Miguel A. Zuniga

Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Background: Depression affects more Hispanics with type 2 diabetes than other ethnic groups. This exploratory, binational study examined the prevalence and correlates of clinical depressive symptoms in Hispanics of Mexican origin with type 2 diabetes living on both sides of the Texas Mexico border. Methods: Two binational samples, consisting of 172 adult patients of Mexican origin with type 2 diabetes in South Texas and 200 from the Northeastern region of Mexico, were compared. Logistic regression analyses were used to test personal and social correlates to clinical depressive symptoms. Results: The rate of clinical depressive symptoms was similar in both South Texas and Northeastern Mexico patients (39% and 40.5%, respectively). Gender, education, emergency department visits, and burden of diabetes symptoms were predictors of clinical depressive symptoms in the South Texas sample. Among respondents in the Northeastern Mexico sample, the only statistically significant correlate to clinical depressive symptoms was the burden of diabetes symptoms. Conclusions: Diabetes and depression must be addressed as priorities in diabetes initiatives at the US Mexico border region. Further research is warranted to examine the extent and impact of involving family practice physicians from both sides of the border in depression screenings among patients with type 2 diabetes.

Relationship of Cataract Symptoms of Preoperative Patients and Vision-related Quality of Life

BackgroundThis study was conducted in an attempt to describe the status of cataract symptoms of preoperative cataract patients, as well as to determine the relationship between cataract symptom and vision-related quality of life measures.Research designA cross-sectional study design was used. Study subjects were selected using non-probabilistic methods. The study sample consisted of 132 patients scheduled for cataract surgery in one eye. Information was obtained from study subjects by conducting face-to-face interviews.ParticipantsStudy subjects were adult cataract patients at Samsung and Kunyang General Hospitals in Seoul, Korea, and Tulane University Hospital and Clinics in New Orleans, Louisiana, United States of America.MeasurementsDegree to which study subjects were ‘bothered’ by cataract symptoms was measured by using the 5-item Cataract Symptom Scores (CSS). The number of symptoms, highest scored symptom among the five, number of symptoms extremely bothering, and the mean of cataract symptom score were created based on the CSS measure. Vision-related quality of life was assessed by using the Visual Function 14 Items (VF-14) and Global Measure of Vision (GMV) for trouble and satisfaction.ResultsThe symptoms ‘blurry vision’ and ‘worsening of vision’ were most frequently reported. The symptom ‘colors looking different’ was rarely reported among preoperative cataract patients. The degree to which study subjects were bothered by ‘blurry vision’ and ‘seeing glare, halo, or rings’ was highly associated with visual function, visual trouble, and visual satisfaction. Multiple regression analysis revealed that the newly developed cataract symptom-related scales, as well as total amount of degree to which study subjects were ‘bothered’ by symptoms were highly related to vision-related quality of life measures. These relationships were persistent after controlling for major socio-demographic variables.ConclusionsThe results indicate that cataract symptoms are highly associated with vision-related quality of life. The results also suggest that the number of symptoms, highest scored symptom among the five, number of symptoms extremely bothering, and the mean cataract symptom scores should be considered an important cataract symptom-related scale when analyzing quality of life, including cataract symptom.

Racial variations in cesarean section rates: an analysis of Medicaid data in Louisiana.

The objective of this study was to investigate racial variation in cesarean section rates among Medicaid beneficiaries in Louisiana. Results indicate that over a three-year period, white women had higher rates than women of other races when stratified by age, locality, accompanying diagnoses, and hospital ownership. Comparing Louisiana Medicaid data with birth certificate records, rates among all births were slightly higher than Medicaid births, with the same racial trend. These variations imply significant differences in costs and reimbursement to providers and raising questions about efficiency of current obstetric practices in Louisiana. Implications for a managed care system are discussed.

Combining the benefits of decision science and financial analysis in public health management: a county-specific budgeting and planning model.

State public health agencies are charged with providing and overseeing the management of basic public health services on a population-wide basis. These activities have a re-emphasized focus as a result of the events of September 11, 2001, the subsequent anthrax events, and the continuing importance placed on bioterrorism preparedness, West Nile virus, and emerging infectious diseases (eg, monkeypox, SARS). This has added to the tension that exists in budgeting and planning, given the diverse constituencies that are served in each state. State health agencies must be prepared to allocate finite resources in a more formal manner to be able to provide basic public health services on a routine basis, as well as during outbreaks. This article describes the use of an analytical approach to assist financial analysis that is used for budgeting and planning in a state health agency. The combined benefits of decision science and financial analysis are needed to adequately and appropriately plan and budget to meet the diverse needs of the populations within a state. Health and financial indicators are incorporated into a decision model, based on multicriteria decision theory, that has been employed to acquire information about counties and public health programs areas within a county, that reflect the impact of planning and budgeting efforts. This information can be used to allocate resources, to distribute funds for health care services, and to guide public health finance policy formulation and implementation.

The Role of Quality Improvement In Disease Management: A Statewide Tuberculosis Control Success Story

This study describes Mississippis statewide latent tuberculosis infection (LTBI) control management efforts to improve treatment outcomes using scientific quality improvement tools. LTBI medication completion rates were observed by month and by nine administrative health districts for a 12-month period. Analysis of variance (ANOVA) was conducted to see if there was any significant change between preintervention and postintervention in medication completion rates. Regression analysis was performed to test the linearity of change across the monthly rates. A change from a rate of 79.7 percent to 90.5 percent completion of the LTBI medication regimen was observed after the quality improvement intervention was instituted. During the quality improvement intervention, the mean reached 96.5 percent completion, followed by a slight decline at the end of the intervention to 90.5 percent. The analysis revealed that the mean LTBI medication completion rate across the nine administrative health districts was significantly increased and variability was decreased across all administrative health districts, with minor exceptions. A quality improvement team approach was shown to be effective in disease management by increasing LTBI medication completion. New baseline expectations can be established when quality improvement initiatives are implemented. This success can be linked, in part, to the use of scientific methods, precise and valid data, persuasive and clear goal setting, appropriate feedback, and ongoing monitoring.

Training Primary Care Physicians for Local Health Authority Duties in Texas

Only one fourth of Texas counties have a local health authority (LHA) or health district. Primary care physicians in the remaining counties could be trained in public health basics by providing an online LHA training course and courses at annual meetings of the Texas Medical Association and the Texas Academy of Family Physicians. The Texas Department of State Health Services should develop a web portal for LHAs. The Texas Association of Local Health Officials should also provide automatic limited membership for LHAs. These initiatives would provide public health training to primary care physicians and would greatly improve availability of public health services for the citizens of Texas.