms/cages, (OR 2.2; 95% CI 1.4, 3.3), clothes storage (OR 2.0; 95% CI 1.5, 2.7), bike racks (OR 3.2; 95% CI 3.0, 3.3), and policies that supported bicycling to work (OR 3.3, 95% CI 2.5, 4.4) were associated with significantly higher odds of being a bicycle commuter. Only showers in the workplace showed a significant interaction by sex; showers were directly associated with being a bicycle commuter for males (OR 2.1; 95% CI 2.0, 2.1), but inversely associated with being a bicycle commuter for females (OR 0.9; 95% CI 0.8, 0.9). As compared to no facilitators, having 1 facilitator was associated with 2.1 times higher odds (95% CI 1.8, 2.6), 2 facilitators with 3.1 times higher odds (95% CI 2.1, 4.5), 3 facilitators with 4.4 times higher odds (95% CI 4.2, 4.8), and 4 or more facilitators with 7.9 times higher odds of being a bicycle commuter (95% CI 7.0, 9.0). Conclusions: The presence of workplace facilities/policies is associated with higher odds of bicycling to work. Workplaces should consider how the institutional environment can promote active transportation, and, in turn, employee health.

Ethnicity, income, and disaster preparedness in Deep South Texas, United States.

This paper examines the influence of a series of demographic and socioeconomic factors on preparedness outcomes for a sample of residents of the Rio Grande Valley in the southernmost part of Texas, United States. Data were collected as part of the regional Pulse of the Valley Study, a general social survey of south Texas residents conducted by the Center for Survey Research at the University of Texas-Rio Grande Valley. The purpose of this investigation is to understand better the effects of ethnicity and income on preparedness within a region of the US that suffers from widespread poverty and limited infrastructure and is prone to flooding and hurricanes. Taken together, the results suggest that while age, disaster experience, and income are associated with preparedness, the relationship between preparedness and ethnicity remains complex. Furthermore, policymakers should consider initiatives that address the socioeconomic and other issues that shape preparedness for a disaster.

Readmission Patterns After GI Cancer Hospitalizations: The Medical Versus Surgical Patient.

Readmission within 30 days has been used as a metric for quality of care received at hospitals for certain diagnoses. In the era of accountability, value-based care, and increasing cancer costs, policymakers are looking into cancer readmissions as well. It is important to describe the readmission profile of patients with cancer in the most clinically relevant approach to inform policy and health care delivery that can positively impact patient outcomes. We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data. We included elderly Texas residents diagnosed with GI cancer and identified risk factors for unplanned readmission using generalized estimating equations, comparing medical with surgical cancer-related hospitalizations. We analyzed 69,693 hospitalizations from 31,736 patients. The unplanned readmission rate was higher after medical hospitalizations than after surgical hospitalizations (21.6% v 13.4%, respectively). Shared risk factors for readmission after medical and surgical hospitalizations included advanced disease stage, high comorbidity index, and emergency room visit and radiation therapy within 30 days before index hospitalization. Several other associated factors and reasons for readmission were noted to be unique to medical or surgical hospitalizations alone. Unplanned readmissions among elderly patients with GI cancer are more common after medical hospitalizations compared with surgical hospitalizations. There are shared risk factors and unique risk factors for these hospitalizations that can inform policy, health care delivery, and interventions to reduce readmissions. Other findings underscore the importance of care coordination and comorbidity management in this patient population.

932: Words Matter: Measured Impact of Political Rhetoric on Timely & Regular Access of Prenatal Care Among Latino & Hispanic Women in Houston, Texas from 2011-2017

Timely & regular access to prenatal care (PNC) is a long accepted global predictor of decreased maternal & infant morbidity and mortality. In the US, recent vital statistics data suggest a concerning increase in maternal mortality; Texas has the highest rate in the developed world. Given the high number of both undocumented and uninsured residents in Texas, we sought to determine if recent political rhetoric might be a contributing factor lending to diminished PNC and resultant maternal morbidity. IRB approved population-based cohort study (8/2011-7/2017). In their native language, subjects were consented & queried regarding country of origin, time in US, insurance, education and household income. Up to 4900 additional variables were abstracted including documentation of prenatal visits (PNV), antenatal and intrapartum care & lab values. Publicly available google search trends were mined for search terms “Make America Great Again”, “Mexico wall” and “Deportation” in the southern US. The time of first deviation from the mode google search popularity value for each term was ascertained (mode inflection). Perinatal data was averaged over 15 day moving windows to determine mean days from conception to 1st PNV, number of PNVs, and intrapartum nadir hemoglobin (Hgb) as a proxy for likely iron deficiency and/or PPH. Linear regression and Student's t-tests were used to determine linear trends and mean differences before and after mode inflection. 24,933 occurred during the study period. A mode inflection date of 7/1/2015 was extrapolated from the google search analytics (Fig 1A). Coincident with the mode inflection, there was a significant increase in days until first PNV, fewer PNVs and a decreased trend of mean Hgb nadir (Fig 1B). These observations were notably significant among gravidae of Central American and Mexican origin, but not South Americans (Fig 1C). Our findings are of likely significant public health importance, and suggest that recent political rhetoric alters timely and regular access to PNC among nearly 25,000 deliveries in Texas. We speculate that such rhetoric lends to delayed and diminished PNC in vulnerable populations, and may contribute to maternal mortality in our region. These observations are worth of future causal analysis.

The Rise and Fall of Ignacio Perez Sr. and Jr., Patriarchs of the Most Powerful Family in Early Nineteenth-Century Texas

The Rise and Fall of Ignacio Perez Sr. and Jr., Patriarchs of the Most Powerful Family in Early Nineteenth-Century Texas Bradley Folsom* Click for larger view View full resolution The Spanish Governor's palace in San Antonio, August 1963. This building was purchased by Ignacio Pérez Sr. in 1804 and home to the Pérez family for decades thereafter. Used by permission of the Texas Historical Commission. Downloaded from the Portal to Texas History, a digital repository hosted by the UNT Libraries, https://texashistory.unt.edu/ark:/67531/metapth953744/ [Accessed July 20, 2018]. [End Page 144] In the first days of October 1823, Ignacio Pérez lay dying. At that time, he was the most powerful, influential, and wealthy resident of Texas. He was Texas's most successful rancher, having amassed thousands of heads of cattle on his five leagues of property outside San Antonio de Béxar.1 Many considered Pérez to be northern Mexico's most capable military officer. He had fought numerous sorties against the Comanches and Apaches, whose raids made life difficult for Mexican residents of Texas. He had also defeated revolutionaries and invaders from the United States on multiple occasions, personally leading two expeditions that drove famed filibusterer James Long from Texas. In addition to his economic and military success, Pérez had served in high political offices, including a stint as governor of Texas.2 Having lived such an accomplished life and having willed a substantial fortune to his family, it would be reasonable to assume that the Pérez patriarch closed his eyes for the last time content that he had secured his family's wealth and legacy for future generations. [End Page 145] On October 26, 1852, Ignacio Pérez's first son and namesake, Ignacio Pérez Jr., stood adjacent to the San Antonio River aiming a gun at his head. In the twenty-nine years since his father's death, Pérez had seen his family's fortune, reputation, and prominence in Texas politics diminish. There were many reasons for the Pérez family's fall from grace, but Pérez blamed himself.3 Unlike his father, who was often willing to use cruelty and cunning for gain, the younger Pérez was known to be kind to a fault. Ignacio Jr. also lacked his father's foresight and military prowess. Throughout his life, the elder Pérez had consistently and successfully predicted the various political shifts that had occurred in Texas and had acted in ways that protected and promoted the best interests of his family. As evidenced by his decision to withhold support for the revolutionaries in the Texas Revolution, the younger Pérez had attempted to do the same but had met with much less success. His actions not only marked Pérez for retaliation from the Anglo Americans who had come to dominate post-revolutionary Texas, but saw his family's fall from the top of Texas's political and economic hierarchy. Within a few years of the revolution, Anglo Americans had chased the Pérez family to Mexico, the new government had seized much of their livestock, and squatters had claimed portions of the familial land. The guilt of losing this fortune drove Pérez Jr. to the brink of insanity, and it would cause him to pull the trigger on his firearm that October evening.4 The rise and fall of the Pérez family illustrate the changing realities in the Texas economic and political system during the first half of the nineteenth century. Under Spanish rule, bold men like Ignacio Pérez Sr., often used military accomplishments, family connections, and profit from raising livestock to become wealthy, achieve high social status, and gain political offices in Texas.5 This formula for success began to change when Mexico gained its independence and invited Anglo Americans to populate Texas. Following the Texas Revolution, Anglo Texans drastically transformed Texas politics in ways that marginalized Tejano elites. These changes also made it easier for Anglo Americans to use the legal system and violence to divest Tejanos of their property.6 Nowhere was this change more evident than in the fall...

Trends in Racial/Ethnic Disparities Among Patients Living with HIV in Texas, 1996 to 2013.

National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996-1997 (T1), 1998-2006 (T2), 2007-2010 (T3), and 2011-2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1,Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74-0.87, p < 0.001; HR = 0.82, 95% CI = 0.78-0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66-0.79, p < 0.001; HR = 0.77, 95% CI = 0.74-0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00-1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30-2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34-2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.

From the Other Side

It is unclear how to start this column. A few days before this year's SEG Annual Meeting, a strange chap called Harvey encamped over the Houston area. He stayed around for a few days and dumped 50 inches of rain. That was great for the rhubarb but not so good for the residents of Houston and south Texas. During the hurricane, residents kept close watch on the bayou water levels. One morning, I arose and took a step into my sunken living room. I encountered a few inches of water. Oh well, I thought. I quickly moved a lot of furniture to the next level up, which was a little more than a foot higher. I was happy with the situation even though the carpet in the living room was history. It quit raining, but the water remained — a few inches in the sunken living room. There was an announcement that the two reservoirs (behind the earthen dams) were going to increase the release of water to 7000 cubic feet/minute. That added about five feet of water.

Assessing the Prevalence of Risk Factors for Neglected Tropical Diseases in Brazos County, Texas.

Introduction:Although more than one billion people live at risk of neglected tropical diseases (NTDs) in areas of Asia, sub-Saharan Africa, and Latin America, the degree to which they burden countries like the U.S. is unclear. Even though many NTDs such as dengue, leishmaniasis, and Chagas disease are typically not endemic to the U.S., the possibility of their emergence is noteworthy, especially in states like Texas with high levels of poverty, large immigrant populations, geographic proximity to endemic areas, and a climate amenable to the vectors for these diseases. Despite the health threat that emerging NTDs may pose, little is known about the prevalence of risk factors for NTDs in the U.S.Methods:We tested the Community Assessment for Public Health Emergency Response (CASPER) method to assess the prevalence of risk factors for NTDs in Brazos County, Texas.Results: We found relatively low prevalence of risk factors related to travel (5.2% of respondents visited an endemic area in the previous 3 months); however, few respondents reported adherence to mosquito prevention, such as wearing long sleeves and long pants (14.1%, 95% CI: 13.9,14.4) and repellant containing DEET (13.5%, 95% CI: 13.2,13.7). Between 5.4% and 35.8% of respondents had a visible container (e.g., pet water dishes, flower pots, bird baths) that could support mosquito breeding.Discussion:CASPER findings present public health authorities with potential avenues for implementing health education and other interventions aimed at reducing exposure to risk factors for NTDs among Texas residents.

Quality of life after surgery for intracranial meningioma.

To the authors' knowledge, limited data exist regarding long-term quality of life (QOL) for patients diagnosed with intracranial meningioma. The data in the current study concerned 1722 meningioma cases diagnosed among residents of Connecticut, Massachusetts, California, Texas, and North Carolina from May 1, 2006 through March 14, 2013, and 1622 controls who were frequency matched to the cases by age, sex, and geography. These individuals were participants in a large, population-based, case-control study. Telephone interviews were used to collect data regarding QOL at the time of initial diagnosis or contact, using the Medical Outcomes Study Short-Form 36 Health Survey. QOL outcomes were compared by case/control status. Patients diagnosed with meningioma reported levels of physical, emotional, and mental health functioning below those reported in a general healthy population. Case participants and controls differed most significantly with regard to the domains of Physical and Social Functioning, Role-Physical, Role-Emotional, and Vitality. In the current study, patients with meningioma experienced statistically significant decreases in QOL compared with healthy controls of a similar demographic breakdown, although these differences were found to vary in clinical significance. Cancer 2018;124:161-6. © 2017 American Cancer Society.

Texas incident said to show need for chemical safety rule

Industrial safety advocates and Texas residents say a flood-related fires and explosions at the Arkema chemical plant in Crosby, Texas, underscores the need for a worker and community safety regulation. Issued by the Obama Administration in January and blocked by the Trump Environmental Protection Agency in March, that regulation would require chemical safety improvements at industrial plants. If fully implemented, the new regulation would require greater public disclosure from companies that use large amounts of certain chemicals, notes Yvette Arellano, spokesperson with TEJAS, the Texas Environmental Justice Advocacy Services, a community-based nonprofit. The rule would also call for firms to conduct root-cause analysis after an accident, she adds. When it postponed the regulation, EPA reopened discussions of what the final rule should require. This reexamination won’t be complete until February 2019, EPA Administrator Scott Pruitt has said. Pruitt attributed the delay to opposition to the rule from companies. Among them

High cancer mortality for US-born Latinos: evidence from California and Texas

BackgroundLatinos born in the US, 36 million, comprise 65% of all US Latinos. Yet their cancer experience is nearly always analyzed together with their foreign-born counterparts, 19 million, who constitute a steady influx of truly lower-risk populations from abroad. To highlight specific cancer vulnerabilities for US-born Latinos, we compare their cancer mortality to the majority non-Latino white (NLW) population, foreign-born Latinos, and non-Latino blacks.MethodsWe analyzed 465,751 cancer deaths from 2008 to 2012 occurring among residents of California and Texas, the two most populous states, accounting for 47% of US Latinos. This cross-sectional analysis, based on granular data obtained from death certificates on cause of death, age, race, ethnicity and birthplace, makes use of normal standardization techniques and negative binomial regression models.ResultsWhile Latinos overall have lower all-cancers-combined mortality rates than NLWs, these numbers were largely driven by low rates among the foreign born while mortality rates for US-born Latinos approach those of NLWs. Among Texas males, rates were 210 per 100,000 for NLWs and 166 for Latinos combined, but 201 per 100,000 for US-born Latinos and 125 for foreign-born Latinos. Compared to NLWs, US-born Latino males in California had mortality rate ratios of 2.83 (95% CI: 2.52–3.18) for liver cancer, 1.44 (95% CI: 1.30–1.61) for kidney cancer, and 1.25 (95% CI: 1.17–1.34) for colorectal cancer (CRC). Texas results showed a similar site-specific pattern.ConclusionsSpecific cancer patterns for US-born Latinos, who have relatively high cancer mortality, similar overall to NLWs, are masked by aggregation of all Latinos, US-born and foreign-born. While NLWs had high mortality for lung cancer, US-born Latinos had high mortality for liver, kidney and male colorectal cancers. HCV testing and reinforcement of the need for CRC screening should be a priority in this specific and understudied population. The unprecedented proximity of overall rates between NLWs and US-born Latino populations runs counter to the prevailing narrative of Latinos having significantly lower cancer risk and mortality. Birthplace data are critical in detecting meaningful differences among Latinos; these findings merit not only clinical but also public health attention.

A Capabilities Approach to Environmental Impact on Nursing Home Resident Quality of Life

Nursing homes are the major provider of intermediate and long-term care outside of the hospital setting to individuals whose capacity for self-care is limited due to physical or cognitive impairments. Yet, despite their need for assistance, residents of nursing homes want to control their lives, set their routines, and do enjoyable things. The extent to which residents can maintain autonomy and dignity is important. The current study suggests an environmental gerontological framework, rooted in a capabilities approach, that can be used to consider environmental impact on quality of life in nursing homes. Using a cross-sectional survey of nursing home residents in Texas, environmental factors that might predict residents' quality of life as well as possible interactions of environmental factors and residents' characteristics that might predict well-being were examined. Environmental orientation and perception of social activities were important predictors of residents' quality of life, but geographic location and facility size were not important predictors. [Res Gerontol Nurs. 2017; 10(4):162-170.].

The Prevalence of and Factors Associated With Receiving Concurrent Controlled Substance Prescriptions

ABSTRACTBackground: Controlled substance prescription (CSP) use and abuse in the United States has become a public health epidemic. One common and dangerous indicator of abuse involves obtaining CSPs concurrently. Objective: The objective of this study was to identify the prevalence and factors associated with individuals receiving potentially inappropriate concurrent CSPs. Methods: This was a retrospective, cohort analysis using data from the 2013–2014 Texas prescription drug monitoring program (PDMP). Descriptive statistics and a multiple logistic regression analysis were conducted to examine the individual-level and prescription utilization factors associated with individuals obtaining concurrent CSPs. Results: Among Texas residents, 1,640,015 individuals (6.10% of all Texas residents and 15.99% of all CSP utilizers) were identified with at least one concurrent CSP combination. Concurrent opioid prescriptions were found to be the most prevalent concurrent use combination (n = 1,574,572). Having prescriptions for opioids, being ≥18 years of age, utilizing CSPs for >30 days, utilizing greater than one CSP, having a multiple provider episode, and traveling >25 miles to obtain CSPs were all statistically significant predictors of utilizing concurrent CSPs. Conclusion: The study findings indicate a high prevalence of individuals utilizing concurrent CSPs. This practice is concerning when considering that many overdose deaths result from the concurrent use of CSPs. Prescribers should utilize PDMPs to ensure that aberrant prescription drug behaviors, such as the use of concurrent opioids and benzodiazepines do not readily occur.