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DSHS Authors: 2014 Research Articles by DSHS Staff


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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mrl-diamond2014 Articles (in date order with most recent first)

Forrester MB. Referral of Pediatric Laundry Detergent Pack Exposure Reported to Poison Centers [published online ahead of print September 9, 2104]. J Emerg Med. doi:10.1016/j.jemermed.2014.06.034.
BACKGROUND: Concentrated laundry detergent packs are new products that may be more likely to cause adverse effects and serious medical outcomes among young children than traditional laundry detergent products. OBJECTIVE: The intent of this study was to examine whether certain factors might be associated with the referral of pediatric laundry detergent pack exposures by poison centers. METHODS: Cases were laundry detergent pack exposures involving patients age 5 years or younger reported to Texas poison centers during February 2012 to August 2013. The health care facility referral rate was calculated for selected factors. RESULTS: Of 912 exposures, 720 were managed on site and 192 were referred to a health care facility. The referral rate was 16.1% for patients with not serious outcomes and 71.6% for serious outcomes. The referral rate was 32.0% for patients age younger than 1 year and 14.3% to 22.1% for the older age groups. 31.0% of PurexTM, 25.5% of AllTM, and 19.3% of TideTM product exposures were referred. The referral rate was 33.3% for ocular exposures, 19.4% for dermal contact, and 20.2% for ingestions. The most common clinical effects and their referral rates were vomiting (30.5%), cough or choke (45.1%), ocular irritation (34.6%), red eye (25.4%), nausea (25.4%), drowsiness or lethargy (67.5%), oral irritation (16.7%), and dermal edema (68.4%). CONCLUSIONS: Pediatric exposures to laundry detergent packs were more likely to be referred to health care facilities if the laundry detergent pack brand was PurexTM, the exposure was ocular, or particular ocular, respiratory, dermal, or neurologic clinical effects were present.

Forrester MB. NBOMe designer drug exposures reported to Texas poison centers [published online ahead of print august 12, 2014]. J Addict Dis. doi: 10.1080/10550887.2014.950027
Use of 2-methoxybenzyl analogues of 2C-X phenethylamines (NBOMe) is increasing in the United States. Twenty-five NBOMe exposures reported to Texas poison centers during 2012-2013 were identified; 76% involved 25I-NBOMe, 12% 25C-NBOMe, and 12% an unknown NBOMe. Eighty-eight percent of the patients were male; the mean age was 17 years (range 14-25 years). The exposure route was 72% ingestion alone, 12% inhalation alone, 4% ingestion and inhalation, and 12% unknown route. The most common clinical effects were tachycardia (52%), agitation (48%), hallucinations (32%), hypertension (32%), confusion (24%), and mydriasis (20%). Two patients died.

Langlois PH, Moffitt KB, Scheuerle AE. A modified panel of sentinel congenital anomalies for potential use in mutation epidemiology based on birth defects registry data [published online ahead of print June 10, 2014]. Am J Med Genet A. doi: 10.1002/ajmg.a.36623
Since 1983, several authors have used panels of "sentinel" congenital anomalies that might serve as indicators of the human genome mutation rate. The current study suggests a considerably updated panel, and applies it to public health birth defects registry data to determine the potential number of de novo cases. Data were taken from deliveries in 1999-2009 from the Texas Birth Defects Registry, an active surveillance program. Cases with one of the conditions or syndromes in the panel were identified using codes and text searches. Frequencies and birth prevalence were calculated for the overall panel and subcategories within it. Of the 60 conditions appearing in previous papers on sentinel phenotypes, 21 (35%) were used in the current study along with 27 new phenotypes. We found 1,694 cases. Of those, 1,100 exhibited phenotypes thought to arise de novo in at least 90% of the cases ("all/almost all" subpanel), and 594 considered de novo in roughly 50-90% of cases ("most" subpanel). Chromosomal deletion disorders were present in 523 cases and imprinting disorders in 243. After adjusting for maternal age, occurrence of cases in the total panel, "most" subpanel, and imprinting disorders subpanel were significantly associated with paternal age. Our panel of sentinel phenotypes differs from previous panels due to evolved knowledge of genetic disorders, different approaches with respect to interviewing, and different operational definitions. It is hoped that using an overall panel as well as subpanels may maximize statistical power as well as suggest potential mechanisms.

Forrester MB. Lurasidone ingestions reported to Texas poison centers. J Pharm Technol. 2014;30:125-129.

Eshofonie AO, Lin H, Valcin RP, Martin LR, Grunenwald PE. An Outbreak of Pertussis in Rural Texas: An Example of the Resurgence of the Disease in the United States [Published online ahead of print June 14, 2014] .  J Community Health. doi:10.1007/s10900-014-9902-2
During 2012, an increase in the number of pertussis cases or outbreaks was reported among most states within the United States. The majority of these cases included previously vaccinated children between the ages of 7-10 years. This underscores the growing concern regarding current immunization practices and vaccine efficacy, especially as it pertains to pertussis prevention within this age group. In the fall of 2012, an outbreak of pertussis occurred within a school district in a rural Texas county that was reflective of this national pattern. Our objective is to describe this outbreak, highlight the similarities with the national trend, and identify strategies for better disease prevention. The cases in this outbreak were interviewed and laboratory testing done. Information regarding exposure and immunization history among cases was obtained. Immunization audits of the affected institutions were also conducted. We performed a descriptive analysis of the collected data using EPI-INFO software v.3.5.3. A total of 34 cases were identified in this outbreak, of which 23 were PCR confirmed and 11 were epidemiologically linked. Ages ranged from 5 months to 12 years, and 62 % were among children aged 7-10 years. All cases were up-to-date on their pertussis vaccinations. Immunization coverage rate was over 90 % within each of the affected institutions. The characteristics of this outbreak bear striking similarities to the current national trend in terms of age groups and immunization status of the affected cases. Increased focus on this vulnerable target group, including heightened scrutiny of vaccine efficacy and delivery, is indicated.

Forrester MB. Buckyball magnet ingestions: Small objects that can cause big problems. TX Public Health J. 2014;66(2):4.
No abstract.

Forrester MB. Rodent glue traps: A sticky problem with young children. TX Public Health J. 2014;66(2):5.
No abstract.

Forrester M. Neonicotinoid insecticide exposures reported to six poison centers in Texas [published online ahead of print February 10, 2014]. Hum Exp Toxicol. 2014;33(6):568-573. doi:10.1177/0960327114522500
Neonicotinoids are a relatively newer class of insecticide. Used primarily in agriculture, neonicotinoids are also used for flea control in domestic animals. Information on human exposures to neonicotinoids is limited. Neonicotinoid exposures reported to Texas poison centers during 2000-2012 were identified and the distribution by selected factors examined. Of 1,142 total exposures, most products contained imidacloprid (77%) or dinotefuran (17%). The exposures were seasonal with half reported during May-August. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). The distribution by patient age was 5 years or less (28%), 6-19 years (9%), 20 years or more (61%), and unknown (2%); and 64% of the patients were female. Of all, 97% of the exposures were unintentional and 97% occurred at the patient's own residence. The management site was on-site (92%), already at/en route to a health care facility (6%), and referred to a health care facility (2%). The medical outcomes included no effect (22%), minor effect (11%), moderate effect (1%), not followed judged nontoxic (14%), not followed minimal effects (46%), unable to follow potentially toxic (1%), and unrelated effect (4%). The most commonly reported adverse clinical effects were ocular irritation (6%), dermal irritation (5%), nausea (3%), vomiting (2%), oral irritation (2%), erythema (2%), and red eye (2%). The most frequently reported treatments were dilution/wash (85%) and food (6%). In summary, these data suggest that the majority of neonicotinoid exposures reported to the poison centers may be managed outside of health care facilities with few clinical effects expected.

Forrester MB, Maxwell JC. Krokodil: an urban legend in the United States so far. TX Public Health J. 2014;66(1):9-10.
No abstract.

Tsai RJ, Sievert R, Prado J, et al. Notes from the field: acute illness associated with use of pest strips - seven U.S. states and Canada. MMWR Morb Mortal Wkly Rep. 2014;63:42-43.
No abstract.

Morris SA, Ethen MK, Penny DJ, et al. Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation. 2014;129(3):285-92.
BACKGROUND: Most studies have not demonstrated improved survival after prenatal diagnosis of critical congenital heart disease, including hypoplastic left heart syndrome (HLHS). However, the effect of delivery near a cardiac surgical center (CSC), the recommended action after prenatal diagnosis, on HLHS mortality has been poorly investigated. METHODS AND RESULTS: Using Texas Birth Defects Registry data, 1999 through 2007, which monitored >3.4 million births, we investigated the association between distance (calculated driving time) from birth center to CSC and neonatal mortality in 463 infants with HLHS. Infants with extracardiac birth defects or genetic disorders were excluded. The associations between prenatal diagnosis, CSC HLHS volume, and mortality were also examined. Neonatal mortality in infants born <10 minutes from a CSC was 21.0%, 10 to 90 minutes 25.2%, and >90 minutes 39.6% (P for trend <0.001). Prenatal diagnosis alone was not associated with improved survival (P=0.14). In multivariable analysis, birth >90 minutes from a CSC remained associated with increased mortality (odds ratio, 2.03; 95% confidence interval, 1.19-3.45), compared with <10 minutes. In subanalysis, birth >90 minutes from a CSC was associated with higher pretransport mortality (odds ratio, 6.69; 95% confidence interval, 2.52-17.74) and birth 10 to 90 minutes with higher presurgical mortality (odds ratio, 4.45; 95% confidence interval, 1.17-17.00). Higher surgical mortality was associated with lower CSC HLHS volume (odds ratio per 10 patients, 0.88; 95% confidence interval, 0.84-0.91). CONCLUSIONS: Infants with HLHS born far from a CSC have increased neonatal mortality, and most of this mortality is presurgical. Efforts to improve prenatal diagnosis of HLHS and subsequent delivery near a large volume CSC may significantly improve neonatal HLHS survival.


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Last updated September 16, 2014