San Antonio Metropolitan Health District

San Antonio, TX, United States

San Antonio Metropolitan Health District

San Antonio, TX, United States
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Tohme R.A.,Epidemic Intelligence Service | Tohme R.A.,Centers for Disease Control and Prevention | Drobeniuc J.,Centers for Disease Control and Prevention | Sanchez R.,San Antonio Metropolitan Health District | And 5 more authors.
Clinical Infectious Diseases | Year: 2011

Locally acquired hepatitis E infection is increasingly being observed in industrialized countries. We report 2 cases of autochthonous acute hepatitis E in the United States. Hepatitis E virus genotype 3a related to US-2 and swine hepatitis E virus strains was isolated from one of the patients, indicating potential food-borne or zoonotic transmission. © 2011 The Author.


Johnson N.M.,Texas A&M University | Qian G.,University of Georgia | Xu L.,University of Georgia | Tietze D.,Texas A&M University | And 11 more authors.
Science of the Total Environment | Year: 2010

The incidence of hepatocellular carcinoma (HCC) is significantly elevated in a Hispanic community in Bexar County, Texas. Chronic exposure to dietary aflatoxins (AFs) is a major risk factor for HCC; increased risk has been linked to polycyclic aromatic hydrocarbon (PAH) co-exposure and hepatitis virus infection. The aims of this study were to assess AF and PAH exposures, investigate dietary factors that may contribute to increased AF exposure, and determine the prevalence of hepatitis virus infection in Bexar Co. Blood and urine samples were collected from 184 volunteers for biomarker analyses and hepatitis screening. Serum AFB1-lysine adduct, urinary AFM1 and 1-hydroxypyrene (1-OHP) levels were measured using high-performance liquid chromatography. The average AFB1-lysine adduct level detected in 20.6% of serums was 3.84±3.11pg/mg albumin (range 1.01-16.57pg/mg). AFM1 was detected in 11.7% of urines, averaging 223.85±250.56pg/mg creatinine (range 1.89-935.49pg/mg). AFM1 detection was associated with increased consumption of corn tortillas (p=0.009), nuts (p=0.033) and rice (p=0.037). A significant difference was observed between mean 1-OHP values of non-smokers (0.07±0.13) and smokers (0.80±0.68) μmol/mol creatinine (p<0.01). A high hepatitis C virus positivity rate (7.1%) was observed. Findings suggest that the incidence and level of AF and PAH exposure were less than those observed in a high-risk population; however, participants consuming higher amounts of foods prone to AF contamination may be more vulnerable to exposure and interactions with other environmental/biological factors (i.e., HCV). © 2010 Elsevier B.V.


Smith P.B.,Baylor College of Medicine | Realini J.P.,Healthy Futures of Texas | Buzi R.S.,Baylor College of Medicine | Martinez M.,San Antonio Metropolitan Health District
Journal of Sex and Marital Therapy | Year: 2011

A qualitative evaluation explored the experiences and perceived benefits of students who participated in an abstinence-plus sex education program at enrollment and conclusion. The sample included 1130 inner-city high school students, 73.7% of whom were Hispanic. Thematic analysis was used to identify main themes in responses made by students to 3 open-ended questions. The most common preparticipation request was for information about sexually transmitted infections. At program conclusion, the most common response theme involved the quality of course delivery. Students indicated that they appreciated the facilitators who allowed open conversations. The implications of these findings to sex education programs are discussed. Copyright © Taylor & Francis Group, LLC.


Realini J.P.,Healthy Futures of Texas | Buzi R.S.,Baylor College of Medicine | Smith P.B.,Baylor College of Medicine | Martinez M.,San Antonio Metropolitan Health District
Journal of Sex and Marital Therapy | Year: 2010

This study examines the effectiveness of Big Decisions, a sexuality curriculum developed to promote abstinence, as well as condom and contraceptive use, while overcoming school districts' concern about controversy surrounding sex education. The authors used a pre- and post-test survey design to measure changes in attitudes, self-efficacy, and behavioral intentions regarding sex, pregnancy, sexually transmitted diseases, and condom use. The sample for this analysis included 788 inner-city 9th-grade students, the majority of which (78.4%) were Hispanic. Pre- to posttest data comparisons demonstrated improvement in mean scores for each item, with statistically significant changes for 11 of the 12 items measured. The male participants' pretest responses reflected higher risk status than did those of female participants. A large majority (87.8%) of students rated the program as great or good. The results suggest that Big Decisions provides a promising approach to reaching minority students with both abstinence and risk-reduction messages. © 2010 Taylor & Francis Group, LLC.


Werling J.,San Antonio Metropolitan Health District | Alsip B.J.,San Antonio Metropolitan Health District | Alsip B.J.,University of Texas Health Science Center at San Antonio
Postgraduate Medicine | Year: 2010

Most children with meningococcal disease have apparent clinical signs of illness, but some do not initially present with clinical toxicity. These children with unsuspected meningococcal disease may potentially be discharged after outpatient evaluation and may deteriorate rapidly. We present the case of a 15-week-old infant boy who was brought to a private physician with symptoms of a common cold and was sent home. Three days later, his parents brought him to the hospital emergency department stating he was congested and crying a lot. He was again discharged. Another 2 days passed and his parents returned to the emergency department complaining that the infant was experiencing breathing problems. Following an examination, he was admitted to the hospital where symptoms worsened. Several hours after the infant was brought to the emergency room, he succumbed to what was later confirmed to be meningococcal disease. © Postgraduate Medicine.


Sosa E.T.,University of Texas at San Antonio | Biediger-Friedman L.,Texas State University | Banda M.,San Antonio Metropolitan Health District
Health Promotion Practice | Year: 2014

Background. Restaurant initiatives provide an efficient opportunity to impact large numbers of patrons. The purpose of this study is to measure patron purchasing behaviors during the ¡Por Vida! menu designation initiative. Method. This study used a cross-sectional design and survey data to assess 23 restaurants throughout Bexar County and 152 restaurant patrons. The Patron Awareness Questionnaire assessed if patrons noticed the logo; believed nutrition, cost, and taste were important in making purchasing decisions; and purchased a ¡Por Vida! item. Descriptive statistics, Spearman correlations, and logistic regression were used to analyze the data. Results. Most (93.4%) patrons considered taste very important when deciding what to eat. Cost was very important to 63.8% and nutrition was very important to 55.9% of the sample. The strongest predictors of purchasing a ¡Por Vida! item were the patrons' ages being between 18 and 35 years (odds ratio = 1.474; confidence interval = 0.017, 0.812; p<.05) and if patrons saw the logo (odds ratio = 4.327; confidence interval = 1.696-11.036; p<.01). Discussion/Conclusion. Menu logo designation initiatives can potentially influence patron purchasing behaviors among a segment of the population when the logo is visible. © 2012 Society for Public Health Education.


Sunil T.S.,University of Texas at San Antonio | Spears W.D.,Wright State University | Hook L.,University Health Systems | Castillo J.,San Antonio Metropolitan Health District | Torres C.,San Antonio Metropolitan Health District
Maternal and Child Health Journal | Year: 2010

Healthy People 2010 goals set a target of 90% of mothers starting prenatal care in the first trimester of pregnancy. While there are questions about the value of prenatal care (PNC), there is much observational evidence of the benefits of PNC including reduction in maternal, fetal, perinatal, and infant deaths. The objective of this study was to understand barriers to PNC as well as factors that impact early initiation of care among low-income women in San Antonio, Texas. A survey study was conducted among low-income women seeking care at selected public health clinics in San Antonio. Interviews were conducted with 444 women. Study results show that women with social barriers, those who were less educated, who were living alone (i.e. without an adult partner or spouse), or who had not planned their pregnancies were more likely to initiate PNC late in their pregnancies. It was also observed that women who enrolled in the WIC program were more likely to initiate PNC early in their pregnancies. Women who initiated PNC late in pregnancy had the highest odds of reporting service-related barriers to receiving care. However, financial and personal barriers created no significant obstacles to women initiating PNC. The majority of women in this study reported that they were aware of the importance of PNC, knew where to go for care during pregnancy, and were able to pay for care through financial assistance, yet some did not initiate early prenatal care. This clearly establishes that the decision making process regarding PNC is complex. It is important that programs consider the complexity of the decision-making process and the priorities women set during pregnancy in planning interventions, particularly those that target low-income women. This could increase the likelihood that these women will seek PNC early in their pregnancies. © 2008 Springer Science+Business Media, LLC.


Schlenker T.,San Antonio Metropolitan Health District | Dresang L.T.,University of Wisconsin - Madison | Ndiaye M.,Public Health Madison and Dane County | Buckingham W.R.,University of Wisconsin - Madison | Leavitt J.W.,University of Wisconsin - Madison
Wisconsin Medical Journal | Year: 2012

Objectives: In Dane County, Wisconsin, the black-white infant mortality gap started decreasing from 2000 and was eliminated from 2004 to 2007. Unfortunately, it has reappeared since 2008. This paper examines risk factors and levels of prenatal care to identify key contributors to the dramatic decline and recent increase in black infant mortality and extremely premature birth rates. Methods: This retrospective cohort study analyzed approximately 100,000 Dane County birth, fetal, and infant death records from 1990 to 2007. Levels of prenatal care received were categorized as "less-than-standard," "standard routine" or "intensive." US Census data analysis identified demographic and socioeconomic changes. Infant mortality rates and extremely premature (≤ 28 weeks gestation) birth rates were main outcome measures. Contributions to improved outcomes were measured by calculating relative risk, risk difference and population attributable fraction (PAF). Mean income and food stamp use by race were analyzed as indicators of general socioeconomic changes suspected to be responsible for worsening outcomes since 2008. Results: Risk of extremely premature delivery for black women receiving standard routine care and intensive care decreased from 1990-2000 to 2001-2007 by 77.8% (95% CI = 49.9-90.1%) and 57.3% (95% CI = 27.6-74.8%) respectively. Women receiving less-than-standard care showed no significant improvement over time. Racial gaps in mean income and food stamp use narrowed 2002-2007 and widened since 2008. Conclusions: Prenatal support played an important role in improving black birth outcomes and eliminating the Dane County black-white infant mortality gap. Increasing socioeconomic disparities with worsening US economy since 2008 likely contributed to the gap's reappearance © 2012 Wisconsin Medical Society.


Schlenker T.,San Antonio Metropolitan Health District | Huber C.A.,University Health System
Journal of Public Health Management and Practice | Year: 2015

addition to the Affordable Care Act, states are more frequently turning to Medicaid waivers to achieve the "Triple Aim" goals of improving the experience of care, improving population health, and reducing per capita costs. These demonstration waivers provide opportunities to test innovative ways to finance and deliver care. Texas is currently implementing a waiver known as the Transformation and Quality Improvement Program. Its inclusion of public health agencies is a unique approach to a system typically limited to traditional providers. San Antonio Metropolitan Health District is one public health agency taking advantage of this new funding opportunity to implement 6 new or expanded programs targeting health issues of highest priority in this south Texas region. This article discusses the use of Medicaid waivers and the advantages and challenges of public health agency participation. © 2015 Wolters Kluwer Health.


PubMed | San Antonio Metropolitan Health District
Type: Journal Article | Journal: WMJ : official publication of the State Medical Society of Wisconsin | Year: 2013

In Dane County, Wisconsin, the black-white infant mortality gap started decreasing from 2000 and was eliminated from 2004 to 2007. Unfortunately, it has reappeared since 2008. This paper examines risk factors and levels of prenatal care to identify key contributors to the dramatic decline and recent increase in black infant mortality and extremely premature birth rates.This retrospective cohort study analyzed approximately 100,000 Dane County birth, fetal, and infant death records from 1990 to 2007. Levels of prenatal care received were categorized as less-than-standard, standard routine or intensive. US Census data analysis identified demographic and socioeconomic changes. Infant mortality rates and extremely premature ( < or = 28 weeks gestation) birth rates were main outcome measures. Contributions to improved outcomes were measured by calculating relative risk, risk difference and population attributable fraction (PAF). Mean income and food stamp use by race were analyzed as indicators of general socioeconomic changes suspected to be responsible for worsening outcomes since 2008.Risk of extremely premature delivery for black women receiving standard routine care and intensive care decreased from 1990-2000 to 2001-2007 by 77.8% (95% CI = 49.9-90.1%) and 57.3% (95% CI = 27.6-74.8%) respectively. Women receiving less-than-standard care showed no significant improvement over time. Racial gaps in mean income and food stamp use narrowed 2002-2007 and widened since 2008.Prenatal support played an important role in improving black birth outcomes and eliminating the Dane County black-white infant mortality gap. Increasing socioeconomic disparities with worsening US economy since 2008 likely contributed to the gaps reappearance.

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