Projects target health of South Texans

Diabetes, Mexican American elders in nursing homes, hepatitis E, child abuse and the lack of oral health care. These health issues of special concern to South Texas are the focus of 13 new research projects at The University of Texas Health Science Center at San Antonio.

With $1.3 million in funding from the Texas Legislature for the 1993-1995 biennium, the university's South Texas Health Research Center (STHRC) recently awarded grants to 13 faculty, says Ciro V. Sumaya, MD, director of the STHRC.

"The South Texas Health Research Center is an example of how research at academic health centers can be directly applied to their communities," Dr. Sumaya says. "We are among a select group of health universities doing this. If academic health centers are to thrive in these times of health care reform, we have to show our communities that we are part of the solution."

The STHRC, now in its fifth year, has funded 40 projects since it was created by a special appropriation from the Texas Legislature in 1989. The center has leveraged its $3.4 million from the state into an additional $18.1 million in grants from federal and private sources (a 5 to 1 ratio of leveraged dollars).

The STHRC mission is to improve South Texans' health status and health services through a variety of approaches Ń research, policy development, professional education and community health promotion.

The new projects, listed by name, investigator, department and counties where the research will be conducted, are:

+"Ethnic and Rural/Urban Influences on Caregiver Burden," Delia Salda–a, PhD, psychiatry department, Bexar County. Study will assess ethnic and socioeconomic differences in Mexican-American and non-Hispanic white women who care for severely mentally ill patients. Caregivers' levels of burden and support will be linked to well-being and psychological distress.

+"Hispanic Established Populations for Epidemiological Studies of the Elderly (EPESE,)" David Espino, MD, family practice department, all counties in South Texas. This longitudinal study addresses the health of 3,000 Mexican-American elders in Texas, New Mexico, Colorado, Arizona and California. In-home interviews are being conducted to determine levels of diabetes, urinary incontinence, hearing/vision problems and depression. Data will be correlated to people's level of assimilation and socio-economic status.

+"Health Catastrophe and Independence in Mexican-American Elders: Functional Recovery After Major Abdominal Surgery," Valerie Lawrence, MD, medicine department, Bexar County. This project aims to map the course of patients' recovery from major stomach surgery as it relates to their ability to carry on normal daily activities. In the process, researchers will identify important factors that determine long-term outcome.

+"Mexican-Americans in South Texas Nursing Homes: Identifying Health Care Needs," Laura Chiodo, MD, medicine department, Cameron, Hidalgo, Starr, Webb, Willacy and Zapata counties. Goal is to improve the health and function of nursing home residents in South Texas. Study seeks to provide relevant information for health policymakers regarding long-term care for Mexican- Americans.

+"Child Care Worker Training to Identify, Refer and Support Children at Risk for Abuse," Kathleen Fletcher, PhD, and Juan Parra, MD, pediatrics department, Bexar and surrounding counties. This project's goal is to increase early identification and referral to appropriate agencies for children who may be suffering abuse or neglect. The program will assist professional support for children and parents, and will increase workers' awareness of community resources. A three-session training course will be offered at 50 child care centers.

+"Influence of Infection and Host Response on the Effectiveness of Periodontal Therapy in Diabetic Hispanics," John Novak, MDS, periodontics department, Bexar County. Diabetics are at greater risk for periodontal, or gum, disease. This study aims to identify the microbes that may cause gum disease. It also will assess the children of diabetics who have periodontitis to see if they're at risk for developing gum disease later in life.

+"A Program to Develop Risk Predictors and Intervention Strategies in Patients with Previous Gestational Diabetes Mellitus," Michael Berkus, MD, obstetrics and gynecology department, Bexar County. This study will screen all postpartum women in South Texas previously identified with gestational diabetes. It will treat them in order to delay the onset of overt diabetes, or recurrence of the gestational form. This condition affects about 10 percent of all pregnancies in South Texas.

+"Incidence, Cost and Geographic Distribution of Diabetes-Related Lower Extremity Amputations in South Texas," Lawrence Lavery, DPM, orthopaedics department, Cameron, El Paso, Hidalgo, Nueces, San Patricio and Webb counties. The study's goal is to identify areas in South Texas where lower extremity amputations occur at a higher rate than usual, in order to plan intervention programs. It's already known that the incidence of diabetes is three times greater in Mexican-Americans than in non-Hispanic whites. But the issue of foot amputations in diabetics has not been addressed in this population.

+"Epidemiology and Risk Assessment of Hepatitis E Infections in South Texas: A Collaborative Study," Connie Mahon, MS, clinical laboratory sciences department, all South Texas counties. The newly -recognized hepatitis E virus (HEV) is primarily transmitted through drinking sewage-contaminated water. This study will determine the prevalence of HEV antibodies in South Texas and border cities. It also will evaluate acute cases of suspected hepatitis in Eagle Pass, Del Rio and McAllen. Genelabs Inc. in San Antonio and Brooks Air Force Base Armstrong Laboratory are collaborators.

+"Proposal for Treating Early Infant-Caregiver Relationship Disturbances," Martha Medrano, MD, psychiatry department, Bexar County. Mothers and their new infants who are at high risk for attachment and relational difficulties will be referred from the Department of Regulatory Services for assessment and treatment. The treatment is problem-focused, brief in duration and uses video technology to highlight positive family interaction.

+"Oral Health in the South Texas/Mexico Border," Ramon Baez, DDS, general practice department, Cameron, Hidalgo and Starr counties. Preliminary results from the study revealed early loss of "baby" teeth and first permanent molars, orthodontic problems in children, and poor oral hygiene among all age groups. Patients also indicated inability to pay for dental care. In addition to surveying the underserved population about its dental health, dental researchers provide free dental checkups and offer emergency care as needed.

+"Improvement of Postprandial Metabolic Parameters in Mexican Americans," Joyce Schwartz, MD, pathology department, Bexar County. This study may offer an earlier way to detect people who will develop diabetes. Initial results showed that in Mexican- Americans with diabetes, an oral glucose solution emptied from their stomachs much more quickly than it did in people without diabetes. The solution will be tested further on Mexican- Americans with recently diagnosed type II diabetes, and on those who are not diabetic, but had rapid stomach emptying.

+"Assessing and Predicting Oral Health Status in South Texas Mexican -American and non-Hispanic White Nursing Facility Residents," Karen Troendle, DDS, restorative dentistry department, Cameron, Hidalgo, Starr, Webb, Willacy and Zapata counties. This project will report the prevalence of oral disease requiring treatment among the institutionalized elderly in the lower Rio Grande Valley. It also will develop a strategy to implement a more effective oral health care component into area nursing homes.